bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiwavelength approach to classifying transient events in the direction of M 31
Authors: Soraisam Monika D. , Gilfanov Marat , Kupfer Thomas , Prince Thomas A. , Masci Frank , Laher Russ R. , Kong Albert K. H.
Published: April 2018

Context. In the hunt for rare time-domain events, it is important to consider confusing exotic extragalactic phenomena with more common Galactic foreground events.

Aims. We show how observations from multiple wavebands, in this case optical and X-ray observations, can be used to facilitate the distinction between the two.

Methods. We discovered an extremely bright and rapid transient event during optical observations of the M 31 galaxy taken by the intermediate Palomar Transient Factory (iPTF). The persistent optical counterpart of this transient was previously thought to be a variable star in M 31 without any dramatic flux excursions. The iPTF event initially appeared to be an extraordinarily rapid and energetic extragalactic transient, which had a ≈3 mag positive flux excursion in less than a kilosecond; one of the exciting possibilities was this event could be a very fast nova in M 31. The nature of the source was resolved with the help of Chandra archival data, where we found an X-ray counterpart and obtained its X-ray spectrum.

Results. We find the X-ray spectrum of the quiescent emission can be described by a model of optically thin plasma emission with a temperature of ≈7 MK, typical for coronal emission from an active star. The combination of the X-ray luminosity, which is calculated assuming the source is located in M 31 (~3 × 1036 erg s−1), and the color temperature exclude any type of known accreting compact object or active star in M 31. We argue instead that the optical transient source is an M-type main-sequence, active star located in the disk of the Milky Way at a distance of ~0.5–1 kpc. Its persistent X-ray luminosity is in the ≈1.3–5 × 1030 erg s−1 range and it has the absolute optical magnitude of 9.5–11.0 mag in the R band. The observed optical flare has the equivalent duration of ≈95 min and total energy of ≈(0.3–1) × 1035 erg in the R band, which places it among the brightest flares ever observed from an M-type star. This case can serve as an example for the classification of Galactic and extragalactic events in upcoming high-cadence time-domain projects, such as the Zwicky Transient Facility and the Large Synoptic Survey Telescope.
Relationships between the distribution ofGalba truncatula(Gastropoda: Lymnaeidae) climatic conditions and the altitude of municipalities in Haute Vienne (France)
Authors: Dreyfuss Gilles , Vignoles Philippe , Rondelaud Daniel
Published: April 2018

A retrospective study on 7407 populations ofGalba truncatulafound in the department of Haute Vienne for 37 years (1970–2006) was carried out to determine if altitude and climate on acid soils had an effect on the distribution of populations and the characteristics of their habitats. Out of a total of 13 478 water points surveyed in 179 municipalities, the overall frequency of snail populations was 54.9% but varied with the habitat type and the municipality on which these water points are located. The frequency of snail populations significantly decreased when the mean altitude of municipalities or their mean annual rainfall increased. Conversely, this frequency significantly increased with increasing mean annual temperature. The characteristics of habitats were analysed for 6281 populations in relation to the mean altitude of municipalities. The area ofG. truncatulahabitats and the density of overwintering snails per m2of habitat significantly decreased with increasing altitude. On the acid soils of Haute Vienne, the distribution ofG. truncatulapopulations is closely related to the altitude and climatic conditions of municipalities.
Interdiction de l’exploitation minière en Antarctique, une réalité menacée ?
Authors: Choquet Anne
Published: April 2018

Plus de vingt-cinq ans ont passé depuis l’adoption du protocole au traité sur l’Antarctique relatif à la protection de l’environnement (signé à Madrid en 1991) qui consacre l’interdiction des activités relatives aux ressources minérales, sauf à des fins scientifiques. L’enjeu de la raréfaction des sources d’énergie fossile accentue les convoitises de ceux qui souhaiteraient exploiter des ressources antarctiques. Dans la mesure où le protocole de Madrid prévoit la possibilité d’amender ses dispositions et en raison de malentendus parmi le grand public et les médias sur les conditions d’une levée de l’interdiction des activités minières, les États ont choisi de réaffirmer, en 2016, l’interdiction des activités relatives aux ressources minérales en Antarctique autres que la recherche scientifique.
A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus
Authors: Pastore Danilo Eduardo Abib , Costa Maria Laura , Parpinelli Mary Angela , Surita Fernanda Garanhani
Published: April 2018

Objective To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence.

Methods An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms “systemic lupus erythematosus” AND “high-risk pregnancy” OR “prenatal care.” Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation.

Results Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heart-block) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity.

Conclusion Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.
Acute Post-Tracheostomy Clinical Decompensations in Infants—Are There Predictive Markers?
Authors: Taylor Jane , Petralia Antonio , Oschman Alexandra , Norberg Mike , Weatherly Robert , Truog William , Manimtim Winston , Nyp Michael
Published: April 2018

Objective To report on the population of infants receiving a tracheostomy, identify acute post-tracheostomy clinical decompensations, and seek predictive markers associated with acute complications following the placement of a tracheostomy.

Study Design Retrospective deidentified clinical data was provided by the Infant Pulmonary Data Repository at Children's Mercy Hospital, Kansas City. Data from infants undergoing tracheostomy from January 1, 2008 through September 30, 2016 were divided into one of two study groups based on clinical correlations: (1) no acute decompensations within 72 hours post-tracheostomy or (2) acute clinical decompensation defined as sustained escalation of respiratory care within the 72 hours following tracheostomy.

Results Thirty-four percent of infants undergoing tracheostomy during this period developed acute post-tracheostomy clinical decompensations. Elevated pre-tracheostomy positive end expiratory pressure, mean airway pressure, and echocardiogram findings suggestive of pulmonary hypertension (PH) or ventricular dysfunction were associated with acute post-tracheostomy clinical decompensations. Additionally acute post-tracheostomy clinical decompensation was associated with higher rate of death prior to discharge.

Conclusion Infants requiring higher respiratory support and infants with PH or ventricular dysfunction are at risk of acute post-tracheostomy clinical decompensation, thus identifying these patients may lead to better pre-tracheostomy counseling and potentially targeted treatments to decrease this risk.
PROLONG Clinical Study Protocol: Hydroxyprogesterone Caproate to Reduce Recurrent Preterm Birth
Authors: Gyamfi-Bannerman Cynthia , Biggio Joseph , Chauhan Suneet , Hughes Brenna , Louis Judette , Manuck Tracy , Miller Hugh , Das Anita , Birch Robert , Jozwiakowski Michael , Blackwell Sean
Published: April 2018

The objective of this commentary is to describe the background, rationale, and methods of the PROLONG (Progestin's Role in Optimizing Neonatal Gestation) trial, which is a multicenter, multinational, placebo-controlled, randomized clinical trial (RCT) designed to assess the safety and efficacy of Makena (hydroxyprogesterone caproate injection, 250 mg/mL) in reducing the risk of preterm birth (PTB) and neonatal morbidity/mortality in women pregnant with a singleton gestation who had a previous singleton spontaneous PTB. The total sample size of the RCT will include 1,707 women. The trial has two coprimary outcomes: PTB less than 35 weeks and a composite neonatal morbidity and mortality index. This study sample size will provide 90% power to assess for a 35% reduction in neonatal morbidity and mortality. Secondary outcomes will include 2-year follow-up of infants. The trial is ongoing and targeted to complete recruitment in 2018.
Differentiating Subchondral Insufficiency Fracture from Osteonecrosis May Help Avoid Unnecessary Total Hip Arthroplasty
Authors: Moya-Angeler Joaquin , Haring R , Li Angela , Greditzer IV Harry , Lane Joseph , Gianakos Arianna
Published: April 2018

Differentiation of subchondral insufficiency fracture (SIF) from osteonecrosis (ON) is clinically important. The purpose of this study is to correlate the X-ray and magnetic resonance imaging (MRI) findings in cases that have been diagnosed histopathologically as SIF or ON, define features on X-ray and MRI analysis, and identify clinical features that may aid in the diagnosis of SIF from ON. Two blinded radiologists evaluated 104 femoral heads that were diagnosed on histopathology as either ON or SIF. Radiographs and MRIs were evaluated for pertinent radiologic features. If a low signal intensity band was present on MRI, size/depth, shape (parallel/concave/serpentine), and consistency (fatty/edematous/fibrous/mixed) were characterized. About 48.1% of SIF cases were misdiagnosed on X-ray. On MRI, SIF was associated with the presence of a parallel band (p < 0.001), while ON was associated with a serpentine band (p < 0.001). Fifty-eight percent of SIF cases had low intensity signal bands that were fibrous (p < 0.001), while 86% of ON cases had mixed signal bands (p < 0.001). Mean depth for SIF and ON patients was 1.56 mm and 15.36 mm, respectively. Women with bone mineral density <  − 1, and age > 50 years had higher odds of SIF (p = 0.047, p = 0.014, p = 0.034, respectively). SIF is often misdiagnosed on X-ray, and the presence, shape, quality, and depth of the band on MRI can help distinguish SIF from ON. Patients with inconclusive X-ray findings with clinical features that match potential SIF should be considered for MRI. It is reasonable to allow for nonoperative management before recommending operative procedures in patients suspected of having SIF, as these fractures may be possibly managed conservatively.
Können Hüftprotektoren das Risiko für Hüftfrakturen bei älteren Patienten wirksam vermindern?
Authors: Pfeifer M.
Published: April 2018

Entsprechend früherer Studien können Hüftprotektoren das Risiko für Hüftfrakturen bei älteren Bewohnern von Pflegeheimen reduzieren. Neuere Studien hingegen konnten diese Wirksamkeit nicht mehr bestätigen. Deshalb hat sich mittlerweile eine internationale Forschungsgruppe zum Thema Hüftprotektoren gebildet, die Kriterien formuliert hat, nach denen zukünftige Studien zum Nachweis der Wirksamkeit durchgeführt werden sollen. Die Erfüllung dieser Kriterien führt allerdings dazu, dass neuere klinische Studien noch teurer und aufwendiger werden. Dadurch wird es fraglich, ob diese Studien in Zukunft überhaupt noch durchgeführt werden.
Systemisch inflammatorische Erkrankungen als Differenzialdiagnose in der Neugeborenenperiode – Inflammasom-vermittelte Erkrankungen
Authors: Hofmann S. R. , Bruck N. , Hahn G. , Rösen-Wolff A. , Hedrich C. M.
Published: April 2018

Autoinflammatorische Erkrankungen sind durch systemische oder organbezogene Entzündung gekennzeichnet, welche zumindest initial von fehlregulierten Mechanismen des angeborenen Immunsystems ausgehen. Einige monogene autoinflammatorische Erkrankungen manifestieren in der Perinatalperiode, sodass sie Differenzialdiagnosen zu Infektionen des Neugeborenen darstellen. Im vorliegenden Artikel werden Einblicke in die klinische Präsentation und die molekulare Pathophysiologie Inflammasom-vermittelter monogener Erkrankungen mit Manifestation im Neugeborenenalter gegeben.
Investigation of electronic structures and optical properties of β-Si3N4 doped with IV A elements: A first-principles simulation
Authors: Lu Xuefeng , Gao Xu , Ren Junqiang , Li Cuixia , Guo Xin , Wei Yupeng , La Peiqing
Published: April 2018

Based on first-principles simulations with the generalized gradient approximation (GGA) of the Perdew-Burke-Ernzerhof (PBE) functional, we studied the electronic structures and optical properties of hexagonal silicon nitride (β-Si3N4) doped with IV A elements, C, Ge, Sn and Pb. It was found that the Ge-doped system is characterized by a more stable structure with a lower formation energy of 2.584 eV compared with those of the C-, Sn- and Pb-doped systems of 3.877 eV, 5.249 eV and 7.672 eV, respectively. The band gap (EG) of the Pb-doped system was the lowest at 1.6 eV, displaying semiconducting characteristics. Additionally, there was a transition from a direct band gap to an indirect band gap in the C-doped system. Charge difference density analysis showed that the covalent property of the C-N bonds was enhanced by expansion of the electron-free region and the larger Mulliken population values of 0.71 and 0.86. Furthermore, lower absorption and reflectivity peaks at 11.30 eV were observed for the C-doped system, demonstrating its broader potential for application in photoelectric and microelectronic devices.
Surface plasmon absorption in MoS2 and graphene-MoS2 micro-gratings and the impact of a liquid crystal substrate
Authors: Reshetnyak V. Yu. , Zadorozhnii V. I. , Pinkevych I. P. , Bunning T. J. , Evans D. R.
Published: April 2018

The absorption coefficients of a far-infrared wave are calculated at normal incidence for MoS2 and graphene-MoS2 micro-ribbon gratings placed between a nematic LC and an isotropic dielectric medium. Maxima in the absorption spectra, which are related to the excitation of the surface plasmons in micro-ribbons of these gratings, are observed. The spectral position of absorption maxima depends on the grating spacing, micro-ribbon width, and conductivity of the ribbons. The impact of the 2D electron concentration of the MoS2 ribbons on the plasmon bands is different for a MoS2-grating versus a graphene-MoS2 grating. The influence of the LC orientational state on the absorption spectra of the gratings enables the manipulation of the absorption peak magnitude.
Sr/Na co-doped brushite coating on SiC–C/C with brushite seeds
Authors: Zhang Leilei , Guo Yao , Li Hejun , Zhao Fei , Pei Lina , Guan Kejie , Zhu Feiyan
Published: April 2018

Strontium/sodium (Sr/Na) co-doped brushite (SSCB) coatings were applied on SiC-modified carbon/carbon composites (SC) with undoped brushite seeds. Undoped brushite seeds were synthesised on SC by the microwave-assisted hydrothermal method, which facilitated the rapid formation of SSCB. SSCB coatings were prepared by an electrochemical deposition method. SSCB coatings could fully cover SC in 10 min with the existence of undoped brushite seeds. It was vertical aligned and exhibited plate shape with 0.5–3.5 μm in width and 30–150 nm in thickness. SSCB coatings exhibited good in-vitro bioactivity in simulated body fluid. SSCB coatings combined with undoped brushite seeds could be used to bioactive modification for biomaterials.
Comparative study of polyethylene polyamines as activator molecules for a structurally unstable group I ribozyme
Authors: Gulshan Mst Ara , Matsumura Shigeyoshi , Higuchi Tsunehiko , Umezawa Naoki , Ikawa Yoshiya
Published: April 2018

Polyamines are a promising class of molecules that can modulate RNA enzyme activities. To analyze the effects of the number of amine moieties systematically, we employed four polyamines sharing dimethylene units to connect amine moieties. As a model RNA enzyme, we used a structurally unstable group I ribozyme, which was activated most and least efficiently by tetraethylenepentamine and diethylenetriamine respectively.
Novel diagnostic tool for prediction of variant spliceogenicity derived from a set of 395 combined in silico/in vitro studies: an international collaborative effort
Authors: Leman Raphaël , Gaildrat Pascaline , Le Gac Gérald , Ka Chandran , Fichou Yann , Audrezet Marie-Pierre , Caux-Moncoutier Virginie , Caputo Sandrine M , Boutry-Kryza Nadia , Léone Mélanie , Mazoyer Sylvie , Bonnet-Dorion Françoise , Sevenet Nicolas , Guillaud-Bataille Marine , Rouleau Etienne , Bressac-de Paillerets Brigitte , Wappenschmidt Barbara , Rossing Maria , Muller Danielle , Bourdon Violaine , Revillon Françoise , Parsons Michael T , Rousselin Antoine , Davy Grégoire , Castelain Gaia , Castéra Laurent , Sokolowska Joanna , Coulet Florence , Delnatte Capucine , Férec Claude , Spurdle Amanda B , Martins Alexandra , Krieger Sophie , Houdayer Claude
Published: April 2018

Variant interpretation is the key issue in molecular diagnosis. Spliceogenic variants exemplify this issue as each nucleotide variant can be deleterious via disruption or creation of splice site consensus sequences. Consequently, reliable in silico prediction of variant spliceogenicity would be a major improvement. Thanks to an international effort, a set of 395 variants studied at the mRNA level and occurring in 5′ and 3′ consensus regions (defined as the 11 and 14 bases surrounding the exon/intron junction, respectively) was collected for 11 different genes, including BRCA1, BRCA2, CFTR and RHD, and used to train and validate a new prediction protocol named Splicing Prediction in Consensus Elements (SPiCE). SPiCE combines in silico predictions from SpliceSiteFinder-like and MaxEntScan and uses logistic regression to define optimal decision thresholds. It revealed an unprecedented sensitivity and specificity of 99.5 and 95.2%, respectively, and the impact on splicing was correctly predicted for 98.8% of variants. We therefore propose SPiCE as the new tool for predicting variant spliceogenicity. It could be easily implemented in any diagnostic laboratory as a routine decision making tool to help geneticists to face the deluge of variants in the next-generation sequencing era. SPiCE is accessible at (https://sourceforge.net/projects/spicev2-1/).
How to Think—Not Feel—about Tobacco Harm Reduction
Authors: Warner Kenneth E
Published: April 2018

Introduction

The debate over tobacco harm reduction (THR) has divided the tobacco control community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence.

Methods

After briefly discussing harm reduction in public health and specifically in tobacco control, this paper identifies major issues concerning e-cigarettes and reviews relevant evidence. Issues include: e-cigarettes’ risks compared to cigarette smoking; the effect of vaping on youth smoking; vaping’s impact on adult smoking cessation; the net long-term public health implications of vaping; and differences in views on policy issues. The intent is to provide a broad overview of issues and evidence, directing readers to more detailed reviews of specific issues.

Findings

Principal findings include the following: (1) while longitudinal studies suggest that vaping increases never-smoking young people’s odds of trying smoking, national survey data indicate that adolescents’ 30-day smoking prevalence decreased at an unprecedented rate precisely whereas vaping increased. Use of all other tobacco products also declined. (2) Recent population-level studies add evidence that vaping is increasing adult smoking cessation. (3) Vaping is likely to make a positive contribution to public health.

Conclusions

THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR.

Implications

Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes. Furthermore, it requires examining different kinds of evidence when considering specific issues. For example, those concerned by longitudinal study findings that vaping increases students’ trial of cigarettes should consider US national survey evidence that youth smoking has decreased at an unprecedented rate. A review of the major issues suggests that the potential of vaping to assist adult smokers to quit outweighs the potential negatives.
Microarteriovenous Malformations—Value of Indocyanine Green Fluorescence and Nuances of Surgical Excision: 2-Dimensional Operative Video
Authors: Sorenson Thomas J , Carlstrom Lucas , Lanzino Giuseppe
Published: April 2018

MicroAVMs (microarteriovenous malformation) are arteriovenous shunts with a nidus smaller than 1 centimeter.
1
They are typically diagnosed after hemorrhage. When the nidus is very small, diagnosis can be challenging even on catheter angiography and careful examination of the arterial and capillary phases is required to identify the early shunt. Because of the very small size, identification and localization of the actual AV shunt can be problematic during surgical exploration. Advances in frameless stereotactic neuronavigation and the introduction of intraoperative indocyanine green (ICG) fluorescein provide useful adjuncts in the surgical treatment of these relatively uncommon lesions. In this video, we present 2 cases which document the value of intraoperative ICG fluorescein as well as some of the surgical pitfalls in the treatment of these lesions.
Quantification ofAgrobacterium vitisfrom Grapevine Nursery Stock and Vineyard Soil using Droplet Digital PCR
Authors: Voegel Tanja M. , Nelson Louise M.
Published: April 2018

Current detection methodologies for Agrobacterium vitis, causing crown gall of grapevines, are time intensive and lack the ability to quantify pathogen abundance in nursery stock and soil. Information on pathogen abundance is a key component to develop management strategies. The aim of this study was to develop a rapid and sensitive quantification assay for grapevine nursery stock and vineyard soil via droplet digital polymerase chain reaction targeting the virA gene. DNA isolated from roots of dormant grapevines originating from nurseries in Germany, California, and Ontario were tested for virA abundance. Bacterial numbers varied with grapevine origin; plants from California had the highest numbers. In addition, rhizosphere soil from two vineyards in the Okanagan valley in British Columbia was tested over a growing season. Sampling time during the season did not affect virA gene abundance. The older vineyard had higher soil A. vitis populations than the younger vineyard. The assay developed here has potential for use in national clean plant programs to prevent import of infected grapevine nursery stock and to test vineyard soil for abundance of the pathogen before planting.
The Effect of Parity on Efficacy and Safety Outcomes in Induction of Labor [31B]
Authors: Miller Hugh , Billips Benjamin , Dutia Roxanne , Soskin Luba , Raymond Kyle , Powers Barbara
Published: April 2018

INTRODUCTION:

We investigated the effect of parity on induction of labor (IOL) outcomes in women treated with either misoprostol (MVI) or dinoprostone vaginal inserts (DVI).

METHODS:

Pooled IOL outcome data were analyzed from 3 phase II/III trials using DVI 10mg and MVI 200µg in nulliparous (DVI n=715/MVI n=522) versus parous (DVI n=390/MVI n=283) women during first hospitalization. Descriptive statistics compared demographics; logistic regression assessed the relationship between parity, treatment, and outcomes. Adverse events (AEs) investigated: 1) abnormal fetal heart rate (FHR II/III), 2) uterine tachysystole (UT), 3) abnormal FHR with/without UT (FHR/UT), 4) abnormal labor affecting the fetus (UT with FHR II/III), 5) UT or hypertonus with/without FHR II/III (UH), 6) meconium, and 7) arrested labor (AL).

RESULTS:

Demographics were similar between groups except parous women were older. Parity was associated with a higher odds of vaginal delivery (VD) and lower odds of Cesarean delivery (CD) compared to nulliparity (P<.001). Parous women had fewer specific AEs (FHR II/III, FHR/UT, UH, meconium, AL; P<.001). No differences in odds of VD or CD were observed between treatments. Women in both parity groups had a greater risk of UH (P<.001) if treated with MVI vs DVI, but only nullipara showed greater odds of UT with FHR II/III, FHR/UT, and meconium if treated with MVI vs. DVI (P<.05). There was no statistical evidence of an interaction between parity and treatment.

CONCLUSION:

Parity had improved efficacy and safety outcomes compared to nulliparity. Treatment with MVI led to greater risk of certain AEs; these were more frequently noted in nullipara.
Anemia in Pregnancy and Risk of Blood Transfusion [11C]
Authors: Scholz Rob , Young Danielle , Scavone Barbara , Hofer Jennifer , Siddiqui Maryam
Published: April 2018

INTRODUCTION:

A third of women have antepartum anemia, potentially leading to maternal and neonatal morbidity and mortality. Allogenic blood transfusion is often an appropriate treatment. Available evidence suggests antepartum correction may decrease postpartum transfusion volumes. This retrospective cohort study investigated the relationship between anemia at mid-trimester (24-28 weeks or third trimester) and estimated blood loss (EBL) and transfusion at delivery.

METHODS:

All deliveries between January 2014 and March 2015 at our institution were eligible for inclusion. Exclusion criteria included delivery <24 weeks gestational age and unknown mid-trimester hemoglobin. Anemia was defined as hemoglobin

RESULTS:

1071 patients were included. 473 (44.16%) were anemic at mid-trimester and 36 (3.36%) required postpartum transfusion. Of patients non-anemic at mid-trimester, 7% were anemic at delivery compared to 57% of those who were anemic at mid-trimester (p<0.001). Five (0.84%) non-anemic patients required transfusion compared to 31 (6.55%) anemic patients (p=<0.001). Of transfused patients, EBL was higher in non-anemic compared to anemic patients (mean EBL 2520.00+/-962.81ml vs. 1601.45+/-1464.38ml, p=0.04). Mean transfusion volume did not differ (not anemic 3.60+/-1.67 vs. anemic 2.67+/-2.44, p=0.011).

CONCLUSION:

Patients with anemia at mid-trimester were significantly more likely to be anemic at delivery. These patients had higher rates of postpartum blood transfusion despite lower EBL than non-anemic patients. The trend toward lower transfusion volume for anemic patients suggests that these may be preventable. Treatment of anemia at mid-trimester is essential.
Maternal and Neonatal Outcomes of Appendicitis in Pregnancy [19D]
Authors: Shields Michelanne , Chatroux Louisa R. , Hersh Alyssa R. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

We sought to determine the differences in pregnancy outcomes seen in women with diagnosed appendicitis when compared to women who do not have this diagnosis.

METHODS:

A retrospective cohort study of 1,853,219 women in California with singleton, vertex, non-anomalous, term gestations was performed to assess the prevalence of maternal and neonatal outcomes in women with appendicitis during pregnancy as compared to unaffected women. Maternal outcomes included chorioamnionitis, placental abruption, cesarean delivery, post-partum hemorrhage, and maternal sepsis. Neonatal outcomes included preterm delivery (divided into <37, <34, and <32 weeks gestational age), intrauterine fetal demise (IUFD), respiratory distress syndrome (RDS), and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons.

RESULTS:

Women with appendicitis had an increased risk of adverse outcomes in pregnancy. Appendicitis was associated with a statistically significant increase in cesarean delivery (odds ratio [OR], 7.37; 95% confidence interval [CI], 4.58-11.84), preterm delivery prior to 37 weeks (OR, 11.92; CI, 7.85-18.09), and blood transfusion (OR 20.56, CI, 10.86-38.89). It was also associated with several statistically significant adverse neonatal outcomes, including intrauterine death (OR, 4.16 (CI, .56-30.88), respiratory distress syndrome (OR, 14.78; CI, 7.89-27.64), and neonatal death (OR 19.29, CI (5.70-65.19).

CONCLUSION:

Women with appendicitis in pregnancy are at higher risk of complications than all-comers, with a statistically significant rates of both preterm delivery, cesarean delivery, and neonatal death. Whether this increased risk was due to confounding factors, impact of surgical treatment, or disease pathophysiology, and how these risks can be mitigated through health care practice advancements deserves further consideration.
Intern Bootcamp Cervical Dilation Simulation: Findings and Assessment [34M]
Authors: Chahine E. Britton , Rizk Sara , Young Marisa , Moynihan Aimee , Arluck Jessica , Walker Patrice
Published: April 2018

INTRODUCTION:

Evaluation of cervical dilation during labor is a learned tactile skill that requires consistency in order to adequately manage laboring patients. Traditionally this skill has been taught by subjecting laboring women to multiple pelvic exams in order to ensure that more junior providers have a similar assessment of a patient’s dilation as compared with more experienced providers. The purpose of this study is to see if simulated cervical dilation models can begin to teach this learned tactile skill and shorten the learning curve to competency.

METHODS:

We modified a cervical dilation simulation model and integrated this into our intern bootcamp. A baseline level of accuracy was obtained on our model and then learners practiced performing simulated cervical exams on our simulation model. On subsequent days, a series of four cervical exam quizzes were given and cervical exam accuracy was assessed for each quiz. A survey of impressions of the model and self-rated confidence regarding cervical exams was also obtained.

RESULTS:

There was a general trend of improving accuracy in the cervical exams with increasing exposure. Prior to the workshop 100% of residents did not feel confident in their cervical exams with 75% of respondents having no experience performing cervical exams on a laboring patient. After the workshop, 100% of the residents felt somewhat confident in their cervical exams.

CONCLUSION:

This simulation provides an innovative way to teach inexperienced providers basic obstetric skills that can be used in immediate practice.
Brainstem Glioma in Pregnancy: A Systematic Review [6N]
Authors: Rosen Adam , Anderson Valerie , Bercovic Eduard , Laperriere Normand , D'Souza Rohan
Published: April 2018

INTRODUCTION:

Information on pregnancy outcomes in women with brainstem glioma during pregnancy is limited to case reports.

METHODS:

We conducted a systematic review in accordance with PRISMA guidelines and registered with the PROSPERO website (CRD42017060196). Four databases were searched using appropriate indexing terms. Quality assessment was performed in duplicate using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. Outcomes were reported as proportions.

RESULTS:

We identified 2726 titles and abstracts of which 89 full texts were screened and 12 articles describing 17 pregnancies in 16 women were included. Most studies had a low or moderate risk of bias. Of the 14 (82.4%) antenatal diagnoses, 10 (58.8 %) were made in the second trimester. Clinical presentation included headaches, nausea and vomiting, focal neurological findings and sudden death. Antenatal treatment included surgical resection in four women, radiation in three and endoscopic third ventriculostomy in one. Postpartum treatment included surgical resection and radiation in two women each. Of the eight maternal deaths (47.1%), five were in the antenatal period, and three were within four months of delivery. Follow up was available for six of the eight survivors, for a median of 24 months, during which time two (33.3%) deteriorated. Fetal outcomes included 4/17 (23.5%) losses secondary to maternal demise, one therapeutic abortion and 5/12 (41.7%) preterm deliveries (median 34 weeks, interquartile range 6).

CONCLUSION:

Prognosis for women with brainstem glioma remains guarded despite multidisciplinary care in tertiary-level centers and prompt attention to diagnosis and treatment. In survivors, fetal outcomes are reassuring.
Weekday Wellness: Integrating Wellness into an Educational Curriculum [5O]
Authors: Chang Katherine , Hall Evelyn , Gorrindo Phillip , Gerber Susan
Published: April 2018

INTRODUCTION:

Residencies work to balance the demands of training, service, education, and wellness. The ACGME has recognized the importance of trainee wellness, and a new emphasis has been placed on this topic. Prior literature describes burnout rates of >50% among OB/GYN residents. It is important to better quantify the rates of burnout among OB/GYN trainees and develop initiatives to meaningfully impact burnout.

METHODS:

We administered an anonymous, mixed-methods residency-wide survey to obtain opinions about our proposed Wellness Initiative and to gather baseline data using the WHO Well-Being Survey and the Maslach Abbreviated Burnout Inventory. Quantitative results were analyzed with descriptive statistics. Qualitative results were coded by two independent reviewers and relevant themes were developed.

RESULTS:

27/47 residents responded to the survey (57%). Of these, 48% met criteria for burnout and 67% had low mood or depression. Most residents supported this Wellness Initiative (96%), felt it would improve overall resident wellness (74%), and did not feel it would negatively impact education (96%). Themes identified include: optimism among interns, depersonalization and emotional exhaustion attributed to lack of personal time among senior trainees.

CONCLUSION:

Rates of overall burnout increase with each postgraduate year. Within the subscales of burnout, emotional exhaustion is most significantly affected while personal accomplishment remains high. Creative ways of integrating activities that strengthen resilience into an educational curriculum are needed to improve resident wellness and impact high rates of OB/GYN resident burnout.
Perinatal Depression Screening and Treatment in an Obstetrics Clinic with a High Risk Patient Population [8P]
Authors: Koniares Katherine , Fernandez Miguel A.
Published: April 2018

INTRODUCTION:

Perinatal depression affects 1/7 women in the general population. The prevalence increases to 1/5 women in high risk populations, including those with lower income and education, history of depression, unintended pregnancy, and poor social supports. The Edinburgh Postnatal Depression Scale (EPDS) consists of 10 questions, takes less than 5 minutes to complete, and has been validated in pregnant and postpartum patients.

METHODS:

Between October 24-November 18, 2016, 1st trimester, 2nd trimester, 3rd trimester, and postpartum patients in the obstetrics clinic were screened for perinatal depression using the EPDS. Patients that screened positive for perinatal depression received an immediate intervention and referral for further treatment was made as appropriate.

RESULTS:

The overall prevalence of perinatal depression was 24% (n=63), which is higher than previously reported. 7/18 (39%) patients screened positive for depression in the 2nd trimester. 6/35 (17%) patients screened positive in the 3rd trimester. Of the 10 postpartum patients screened, 2 (20%) patients screened positive for depression. The EPDS is scored on a scale of 0-30. The average score for Spanish speaking patients was 6.3 and the average score for English speaking patients was 8.9.

CONCLUSION:

The high prevalence of perinatal depression in this population demonstrates the need for regular screening and the provision of interventions during obstetrics appointments. Support for the Bringing Postpartum Depression Out of the Shadows Act, which aims to increase funding for screening and treatment of perinatal depression, is essential to decrease the detrimental impact perinatal depression can have on mothers and their newborns.
Management of Cervical Ectopic Pregnancies: A Systematic Review [9Q]
Authors: Chia Victoria , Handal-Orefice Roxane , LaTortue-Albino Paula , Mulekar Sujata , White Katharine
Published: April 2018

INTRODUCTION:

Cervical pregnancies are 0.01% of ectopic pregnancies and pose a considerable risk of hemorrhage. There is currently no consensus on management. This is a systematic review of published cases in the last decade.

METHODS:

PubMed and other databases were searched on July 2, 2017 using variations of the terms “cervical ectopic pregnancy” and “cervical pregnancy” for peer-reviewed citations published in English, Spanish, or French between 2007 and 2017.

RESULTS:

One-hundred-and-eleven articles representing 209 patients were included. Initial interventions included expectant management (3); vaginal removal of lesion (2); uterine artery embolization (UAE) (1); UAE and curettage (34); curettage (42); UAE and methotrexate (22); methotrexate alone (79); hysteroscopic resection (12), UAE and laparoscopy (5), and hysterectomy (6). Sixty patients failed initial intervention, including 38 who received methotrexate alone (58%), 5 who underwent methotrexate with UAE (26%), and 10 who underwent curettage (23%). Thirty-seven patients experienced hemorrhage, including 21% who initially received methotrexate; 40% who initially underwent curettage; and 12% of those initially managed with curettage and UAE. These patients were managed with hysterectomy (6); cerclage (4); curettage (7); UAE (7), and UAE and curettage (3). Overall patients did well with conservative management.

CONCLUSION:

For stable cervical ectopic patients, conservative management with methotrexate (including intraamniotic feticide if fetal cardiac activity is present) may be considered. Importantly, uterine artery embolization is worth considering prior to either surgical or medical management, and is recommended in any unstable patient.
Reproductive Outcomes After Laparoscopic Radiofrequency Ablation of Symptomatic Myomas [12Q]
Authors: Berman Jay M. , Shashuoa Abraham , Olson Christopher , Brucker Sara , Thiel John , Bhagavath Bala
Published: April 2018

INTRODUCTION:

More than 2,000 cases of laparoscopic intrabdominal ultrasound-guided radiofrequency ablation (Lap-RFA) of symptomatic myomas have been performed in the United States and internationally. Safe conception and childbearing following Lap-RFA are of great interest to patients, obstetrician-gynecologists, and reproductive endocrinologists and surgeons. Our purpose is to study the safety and gestational outcomes among reported pregnancies post Lap-RFA.

METHODS:

Gynecologic surgeons, who perform Lap-RFA, complete standardized data collection forms that capture specific details describing their consenting patients’ preoperative, intraoperative, and postoperative data as well as any pregnancy data. Reproductive outcomes have been collected and analyzed using descriptive statistics.

RESULTS:

Twenty-seven women (age range, 30-43 years old) conceived 28 times after Lap-RFA treatment. Of the 28 gestations, 23 (82.1%) resulted in full-term deliveries of healthy infants, 2 (7.1%) pregnancies are ongoing (due October and November), 2 (7.1%) pregnancies terminated in first-trimester spontaneous abortions, and 1 (3.6%) pregnancy terminated spontaneously in the second trimester. Time from treatment to conception ranged from 1 month to 28 months. Eleven (47.8%) of the births were by vaginal delivery. No cases of abnormal placentation or endometrial defect were observed.

CONCLUSION:

Accumulating evidence indicates that safe childbearing with full-term gestation can be achieved after Lap-RFA of symptomatic myomas. Continued collection of obstetric data from commercial Lap-RFA cases and Lap-RFA clinical trials are needed to support these preliminary findings.
Physical Therapy is an Effective Treatment for Vulvodynia [30Q]
Authors: Hoerle Tess , Dominguez Sarah , Fitzgerald Sharon , Ault Kevin
Published: April 2018

INTRODUCTION:

Vulvodynia is a chronic pain disorder of the vulva, with an unknown cause. It effects between 3-15% of women, but is underreported and many times misdiagnosed. Definitive treatment options are limited due to lack of research and data collected. The purpose of this study is to show that physical therapy is the appropriate treatment for women with vulvodynia.

METHODS:

Patients from our tertiary care center were sent to a physical therapy office where the Vulvar Pain Functional Status Questionnaire (VQ) was collected on patients who met the diagnostic criteria for vulvodynia. The VQ is a validated survey that consists of 11 questions and has a total of 33 points with the more points received correlating to higher levels of pain. The VQ was collected when physical therapy started and then on the last day of treatment. A paired samples t-test was completed to detect differences in pre and post VQ scores for patients who completed both surveys.

RESULTS:

Thirty-six patients were eligible for inclusion in the study. Prior to starting physical therapy the mean VQ result was 11.11 (SD: 4.21) and after physical therapy was 6.78 (SD: 4.83) (P <.0001). A significant decrease in the mean score indicates that women improved after receiving physical therapy for vulvodynia.

CONCLUSION:

We conclude that physical therapy is an effective treatment for women who have been diagnosed with vulvodynia.
Hypertensive Disorders of Pregnancy among Mothers of Medically Fragile Infants [38R]
Authors: Stuebe Alison M. , Tucker Christine , Bryant Katherine , McClain Erin , Ferrari Renee , Verbiest Sarah
Published: April 2018

INTRODUCTION:

We sought to quantify the prevalence and early postpartum (PP) follow-up for hypertensive disorders of pregnancy among mothers of medically fragile infants (MMFI).

METHODS:

We conducted a retrospective cohort study of mothers delivering at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016. We defined MMFI as mothers of infants with a NICU length of stay ≥3 days and mothers of well babies (MWB) as mothers of infants not admitted to the NICU. We ascertained hypertensive disorders using blood pressures (BP) measured in routine clinical care between 20 weeks of pregnancy and PP discharge from Electronic Medical Records. Rates of mild and severe hypertension and completion of recommended follow-up among MMFI and MWB were compared with chi square test.

RESULTS:

Among 6,851 women who gave birth to one or more liveborn infants, 34.4% met criteria for mild hypertension, and 9.0% for severe hypertension. Hypertension was more common among MMFI; 38.2% met criteria for mild hypertension and 26.1% for severe hypertension. Among women with an indication, MMFI were more likely than MWB to have a PP BP check between discharge and 10 days PP (22.0% vs. 14.2%, p=0.01). MMFI whose infants were still hospitalized at 10 days PP were no more likely than MMFI whose infants had been discharged to have had a PP BP check (23.2 vs 22.8%, p=0.93).

CONCLUSION:

The prevalence of hypertensive disorders among MMFI is high, and few received indicated PP BP follow-up assessment. Evaluation of maternal health at the infant's bedside may improve follow-up and reduce maternal morbidity.
Treatment of Iron Deficiency Anemia in Pregnancy With Intravenous Versus Oral Iron: A Meta-Analysis of RCTs [10OP]
Authors: Govindappagari Shravya , Burwick Richard M.
Published: April 2018

INTRODUCTION:

According to the World Health Organization, anemia affects 42% of pregnancies globally. Oral (PO) iron is standard of care, but poor absorption limits efficacy. Thus, intravenous (IV) iron has been compared to PO iron in randomized control trials (RCTs). We performed an RCT meta-analysis to assess the benefits of IV iron in pregnancy.

METHODS:

This meta-analysis was performed according to Meta-analysis of Observational studies in Epidemiology (MOOSE) guidelines. We searched PUBMED, clinicaltrials.gov, Google scholar, and Cochrane library. 297 articles were reviewed, and after exclusions, 10 RCTs comparing IV to PO iron in pregnancy were included. Studies confirmed iron-deficiency anemia before treatment. Endpoints were: 1) Subjects achieving target hemoglobin; 2) Hemoglobin increase at 4 weeks and; 3) Subjects experiencing adverse effects. Meta-analyses were performed with Stata (College Station, TX), with summary odds ratios by Mantel-Haenszel method and pooled risk difference by Cohen's method.

RESULTS:

Data from 10 RCTs were utilized for pooled meta-analysis. Pregnant women were more likely to achieve target hemoglobin with IV versus PO iron (7 studies), summary OR 2.7 (95% CI 2.0–3.6), P<.001. Hemoglobin levels increased more at 4 weeks with IV iron (8 studies), mean difference 1.2 g/dL (95% CI 1.0–1.3), P<.001. Adverse reactions were lower with IV versus PO iron (10 studies), summary OR 0.54 (95% CI 0.41–0.72), P<.001.

CONCLUSION:

In this RCT meta-analysis, IV iron is superior to oral iron for treatment of iron-deficiency anemia in pregnancy. Women receiving IV iron more often achieve desired hemoglobin targets, faster, with less side effects.
Regional Anesthesia Complications Correlated With Morbid Obesity [34F]
Authors: Rimsza Rebecca R. , O'Brien Megan , Miller Collin , Vricella Laura
Published: April 2018

INTRODUCTION:

Maternal obesity increases anesthesia complication at Cesarean Delivery(CD). We sought to evaluate the contribution of technical factors to anesthesia complications during scheduled CD.

METHODS:

All patients undergoing scheduled CD under spinal anesthesia at 37-41 weeks from 2015-2017 were included. Exclusion criteria included planned general anesthesia. Primary outcome was total spinal procedure time. Secondary outcomes: number of spinal placement attempts, spinal needle > 3.5 inches, failed placement of spinal with conversion to general anesthesia, high spinal blockade, and additional intravenous analgesics.

RESULTS:

Of 575 included patients, 131 (23%) had BMI <30 kg/m2 (Group I), 275 (48%) had BMI 30.0-39.9 kg/m2 (Group II), and 169 (29%) had BMI > 40.0 kg/m2 (Group III). Total spinal time increased with BMI (I:5±4 min, II:6±9 min, III:8±7 min, P < .01). More than 1 spinal placement attempt was more frequent among obese patients [I:7/122 (6%), II:27/248 (11%), III:36/157 (23%), P < .001], as was needle length > 3.5 cm [I:2/122 (2%) vs. II:13/238(6%), III:39/158(25%), P = .04]. More obese patients required additional intravenous analgesics [I:12(9%), II: 31(11%), III:20(12%), P = .03] to complete the surgery. Failed placement of spinal with conversion to general (n = 3,2,2, P = 1) and high spinal blockade (n = 0,2,2, P = 1) were both uncommon and similar between groups.

CONCLUSION:

Although spinal anesthesia placement was more complicated among obese patients, the incidence of serious anesthesia complications remained low. Spinal anesthesia remains an acceptable choice for scheduled CD in obese patients.