Factors Associated with Torsion in Pediatric Patients with Ovarian Masses.

BACKGROUND: Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy. METHODS: A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion. RESULTS: Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P < 0.01 for all). Patients with a mass >5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy. CONCLUSIONS: In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered.

Water quality perceptions and natural resources Extraction: A matter of geography?

Recent events in the United States have shown the vulnerability of water quality in certain communities. Accordingly, we conducted a survey in a large community in north central West Virginia (US) to explore the factors that influence the perceptions of water quality. We sought to assess whether respondent's proximity to a mine, gas/oil well, or bodies of water would affect their perceived health risks and environmental concern. Additionally, we aimed at understanding how these perceptions were affected by the density of these sites and the presence of these sites within defined distances. As West Virginia is rapidly expanding its natural gas production, there is no research that has objectively associated water quality perceptions with geographic location in regard to oil and gas extraction sites. With small effect sizes, our results add some evidence to the link between unconventional oil and gas extraction, geographic location, and water quality perceptions. This study suggests the need for further water quality monitoring and increased public communication about water management practices in West Virginia.

An Examination of Whitewater Boaters' Place Attachment and Specialization in Four Different River Settings.

Research on place attachment suggests that place identity and place dependence differ between recreationists with varying levels of specialization, recreating in different settings and with different resource proximities to their home. To further explore this relationship, we compared place attachment and recreation specialization of whitewater boaters in four different river settings. Data were collected on three rivers in the US and one in Austria. Place attachment was measured using four place identity and four place dependence items. Recreation specialization was treated as a multivariate construct consisting of the three dimensions; behavior, skill, and enduring involvement. The results of a cluster analysis revealed three specialization clusters. Two ANOVAs were performed by using place dependence and place identity as dependent variables and specialization clusters and the sampling rivers as independent variables. Place identity was not expressed differently between rivers but differed in specialization clusters. Place dependence was different between rivers but not between specialization clusters. Findings suggest that place attachment dimensions vary in river setting and specialization levels. Management should take into account that boaters exhibit different place attachment based on the specialization level and resource proximity to their home.

Predicting water filter and bottled water use in Appalachia: a community-scale case study.

A questionnaire survey was conducted in order to assess residents' perceptions of water quality for drinking and recreational purposes in a mid-sized city in northcentral West Virginia. Two logistic regression analyses were conducted in order to investigate the factors that influence bottle use and filter use. Results show that 37% of respondents primarily use bottled water and that 58% use a household filter when drinking from the tap. Respondents with lower levels of environmental concern, education levels, and lower organoleptic perceptions were most likely to perceive health risks from tap water consumption, and were most likely to use bottled water. Income, age, and organoleptic perceptions were predictors of water filter use among respondents. Clean water for recreational purposes was not found to be significant with either of these models. Our results demonstrate that bottle use and filter use are explained differently. We argue that more education and better communication about local tap water quality would decrease the use of bottled water. We demonstrate that household filters could be used as an alternative to bottled water.

A Structural Equation Modeling approach to water quality perceptions.

Researches on water quality perceptions have used various techniques and models to explain relationships between specific variables. Surprisingly, Structural Equation Modeling (SEM) has received little attention in water quality perceptions studies, and reporting has been inconsistent among existing studies. One objective of this article is to provide readers with a methodological example for conducting and reporting SEM. Another objective is to build a model that explains the different relationships among the diverse factors highlighted by previous studies on water quality perceptions. Our study focuses on the factors influencing people's perceptions of water quality in the Appalachian region. As such, researchers have conducted a survey in a mid-sized city in northcentral West Virginia to assess residents' perceptions of water quality for drinking and recreational purposes. Specifically, we aimed to understand the relationships between perceived water quality, health risk perceptions, organoleptic perceptions, environmental concern, area satisfaction and perceptions of surface water quality. Our model provided a good fit that explained about 50% of the variance in health risk perceptions and 43% of the variance in organoleptic perceptions. Environmental concern, area satisfaction and perceived surface water quality are important factors in explaining these variances. Perceived water quality was dismissed in our analysis due to multicollinearity. Our study demonstrates that risk communication needs to be better addressed by local decision-makers and water managers.

Setting Preferences of High and Low Use River Recreationists: How Different are They?

Whitewater boaters often choose a river based on their preferences for attributes important for their trip experience. This study explored whether preferences and tradeoffs of whitewater boaters for social, resource, and managerial attributes of riverscapes differ among a high and a low use river in the United States by employing a stated choice approach. River trip scenarios were displayed using verbal descriptions and computer-generated photographs. Results indicate that use levels were more important for boaters on the low use river, whereas river difficulty and river access fee was of higher importance for the high use river boaters, who are more involved in this whitewater activity. Preferences for waiting times and trip length did not differ between the samples. Findings suggest that whitewater boaters of high and low use rivers have a different tradeoff behavior among river setting attributes, which has implications for river recreation management.

Catalysis of CO2 absorption in aqueous solution by inorganic oxoanions and their application to post combustion capture.

To reduce CO2 emission into the atmosphere, particularly from coal-fired power stations, post combustion capture (PCC) using amine-based solvents to chemically absorb CO2 has been extensively developed. From an infrastructure viewpoint, the faster the absorption of CO2, the smaller the absorber required. The use of catalysts for this process has been broadly studied. In this manuscript, a study of the catalytic efficiencies of inorganic oxoanions such as arsenite, arsenate, phosphite, phosphate, and borate is described. The kinetics of the accelerated CO2 absorption at 25 °C was investigated using stopped-flow spectrophotometry. The catalytic rate constants of these anions for the reaction of CO2 with H2O were determined to be 137.7(3), 30.3(7), 69(2), 32.7(9), and 13.66(7) M(-1)s(-1), respectively. A new mechanism for the catalytic reaction of oxoanions with CO2 has also been proposed. The applicability of these catalysts to PCC was further studied by simulation of the absorption process under PCC conditions using their experimental catalytic rate constants. Arsenite and phosphite were confirmed to be the best catalysts for CO2 capture. However, considering the toxicological effect of arsenic and the oxidative instability of phosphite, phosphate would be the most promising inorganic catalyst for PCC process from the series of inorganic oxoanions studied.

Median Arcuate Ligament Syndrome in Children: A Single-Center Experience.

BACKGROUND: Data on median arcuate ligament syndrome (MALS) in children are scant. It is postulated that MALS can cause chronic abdominal pain. It is unclear what percentage of children with this condition are symptomatic and what comorbidities are associated with this syndrome. METHODS: In this retrospective study, data on consecutive patients in a single center diagnosed coincidentally with MALS during routine echocardiogram were reviewed. Symptom burden, comorbidities, and the effect of anthropometric indices on MALS were investigated. Descriptive statistics and nonparametric tests were used to describe the findings and to compare variables with normal distribution. RESULTS: Between 2013 and 2020, there were 82 children, 55 females (67%), mean age 13.9 ± 3.2 years, with MALS and complete record. Mean velocity across the stenotic area was 2.6 ± 0.4 m/s. Forty-six patients (57%) had abdominal pain. Age, gender, weight, body mass index (BMI), and Doppler velocity had no statistically significant influence on symptom occurrence. Conversely, patients with joint hypermobility and symptoms of orthostatic intolerance were more likely to have abdominal pain from MALS. Of 24 patients with joint hypermobility, 18 patients had abdominal pain (p=0.027). Thirty-eight patients with orthostatic intolerance (OI) with MALS complained of abdominal pain vs 13 patients with OI and no abdominal pain (p=<0.0001). CONCLUSION: Nearly half of patients with MALS had abdominal pain. Age, gender, weight, and the degree of stenosis had no statistically significant influence on symptom occurrence. OI, specifically postural orthostatic tachycardia syndrome (POTS), and joint hypermobility on exam predicted a higher propensity for abdominal pain in patients with MALS.

Spinal anesthesia for open gastrostomy in an infant after stage I Norwood for hypoplastic left heart.

Infants with hypoplastic left heart are at increased risk of adverse events including mortality when they undergo procedures with general anesthesia in the inter-stage period after stage I Norwood. This is primarily caused by an imbalance between pulmonary and systemic blood flows augmented by decreased function of the single ventricle. These factors can be aggravated by general anesthesia, hence the increased risk. Many of these infants experience feeding dysfunction and require a gastrostomy to optimize nutrition. We report a case of open gastrostomy in an infant with Norwood physiology under spinal anesthesia with an excellent outcome.

Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms.

PURPOSE: The purpose of this study was to determine the diagnostic accuracy of tumor markers for malignancy in girls with ovarian neoplasms. METHODS: A retrospective review of girls 2-21 years who presented for surgical management of an ovarian neoplasm across 10 children's hospitals between 2010 and 2016 was performed. Patients who had at least one concerning feature on imaging and had tumor marker testing were included in the study. Sensitivity, specificity, and negative and positive predictive values (PPV) of tumor markers were calculated. RESULTS: Our cohort included 401 patients; 22.4% had a malignancy. Testing for tumor markers was inconsistent. AFP had high specificity (98%) and low sensitivity (42%) with a PPV of 86%. The sensitivity, specificity, and PPV of beta-hCG was 44%, 76%, and 32%, respectively. LDH had high sensitivity (95%) and Inhibin A and Inhibin B had high specificity (97% and 92%, respectively). CONCLUSIONS: Tumor marker testing is helpful in preoperative risk stratification of ovarian neoplasms for malignancy. Given the variety of potential tumor types, no single marker provides enough reliability, and therefore a panel of tumor marker testing is recommended if there is concern for malignancy. Prospective studies may help further elucidate the predictive value of tumor markers in a pediatric ovarian neoplasm population. TYPE OF STUDY: Retrospective Cohort Review. LEVEL OF EVIDENCE: Level III.

Factors Associated With Management of Pediatric Ovarian Neoplasms.

BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

Transition metal-substituted Dawson anions as chemo- and regio-selective oxygen transfer catalysts for H2O2 in the epoxidation of allylic alcohols.

Organic-soluble transition metal-substituted Dawson compounds [(n-C(4)H(9))(4)N](9)[P(2)W(17)O(61)M(Br)] (M(n+) = Co(2+), Ni(2+), Cu(2+) and Zn(2+)), [(n-C(4)H(9))(4)N](7)[HP(2)W(17)O(61)M(Br)] (M(n+) = Cr(3+), Mn(3+) and Fe(3+)) and [K/(n-C(4)H(9))(4)N](10-n)[P(2)W(17)O(61)M(H(2)O)] (M(n+) = Ir(4+), Ru(3+) and Pd(2+)) have been investigated as oxygen transfer agents for H(2)O(2) to a series of primary allylic alcohols to generate epoxides under biphasic reaction conditions (1,2-dichloroethane/H(2)O) at 30 or 35 degrees C, such that the effect of variations in the substituted transition metals could be evaluated. The allylic alcohols involved the species R(1)R(2)C=C(R(3))CH(2)-OH (where R(1), R(2) and R(3) = H or Me), as well as cyclic (2-cyclohexen-1-ol), bicyclic [(R-)-(-)-myrtenol and (R-)-(-)-nopol] and species with two unsaturated sites (geraniol and nerol). The reactions are highly chemoselective and regioselective. The order of reactivity for the M(II)-substituted species is Pd(II) > Zn(II) > Co(II) > Ni(II), and for M(III) and M(IV) substitution is Mn(III) approximately Ir(IV) > Fe(III) > Cr(III). The observed orders are consistent with the formation of metal(n+)-alcohol species as part of the reaction mechanism. For the more polarizing Ir(IV), however, Ir(IV)-alcoholate species are likely involved in the mechanism. Formation constants for the Mn(III) and Co(II)-phosphopolyoxotungstate-alcohol species with all of the above alcohols have been evaluated in 1,2-dichloroethane at 25 degrees C and range from 19.0-3.5 M(-1). The most likely transition state involves coordination of the alcohol to the transition metal substituted at the lacunary site, or alkoxide in the case of Ir(IV), along with interaction of the double bond of the alcohol with a peroxo group located at a W(VI) site adjacent to the substituted transition metal.

beta-Klotho and FGF-15/19 inhibit the apical sodium-dependent bile acid transporter in enterocytes and cholangiocytes.

beta-Klotho, a newly described membrane protein, regulates bile acid synthesis. Fibroblast growth factor-15 (FGF-15) and FGF receptor-4 (FGFR4) knockout mice share a similar phenotype with beta-Klotho-deficient mice. FGF-15 secretion by the intestine regulates hepatic bile acid biosynthesis. The effects of beta-Klotho and FGF-15 on the ileal apical sodium bile transporter (ASBT) are unknown. beta-Klotho siRNA treatment of the mouse colon cancer cell line, CT-26, and the human intrahepatic biliary epithelial cells (HIBEC) resulted in upregulation of endogenous ASBT expression that was associated with reduced expression of the farnesoid X receptor (FXR) and the short heterodimer partner (SHP). Silencing beta-Klotho activated the ASBT promoter in CT-26, Mz-ChA-1 (human cholangiocarcinoma), and HIBEC cells. Site-directed mutagenesis of liver receptor homolog-1 (mouse) or retinoic acid receptor/retinoid X receptor (RAR/RXR) (human) cis-elements attenuated the basal activity of the ASBT promoter and abrogated its response to beta-Klotho silencing. siSHP, siFXR, or dominant-negative FXR treatment also eliminated the beta-Klotho response. FGF-15 secretion into cell culture media by CT-26 cells was diminished after siFGF-15 or sibeta-Klotho treatment and enhanced by chenodeoxycholic acid. Exogenous FGF-19 repressed ASBT protein expression in mouse ileum, gallbladder, and in HIBEC and repressed ASBT promoter activity in Caco-2, HIBEC, and Mz-ChA-1 cells. Promoter repression was dependent on the expression of FGFR4. These results indicate that both beta-Klotho and FGF-15/19 repress ASBT in enterocytes and cholangiocytes. These novel signaling pathways need to be considered in analyzing bile acid homeostasis.

Dickkopf-1 (DKK1) reveals that fibronectin is a major target of Wnt signaling in branching morphogenesis of the mouse embryonic lung.

Members of the Dickkopf (Dkk) family of secreted proteins are potent inhibitors of Wnt/beta-catenin signaling. In this study we show that Dkk1, -2, and -3 are expressed distally in the epithelium, while Kremen1, the needed co-receptor, is expressed throughout the epithelium of the developing lung. Using TOPGAL mice [DasGupta, R., Fuchs, E., 1999. Multiple roles for activated LEF/TCF transcription complexes during hair follicle development and differentiation. Development 126, 4557-4568] to monitor the Wnt pathway, we show that canonical Wnt signaling is dynamic in the developing lung and is active throughout the epithelium and in the proximal smooth muscle cells (SMC) until E12.5. However, from E13.5 onwards, TOPGAL activity is absent in the SMC and is markedly reduced in the distal epithelium coinciding with the onset of Dkk-1 expression in the distal epithelium. To determine the role of Wnt signaling in early lung development, E11.5 organ cultures were treated with recombinant DKK1. Treated lungs display impaired branching, characterized by failed cleft formation and enlarged terminal buds, and show decreased alpha-smooth muscle actin (alpha-SMA) expression as well as defects in the formation of the pulmonary vasculature. These defects coincide with a pattern of decreased fibronectin (FN) deposition. DKK1-induced morphogenetic defects can be mimicked by inhibition of FN and overcome by addition of exogenous FN, suggesting an involvement of FN in Wnt-regulated morphogenetic processes.