bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Labor Epidural Analgesia at a High-volume Tertiary Care Obstetric Unit: A Before-and-After Study
Authors: Easther R.G. , Downey K. , Watts N. , Ye X.Y. , Carvalho J.C.A. 
Published: November 2021

(Reg Anesth Pain Med. 2021;46:157–163. doi: 10.1136/rapm-2020-101873. [Epub November 6, 2020]. PMID: 33159006)
Randomized controlled trials show neuraxial analgesia minimizes pain and improves patient experience across North America, yet these findings are under controlled conditions within homogenous populations. Also, practice changes were made between 2011 and 2017 at the institution’s obstetric unit including a more consistent epidural loading dose of local anesthetic plus fentanyl, increased hourly and maximum limits of bupivacaine, and conversion from continuous epidural infusion to programmed intermittent epidural bolus (PIEB) regimen. Any changes in reported data between the 2 time periods provide insight on the quality of labor analgesia. This study aimed to improve maternal care and outcomes by further understanding the safety, quality, and patient satisfaction of labor analgesia using prospective observational studies.
Obstetric Anal Sphincter Injuries (OASIS) in Multiparous Women With the Use of Epidural Anaesthesia: A Retrospective Cohort Study
Authors: Putri  , Simons K. , Nettle J. , Woodward A. 
Published: November 2021

(Aust N Z J Obstet Gynaecol. 2021;61:30–34)
Epidural anesthesia is the gold standard for managing labor pain. But it is also associated with longer second stage of labor and an increased risk of instrumental vaginal delivery, which can lead to obstetric anal sphincter injuries (OASIS). The risk of OASIS is 5.7% in women giving birth for the first time, compared with 1.5% in multiparous women with no history of OASIS. The aim of this study was to evaluate the impact of epidural use in multiparous women on the rates of OASIS and other outcomes.
A Prospective, Up-down Sequential Allocation Study Investigating the Effectiveness of Vital Capacity Breaths Using High-flow Nasal Oxygenation versus a Tight-fitting Face Mask to Preoxygenate Term Pregnant Women
Authors: Al-Sulttan S. , Bampoe S. , Howle R. , Setty T. , Columb M. , Patel A. , Fernando R. , Husain T. , Sultan P. 
Published: November 2021

(Int J Obstet Anesth. 2021;45:28–33)
While neuraxial anesthesia is the preferred technique for cesarean delivery (CD), sometimes general anesthesia (GA) is warranted. Preoxygenation before rapid-sequence induction of GA in obstetric patients can prolong the time to oxygen desaturation. High-flow nasal oxygenation (HFNO) has been used in other settings, but there is a lack of data on its use in the obstetric population. A previous study examined the use of HFNO, using tidal volume breaths rather than vital capacity (VC) breaths. This current study aimed to determine the number of VC breaths needed using HFNO to achieve FETO2 ≥90% in pregnant women undergoing CD at term, and compare this to the number of VC breaths needed to achieve FETO2 ≥90% using a tight-fitting face mask for preoxygenation.
Vasodilator Dysfunction in Human Obesity: Established and Emerging Mechanisms
Authors: Schinzari Francesca , Tesauro Manfredi , Cardillo Carmine 
Published: November 2021

Abstract:
Human obesity is associated with insulin resistance and often results in a number of metabolic abnormalities and cardiovascular complications. Over the past decades, substantial advances in the understanding of the cellular and molecular pathophysiological pathways underlying the obesity-related vascular dysfunction have facilitated better identification of several players participating in this abnormality. However, the complex interplay between the disparate mechanisms involved has not yet been fully elucidated. Moreover, in medical practice, the clinical syndromes stemming from obesity-related vascular dysfunction still carry a substantial burden of morbidity and mortality; thus, early identification and personalized clinical management seem of the essence. Here, we will initially describe the alterations of intravascular homeostatic mechanisms occurring in arteries of obese patients. Then, we will briefly enumerate those recognized causative factors of obesity-related vasodilator dysfunction, such as vascular insulin resistance, lipotoxicity, visceral adipose tissue expansion, and perivascular adipose tissue abnormalities; next, we will discuss in greater detail some emerging pathophysiological mechanisms, including skeletal muscle inflammation, signals from gut microbiome, and the role of extracellular vesicles and microRNAs. Finally, it will touch on some gaps in knowledge, as well as some current acquisitions for specific treatment regimens, such as glucagon-like peptide-1 enhancers and sodium-glucose transporter2 inhibitors, that could arrest or slow the progression of this abnormality full of unwanted consequences.
Surgical Correction of Popliteal Pterygium with Serial Splinting: A Case Report and Review of Literature
Authors: Sewilam Mohammed , Hassan Ahmed Sabry , Shoaib Amr , Alrayes Majd 
Published: November 2021

Summary:
Popliteal pterygium syndrome is an extremely rare congenital disorder, with only a few cases reported in the literature. It consists of facial, genitourinary, and musculoskeletal anomalies. A very striking characteristic of this syndrome is the popliteal pterygium contracture, which is considered the most challenging malformation to be corrected. Hence, we report a case of popliteal pterygium contracture in a 30-month-old female child with no family history of popliteal pterygium syndrome. The child was treated successfully with satisfactory results, by combining surgical intervention with postoperative serial splinting. We discuss here the tips and tricks of the surgical approach we performed, which was followed by serial splinting and physiotherapy. In addition, a literature-based review was performed providing a summary of all relevant reported cases.
Women’s awareness about menopausal symptoms and its management: a cross-sectional study in 2 selected settings of Asmara, Eritrea
Authors: Idris Idris M. , Amr Drar A. 
Published: November 2021

Objective:
The authors tried to identify women’s level of awareness about menopausal symptoms and the measures they take to relieve the menopausal symptoms in selected areas of Asmara, Eritrea.

Methodology:
A cross-sectional study design was utilized from November 1 to 21, 2018. Data about menopausal symptoms and the relieving measures taken were collected using a pretested questionnaire from 180 selected women from Asmara College of Health Sciences and Public Transportation of Zoba Maekel. Bivariate and multivariate logistic regression was used to identify associations of demographic variables with level of awareness using SPSS (Version 22.0).

Results:
More than half of the study participants (56%) were between the age group of 40 and 45 and the mean age at which menopause had started was 45 years. About 52% of them reached menopause out of whom more than half (56%) were not aware of menopausal symptoms. The main menopausal symptoms mentioned were absence of periods (34.4%), followed by irritability (32.8%) and hot flashes (27.8%). About seven-tenth of the participants (68.3%) did not take any action to relive the menopausal symptoms. Women with higher level of education [adjusted odds ratio (95% confidence interval): 2.12 (1.07, 3.96)], who were from a nuclear family [adjusted odds ratio (95% confidence interval): 1.65 (0.76, 3.23)] were having a significantly better level of awareness about menopause and its symptoms.

Conclusion:
Majority of the women were not aware of the menopausal symptoms and the measures that should be taken. Appropriate actions to increase women’s awareness level regarding menopause should be incorporated as a critical aspect in promoting women’s health.
First Clinical Experience With Ophthalmic e-Device for Unaided Patient Self-Examination During COVID-19 Lockdown
Authors: van der Star Lydia , Mulders-Al-Saady Rana , Phan Alex , Truong Buu , Suen Benjamin , Krijgsman Marina , Persoons Robin , Bourgonje Vincent J. A. , van Dijk Korine , Talke Frank E. , Melles Gerrit R. J. 
Published: November 2021

Purpose:
The aim of this study was to describe a new type of medical device that allows for internet-enabled patient self-screening, without the aid of an ophthalmic professional, through biomicroscopy self-imaging and self-measurement of the best-corrected visual acuity (BCVA).

Methods:
In this prospective nonrandomized comparative study, 56 patients were instructed to screen their own eyes using a custom-built e-Device containing miniaturized slitlamp optics and a visual acuity Snellen chart virtually projected at 20 ft. BCVA measurements were recorded, and biomicroscopic videos were scored for image quality of the anterior segment status on a scale from 1 to 5 (1 = poor and 5 = excellent) by a blinded observer.

Results:
After a short instruction, all patients were able to self-image their eyes and perform a self-BCVA measurement using the e-Device. Patient self-image quality with the e-Device scored on average 3.3 (±0.8) for videos (n = 76) and 3.6 (±0.6) for photographs (n = 49). Self-BCVA measurement was within 1 Snellen line from routine BCVA levels in 66 of 72 eyes (92%). When compared with conventional biomicroscopy, patient self-biomicroscopy allowed for recognition of the relevant pathology (or absence thereof) in 26 of 35 eyes (74%); 9 cases showed insufficient image quality attributed to device operating error (n = 6) and mild corneal edema and/or scarring (n = 3). Patient satisfaction with the device was 4.4 (±0.9).

Conclusions:
An e-Device for combined BCVA self-measurement and biomicroscopy self-imaging may have potential as an aid in remote ophthalmic examination in the absence of an ophthalmic professional and may be considered for patients who are unable to visit an ophthalmic clinic for routine follow-up.
Corneal Neurotization Using the Great Auricular Nerve for Bilateral Congenital Trigeminal Anesthesia
Authors: Lau Nicola , Osborne Sarah F. , Vasquez-Perez Alfonso , Wilde Caroline L. , Manisali Mehmet , Jayaram Rahul 
Published: November 2021

Purpose:
The purpose of this study was to describe an indirect corneal neurotization (CN) technique for congenital bilateral trigeminal anesthesia using the greater auricular nerve (GAN) as a donor.

Method:
CN was performed to preserve the integrity of the only seeing eye in a 4-year-old boy with pontine tegmental cap dysplasia and bilateral trigeminal anesthesia. He had recurrent corneal ulceration and scarring despite full medical treatment. The GAN was used as a donor, and the sural nerve was harvested and used as a bridge which was tunneled to the sub-Tenon space in the inferior fornix. The fascicles were distributed into the 4 quadrants and sutured to the sclera near the limbus.

Result:
This technique resulted in providing corneal sensation and improving stability of the epithelium. Corneal opacity gradually decreased allowing significant visual improvement evidenced in the early postoperative months.

Conclusions:
Using the GAN technique for CN bypasses trigeminal innervation and has the potential to improve corneal sensation. The GAN is a large caliber nerve and provides a large amount of axons and robust neurotization. This technique would be desirable for cases with bilateral congenital trigeminal anesthesia, such as pontine tegmental cap dysplasia.
Developing and Aligning a Safety Event Taxonomy for Inpatient Psychiatry
Authors: Barnes Todd , Fontaine Thomas , Bautista Cynthia , Lee Jaeyon , Stanley Rebecca 
Published: November 2021

Objective
The aim of this project was to develop and align an inpatient psychiatric safety event taxonomy that would blend well-established safety events with psychiatry-specific concerns.

Methods
A hybrid inductive-deductive thematic analysis was used to generate novel descriptive safety event categories for inpatient psychiatry and align these categories with an established taxonomic framework. In the inductive phase, an initial taxonomy was developed by describing the semantic subject and context of reported safety concerns. In the deductive phase, existing literature, national standards, and local content experts were used to align our taxonomy with the safety event measurement system at our institution.

Results
A total of 2291 events were extracted and 483 were analyzed. After thorough review, the data was divided into 4 domains: (1) Provision of care, (2) patient actions, (3) environment/equipment, and (4) safety culture. Each domain reflects a mutually exclusive typology of events and provides a parsimonious view of safety concerns in inpatient psychiatry. Each domain was further divided into categories, subcategories, and subcategory details.

Conclusions
Safety events on inpatient psychiatric units are understudied and lack the measurement infrastructure to identify care processes that result in exposure to harm. We develop and align an inpatient psychiatric safety taxonomy based on real-world data, existing literature, and measurement standards. This taxonomy can be used by psychiatric hospitals to improve their patient safety measurement systems—and ultimately—the safety of their patients and communities.
Why do plasmids manipulate the expression of bacterial phenotypes?
Authors: Billane Kathryn , Harrison Ellie , Cameron Duncan , Brockhurst Michael A. 
Published: November 2021

Conjugative plasmids play an important role in bacterial evolution by transferring niche-adaptive traits between lineages, thus driving adaptation and genome diversification. It is increasingly clear, however, that in addition to this evolutionary role, plasmids also manipulate the expression of a broad range of bacterial phenotypes. In this review, we argue that the effects that plasmids have on the expression of bacterial phenotypes may often represent plasmid adaptations, rather than mere deleterious side effects. We begin by summarizing findings from untargeted omics analyses, which give a picture of the global effects of plasmid acquisition on host cells. Thereafter, because many plasmids are capable of both vertical and horizontal transmission, we distinguish plasmid-mediated phenotypic effects into two main classes based upon their potential fitness benefit to plasmids: (i) those that promote the competitiveness of the host cell in a given niche and thereby increase plasmid vertical transmission, and (ii) those that promote plasmid conjugation and thereby increase plasmid horizontal transmission. Far from being mere vehicles for gene exchange, we propose that plasmids often act as sophisticated genetic parasites capable of manipulating their bacterial hosts for their own benefit.This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Translational demand is not a major source of plasmid-associated fitness costs
Authors: Rodríguez-Beltrán Jerónimo , León-Sampedro Ricardo , Ramiro-Martínez Paula , de la Vega Carmen , Baquero Fernando , Levin Bruce R. , San Millán Álvaro 
Published: November 2021

Plasmids are key drivers of bacterial evolution because they are crucial agents for the horizontal transfer of adaptive traits, such as antibiotic resistance. Most plasmids entail a metabolic burden that reduces the fitness of their host if there is no selection for plasmid-encoded genes. It has been hypothesized that the translational demand imposed by plasmid-encoded genes is a major mechanism driving the fitness cost of plasmids. Plasmid-encoded genes typically present a different codon usage from host chromosomal genes. As a consequence, the translation of plasmid-encoded genes might sequestrate ribosomes on plasmid transcripts, overwhelming the translation machinery of the cell. However, the pervasiveness and origins of the translation-derived costs of plasmids are yet to be assessed. Here, we systematically altered translation efficiency in the host cell to disentangle the fitness effects produced by six natural antibiotic resistance plasmids. We show that limiting translation efficiency either by reducing the number of available ribosomes or their processivity does not increase plasmid costs. Overall, our results suggest that ribosomal paucity is not a major contributor to plasmid fitness costs.This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Conjugative plasmid transfer is limited by prophages but can be overcome by high conjugation rates
Authors: Igler Claudia , Schwyter Lukas , Gehrig Daniel , Wendling Carolin Charlotte 
Published: November 2021

Antibiotic resistance spread via plasmids is a serious threat to successfully fight infections and makes understanding plasmid transfer in nature crucial to prevent the rise of antibiotic resistance. Studies addressing the dynamics of plasmid conjugation have yet neglected one omnipresent factor: prophages (viruses integrated into bacterial genomes), whose activation can kill host and surrounding bacterial cells. To investigate the impact of prophages on conjugation, we combined experiments and mathematical modelling. UsingEscherichia coli, prophageλand the multidrug-resistant plasmid RP4 we find that prophages can substantially limit the spread of conjugative plasmids. This inhibitory effect was strongly dependent on environmental conditions and bacterial genetic background. Our empirically parameterized model reproduced experimental dynamics of cells acquiring either the prophage or the plasmid well but could only reproduce the number of cells acquiring both elements by assuming complex interactions between conjugative plasmids and prophages in sequential infections. Varying phage and plasmid infection parameters over empirically realistic ranges revealed that plasmids can overcome the negative impact of prophages through high conjugation rates. Overall, the presence of prophages introduces an additional death rate for plasmid carriers, the magnitude of which is determined in non-trivial ways by the environment, the phage and the plasmid.This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
What makes a megaplasmid?
Authors: Hall James P. J. , Botelho João , Cazares Adrian , Baltrus David A. 
Published: November 2021

Naturally occurring plasmids come in different sizes. The smallest are less than a kilobase of DNA, while the largest can be over three orders of magnitude larger. Historically, research has tended to focus on smaller plasmids that are usually easier to isolate, manipulate and sequence, but with improved genome assemblies made possible by long-read sequencing, there is increased appreciation that very large plasmids—known as megaplasmids—are widespread, diverse, complex, and often encode key traits in the biology of their host microorganisms. Why are megaplasmids so big? What other features come with large plasmid size that could affect bacterial ecology and evolution? Are megaplasmids 'just' big plasmids, or do they have distinct characteristics? In this perspective, we reflect on the distribution, diversity, biology, and gene content of megaplasmids, providing an overview to these large, yet often overlooked, mobile genetic elements.
This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Plasmid co-infection: linking biological mechanisms to ecological and evolutionary dynamics
Authors: Igler Claudia , Huisman Jana S. , Siedentop Berit , Bonhoeffer Sebastian , Lehtinen Sonja 
Published: November 2021

As infectious agents of bacteria and vehicles of horizontal gene transfer, plasmids play a key role in bacterial ecology and evolution. Plasmid dynamics are shaped not only by plasmid–host interactions but also by ecological interactions between plasmid variants. These interactions are complex: plasmids can co-infect the same cell and the consequences for the co-resident plasmid can be either beneficial or detrimental. Many of the biological processes that govern plasmid co-infection—from systems that exclude infection by other plasmids to interactions in the regulation of plasmid copy number—are well characterized at a mechanistic level. Modelling plays a central role in translating such mechanistic insights into predictions about plasmid dynamics and the impact of these dynamics on bacterial evolution. Theoretical work in evolutionary epidemiology has shown that formulating models of co-infection is not trivial, as some modelling choices can introduce unintended ecological assumptions. Here, we review how the biological processes that govern co-infection can be represented in a mathematical model, discuss potential modelling pitfalls, and analyse this model to provide general insights into how co-infection impacts ecological and evolutionary outcomes. In particular, we demonstrate how beneficial and detrimental effects of co-infection give rise to frequency-dependent selection on plasmid variants.
This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.
Unraveling a Bacterial Starvation Response Through the Direct Targets of a Starvation-Induced Transcriptional Activator
Authors: Ma Muqing , Li Ting , Lemon David J. , Caro Eduardo A. , Ritchie Linnea , Ryan Charles , Spearing Victoria M. , Welch Roy D. , Garza Anthony G. , Murphy Kimberly A. 
Published: November 2021

ABSTRACTOrganisms frequently encounter environments with nutrient shortages and their survival depends on changes in physiology and the ability to conserve resources. In bacteria, many physiological changes associated with starvation have been identified, but the underlying genetic components and regulatory networks that direct these physiological changes are often poorly defined. Here, we aimed to better define the gene regulatory networks that mediate the starvation response in Myxococcus xanthus, a bacterium that copes with starvation by producing fruiting bodies filled with dormant and stress-resistant spores. We focused on the direct promoter/gene targets of Nla28, a transcriptional activator/enhancer binding protein (EBP) that is important for early rounds of gene expression following starvation. Using expression profiling to identify genes that are downregulated in nla28 mutant cells and bioinformatics to identify the putative promoters of these genes, 12 potential promoter targets (37 genes) of Nla28 were identified. The results of in vitro promoter binding assays, coupled with in vitro and in vivo mutational analyses, suggested that the 12 promoters are in vivo targets of Nla28 and that Nla28 dimers use tandem, imperfect repeats of an 8-bp sequence for binding. Interestingly, nine of the Nla28 target promoters are intragenic, located in the protein coding sequence of an upstream gene or in the protein coding sequence of one gene within an operon (internal promoters). Based on mutational analyses, we concluded that the 12 Nla28 target loci contain at least one gene important for production of stress-resistant spores following starvation. Most of these loci contain genes predicted to be involved in regulatory or defense-related functions. Using the consensus Nla28 binding sequence, followed by bioinformatics and expression profiling, 58 additional promoters and 102 genes were tagged as potential Nla28 targets. Among these putative Nla28 targets, functions such as regulatory, metabolic and cell envelope biogenesis were commonly assigned to genes.