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1.
Nature ; 620(7972): 116-121, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37407821

RESUMEN

Granites are nearly absent in the Solar System outside of Earth. Achieving granitic compositions in magmatic systems requires multi-stage melting and fractionation, which also increases the concentration of radiogenic elements1. Abundant water and plate tectonics facilitate these processes on Earth, aiding in remelting. Although these drivers are absent on the Moon, small granite samples have been found, but details of their origin and the scale of systems they represent are unknown2. Here we report microwave-wavelength measurements of an anomalously hot geothermal source that is best explained by the presence of an approximately 50-kilometre-diameter granitic system below the thorium-rich farside feature known as Compton-Belkovich. Passive microwave radiometry is sensitive to the integrated thermal gradient to several wavelengths depth. The 3-37-gigahertz antenna temperatures of the Chang'e-1 and Chang'e-2 microwave instruments allow us to measure a peak heat flux of about 180 milliwatts per square metre, which is about 20 times higher than that of the average lunar highlands3,4. The surprising magnitude and geographic extent of this feature imply an Earth-like, evolved granitic system larger than believed possible on the Moon, especially outside of the Procellarum region5. Furthermore, these methods are generalizable: similar uses of passive radiometric data could vastly expand our knowledge of geothermal processes on the Moon and other planetary bodies.

2.
Am J Physiol Heart Circ Physiol ; 326(3): H636-H647, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38156886

RESUMEN

As females age, they transition through menopause, experiencing a decrease in estrogen and an increase in cardiovascular and neurodegenerative disease risk. Most standard rodent chows contain phytoestrogen-rich soybean meal, which can mimic the effects of estrogen. Understanding the impact of this soybean meal on vascular outcomes is crucial to proper experimental design. Thus, this study aimed to compare the effects of standard and soy-free chows on cerebral artery endothelial function and cognitive function in ovariectomized mice. Young female C57Bl/6J mice (n = 43; ∼6 mo) were randomly assigned to three groups: sham, ovariectomy (OVX), or ovariectomy on a diet containing soy (OVX + Soy). In posterior cerebral arteries, the OVX mice had a 27% lower maximal response to insulin compared with the sham mice. The OVX + Soy mice had a 27% greater maximal vasodilation to insulin compared with the OVX mice and there were no differences in vasodilation between the OVX + Soy and sham groups. The group differences in vasodilation were mediated by differences in nitric oxide bioavailability. The OVX + Soy mice also had greater insulin receptor gene expression in cerebral arteries compared with the OVX mice. However, no differences in aortic or cerebral artery stiffness were observed between groups. Interestingly, the OVX + Soy group scored better on nesting behavior compared with both sham and OVX groups. In summary, we found that ovariectomy impairs insulin-mediated vasodilation in cerebral arteries, but a diet containing soy mitigates these effects. These findings highlight the importance of considering dietary soy when performing vascular and behavioral tests in mice, particularly in females.NEW & NOTEWORTHY To properly design experiments, we must consider how variables like diet impact our outcomes, particularly the effects of soy on females. We found that cerebral artery vasodilation in response to insulin was impaired in ovariectomized female mice compared with intact shams. However, ovariectomized mice fed a soy diet had a preserved cerebral artery insulin-mediated vasodilation. These results highlight that the effects of diet on vascular function may explain inconsistencies found between studies.


Asunto(s)
Insulinas , Enfermedades Neurodegenerativas , Ratones , Femenino , Animales , Humanos , Dieta , Estrógenos , Arterias Cerebrales , Ovariectomía
4.
Am J Perinatol ; 2024 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-38802080

RESUMEN

OBJECTIVE: This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success. STUDY DESIGN: This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. RESULTS: A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (ß = -0.06, p-value 0.01) and required more time at each breastfeeding session (ß = 0.08, p-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (ß = 0.06, p = 0.008). CONCLUSION: Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic-pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period. KEY POINTS: · Women who experience PPH after vaginal delivery have decreased breastfeeding success.. · Further work is needed to elicit the mechanism behind this association.. · These women may require additional support for successful breastfeeding initiation postpartum..

5.
J Assist Reprod Genet ; 41(5): 1193-1202, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38472563

RESUMEN

PURPOSE: To evaluate the impact of a single-step (SS) warming versus standard warming (SW) protocol on the survival/expansion of vitrified blastocysts and their clinical outcomes post-frozen embryo transfer (FET). METHODS: Retrospective analysis was performed on 200 vitrified/warmed research blastocysts equally divided amongst two thawing protocols utilizing the Fujifilm Warming NX kits (Fujifilm, CA). SW utilized the standard 14-minute manufacturer's guidelines. SS protocol required only a one-minute immersion in thaw solution (TS) before the embryos were transferred to culture media. A time-interrupted study was performed evaluating 752 FETs (SW: 376 FETs, SS 376 FETs) between April 2021-December 2022 at a single academic fertility clinic in Boston, Massachusetts. Embryologic, clinical pregnancy, and live birth outcomes were assessed using generalized estimated equation (GEE) models, which accounted for potential confounders. RESULTS: There was 100% survival for all blastocysts (n = 952 embryos) with no differences in blastocyst re-expansion regardless of PGT status. Adjusted analysis showed no differences in implantation, clinical pregnancy, spontaneous abortion, or biochemical pregnancy rate. A higher odds of multiple gestation [AdjOR(95%CI) 1.06 (1.01, 1.11), p = 0.019] were noted, even when adjusting for number of embryos transferred [AdjOR(95%CI) 1.05 (1.01, 1.10)]. Live birth outcomes showed no differences in live birth rates or birthweight at delivery. CONCLUSIONS: The study found equivalent outcomes for SS and SW in all parameters except for a slight rise in the rate of multiple gestations. The results suggest that SS warming is an efficient, viable alternative to SW, reducing thaw times without adverse effects on live birth rates or neonatal birth weights.


Asunto(s)
Tasa de Natalidad , Blastocisto , Criopreservación , Transferencia de Embrión , Nacimiento Vivo , Índice de Embarazo , Vitrificación , Humanos , Femenino , Embarazo , Nacimiento Vivo/epidemiología , Blastocisto/fisiología , Criopreservación/métodos , Transferencia de Embrión/métodos , Adulto , Técnicas de Cultivo de Embriones/métodos , Fertilización In Vitro/métodos , Estudios Retrospectivos , Implantación del Embrión , Resultado del Embarazo
6.
J Pediatr Orthop ; 43(6): 400-406, 2023 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-36922007

RESUMEN

BACKGROUND AND OBJECTIVES: Venous thromboembolic events (VTE) complicate acute hematogenous musculoskeletal infections (MSKIs) among hospitalized children. However, there is limited guidance for which specific MSKI patients are at the greatest VTE risk. This study aimed to identify VTE risk factors for children hospitalized with MSKIs. METHODS: A retrospective chart review was performed of children hospitalized with MSKIs at a single quaternary care pediatric hospital during a 9-year period. Patients with chronic MSKIs, non-hematogenous infections, or significant contributing comorbidities were excluded. Demographic and clinical characteristics were compared between patients with and without VTE using forward stepwise conditional multivariable logistic regression to identify VTE risk factors. RESULTS: Among 335 included patients, 7 (2.1%) developed a VTE. There was no difference in age, sex, or obesity rates for those with or without VTE. Patients with methicillin-resistant Staphylococcus aureus (MRSA) infections and/or critical illness were more likely to develop a VTE with summative adjusted odds ratios of 31.7 and 26.4, respectively. In addition, patients with VTEs had longer hospitalizations (median 4.7 vs. 12.8 d, P <0.001), longer courses of intravenous antimicrobials (median 3.7 vs. 13.5 d, P =0.001), and longer time to fever resolution (median 25.7 vs. 162 h, P =0.004). CONCLUSIONS: VTE prevalence among children with acute MSKIs is low. MRSA infection and critical illness significantly increase the risk for VTE development in these patients. Future prospective studies are needed to determine if VTEs in high-risk MSKI patients can be prevented.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina , Tromboembolia Venosa , Humanos , Niño , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Estudios Retrospectivos , Enfermedad Crítica , Factores de Riesgo
7.
Am J Physiol Heart Circ Physiol ; 323(6): H1057-H1067, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36240435

RESUMEN

With the increasing appreciation for sex as a biological variable and the inclusion of female mice in research, it is important to understand the influence of the estrous cycle on physiological function. Sex hormones are known to modulate vascular function, but the effects of the mouse estrous cycle phase on arterial stiffness, endothelial function, and arterial estrogen receptor expression remain unknown. In 23 female C57BL/6 mice (6 mo of age), we determined the estrous cycle stage via vaginal cytology and plasma hormone concentrations. Aortic stiffness, assessed by pulse wave velocity, was lower during the estrus phase compared with diestrus. In ex vivo assessment of isolated pressurized mesenteric and posterior cerebral arteries, the responses to acetylcholine, insulin, and sodium nitroprusside, as well as nitric oxide-mediated dilation, were not different between estrous cycle phases. In the aorta, expression of phosphorylated estrogen receptor-α was higher for mice in estrus compared with mice in proestrus. In the cerebral arteries, gene expression for estrogen receptor-ß (Esr2) was lowest for mice in estrus compared with diestrus and proestrus. These results demonstrate that the estrus phase is associated with lower in vivo large artery stiffness in mice. In contrast, ex vivo resistance artery endothelial function is not different between estrous cycle phases. Estrogen receptor expression is modulated by the estrus cycle in an artery-dependent manner. These results suggest that the estrous cycle phase should be considered when measuring in vivo arterial stiffness in young female mice.NEW & NOTEWORTHY To design rigorous vascular research studies using young female rodents, the influence of the estrous cycle on vascular function must be known. We found that in vivo aortic stiffness was lower during estrus compared with the diestrus phase in female mice. In contrast, ex vivo mesenteric and cerebral artery endothelial function did not differ between estrous cycle stages. These results suggest that the estrous cycle stage should be accounted for when measuring in vivo arterial stiffness.


Asunto(s)
Rigidez Vascular , Ratones , Femenino , Animales , Receptores de Estrógenos , Análisis de la Onda del Pulso , Ratones Endogámicos C57BL , Ciclo Estral/fisiología , Estrógenos , Arterias
8.
J Pediatr Hematol Oncol ; 44(1): e293-e295, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33235142

RESUMEN

Relapse of infection due to SARS-CoV-2 has been rarely described and there is little guidance regarding the management of such cases in immunocompromised hosts. We present a case of an adolescent female with B-cell acute lymphoblastic leukemia hospitalized multiple times for symptomatic SARS-CoV-2 infection who was safely treated with 2 courses of remdesivir (RDV) and has had no additional readmissions to date. Though additional studies are needed to confirm the safety and efficacy of an additional course of RDV in the setting of relapsed or prolonged severe COVID-19, our observations suggest that a second course of RDV may be considered.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Huésped Inmunocomprometido , Adenosina Monofosfato/uso terapéutico , Adolescente , Alanina/uso terapéutico , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/inmunología , Manejo de la Enfermedad , Femenino , Hospitalización , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras B/inmunología , SARS-CoV-2/aislamiento & purificación
9.
Am J Perinatol ; 2022 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-35863374

RESUMEN

OBJECTIVE: This article identifies how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding. STUDY DESIGN: This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017 to 2018. Exclusion criteria included major postpartum complications requiring admission to the surgical intensive care unit or neonatal intensive care unit, general anesthesia, and major fetal anomalies. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. Multivariable linear and logistic regression were used to assess the association between mode of delivery and markers of breastfeeding success after adjusting for potential confounders. A Tukey's post hoc analysis with pairwise comparisons was performed to assess differences in breastfeeding outcomes between vaginal delivery, scheduled cesarean section, and cesarean section after labor. RESULTS: A total of 2,966 women met inclusion criteria during the study period, 1,936 (65.3%) of whom underwent spontaneous vaginal delivery, 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor. There were significant differences in maternal age, obesity, race/ethnicity, insurance status, gestational age at delivery, birth weight, and 1-minute Apgar's score less than 7 between vaginal delivery, scheduled cesarean section, and cesarean section after labor. There were also significant differences between indication for oxytocin, type of anesthesia, and postpartum hemorrhage between the three groups. After controlling for these factors, women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR = 1.71, 95% CI: 1.04-1.31) in comparison to women who delivered via cesarean section in labor or scheduled cesarean section. The infants of these women also had an increased number of breastfeeding sessions on average (ß = 0.06, p = 0.002), required fewer number of daily formula feedings (ß = 0.14, p < 0.001), and experienced a smaller percentage in neonatal weight loss over the first 2 to 3 days of life (ß = 0.18, p < 0.001) compared to those born after cesarean section and cesarean section after labor. These women comparatively required less time at each breastfeeding session (ß = 0.06, p = 0.005), and produced fewer wet diapers and stools on average (ß = 0.12, p < 0.001 and ß = 0.12, p < 0.001, respectively). On post hoc analysis with pairwise comparisons, and on separate sensitivity analysis of only women who underwent cesarean delivery, there was no difference in breastfeeding outcome measures between scheduled cesarean section and cesarean section in labor. CONCLUSION: Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation. These women may need more support with breastfeeding after surgery in order to experience similar benefits for neonatal growth and weight gain. KEY POINTS: · Women who deliver by cesarean section are less likely to maintain exclusive breastfeeding.. · Women who deliver by cesarean section are more likely to require formula supplementation.. · Women may need more support with breastfeeding after cesarean delivery..

10.
J Pediatr Orthop ; 42(2): e206-e211, 2022 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-34923507

RESUMEN

BACKGROUND: Identifying the causative pathogen for acute hematogenous musculoskeletal infections (MSKIs) allows for directed antimicrobial therapy and diagnostic confidence. However, 20% to 50% of children with acute MSKIs remain culture negative. The objective of this study was to compare characteristics of culture negative MSKI patients to those where a pathogen is identified. METHODS: Electronic medical records of children admitted between July 2014 to September 2018 to a single quaternary care pediatric hospital with acute MSKIs were retrospectively reviewed. Clinical and demographic characteristics were compared between culture positive and culture negative MSKIs. RESULTS: A total of 170 patients were included of whom 43 (25%) were culture negative. All culture negative patients had at least 1 culture type obtained, and the majority (84%) had both blood and source cultures performed. When compared with patients with a causative pathogen identified, culture negative patients were younger (2.3 vs. 9.8 y), smaller (13.5 vs. 31.6 kg), less likely to be febrile on arrival (56% vs. 77%), less likely to have an abscess on imaging (23% vs. 48%), and were more likely to have uncomplicated septic arthritis (35% vs. 8%). No critically ill patient was culture negative. Seven culture negative patients had additional Kingella kingae testing performed, none of which were positive. CONCLUSIONS: Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis. LEVEL OF EVIDENCE: This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence.


Asunto(s)
Artritis Infecciosa , Kingella kingae , Sistema Musculoesquelético , Osteomielitis , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/epidemiología , Niño , Humanos , Lactante , Osteomielitis/tratamiento farmacológico , Estudios Retrospectivos
11.
J Surg Res ; 267: 217-223, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34153565

RESUMEN

BACKGROUND: Traumatic injuries remain one of the leading causes of death in the United States. Patients who survive traumatic injuries but return to the emergency department with repeat injuries are said to suffer from injury recidivism. Numerous studies have described trends in injury recidivism using trauma registry and survey data. To our knowledge, no prior study has leveraged electronic medical record (EMR) data to characterize injury recidivism. The EMR is potentially more comprehensive as it contains details of patients who visited the emergency department after injury but did not meet the criteria for inclusion in the trauma registry. Such injuries could be predictive of future recidivism. We therefore aimed to describe patterns of injury recidivism seen at a Level 1 trauma center using the EMR. METHODS: A retrospective review was conducted of all injury-related encounters between January 2016 and December 2019. Manual review was conducted of all recidivistic encounters with < 11 months between encounters to ensure the recidivistic encounter was not a sequela of the index visit. A general estimating equation logistic regression adjusted for age, race, sex, and insurance payor, estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between injury mechanism and odds of recidivistic encounter. RESULTS: A total of 20,566 index encounters was included during the study period. Of the 20,566 encounters, 7.6% (n = 1570) had a recidivistic encounter during the study period, half of which (n = 781) occurred within the first year of the index encounter. An over two-fold increased odds of recidivism was observed for blunt assault encounters (OR 2.53, 95% CI 2.03-3.15) and unintentional falls (OR 2.10, 95% CI 1.76-2.52). For both mechanisms, this increase was observed across the three years following the index encounter. CONCLUSIONS: Our study found that patients with assault injuries have the highest odds of injury recidivism and assault-related recidivistic encounters. These results demonstrate the feasibility and utility of incorporating EMR data, and suggest that the development of targeted interventions focused on mitigating assault injuries, such as hospital-based violence intervention programs, should be considered in our region.


Asunto(s)
Registros Electrónicos de Salud , Heridas y Lesiones , Servicio de Urgencia en Hospital , Humanos , Estudios Retrospectivos , Centros Traumatológicos , Estados Unidos/epidemiología , Violencia , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología
12.
Am J Perinatol ; 38(8): 779-783, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-31887747

RESUMEN

OBJECTIVE: This study estimates the association of a first trimester finding of subchorionic hematoma (SCH) with third trimester adverse pregnancy outcomes in women with twin pregnancies. STUDY DESIGN: Retrospective cohort study of twin pregnancies prior to 14 weeks at a single institution from 2005 to 2019, all of whom had a first trimester ultrasound. We excluded monoamniotic twins, fetal anomalies, history of fetal reduction or spontaneous reduction, and twin-to-twin transfusion syndrome. Ultrasound data were reviewed, and we compared pregnancy outcomes after 24 weeks in women with and without a SCH at their initial ultrasound 60/7 to 136/7 weeks. Regression analysis was used to control for any differences in baseline characteristics. RESULTS: A total of 760 women with twin pregnancies met inclusion criteria for the study, 68 (8.9%) of whom had a SCH. Women with SCH were more likely to have vaginal bleeding and had their initial ultrasound at earlier gestational ages. On univariate analysis, SCH was not significantly associated with gestational age at delivery, preterm birth, birthweight of either twin, low birthweight percentiles of either twin, fetal demise, or preeclampsia. SCH was associated with placental abruption on univariate analysis, but not after controlling for vaginal bleeding and gestational age at the time of the initial ultrasound (adjusted odds ratio: 2.00, 95% confidence interval: 0.63-6.42). Among women with SCH, SCH size was not associated with adverse pregnancy outcomes. CONCLUSION: In women with twin pregnancies, the finding of a first trimester SCH is not associated with adverse pregnancy outcomes >24 weeks.


Asunto(s)
Hematoma/complicaciones , Complicaciones del Embarazo , Resultado del Embarazo , Embarazo Gemelar , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Primer Trimestre del Embarazo , Estudios Retrospectivos , Gemelos , Ultrasonografía Prenatal , Hemorragia Uterina/complicaciones
13.
Am J Perinatol ; 37(13): 1289-1295, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32344443

RESUMEN

OBJECTIVE: This study aimed to identify the incidence of and risk factors for early preterm birth (PTB) (delivery <34 weeks) in women without prior PTB and current short cervix (≤20 mm) prescribed vaginal progesterone. STUDY DESIGN: Retrospective cohort study of singletons without prior PTB diagnosed with short cervix (≤20 mm) between 180/7 and 236/7 weeks. Women who accepted vaginal progesterone and had delivery outcomes available were included. Demographic/obstetric history, cervical length, and pregnancy characteristics compared between women with early PTB versus delivery ≥34 weeks. Multiple logistic regression analysis used to identify predictors; odds ratio for significant factors used to generate a risk score. Risk score and risk of early PTB assessed with receiver operating characteristic curve (ROCC). Perinatal outcomes compared by risk score. RESULTS: Among 109 patients included, 29 (27%) had a spontaneous PTB <34 weeks. In univariate analysis, only gestational age at ultrasound, presence funneling, and mean cervical length were significantly different between those with and without early sPTB. With multiple logistic regression analysis, only gestational age at diagnosis (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.46-0.96; p = 0.028) and index cervical length (OR: 0.84; 95% CI: 0.76-0.93; p = 0.001) remained significantly associated with early PTB. ROCC for the risk score incorporating cervical length and gestational age was predictive of early PTB with an AUC of 0.76 (95% CI: 0.67-0.86; p < 0.001). A high-risk score was predictive of early PTB with a sensitivity of 79%, specificity of 75%, positive predictive value of 54%, and negative predictive value of 91%. Women with a high-risk score had worse perinatal outcomes compared with those with low-risk score. CONCLUSION: A total of 27% of patients with short cervix prescribed vaginal progesterone will have a sPTB < 34 weeks. Patients at high risk for early PTB despite vaginal progesterone therapy may be identified using gestational age and cervical length at diagnosis of short cervix. Given the narrow window for intervention after diagnosis of short cervix, this has important implications for clinical care.


Asunto(s)
Medición de Longitud Cervical , Cuello del Útero/patología , Edad Gestacional , Nacimiento Prematuro/prevención & control , Progesterona/administración & dosificación , Administración Intravaginal , Adulto , Cerclaje Cervical/métodos , Femenino , Humanos , Estimación de Kaplan-Meier , Muerte Perinatal , Valor Predictivo de las Pruebas , Embarazo , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
14.
Brain Behav Immun ; 76: 37-47, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30394314

RESUMEN

Toll-like receptor-4 (TLR4) is a transmembrane receptor that initiates an immune response following a bacterial infection or host derived molecules associated with cellular distress. Beyond triggering inflammation, TLR4 has been implicated in modulating behavioral and cognitive processes in a physiologically normal state, as young adult TLR4 deficient mice show learning enhancements in select tasks. Currently unknown is whether these benefits are present in both sexes and persist with aging. The present study evaluated spatial memory, anxiety-like behavior, and central levels of pro- and anti-inflammatory molecules in young (4-5 months) and aged (18-19 months) TLR4 deficient (TLR4-/-) and wild-type (WT) male and female mice. Results confirmed that TLR4-/- mice show enhanced spatial memory compared to WT mice. These effects were age- and sex-specific, as memory retention was superior in the TLR4-/- young males and aged females. While TLR4-/- mice showed age-related changes in behavior, these changes were attenuated relative to aged WT mice. Further, aged TLR4-/- mice showed differential expression of molecules involved in interleukin (IL)-1 signaling in the hippocampus. For instance, aged TLR4-/- females showed heightened expression of IL-1 receptor antagonist (IL-1ra) and the IL-1 accessory proteins AcP and AcPb. Collectively, these data provide the initial evidence that TLR4 deficiency enhances cognitive function and modulates the inflammatory profile of the hippocampus in a sex- and age-dependent manner.


Asunto(s)
Interleucina-1/genética , Memoria Espacial/fisiología , Receptor Toll-Like 4/metabolismo , Factores de Edad , Animales , Ansiedad/genética , Ansiedad/metabolismo , Cognición/fisiología , Femenino , Hipocampo/metabolismo , Inflamación/metabolismo , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-1/metabolismo , Lipopolisacáridos/metabolismo , Masculino , Aprendizaje por Laberinto/fisiología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Receptores de Interleucina-1/metabolismo , Factores Sexuales , Transducción de Señal/fisiología , Receptor Toll-Like 4/genética
17.
J R Army Med Corps ; 164(2): 133-138, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29326127

RESUMEN

INTRODUCTION: The evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons. METHOD: A systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma. A multidisciplinary consensus group was convened following this with military HFN trauma expertise to define those procedures commonly required to conduct deployed, in-theatre HFN surgical combat trauma management. RESULTS: Head, face, neck and eye damage control surgical procedures were identified as comprising surgical cricothyroidotomy, cervico-facial haemorrhage control and decompression of orbital haemorrhage through lateral canthotomy. Acute in-theatre surgical skills required within 24 hours consist of wound debridement, surgical tracheostomy, decompressive craniectomy, intracranial pressure monitor placement, temporary facial fracture stabilisation for airway management or haemorrhage control and primary globe repair. Delayed in-theatre procedures required within 5 days prior to predicted evacuation encompass facial fracture fixation, delayed lateral canthotomy, evisceration, enucleation and eyelid repair. CONCLUSIONS: The identification of those skill sets required for deployment is in keeping with the General Medical Council's current drive towards credentialing consultants, by which a consultant surgeon's capabilities in particular practice areas would be defined. Limited opportunities currently exist for trainees and consultants to gain experience in the management of traumatic head, face, neck and eye injuries seen in a kinetic combat environment. Predeployment training requires that the surgical techniques described in this paper are covered and should form the curriculum of future military-specific surgical fellowships. Relevant continued professional development will be necessary to maintain required clinical competency.


Asunto(s)
Competencia Clínica , Traumatismos Craneocerebrales/cirugía , Medicina Militar , Personal Militar , Traumatismos del Cuello/cirugía , Traumatología , Consenso , Traumatismos Faciales/cirugía , Humanos , Reino Unido
18.
Microbiology (Reading) ; 162(10): 1808-1821, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27527105

RESUMEN

Despite its presence in most bacteria, yqgF remains one of only 13 essential genes of unknown function in Escherichia coli. Predictions of YqgF function often derive from sequence similarity to RuvC, the canonical Holliday junction resolvase. To clarify its role, we deleted yqgF from a bacterium where it is not essential, Acinetobacter baylyi ADP1. Loss of yqgF impaired growth and increased the frequency of transformation and allelic replacement (TAR). When E. coli yqgF was inserted in place of its A. baylyi chromosomal orthologue, wild-type growth and TAR were restored. Functional similarities of yqgF in both gamma-proteobacteria were further supported by defective 16S rRNA processing by the A. baylyi mutant, an effect previously shown in E. coli for a temperature-sensitive yqgF allele. However, our data question the validity of deducing YqgF function strictly by comparison to RuvC. A. baylyi studies indicated that YqgF and RuvC can function in opposition to one another. Relative to the wild type, the ΔyqgF mutant had increased TAR frequency and increased resistance to nalidixic acid, a DNA-damaging agent. In contrast, deletion of ruvC decreased TAR frequency and lowered resistance to nalidixic acid. YqgF, but not RuvC, appears to increase bacterial susceptibility to DNA damage, including UV radiation. Nevertheless, the effects of yqgF on growth and TAR frequency were found to depend on amino acids analogous to catalytically required residues of RuvC. This new heterologous system should facilitate future yqgF investigation by exploiting the viability of A. baylyi yqgF mutants. In addition, bioinformatic analysis showed that a non-essential gene immediately upstream of yqgF in A. baylyi and E. coli (yqgE) is similarly positioned in most gamma- and beta-proteobacteria. A small overlap in the coding sequences of these adjacent genes is typical. This conserved genetic arrangement raises the possibility of a functional partnership between yqgE and yqgF.


Asunto(s)
Acinetobacter/genética , Proteínas Bacterianas/metabolismo , Daño del ADN , Acinetobacter/metabolismo , Acinetobacter/efectos de la radiación , Alelos , Proteínas Bacterianas/genética , Daño del ADN/efectos de la radiación , Escherichia coli/genética , Escherichia coli/metabolismo , Genes Esenciales , Transformación Bacteriana/efectos de la radiación , Rayos Ultravioleta
19.
Cell Biochem Funct ; 32(2): 209-16, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24604335

RESUMEN

Vascular calcification shares many similarities with skeletal mineralisation and involves the phenotypic trans-differentiation of vascular smooth muscle cells (VSMCs) to osteoblastic cells within a calcified environment. Various microRNAs (miRs) are known to regulate cell differentiation; however, their role in mediating VSMC calcification is not fully understood. miR-microarray analysis revealed the significant down-regulation of a range of miRs following nine days in culture, including miR-199b, miR-29a, miR-221, miR-222 and miR-31 (p < 0.05). Subsequent studies investigated the specific role of the miR-221/222 family in VSMC calcification. Real-time quantitative polymerase chain reaction data confirmed the down-regulation of miR-221 (32.4%; p < 0.01) and miR-222 (15.7%; p < 0.05). VSMCs were transfected with mimics of miR-221 and miR-222, individually and in combination. Increased calcium deposition was observed in the combined treatment (two-fold; p < 0.05) but not in individual treatments. Runx2 and Msx2 expression was increased during calcification, but no difference in expression was observed following transfection with miR mimics. Interestingly, miR-221 and miR-222 mimics induced significant changes in ectonucleotide phosphodiesterase 1 (Enpp1) and Pit-1 expression, suggesting that these miRs may modulate VSMC calcification through cellular inorganic phosphate and pyrophosphate levels.


Asunto(s)
MicroARNs/metabolismo , Calcificación Vascular/metabolismo , Animales , Aorta/citología , Diferenciación Celular , Masculino , Ratones Endogámicos C57BL , MicroARNs/genética , Músculo Liso Vascular/patología , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/patología , Hidrolasas Diéster Fosfóricas/genética , Hidrolasas Diéster Fosfóricas/metabolismo , Pirofosfatasas/genética , Pirofosfatasas/metabolismo , Factor de Transcripción Pit-1/genética , Factor de Transcripción Pit-1/metabolismo , Calcificación Vascular/patología
20.
Sch Psychol ; 39(3): 302-311, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38407111

RESUMEN

Educators' high levels of stress have been well documented in existing literature, though little research has directly looked at comparisons of stress experiences and needs for support based on school level. The present study included 33 teachers (19 elementary and 14 middle school) from one school district who participated in semistructured interviews. Responses to questions regarding their primary source(s) of stress and their ideal solution(s) to relieve that stress revealed distinctions between elementary and middle school teachers. Elementary teachers described stress related to a sense of responsibility or need to care for students and meet their social, emotional, behavioral, and academic needs. Their ideal solution primarily involved receiving more emotional support and more support staff in the classroom to help meet all students' needs. In contrast, middle school teachers reported the majority of their stress as stemming from external demands or pressures such as test scores, high or unattainable expectations from administrators or parents, and not having enough time. Middle school teachers' ideal solutions largely entailed a shift in the use of their time, specifically to remove tasks (e.g., unnecessary staff meetings) and be able to focus their time on what matters the most (e.g., teaching students). These findings indicate that although almost all of these teachers reported being highly stressed, their sources of stress and perceived needs for support varied based on school level. Efforts to promote teacher well-being must consider school level and teachers' own perspectives on what they need in order to provide the most beneficial supports. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Asunto(s)
Maestros , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Investigación Cualitativa , Instituciones Académicas , Estrés Laboral/psicología , Estrés Psicológico/psicología , Apoyo Social
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