Impact of 4-to-3 Lane Conversions on Emergency Response.

4-to-3 lane conversions, often called road diets, have been implemented throughout the U.S. as a means to reduce crashes. However, the reduction in lanes has led to community wide concerns across the country regarding the possible negative effect on emergency responses. This study investigates the impact of 4-to-3-lane roadway conversions on emergency response in Iowa through surveys and a retrospective analysis of EMS data. The 170 survey responses were analyzed descriptively, and a text analysis was done on two open text survey questions. Generalized linear models were constructed to examine the impact of lane conversions on emergency response times. Over half of EMS respondents believed there was no effect or a positive effect on responses, while 40% believed there was a negative effect. The negative effect was often attributed to driver confusion on how to properly yield to EMS vehicles. Despite the differing perceptions, EMS response rates from before to after the implementation of 4-to-3 lane conversions did not meaningfully differ. Overall, there was a lack of evidence of an effect of 4-to-3 lane conversions on EMS response rates in Cedar Rapids, Iowa. However, survey results showed that public guidance on how to properly respond to the presence of EMS vehicles on these roadways may be needed. This study provides evidence for addressing local concerns about road diets and emergency response to add to other known safety benefits. Results of this analysis may be applicable to other lane conversion sites when appropriately combined with local context relevant to the target area.

Rapid outpatient evaluation for emergency department patients with intermediate risk chest pain safely reduces admissions.

Objective: This study aims to assess the safety of an outpatient chest pain pathway (OCPP) for patients presenting to the emergency department (ED) with chest pain and a HEART score of 4 or 5. Methods: This is a retrospective, observational, non-inferiority study assessing the impact of the OCPP on the management and outcomes of ED patients with HEART score of 4 or 5. The study compared patients evaluated in the pre-OCPP (January‒May 2018) and the post-OCPP period (January‒October 2022). Data were collected via non-blinded chart review. The primary outcome was the rate of acute myocardial infarction (AMI) and death in patients utilizing the OCPP compared to patients with HEART score 4 or 5 in 2018. Secondary outcomes included admission rates before and after the implementation of this pathway. Non-inferiority of the post-intervention study epoch for the AMI/death composite outcome was assessed via the two one-sided tests (TOST), procedure. Results: After implementing the OCPP, rates of patients with ED HEART score of 4 or 5 admitted from the ED decreased from 85.1% (605/711) to 74.1% (1239/1671) in 2022. Of the 432 total patients discharged in 2022, 237 (54.6%) patients were referred to emergent cardiology follow-up via the OCPP. The 30-day rate of AMI/death for patients discharged via the OCPP was 0.4% (1/237), as compared to 2.2% (8/368) in 2018. When compared to rates of AMI/death for all patients with HEART score 4 or 5 in 2018, outcomes for OCPP patients were found to be non-inferior. Conclusion: The OCPP resulted in non-inferior rates of AMI/death in patients with HEART scores of 4 or 5 as compared to usual care.

Fluorescent labeling of micro/nanoplastics for biological applications with a focus on "true-to-life" tracking.

The increased environmental presence of micro-/nanoplastics (MNPLs) and the potential health risks associated with their exposure classify them as environmental pollutants with special environmental and health concerns. Consequently, there is an urgent need to investigate the potential risks associated with secondary MNPLs. In this context, using "true-to-life" MNPLs, resulting from the laboratory degradation of plastic goods, may be a sound approach. These non-commercial secondary MNPLs must be labeled to track their presence/journeys inside cells or organisms. Because the cell internalization of MNPLs is commonly analyzed using fluorescence techniques, the use of fluorescent dyes may be a sound method to label them. Five different compounds comprising two chemical dyes (Nile Red and Rhodamine-B), one optical brightener (Opticol), and two industrial dyes (Amarillo Luminoso and iDye PolyPink) were tested to determine their potential for such applications. Using commercial standards of polystyrene nanoplastics (PSNPLs) with an average size of 170 nm, different characteristics of the selected dyes such as the absence of impact on cell viability, specificity for plastic staining, no leaching, and lack of interference with other fluorochromes were analyzed. Based on the overall data obtained in the wide battery of assays performed, iDye PolyPink exhibited the most advantages, with respect to the other compounds, and was selected to effectively label "true-to-life" MNPLs. These advantages were confirmed using a proposed protocol, and labeling titanium-doped PETNPLs (obtained from the degradation of milk PET plastic bottles), as an example of "true-to-life" secondary NPLs. These results confirmed the usefulness of iDye PolyPink for labeling MNPLs and detecting cell internalization.

Hazard assessment of nanoplastics is driven by their surface-functionalization. Effects in human-derived primary endothelial cells.

During plastic waste degradation into micro/nanoplastics (MNPLs) their physicochemical characteristics including surface properties (charge, functionalization, biocorona, etc.) can change, potentially affecting their biological effects. This paper focuses on the surface functionalization of MNPLs to determine if it has a direct impact on the toxicokinetic and toxicodynamic interactions in human umbilical vein endothelial cells (HUVECs), at different exposure times. Pristine polystyrene nanoplastics (PS-NPLs), as well as their carboxylated (PS-C-NPLs) and aminated (PS-A-NPLs) forms, all around 50 nm, were used in a wide battery of toxicological assays. These assays encompassed evaluations on cell viability, cell internalization, induction of intracellular reactive oxygen species (iROS), and genotoxicity. The experiments were conducted at a concentration of 100 µg/mL, chosen to ensure a high internalization rate across all treatments while maintaining a sub-toxic concentration. Our results show that all PS-NPLs are internalized by HUVECs, but the internalization dynamic depends on the particle's functionalization. PS-NPLs and PS-C-NPLs internalization modify the morphology of the cell increasing its inner complexity/granularity. Regarding cell toxicity, only PS-A-NPLs reduced cell viability. Intracellular ROS was induced by the three different PS-NPLs but at different time points. Genotoxic damage was induced by the three PS-NPLs at short exposures (2 h), but not for PS-C-NPLs at 24 h. Overall, this study suggests that the toxicological effects of PSNPLs on HUVEC cells are surface-dependent, highlighting the relevance of using human-derived primary cells as a target.

Harmful effects of true-to-life nanoplastics derived from PET water bottles in human alveolar macrophages.

The increasing presence of secondary micro/nanoplastics (MNPLs) in the environment requires knowing if they represent a real health concern. To such end, an important point is to test representative MNPLs such as the denominated true-to-life MNPLs, resulting from the degradation of plastic goods in lab conditions. In this study, we have used polyethylene terephthalate (PET) NPLs resulting from the degradation of PET water bottles. Since inhalation is an important exposure route to environmental MNPLS, we have used mouse alveolar macrophages (MH-S) as a target cell, and the study focused only on the cells that have internalized them. This type of approach is novel as it may capture the realistic adverse effects of PETNPLs only in the internalized cells, thereby mitigating any biases while assessing the risk of these MNPLs. Furthermore, the study utilized a set of biomarkers including intracellular reactive oxygen species (ROS) levels, variations on the mitochondrial membrane potential values, and the macrophage polarization to M1 (pro-inflammatory response) and M2 (anti-proinflammatory response) as possible cellular effects due to PETNPLs in only the cells that internalized PETNPLs. After exposures lasting for 3 and 24 h to a range of concentrations (0, 25, 50, and 100 µg/mL) the results indicate that no toxicity was induced despite the 100% internalization observed at the highest concentration. Significant intracellular levels of ROS were observed, mainly at exposures lasting for 24 h, in an indirect concentration-effect relationship. Interestingly, a reduction in the mitochondrial membrane potential was observed, but only at exposures lasting for 24 h, but without a clear concentration-effect relationship. Finally, PETNPL exposure shows a significant polarization from M0 to M1 and M2 subtypes. Polarization to M1 (pro-inflammatory stage) was more marked and occurred at both exposure times. Polarization to M2 (anti-inflammatory stage) was only observed after exposures lasting for 24 h. Due to the relevance of the described biomarkers, our results underscore the need for further research, to better understand the health implications associated with MNPL exposure.

Predictors of rural driver self-reported passing behaviors when interacting with farm equipment on the roadway.

Background: Crashes involving farm equipment (FE) are a major safety concern for farmers as well as all other users of the public road system in both rural and urban areas. These crashes often involve passenger vehicle drivers striking the farm equipment from behind or attempting to pass, but little is known about drivers' perceived norms and self-reported passing behaviors. The objective of this study is to examine factors influencing drivers' farm equipment passing frequencies and their perceptions about the passing behaviors of other drivers. Methods: Data were collected via intercept surveys with adult drivers at local gas stations in two small rural towns in Iowa. The survey asked drivers about their demographic information, frequency of passing farm equipment, and perceptions of other drivers' passing behavior in their community and state when approaching farm equipment (proximal and distal descriptive norms). A multinomial logistic regression model was used to estimate the relationship between descriptive norms and self-reported passing behavior. Results: Survey data from 201 adult drivers showed that only 10% of respondents considered farm equipment crashes to be a top road safety concern. Respondents who perceived others passing farm equipment frequently in their community were more likely to report that they also frequently pass farm equipment. The results also showed interactions between gender and experience operating farm equipment in terms of self-reported passing behavior. Conclusions/Implications: Results from this study suggest local and state-level norms and perceptions of those norms may be important targets for intervention to improve individual driving behaviors around farm equipment.

Rates and predictors of teen driver crash culpability.

BACKGROUND: Motor-vehicle crash risk is highest among teen drivers. Despite a wealth of research on the topic, there are still many contributors to these crashes that are not well understood. The current study sought to examine the contribution of graduated driver licensing (GDL) restrictions, sex, age, roadway circumstances, and citation history to teen drivers' crash culpability. METHOD: Crash system data from the Iowa Department of Transportation were linked with traffic-related charges from the Iowa Court Information System. Crashes involving teens aged 14 to 17 years between 2016 and 2019 were analyzed (N = 19,847). Culpability was determined using the driver contributing circumstances from the crash report. Moving and non-moving traffic citations issued prior to the date of each crash were considered. A multivariable logistic regression model was constructed to examine predictors of crash culpability. RESULTS: Teen drivers were determined to be culpable for more than two thirds of crashes (N = 13,604, 68.54%). Culpability was more prevalent among males, younger teens, in rural areas, in the presence of reported roadway contributing circumstances, during hours of restricted nighttime driving, and among teens with citation histories that included both moving and non-moving citations. Similarly, multivariable model results indicated that the likelihood of culpability was higher among males, in rural areas, and at each stage of GDL compared to teen drivers with unrestricted licenses. While drivers with a history of both moving and non-moving violations were more likely to be culpable, those with a history of only moving or only non-moving violations were less likely to be culpable compared to those with no violation history. CONCLUSION: Sex, crash location, and GDL stage were associated with teen driver crash culpability. A singular prior moving or non-moving violation may play a protective role in teen crash culpability.

Titanium-doped PET nanoplastics of environmental origin as a true-to-life model of nanoplastic.

The increased presence of secondary micro/nanoplastics (MNPLs) in the environment requires urgent studies on their potentially hazardous effects on exposed organisms, including humans. In this context, it is essential to obtain representative MNPL samples for such purposes. In our study, we have obtained true-to-life NPLs resulting from the degradation, via sanding, of opaque PET bottles. Since these bottles contain titanium (TiO2NPs), the resulting MNPLs also contain embedded metal. The obtained PET(Ti)NPLs were extensively characterized from a physicochemical point of view, confirming their nanosized range and their hybrid composition. This is the first time these types of NPLs are obtained and characterized. The preliminary hazard studies show their easy internalization in different cell lines, without apparent general toxicity. The demonstration by confocal microscopy that the obtained NPLs contain Ti samples offers this material multiple advantages. Thus, they can be used in in vivo approaches to determine the fate of NPLs after exposure, escaping from the existing difficulties to follow up MNPLs in biological samples.

Farm Vehicle Following Distance Estimation Using Deep Learning and Monocular Camera Images.

This paper presents a comprehensive solution for distance estimation of the following vehicle solely based on visual data from a low-resolution monocular camera. To this end, a pair of vehicles were instrumented with real-time kinematic (RTK) GPS, and the lead vehicle was equipped with custom devices that recorded video of the following vehicle. Forty trials were recorded with a sedan as the following vehicle, and then the procedure was repeated with a pickup truck in the following position. Vehicle detection was then conducted by employing a deep-learning-based framework on the video footage. Finally, the outputs of the detection were used for following distance estimation. In this study, three main methods for distance estimation were considered and compared: linear regression model, pinhole model, and artificial neural network (ANN). RTK GPS was used as the ground truth for distance estimation. The output of this study can contribute to the methodological base for further understanding of driver following behavior with a long-term goal of reducing rear-end collisions.

Understanding undergraduate students' eHealth usage and views of the patient-provider relationship.

eHealth has grown exponentially alongside technology and has become widely accessed by some populations, but little is documented about how undergraduate students use eHealth or perceive their eHealth literacy. As access to online information and non-traditional options for interacting with providers has increased, patient views of the provider-patient relationship may also be changing. This study evaluates how frequently undergraduates use eHealth, how they perceive their ability to use eHealth appropriately, and how they view their patient-provider relationships. A mixed methods approach was used to address the research questions, with quantitative data from a survey and qualitative data from follow-up interviews of twelve of the survey respondents. The survey was distributed to over 650 undergraduate students in introductory biology laboratory courses for students of all fields of interest at one university. Based on 527 survey responses and 12 interviews, students reported commonly using eHealth but being skeptical of telehealth appointments. Although students generally felt capable of finding and interpreting eHealth sources, they were not strongly confident in their ability to do so. Use of eHealth was not seen as altering the patient-provider relationship, but students expressed a desire for their physician to act more as a counselor or advisor than a guardian. Students from minority populations were more likely to use eHealth in comparison to their peers. In addition, student comfort with their provider differed by race and ethnicity, as well as whether they shared the same gender identity as their provider. This research highlights how undergraduate students, who are often making medical decisions for themselves for the first time as adults, access health information and view the patient-provider relationship differently than the traditional guardian or paternalistic model. In addition, having diverse, culturally competent medical providers are critical for students to develop the relationship with their provider that they desire.

Citizen Science in Postsecondary Education: Current Practices and Knowledge Gaps.

Citizen science involves the public in science to investigate research questions. Although citizen science facilitates learning in informal educational settings, little is known about its use or effects in postsecondary (college or university) settings. Using a literature review and a survey, we describe how and why citizen science is being used in postsecondary courses, as well as the impacts on student learning. We found that citizen science is used predominantly in biologically related fields, at diverse types of institutions, to improve student engagement and expose students to authentic research. Considerable anecdotal evidence supporting improved student learning from these experiences exists, but little empirical evidence exists to warrant any conclusion. Therefore, there is a need to rigorously assess the relationship between citizen science participation and postsecondary student learning. We highlight considerations for instructors planning to incorporate citizen science and for citizen science projects wanting to facilitate postsecondary use.

A randomized trial to test the impact of parent communication on improving in-vehicle feedback systems.

This randomized controlled trial evaluated the impact of integrating Steering Teens Safe, a parent communication intervention, with feedback from an in-vehicle video recording system. In-vehicle video systems that trigger a recording when the vehicle exceeds a g-force threshold have been used to provide feedback to young drivers. Few of these programs have involved parental engagement. Parent-teen dyads were randomized to three groups and 150 dyads completed the study. All groups received an in-vehicle video system that recorded driving events. The control group received no feedback or intervention. In the first intervention group, teens received real-time feedback, and parent-teen dyads received summary feedback, based on information recorded by the in-vehicle system. The second intervention group received the same feedback, plus parents were taught strategies to improve communication with their teen about safe driving. The primary outcome variable was unsafe driving event rates per 1000 miles driven and the primary independent variable was group assignment. Generalized linear models were used to calculate effect estimates. Compared with the control group, the Event Recorder Feedback group had a rate ratio of 0.35 (95% CI = 0.24 - 0.50) and the combined intervention group (Event Recorder Feedback and parent communication) had a rate ratio of 0.21 (95% CI = 0.15 - 0.30). Furthermore, the combined intervention group had a significantly lower event rate than the Event Recorder Feedback only group (rate ratio = 0.60, 95% CI = 0.41 - 0.87). While in-vehicle feedback systems can help reduce unsafe driving events in early independent driving, teaching parents strategies for effective communication with their young driver may further improve impact.

Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity.

To determine intraabdominal pressure (IAP) in women during CrossFit and to determine whether parity, age, or CrossFit experience affects IAP during CrossFit exercises, we evaluated 10 women: 5 experienced and active CrossFitters and 5 who were not regularly engaged in CrossFit. A Laborie urodynamics abdominal pressure probe with the Goby wireless system measured IAP during 10 repetitions of 13 different CrossFit exercises. Women had a mean age of 36 years. A significant difference was found between mean peak IAP of the 5 parous vs the 5 nulliparous women (P = 0.009). Experience with CrossFit did not affect mean peak IAP achieved with exercise. In some exercises, there was a significant change in IAP as participants progressed through repetitions (P = 0.003 for back squats and 0.04 for sit-ups). Participants achieved IAP values that were markedly higher than those previously published.

Time trends for bacterial species and resistance patterns in semen in patients undergoing evaluation for male infertility.

Semen from asymptomatic men who are being evaluated as male partners in interfile couples have been reported to contain a variety of bacteria. Longitudinal studies of the variation of these bacteria over time and their resistance patterns have not been commonly reported. At our institution, residues from semen samples are routinely evaluated for bacteria, including antibiotic sensitivity profiles. We set out to profile the changes in semen bacteria and antibiotic resistance at our institution over time. A total of 72 semen isolates were examined for type of bacteria and sensitivity to a panel of antibiotics. The results were divided into two separate 5-year intervals (the first beginning in 2006, the second in 2011) and compared. The majority of bacteria were skin flora, with Streptococcus and Staphylococcus being the most prevalent. The resistance data for these two pathogens showed minimal statistically significant difference between the two time periods, although the Staphylococcus species did show a trend toward increasing resistance, suggesting that antibiotics currently used in sperm cell preparations may need to be varied.

Characterizing variable biogeochemical changes during the treatment of produced oilfield waste.

At the forefront of the discussions about climate change and energy independence has been the process of hydraulic fracturing, which utilizes large amounts of water, proppants, and chemical additives to stimulate sequestered hydrocarbons from impermeable subsurface strata. This process also produces large amounts of heterogeneous flowback and formation waters, the subsurface disposal of which has most recently been linked to the induction of anthropogenic earthquakes. As such, the management of these waste streams has provided a newfound impetus to explore recycling alternatives to reduce the reliance on subsurface disposal and fresh water resources. However, the biogeochemical characteristics of produced oilfield waste render its recycling and reutilization for production well stimulation a substantial challenge. Here we present a comprehensive analysis of produced waste from the Eagle Ford shale region before, during, and after treatment through adjustable separation, flocculation, and disinfection technologies. The collection of bulk measurements revealed significant reductions in suspended and dissolved constituents that could otherwise preclude untreated produced water from being utilized for production well stimulation. Additionally, a significant step-wise reduction in pertinent scaling and well-fouling elements was observed, in conjunction with notable fluctuations in the microbiomes of highly variable produced waters. Collectively, these data provide insight into the efficacies of available water treatment modalities within the shale energy sector, which is currently challenged with improving the environmental stewardship of produced water management.

Utilization of cryopreserved sperm cells based on the indication for storage.

Purpose: Cryopreservation of sperm from human semen has been available since the 1950s. The actual utilization of available cryopreservation technology has been infrequently reported. We set out to examine the utilization and outcomes of cryopreserved sperm cells based on the indication for storage. Materials and Methods: A dataset was developed from retrospective review. The purposes for cryopreservation, eventual utilization, and outcomes of use for insemination were recorded. The types of utilization were accumulated as proportions for different purposes. The timing for use of samples for insemination procedures was evaluated using survival statistics. The frequency of patients arranging to destroy samples was also reported. Results: From September 1988 through March 2015, 1442 samples were cryopreserved. Samples were cryopreserved for four primary purposes: infertility treatments focused on intrauterine insemination (IUI) or in vitro fertilization/intracellular injection (IVF/ICSI), for fertility preservation related to cancer treatment, or prior to military deployment. Total utilization rates were 19.3%. Samples cryopreserved for IUI were more likely to be used (64.3%), while samples cryopreserved as backup for IVF/ICSI were more likely to be destroyed (29.8%). Pregnancy rates varied based on the indication and ART used. Pregnancies per cycle were 35% for IVF/ICSI and were 10% for IUI. Conclusions: Cryopreservation of sperm is a valuable and underutilized resource, particularly amongst male cancer patients. This technology can facilitate infertility treatments based on a variety of indications, including deployment-a patient cohort unique to our dataset.

Screen for Slit/Robo signaling in trunk neural cells reveals new players.

Slits ligands and their Robo receptors are involved in quite disparate cell signaling pathways that include axon guidance, cell proliferation, cell motility and angiogenesis. Neural crest cells emerge by delamination from neural cells in the dorsal neural tube, and give rise to various components of the peripheral nervous system in vertebrates. It is well established that these cells change from a non-migratory to a highly migratory state allowing them to reach distant regions before they differentiate. However, but the mechanism controlling this delamination and subsequent migration are still not fully understood. The repulsive Slit ligand family members, have been classified also as true tumor suppressor molecules. The present study explored in further detail what possible Slit/Robo signals are at play in the trunk neural cells and neural crest cells by carrying out a microarray after Slit2 gain of function in trunk neural tubes. We found that in addition to molecules known to be downstream of Slit/Robo signaling, there were a large set of molecules known to be important in maintaining cells in non-motile, epithelia phenotype. Furthermore, we found new molecules previously not associated with Slit/Robo signaling: cell proliferation markers, Ankyrins and RAB intracellular transporters. Our findings suggest that neural crest cells use and array of different Slit/Robo pathways during their transformation from non-motile to highly motile cells.

Exploring the links between groundwater quality and bacterial communities near oil and gas extraction activities.

Bacterial communities in groundwater are very important as they maintain a balanced biogeochemical environment. When subjected to stressful environments, for example, due to anthropogenic contamination, bacterial communities and their dynamics change. Studying the responses of the groundwater microbiome in the face of environmental changes can add to our growing knowledge of microbial ecology, which can be utilized for the development of novel bioremediation strategies. High-throughput and simpler techniques that allow the real-time study of different microbiomes and their dynamics are necessary, especially when examining larger data sets. Matrix-assisted laser desorption-ionization (MALDI) time-of-flight mass spectrometry (TOF-MS) is a workhorse for the high-throughput identification of bacteria. In this work, groundwater samples were collected from a rural area in southern Texas, where agricultural activities and unconventional oil and gas development are the most prevalent anthropogenic activities. Bacterial communities were assessed using MALDI-TOF MS, with bacterial diversity and abundance being analyzed with the contexts of numerous organic and inorganic groundwater constituents. Mainly denitrifying and heterotrophic bacteria from the Phylum Proteobacteria were isolated. These microorganisms are able to either transform nitrate into gaseous forms of nitrogen or degrade organic compounds such as hydrocarbons. Overall, the bacterial communities varied significantly with respect to the compositional differences that were observed from the collected groundwater samples. Collectively, these data provide a baseline measurement of bacterial diversity in groundwater located near anthropogenic surface and subsurface activities.

Incidence of Bladder Injury During Retropubic Midurethral Sling Placement After Prior Burch Colpopexy.

OBJECTIVES: To elucidate if prior Burch changes the risk of bladder injury or rates of voiding dysfunction and continence in the immediate postoperative period when undergoing retropubic midurethral sling (MUS) placement. METHODS: In this retrospective case control, charts were selected by Current Procedural Terminology codes for MUS placement. Women undergoing retropubic MUS placement with history of Burch urethropexy were considered. For every case, 2 age-matched and parity-matched controls without prior Burch were selected. RESULTS: In total, 538 charts were reviewed from 2010 to 2014. Twenty cases were found. There was a difference (P = 0.023) in trocar penetration of the bladder. Twenty-five percent (5/20) of women with prior Burch had a 9-fold (odds ratio [OR], 9.0; 95% confidence interval [CI], 1.0-82) higher chance of bladder penetration compared with women without prior retropubic surgery as calculated with Mantel-Haenszel paired test. Women with prior Burch had more success passing their voiding trials (OR, 7.5; 95% CI, 1.1-49.2). At 6 weeks, there was no difference in voiding dysfunction. Cure of stress incontinence at 6 weeks occurred more in controls than cases (P = 0.044) with match pairs manifesting an OR of 0.20 and 95% CI of 0.04-1.1. DISCUSSION: This study shows a significant increase risk of trocar penetration of the bladder during retropubic MUS placement in women with a history of Burch urethropexy. Despite this, MUS placement was successful in all women. Women with prior surgery were much more likely to pass their voiding trials. There was no difference in voiding dysfunction at 6 weeks between the 2 groups. CONCLUSIONS: This indicates that though bladder penetration with a trocar is more common in the setting of previous retropubic surgery, it does not impact a woman's short-term intraoperative or postoperative course.

Apoptotic and stress signaling markers are augmented in preeclamptic placenta and umbilical cord.

OBJECTIVE: Preeclampsia (preE) has a significant link to alterations of placental function leading to stress and apoptotic signaling, which pass the placental barrier and leave persistent defect in the circulation of the offspring. We assessed apoptotic signaling in placentas and umbilical cords from patients with and without preE. METHODS: We collected placental and cord tissues from 27 normal pregnant (NP) women and 20 preE consenting patients after delivery in an IRB approved prospective study. p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation, pro-apoptotic Bcl-2-associated X (Bax), anti-apoptotic Bcl-2, caspase-9, and pro-inflammatory cyclooxygenase-2 (Cox-2) were evaluated by western blot and immunohistochemistry. Comparisons were performed using Student's t-test. RESULTS: p38 phosphorylation (Placenta: 1.5 fold, Cord: 1.7 fold), ratio of Bax/Bcl-2 (Placenta: 1.7 fold, Cord: 2.2 fold), caspase-9 (Placenta: 1.5 fold, Cord: 1.8 fold) and Cox-2 (Placenta: 2.5 fold, Cord: 2.3 fold) were up-regulated (p < 0.05) in preE compared to NP patients. Average hospital stays for preE babies were longer than NP babies. No complications were reported for NP babies; however, all of preE babies had multiple complications. CONCLUSIONS: Apoptotic and stress signaling are augmented in preE placenta and cord tissue that alter the intrauterine environment and activates the detrimental signaling that is transported to fetus.