bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in abscisic acid content during and after drought are related to carbohydrate mobilization and hydraulic recovery in poplar stems
Authors: Brunetti Cecilia , Savi Tadeja , Nardini Andrea , Loreto Francesco , Gori Antonella , Centritto Mauro 
Published: March 2020

AbstractDrought compromises plant's ability to replace transpired water vapor with water absorbed from the soil, leading to extensive xylem dysfunction and causing plant desiccation and death. Short-term plant responses to drought rely on stomatal closure, and on the plant's ability to recover hydraulic functioning after drought relief. We hypothesize a key role for abscisic acid (ABA) not only in the control of stomatal aperture, but also in hydraulic recovery. Young plants of Populus nigra L. were used to investigate possible relationships among ABA, non-structural carbohydrates (NSC) and xylem hydraulic function under drought and after re-watering. In Populus nigra L. plants subjected to drought, water transport efficiency and hydraulic recovery after re-watering were monitored by measuring the percentage loss of hydraulic conductivity (PLC) and stem specific hydraulic conductivity (Kstem). In the same plants ABA and NSC were quantified in wood and bark. Drought severely reduced stomatal conductance (gL) and markedly increased the PLC. Leaf and stem water potential, and stem hydraulic efficiency fully recovered within 24 h after re-watering, but gL values remained low. After re-watering, we found significant correlations between changes in ABA content and hexoses concentration both in wood and bark. Our findings suggest a role for ABA in the regulation of stem carbohydrate metabolism and starch mobilization upon drought relief, possibly promoting the restoration of xylem transport capacity.
Mindfulness Meditation and Anxiety in Nursing Students
Authors: Stinson Cynthia , Curl Eileen Deges , Hale Gina , Knight Stacey , Pipkins Cynthia , Hall Iva , White Kelli , Thompson Nancy , Wright Christy 
Published: March 2020

Abstract
This quasi-experimental study used a convenience sample of nursing students (n = 49) to evaluate the effectiveness of mindfulness meditation on anxiety. Students participated in mindfulness meditation sessions and completed the State-Trait Anxiety Inventory. A statistically significant reduction in trait anxiety was found in the intervention group (p = .000); state anxiety decreased but not significantly. In contrast, anxiety increased significantly in the comparison group, but progression was not significantly different between groups. Trait anxiety may decrease with mindfulness meditation.
Prospective Implementation and Evaluation of a Decision-Tree Algorithm for Route of Hysterectomy
Authors: Schmitt Jennifer J. , Baker Mary V. , Occhino John A. , McGree Michaela E. , Weaver Amy L. , Bakkum-Gamez Jamie N. , Dowdy Sean C. , Pasupathy Kalyan S. , Gebhart John B. 
Published: March 2020

OBJECTIVE:
To evaluate the rate of vaginal hysterectomy and outcomes after initiation of a prospective decision-tree algorithm to determine the optimal surgical route of hysterectomy.

METHODS:
A prospective algorithm to determine optimal route of hysterectomy was developed, which uses the following factors: history of laparotomy, uterine size, and vaginal access. The algorithm was implemented at our institution from November 24, 2015, to December 31, 2017, for patients requiring hysterectomy for benign indications. Expected route of hysterectomy was assigned by the algorithm and was compared with the actual route performed to identify compliance compared with deviation. Surgical outcomes were analyzed.

RESULTS:
Of 365 patients who met inclusion criteria, 202 (55.3%) were expected to have a total vaginal hysterectomy, 57 (15.6%) were expected to have an examination under anesthesia followed by total vaginal hysterectomy, 52 (14.2%) were expected to have an examination under anesthesia followed by robotic-assisted total laparoscopic hysterectomy, and 54 (14.8%) were expected to have an abdominal or robotic–laparoscopic route of hysterectomy. Forty-six procedures (12.6%) deviated from the algorithm to a more invasive route (44 robotic, two abdominal). Seven patients had total vaginal hysterectomy when robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy was expected by the algorithm. Overall, 71% of patients were expected to have a vaginal route of hysterectomy per the algorithm, of whom 81.5% had a total vaginal hysterectomy performed; more than 99% of the total vaginal hysterectomies attempted were successfully completed.

CONCLUSION:
Vaginal surgery is feasible, carries a low complication rate with excellent outcomes, and should have a place in gynecologic surgery. National use of this prospective algorithm may increase the rate of total vaginal hysterectomy and decrease health care costs.
Racial and Ethnic Disparities in Perinatal Insurance Coverage
Authors: Daw Jamie R. , Kolenic Giselle E. , Dalton Vanessa K. , Zivin Kara , Winkelman Tyler , Kozhimannil Katy B. , Admon Lindsay K. 
Published: March 2020

OBJECTIVE:
To measure the association between race–ethnicity and insurance status at preconception, delivery, and postpartum and the frequency of insurance gaps and transitions (disruptions) across these time points.

METHODS:
We conducted a cross-sectional analysis of survey data from 107,921 women in 40 states participating in the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System from 2015 to 2017. We calculated unadjusted estimates of insurance status at preconception, delivery, and postpartum and continuity across these time points for seven racial–ethnic categories (white non-Hispanic, black non-Hispanic, indigenous, Asian or Pacific Islander, Hispanic Spanish-speaking, Hispanic English-speaking, and mixed race or other). We also examined unadjusted estimates of uninsurance at each perinatal time period by state of residence. We calculated adjusted differences in the predicted probability of uninsurance at preconception, delivery, and postpartum using logistic regression models with interaction terms for race–ethnicity and income.

RESULTS:
For each perinatal time point, all categories of racial–ethnic minority women experienced higher rates of uninsurance than white non-Hispanic women. From preconception to postpartum, 75.3% (95% CI 74.7–75.8) of white non-Hispanic women had continuous insurance compared with 55.4% of black non-Hispanic women (95% CI 54.2–56.6), 49.9% of indigenous women (95% CI 46.8–53.0) and 20.5% of Hispanic Spanish-speaking women (95% CI 18.9–22.2). In adjusted models, lower-income Hispanic women and indigenous women had a significantly higher predicted probability of uninsurance in the preconception and postpartum period compared with white non-Hispanic women.

CONCLUSION:
Disruptions in perinatal insurance coverage disproportionately affect indigenous, Hispanic, and black non-Hispanic women. Differential insurance coverage may have important implications for racial–ethnic disparities in access to perinatal care and maternal–infant health.
Prenatal Diagnosis of a Furcate Placenta
Authors: Cohen Bruce , Wilson Monika , Cohen Austin , Yum Mimi 
Published: March 2020

BACKGROUND:
A furcate placental cord insertion is rare and potentially dangerous. Prenatal diagnosis of this finding has been reported on only two prior occasions.

CASE:
We present the case of a 33-year-old patient who, at 35 weeks of gestation, was suspected on ultrasonography to have a cord insertion that was both furcate and velamentous. Because of this finding, the patient underwent labor induction at 37 weeks of gestation and delivered a vigorous neonate vaginally. Pathologic evaluation confirmed furcate placenta.

CONCLUSION:
The identification of a furcate placenta, a potentially lethal umbilical cord insertion site abnormality, is possible prenatally. Future research should elucidate the prevalence of furcate cord insertions as well as whether they impose increased fetal risk.
Plasma Concentrations of Tranexamic Acid in Postpartum Women After Oral Administration
Authors: Muhunthan Kopalasuntharam , Balakumar Sandrasegarampillai , Navaratnaraja Thiyahini S. , Premakrishna Sundaralingam , Arulkumaran Sabaratnam 
Published: March 2020

OBJECTIVE:To evaluate the pharmacokinetics of tranexamic acid after oral administration to postpartum women.METHODS:We conducted a single-center pharmacokinetic study at Teaching Hospital—Jaffna, Sri Lanka, on 12 healthy postpartum women who delivered vaginally. After oral administration of 2 g of immediate-release tranexamic acid 1 hour after delivery, pharmacokinetic parameters were measured on plasma samples at 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, and 12 hours. Plasma tranexamic acid concentrations were determined by high-performance liquid chromatography. The outcome measures were maximum observed plasma concentration, time to maximum plasma concentration, time to reach effective plasma concentration, time period effective serum concentration lasted, area under the curve for drug concentration, and half-life of tranexamic acid.RESULTS:The mean maximum observed plasma concentration was 10.06 micrograms/mL (range 8.56–12.22 micrograms/mL). The mean time to maximum plasma concentration was 2.92 hours (range 2.5–3.5 hours). Mean time taken to reach the effective plasma concentration of 5 micrograms/mL and the mean time this concentration lasted were 0.87 hours and 6.73 hours, respectively. Duration for which plasma tranexamic acid concentration remained greater than 5 micrograms/mL was 5.86 hours. Half-life was 1.65 hours. Area under the curve for drug concentration was 49.16 micrograms.h/mL (range 43.75–52.69 micrograms.h/mL).CONCLUSION:Clinically effective plasma concentrations of tranexamic acid in postpartum women may be achieved within 1 hour of oral administration. Given the promising pharmacokinetic properties, we recommend additional studies with larger sample sizes to investigate the potential of oral tranexamic acid for the treatment or prophylaxis of postpartum hemorrhage.
Antenatal Diagnosis of Marginal and Velamentous Placental Cord Insertion and Pregnancy Outcomes
Authors: O'Quinn Candace , Cooper Stephanie , Tang Selphee , Wood Stephen 
Published: March 2020

OBJECTIVE:
To evaluate the association between antenatal diagnosis of velamentous and marginal placental cord insertions with adverse perinatal outcomes of small-for-gestational-age (SGA) birth weight (less than the 5th percentile), caesarean birth, and perinatal mortality.

METHODS:
Using a diagnostic imaging database, we performed a cohort study of all consecutive singleton pregnancies (35,391), including 1,427 cases of marginal and 107 cases of velamentous cord insertion, delivered after 24 6/7 weeks of gestation between January 1, 2012, and December 31, 2015, at a single Canadian tertiary care center. Cases with placenta previa, vasa previa, no documented cord insertion, or fetal anomalies were excluded.

RESULTS:
In the overall cohort, the rate of birth weight less than the 5th percentile was 5.2%, the rate of cesarean delivery was 27.1%, and the rate of perinatal mortality was 0.24%. Velamentous cord insertion was associated with SGA (relative risk [RR] 2.19, 95% CI 1.28–3.74). This persisted after controlling for smoking during pregnancy, diabetes, and hypertension (adjusted odds ratio [aOR] 1.98, 95% CI 1.03–3.84). Velamentous cord insertion was also associated with an increased risk of caesarean birth (RR=1.38, 95% CI=1.08–1,77) and perinatal death (1.87%, RR 8.15, 95% CI 2.02–32.8), a relationship that persisted after controlling for smoking during pregnancy, diabetes, and hypertension (aOR 1.53, 95% CI 1.01–2.32). Marginal cord insertion was not associated with birth weight less than the 5th percentile (RR 1.23, 95% CI 1.00–1.51), cesarean delivery (RR 1.01, 95% CI 0.92–1.10), or perinatal death (RR 1.53, 95% CI 0.62–3.78).

CONCLUSION:
Antenatal diagnosis of velamentous placental cord insertion is associated with birth weight less than the 5th percentile.
Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy
Authors: Goggins Emily R. , Chamberlain Allison T. , Kim Tesia G. , Young Marisa R. , Jamieson Denise J. , Haddad Lisa B. 
Published: March 2020

OBJECTIVE:
To describe factors associated with not being tested for Chlamydia trachomatis and Neisseria gonorrhea infection during pregnancy and for testing positive and to describe patterns of treatment and tests of reinfection.

METHODS:
We conducted a retrospective cohort study of women who delivered at an urban teaching hospital from July 1, 2016 to June 30, 2018. Women with at least one prenatal care or triage visit were included. The index delivery was included for women with multiple deliveries. We used logistic regression to analyze factors associated with not being tested and for testing positive for these infections in pregnancy. Cox proportional hazards models were used to examine factors associated with time to treatment and tests of reinfection. We reviewed medical records to determine reasons for delays in treatment longer than 1 week.

RESULTS:
Among 3,265 eligible deliveries, 3,177 (97%) women were tested during pregnancy. Of these, 370 (12%) tested positive (287 chlamydia, 35 gonorrhea, 48 both), and 15% had repeat infections. Prenatal care adequacy and insurance status were risk factors for not being tested. Age, race and ethnicity, alcohol use, and sexually transmitted infection history were associated with testing positive. Time to treatment ranged from 0 to 221 days, with the majority (55%) of patients experiencing delays of more than 1 week. Common reasons for delays included lack of clinician recognition and follow-up of abnormal results (65%) and difficulty contacting the patient (33%).

CONCLUSION:
Traditional risk factors are associated with increased risk of infection during pregnancy. Prenatal care adequacy and insurance status were associated with the likelihood of being tested. Delays in treatment and tests of reinfection were common. Point-of-care testing and expedited partner therapy should be explored as ways to improve the management of these infections in pregnancy.
Trends in cup position utilizing computer-assisted navigation during total hip arthroplasty: A retrospective observational study
Authors: Mays Rachel R. , Benson Jessica R. , Muir Jeffrey M. , Meftah Morteza 
Published: March 2020

Background:
Proper positioning of the acetabular cup deters dislocation after total hip arthroplasty (THA) and is therefore a key focus for orthopaedic surgeons. The concept of a safe zone for acetabular component placement remains widely utilized in contemporary THA practice; however, components positioned in this safe zone still dislocate. The purpose of this study was to characterize trends in acetabular cup positioning and to determine if the surgical approaches used affected the rate at which the components were placed in the safe zones.

Methods:
This retrospective, observational study reviewed acetabular cup position in 1236 patients who underwent THA using computer-assisted navigation. Outcomes included acetabular cup position measurements derived from a surgical navigation device and surgical approach.

Results:
The overall mean cup position of all recorded cases was 21.8 degrees (±7.7 degrees, 95% CI=6.7 degrees, 36.9 degrees) of anteversion and 40.9 degrees (±6.5 degrees, 95% CI=28.1 degrees, 53.7 degrees) of inclination. For anteversion and inclination, 65.5% (809/1236) of acetabular cup components were within the Lewinnek safe zone, and 58.4% (722/1236) were within the Callanan safe zone. Acetabular cups were placed at a mean of 6.8 degrees of anteversion (posterior/lateral approach: 7.0 degrees, anterior approach: 5.6 degrees) higher than the Lewinnek and Callanan safe zones, whereas inclination was positioned 0.9 degrees higher than the reported Lewinnek safe zone and 3.4 degrees higher than the Callanan safe zone.

Conclusions:
Our data show that while most acetabular cups were placed within the traditional safe zones, the mean anteversion orientation is considerably higher than those suggested by the Lewinnek and Callanan safe zones. The implications of this observation warrant further investigation.

Level of Evidence:
Level III.
Estimation of the Effective Dose of Radiation Workers: Optimization Based on the Weight Percentile
Authors: Shahri Keyhandokht Karimi 
Published: March 2020

Abstract
Radiation workers might be exposed to polyenergetic photon radiation beams at different directions in their working environments. In this regard, their effective dose (E) should be accurately estimated using a two-dosimeter algorithm (TDA), based on the measurements of two thermoluminescent dosimeters (TLDs) or film badges that are mounted on the front and back of the body. However, considering different human anatomies, radiation workers may have a variety of weight percentiles. This work sought to find whether TDA obtained for the reference weight percentile (50th) can be used for higher weight percentiles (including; 65th, 75th, 85th, and 95th). MCNPX was used to simulate different weight percentiles on the revised ORNL phantom by adding extra layers of muscle and adipose on the torso. Then front and back TLD responses were calculated for external beam photon energies of 40 keV to 10 MeV in different irradiation geometries. The results revealed that E value declines with increasing the weight percentile. In this study, three TDA were investigated consisting of Eest = 0.73 Rf + 0.53 Rb (73/53), Eest = 0.55 Rf + 0.50 Rb (55/50), and Eest = 0.70 Rf + 0.30 Rb (70/30). The ratio of Eest/E was calculated for each TDA in different energy bins and weight percentiles. Results obtained using the 55/50 and 70/30 showed higher underestimation for most of the energy bins, especially for PA and AP geometries. Compared to these two TDA, the 73/53 algorithm resulted in higher overestimation for RLAT and LLAT geometries for the same energy bins. Variation of the algorithms showed a similar trend for the studied weight percentiles. To conclude, results obtained by TDA for the 50% weight percentile are applicable for weight percentiles >50%.
Amount of Brain Edema Correlates With Neurologic Recovery in Pediatric Cerebral Malaria
Authors: Kampondeni Samuel , Seydel Karl B. , Zhang Bo , Small Dylan S. , Birbeck Gretchen L. , Hammond Collen A. , Chilingulo Cowles , Taylor Terrie E. , Potchen Michael J. 
Published: March 2020

Background:
Cerebral malaria (CM) remains a leading cause of mortality and morbidity in children in sub-Saharan Africa. Recent studies using brain magnetic resonance imaging have revealed increased brain volume as a major predictor of death. Similar morphometric predictors of morbidity at discharge are lacking. The aim of this study was to investigate the utility of serial cranial cisternal cerebrospinal fluid (CSF) volume measurements in predicting morbidity at discharge in pediatric CM survivors.

Methods:
In this case–control study, 54 Malawian pediatric CM survivors with neurologic sequelae evident at discharge who underwent serial magnetic resonance imaging scans while comatose were matched to concurrently admitted children with serial imaging who made full recoveries. Serial cranial cisternal CSF volume quantified by radiologists blinded to outcome was evaluated as a predictor of neurologic deficits at discharge. The probability of neurologic sequelae was determined using a model that included coma duration and changes in cisternal CSF volume over time.

Results:
Coma duration before admission was similar between cases and controls (16.1 vs. 15.3; P = 0.81), but overall coma was longer among children with sequelae (60 vs. 38 hours; P < 0.01). Lower initial CSF volumes and decreased volumes over time were both associated with a higher probability of neurologic sequelae at discharge.

Conclusions:
Among pediatric CM survivors with prolonged coma, lower initial CSF volume and decreasing volume during coma is associated with neurologic sequelae at discharge. These findings suggest that cerebral edema is an underlying contributor to both morbidity and mortality in pediatric CM.
Intestinal Spirochetes in Cancer Patients
Authors: Cheema Asima , Jejelowo Oluwafisayo , Syed Misbahuddin , Ramsakal Asha , Greene John N. 
Published: March 2020

Abstract
The clinical significance of human intestinal spirochetosis is a debated topic, with possible links to various gastrointestinal symptoms such as diarrhea and hematochezia. The most commonly associated organisms in humans involve Brachyspira aalborgi and Brachyspira pilosicoli. However, the presence of spirochetes within the colorectal epithelium does not always suggest pathogenicity, and treatment does not always lead to symptom improvement. Men who have sex with men and patients infected with the HIV have been considered at higher risk of colonization and subsequently becoming symptomatic, possibly related to an underlying immunosuppressed state. We present a series of 3 case reports of human intestinal spirochetosis in immunocompromised cancer patients at the Moffitt Cancer Center and Research Institute. The aim of this study is to increase awareness of this entity in immunocompromised cancer patients and non–HIV-positive immunosuppressed patients, particularly when presenting with gastrointestinal symptoms of unclear etiology.
Carpal Tunnel Syndrome as Sentinel for Harmful Hand Activities at Work
Authors: Tabatabaeifar Sorosh , Svendsen Susanne Wulff , Frost Poul 
Published: March 2020

Objective:
Evaluate incidence rates (IRs) of carpal tunnel syndrome (CTS) as sentinels to identify job groups with high hand-wrist exposures.

Methods:
A nationwide register-based cohort study of all born in Denmark. During follow-up 2010 to 2013, we identified first-time CTS diagnoses. We established job groups, calculated sex-specific age-standardized IRs (SIRs) per job group. We linked occupational codes with a job exposure matrix, calculated mean hand load estimate per job group, and plotted hand load against the SIRs.

Results:
We followed 1,171,580 men and 1,137,854 women for 4,046,851 and 3,994,987 person-years; identified 4405 cases among men, 7858 among women; obtained crude IRs of 10.9 and 19.7 per 10,000 person-years. For both sexes, there was a positive association between SIRs and hand load.

Conclusions:
Higher SIRs pointed to job groups with higher hand load. Elevated SIRs of CTS may serve as sentinels of harmful hand activities.
The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease
Authors: Celebi Savas , Ozcan Celebi Ozlem , Berkalp Berkten , Amasyali Basri 
Published: March 2020

Objective
Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD.

Methods
In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (≤22), those with an intermediate SYNTAX score (23≥ SYNTAX score ≤32) and those with a high SYNTAX score (>32).

Results
We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826).

Conclusion
The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.