Gender analysis of Journal of Perinatology authorship during COVID-19

OBJECTIVE

To examine authorship gender distributions before and during COVID-19 in the Journal of Perinatology.

STUDY DESIGN

We collected data from the Journal of Perinatology website. The author gender was determined using Genderize.io or a systematic internet search. Our primary outcome was the difference between the number of published articles authored by women during the pandemic period (March 2020-May 2021, period two), compared with the preceding 15-month period (period one). We analyzed the data using chi-square tests.

RESULTS

Publications increased from period one to two by 8.9%. There were slightly more female than male first (62%) and overall (53%) authors, but fewer last authors (43%) for the combined time periods. Female authorship distribution was not different between periods.

CONCLUSIONS

Though publications increased overall, authorship gender distribution did not change significantly during the COVID-19 pandemic. Women authors remain underrepresented overall and specifically as last author, considering the majority of neonatologists are women.

Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation

PURPOSE

Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate.

METHOD

In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level.

RESULTS

The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001).

CONCLUSIONS

Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.

A Pathogenic Relationship of Bronchopulmonary Dysplasia and Retinopathy of Prematurity? A Review of Angiogenic Mediators in Both Diseases

Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are common and significant morbidities of prematurely born infants. These diseases have in common altered and pathologic vascular formation in the face of incomplete organ development. Therefore, it is reasonable to question whether factors affecting angiogenesis could have a joint pathogenic role for both diseases. Inhibition or induced expression of a single angiogenic factor is unlikely to be 100% causative or protective of either of BPD or ROP. It is more likely that interactions of multiple factors leading to disordered angiogenesis are present, increasing the likelihood of common pathways in both diseases. This review explores this possibility by assessing the evidence showing involvement of specific angiogenic factors in the vascular development and maldevelopment in each disease. Theoretical interactions of specific factors mutually contributing to BPD and ROP are proposed and, where possible, a timeline of the proposed relationships between BPD and ROP is developed. It is hoped that future research will be inspired by the theories put forth in this review to enhance the understanding of the pathogenesis in both diseases.

Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm

OBJECTIVE

A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.

STUDY DESIGN

In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders.

RESULTS

An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6).

CONCLUSION

Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.

Experimental Investigation of PC-Films Using Optical Measurements

The alignment of polymer chains is a well known microstructural evolution effect due to straining of polymers. This has a drastic influence on the macroscopic properties of the initially isotropic material. In this work, cold forming is performed at room temperature on a tensile testing machine. Polycarbonate films are examined in two loading phases. In the first phase, the specimen is loaded to induce anisotropy, and in the second, it is re-loaded, while the material direction is varied. The investigations are supported by an optical measurement system to gain knowledge about the inhomogeneous material behavior in the initial loading phase and about the anisotropic homogeneous behavior during the re-loading phase. Two dimensional strain contours are obtained from the test data. Additionally, we propose a method for approximation of the macroscopic true stress and compare the results with a common approach based on volume consistency. In the future, the test data will set a basis for parameter identification of constitutive equations taking into account a combination of inhomogenous and homogenous material behavior, exhibiting strain induced anisotropy.

Betriebswirtschaftliche Auswirkungen der thorakalen Epiduralanästhesie bei urologischen Operationen

INTRODUCTION

Using the surgical procedure OPS 5-604.0 (radical retropubic prostatectomy) as an example, our study identifies revenue-relevant patient characteristics and describes the impact of the perioperative application of thoracic epidural analgesia (TEA).

METHODS

Factors affecting duration of stay were determined in 460 patients undergoing OPS 5-604.0 in the year 2001 and 2002 using multifactorial regression analysis. Preoperative parameters served as factors for matched-pair analysis of the effects of TEA.

RESULTS

Characteristics significantly affecting length of postoperative hospital stay were ASA status, age, preoperative haemoglobin concentration, postoperative tachycardia, number of transfused packed red cells, wound infection and surgical revision. Based on identical matching criteria 27 pairs (with/without TEA) could be formed. While the induction time in the TEA group was 8+/-18 min longer (p=0.04), emergence was briefer by 3+/-9 min (p=0.045). Neither anaesthesia presence time nor anaesthesia costs or total costs of surgery differed significantly between the pairs. However, duration of epidural postoperative pain therapy was longer with TEA but in contrast, the postoperative length of hospital stay after TEA was reduced. Assuming a continuous demand for OPS 5-604.0 procedures, TEA enables 32 more procedures to be carried out per year with an increased yield on turnover of 2.7%.

CONCLUSION

At first sight combined anaesthesia procedures require more human resources and material, however, as a result of shortened hospital stay and optimized pain therapy patient satisfaction increases and a substantial potential for increased revenue is gained.

Inhibition of phosphoinositide-specific phospholipase C results in the induction of pathogenesis-related genes in soybean

The inositol 1,4,5-trisphosphate (IP3) content is decreased in soybean cells following infection with Pseudomonas syringae pv. glycinea (Psg). In this investigation, a differential display approach was applied to isolate soybean genes that are transcriptionally up-regulated by the inhibition of phosphoinositide-specific phospholipase C (PI-PLC) activity and to study if the transcription of those genes is altered following Psg infection. Four genes, transcriptionally activated following treatment with the PI-PLC-specific inhibitor U-73122, were cloned. Three of the four genes were induced following infection with Psg. The transcripts of a hydrolase homologue (GmHy) were induced in the incompatible but not compatible soybean-Psg interaction. The transcripts of a putative ascorbate oxidase gene (GmAO) were induced in both compatible and incompatible interactions. GmHy and GmAO may represent new classes of pathogenesis-related genes. In addition to these two novel genes, homologues of PR-10 and polygalacturonase inhibitor protein (GmPR10 and GmPGIP, respectively) were identified. These two genes have previously been reported as pathogenesis-related. Transcripts of GmPR-10, but not GmPGIP, were induced in both compatible and incompatible soybean-Psg interactions. Induction of these genes, except for GmPGIP, following inhibition of PI-PLC by either the U-73122 treatment or bacterial infection suggests that PI-PLC may negatively regulate the expression of defence genes.

The matrix metalloproteinase gene GmMMP2 is activated in response to pathogenic infections in soybean

Matrix metalloproteinases (MMPs) play an important role in host defense responses against pathogens in mammals where their activities lead to the production of antimicrobial peptides. We have identified a novel soybean (Glycine max) metalloproteinase gene, GmMMP2, that is transcriptionally up-regulated in infected tissues. The deduced amino acid sequence indicates that this gene belongs to the MMP family. It is a preproprotein containing an N-terminal signal peptide, a cysteine switch, a zinc-binding catalytic motif, and a C-terminal transmembrane domain. The GmMMP2 expressed in and purified from Escherichia coli exhibited an in vitro enzymatic activity in digesting myelin basic protein. All plant metalloproteinases reported so far have no known functions. However, they have been suggested to be involved in extracellular cell matrix degradation during development or senescence. Our investigations demonstrate that the GmMMP2 transcript levels were rapidly increased in compatible and incompatible interactions of soybean tissues with the oomycete pathogen Phytophthora sojae or the bacterial pathogen Pseudomonas syringae pv. glycinea. In agreement with the GmMMP2 activation, a metalloproteinase activity was gradually increased in suspension-cultured cells following the bacterial infection. GmMMP2 was also activated in response to wounding and dehydration. However, GmMMP2 activation did not correlate with the oxidative burst leading to the hypersensitive response cell death or the tissue senescence progress that involves programmed cell death. Our investigations suggest that GmMMP2 may be involved in a novel defense response of soybean against pathogenic infections.

The matrix metalloproteinase gene GmMMP2 is activated in response to pathogenic infections in soybean

Matrix metalloproteinases (MMPs) play an important role in host defense responses against pathogens in mammals where their activities lead to the production of antimicrobial peptides. We have identified a novel soybean (Glycine max) metalloproteinase gene, GmMMP2, that is transcriptionally up-regulated in infected tissues. The deduced amino acid sequence indicates that this gene belongs to the MMP family. It is a preproprotein containing an N-terminal signal peptide, a cysteine switch, a zinc-binding catalytic motif, and a C-terminal transmembrane domain. The GmMMP2 expressed in and purified from Escherichia coli exhibited an in vitro enzymatic activity in digesting myelin basic protein. All plant metalloproteinases reported so far have no known functions. However, they have been suggested to be involved in extracellular cell matrix degradation during development or senescence. Our investigations demonstrate that the GmMMP2 transcript levels were rapidly increased in compatible and incompatible interactions of soybean tissues with the oomycete pathogen Phytophthora sojae or the bacterial pathogen Pseudomonas syringae pv. glycinea. In agreement with the GmMMP2 activation, a metalloproteinase activity was gradually increased in suspension-cultured cells following the bacterial infection. GmMMP2 was also activated in response to wounding and dehydration. However, GmMMP2 activation did not correlate with the oxidative burst leading to the hypersensitive response cell death or the tissue senescence progress that involves programmed cell death. Our investigations suggest that GmMMP2 may be involved in a novel defense response of soybean against pathogenic infections.

Antisense-mediated depletion of potato leaf omega3 fatty acid desaturase lowers linolenic acid content and reduces gene activation in response to wounding

Fatty acid omega3 desaturases act on membrane lipids to catalyse the formation of trienoic fatty acids, the most abundant in plant tissues being alpha-linolenic acid. This fatty acid is a precursor of jasmonic acid, a plant growth regulator involved in the control of wound-induced gene activation in plants and in the induction of tuberization in potato. We isolated a potato omega3 desaturase cDNA, possibly encoding a plastidial isoform, and used it to investigate its expression pattern throughout plant development and in response to wounding. Plastidial omega3 desaturase gene transcripts accumulate rapidly upon wounding, preceding the jasmonate-dependent induction of the wound-responsive proteinase inhibitor II gene. We generated transgenic potato plants constitutively expressing an antisense RNA to this plastidial omega3 desaturase. Selected transgenic lines in which the cognate omega3 desaturase mRNA is largely depleted show a marked reduction, of up to 60%, in trienoic acids in leaves and tubers. In these lines, a corresponding reduction in jasmonate content and proteinase inhibitor II expression is observed upon wounding. Our results indicate that a reduction in omega3 desaturase mRNA levels compromises the wound-induced activation of proteinase inhibitor II, suggesting that wound-induced synthesis of linolenic acid is required for jasmonic acid production. The antisense-mediated depletion of fatty acid omega3 desaturases is a viable alternative for reducing trienoic fatty acid content in plant species in which a mutant screening approach is not applicable.

Abscisic acid and jasmonic acid activate wound-inducible genes in potato through separate, organ-specific signal transduction pathways

Mechanical damage to leaf tissue causes an increase in abscisic acid (ABA) which in turn activates the biosynthesis of jasmonic acid (JA). The resulting higher endogenous JA levels subsequently activate the expression of wound-inducible genes. This study shows that JA induces the expression of different sets of genes in roots and leaves of potato plants. When roots of intact plants were treated with JA, high levels of proteinase inhibitor II (pin2), cathepsin D inhibitor, leucine aminopeptidase and threonine deaminase mRNAs accumulated in the systemic leaves. However, in the treated roots, very low, if any, expression of these genes could be detected. In contrast, a novel, root-specific pin2 homologue accumulated in the JA-treated root tissue which could not be detected in leaves, either systemic or those directly treated with JA. Application of okadaic acid and staurosporine revealed that a protein phosphorylation step is involved in the regulation of this differential response. In leaves, a protein phosphatase is required for the JA-induced expression of pin2 and the other genes analysed. This phosphatase activity is not necessary for the JA-induced expression of a pin2 homologue in roots, suggesting the existence of different transduction pathways for the JA signal in these organs. The requirement of a protein phosphatase activity for JA-mediated gene induction has enabled identification of a JA-independent pathway for ABA induction of pin2 and the other wound-inducible genes. This alternative pathway involves a protein kinase, and appears to be selective for wound-inducible genes. Our data suggest the presence of a complex, organ-specific transduction network for regulating the effects of the plant hormones ABA and JA on gene expression upon wounding.

Serum levels of sCD23 and sCD25 in children with asthma and in healthy controls

To investigate whether markers of lymphocyte activation are useful markers of disease activity in childhood asthma, we studied serum levels of soluble CD25 (receptor for IL-2) and soluble CD23 (low-affinity receptor for IgE) in 178 children (aged 2-18 years) suffering from mild to moderate asthma (mean asthma severity score: 2, range: 1-4), and in 175 healthy age-matched controls. Levels of sCD23 and sCD25 were inversely related to age. sCD23 was lower in patients with asthma (means per age group: 4.93-2.29 micrograms/l; controls: 6.92-4.11 micrograms/l, P < 0.05), while sCD25 tended to be higher (1601-597 kU/ml, controls: 1350-661 kU/ml, P = NS). sCD25 correlated significantly with asthma severity score (r = 0.41; P < 0.01) and MEF25 (maximum expiratory flow at 25% of vital capacity, r = -0.43; P < 0.05) in children < 10 years, while sCD23 correlated with asthma severity (r = 0.28; P < 0.05) in children > 10 years. On follow-up, levels of sCD25 normalized with clinical improvement. In children with nonatopic asthma, levels of sCD25 were significantly higher than in atopic patients. Our observations provide further evidence of the role of T-cell activation in asthma. Monitoring of lymphocyte activation markers, particularly levels of sCD25, may be useful in the follow-up of asthmatic children.