The impact of fetal sex on pregnancy and neonatal outcomes in twin gestation.

PURPOSE: Fetal sex is independently associated with pregnancy complications and impacts neonatal outcomes. Evidence suggests that females have an advantage over males, with a better outcome in the perinatal period. In addition, fetal outcome in twin gestations is also related to the intrauterine position of the fetus, such as the first, the presenting or second twin. It has been demonstrated that the neonatal outcome of the second fetus is worse than that of the first fetus. This study aimed to examine the influence of fetal sex on obstetric outcomes in twin pregnancies based on the location of the fetus in the uterus. METHODS: Retrospective study. Maternal and obstetric outcomes were compared among three groups: male‒male, female‒female, and male‒female groups. Comparisons of neonatal outcomes were performed among the four groups: male A-male B, male A-female B, female A-male B, and female A-female B. RESULTS: A total of 1073 twin gestations were included, comprising 288 male‒male, 288 female‒female, and 497 male‒female gestations. A greater percentage of neonates admitted to the NICU was observed for male fetuses than for female fetuses. Adverse composite neonatal outcome was more common in the male‒male group than in the female‒male group and in the female‒female group. CONCLUSION: Twin gestation with a first twin male tends to have worse neonatal outcomes than does twin gestation with a first twin female. The presence of a male co-twin increases the risk of adverse outcomes.

Quantum Monte Carlo Method in the Steady State.

We present a numerically exact steady-state inchworm Monte Carlo method for nonequilibrium quantum impurity models. Rather than propagating an initial state to long times, the method is directly formulated in the steady state. This eliminates any need to traverse the transient dynamics and grants access to a much larger range of parameter regimes at vastly reduced computational costs. We benchmark the method on equilibrium Green's functions of quantum dots in the noninteracting limit and in the unitary limit of the Kondo regime. We then consider correlated materials described with dynamical mean field theory and driven away from equilibrium by a bias voltage. We show that the response of a correlated material to a bias voltage differs qualitatively from the splitting of the Kondo resonance observed in bias-driven quantum dots.

The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel.

AIM: The aim was to evaluate the influence of a half day, hands-on, workshop on the detection and repair of obstetric anal sphincter injuries (OASIs). METHOD: Starting in February 2011, hands-on workshops for the diagnosis and repair of OASIs were delivered by trained urogynaecologists in departments of tertiary medical centres in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association annual conferences. Participants included medical staff, midwives and surgical residents from each medical centre. We collected data regarding the rate of OASIs, 1 year before and 1 year following the workshop, in 11 medical centres. The study population was composed of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (< 24 weeks), birth weight < 500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis. RESULTS: In the reviewed centres, 70 663 (49.3%) women delivered prior to the workshop (pre-workshop group) and 72 616 (50.7%) women delivered following the workshop (post-workshop group). Third- or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (P = 0.002). The increase in diagnosis was significant also in women with third-degree tears alone, 226 women (0.32%) before the workshop and 298 (0.41%) following the workshop, an increase of 28.3% (P = 0.005). CONCLUSION: The detection rate of OASIs has significantly increased following the hands-on workshop. The implementation of such programmes is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.

Utility of the Spanish version of the Everyday Cognition scale in the diagnosis of mild cognitive impairment and mild dementia in an older cohort from the Argentina-ADNI.

INTRODUCTION: The performance of activities of daily living in elderly patients with memory disorders is directly related to living independently and to autonomy. Documenting and assessing functional capacity through detailed scales is important for both diagnostic and treatment recommendations. The Everyday Cognition (ECog) scale is a relatively new informant-rated measure of cognitive and functional abilities. In the present study, the discriminant validity of the ECog scale was evaluated in cognitively intact controls (CN) and in patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) from the Argentina-ADNI cohort to establish diagnostic accuracy. In addition, we compared the sensitivity and specificity of ECog against Functional Assessment Questionnaire (FAQ) scale to discriminate among the three groups. METHODS: We evaluated 15 CN, 28 MCI, and 13 mild AD subjects. External, convergent and divergent validity and internal consistency were examined. RESULTS: The average total score on the ECog was significantly different across the three diagnostic syndromes (p < .05). The ECog was more sensitive than FAQ in discriminating between CN and MCI patients and between MCI and AD subjects. The ECog showed a strong correlation with FAQ, and moderate correlations with neuropsychological tests. Cronbach's alpha was .98. CONCLUSIONS: The ECog scale is an efficient instrument for the differentiation of individuals with mild dementia or MCI from normal older adults, with good accuracy and good correlation with other tests measuring daily and cognitive functions. Comparing against FAQ, ECog was more useful in assessing changes in functionality in MCI patients.

Effect of the Anti-C1s Humanized Antibody TNT009 and Its Parental Mouse Variant TNT003 on HLA Antibody-Induced Complement Activation-A Preclinical In Vitro Study.

The classic pathway (CP) of complement is believed to significantly contribute to alloantibody-mediated transplant injury, and targeted complement inhibition is currently considered to be a promising approach for preventing rejection. Here, we investigated the mode of action and efficacy of the humanized anti-C1s monoclonal antibody TNT009 and its parental mouse variant, TNT003, in preclinical in vitro models of HLA antibody-triggered CP activation. In flow cytometric assays, we measured the attachment of C1 subcomponents and C4/C3 split products (C4b/d, C3b/d) to HLA antigen-coated flow beads or HLA-mismatched aortic endothelial cells and splenic lymphocytes. Anti-C1s antibodies profoundly inhibited C3 activation at concentrations >20 µg/mL, in both solid phase and cellular assays. While C4 activation was also prevented, this was not the case for C1 subcomponent attachment. Analysis of serum samples obtained from 68 sensitized transplant candidates revealed that the potency of inhibition was related to the extent of baseline CP activation. This study demonstrates that anti-C1s antibodies TNT009 and TNT003 are highly effective in blocking HLA antibody-triggered complement activation downstream of C1. Our results provide the foundation for clinical studies designed to investigate the potential of TNT009 in the treatment or prevention of complement-mediated tissue injury in sensitized transplant recipients.

Photon-Induced Quantum Oscillations of the Terahertz Conductivity in Graphene.

In this work, we present a theory that is able to explain the nonmonotonic decreasing behavior (observed in experimental data1-12) of the graphene terahertz conductivity with the increase of the field frequency. In this connection, the displacement of the structure of topological states inside the energy band gap, which appears in graphene due to the strong photon-electron coupling, and the narrowing of this gap, as result of electron transitions from bound photon-dressed electron states to extended states outside the energy gap driven by the field frequency, lead to a periodic change of singularities near the edge of the band gap, resulting in subtle quantum oscillations of the dynamical terahertz conductivity. This quantum contribution complements the Drude response, which fits the spectral range. On the other hand, the scattering processes by impurities favor interband transitions, suppressing this way intraband terahertz absorptions, which are related to optical transitions from inside to outside the gap.

Adverse circulatory effects of passive smoking during infancy: surprisingly strong, manifest early, easily avoided.

AIM: To compare blood pressure reactions (BPR) of infants to mild stress for evidence of adverse cardiovascular effects of passive exposure to tobacco smoke during pregnancy and early infancy. METHODS: An observational field study conducted in Crete. We compared 4- to 6-month olds of lifelong nonsmokers minimally (controls, n = 9) or frequently exposed to tobacco smoke (passive smokers; n = 10) with those born to habitual smokers (n = 6). Smoke exposure was verified biochemically (urine cotinine each trimester and at study). We recorded beat-to-beat blood pressure (BP) during brief repositioning manoeuvres performed during a daytime nap and analysed BPR (% change in BP during head-up tilt) for associations with maternal and infant cotinine. RESULTS: We observed a 20-fold difference between BPR of infants of controls versus passive smokers - exceptional given number of infants (α error/confidence level <10% i.e. power >90%). The BPR declined linearly as the infant's (but not mother's) cotinine level rose (p = 0.04), indicating abnormal BPR was caused mainly by postnatal smoke exposure. Infants of active smokers differed from those of passive smokers. CONCLUSION: Cardiovascular effects of passive smoking by a newborn infant manifest early on and are exceptionally strong. They can be largely avoided by keeping the home smoke rigorously free.

Dieldrin accumulation, distribution in plant parts and phytoextraction potential for several plant species and Cucurbita pepo varieties.

Dieldrin, an organochlorine pesticide (OCP) widely used for crop protection in the second half of the 20th century till the 70's, is worldwide still present in arable soils. It can be transferred to crops, notably cucurbits, depending on plant species and cultivars. Finding strategies to decrease OCP bioavailability in soil is therefore a main concern. Phytomanagement strategies could provide (i) ready-to-use short term solution for maintaining the production of edible plant parts with dieldrin concentrations below the Maximum Residue Limits (MRL) and (ii) long-term solution for dieldrin phytoextraction reducing progressively its bioavailability in the soil. This field study aimed at determining dieldrin accumulation capacities and allocation pattern in 17 non-Cucurbitaceae species and 10 Cucurbita pepo varieties, and assessing the dieldrin phytoextraction potential of these plant species when grown to maturity in a historically dieldrin-contaminated soil. Out of the non-Cucurbitaceae species, vetiver was the only one able to accumulate significant amounts of dieldrin, which mainly remained in its roots. All C. pepo varieties were able to uptake and translocate high dieldrin amounts into the shoots, leading to the highest phytoextraction potential. Despite the intraspecific variability in dieldrin concentration in zucchini plant parts, mainly in the reproductive organs, the phytoextraction capacity for shoots and fruits was high for all tested varieties (147 to 275 µg dieldrin plant-1, corresponding to 5.6 % of the n-heptane extractable soil dieldrin), even for the one with low fruit dieldrin concentration. Both food safety and phytoextraction could be achieved by selecting productive zucchini varieties displaying low dieldrin concentration in fruits and high one in shoots.

Morphological Diversity of Turtle Hyoid Apparatus is Linked to Feeding Behavior.

The hyoid apparatus of tetrapods is highly diverse in its morphology. It plays an important role in feeding, breathing, sound production, and various other behaviors. Among turtles, the diversity of the hyoid apparatus has been recurrently linked to their habitat. The ossification of the hyoid corpus is often the main trait used in correlations with "niche" occupancy, an ossified corpus being associated with aquatic environments and a cartilaginous corpus with terrestrial life. Most studies conducted so far have focused on species belonging to Testudinoidea, the clade that occupies the biggest diversity of habitats (i.e., terrestrial, semi-terrestrial, and aquatic animals), while other turtle lineages have been largely understudied. We assessed the adult anatomy of the hyoid apparatus of 92 turtle species from all "families", together with ossification sequences from embryological series of 11 species, some described for the first time here. Using nearly 40 different discrete anatomical characters, we discuss the evolutionary patterns and the biological significance of morphological transformations in the turtle hyoid elements. Morphological changes are strongly associated to feeding modes, with several instances of convergent evolution within and outside the Testudines clade, and are not as strongly connected to habitat as previously thought. Some of the hyoid character states we describe are diagnostic of specific turtle clades, thus providing phylogenetically relevant information.

El aparato hyoideo de los tetrápodos es muy diverso en su morfología. El mismo desempeña un papel importante en la alimentación, la respiración, la producción de sonidos y otras funciones. En las tortugas, la diversidad del aparato hyoideo se ha relacionado con el hábitat. La osificación del cuerpo hyoideo es a menudo el rasgo principal utilizado en correlaciones con la ocupación de "nichos"; un cuerpo osificado se asocia con ambientes acuáticos y un cuerpo cartilaginoso con la vida terrestre. La mayoría de los estudios realizados se han centrado en especies pertenecientes a Testudinoidea, el clado que ocupa la mayor diversidad de hábitats (terrestre, semiterrestre y acuático), mientras que otros linajes de tortugas han sido poco estudiados. Evaluamos la anatomía adulta del aparato hyoideo de 92 especies de tortugas de todas las "familias", junto con secuencias de osificación de series embriológicas de once especies, algunas descritas por primera vez aquí. Utilizando casi 40 caracteres anatómicos discretos diferentes, discutimos los patrones evolutivos y el significado biológico de lastransformaciones morfológicas en los elementos hyoideos de las tortugas. Los cambios morfológicos están asociados con los modos de alimentación, con varios casos de convergencia dentro y fuera del clado Testudines; la asociación con el hábitat no es tan robusta como se ha hipotetizado. Algunos de los estados de caracteres que describimos son diagnósticos de clados de tortugas específicos, proporcionando así información filogenéticamente relevante.

Chain conformation in polymer nanocomposites with uniformly dispersed nanoparticles.

The effect of nanoparticles (NP) on chain dimensions in polymer melts has been the source of considerable theoretical and experimental controversy. We exploit our ability to ensure a spatially uniform dispersion of 13 nm silica NPs miscible in polystyrene melts, together with neutron scattering, x-ray scattering, and transmission electron microscopy, to show that there is no measurable change in the polymer size in miscible mixtures, regardless of the relative sizes of the chains and the nanoparticles, and for NP loadings as high as 32.7 vol%. Our results provide a firm basis from which to understand the properties of polymer nanocomposites.

Reconstruction of surface potential from Kelvin probe force microscopy images.

We present an algorithm for reconstructing a sample surface potential from its Kelvin probe force microscopy (KPFM) image. The measured KPFM image is a weighted average of the surface potential underneath the tip apex due to the long-range electrostatic forces. We model the KPFM measurement by a linear shift-invariant system where the impulse response is the point spread function (PSF). By calculating the PSF of the KPFM probe (tip+cantilever) and using the measured noise statistics, we deconvolve the measured KPFM image to obtain the surface potential of the sample.The reconstruction algorithm is applied to measurements of CdS-PbS nanorods measured in amplitude modulation KPFM (AM-KPFM) and to graphene layers measured in frequency modulation KPFM (FM-KPFM). We show that in the AM-KPFM measurements the averaging effect is substantial, whereas in the FM-KPFM measurements the averaging effect is negligible.

Controlled-release oxycodone and naloxone in the treatment of chronic low back pain: a placebo-controlled, randomized study.

BACKGROUND: For Canadian regulatory purposes, an analgesic study was required to complement previously completed, pivotal studies on bowel effects and analgesia associated with controlled-release (CR) oxycodone/CR naloxone. OBJECTIVES: To compare the analgesic efficacy and safety of CR oxycodone/CR naloxone versus placebo in patients with chronic low back pain. METHODS: Patients requiring opioid therapy underwent a two- to seven-day opioid washout before being randomly assigned to receive either 10 mg/5 mg CR oxycodone/CR naloxone or placebo every 12 h, titrated weekly according to efficacy and tolerability to 20 mg/10 mg, 30 mg/15 mg or 40 mg/20 mg every 12 h. After four weeks, patients crossed over to the alternative treatment for an additional four weeks. Acetaminophen/codeine (300 mg/30 mg every 4 h to 6 h as needed) was provided as rescue medication. RESULTS: Of the 83 randomized patients, 54 (65%) comprised the per-protocol population. According to per-protocol analysis, CR oxycodone/CR naloxone resulted in significantly lower mean (± SD)pain scores measured on a visual analogue scale (48.6 ± 23.1 mm versus 55.9 ± 25.4 mm; P=0.0296) and five-point ordinal pain intensity scores (2.1 ± 0.8 versus 2.4 ± 0.9; P=0.0415) compared with placebo. After the double-blinded phase, patients and investigators both preferred CR oxycodone/CR naloxone over placebo. These outcomes continued in the 79% of patients who chose to continue receiving CR oxycodone/CR naloxone in a six-month, open-label evaluation. CONCLUSIONS: In patients complying with treatment as per protocol, CR oxycodone/CR naloxone was effective for the management of chronic low back pain of moderate or severe intensity.

Sympathomimetic amines effectively control pain for interstitial cystitis that had not responded to other therapies.

PURPOSE: To further investigate the efficacy of treatment of interstitial cystitis that had been refractory to standard treatment with sympathomimetic amines. METHODS: Dextroamphetamine sulfate sustained release capsules up to 30 mg per day were prescribed in women with refractory painful bladder syndrome/interstitial cystitis in six new cases. The patients were carefully evaluated for relief of symptoms. RESULTS: All six women found marked relief in their painful bladder syndrome in a rather short length of time. The benefit persisted as long as the therapy was maintained. Temporary cessation resulted in prompt return of symptoms, but resumption of sympathomimetic amines again allowed good relief of bladder pain and related symptoms. CONCLUSIONS: Because of very few side-effects and no drug dependence in the dosage used, sympathomimetic amines should be considered for first-line therapy.

muFlowReacT: A Library to Solve Multiphase Multicomponent Reactive Transport on Unstructured Meshes.

In this paper we present a new reactive transport code for the efficient simulation of groundwater quality problems. The new code couples the two previously existing tools OpenFoam and PhreeqcRM. The major objective of the development was to transfer and expand the capabilities of the MODFLOW/MT3DMS-family of codes, especially their outstanding ability to suppress numerical dispersion, to a versatile and computationally efficient code for unstructured grids. Owing to the numerous, previously existing transport solvers contained in OpenFoam, the newly developed code achieves this objective and provides a solid basis for future expansions of the code capabilities. The flexibility of the OpenFoam framework is illustrated by the addition of diffusional processes for gaseous compounds in the unsaturated zone and the advection of gases (multiphase transport). The code capabilities and accuracy are illustrated through several examples: (1) a simple 2D case for conservative solute transport under saturated conditions, (2) a gas diffusion case with reactions in the unsaturated zone, (3) a hydrogeologically complex 3D reactive transport problem, and finally (4) the injection of CO2 into a deep aquifer with acidification being buffered by carbonate minerals.

Inter and intraspecific variability of dieldrin accumulation in Cucurbita fruits: New perspectives for food safety and phytomanagement of contaminated soils.

Due to past agricultural practices, it is common to identify arable soils contaminated with persistent and potentially toxic organochlorine pesticides (OCPs). Occurrence of OCPs, including dieldrin, in vegetables can lead to chronic exposure of the consumers. Some market vegetables, particularly the Cucurbitaceae, are known to accumulate high OCP concentrations. Dieldrin concentration in Cucurbita fruits can exceed the Maximal Residue Limit (MRL) resulting in cultivation and sale restrictions for market gardeners. To assess the intra- and interspecific variability of Cucurbitaceae species for low dieldrin concentration in fruits could be a solution. Here, 24 varieties from seven Cucurbitaceae species were cultivated outdoors in large pots, until fruiting, in soils historically contaminated with dieldrin. More than 330 fruits were harvested and analyzed for determining the inter and intraspecific variability of dieldrin accumulation. Significant interspecific differences occurred with mean fruit concentration ranging between 4.2 ± 7.0 and 85.0 ± 19.4 µg dieldrin kg-1 fresh weigh (FW) in watermelons (C. lanatus L.) and cucumbers (C. sativus L.), respectively. Intraspecific differences only occurred for Cucurbita pepo L. with mean concentration ranging between 4.9 ± 1.1 and 70.3 ± 3.6 µg dieldrin kg-1 FW for the varieties Noire maraîchère and Orélia, respectively. For this plant species, the influence of soil concentration, plant exposure time and biomass on fruit dieldrin concentration depended mainly on varieties.

The effect of growth hormone on sleep-related cardio-respiratory control in Prader-Willi syndrome.

AIM: To evaluate the effects of growth hormone (GH) treatment on control of breathing, heart rate and blood pressure during sleep in Prader-Willi Syndrome (PWS). STUDY DESIGN: In a prospective clinical case series study, sixteen consecutive PWS patients (median age 16 months at enrolment) were followed-up 6 months (2-32 months) after commencing GH treatment. We compared heart rate (HR), Pulse Transit Time (PTT; an index of blood pressure, BP) and ventilatory responses to standard chemostimuli (4% CO(2) and 100% O(2)) during quiet sleep prior to and after commencing GH treatment. RESULTS: Growth hormone treatment increased arterial oxygenation during sleep but did not significantly improve breathing stability (apnoea-hypopnoea index remained unchanged). GH treatment did not alter ventilatory, HR and PTT chemoreceptor-mediated responsiveness (p = 0.23-0.97) but did significantly improve the coupling between and HR and PTT, indicating that HR and BP rose (or fell) in parallel after but not before GH therapy (p = 0.01). CONCLUSION: Growth hormone treatment improves arterial oxygenation and cardiovascular function during sleep; these changes are not owing to improved (stronger) chemoreflex-mediated autonomic drive.

Warfarin therapeutic monitoring: is 70% time in the therapeutic range the best we can do?

WHAT IS KNOWN AND OBJECTIVE: Warfarin, an oral anticoagulant, which has been in clinical use for over sixty years, remains a challenge for clinicians to utilize, given the multiplicity of items which can limit its efficacy. Our objective is to review the evidence and comment on whether INR control can be better than has been currently reported in various studies. COMMENT: The duration of time a patient's international normalized ratio (INR) is maintained within the therapeutic range (time in the therapeutic range, TTR) for his or her particular indication for the drug impacts the effectiveness and safety of warfarin therapy. Maintaining a therapeutic INR while on warfarin is difficult, and numerous studies employing various strategies confirm the challenge, but not the impossibility of achieving a TTR above 70%. WHAT IS NEW AND CONCLUSION: Maintaining a therapeutic INR requires a dedicated multi-faceted approach. With diligence, skill and various therapeutic strategies, a TTR >70% can be achieved.

[Patients with an increased risk of developing a first psychotic episode: two cases]. / Twee patiënten met verhoogd risico op een eerste psychose.

Patients with an 'at risk mental state' (ARMS) run an increased risk of developing a psychosis within the near future. Patients with an arms can be divided into three groups: those with genetic predisposition to schizophrenia and displaying decreased social functioning, those with attenuated psychotic symptoms and those with brief limited and intermittent psychotic symptoms (BLIPS). Patients with an arms are often suffering from comorbid anxiety and depressive symptoms. Our study focuses on two patients with an ARMS.

Cloning and molecular characterization of Dashurin encoded by C20orf116, a PCI-domain containing protein.

BACKGROUND: Characterization of gene products originating from undefined open reading frames and delineation of biological functions has become the task after the human genome has been decoded. METHODS: We cloned the human C20orf 116 and defined its transcript in liver, kidney and various brain regions by Northern analysis. Antibodies against recombinant protein used for immunofluorescence and immunoblots confirmed its expression in these tissues. With the focus on kidney, its tubular expression and presence in glomerula were shown. RESULTS: A 28 aa long signal peptide predicted by in silico analysis is reflected by visualization of size variants of approximately 3kDa difference suggesting a signal peptidase cleavage of the proform. Cell compartment separation confirmed the presence of Dashurin in peroxisomes/mitochondria, microsomes, cytosol and nucleus. This is in line with green fluorescent protein (GFP)-Dashurin fusion protein shuttling between cytosol and nucleus. Luciferase reporter studies revealed a 2-3 fold increase of promoter activities upon over-expression. Bioinformatic analysis identified a PCI-domain at the C-terminus providing protein-protein interaction capabilities. CONCLUSION: Our present findings suggest the involvement of Dashurin in gene transcription or mRNA translation. GENERAL SIGNIFICANCE: Dashurin shares the PCI-domain with three multisubunit protein complexes (26S proteasome, COP9 signalosome and eIF3 translation initiation factor).

Shack-Hartmann multiple spots with diffractive lenses.

In this Letter we aim to bring an understanding to the apparition of multiple spots when using a Shack-Hartmann (SH) wavefront sensor behind diffractive lenses. In contrast to previous work, this phenomenon is described in terms of diffractive orders. It is illustrated with Zemax simulations, where three kinds of diffractive lenses (monofocal, bifocal, and trifocal) are set behind a microlens array. The presence of multiple spots is related to the phase jump of the diffractive profile and also to the number of steps seen through the microlens pupil. The possibility of assessing the optical quality of such lenses using SH measurements is discussed, in particular within the field of ophthalmology, where the need for precautions is underlined.