bluuebunny/crossref_metadata_2025 huggingface dataset:
Income inequality not gender inequality positively covaries with female sexualization on social media
Authors: Blake Khandis R. , Bastian Brock , Denson Thomas F. , Grosjean Pauline , Brooks Robert C.
Published: August 2018

Significance

Female sexualization is increasing, and scholars are divided on whether this trend reflects a form of gendered oppression or an expression of female competitiveness. Here, we proxy local status competition with income inequality, showing that female sexualization and physical appearance enhancement are most prevalent in environments that are economically unequal. We found no association with gender oppression. Exploratory analyses show that the association between economic inequality and sexualization is stronger in developed nations. Our findings have important implications: Sexualization manifests in response to economic conditions but does not covary with female subordination. These results raise the possibility that sexualization may be a marker of social climbing among women that track the degree of status competition in the local environment.
Control of the hierarchical self-assembly of polyoxometalate-based metallomacrocycles by redox trigger and solvent composition
Authors: Piot Madeleine , Abécassis Benjamin , Brouri Dalil , Troufflard Claire , Proust Anna , Izzet Guillaume
Published: August 2018

Significance

Hierarchical self-assembly is a powerful route allowing the elaboration of complex supramolecular architectures with emergent structuration or properties. Starting from well-defined molecular building units, this synthetic strategy relies on the construction of a preassembled structural motif that can further self-assemble through additional noncovalent interactions. In this context, we developed a system based on a covalent organic–inorganic polyoxometalate hybrid building block combining metal-driven self-assembly and electrostatic interactions. We herein show that in this system, the supramolecular organization can be controlled by a redox stimulus and/or the solvent composition giving rise to various types of nanoarchitectures from discrete metallomacrocycles to 1D worm-like nanoobjects.
Refusing to TAP out: 16 new human TEIPPs identified
Authors: Gigoux Mathieu , Wolchok Jedd
Published: August 2018

In this issue of JEM, Marijt et al. (https://doi.org/10.1084/jem.20180577) report their discovery of 16 novel human TAP-independent TEIPP peptides, whereas only one had been previously identified. This opens the door to new therapeutic options for patients with TAP-deficient tumors.
The inverse problem of magnetorelaxometry imaging
Authors: Föcke Lea , Baumgarten Daniel , Burger Martin
Published: August 2018

The aim of this paper is to provide a solid mathematical discussion of the inverse problem in magnetorelaxometry imaging (MRXI), a currently developed technique for quantitative biomedical imaging using magnetic nanoparticles. We provide a detailed discussion of the mathematical modeling of the forward problems including possible ways to magnetically activate the particles and measure its magnetic response, leading to a severely ill-posed linear inverse problem. Moreover, we formulate an idealized version of the inverse problem for infinitesimal small activation coils, which allows for a more detailed analysis of uniqueness issues.

We propose a variational regularization approach to compute stable approximations of the solution and discuss its discretization and numerical solution. Results on synthetic data are presented and improvements to methods used previously in practice are demonstrated.
Detecting Large Simple Rational Hecke Modules for Γ0(N) via Congruences
Authors: Lipnowski Michael , Schaeffer George J
Published: August 2018

We describe a novel method for bounding the dimension $d$ of the largest simple Hecke submodule of $S_{2}(\Gamma _{0}(N);\mathbb{Q})$ from below. Such bounds are of interest because of their relevance to the structure of $J_{0}(N)$, for instance. In contrast with previous results of this kind, our bound does not rely on the equidistribution of Hecke eigenvalues. Instead, it is obtained via a Hecke-compatible congruence between the target space and a space of modular forms whose Hecke eigenvalues are easily controlled. We prove conditional bounds, the strongest of which is $d\gg _{\epsilon } N^{1/2-\epsilon }$ over a large set of primes $N$, contingent on Soundararajan’s heuristics for the class number problem and Artin’s conjecture on primitive roots. For prime levels $N\equiv 7\mod 8,$ our method yields an unconditional bound of $d\geq \log _{2}\log _{2}(\frac{N}{8})$, which is larger than the known bound of $d\gg \sqrt{\log \log N}$ due to Murty–Sinha and Royer. A stronger unconditional bound of $d\gg \log N$ can be obtained in more specialized (but infinitely many) cases. We also propose a number of Maeda-style conjectures based on our data, and we outline a possible congruence-based approach toward the conjectural Hecke simplicity of $S_{k}(\textrm{SL}_{2}(\mathbb{Z});\mathbb{Q})$.
Does Science Fiction Affect Political Fact? Yes and No: A Survey Experiment on “Killer Robots”
Authors: Young Kevin L , Carpenter Charli
Published: August 2018

Some scholars suggest popular culture shapes public attitudes about foreign policy in ways that can affect real-world political outcomes, but relatively few studies test this proposition. We examine whether—and more importantly how—popular culture affects public opinion on foreign policy through a survey experiment on American attitudes toward fully autonomous weapons. We queried respondents about their consumption of popular culture—including a number of iconic science-fiction films featuring armed artificial intelligence (AI)—before or after questions about autonomous weapons. We find that science fiction “priming” exerts no independent effect on political attitudes, nor does referring to autonomous weapons as “killer robots.” However, consumption of frightening armed AI films is associated with greater opposition to autonomous weapons. This “sci-fi literacy” effect increases for the highest consumers of science fiction if they are “primed” about popular culture before reporting their attitudes—what we call the “sci-fi geek effect.” Our project advances current understanding of how popular culture affects public opinion on foreign policy and suggests avenues for further inquiry.
Colorado Seed Potato Certification Data Analysis Shows Mosaic and Blackleg are Major Diseases of Seed Potato and Identifies Tolerant Potato Varieties
Authors: Zeng Yuan , Fulladolsa Ana Cristina , Houser Andrew , Charkowski Amy O.
Published: August 2018

Seed potato certification programs aim to limit disease incidence in planting material to levels below a threshold that causes significant losses to seed potato buyers. Records maintained for seed potato certification can be analyzed for trends in seed potato varietal mixture and disease incidences over time. We used logistic regression models to determine effects of year, potato variety, and their interaction on the incidences of potato diseases and disorders based on seed potato certification data collected in Colorado from 2012 to 2016. The effect of seed generation of important varieties on the incidence of common potato diseases was also quantified. Among the documented diseases, mosaic, caused primarily by Potato virus Y, is a persistent problem leading to high percentage of seed lot rejections in both summer and winter inspections, while blackleg, caused by Dickeya spp. and Pectobacterium spp., was a common disease causing summer rejections. The model demonstrated year, potato variety, and their interaction were key factors contributing to incidence of varietal mixture, or one or more potato diseases and disorders. For summer inspections, our models identified 53, 42, and six varieties sensitive to mosaic, blackleg, and leafroll, respectively. There were 17, 15, and six varieties that were tolerant to mosaic, blackleg, and leafroll regardless of pathogen pressures in the environment. For winter inspections, 51 varieties were sensitive to mosaic and three to leafroll, whereas 45 and one were relatively tolerant to mosaic and leafroll. The pattern of seed generation effects of selected potato varieties on mosaic and blackleg incidence was inconsistent across inspection years. In addition, we observed a significant negative correlation between the relative abundance of the green peach aphid, Myzus persicae, and mosaic in winter inspections. Mosaic incidences in summer and leafroll incidences were not influenced by common aphid species captured or total aphids in the valley. These results identify mosaic and blackleg as major causes of seed potato rejections and downgrades, sensitive and tolerant varieties, and provide suggestions for improving integrated crop management practices in Colorado.
Variation Among Orchardgrass (Dactylis glomerata) Germplasm for Choke Prevalence Caused by Epichloë typhina
Authors: Bushman B. Shaun , Singh Devesh , Lamp Robin , Young Carolyn A. , Charlton Nikki D. , Robins Joseph G. , Anderson Nicole
Published: August 2018

Orchardgrass, or cocksfoot (Dactylis glomerata L.), is a cool-season forage grass susceptible to the choke disease caused by Epichloë typhina. Choke has been reported in orchardgrass seed production fields across the temperate regions of the world, but fungicides have not been efficacious in reducing choke incidence or prevalence. To assess the potential for genetic resistance or tolerance of orchardgrass to choke, we evaluated the variation in orchardgrass cultivars and accessions for choke prevalence and characterized infected plants for endophyte secondary metabolite and mating type gene presence. Significant variation was detected across years and locations. Choke prevalence did not always increase with the age of the stand, nor did choke prevalence correlate with flowering time or swathing time of the entries. Both mating types of E. typhina were detected in approximately equal proportions, and no evidence for loline, ergot alkaloid, or indole-diterpene biosynthesis was found. Plants with multiple infected tillers often showed more than one mating type present in the plant, indicating multiple infection events rather than a single infection event that spread to multiple tillers. Both accessions and cultivars with significant choke, and no choke, were detected, which constitute sources of germplasm for further testing and breeding.
Fast Quenching the Burst of Host Salicylic Acid Is Common in Early Strawberry/Colletotrichum fructicola Interaction
Authors: He Chengyong , Duan Ke , Zhang Liqing , Zhang Ling , Song Lili , Yang Jing , Zou Xiaohua , Wang Yanxiu , Gao Qinghua
Published: August 2018

The fungus Colletotrichum fructicola (a species of C. gloeosporioides complex) causes devastating anthracnose in strawberry. Like other species of the genus Colletotrichum, it uses a composite strategy including both the biotrophic and necrotrophic processes for pathogenesis. Host-derived hormones are central regulators of immunity, among which salicylic acid (SA) is the core defense one against biotrophic and hemibiotrophic pathogens. However, the manner and timing of pathogen manipulation of SA are largely elusive in strawberry. To achieve better understanding of the early challenges that SA-mediated defense experiences during strawberry/C. fructicola interaction, dynamic changes of SA levels were followed through the high-performance liquid chromatography method. A very early burst of free SA at 1 h postinoculation (hpi) followed by a fast quenching during the next 12 h was noticed, although rhythm variations were present in two hosts. Transcriptional characterization of genes related to SA pathway in two varieties on C. fructicola inoculation revealed that these genes were differentially expressed, although they were all induced at different time points. At the same time, three types of genes encoding homologous effectors interfering with SA accumulation were found to be first inhibited but sequentially activated during the first 24 hpi. Furthermore, subcellular localization analysis suggests that CfShy1 is a weapon of C. fructicola for strawberry invasion. Based on these results, we propose that the infection strategy that C. fructicola utilizes on strawberry is specialized, which is implemented through the optimized expression of a specific set of effector genes. Transcriptional characterization of host genes supports that de novo SA biosynthesis and the free SA release from methyl salicylate might contribute equally to the intricate control of SA homeostasis in strawberry. C. fructicola manipulation of SA-dependent resistance in strawberry might be closely related to multihormonal interplay among SA, jasmonic acid, abscisic acid, and cytokinin.
Aging of the immune system causes reductions in muscle stem cell populations, promotes their shift to a fibrogenic phenotype, and modulates sarcopenia
Authors: Wang Ying , Wehling-Henricks Michelle , Welc Steven S. , Fisher Allison L. , Zuo Qun , Tidball James G.
Published: August 2018

Aging is associated with diminished muscle mass, reductions in muscle stem cell functions, and increased muscle fibrosis. The immune system, especially macrophages, can have important roles in modulating muscle growth and regeneration, suggesting that the immune system may also have significant influences on muscle aging. Moreover, the immune system experiences changes in function during senescence, suggesting that regulatory interaction between muscle cells and the immune system may also change during aging. In this study, we performed bone marrow transplantations between age‐mismatched donor and recipient mice to test the influence of the age of the immune system on muscle aging. Transplantation of young bone marrow cells into old recipients prevented sarcopenia and prevented age‐related change in muscle fiber phenotype. Transplantation of old bone marrow cells into young animals reduced satellite cell numbers and promoted satellite cells to switch toward a fibrogenic phenotype. We also demonstrated that conditioned media from young, but not old, bone marrow cells promoted myoblast proliferation in vitro, and we found that factors released by young bone marrow cells were more supportive of myotube differentiation in vitro. Together, our results demonstrate that aging of bone marrow cells promotes the age‐related reduction of satellite cell number and function and contributes to sarcopenia.—Wang, Y., Wehling‐Henricks, M., Welc, S. S., Fisher, A. L., Zuo, Q., Tidball, J. G. Aging of the immune system causes reductions in muscle stem cell populations, promotes their shift to a fibrogenic phenotype, and modulates sarcopenia. FASEB J. 33, 1415–1427 (2019). www.fasebj.org
Potent anti‐inflammatory properties of HDL in vascular smooth muscle cells mediated by HDL‐S1P and their impairment in coronary artery disease due to lower HDL‐S1P: a new aspect of HDL dysfunction and its therapy
Authors: Keul Petra , Polzin Amin , Kaiser Klaus , Gräler Markus , Dannenberg Lisa , Daum Günter , Heusch Gerd , Levkau Bodo
Published: August 2018

Dysfunctional HDL is associated with coronary artery disease (CAD), but its effect on inflammation in vascular smooth muscle cells (VSMCs) in atherosclerosis is unknown. We investigated the effect of healthy human HDL and CAD‐HDL on TNF‐α–driven inflammation in VSMCs and examined whether HDL‐associated sphingosine‐1‐phosphate (HDL‐S1P) could modulate inflammation with the aim of designing novel HDL‐based anti‐inflammatory strategies. Healthy human HDL, human CAD‐HDL, and mouse HDL were isolated by ultracentrifugation, S1P was measured by liquid chromatography–tandem mass spectrometry, and TNF‐α–induced inflammation was characterized by gene expression and analysis of NF‐κB–dependent signaling. Mechanisms of S1P interference with TNF‐α were assessed by S1P receptor antagonists, mouse knockouts, and short interfering RNA. We observed that healthy HDL potently inhibited the induction of TNF‐α‐stimulated inflammatory genes, such as iNOS (inducible NO synthase) and MMP9 (matrix metalloproteinase 9), a process that was entirely dependent on HDL‐S1P, as evidenced by loss‐of‐function using S1P‐less HDL and mimicked by genuine S1P. Inhibition was based on suppression of TNF‐α–activated Akt signaling resulting in reduced IkBαSer32 and p65Ser534 NF‐κB phosphorylation based on a persistent phosphatase and tensin homolog activation by S1P through the S1P receptor 2. Intriguingly, S1P suppressed inflammation even hours after initial TNF‐α stimulation. The anti‐inflammatory effect of healthy HDL correlated with HDL‐S1P content and was superior to that of CAD‐HDL featuring lower HDL‐S1P. Nevertheless, therapeutic loading of HDL with S1P completely restored the antiinflammatory capacity of CAD‐HDL and greatly boosted that of both healthy and CAD‐HDL. Suppression of inflammation by HDL‐S1P defines a novel pathophysiologic characteristic that distinguishes functional from dysfunctional HDL. The anti‐inflammatory HDL function can be boosted by S1P‐loading and exploited by S1P receptor‐targeting to prevent and even turn off ongoing inflammation.—Keul, P., Polzin, A., Kaiser, K., Gräler, M., Dannenberg, L., Daum, G., Heusch, G., Levkau, B. Potent anti‐inflammatory properties of HDL in vascular smooth muscle cells mediated by HDL‐S1P and their impairment in coronary artery disease due to lower HDL‐S1P: a new aspect of HDL dysfunction and its therapy. FASEB J. 33, 1482–1495 (2019). www.fasebj.org
Timing of Antenatal Corticosteroid Administration and Survival in Extremely Preterm Infants: A National Population-based Cohort Study
Authors: Norberg H. , Kowalski J. , Marsal K. , Norman M.
Published: August 2018

(BJOG 2017;124:1567–1574)

Antenatal corticosteroid (ACS) treatment is recommended for all women who are at risk of preterm birth before 34 weeks’ gestation and reduces neonatal death, respiratory distress syndrome, intraventricular hemorrhage, and other adverse events in preterm infants. Data regarding the effects of ACS on extremely preterm infants is limited. This study aimed to investigate the impact of the administration-to-birth time interval on survival in extremely preterm infants.
Neonatal Effects after Vasopressor During Spinal Anesthesia for Cesarean Section: A Multicenter, Randomized Controlled Trial
Authors: Uerpairojkit K. , Anusorntanawat R. , Sirisabya A. , Chaichalothorn M. , Charuluxananana S.
Published: August 2018

(Int J Obstet Anesth 2017;32:41–47)

Hypotension is common in woman receiving spinal anesthesia for cesarean delivery and can adversely affect uteroplacental perfusion. While phenylephrine is now generally considered the vasopressor of choice for treatment of spinal-induced hypotension, ephedrine is also still frequently used in certain situations, such as in the setting of maternal bradycardia. Although these drugs are commonly administered during cesarean delivery, there are limited data about their effects on the neonate. This current multicenter, randomized controlled study compared the effects of ephedrine and phenylephrine on neonatal vital signs and blood glucose concentrations shortly after cesarean delivery.
Association Between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study
Authors: Lange E.M.S. , Segal S. , Pancaro C. , Wong C.A. , Grobman W.A. , Russell G.B. , Toledo P.
Published: August 2018

(Anesthesiology. 2017;127:942–952)

Maternal fever is associated with neonatal seizures, cerebral palsy, hypotonia, and other adverse neonatal outcomes; it complicates up to one third of all labors. Increased levels of interleukin 6 (IL-6) have been observed in maternal fever, in both inflammatory and infectious etiologies. In animals, magnesium sulfate has suppressed IL-6 induced maternal fevers and is used in humans to reduce the risk of cerebral palsy in infants. This study aimed to investigate the association between intrapartum maternal fever and maternal magnesium administration.
Epidural Space Identification With Loss of Resistance Technique for Epidural Analgesia During Labor: A Randomized Controlled Study Using Air or Saline: New Arguments for an Old Controversy
Authors: Brogly N. , Guasch E. , Alsina E. , García C. , Puertas L. , Dominguez A. , Diez Je , Gómez J. , Gilsanz F.
Published: August 2018

(Anesth Analg. 2018;126:532–536)

The saline loss of resistance (SLOR) technique was established as the preferred method for epidural space identification in the 1980s, after air LOR (ALOR) was found to have a higher incidence of adverse effects. However, in review of the literature, the authors of the present study discovered that many of the studies had methodological issues. Furthermore, recent meta-analyses based on these studies have been unable to demonstrate superiority of SLOR over ALOR. Consequently, the authors assessed the effect of epidural space identification technique on the onset of anesthetic block, as well as screened for possible variables related to analgesia quality during labor and delivery, which might be affected by use of the ALOR or SLOR technique.
An Up-down Determination of the Required Seated Duration After Intrathecal Injection of Bupivacaine and Fentanyl for the Prevention of Hypotension During Cesarean Delivery
Authors: Moore A. , El-Mouallem E. , El-Bahrawy A. , Kaufman I. , Moustafa M. , Derzi S. , Hatzakorzian R. , Lipishan W.
Published: August 2018

(Can J Anaesth 2017;64:1002–1008)

Prolonged seated time following intrathecal injection can prevent hypotension during cesarean delivery by limiting the upward spread of hyperbaric local anesthesia, but the limited studies of this technique have shown conflicting results. This study aimed to determine the median seated time for the prevention of hypotension following intrathecal injection of either 11.25 or 15 mg of hyperbaric bupivacaine with preservative-free morphine and fentanyl. The secondary aim of the study was to measure the rates of supplemental analgesia requirements for patients with who remained seated for an extended duration after spinal anesthesia administration.
Clinical Pain-related Outcomes and Inflammatory Cytokine Response to Pain Following Insomnia Improvement in Adults With Knee Osteoarthritis
Authors: Heffner Kathi L. , France Christopher R. , Ashrafioun Lisham , Quiñones Maria , Walsh Patrick , Maloney Michael D. , Giordano Brian D. , Pigeon Wilfred R.
Published: August 2018

Objectives:

Clinical insomnia is known to affect pain, but mechanisms are unclear. Insomnia can dysregulate inflammatory pathway, and inflammation plays a mediating role in pain. It is unclear whether insomnia-related alterations in inflammation can be modified with insomnia improvement, and if such alterations parallel improvement in pain. The current study objective was to provide proof of concept for the role of insomnia in inflammation and pain by testing whether improving insomnia would reduce pain and related physical function, and, concurrently, modulate inflammatory responses.

Materials and Methods:

Thirty adults with osteoarthritis knee pain and insomnia (Insomnia Severity Index >10) provided baseline measures of osteoarthritis and laboratory pain, and serial blood samples for inflammatory biomarkers, interleukin 6, and tumor necrosis factor α, before and after pain testing. To manipulate insomnia, participants were randomly assigned to a 6-week cognitive-behavioral therapy for insomnia (n=16); or wait-list control (n=14). At 8-weeks (time 2), all measures were repeated. To directly test insomnia improvement effects, participants were grouped by insomnia status at time 2 after confirming baseline equivalency on all outcomes.

Results:

Compared with those maintaining insomnia at time 2 (Insomnia Severity Index ≥8; n=18), those whose insomnia improved at time 2 (n=12) had significantly improved physical functioning, decline in knee pain during transfer activities, and attenuated increase in interleukin 6 and less decrease in tumor necrosis factor α across the pain testing session.

Discussion:

These findings suggest further exploration of inflammatory pathways linking clinical insomnia, and its improvement, to chronic pain.
Effect of Intravenous Oxycodone in Combination With Different Doses of Dexmedetomdine on Sleep Quality and Visceral Pain in Patients After Abdominal Surgery
Authors: Jiang Zongming , Zhou Guozhong , Song Qiliang , Bao Chenying , Wang Hua , Chen Zhonghua
Published: August 2018

Objective:

Oxycodone or dexmedetomidine (DEX) alone are widely used in clinical practice. The aim of this study was to observe the effect of 2 oxycodone and DEX combinations on postoperative sleep quality.

Methods:

This was a prospective and randomized clinical study. A total of 99 patients underwent laparoscopic-assisted operations on stomach and intestines with general anesthesia were enrolled and randomly divided into 3 groups according to postoperative analgesic protocol (n=33 each). The analgesic protocols were as follows after the surgery. In group C, 0.6 mg/kg oxycodone alone was diluted to 100 mL in 0.9% saline. In group D1 or D2, 0.6 mg/kg oxycodone combined with 2.4 μg/kg or 4.8 μg/kg DEX was diluted to 100 mL in 0.9% saline, respectively. The intravenous patient-controlled analgesia device was set up to deliver a continuous infusion of 3 mL/h and a bolus of 1 mL, with a 12-minute lockout interval. The primary outcome was the percentage of stage 2 nonrapid eye movement (stage N2) sleep. Polysomnography was performed the night before operation (PSG-night0), the first (PSG-night1) and second (PSG-night2) nights after surgery.

Results:

A total of 97 patients were included in the final analysis. Compared with group C, N2 sleep were higher in groups D1 and D2 on PSG-night1 (54±9% and 53±10%, respectively) and PSG-night2 (55±7% and 56±8%, respectively) (P<0.001 for all comparisons). No differences were observed regarding N1 and N2 sleep between groups D1 and D2 on PSG-night1 and PSG-night2 (P>0.05). Group C had higher percentage of N1 sleep on PSG-night1 (37±5%) and PSG-night2 (33±3%) when compared with groups D1 and D2 (P<0.001 for the comparisons). Groups D1 and D2 required lower rates of rescue analgesia (5% and 4.7%, respectively; P=0.012) and effective pressing times (10.7±4.8 times and 9.9±2.6 times, respectively; P<0.05) when compared with group C, whereas no statistical significance was found between groups D1 and D2. Furthermore, there were no significant difference about resting visual analogue scales at 4, 6, and 12 hours postoperatively between groups D1 and D2. In comparison with the other 2 groups, group D2 had a higher occurrence of postoperative hypotension (24.2%) (P<0.05), though without significant sinus bradycardia.

Discussion:

DEX combined with oxycodone can improve sleep quality and provide good visceral analgesia. However, larger doses of DEX does not further improve sleep but increases the risk of hypotension.
One-Step Approach to Identifying Gestational Diabetes Mellitus
Authors: Pocobelli Gaia , Yu Onchee , Fuller Sharon , Fraser James R. , Wartko Paige D , Chen Lu , Newton Katherine M. , Dimer Jane , McCulloch David K. , Warwick Susan , Dublin Sascha
Published: August 2018

OBJECTIVE:

To compare perinatal outcomes before and after a clinical guideline change from a two-step to a one-step approach to screening for gestational diabetes mellitus (GDM).

METHODS:

We conducted a before–after cohort study of women with singleton live birth deliveries within Kaiser Permanente Washington, a mixed-model health plan in Washington state. We used Kaiser Permanente Washington electronic health data and linked birth certificates. We compared outcomes before (January 2009–March 2011) and after (April 2012–December 2014) the guideline change among women who received prenatal care from health care providers internal to Kaiser Permanente Washington (n=4,977 before, n=6,337 after). We made the same comparison among women who received prenatal care from external health care providers (not exposed to the guideline change; n=3,386 before, n=4,454 after) to control for time trends unrelated to the guideline change. Adjusted relative risks and 95% CIs were estimated using Poisson generalized estimating equations.

RESULTS:

After the guideline change, receipt of the one-step approach became widespread among women cared for by Kaiser Permanente Washington internal providers (87%), and use of insulin increased 3.7-fold from 1.2% to 4.4%. Among women cared for by Kaiser Permanente Washington internal providers, GDM increased from 6.9% to 11.4%, induction of labor from 25.2% to 28.6%, neonatal hypoglycemia from 1.3% to 2.0%, and outpatient nonstress testing from 134.6 to 157.0 test days per 100 women. After accounting for background trends in outcomes (based on the women cared for by external providers), the guideline change was associated with increased incidence of GDM (relative risk [RR] 1.41, 95% CI 1.17–1.69), labor induction (RR 1.20, 95% CI 1.09–1.32), neonatal hypoglycemia (RR 1.77, 95% CI 1.14–2.75), and nonstress testing (RR 1.12, 95% CI 1.02–1.24% per 100 women). There was no association with other outcomes including cesarean delivery or macrosomia.

CONCLUSION:

Adopting the one-step approach was associated with a 41% increase in the diagnosis of GDM without improved maternal or neonatal outcomes.
Identification and Management of Abdominal Wall Varices in Pregnancy
Authors: Wood Amber M. , Grotegut Chad A. , Ronald James , Pabon-Ramos Waleska , Pedro Christina , Knechtle Stuart J. , Wysokinska Ewa , Rubin Geoffrey D. , Brady Carla W. , Gilner Jennifer B.
Published: August 2018

BACKGROUND:

Portal hypertension in pregnancy is associated with elevated risk of variceal hemorrhage. Ectopic varices, those located outside the esophagus or stomach, are rare but have a high risk of associated maternal morbidity or mortality.

CASE:

A 31-year-old woman, gravida 2 para 0010, with cirrhosis and portal hypertension was found to have abdominal wall ectopic varices on third-trimester obstetric ultrasonography. Computed tomography angiography confirmed these findings. Given concern for catastrophic hemorrhage during delivery, she underwent transjugular intrahepatic portosystemic shunt placement at 35 weeks of gestation, with reduction in the pressure gradient within the portosystemic circulation. She subsequently underwent an uncomplicated cesarean delivery.

CONCLUSION:

Identification of ectopic varices on obstetric ultrasonography may allow for treatment before delivery, decreasing the risk of serious maternal morbidity or mortality.
Early Hearing Detection and Intervention: Timely Diagnosis, Timely Management
Authors: Findlen Ursula M. , Hounam Gina M. , Alexy Emily , Adunka Oliver F.
Published: August 2018

Objective:

A quality improvement study was completed to assess the impact of three clinical practice changes on the timing of diagnosis and intervention for congenital hearing loss.

Design:

A retrospective chart review was conducted for 800 infants evaluated for congenital hearing loss before and after implementing three clinical practice changes: the use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expediting scheduling of initial assessment. The impact of middle ear involvement on age at diagnosis and history of neonatal intensive care unit stay on age at treatment was also examined.

Results:

The use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expedited scheduling of initial assessment each resulted in a decrease of age at diagnosis. Ultimately, the age at initial assessment was the only significant predictor related to decreased timeline for diagnosis. Middle ear pathology significantly increased age at diagnosis, while history of time in the neonatal intensive care unit significantly increased the age at provision of amplification as a treatment for permanent hearing loss.

Conclusions:

The technology used for assessment, clinical protocol, and timing of assessment of infants can impact the timeline for diagnosis and treatment of congenital hearing impairment. Given the significant sequelae of delayed or missed diagnosis of hearing loss in infancy, implementing clinical practice changes should be considered at pediatric diagnostic centers.
Preliminary Safety and Tolerability of a Novel Subcutaneous Intrathecal Catheter System for Repeated Outpatient Dosing of Nusinersen to Children and Adults With Spinal Muscular Atrophy
Authors: Strauss Kevin A. , Carson Vincent J. , Brigatti Karlla W. , Young Millie , Robinson Donna L. , Hendrickson Christine , Fox Michael D. , Reed Robert M. , Puffenberger Erik G. , Mackenzie William , Miller Freeman
Published: August 2018

Background:

Many patients with spinal muscular atrophy (SMA) who might benefit from intrathecal antisense oligonucleotide (nusinersen) therapy have scoliosis or spinal fusion that precludes safe drug delivery. To circumvent spinal pathology, we designed a novel subcutaneous intrathecal catheter (SIC) system by connecting an intrathecal catheter to an implantable infusion port.

Methods:

Device safety and tolerability were tested in 10 SMA patients (age, 5.4 to 30.5 y; 80% with 3 copies of SMN2); each received 3 sequential doses of nusinersen (n=30 doses). Pretreatment disease burden was evaluated using the Revised Hammersmith Scale, dynamometry, National Institutes of Health pegboard, pulmonary function testing, electromyography, and 2 health-related quality of life tools.

Results:

Device implantation took ≤2 hours and was well tolerated. All outpatient nusinersen doses were successfully administered via SIC within 20 minutes on the first attempt, and required no regional or systemic analgesia, cognitive distraction, ultrasound guidance, respiratory precautions, or sedation. Cerebrospinal fluid withdrawn from the SIC had normal levels of glucose and protein; cerebrospinal fluid white blood cells were slightly elevated in 2 (22%) of 9 specimens (median, 1 cell/µL; range, 0 to 12 cells/µL) and red blood cells were detected in 7 (78%) specimens (median, 4; range, 0 to 2930 cells/µL).

Discussion:

Preliminary observations reveal the SIC to be relatively safe and well tolerated in SMA patients with advanced disease and spinal fusion. The SIC warrants further study and, if proven effective in larger trials of longer duration, could double the number of patients able to receive nusinersen worldwide while reducing administration costs 5- to 10-fold.
Prevention of Nerve Root Thermal Injury Caused by Bipolar Cauterization Near the Nerve Roots
Authors: Ohyama Shoichiro , Takahashi Shinji , Tamai Koji , Hori Yusuke , Hirakawa Yoshihiro , Hoshino Masatoshi , Suzuki Akinobu , Nakamura Hiroaki
Published: August 2018

Study Design.

This was a controlled, interventional animal study.

Objective.

This study aimed to investigate the thermal injury of nerve root by cauterization near the nerve root and to identify the prevention or rescue procedure of nerve root injury.

Summary of Background Data.

In spine surgery, bipolar cauterization of epidural venous plexus near the nerve root is an essential procedure to control bleeding. Although a potential risk of neurological thermal damage exists, the underlying mechanism and prevention have not been elucidated.

Methods.

Temperature measurement and histological evaluation after bipolar cauterization near the posterior branch of the nerve root were performed using a rabbit model. Subsequently, the effect of saline irrigation or changing the direction of bipolar forceps to reduce thermal elevation during bipolar cauterization was evaluated. Finally, the effectiveness of locally injected corticosteroid after bipolar cauterization was evaluated.

Results.

After bipolar cauterization, temperature of the surrounding site reached 60.9 °C, and 47.8% of the nerves were histologically injured. Using saline irrigation, thermal elevation was significantly suppressed up to 42.7 °C (P < 0.01), and no nerve was histologically injured. When bipolar cauterization was performed in the perpendicular direction, temperature of the surrounding site reached only 40.4 °C (P < 0.01). Locally injected corticosteroid reduced the incidence of nerve injury to 25.0%. However, a significant increase in nerve damage remained compared with the sham group (P < 0.01).

Conclusion.

Bipolar cauterization near the nerve roots can increase the temperature of nerve roots and cause thermal nerve root injury, despite no accidental direct nerve root injury. Using saline irrigation, or setting bipolar forceps perpendicular to nerve roots, thermal elevation could be suppressed and nerve injury could be prevented. Therefore, it is recommended that surgeons set bipolar forceps perpendicular to nerve roots or use saline irrigation for the prevention of nerve root injury.

Level of Evidence: N/A
Syndesmotic Injuries Treated With an Aperture Fixation Device
Authors: Desai Sarang
Published: August 2018

Syndesmotic injuries commonly occur in rotation injuries to the ankle. Suspensory suture button devices have become commonplace but are known to have several drawbacks. The aperture fixation device composed of a threaded tibia anchor, fixed length suture bridge, and telescoping fibular anchor. It preserves the concept of retaining physiological motion of the syndesmosis but provides several potential advantages over suspensory suture button devices. The most important and unique is it provides aperture fixation. This concept is significant in that it provides more strength and stiffness and less stretch and creep compared with suspensory suture button devices. It eliminates the issue of suture-tibial tunnel widening and toggling, promotes more secure fixation of the syndesmosis, allows treatment of axially unstable fractures (Maisonneuve), prevents suture creep that may lead to syndesmosis widening, and has no medial soft tissue or neurovascular risk. A 14-patient case series with promising short-term data is presented.

Level of Evidence: Diagnostic Level IV (eg, 1, 2, 3…). See Instructions for Authors for a complete description of levels of evidence.
Hearts and Minds: Stress, Anxiety, and Depression
Authors: Silverman Alexandra L. , Herzog Alfred A. , Silverman David I.
Published: August 2018

Anxiety, depression, and stress are exceedingly common in patients with cardiovascular disease (CVD). They increase the risk of cardiac events and are associated with much worse outcomes. A causal relationships exists between anxiety/depression and adverse cardiac events such as acute myocardial infarction and sudden cardiac death. Various treatments, including psychologic therapies and pharmacotherapy, can used to treat patients with these disorders. This review discusses the epidemiology, pathogenesis, and treatment options for patients with CVD who suffer from these conditions and argues that they should be treated as concomitant risk factors for CVD.
Maternal Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Breastfeeding Duration in the Norwegian Mother and Child Cohort
Authors: Rosen Emma M. , Brantsæter Anne Lise , Carroll Rachel , Haug Line S. , Singer Alison B. , Zhao Shanshan , Ferguson Kelly K.
Published: August 2018

Background:

Per- and polyfluoroalkyl substances (PFASs) have been widely produced, many of them persist in the environment, and have been associated with various health effects. Previous studies have identified inverse associations between perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and breastfeeding duration, but have been limited in investigation of other PFASs.

Methods:

We measured the associations between plasma concentrations of nine different PFASs and cessation of breastfeeding before 3 and 6 complete months using women from the Norwegian Mother and Child Cohort Study (MoBa). The study population includes 1716 primarily nulliparous women from two previous studies of MoBa participants, enrolled from 2003 to 2007. The association was measured using Cox proportional hazards model. Mixtures analyses were performed using Elastic net regularization to identify interactive effects and control for copollutant confounding.

Results:

Concentrations of PFASs in this population were lower than concentrations in the previous studies on this topic. We found associations between increasing concentrations of perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), and decreased breastfeeding cessation (increased duration). The strongest associations were seen between PFDA and PFUnDA and cessation before 3 months: (both hazard ratios = 0.73; 95% confidence intervals = 0.62, 0.86). In our population, the other PFASs appeared to be unassociated with breastfeeding cessation. The mixtures analyses identified meaningful interactions between PFUnDA:PFDA, perfluorohexane sulfonate (PFHXS):PFOA, and PFOA:PFOS.

Conclusions:

The identification of associations between previously unexamined PFASs concentrations and increased breastfeeding duration is novel and may be explained by differences in transplacental transfer rates.
Factors associated with age at natural menopause among elderly women in São Paulo, Brazil
Authors: Lay Alejandra Andrea Roman , Duarte Yeda Aparecida de Oliveira , Filho Alexandre Dias Porto Chiavegatto
Published: August 2018

Objectives:

To analyze factors associated with age at natural menopause in elderly women who are part of the Health, Well-Being and Aging Study— which is a representative sample of elderly residents of the municipality of São Paulo, Brazil.

Methods:

Multivariate Cox proportional-hazards analysis using data from a total of 1,415 women with natural menopause. We included 163 women with hysterectomy, oophorectomy, and estrogen therapy as censored data.

Results:

The median age of natural menopause was 50 years. In the multivariate Cox proportional hazards, smoking was associated with earlier age at natural menopause for the three cohorts (2000, 2006, and 2010). Current smokers had a 35% higher risk of earlier natural menopause (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.12, 1.62) and former smokers had a 27% higher risk of earlier natural menopause (HR 1.27, 95% CI 1.09, 1.50), in comparison with never-smokers. Women with 8 years or more of formal education had a 33% lower risk of earlier natural menopause (HR 0.67, 95% CI 0.50, 0.89) than women with no education, and women who were separated, widowed, or divorced had a 15% higher risk of earlier natural menopause (HR 1.15, 95% CI 1.00, 1.31) in comparison with married women. Marital status and parity were associated with later age at natural menopause only in 2006.

Conclusions:

We found significant associations of age at natural menopause with reproductive and lifestyle factors similar to some studies of women from developed countries.
Association of menopause and type 2 diabetes mellitus
Authors: Ren Yongcheng , Zhang Ming , Liu Yu , Sun Xizhuo , Wang Bingyuan , Zhao Yang , Liu Dechen , Liu Xuejiao , Zhang Dongdong , Liu Feiyan , Cheng Cheng , Liu Leilei , Chen Xu , Zhou Qionggui , Hu Dongsheng
Published: August 2018

Objective:

Limited information is available on the direct effect of menopause and risk of type 2 diabetes mellitus (T2DM) among women with different metabolic types. We aimed to investigate whether menopause is a direct risk factor for T2DM.

Methods:

In this population-based cross-sectional study, women were recruited from a rural area of China from July to August 2013 and July to August 2014. Multivariate logistic regression analysis yielded adjusted odds ratios (ORs) and 95% CIs. Mediation analysis was performed to examine the contribution of age to menopause status-related T2DM.

Results:

We included 8,191 women (median age 56, interquartile range 47-65). The prevalence of T2DM was 13.22%. Risk of T2DM was increased with postmenopause versus premenopause status after adjustment (adjusted OR [aOR] = 1.90, 95% CI = 1.51-2.37), with the strongest association between postmenopause status and T2DM among women with body mass index (BMI) <24.0 kg/m2 (aOR, 3.25; 95% CI, 1.98-5.32). Risk of T2DM was increased with postmenopause status interacting with BMI, hypertension, triglycerides level, and waist circumference. On mediation analysis, age partially mediated the menopause status–T2DM association (indirect effect: OR = 1.27, 95% CI = 1.13-1.46; direct effect: OR = 1.88, 95% CI = 1.49-2.36).

Conclusions:

The prevalence of T2DM is high among women, and postmenopause status might be a stable and significant risk factor for T2DM; especially, postmenopausal women with normal weight should not be ignored in addressing the risk.
Brinzolamide-induced Follicular Conjunctivitis
Authors: Young Jonathan W. , Clements John L. , Morrison John C. , Takusagawa Hana L.
Published: August 2018

We report a case of a patient who developed a severe case of follicular conjunctivitis from brinzolamide after 1.5 years of consistent use. This patient was rechallenged again after resolution of the follicles and subsequently redeveloped similar conjunctivitis. This is the first confirmed reported case of follicular conjunctivitis from brinzolamide use.
Cranio-orbital Resection Does Not Appear to Improve Survival of Patients With Lacrimal Gland Carcinoma
Authors: Rose Geoffrey E. , Gore Sri K. , Plowman Nicholas P.
Published: August 2018

Purpose:

To ascertain long-term outcome of treatment for primary epithelial malignancies of the lacrimal gland and compare outcomes after cranio-orbital resection or after macroscopic tumor resection with radiotherapy.

Methods:

Comparative case series of 79 patients (49 male; 62%) treated for primary epithelial malignancies of the lacrimal gland at Moorfields Eye Hospital between 1972 and 2014. Patients were identified from clinical and pathological databases and, where available, the clinical, pathological, and imaging records reviewed. The primary outcome measures were overall survival after diagnosis, disease-free survival, and final visual acuity for patients having cranio-orbital resection (exenteration plus local bone removal), compared with macroscopic tumor resection plus radiotherapy.

Results:

The mean age at presentation was 48 years (median: 50 years; range: 13–84 years), with 53 (67%) having adenoid cystic carcinoma, 15 (19%), primary adenocarcinoma, and 11 (14%) carcinoma ex-pleomorphic adenoma (malignant mixed tumor). The overall survival probability of the cohort (79 patients) was 0.59 at 5 years and 0.52 at 10 years, with 36/79 (46%) patients suffering tumor-related deaths; 14 patients died from other causes, and 4 patients were lost to follow up after the minimum follow-up period. The probability of disease-free survival at 5 years for patients with adenoid cystic carcinoma, adenocarcinoma, and malignant mixed tumor was 0.52, 0.4, and 0.64, respectively, with the comparable figures at 10 years being 0.44, 0.40, and 0.64. Most importantly, the 9 patients undergoing cranio-orbital resection and the 44 having solely macroscopic tumor resection plus radiotherapy had similar overall survival (p = 0.59) and disease-free survival (p = 0.89). Subgroup analysis of the 2 treatment modalities for patients with adenoid cystic carcinoma (8 cranio-orbital resection and 32 debulking and radiotherapy) demonstrated similar results for disease-free survival (p = 0.87). Likewise, there were no significant differences between rates of recurrences between the 2 different treatments. For the 50 patients who had eye-preserving surgery and long-term visual acuity data, the final acuity was better or equal to 0.6 logMAR (6/24 Snellen) in 25 (50%).

Discussion:

There is no difference in either survival or tumor recurrence for lacrimal gland carcinoma treated with cranio-orbital resection, or eye-preserving tumor excision and radiotherapy. The authors, therefore, continue to advocate local resection and radiotherapy for almost all patients with primary epithelial malignancies of the lacrimal gland—this treatment having lower morbidity, causing less disfigurement, and, importantly, preserving useful vision in most patients.