Assessment of serum levels and placental bed tissue expression of IGF-1, bFGF, and PLGF in patients with placenta previa complicated with placenta accreta spectrum disorders

OBJECTIVE

This study aims to detect the serum levels of IGF-1, bFGF, and PLGF and their expressions in placental bed tissues of patients with placenta previa complicated with PAS disorders.

METHODS

This case and control study included 40 multiparous pregnant women with complete placenta previa between 34 weeks and 38 weeks of gestation and they were divided into two groups: 25 patients with PAS (case group) and 15 patients without PAS (control group). The venous blood samples were collected 2 h before the cesarean section, and the placental bed tissues were taken intraoperatively at the placental implantation site and then were histologically examined to evaluate the gravity of the myometrial invasion of the placenta. According to FIGO PAS increasing grading, the 25 patients were also divided into three groups: PAS grade I group, PAS grade II group, and PAS grade III group. The concentrations of IGF-1, bFGF, and PLGF in serum were measured using ELISA, and the mean ratio of the relative mRNA expression of each biomarker in placental bed tissues was calculated using qRT-PCR. The staining intensity and the positive cells were quantitatively measured and expressed as means by using Image J software for IHC analysis.

RESULTS

IGF-1 had low serum levels and high placental bed expression in placenta previa patients with PAS disorders compared to those without PAS (all p < 0.0001). PLGF had high serum levels (p = 0.0200) and high placental bed expression (p < 0.0001) in placenta previa patients with PAS disorders compared to those without PAS. IGF-1 serum levels decreased up to PAS grade II (means were 24.3 ± 4.03, 21.98 ± 3.29, and 22.03 ± 7.31, respectively for PAS grade I, PAS grade II, PAS grade III groups, p = 0.0006). PLGF serum levels increased up to PAS grade II (means were 12.96 ± 2.74, 14.97 ± 2.56, and 14.89 ± 2.14, respectively for the three groups, p = 0.0392). However, IGF-1 and PLGF mRNA placental bed expression increased up to PAS grade III. The relative expression of mRNA means for the three groups was 3.194 ± 1.40, 3.509 ± 0.63, and 3.872 ± 0.70, respectively for IGF-1; and 2.784 ± 1.14, 2.810 ± 0.71, and 2.869 ± 0.48, respectively for PLGF (all p < 0.0001). Their IHC (immunohistochemical) staining also had increasing trends, but p > 0.05. bFGF was not significantly expressed in placenta previa with PAS disorders in most of the analysis sections (p > 0.05).

CONCLUSIONS

Low serum levels and high expression in placental bed tissues of IGF-1, or high serum levels and high expression in placental bed tissues of PLGF, may differentiate placenta previa patients with FIGO PAS grade I and PAS grade II from those without PAS disorders. However, they could not significantly predict the degree of placental invasiveness in FIGO PAS grades II and III.

Successful multidisciplinary team management of placenta accreta spectrum disorder: A referral center model in a middle-income country

OBJECTIVE

The aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand.

METHODS

This retrospective single-center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016.

RESULTS

Of 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001).

CONCLUSION

The incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle-income country setting.

Mapping the spatial distribution of primary and secondary PM2.5 in a multi-industrial city by combining monitoring and modeling results

Industrial cities are strongly influenced by primary emissions of PM2.5 from local industries. In addition, gaseous precursors, such as sulfur oxides (SOX), nitrogen oxides (NOX), and volatile organic compounds (VOCs), emitted from industrial sources, undergo conversion into secondary inorganic and organic aerosols (SIAs and SOAs). In this study, the spatial distributions of primary and secondary PM2.5 in Ulsan, the largest industrial city in South Korea, were visualized. PM2.5 components (ions, carbons, and metals) and PM2.5 precursors (SO2, NO2, NH3, and VOCs) were measured to estimate the concentrations of secondary inorganic ions (SO42-, NO3-, and NH4+) and secondary organic aerosol formation potential (SOAFP). The spatial distributions of SIAs and SOAs were then plotted by combining atmospheric dispersion modeling, receptor modeling, and monitoring data. Spatial distribution maps of primary and secondary PM2.5 provide fundamental insights for formulating management policies in different districts of Ulsan. For instance, among the five districts in Ulsan, Nam-gu exhibited the highest levels of primary PM2.5 and secondary nitrate. Consequently, controlling both PM2.5 and NO2 emissions becomes essential in this district. The methodology developed in this study successfully identified areas with dominant contributions from both primary emissions and secondary formation. This approach can be further applied to prioritize control measures during periods of elevated PM levels in other industrial cities.

The molecular mechanisms regulating the assembly of the autophagy initiation complex

The autophagy initiation complex is brought about via a highly ordered and stepwise assembly process. Two crucial signaling molecules, mTORC1 and AMPK, orchestrate this assembly by phosphorylating/dephosphorylating autophagy-related proteins. Activation of Atg1 followed by recruitment of both Atg9 vesicles and the PI3K complex I to the PAS (phagophore assembly site) are particularly crucial steps in its formation. Ypt1, a small Rab GTPase in yeast cells, also plays an essential role in the formation of the autophagy initiation complex through multiple regulatory pathways. In this review, our primary focus is to discuss how signaling molecules initiate the assembly of the autophagy initiation complex, and highlight the significant roles of Ypt1 in this process. We end by addressing issues that need future clarification.

Optimization of PAS stain and similar Schiff's based methods for glycogen demonstration in liver tissue

Demonstration of glycogen in tissue holds considerable diagnostic relevance across various pathological conditions, particularly in certain tumors. The histochemical staining of glycogen using methods utilizing Schiff's reagents is subject to influences arising from the type of fixative, fixation temperature, and oxidizing agents employed. This study aimed to assess diverse fixatives, fixation temperatures, and oxidizing agents, each with variable treatment durations, in conjunction with Schiff's reagent for optimal glycogen demonstration. Paraffin blocks derived from a rabbit's liver served as the experimental substrate, encompassing 340 paraffin sections subjected to different procedures. For tissues fixed at 4 °C, good staining outcomes, as determined by the periodic acid-Schiff (PAS) stain, were observed with 10% neutral buffered formalin (NBF), 80% alcohol, and Bouin's solution. Tissues fixed at room temperature (RT) demonstrated good PAS staining results with both 10% NBF and 80% alcohol. Notably, other oxidizing agents exhibited poor outcomes across all fixatives and fixation temperature, with two exceptions, as satisfactory staining results were obtained when using 5% chromic acid. Consequently, Both 10% NBF and 80% emerge as preferred fixatives of choice for glycogen demonstration when coupled with PAS stain. It is noteworthy that Bouin's solution could also provide good outcomes when fixation occurred at 4 °C.

The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children

BACKGROUND

Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery.

OBJECTIVE

The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination.

METHODS

This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated.

RESULTS

One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%.

CONCLUSIONS

Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.

Plant a seed series: the impact of an online outreach package on school pupils' knowledge, skills, and attitudes to medicine

BACKGROUND

Medicine is one of the most inaccessible professions in the United Kingdom (UK). The Plant a Seed (PAS) series was created to address this; it is an online pre-recorded three-part video series to "Inspire", "Educate" and "Motivate" pupils from widening participation backgrounds on Medicine. We explored the impact of PAS on pupils' knowledge, skills and attitude to Medicine.

METHODS

We conducted a national pretest-posttest study of Years 7-9 pupils in the UK. 503 schools were invited to PAS, following ethics approval. Consented pupils viewed all three episodes asynchronously and completed a pre-and post-series Likert scale confidence questionnaire, which evaluated their knowledge, skills and attitudes to a medical career. A Shapiro-Wilk test showed the lack of a normal distribution (p < 0.05); therefore, a Wilcoxon signed-rank test statistically compared pretest-posttest results of each pupil.

RESULTS

70 pupils in Years 7-9 from 2 schools participated in this study. PAS was shown to significantly increase pupils' knowledge of the role and life of a doctor, medicine as a degree, admissions requirements, and careers in medicine (p < 0.05). There was a significant increase in pupils believing they could study medicine. The intervention did not significantly increase the desire for pupils to study medicine (p = 0.187).

CONCLUSION

PAS significantly improved pupils' knowledge, skills and confidence demonstrating the need and benefit to enrolment of the programme at scale. It did not significantly increase the number of pupils wishing to study medicine. Analysis at scale is required to evaluate the effectiveness of PAS as a key intervention to break down barriers to medicine.

Sea-blue histiocytosis

A 78-year-old woman with hypertrophic cardiomyopathy underwent a septal myomectomy and valve replacement. In the immediate postoperative period she developed shock of mixed etiology and died. At autopsy, hepatomegaly and splenomegaly were identified, with PAS and Giemsa positive intracellular ceroid granular deposits. Sea-blue histiocytosis is an extremely rare, chronic and benign deposit disease. It is characterized by hepatosplenomegaly, thrombocytopenia and lymphadenopathy. The presence of ceroid substance in granules in PAS and Giemsa stains should establish the diagnosis of suspicion.

Quality of life and swallowing outcomes following major glossectomy: A prospective single-center experience

BACKGROUND

There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy.

METHODS

Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDADI, and FACT-HN.

RESULTS

Twenty-four patients were available for analysis. The pre- and post-adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT-HN scores. Subscale analysis of FACT-HN scores revealed maximum deficit in the head and neck cancer-specific score domain followed by functional domain and social well-being domain, with serial improvement noted in the post-adjuvant setting.

CONCLUSION

This study showed serial improvement in terms of swallowing dysfunction although social and functional well-being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible.

Microcellular approach for the pathogenesis of placenta accreta spectrum inflammatory versus apoptotic pathways; a thorough look on Treg, dNK and VEGF

Placenta accreta spectrum (PAS) is a disorder of irregular placental invasion to the surrounding structures, it is a leading cause of maternal morbidity and mortality. This study was theorized to perceive the role of Treg cells and VEGF which appealed to play a role in the pathogenesis of nonstandard extreme placental invasion. The study was carried out on 40 pregnant women; Group I (control group), and Group II (placenta accrete spectrum PAS). Light microscopic, immune-histochemical; CD 56 (NK CELLS) and CD 45 RO (T reg) western blot; P53 and VEGF morphometry and statistical analysis were done. H&E-stained sections revealed Placental tissue in unswerving contact with the myometrium, deficient decidual layer, hemorrhage, congested edematous blood vessels. The mean area percent of collagen, Treg, P53, and VEGF exposed a significant increase in the placenta accreta group when compared to that of control women. Nonetheless, the mean area percent of NK cells displayed a significant decrement PAS cases are associated with low levels of NK cells and increased levels of Treg cells, P 53, and VEGF, promoting the hyperinvasive behavior of trophoblasts of placenta accreta and dysregulate placental vascular remodeling.

Deep Learning Model Based on Multisequence MRI Images for Assessing Adverse Pregnancy Outcome in Placenta Accreta

BACKGROUND

Preoperative assessment of adverse outcomes risk in placenta accreta spectrum (PAS) disorders is of high clinical relevance for perioperative management and prognosis.

PURPOSE

To investigate the association of preoperative MRI multisequence images and adverse pregnancy outcomes by establishing a deep learning model in patients with PAS.

STUDY TYPE

Retrospective.

POPULATION

323 pregnant women (age from 20 to 46, the median age is 33), suspected of PAS, underwent MRI to assess the PAS, divided into the training (N = 227) and validation datasets (N = 96).

FIELD STRENGTH/SEQUENCE

1.5T scanner/fast imaging employing steady-state acquisition sequence and single shot fast spin echo sequence.

ASSESSMENT

Different deep learning models (i.e., with single MRI input sequence/two sequences/multisequence) were compared to assess the risk of adverse pregnancy outcomes, which defined as intraoperative bleeding ≥1500 mL and/or hysterectomy. Net reclassification improvement (NRI) was used for quantitative comparison of assessing adverse pregnancy outcome between different models.

STATISTICAL TESTS

The AUC, sensitivity, specificity, and accuracy were used for evaluation. The Shapiro-Wilk test and t-test were used. A P value of <0.05 was considered statistically significant.

RESULTS

215 cases were invasive placenta accreta (67.44% of them with adverse outcomes) and 108 cases were non-invasive placenta accreta (9.25% of them with adverse outcomes). The model with four sequences assessed adverse pregnancy outcomes with AUC of 0.8792 (95% CI, 0.8645-0.8939), with ACC of 85.93% (95%, 84.43%-87.43%), with SEN of 86.24% (95% CI, 82.46%-90.02%), and with SPC of 85.62% (95%, 82.00%-89.23%) on the test cohort. The performance of model with four sequences improved above 0.10 comparing with that of model with two sequences and above 0.20 comparing with that of model with single sequence in terms of NRI.

DATA CONCLUSION

The proposed model showed good diagnostic performance for assessing adverse pregnancy outcomes.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

Phagophore closure, autophagosome maturation and autophagosome fusion during macroautophagy in the yeast Saccharomyces cerevisiae

Macroautophagy, hereafter referred to as autophagy, is a complex process in which multiple membrane-remodeling events lead to the formation of a cisterna known as the phagophore, which then expands and closes into a double-membrane vesicle termed the autophagosome. During the past decade, enormous progress has been made in understanding the molecular function of the autophagy-related proteins and their role in generating these phagophores. In this Review, we discuss the current understanding of three membrane remodeling steps in autophagy that remain to be largely characterized; namely, the closure of phagophores, the maturation of the resulting autophagosomes into fusion-competent vesicles, and their fusion with vacuoles/lysosomes. Our review will mainly focus on the yeast Saccharomyces cerevisiae, which has been the leading model system for the study of molecular events in autophagy and has led to the discovery of the major mechanistic concepts, which have been found to be mostly conserved in higher eukaryotes.

Autophagy in a Nutshell

Autophagy is an intracellular catabolic process that eliminates cytoplasmic constituents selectively by tight engulfment in an isolation membrane or recycles bulk cytoplasm by nonselective sequestration. Completion of the isolation membrane forms a double membrane vesicle, termed autophagosome, that proceeds to fusion with the lysosome, where the inner membrane and its cytoplasmic content are degraded. Autophagosome biogenesis is unique in that the newly-formed membrane, termed phagophore, is elongated by direct lipid flow from a proximal ER-associated donor membrane. Recent years mark a tremendous advancement in delineating the direct regulation of this process by different lipid species and associated protein complexes. Here we schematically summarize the current view of autophagy and autophagosome biogenesis.

Tuberculosis isolated from patients in Thailand

Para-amino salicylic acid (PAS) was first reported by Lehmann in 1946 and used for tuberculosis treatment. However, due to its adverse effects, it is now used only as a second line anti-tuberculosis drug for treatment of multidrug resistant or extensively drug resistant M. tuberculosis. The structure of PAS is similar to para-amino benzoic acid (pABA), an intermediate metabolite in the folate synthesis pathway. The study has identified mutations in genes in folate pathway and their intergenic regions for their possibilities in responsible for PAS resistance. Genomic DNA from 120 PAS-resistant and 49 PAS-sensitive M. tuberculosis isolated from tuberculosis patients in Thailand were studied by whole genome sequencing. Twelve genes in the folate synthesis pathway were investigated for variants associated with PAS resistance. Fifty-one SNVs were found in nine genes and their intergenic regions (pabC, pabB, folC, ribD, thyX, dfrA, thyA, folK, folP). Functional correlation test confirmed mutations in RibD, ThyX, and ThyA are responsible for PAS resistance. Detection of mutation in thyA, folC, intergenic regions of thyX, ribD, and double deletion of thyA dfrA are proposed for determination of PAS resistant M. tuberculosis.

Novel markers of Doppler ultrasonography in the placenta accreta spectrum to predict complications

Objective

Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers.

Material and Methods

This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology.

Results

Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively.

Conclusion

Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers.

Periostin promotes extensive neovascularization in placenta accreta spectrum disorders via Notch signaling

OBJECTIVE

Extensive neovascularization, closely linked to massive intraoperative blood loss, is a pathological hallmark of placenta accreta spectrum (PAS) cases. This study aims to explore proteins related to neovascularization and elucidate their regulatory roles in PAS, enhancing our understanding of this condition.

METHODS

The isobaric tags for relative and absolute quantitation technique were used to identify and quantify the differentially expressed proteins in placentas from PAS and healthy pregnant women. Immunofluorescence staining and western blot analysis were conducted to determine the protein expression and localization. Gain-of-function experiments were used to conduct cell proliferation and migration assays. In addition, the tube formation assay was performed to evaluate angiogenesis in vitro. The Notch inhibitor DAPT was used to determine the involvement of Notch signaling in angiogenesis in PAS.

RESULTS

Periostin (POSTN) exhibited higher expression in PAS placentas than in normal placentas. Moreover, the overexpression of POSTN in endothelial cells promoted cell proliferation, mobility, and endothelial angiogenesis via the Notch signaling pathway in vitro.

CONCLUSION

Elevated POSTN expression in PAS is associated with increased angiogenesis, indicating its potential as a molecular marker for significant intraoperative blood loss.

Association between mutations in a thyX-hsdS.1 region and para-aminosalicylic acid resistance in Mycobacterium tuberculosis clinical isolates

Although para-aminosalicylic acid (PAS) has been used to treat tuberculosis agent for decades, its mechanisms of resistance are still not thoroughly understood. Previously, sporadic studies showed that certain mutations in the thyX-hsdS.1 region caused PAS resistance in M. tuberculosis, but a comprehensive analysis is lacking. Recently, we found a G-10A mutation in thyX-hsdS.1 in a PAS-resistant clinical isolate, but it did not cause PAS resistance. SNPs in thyX-hsdS.1 in 6550 clinical isolates were analyzed, and 153 SNPs were identified. C-16 T was the most common SNP identified (54.25%, 83/153), followed by C-4T (7.19%, 11/153) and G-9A (6.54%, 10/153). Subsequently, the effects of those SNPs on the promoter activity of thyX were tested, and the results showed that mutations C-1T, G-3A, C-4T, C-4G, G-7A, G-9A, C-16T, G-18C, and C-19G led to increased promoter activity compared with the wild-type sequence, but other mutations did not. Then, thyX and wild-type thyX-hsdS.1, or thyX-hsdS.1 containing specific SNPs, were overexpressed in M. tuberculosis H37Ra. The results showed that mutations resulting in increased promoter activity also caused PAS resistance. Moreover, the results of an electrophoretic mobility shift assay showed that thyX-hsdS.1 containing the C-16T mutation had a higher binding capacity to RNA polymerase than did the wild-type sequence. Taken together, our data demonstrated that among the SNPs identified in thyX-hsdS.1 of M. tuberculosis clinical isolates, only those able to increase the promoter activity of thyX caused PAS resistance and therefore can be considered as molecular markers for PAS resistance.

Passive air sampling of VOCs, O3, NO2, and SO2 in the large industrial city of Ulsan, South Korea: spatial-temporal variations, source identification, and ozone formation potential

Concerns about volatile organic compounds (VOCs) have increased due to their toxicity and secondary reaction with nitrogen oxides (NOX) to form ozone (O3). In this study, passive air sampling of VOCs, O3, NO2, and SO2 was conducted in summer, fall, winter, and spring from 2019 to 2020 at six industrial and ten urban sites in Ulsan, the largest industrial city in South Korea. Over the entire sampling period, the concentration of toluene (mean: 8.75 μg/m3) was the highest of the 50 target VOCs, followed by m,p-xylenes (4.52 μg/m3), ethylbenzene (4.48 μg/m3), 3-methylpentane (4.40 μg/m3), and n-octane (4.26 μg/m3). Total (Σ50) VOC levels did not statistically differ between seasons, indicating that large amounts of VOCs are emitted into the atmosphere throughout the year. On the other hand, O3, NO2, and SO2 exhibited strong seasonal variation depending on the meteorological conditions and emission sources. The spatial distribution of Σ50 VOCs, NO2, and SO2 indicated that industrial complexes were major sources in Ulsan, while O3 had the opposite spatial distribution. Using a positive matrix factorization model, five major sources were identified, with industrial effects dominant. Aromatic compounds, such as m,p,o-xylenes, toluene, and 1,2,4-trimethylbenzene, significantly contributed to O3 formation. The VOC/NO2 ratio and O3 concentrations suggested that reducing VOC emissions is more effective than reducing NO2 emissions in terms of preventing the secondary formation of O3. The findings of this study allow for a better understanding of the relationship between VOCs, O3, NO2, and SO2 in industrial cities.

Incorporation of a repeated polypeptide sequence in therapeutic antibodies as a universal masking procedure: A case study of T cell-engaging bispecific antibodies

Prodrug design is a promising approach for reducing the off-target effects of therapeutic antibodies, particularly bispecific antibodies (bsAbs) that recruit T cells for activation; this design uses masking sequences that inhibit antibody binding until they reach the tumor microenvironment, where they are removed. In this study, we propose PAS, a polypeptide sequence composed of repeated Pro, Ala, and Ser residues, as a universal masking sequence. PAS has no specificity, but can inhibit antibody binding through steric hindrance caused by its large fluid dynamic radius and disordered structure; additionally, its length can be adjusted. We fused PAS to the N-terminus of an anti-CD3 single-chain variable fragment (scFv) and a bsAb, that targets both the epidermal growth factor receptor and CD3, via a recognition sequence cleaved by cancer-related proteases. PAS integration inhibited anti-CD3 scFv binding with higher efficacy than the epitope sequence, and the extent of inhibition was proportional to the length of the PAS sequence. For masked bsAbs, T cell-binding ability, cancer growth inhibition effects, and T cell activation effects were also reduced depending on the length of PAS and were fully restored upon removing PAS sequences using protease. The masking procedure using PAS was successfully applied to another scFv. The provision to adjust the masking effects of PAS by tuning its length, makes PAS fusion a valuable tool for the universal design of prodrug antibodies.

Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis

OBJECTIVE

To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS).

METHODS

MEDLINE, EMBASE and the Cochrane databases were searched electronically up to 1 November 2022. Studies reporting on the urological outcome of women undergoing Cesarean section for PAS were included. Two independent reviewers performed data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with disagreements resolved by consensus.The primary outcome was the overall occurrence of urological complications. Secondary outcomes were the occurrence of any cystotomy, intentional cystotomy, unintentional cystotomy, ureteral damage, ureteral fistula and vesicovaginal fistula. All outcomes were explored in the overall population of women undergoing surgery for PAS. In addition, we performed subgroup analyses according to the type of surgery (Cesarean hysterectomy, or conservative surgery or management), severity of PAS at histopathology (placenta accreta/increta and placenta percreta), type of intervention (planned vs emergency) and number of cases per year. Random-effects meta-analyses of proportions were used to analyze the data.

RESULTS

There were 62 studies included in the systematic review and 56 were included in the meta-analysis. Urological complications occurred in 15.2% (95% CI, 12.9-17.7%) of cases. Cystotomy complicated 13.5% (95% CI, 9.7-17.9%) of surgical operations. Intentional cystotomy was required in 7.7% (95% CI, 6.5-9.1%) of cases, while unintentional cystotomy occurred in 7.2% (95% CI, 6.0-8.5%) of cases. Urological complications occurred in 19.4% (95% CI, 16.3-22.7%) of cases undergoing hysterectomy and 12.2% (95% CI, 7.5-17.8%) of those undergoing conservative treatment. In the subgroup analyses, urological complications occurred in 9.4% (95% CI, 5.4-14.4%) of women with placenta accreta/increta and 38.5% (95% CI, 21.6-57.0%) of those described as having placenta percreta, and included mainly cystotomy (5.5% (95% CI, 0.6-15.1%) and 22.0% (95% CI, 5.4-45.5%), respectively). Urological complications occurred in 15.4% (95% CI, 8.1-24.6%) of cases undergoing a planned procedure and 24.6% (95% CI, 13.0-38.5%) of those undergoing an emergency intervention. In subanalysis of studies reporting on ≥ 12 cases per year, the incidence of urological complication was similar to that reported in the primary analysis.

CONCLUSIONS

Women undergoing surgery for PAS are at high risk of urological complication, mainly cystotomy. The incidence of these complications was particularly high in women described as having placenta percreta at birth and in those undergoing emergency surgical intervention. The high heterogeneity between the included studies highlights the need for a standardized protocol for the diagnosis of PAS to identify prenatal imaging signs associated with the increased risk of urological morbidity at delivery. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Novel markers of doppler ultrasonography in the placenta accreta spectrum to predict complications

Objective

Ultrasonography is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women; however, the lack of a strong criteria protocol in diagnosis and predicting the severity of the consequences facing pregnant women requires novel markers investigation.

Material and Methods

This prospective cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Therefore, 51 pregnant women were involved in the study. Their characteristic information, medical and surgical history, blood loss severity(severe:>=2500 ml), following hysterectomy, and the histopathology after the surgery were collected. Also, the Doppler of right and left uterine arteries, including the pulsatility index(PI), resistance Index(RI), peak systolic velocity(PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler ultrasonography. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS(bleeding, hysterectomy, pathology).

Results

The mean age of the pregnant women was 35.4±4.11 (median:35.00) years. 17(33.3%) of pregnant women had severe Bleeding. The median of bladder PSV, cervix PSV, and left uterine artery for women with severe bleeding were 57.00(34,90), 26.00(0,63), and 89.00(81,135), while there were 33.00(20,64), 18.00(0.76), and 68.00(61,113) for women without severe bleeding (p-value: <0.001, 0.037, 0.045). 34 (66.66%) pregnant women had hysterectomy. Bladder PSV, cervix PSV, and left uterine PSV for women with hysterectomy were 46.00(20,90), 20.00(0,76), and 68.00(61,135) compared to 39.50(33,46), 20.00(14,26), and 82.00(63,101) for women without (p-value=0.005, 0.013, 0.003).

Conclusion

Bladder PSV, cervix PSV, and uterine PSV are significantly higher in pregnant women with PSV, and they can be appropriate markers in diagnosing PAS and predicting its severity. So that healthcare providers could use them to make better clinical decisions.

Neuronal SAM68 differentially regulates alternative last exon splicing and ensures proper synapse development and function

Alternative splicing in the 3'UTR of mammalian genes plays a crucial role in diverse biological processes, including cell differentiation and development. SAM68 is a key splicing regulator that controls the diversity of 3'UTR isoforms through alternative last exon (ALE) selection. However, the tissue/cell type-specific mechanisms underlying the splicing control at the 3' end and its functional significance remain unclear. Here, we show that SAM68 regulates ALE splicing in a dose-dependent manner and the neuronal splicing is differentially regulated depending on the characteristics of the target transcript. Specifically, we found that SAM68 regulates interleukin-1 receptor-associated protein splicing through the interaction with U1 small nuclear ribonucleoprotein. In contrast, the ALE splicing of protocadherin-15 (Pcdh15), a gene implicated in several neuropsychiatric disorders, is independent of U1 small nuclear ribonucleoprotein but modulated by the calcium/calmodulin-dependent protein kinase signaling pathway. We found that the aberrant ALE selection of Pcdh15 led to a conversion from a membrane-bound to a soluble isoform and consequently disrupted its localization into excitatory and inhibitory synapses. Notably, the neuronal expression of the soluble form of PCDH15 preferentially affected the number of inhibitory synapses. Moreover, the soluble form of PCDH15 interacted physically with α-neurexins and further disrupted neuroligin-2-induced inhibitory synapses in artificial synapse formation assays. Our findings provide novel insights into the role of neuron-specific alternative 3'UTR isoform selections in synapse development.

Effect of mineral elements on the formation of gallbladder stones using spectroscopic techniques

Long-standing gallbladder stones have been recognized as one of the highest risk factors for gallbladder cancer. However, the growth and progression of gallbladder stones are still not well-known, and their uncovering requires accurate information on the formation/nucleation and complex compositional information of gallstones. Multiple and single gallstones are analyzed using laser-induced breakdown spectroscopy (LIBS), photoacoustic spectroscopy (PAS), and Fourier transform infrared spectroscopy (FTIR). Spectral signatures as well as spatial variation in the spectral intensities of different elements are observed in the LIBS spectra of the gallstones. In the multiple-type gallstones, the concentration of inorganic content increases from core to periphery, whereas a single gallstone shows the opposite trend from the point of nucleation/core. It is suggested that the concentration of inorganic elements (Mg, Ca, K, and Na) plays an important role in the nucleation and growth of gallstones; thus, accordingly, multiple- and single-type gallstones are found in the gallbladder. The presence of different electronic bands of molecules, such as CH, C2, CN, and NH, is confirmed by LIBS and FTIR. PAS has identified molecules, such as cholesterol, calcium carbonate, and calcium phosphate, in different gallstone samples. These results show that PAS combined with LIBS is a promising candidate for the compositional analysis of gallstones. Furthermore, principal component analysis (PCA) is used to discriminate different layers present in the gallstones.

Family involvement in euthanasia or Physician Assisted Suicide and dementia: A systematic review

OBJECTIVE

To assess how families are involved in situations of euthanasia or physician assisted suicide (PAS) in dementia.

DESIGN

Systematic review searching literature in nine databases from inception up to October 2021. We included studies on family involvement in euthanasia from the perspective of persons with dementia and family caregivers. Themes were formulated through thematic analysis. The design was registered at Prospero (CRD42022298215).

RESULTS

We assessed 215 of 4038 studies in full text; 19 met the inclusion criteria of which 13 empirical studies. Themes included for people with dementia: being a burden; stage of dementia, and permissibility of euthanasia/PAS. Themes for family were the burden of care, responsibility toward the euthanasia or PAS wish, permissibility of euthanasia/PAS.

CONCLUSION

The wish for euthanasia/PAS arises in situations of burdensome care and fear of future deterioration. The family feels entrusted with the responsibility to enact upon the death wish. In shaping this responsibility, four roles of family can be distinguished: carer, advocate, supporter, and performer. Family as in need of support themselves is understudied.

Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance

OBJECTIVES

To evaluate the prenatal ultrasound features associated with operative complications and to assess the interobserver agreement of prenatal ultrasound assessment with histopathologic confirmation of placenta accreta spectrum (PAS) in a cohort of high-risk patients with detailed intraoperative and histopathologic data.

METHODS

This was a retrospective multicenter cohort study of patients at high risk of PAS referred for specialist perinatal care and management between January 2019 and May 2022. Deidentified ultrasound images were reviewed independently by two experienced operators blinded to clinical details, intraoperative features, outcome and histopathologic findings. The diagnosis of PAS was confirmed by failure of detachment of one or more placental cotyledons from the uterine wall at delivery, and the absence of decidua with distortion of the uteroplacental interface by fibrinoid deposition on histologic examination of the accretic areas obtained by guided sampling of partial myometrial resection or hysterectomy specimens. Patients were categorized as having a low or high likelihood of PAS at birth. Interobserver agreement of prenatal ultrasound assessment with histopathologic confirmation of PAS was assessed using the kappa statistic. Primary outcome was major operative morbidity (blood loss ≥ 2000 mL, unintentional injury to the viscera, admission to intensive care unit or death).

RESULTS

A total of 102 women at high risk of PAS were referred, of whom 66 had evidence of PAS at birth and 36 did not. When blinded to other clinical details, the examiners agreed on the low or high probability of PAS, according to ultrasound features, in 75/102 cases (73.5%). The kappa statistic was 0.47 (95% CI, 0.28-0.66), showing moderate agreement. Morbidity was twice as common with concordant prenatal diagnosis of PAS vs concordant diagnosis of not PAS. Concordant assessment of high probability of PAS was associated with the highest morbidity (66.6%) and a very high (97.6%) likelihood of histopathologic confirmation.

CONCLUSIONS

The probability of histopathologic confirmation is very high with concordant prenatal assessment suggestive of PAS. The interobserver agreement for preoperative assessment with histopathologic confirmation of PAS is only moderate. Morbidity is associated with both histopathologic diagnosis and concordant antenatal assessment of PAS. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Motor Cortical Correlates of Paired Associative Stimulation Induced Plasticity: A TMS-EEG Study

Paired associative stimulation (PAS) is a non-invasive brain stimulation technique that modulates synaptic plasticity in the human motor cortex (M1). Since previous studies have primarily used motor-evoked potentials (MEPs) as outcome measure, cortical correlates of PAS-induced plasticity remain unknown. Therefore, the aim of this observational study was to investigate cortical correlates of a standard PAS induced plasticity in the primary motor cortex by using a combined TMS-EEG approach in a cohort of eighteen healthy subjects. In addition to the expected long-lasting facilitatory modulation of MEPs amplitude, PAS intervention also induced a significant increase in transcranial magnetic stimulation-evoked potentials (TEPs) P30 and P60 amplitude. No significant correlation between the magnitude of PAS-induced changes in TEP components and MEP amplitude were observed. However, the linear regression analysis revealed that the combined changes in P30 and P60 component amplitudes significantly predicted the MEP facilitation after PAS. The findings of our study offer novel insight into the neurophysiological changes associated with PAS-induced plasticity at M1 cortical level and suggest a complex relationship between TEPs and MEPs changes following PAS.

mRNA 3' -UTR-mediate translational control through PAS and CPE in sheep oocyte

In oocytes, the cytoplasmic polyadenylation and maternal mRNAs translation is regulated by cis-elements, including polyadenylation signal (PAS) and cytoplasmic polyadenylation element (CPE) in 3'-UTR. Recent studies illustrate non-canonical polyadenylation mechanisms of translational regulation in mouse oocytes, which is different from that in Xenopus oocytes. However, it is still unclear if this regulation in rodent oocytes functions in the domestic animal oocyte. Here, by using sheep as an animal model, we cloned the 3'-UTRs of Cpeb1 or Btg4 and ligated it into the pRK5-Flag-Gfp vector. Variant numbers and positions of PASs and CPEs within the 3'-UTRs were constructed to detect their effects on translational control. After in vitro-transcription and microinjection into sheep fully grown germinal vesicle stage oocytes, the expression efficiency of mRNAs was detected by the GFP and flag expression. Our results show that: (i) PAS located at the proximal end of 3'-UTR can mediate the translation of the maternal mRNAs, as long as they locate far from CPEs; (ii) The proximal PAS has higher efficiency in regulating transcription than the distal one; (iii) increase of PAS number can promote the translational activity more efficiently; (iv) a single CPE located close to PAS (<50 bp) in 3'-UTRs of Cpeb1 or Btg4 could partially repress translation. In 3'-UTRs of Btg4, two CPEs have a higher inhibitory effect, and three CPEs can completely inhibit mRNA translation. These results confirm the existence of the non-canonical mechanism in domestic animal oocytes.

Structures of biological heme-based sensors of oxygen

Since their initial discovery some 30 years ago, heme-based O₂ sensors have been extensively studied. Among many other lessons, we have learned that they have adapted a wide variety of folds to bind heme for O₂ sensing, and they can couple those sensory domains to transducer domains with many different activities. There is no question that we have learned a great deal about those systems by solving X-ray structures of the truncated pieces of larger multi-domain proteins. All of the studies have, for example, hinted at the importance of protein residues, which were further investigated, usually by site-directed mutagenesis of the full-length proteins together with physico-chemical measurements and enzymatic studies. The biochemistry has suggested that the sensing functions of heme-based O₂ sensors involve not only the entire proteins but also, and quite often, their associated regulatory partners and targets. Here we critically examine the state of knowledge for some well-studied sensors and discuss outstanding questions regarding their structures. For the near future, we may foresee many large complexes with sensor proteins being solved by cryo-EM, to enhance our understanding of their mechanisms.

The dynamin Vps1 mediates Atg9 transport to the sites of autophagosome formation

Autophagy is a key process in eukaryotes to maintain cellular homeostasis by delivering cellular components to lysosomes/vacuoles for degradation and reuse of the resulting metabolites. Membrane rearrangements and trafficking events are mediated by the core machinery of autophagy-related (Atg) proteins, which carry out a variety of functions. How Atg9, a lipid scramblase and the only conserved transmembrane protein within this core Atg machinery, is trafficked during autophagy remained largely unclear. Here, we addressed this question in yeast Saccharomyces cerevisiae and found that retromer complex and dynamin Vps1 mutants alter Atg9 subcellular distribution and severely impair the autophagic flux by affecting two separate autophagy steps. We provide evidence that Vps1 interacts with Atg9 at Atg9 reservoirs. In the absence of Vps1, Atg9 fails to reach the sites of autophagosome formation, and this results in an autophagy defect. The function of Vps1 in autophagy requires its GTPase activity. Moreover, Vps1 point mutants associated with human diseases such as microcytic anemia and Charcot-Marie-Tooth are unable to sustain autophagy and affect Atg9 trafficking. Together, our data provide novel insights on the role of dynamins in Atg9 trafficking and suggest that a defect in this autophagy step could contribute to severe human pathologies.

Effects of a QI intervention on pediatric asthma treatment using patient outcomes and workflow in an emergency department

OBJECTIVE

Evaluate a nurse-initiated quality improvement (QI) intervention aimed at enhancing asthma treatment in a pediatric emergency department (ED), utilizing outcomes and workflow.

METHODS

We evaluated the impact of QI interventions for pediatric patients presenting to the ED with asthma with pre-post analysis. A pediatric asthma score (PAS) of >8 indicated moderate to severe asthma. This secondary analysis of the electronic health record (EHR), evaluated on 1) patient outcomes (time to clinical treatment, ED length of stay [EDLOS], admissions and discharges home), 2) clinical workflow.

RESULTS

We compared 886 visits occurring between 01/01/2015 and 09/27/2015 (pre-implementation period) with 752 visits between 01/01/2016 and 09/27/2016 (post-implementation). Time to first documentation of PAS was decreased post-intervention (p<.001) by >30 min (75 ± 57 to 39 ± 54 min). There were significant decreases in time to treatment with both steroid and bronchodilator administration (both p<.001). EDLOS did not significantly change. Based on acuity level, those discharged home from the ED with high acuity (PAS score ≥8), had a significant decrease in time to initial PAS, steroid and bronchodilator use and EDLOS. Of those with high acuity who were admitted to the hospital, there was a difference pre- to post-implementation, in time to first PAS (p<.05), but not to treatment. Workflow visualization provided additional insights and detailed (task level) comparisons of the timing of ED activities.

CONCLUSIONS

Nurse-initiated ED interventions, can significantly improve the timeliness of pediatric asthma evaluation and treatment. Examining workflow along with the outcomes, can better inform QI evaluations and clinical management.

Optimization and application of passive air sampling method for gaseous elemental mercury in Ulsan, South Korea

We compared uptake rates and concentrations of gaseous elemental mercury (GEM) by passive sampling conditions and investigated the spatial distribution of GEM in Ulsan, the largest industrial city in South Korea. For the optimization of sampling conditions, two outer sampling containers (cylindrical polyethylene terephthalate and two stainless steel bowls), two different sulfur contents of the sorbent (16.3% and 26.3%), and three sampling periods (1, 2, and 3 months) were considered. The uptake rates of GEM were not statistically different by the sampling container, but they were increased with the sulfur contents of activated carbon. A sampling condition using two stainless bowls and lower sulfur contents of activated carbon for 2-3 months was preferred with the highest precision of GEM concentrations. With the same method, passive air samples were collected for 3 months in duplicate from 10 sites in Ulsan. The concentrations of GEM ranged from 3.13 to 11.2 ng/m³ (mean 4.65 ng/m³), and the highest concentration was measured at a non-ferrous industrial complex. A zinc smelter in the non-ferrous industrial complex was identified as a major mercury source in Ulsan. This study is the first passive air sampling study investigating the spatial distributions of GEM in different types of industrial areas as well as residential areas of Ulsan.

Occurrence and ecotoxicological risk assessment of pharmacologically active dyes in the environmental water of Poland

The interest in the fate of pharmacologically active substances (PASs) in the aquatic environment continually increases. However, little is known about pharmacologically active dyes (PADs) as contaminants of water bodies. PADs are used in medicine, but due to their colouring properties are also applied in the textile, cosmetic and food industries. Their large-scale production and widespread applications have caused these dyes permeate to the aquatic environment. The pharmacological activity and toxicological properties of some of these dyes, caused their occurrence in water should be monitored. Up to now, PADs such as crystal violet, malachite green, methylene blue, rhodamine B, have been determined in the water of Greater China and Iran. However, there is no data on whether PADs pose an environmental problem for water bodies in Poland. Thus, different water samples were collected and analysed by the UPLC-MS/MS method allowing the determination of 20 PADs. The tests showed that dyes such as crystal violet, methyl violet 2 B and rhodamine B were found in 2 out of 36 water reservoirs (0.0122-0.0594 μgL^-1). The environmental risk assessment indicated that determined dyes for most model organisms did not pose a risk. Only the presence of methyl violet 2 B (0.0571 μgL^-1) was related to a low risk for rohu carp, and crystal violet (0.0122-0.0209 μgL^-1) showed a moderate risk for medaka fish. The occurrence of PADs was tested on a larger scale in the water samples collected from different water reservoirs in Poland. Based on obtained results, 96.3% of water samples collected from different water bodies (94.5%) were free from dyes. Thus, it could be stated that generally environmental water of Poland is contaminated with PADs at a low level. On the other hand, the presence of dyes in two samples indicates that PADs permeate the water environment, and their occurrence should be monitored.

Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase- resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

Background

Placenta accreta spectrum (PAS) is the most common obstetric complication in current obstetrics in which the placenta is fully or partially attached to the uterine myometrial layer at delivery. This is commonly due to the deficiency of the uterine interface between the uterine endometrial and myometrial layers leading to abnormal decidualization at the uterine scar area, which permits the abnormally placental anchoring villous and trophoblasts, deeply invade the myometrium. The prevalence of PAS is globally at rising trends every day in modern obstetrics originally due to the high increasing rate of cesarean sections, placenta previa, and assisted reproductive technology (ART). Thus, the early and precise diagnosis of PAS is imperative to prevent maternal intrapartum or postpartum bleeding complications.

Objective

The main aim of this review is to debate the current challenges and controversies in the routine diagnosis of PAS diseases in obstetrics.

Data Source

We retrospectively reviewed the recent articles on different methods of diagnosing PAS in PubMed, Google Scholar, Web of Science, Medline, Embase, and other website databases.

Results

Despite that, the standard ultrasound is a reliable and key tool for the diagnosis of PAS, the lack of ultrasound features does not exclude the diagnosis of PAS. Therefore, clinical assessment of risk factors, MRI tests, serological markers, and placental histopathological tests are also indispensable for the prediction of PAS. Previously, limited studies reached a high sensitivity rate of diagnosis PAS in appropriate cases, while many studies recommended the inclusion of different diagnosis methods to improve the diagnosis accuracy.

Conclusion

A multidisciplinary squad with well-experienced obstetricians, radiologists, and histopathologists should be involved in the establishment of the early and conclusive diagnosis of PAS.

Th17-Related Cytokines Involved in Fluoride-Induced Cecal and Rectal Barrier Damage of Ovariectomized Rats

To investigate fluoride (F)-induced intestine barrier damage and the role of estrogen deficiency in this progress, a rat model of estrogen deficiency was established through bilateral surgical removal of ovaries. The F exposure model was then continued by adding sodium fluoride (0, 25, 50, and 100 mg/L, calculated on a fluorine ion basis) to drinking water for 90 days. Afterward, intestinal mucosal structure, barrier function, and inflammatory cytokines were evaluated. The results showed that excessive F decreased the developmental parameters (crypt depth) of the cecum and rectum and inhibited the proliferation capacity of the intestinal epithelia, which are more obvious in the state of estrogen deficiency. The distribution of goblet cells and glycoproteins in the intestinal mucosa decreased with the increase in F concentration, and estrogen deficiency led to a further decline, especially in the rectum. Using the immunofluorescence method, the study showed that excessive F caused interleukin-17A (IL-17A) significantly decrease in the cecum and increase in the rectum. Meanwhile, F treatment remarkably upregulated the expression of intestinal IL-1β, IL-23, and IL-22, while the level of IL-6 was downregulated. In addition, estrogen deficiency increased IL-1β, IL-6, IL-23, and IL-22, but decreased IL-17A expression in the cecum and rectum. Collectively, F exposure damaged intestinal morphological structure, inhibited epithelial cell proliferation and mucus barrier function, and resulted in the disturbance of T helper (Th) 17 cell-related cytokines expression. Estrogen deficiency may further aggravate F-induced damage to the cecum and rectum.

The Plant Homeodomain Protein Clp1 Regulates Fungal Development, Virulence, and Autophagy Homeostasis in Magnaporthe oryzae

Rice blast disease caused by Magnaporthe oryzae is a serious threat to global grain yield and food security. Cti6 is a nuclear protein containing a plant homeodomain (PHD) that is involved in transcriptional regulation in Saccharomyces cerevisiae. The biological function of its homologous protein in M. oryzae has been elusive. Here, we report Clp1 with a PHD domain in M. oryzae, a homologous protein of the yeast Cti6. Clp1 was mainly located in the nucleus and partly in the vesicles. Clp1 colocalized and interacted with the autophagy-related proteins Atg5, Atg7, Atg16, Atg24, and Atg28 at preautophagosomal structures (PAS) and autophagosomes, and the loss of Clp1 increased the fungal background autophagy level. Δclp1 displayed reduced hyphal growth and hyperbranching, abnormal fungal morphology (including colony, spore, and appressorium), hindered appressorial glycogen metabolism and turgor production, weakened plant infection, and decreased virulence. The PHD is indispensable for the function of Clp1. Therefore, this study revealed that Clp1 regulates development and pathogenicity by maintaining autophagy homeostasis and affecting gene transcription in M. oryzae. IMPORTANCE The fungal pathogen Magnaporthe oryzae causes serious diseases of grasses such as rice and wheat. Autophagy plays an indispensable role in the pathogenic process of M. oryzae. Here, we report a Cti6-like protein, Clp1, that is involved in fungal development and infection of plants through controlling autophagy homeostasis in the cytoplasm and gene transcription in the nucleus in M. oryzae. This study will help us to understand an elaborated molecular mechanism of autophagy, gene transcription, and virulence in the rice blast fungus.

When the savior becomes a demon: Silicon oil synechia-induced glaucoma

Background

Silicon oil is an important adjunct for achieving internal tamponade in the treatment of retinal detachment. Silicone oil tamponade often leads to narrowing of the angle and development of adhesions between the iris and anterior chamber angle structures, with consequential elevation of the intraocular pressure. The video showcases the management of these challenging scenarios.

Purpose

To highlight the management of early synechial closures due to silicon oil tamponade.

Synopsis

The video highlights the management of early synechial closure following silicon oil tamponade. Surgical pupilloplasty has been demonstrated to break the peripheral anterior synechias on intraoperative gonioscopy as well as on anterior segment optical coherence tomography (AS-OCT). Performing pupilloplasty in the early phase of development of peripheral anterior synechias (PAS) helps to break the existing synechias and prevent angle closure and sequential deterioration of vision.

Highlights

Surgical pupilloplasty helps to relieve the post silicon oil-induced secondary angle closure glaucoma by breaking the peripheral anterior synechias and significantly opening the anterior chamber angles.

Online Video Link

https://youtu.be/xe2NGlhPBF4.

Additively Manufactured Detection Module with Integrated Tuning Fork for Enhanced Photo-Acoustic Spectroscopy

Starting from Quartz-Enhanced Photo-Acoustic Spectroscopy (QEPAS), we have explored the potential of a tightly linked method of gas/vapor sensing, from now on referred to as Tuning-Fork-Enhanced Photo-Acoustic Spectroscopy (TFEPAS). TFEPAS utilizes a non-piezoelectric metal or dielectric tuning fork to transduce the photoacoustic excitation and an optical interferometric readout to measure the amplitude of the tuning fork vibration. In particular, we have devised a solution based on Additive Manufacturing (AM) for the Absorption Detection Module (ADM). The novelty of our solution is that the ADM is entirely built monolithically by Micro-Metal Laser Sintering (MMLS) or other AM techniques to achieve easier and more cost-effective customization, extreme miniaturization of internal volumes, automatic alignment of the tuning fork with the acoustic micro-resonators, and operation at high temperature. This paper reports on preliminary experimental results achieved with ammonia at parts-per-million concentration in nitrogen to demonstrate the feasibility of the proposed solution. Prospectively, the proposed TFEPAS solution appears particularly suited for hyphenation to micro-Gas Chromatography and for the analysis of complex solid and liquid traces samples, including compounds with low volatility such as illicit drugs, explosives, and persistent chemical warfare agents.

Bookend: precise transcript reconstruction with end-guided assembly

We developed Bookend, a package for transcript assembly that incorporates data from different RNA-seq techniques, with a focus on identifying and utilizing RNA 5′ and 3′ ends. We demonstrate that correct identification of transcript start and end sites is essential for precise full-length transcript assembly. Utilization of end-labeled reads present in full-length single-cell RNA-seq datasets dramatically improves the precision of transcript assembly in single cells. Finally, we show that hybrid assembly across short-read, long-read, and end-capture RNA-seq datasets from Arabidopsis thaliana, as well as meta-assembly of RNA-seq from single mouse embryonic stem cells, can produce reference-quality end-to-end transcript annotations.

After-Sensations and Lingering Pain following Examination in Patients with Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a chronic widespread pain condition with mixed peripheral and central contributions. Patients display hypersensitivities to a spectrum of stimuli. Patients' blunt pressure pain thresholds are typically reduced, and sometimes (∼15%) gentle brushstroke induces allodynia. However, after-sensations following these stimuli have not, to our knowledge, been reported. We examined the perception of blunt pressure and 'pleasant touch' in FMS. Patients were first interviewed and completed standard psychometric questionnaires. We then measured their sensitivity to blunt pressure and perception of pleasant touch including after-sensations; patients were followed for five days evaluating lingering pain from blunt pressure. We recruited 51 FMS patients and 16 pain-free controls (HC) at a UK Pain Management Centre. Forty-four patients completed the after-sensation protocol. Most patients reported pain after application of less mechanical pressure than HCs; median arm and leg thresholds were 167 kPa and 233 kPa. Eighty-four percent (31/37) of patients reported ongoing pain at the site of pressure application one day after testing, and 49% (18/37) still perceived pain at five days. After-sensations following brushstroke were common in the FMS group, reported by 77% (34/44) compared to 25% (4/16) of HCs; 34% (15/44) patients, but no HCs, perceived these after-sensations as uncomfortable. For FMS patients who experienced after-sensations, brushstroke-pleasantness ratings were reduced, and skin was often an important site of pain. Pain after blunt pressure assessment typically lingers for several days. After-sensations following brushstroke stimulation is a previously unreported FMS phenomenon. They are associated with tactile anhedonia and may identify a clinically distinct subgroup.

Analysis of constituents present in smokeless tobacco (Nicotiana tabacum)using spectroscopic techniques

Laser-Induced Breakdown Spectroscopy (LIBS) is an analytical technique used to identify and quantify the elements present in any type of material present in any phase (solid, liquid, gas, and aerosol). In the present work, our objective is to find the presence of toxic and other elements in chewing tobacco (Nicotiana tabacum) using LIBS. Spectral signatures of elements like C, Fe, Si, Mg, Mn, Ca, Ti, Na, H, N, K, O, along with some toxic elements Al, Sr, Li, Cu, Sb, and Cr are observed in the LIBS spectra of these tobacco samples. The spectral intensity ratio is measured for quantitative analysis of elements present in the samples. Further, Atomic Absorption Spectroscopy is used for determining absolute concentration in these samples. A relation between the AAS result and the relative intensity of spectral lines measured in the LIBS is obtained using regression analysis. The multivariate technique, Principal Component Analysis (PCA), discriminates all the samples based on their toxicity and other constituents. Molecular study (Photoacoustic spectroscopy (PAS), UV-Visible (UV-vis), and FT-IR) of tobacco samples were performed to analyze the molecules present in the tobacco samples.

Uterine damage induces placenta accreta and immune imbalance at the maternal-fetal interface in the mouse

INTRODUCTION

Placenta accreta spectrum (PAS) disorder is one of the major complications resulting in maternal death and serious adverse pregnancy outcomes. Uterine damage - principally that associated with cesarean section - is the leading risk factor for the development of PAS. However, the underlying pathogenesis of PAS related to uterine damage remains unclear.

METHODS

For this study, we constructed a mouse PAS model using hysterotomy to simulate a cesarean section in humans. Pregnant mice were sacrificed on embryonic days 12.5 (E12.5) and E17.5. Trophoblast invasion and placental vascularization were analyzed using Hematoxylin-Eosin (H&E) staining and immunohistochemistry (IHC), and the proportions of immune cells at the maternal-fetal interface were analyzed using flow cytometry. We analyzed the expressions of genes in the decidua and placenta using RNA sequencing and subsequent validation by QPCR, and measured serum angiogenic factors by ELISA.

RESULTS

Uterine damage led to increased trophoblast invasion and placental vascularization, with extensive changes to the immune-cell profiles at the maternal-fetal interface. The proportions of T and NK cells in the deciduas diminished significantly, with the decidual NK cells and M - 2 macrophages showing the greatest decline. The expression of TNF-α and IL4 was upregulated in the deciduas, while that of IFN-γ and IL10 was downregulated significantly. The expression of Mmp2, Mmp9, Mmp3, and Dock4 was significantly elevated in the placenta, and the serum levels of anti-angiogenic factors were significantly attenuated.

DISCUSSION

Uterine damage can cause immune imbalance at the maternal-fetal interface, which may contribute to abnormal trophoblast invasion and enhanced vascularization of the mouse placenta.

Premorbid adjustment in childhood is associated with later emotion management in first-episode schizophrenia

Poor premorbid adjustment and social functioning deficits are recognized as cardinal features of schizophrenia. Whether premorbid maladjustment is associated with interpersonal functioning problems that manifest during the first episode of psychosis is less well-established. No previous work has investigated the relationship between premorbid adjustment and a key component of social cognition (emotion management) during the early phase of schizophrenia. A sample of 119 individuals (40 experiencing a first episode of schizophrenia, FE-SZ, 22 experiencing a first episode of another psychotic disorder, FE-OP, and 57 healthy controls, HC) participated in an assessment of premorbid adjustment and emotion management, measured using the Cannon-Spoor Premorbid Adjustment Scale (PAS) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) Managing Emotions (ME) scale. The relationship between premorbid adjustment (from age 5 to onset of psychotic symptoms) and ME was examined, as well as the specific relationship between childhood premorbid adjustment (ages 5-11) and ME. Results indicated that both FE-SZ and FE-OP participants exhibited significantly worse premorbid adjustment (all p's < 0.01) across development and lower ME scores when compared to HC participants. Among FE-SZ participants only, premorbid maladjustment in childhood was correlated with deficits in emotion management. This study is the first to suggest that poor premorbid social and academic functioning in childhood is related to later deficits in emotion management in those experiencing a first episode of schizophrenia. These results point to a possible relationship between early developmental deficits in premorbid social and school functioning and social cognitive deficits during the early (first episode) phase of schizophrenia.

Reversible Shielding and Immobilization of Liposomes and Viral Vectors by Tailored Antibody-Ligand Interactions

Controlling the time and dose of nanoparticulate drug delivery by administration of small molecule drugs holds promise for efficient and safer therapies. This study describes a versatile approach of exploiting antibody-ligand interactions for the design of small molecule-responsive nanocarrier and nanocomposite systems. For this purpose, antibody fragments (scFvs) specific for two distinct small molecule ligands are designed. Subsequently, the surface of nanoparticles (liposomes or adeno-associated viral vectors, AAVs) is modified with these ligands, serving as anchor points for scFv binding. By modifying the scFvs with polymer tails, they can act as a non-covalently bound shielding layer, which is recruited to the anchor points on the nanoparticle surface and prevents interactions with cultured mammalian cells. Administration of an excess of the respective ligand triggers competitive displacement of the shielding layer from the nanoparticle surface and restores nanoparticle-cell interactions. The same principle is applied for developing hydrogel depots that can release integrated AAVs or liposomes in response to small molecule ligands. The liberated nanoparticles subsequently deliver their cargoes to cells. In summary, the utilization of different antibody-ligand interactions, different nanoparticles, and different release systems validates the versatility of the design concept described herein.

Phylogenetic analysis of phytochrome A gene from Lablab purpureus (L.) Sweet

BACKGROUND

Phytochromes are the best characterized photoreceptors that perceive Red (R)/Far-Red (FR) signals and mediate key developmental responses in plants. It is well established that photoperiodic control of flowering is regulated by PHY A (phytochrome A) gene. So far, the members of PHY A gene family remains unexplored in Lablab purpureus, and therefore, their functions are still not deciphered. PHYA3 is the homologue of phytochrome A and known to be involved in dominant suppression of flowering under long day conditions by downregulating florigens in Glycine max. The present study is the first effort to identify and characterize any photoreceptor gene (PHYA3, in this study) in Lablab purpureus and decipher its phylogeny with related legumes.

RESULTS

PHYA3 was amplified in Lablab purpureus cv GNIB-21 (photo-insensitive and determinate) by utilizing primers designed from GmPHYA3 locus of Glycine max. This study was successful in partially characterizing PHYA3 in Lablab purpureus (LprPHYA3) which is 2 kb longer and belongs to exon 1 region of PHYA3 gene. Phylogenetic analysis of the nucleotide and protein sequences of PHYA genes through MEGA X delineated the conservation and evolution of Lablab purpureus PHYA3 (LprPHYA3) probably from PHYA genes of Vigna unguiculata, Glycine max and Vigna angularis. A conserved basic helix-loop-helix motif bHLH69 was predicted having DNA binding property. Domain analysis of GmPHYA protein and predicted partial protein sequence corresponding to exon-1 of LprPHYA3 revealed the presence of conserved domains (GAF and PAS domains) in Lablab purpureus similar to Glycine max.

CONCLUSION

Partial characterization of LprPHYA3 would facilitate the identification of complete gene in Lablab purpureus utilizing sequence information from phylogenetically related species of Fabaceae. This would allow screening of allelic variants for LprPHYA3 locus and their role in photoperiod responsive flowering. The present study could aid in modulating photoperiod responsive flowering in Lablab purpureus and other related legumes in near future through genome editing.

A modified decision tree approach to improve the prediction and mutation discovery for drug resistance in Mycobacterium tuberculosis

BACKGROUND

Drug resistant Mycobacterium tuberculosis is complicating the effective treatment and control of tuberculosis disease (TB). With the adoption of whole genome sequencing as a diagnostic tool, machine learning approaches are being employed to predict M. tuberculosis resistance and identify underlying genetic mutations. However, machine learning approaches can overfit and fail to identify causal mutations if they are applied out of the box and not adapted to the disease-specific context. We introduce a machine learning approach that is customized to the TB setting, which extracts a library of genomic variants re-occurring across individual studies to improve genotypic profiling.

RESULTS

We developed a customized decision tree approach, called Treesist-TB, that performs TB drug resistance prediction by extracting and evaluating genomic variants across multiple studies. The application of Treesist-TB to rifampicin (RIF), isoniazid (INH) and ethambutol (EMB) drugs, for which resistance mutations are known, demonstrated a level of predictive accuracy similar to the widely used TB-Profiler tool (Treesist-TB vs. TB-Profiler tool: RIF 97.5% vs. 97.6%; INH 96.8% vs. 96.5%; EMB 96.8% vs. 95.8%). Application of Treesist-TB to less understood second-line drugs of interest, ethionamide (ETH), cycloserine (CYS) and para-aminosalisylic acid (PAS), led to the identification of new variants (52, 6 and 11, respectively), with a high number absent from the TB-Profiler library (45, 4, and 6, respectively). Thereby, Treesist-TB had improved predictive sensitivity (Treesist-TB vs. TB-Profiler tool: PAS 64.3% vs. 38.8%; CYS 45.3% vs. 30.7%; ETH 72.1% vs. 71.1%).

CONCLUSION

Our work reinforces the utility of machine learning for drug resistance prediction, while highlighting the need to customize approaches to the disease-specific context. Through applying a modified decision learning approach (Treesist-TB) across a range of anti-TB drugs, we identified plausible resistance-encoding genomic variants with high predictive ability, whilst potentially overcoming the overfitting challenges that can affect standard machine learning applications.

The Perceptual Awareness Scale-recent controversies and debates

Accurate insight into subjective experience is crucial for the science of consciousness. The Perceptual Awareness Scale (PAS) was created in 2004 as a method for obtaining precise introspective reports for participants in research projects, and since then, the scale has become increasingly popular. This does not mean, of course, that no critiques have been voiced. Here, we briefly recapitulate our main thoughts on the intended PAS usage and the findings of the first decade, and we update this with the latest empirical and theoretical developments. We focus specifically on findings with relevance to whether consciousness is gradual or all-or-none phenomenon, to what should be considered conscious/unconscious, and to whether PAS is preferable to alternative measures of awareness. We respond in detail to some recent, selected articles.

Gastrin Vaccine Alone and in Combination With an Immune Checkpoint Antibody Inhibits Growth and Metastases of Gastric Cancer

Gastric cancer is a leading cause of cancer-related deaths worldwide. Recently, clinical studies have demonstrated that many of those with advanced gastric cancer are responsive to immune checkpoint antibody therapy, although the median survival even with these new agents is less than 12 months for advanced disease. The gastrointestinal peptide gastrin has been shown to stimulate growth of gastric cancer in a paracrine and autocrine fashion through the cholecystokinin-B receptor (CCK-BR), a receptor that is expressed in at least 56.6% of human gastric cancers. In the current investigation, we studied the role of the gastrin-CCK-BR pathway in vitro and in vivo as well as the expression of the CCK-BR in a human gastric cancer tissue array. CCK-BR and PD-L1 receptor expression and gastrin peptide was found in two murine gastric cancer cells (NCC-S1 and YTN-16) by qRT-PCR and immunocytochemistry. Treatment of NCC-S1 cells with gastrin resulted in increased growth. In vivo, the effects of a cancer vaccine that targets gastrin peptide (polyclonal antibody stimulator-PAS) alone or in combination with a Programed Death-1 antibody (PD-1 Ab) was evaluated in immune competent mice (N = 40) bearing YTN-16 gastric tumors. Mice were treated with PBS, PD-1 Ab (50 µg), PAS (250 µg), or the combination of PD-1 Ab with PAS. Tumor growth was significantly slower than controls in PAS-treated mice, and tumor growth was decreased even more in combination-treated mice. There were no metastases in any of the mice treated with PAS either alone or in combination with PD-1 Ab. Tumor proliferation by the Ki67 staining was significantly decreased in mice treated with PAS monotherapy or the combination therapy. PAS monotherapy or combined with PD-1 Ab increased tumor CD8+ T-lymphocytes and decreased the number of immunosuppressive M2-polarized tumor-associated macrophages. CCK-BR expression was identified in samples from a human tissue array by immunohistochemistry confirming the clinical relevance of this study. These results confirm the significance of the gastrin-CCK-BR signaling pathway in gastric cancer and suggest that the addition of a gastrin vaccine, PAS, to therapy with an immune checkpoint antibody may decrease growth and metastases of gastric cancer by altering the tumor microenvironment.

Efficacy of distal haemostasis during caesarean delivery in women with placenta accreta spectrum disorders

 

Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery.

METHODS

This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (n = 52), patients underwent bilateral uterine artery ligation. In Group 2 (n = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 (n = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon.

RESULTS

PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 (р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 (р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion: The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.

Discrimination of gallbladder stone employing Laser-Induced Breakdown Spectroscopy (LIBS) and Photoacoustic Spectroscopy (PAS)

Compositional analysis of gallstone samples has been carried out, using Laser-Induced Breakdown Spectroscopy (LIBS) and Photoacoustic Spectroscopy (PAS). Classification of gallstone has been made on the basis of intensities of the inorganic and organic constituents present in the LIBS spectra. A regression plot is drawn between LIBS spectral intensities of organic & inorganic elements and the stoichiometric ratio of Cholesterol, Bilirubin and Calcium Carbonate. Atomic lines of various elements, as well as molecular signatures of CaO Orange band, CN Violet band, and C₂ Swan band, are observed in LIBS spectra. The relative hardness of gallstones is estimated from the intensity ratio of ionic to neutral atomic lines of the species observed in LIBS spectra. PAS is used for detecting molecular constituents in the gallstones. Principal Component Analysis (PCA) is performed for the discrimination of gallstones. It is found that PAS data, in combination with LIBS provide a suitable method for the compositional analysis of gallstones.