bluuebunny/crossref_metadata_2025_split huggingface dataset:
Live-Attenuated Respiratory Syncytial Virus Vaccine With Deletion of RNA Synthesis Regulatory Protein M2-2 and Cold Passage Mutations Is Overattenuated
Authors: Cunningham Coleen K , Karron Ruth , Muresan Petronella , McFarland Elizabeth J , Perlowski Charlotte , Libous Jennifer , Thumar Bhagvanji , Gnanashanmugam Devasena , Moye Jack , Schappell Elizabeth , Barr Emily , Rexroad Vivian , Aziz Mariam , Deville Jaime , Rutstein Richard , Yang Lijuan , Luongo Cindy , Collins Peter , Buchholz Ursula ,   International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 2012 Study Team
Published: May 2019

Abstract

Background
The live respiratory syncytial virus (RSV) candidate vaccine LIDcpΔM2-2 is attenuated through deletion of M2-2 and 5 cold-passage mutations.

Methods
RSV-seronegative children aged 6–24 months received a single intranasal dose of 105 plaque-forming units (PFU) of LIDcpΔM2-2 or placebo. RSV serum antibodies, vaccine infectivity, and reactogenicity were assessed.

Results
Four of 11 (36%) vaccinees shed vaccine virus with median peak titers of 1.6 log10 PFU/mL by quantitative culture and 4.5 log10 copies/mL by polymerase chain reaction; 45% had ≥4-fold rise in serum-neutralizing antibodies. Respiratory symptoms or fever were common in vaccinees (64%) and placebo recipients (6/6, 100%).

Conclusions
RSV LIDcpΔM2-2 is overattenuated.
Clinical Trial Numbers. NCT02890381, NCT02948127.
Gene Expression and DNA Methylation Alterations in the Glycine N-Methyltransferase Gene in Diet-Induced Nonalcoholic Fatty Liver Disease-Associated Carcinogenesis
Authors: Borowa-Mazgaj Barbara , de Conti Aline , Tryndyak Volodymyr , Steward Colleen R , Jimenez Leandro , Melnyk Stepan , Seneshaw Mulugeta , Mirshahi Faridodin , Rusyn Ivan , Beland Frederick A , Sanyal Arun J , Pogribny Igor P 
Published: May 2019

AbstractNonalcoholic fatty liver disease (NAFLD) is becoming a major etiological risk factor for hepatocellular carcinoma (HCC) in the United States and other Western countries. In this study, we investigated the role of gene-specific promoter cytosine DNA methylation and gene expression alterations in the development of NAFLD-associated HCC in mice using (1) a diet-induced animal model of NAFLD, (2) a Stelic Animal Model of nonalcoholic steatohepatitis-derived HCC, and (3) a choline- and folate-deficient (CFD) diet (CFD model). We found that the development of NAFLD and its progression to HCC was characterized by down-regulation of glycine N-methyltransferase (Gnmt) and this was mediated by progressive Gnmt promoter cytosine DNA hypermethylation. Using a panel of genetically diverse inbred mice, we observed that Gnmt down-regulation was an early event in the pathogenesis of NAFLD and correlated with the extent of the NAFLD-like liver injury. Reduced GNMT expression was also found in human HCC tissue and liver cancer cell lines. In in vitro experiments, we demonstrated that one of the consequences of GNMT inhibition was an increase in genome methylation facilitated by an elevated level of S-adenosyl-L-methionine. Overall, our findings suggest that reduced Gnmt expression caused by promoter hypermethylation is one of the key molecular events in the development of NAFLD-derived HCC and that assessing Gnmt methylation level may be useful for disease stratification.
Novel morphological structures in frogs: vocal sac diversity and evolution in Microhylidae (Amphibia: Anura)
Authors: Targino Mariane , Elias-Costa Agustín J , Taboada Carlos , Faivovich Julián 
Published: May 2019

Abstract
Vocal sacs are present in most species of frogs and are the product of the interaction of three elements: the gular skin, the superficial submandibular musculature and an internal mucosa derived from the buccal floor. In this paper, we surveyed the structural diversity in the vocal sac of microhylids and related families in 109 exemplar species, including 11 of the 13 currently recognized subfamilies. We defined five characters related to anatomical and histological properties of the m. interhyoideus, as well as the relationship of this muscle and the vocal sac internal mucosa. We describe a vocal sac configuration characterized by highly abundant elastic fibres in association with muscle fibres, a very unusual structure in animal tissues. We discuss the evolution of novel structures in a phylogenetic context and identify new synapomorphies for Microhylidae and internal clades. Furthermore, we comment on the functional implications that these features have in vocal sac inflation.
A Descriptive Analysis of Abortion Clinics’ Aftercare Instructions Following Surgical Abortion [4G]
Authors: Robin Tucker Ann , Tang Michelle , Askew Amy Liao , Truong Tracy , Deans Elizabeth Innes 
Published: May 2019

INTRODUCTION:
Providing patient expectations after a planned procedure is an important component of the preoperative visit. However, recommendations after surgical abortion are often neither standardized nor evidence-based.

METHODS:
The aftercare instructions of 73 National Abortion Federation (NAF) clinics providing surgical abortion were reviewed by three different authors for consistency. Clinics were chosen that provided comprehensive written instructions. The answers to common patient questions were examined.

RESULTS:
Of the clinics, 7 (10%) were academic university affiliated. A follow-up appointment was recommended at 3 weeks by 45% of clinics. The most common behavioral recommendations were to abstain from sex, douching, and tampons for 2 weeks. The majority of clinics did not have recommendations regarding exercise, baths, or swimming. Recommendations for pain included Tylenol™ (60%), NSAIDs (78%), narcotics (22%), and a heating pad (49%). Emergency care was recommended for fever (88%) and excessive pain (81%). Majority (52%) of clinics described abnormal bleeding as soaking 1 pad/hr for 2 hours compared to 2 pads/hr for 2 hours (36%). Normal post-abortion bleeding was defined as irregular (86%) or spotting (44%) with return to menses by 8 weeks as the most common time frame. About half (53%) of clinics counseled regarding breast symptoms, of which 93% described discomfort and 66% described leaking. 77% of clinics mentioned post-abortion emotional reactions, of which 77% used normalizing language and 82% provided specific resources.

CONCLUSION:
While many recommendations will likely remain unsupported by formal evidence, a review of frequent recommendations by expert providers may help formalize surgical abortion aftercare instructions.
Access to Postpartum Sterilization: Are We Underestimating the Risk of Regret? [5G]
Authors: Urbina Josephine P. , Baum Jonathan D. 
Published: May 2019

INTRODUCTION:
To identify barriers to postpartum sterilization at a suburban community teaching hospital.

METHODS:
Retrospective cohort study of pregnant women ages 21-44 who expressed desire for postpartum sterilization by the 28th week of gestation. The study period was from January 2012 to December 2013. Patient demographics and outcomes were analyzed.

RESULTS:
In the study period, 154 women desired postpartum sterilization, 88 (57.1%) underwent the procedure and 66 (42.9%) did not. Change of heart occurred in 38 women (57.5%), medical reasons were given in 14 women (21.2%), and lack of Medicaid sterilization form was noted in 5 women (7.5%). There was lack of a documented reason for not performing the procedure in 9 (13.6%) women.

CONCLUSION:
We found that almost 60% of women experienced a change of heart regarding sterilization which is significantly higher than other reports. The high rate of change of heart and low rate of lack of government consent in our study suggest that women can exercise autonomy and opt out of sterilization even after consenting and completing the required consent form by 28 weeks gestation. While risk of regret appears to vary inversely with age, the relationship between change of heart and sterilization regret warrants further study.
Management of Complex Myometrial Cyst in Pregnancy: Case Report [12G]
Authors: Mama Saifuddin Taiyeb , Fischer Richard L. , Kovacs James 
Published: May 2019

INTRODUCTION:
Acquired myometrial cysts have been associated occasionally with endometriosis, adenomyosis, endosalpingiosis or degenerative leiomyomas. These conditions do not usually pose a danger to the mother or fetus if conception occurs. There are two reports in the literature of benign cystic myometrial masses unrelated to any of the above conditions.

METHODS:
A 33 y.o. female was found to have a cystic mass on the posterior uterine wall during a first trimester ultrasound. An MRI revealed a mass arising from the endometrial cavity extruding cranially and laterally through a right myometrial wall defect partially contained within the uterine serosa, unconnected with the gestational sac. Diagnostic laparoscopy confirmed a large, reducible cystic structure. Following extensive counseling about the possibility of uterine rupture later in gestation, the patient chose to terminate the pregnancy. A laparoscopic-guided dilation and evacuation was performed. The cyst was separately drained, and clear fluid aspirated. Five months postoperatively, the myometrial defect was repaired with a hysterorrhaphy. Histopathology of the excised cyst revealed benign mesothelium without evidence of adenomyosis, endometriosis or leiomyoma. The patient conceived five months later, delivering by repeat caesarean section without any complications.

CONCLUSION:
There are no prior reported cases of complex cystic myometrial masses or herniations unrelated to endosalpingiosis, endometriosis, adenomyosis or leiomyomas; nor of the effects of such a mass on current pregnancy or future fertility. This desired pregnancy was terminated to avoid the potential risk of uterine rupture and associated hemorrhage. Clinicians should be aware of this rare entity.
A Scoping Review of Climate-Change Related Exposures on Obstetrics Outcomes [18G]
Authors: DeNicola Nathaniel G. , Bekkar Bruce , Pacheco Susan , Basu Rupa 
Published: May 2019

INTRODUCTION:
Toxic environmental exposures, specifically climate-change related exposures, pose a unique risk to pregnant women and the developing fetus. Robust evidence analysis is needed to guide clinicians on risk assessment and clinical counseling.

METHODS:
A literature search was conducted by our research team and medical librarian; scope included United States studies from 2007 to 2017. Climate-change related exposures included air pollution components: fine particulate matter (PM 2.5) and ozone, extreme weather, heat and temperature. Exposures ranged throughout all trimesters. Obstetrics outcomes included preterm birth, low birth-weight, and stillbirth. Exposures related to natural disasters were excluded; clinical outcomes related to neurodevelopment, mental illness, gynecology, and fertility were excluded. The Arksey and O'Malley scoping review framework was followed and quality assessment was performed using the Jadad scale.

RESULTS:
A total of 1,842 references were screened. 24 studies related to air pollution and preterm birth met inclusion; 21 found an effect. 27 studies related to air pollution and low birth-weight and met inclusion; 25 found an effect. 4 studies related to air pollution and stillbirth met inclusion; 3 found an effect. 5 studies related to heat and preterm birth met inclusion; 5 found an effect. 3 studies related to heat and low birth-weight met inclusion; 3 found an effect. 2 studies related to heat and stillbirth met inclusion; 2 found an effect.

CONCLUSION:
Climate-change related exposures, specifically air pollution and heat, are associated with an effect on important obstetrics outcomes: preterm birth, low birthweight, and stillbirth. Women's health providers should become familiar with this emerging risk.
Abnormal Screening Echocardiogram in High-Risk Obese Pregnant Women Increases the Risk of Preeclampsia [20G]
Authors: Hopkins Maeve , Levine Lisa D. , Koelper Nathanael , Sammel Mary , Durnwald Celeste 
Published: May 2019

INTRODUCTION:
Obese women with comorbidities such as hypertension (HTN) and diabetes (DM) are at increased risk for preeclampsia (PreE) and perinatal morbidity. This study explores whether screening echocardiogram can identify obese women at higher risk for preeclampsia.

METHODS:
IRB-approved retrospective cohort study of women with BMI ≥40 kg/m2 and one or more risk factor for PreE (diabetes, hypertension, rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as diastolic dysfunction, ejection fraction ≤ 40%, or enlargement of any heart cavity including left ventricle hypertrophy. Multinomial and multivariable logistic regression was used to estimate the relative risk (RR) of gestational hypertension (ghtn), PreE, or severe PreE, and preterm delivery <37 weeks when controlling for potential confounders.

RESULTS:
Of 225 eligible women, 158 underwent screening echocardiograms. 39.9% (63/158) had abnormal echocardiograms. Clinical characteristics were similar between groups. Gestational age at time of echocardiogram was later (26.2 vs 21.5 wks P=0.0001) for women with abnormal echocardiograms, and women with abnormal echocardiogram were more likely to have chronic hypertension (79% vs 60%, P=0.02) and history of preeclampsia (28% vs 11%, P=0.03). After controlling for chronic HTN, history PreE, race, age, BMI, and GA at echo, women with abnormal echocardiogram were at increased risk of ghtn/PreE, 13% vs. 9%, aRR 4.87 (95% CI 1.36-17.53, P=0.02), severe PreE 54% vs. 15%, aRR 8.14 (95% CI 3.26-20.28, P=0.0001), and preterm delivery, 38% vs. 20%, aRR 4.87 (95% CI 1.36-17.53, P=0.02).

CONCLUSION:
Among obese pregnant women with vascular comorbidities, screening echocardiogram helps identify women at highest risk for developing preeclampsia.
Age and Body Mass Index as Independent Risk Factors in Different Indications for Scheduled Primary Cesarean Section [22G]
Authors: Elsamadicy Emad A. , Ha Laura , Goldberg Mack , Le Chi 
Published: May 2019

INTRODUCTION:
There is a paucity of data identifying maternal risk factors that can contribute to women undergoing a scheduled primary cesarean section. We sought to investigate differences in maternal risk factors including age and body mass index (BMI) with the various indications for scheduled primary cesarean section.

METHODS:
Medical records of 502 consecutive patients that underwent a scheduled primary low-transverse cesarean section (PLTCS) at a major academic institution from 2009 to 2017 were reviewed. Patient age, BMI and the specific indication for the scheduled PLTCS were collected and compared using ANOVA statistical analysis.

RESULTS:
Of the 502 consecutive patients reviewed, the indication for PLTCS were majority for breech presentation (33.8%), followed by fetal anomalies (22%), elective (16.8%), fetal macrosomia (10.6%), placenta and vasa previa (7.4%), prior myomectomy (5.8%), cephalopelvic disproportion (2.4%), and for primary HSV or HIV (1.2%). There was a statistically significant difference in the mean age across all cohorts (p<0.0001). The previous myomectomy cohort had oldest mean age at myomectomy at 34.8±5.2 years while the primary HSV cohort had the youngest mean age at 22.5±2.6 years. There was not a statistically significant difference in the mean BMI across cohorts (P=0.236). The fetal macrosomia cohort trended towards the highest BMI of 36.4±10 kg/m2, while the vasa previa cohort trended towards the lowest BMI of 28.3±4.8 kg/m2.

CONCLUSION:
Our study demonstrated significant differences between age and various primary cesarean indications while there was no significant difference in BMI. Further studies are necessary to help identify risk factors associated with different indications for cesarean section.
Amnioreduction in Cases of Polyhydramnios: Indications and Outcomes in Singleton Pregnancies [23G]
Authors: Diaz-Rodriguez Gian E. , Shamshirsaz Alireza A. , Gandhi Manisha , Sanz-Cortes Magdalena , Belfort Michael A. , Dorado Jimmy Espinoza 
Published: May 2019

INTRODUCTION:
There is limited information in regards to complication rates of this procedure in singleton pregnancies, which makes it difficult to counsel patients. Our goal is to evaluate indications, pregnancy outcomes and risk of adverse events following isolated amnioreduction procedures in singleton gestations.

METHODS:
Retrospective cohort of all amnioreduction procedures performed on singleton gestations complicated by polyhydramnios between January 2011 and June 2018 at our referral center. Clinical indications for amnioreduction procedures were categorized as either maternal shortness of breath, maternal sense of abdominal tightness, or preterm uterine contractions. Outcome variables included preterm premature rupture of membranes (PPROM), placental abruption, chorioamnionitis and preterm delivery in isolation or in composite. Data were tested for normality and reported as mean±SD, median [range] and n (%).

RESULTS:
33 patients underwent a median number of 1 [range 1-12] amnioreductions, yielding a total of 66 amnioreduction procedures. Estimated gestational age at delivery in this subgroup was 36 [30-40]. Among the study cohort, there were no instances of PPROM, placental abruption, chorioamnionitis or preterm delivery 12 hrs following the procedure. However, 7/66 (10.6%) of amnioreductions resulted in preterm delivery 12-48 hr post procedure. There were 2 cases of active preterm labor, 2 cases of non-reassuring fetal heart tracing, 1 case of preeclampsia with severe features, and 2 cases with mirror syndrome.

CONCLUSION:
Our data suggests that among singleton gestations, approximately 10% will experience a preterm birth, but none in the immediate procedure interval. This data may be used in counseling of potential candidates of amnioreduction with singleton pregnancies.
Association Between Maternal Glucose Control Intrapartum, Glucose Control Antepartum, and Neonatal Hypoglycemia [35G]
Authors: Zelivianskaia Anna S. , Iqbal Sara Naeem , Mclaughlin Andrew , Kette Bethany , Leibold Aurora 
Published: May 2019

INTRODUCTION:
There are recommendations regarding target antepartum and intrapartum blood glucose values, but associations between degree of glucose control and neonatal hypoglycemia are not well-studied. We researched these factors and the rates of neonatal hypoglycemia in women with gestational and pre-gestational diabetes (DM).

METHODS:
This was a retrospective cohort study of all women diagnosed with gestational diabetes and pre-gestational DM at ≥23 weeks gestational age who delivered at an urban institution from 2016 to 2017. Our primary outcome was neonatal hypoglycemia defined as neonatal blood glucose <40 mg/dL. Antepartum glucose control categories were as follows: good (90% fingersticks within target range, compliant with prenatal care (PNC)), moderate (50-90% fingersticks within target range, compliant with PNC), poor (<50% of fingersticks within target range or missed 3+ prenatal visits). Intrapartum glucose control within target range were categorized as either never controlled or controlled the entire labor course.

RESULTS:
Of 191 neonates, 46 had hypoglycemia, resulting in a rate of 24%. Cases with neonatal hypoglycemia compared to cases without neonatal hypoglycemia were less likely to have good antenatal glucose control (17% vs. 29-34%; P=.048). Good intrapartum glucose control was not associated with neonatal hypoglycemia (P=.403).

CONCLUSION:
In our cohort of women with diabetes, we found that good antenatal glucose control, compared to moderate or poor, was associated with a decreased rate of neonatal hypoglycemia. This finding can be used for counseling and encourage women to better control their blood glucose values. More research is needed regarding the effect of intrapartum glucose control on neonatal hypoglycemia.
Contraceptive Quality Measures: Population-Level Protection Using the Contraceptive Protection Index [1H]
Authors: Saleeby Erin , Peacock Karen , Rabinovitz Julie , Khalfani Nomsa , Walsh Terri 
Published: May 2019

INTRODUCTION:
National Quality Forum (NQF) endorsed contraception metric is now available to assess the proportion of women with reproductive capacity who are using highly effective contraception. The NQF measure does not assess the protection of the population from pregnancy based on the effectiveness of the methods and the distribution of method choice by age. The Contraceptive Protection Index (CPI) does incorporate these variables and can be calculated using the NQF measure data and may be instructive in monitoring population health over time.

METHODS:
We compare two observational cohorts (2013 and 2017) use of contraceptive methods in 54 agencies with some 200 health centers across the state of California. CPI was calculated using efficacy rates from clinical trials. Changes in CPI were evaluated by age group, race, ethnicity, and type of health center (Federally Qualified Health Centers, Health Departments, Planned Parenthoods, university and community clinics).

RESULTS:
Between 2013 and 2017, CPI increased for all groups. Teens (15-17), young adults (18-20) and women over 44 years old demonstrated the largest shift in CPI (increasing 1.4, 1.3, 1.6 respectively). This due to combination of decreases in condom or no method use with concomitant increases in LARC use. Federally Qualified Health Centers and Health Departments demonstrated the largest increases in CPI (1.4 and 1.9 respectively).

CONCLUSION:
Much of the shift in contraceptive use occurred within the group already using highly effective methods. Larger shifts in CPI are observed when women move from no method or condom use to highly effective methods, especially LARC use.
Debunking the Myth: Do MFM Fellows Negatively Impact Resident Obstetrical Skills [15H]
Authors: Dotters-Katz Sarah , Grace Matthew Ryan , Heine R. Phillips , Propst Katie 
Published: May 2019

INTRODUCTION:
Residents often express concern that fellows negatively impact surgical opportunities. We described the impact of MFM fellows on resident surgical opportunities.

METHODS:
After IRB approval, anonymous 27-question e-survey sent to OBGYN residents in US and Puerto Rico in 3/2018. Survey included consent statement, and questions included experience as primary surgeon (PS), for 4th year residents only, comfort performing procedures post-residency (CPPR), and demographics. Residents from programs with MFM fellows (pMFM) were compared to those without (nMFM). Descriptive statistics used as appropriate. Regression performed, controlling for significant variables.

RESULTS:
417 residents completed the survey; 275 (66%) from nMFM and 142 (33%) from pMFM. PMFM residents were more likely to have >7 residents/year, be from an academic residency, and less likely to be planning to practice obstetrics post-residency (all P<0.01). Plan to pursue MFM fellowship did not differ. NMFM residents were more likely to have been PS on a vacuum assisted delivery (VAVD; 77% vs 63%, p<0.01), but equally likely to have been PS at forceps delivery (FAVD; 48% vs 57%, P=0.09). No difference in PS experience was seen for breech deliveries, 3rd or 4th degree repairs, cerclage or cesarean hysterectomy. With regards to CPPR, VAVD was more likely among nMFM trainees, no other differences seen. In regression models, no differences in likelihood of CPPR for any procedures based on the presence of MFM fellows were seen. Among pMFM residents, 94% stated fellows positively impacted their learning.

CONCLUSION:
MFM fellows do not appear to impact residents' competency in obstetric procedures, larger studies are needed to confirm these findings.