Determinants of Severe Maternal Morbidity and Its Racial/Ethnic Disparities in New York City, 2008–2012

Abstract

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008–2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences.

http://bit.ly/2UyX3aj

Improved perioperative outcomes by early unclamping prior to renorrhaphy compared with conventional clamping during robot-assisted partial nephrectomy: a propensity score matching analysis

Abstract

The objective of this study was to evaluate the impact of the early unclamping (EU) technique on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy (RAPN). This study included 96 patients with small renal masses who underwent RAPN performed by a single surgeon using the da Vinci Xi between April 2016 and September 2018. EU and conventional clamping (CC) procedures were defined as those removing the renal artery clamp before and after renorrhaphy, respectively. In this series, contrast-enhanced computed tomography was performed 3–5 days after RAPN to examine the incidence of renal artery pseudoaneurysm (RAP). After adjusting patient variables by 1:1 propensity score matching, 45 patients were included in both the EU and CC groups, and no significant differences in major clinical characteristics were noted between these two groups. Although there was no significant difference in the proportion of patients achieving trifecta or the margin, ischemia and complications score between the two groups, the EU group was significantly superior to the CC group regarding the operative time, console time, warm ischemia time, impairment of renal function 1 day after RAPN, incidence of RAP and postoperative length of hospital stay. Furthermore, RAP occurred in seven patients in the entire cohort (13.3%) receiving CC, including two who required trans-arterial embolization due to severe macrohematuria, whereas RAP was completely prevented by the use of EU. The introduction of the EU technique to RAPN may improve perioperative outcomes, particularly by markedly reducing the risk of RAP even with renorrhaphy.

http://bit.ly/2HK7pmh

C-reactive protein misdiagnoses delayed postoperative spinal implant infections in patients with low-virulent microorganisms

Abstract

Purpose

C-reactive protein (CRP) has been shown to be a powerful parameter for detecting acute postoperative spinal implant infections (PSII) with a high sensitivity and specificity. However, little data are available on the performance of CRP in the diagnosis of delayed PSII. The aim of the current study was therefore to establish cutoff values for diagnosing delayed infection based on serum CRP.

Methods

All patients who underwent a revision surgery after instrumented spinal fusion from January 2013 through January 2016 were included. Demographic data, laboratory values, type of infection (including microbiological and pathological results), comorbidities and clinical manifestation were collected. The European Bone and Joint Infection Society criteria, proposed to diagnose periprosthetic joint infection, were used to diagnose PSII.

Results

A total of 257 patients were included. PSII was diagnosed in 61 patients, representing 24% of the study cohort. There was a significant difference in serum CRP levels between septic and aseptic cohorts (19.3 vs. 4.8 mg/l, p < 0.001). However, 26 patients (43%) from the PSII group had a normal (< 5 mg/l) serum CRP level prior to revision surgery. According to the ROC curve, a serum CRP threshold of 4.05 mg/l had a sensitivity of 64% and specificity of 68%. The most common isolated microorganism was Propionibacterium spp. followed by coagulase-negative staphylococci.

Conclusion

Serum CRP showed low sensitivity and specificity for diagnosis of delayed PSII, even after applying cutoffs optimized by using receiver operating curve analysis, because of the high incidence of low-virulent pathogens.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2HNDBVU

Soil Microbial Metabolic Activity and Community Structure in Drip-Irrigated Calcareous Soil as Affected by Irrigation Water Salinity

Abstract

Saline water irrigation can dramatically change the soil environment and thereby influence soil microbial processes. The objective of this field experiment was to use Biolog and high-throughput sequencing methods to evaluate the metabolic activity and community structure of soil microorganisms after 9 years of saline water irrigation. The results showed that brackish and saline water irrigation significantly increased soil bulk density and salinity, but significantly decreased soil pH, TN, SOM, MBC, and metabolic activity. The Biolog tests of sole-carbon-source utilization indicated that the brackish and saline water treatments significantly reduced the utilization of four carbohydrate sources (D-cellobiose, β-methyl-d-glucoside, D-mannitol, and glucose-1-phosphate), two amino acid sources (L-asparagine and glycyl-L-glutamic acid), two carboxylic acid sources (D-galacturonic acid and D-malic acid), and two polymer sources (Tween 80 and glycogen). Brackish and saline water increased soil bacterial richness (ACE and Chao 1 indices) but had no effect on which bacterial phyla were present. Brackish and saline irrigation water significantly increased the relative abundance of four dominant bacterial phyla (Gemmatimonadetes, Actinobacteria and Chloroflexi, Saccharibacteria). In contrast, the relative abundance of five dominant phyla (Proteobacteria, Acidobacteria, Nitrospirae, Planctomycetes, and Verrucomicrobia) was reduced by brackish and saline irrigation water. Our study suggests that soil bacterial community will form significant differences species under different irrigation water salinity, which can adapt to saline stress by adjusting the species composition. The results of this study increase understanding about the potential effects of saline water irrigation on soil biological processes.

http://bit.ly/2CYPVNa

High-resolution direct position determination based on eigenspace using a single moving ULA

Abstract

High-resolution direct position determination (DPD) using a single moving uniform linear array is considered. In this paper, we firstly propose an improved DPD model based on eigenspace. This model exploits both signal subspaces and noise subspaces which results in higher resolution than those utilizing minimum variance distortionless response, multiple signal classification or subspace fitting. In order to achieve rapid and high precision localization, a hybrid calculation algorithm which combines particle swarm optimization using a ring topology and Broyden–Fletcher–Goldfarb–Shanno is proposed. This algorithm can extract multiple emitter positions with less computational complexity. We combine the improved DPD model and the hybrid calculation algorithm and examine its performance via numerical simulations. The results show that the proposed method can reach Cramer–Rao lower bound when the signal-to-noise ratio is moderate.

http://bit.ly/2t0GYyj

Residual inhibition: from the putative mechanisms to potential tinnitus treatment

Publication date: Available online 1 February 2019

Source: Hearing Research

Author(s): A.V. Galazyuk, R.J. Longenecker, S.V. Voytenko, I. Kristaponyte, G.L. Nelson

Abstract

Neurons in various sensory systems show some level of spontaneous firing in the absence of sensory stimuli. In the auditory system spontaneous firing has been shown at all levels of the auditory pathway from spiral ganglion neurons in the cochlea to neurons of the auditory cortex. This internal “noise” is normal for the system and it does not interfere with our ability to perceive silence or analyze sound. However, this internal noise can be elevated under pathological conditions, leading to the perception of a phantom sound known as tinnitus. The efforts of many research groups, including our own, led to the development of a mechanistic understanding of this process: After cochlear insult the input to the central auditory system becomes markedly reduced. As a result, the neural activity in the central auditory system is enhanced to compensate for this reduced input. Such hyperactivity is hypothesized to be interpreted by the brain as a presence of sound. This implies that suppression of hyperactivity should reduce/eliminate tinnitus. This review explores research from our laboratory devoted to identifying the mechanism underlying residual inhibition of tinnitus, a brief suppression of tinnitus following a sound stimulus. The key mechanisms that govern neural suppression of spontaneous activity in animals closely resemble clinical psychoacoustic findings of residual inhibition (RI) observed in tinnitus patients. This suppression is mediated by metabotropic glutamate receptors (mGluRs). Lastly, drugs targeting mGluRs suppress spontaneous activity in auditory neurons and reduce/eliminate behavioral signs of tinnitus in mice. Thus, these drugs are therapeutically relevant for tinnitus suppression in humans.

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Neuroprotective effects of MK-801 on auditory cortex in salicylate-induced tinnitus: involvement of neural activity, glutamate and ascorbate

Publication date: Available online 1 February 2019

Source: Hearing Research

Author(s): Shan Xiong, Yu Song, Junxiu Liu, Yali Du, Yujing Ding, Huan Wei, Kevin Bryan, Furong Ma, Lanqun Mao

Abstract

Tinnitus may cause anxiety, depression, insomnia, which impair the quality of life of millions worldwide. However, the mechanism of tinnitus remains to be understood, it has been previously hypothesized that the activation of N-methyl-D-aspartate (NMDA) receptor is involved in the tinnitus processes and blockade of the NMDA receptor is regarded as a therapeutic strategy for tinnitus treatment even if the rescue treatment is still proved invalid in some cases. To demonstrate the therapeutic effect of the NMDA receptor blocker on tinnitus, we examined here the spontaneous firing rate (SFR) and the neurochemical dynamics in the auditory cortex (AC) of rats after sodium salicylate (SS) injection, which is a widely used model for tinnitus research. We also recorded their responses to MK-801 treatment. Electrophysiological studies showed that MK-801 significantly suppresses SFR in AC of rats with SS-induced tinnitus. In addition, by using a technique that combining in vivo microdialysis with an online electrochemical system (OECS) and a high-performance liquid chromatography (HPLC), we found that the levels of both glutamate and ascorbate in AC dramatically increased after SS injection and that MK-801 administration attenuated those response. Further studies found that MK-801 given at a time point of 30 min pre- or post- injection of SS were more effective than that given at a time point of 60 min post-SS injection, indicating that the time point of MK-801 intervention has a critical impact on the therapeutic effect. These findings suggest that MK-801 plays a neuroprotective role against hyperactivity during tinnitus induced by SS and that the therapeutic effect depends on the time point of MK-801 intervention, which would advance the studies on understanding of the therapeutic potential of NMDA receptor antagonist in tinnitus therapy.

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