Family Pictures: The Queer Relationalities of Multigenerational Queer Family.

Combining queer theorizing, autoethnography, and relational dialectics theory (RDT), this essay examines how my lesbian mothers and donor struggle to define family, queer family, and their emerging familial identities as grandparents to my own donor-conceived daughter through the competing discourses of biology and history. I further explore how my parents engage their relational history as queer parents as salient models for understanding their emergent familial identities as queer grandparents, as well as how they talk about an anticipated queer grandparent relationship with my daughter in the future. Ultimately, this essay works to articulate a queer(spawn) relationality-one that possibly exists at the (non-)intersection of multiple liminalities-as a means of building on earlier mappings of queer relationality.

Experience-based expert consensus on the intra-operative usage of the Endoflip impedance planimetry system.

INTRODUCTION: The Endoluminal Functional Lumen Imaging Probe (Endoflip™) is a balloon-based catheter that provides real-time, objective feedback regarding the distensibility of any sphincter in the gastrointestinal tract. Usage of the Functional Lumen Imaging Probe (FLIP) has not been standardized, which has limited the interpretation and generalizability of published data. The purpose of this consensus statement is to provide a standardized protocol for obtaining FLIP measurements in order to create a more uniform approach to data collection. METHODS: Five expert foregut surgeons, all of whom utilize the FLIP system in their daily practice, convened on March 19, 2019, to create a standardized protocol for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy. Existing literature was presented and reviewed. Each step of the protocol was discussed in detail until a unanimous consensus was reached. RESULTS: A standardized protocol was developed for obtaining FLIP measurements during hiatal hernia repair and fundoplication, magnetic sphincter augmentation, laparoscopic Heller myotomy, and peroral endoscopic myotomy. CONCLUSION: The FLIP impedance planimetry system is the only technology available that provides surgeons an objective way to assess the tightness of a fundoplication or adequacy of a myotomy during an operation. While considerable research remains to correlate FLIP measurements to patient outcomes, this consensus statement will provide standardization of data collection among FLIP users that will enhance the understanding of future study results.

Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.

Treatment effectiveness for aging changes in the larynx.

OBJECTIVES: To compare the effectiveness of injection augmentation and bilateral thyroplasty surgery in managing age-related changes of the larynx. STUDY DESIGN: Retrospective chart review of patients treated with bilateral thyroplasty and/or injection augmentation. METHODS: We evaluated 22 patients before and after treatment using: 1) normalized glottal gap area and normalized true vocal fold width from endoscopic images; 2) patient self-rating questionnaires; and 3) acoustic and aerodynamic measures. RESULTS: Thyroplasty surgery resulted in 38% of patients demonstrating less bowing compared to 33% after injection, and 63% demonstrated less supraglottic activity compared to 43% after injection (P = 0.09). Change in mean Voice-Related Quality of Life (V-RQOL) scores was 25.5 after thyroplasty compared to -16.4 after injection (P < 0.05). Those exhibiting a greater than 20 change in V-RQOL after treatment were significantly more likely to report swallowing symptoms pretreatment. CONCLUSION: Patients postinjection did not rate themselves on any questionnaires as significantly better compared to pretreatment, whereas patients post-thyroplasty rated themselves as significantly improved on all questionnaires. Patients post-thyroplasty rated their voices as significantly closer to their best voice than patients postinjection. Likewise, 64% of patients who had thyroplasty surgery reported a significant treatment effect compared to 33% for injection augmentation. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2572-2577, 2017.

Single cell trapping in larger microwells capable of supporting cell spreading and proliferation.

Conventional cell trapping methods using microwells with small dimensions (10-20 µm) are useful for examining the instantaneous cell response to reagents; however, such wells have insufficient space for longer duration screening tests that require observation of cell attachment and division. Here we describe a flow method that enables single cell trapping in microwells with dimensions of 50 µm, a size sufficient to allow attachment and division of captured cells. Among various geometries tested, triangular microwells were found to be most efficient for single cell trapping while providing ample space for cells to grow and spread. An important trapping mechanism is the formation of fluid streamlines inside, rather than over, the microwells. A strong flow recirculation occurs in the triangular microwell so that it efficiently catches cells. Once a cell is captured, the cell presence in the microwell changes the flow pattern, thereby preventing trapping of other cells. About 62% of microwells were filled with single cells after a 20 min loading procedure. Human prostate cancer cells (PC3) were used for validation of our system.

LC-MS/MS analysis of differential centrifugation fractions from native inner medullary collecting duct of rat.

We carried out LC-MS/MS-based proteomic profiling of differential centrifugation fractions from rat inner medullary collecting duct (IMCD): 1) to provide baseline knowledge of the IMCD proteome and 2) to evaluate the utility of differential centrifugation in assessing trafficking of the water channel aquaporin-2 (AQP2). IMCD suspensions were freshly prepared from rat kidneys using standard methods. Homogenized samples were subjected to sequential centrifugations at 1,000, 4,000, 17,000, and 200,000 g. These samples, as well as the final supernatant, were subjected to LC-MS/MS analysis. Preliminary immunoblotting confirmed that the ratio of AQP2 in the 17,000-g fraction to the 200,000-g fraction underwent an increase in response to the vasopressin analog dDAVP, largely due to a reduction in the 200,000-g fraction. Immunoblotting for the major phosphorylated forms of AQP2 revealed that phosphorylated AQP2 was present in both the 17,000- and 200,000-g fractions. LC-MS/MS analysis showed that markers of "intracellular vesicles," chiefly endosomal markers, were present in both the 17,000- and the 200,000-g fractions. In contrast, plasma membrane proteins were predominantly present in the 4,000- and 17,000-g fractions. Proteins associated with several multiprotein complexes (e.g., actin-related protein 2/3 complex and proteasome complex) were virtually exclusively present in the 200,000-g fraction. Overall, we identified 656 proteins, including 189 not previously present in the IMCD database. The data show that both the 17,000- and 200,000-g fractions are highly heterogeneous and cannot be equated with "plasma membrane" and "intracellular vesicle" fractions, respectively, leading us to propose an alternative approach for use of differential centrifugation to assess vesicular trafficking to the plasma membrane.