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Adverse pregnancies outcomes present a clinical dilemma in Perinatal medicine. This is partly due to lack of accuracy of current biomarkers to predict high-risk pregnancies at an earlier stage. The placental alkaline phosphatase (PLAP) carrying extracellular vesicles (EVs), and their cargo have been reported as a source of biomarkers for placental health and an indication of pre-eclampsia progression. We postulate that PLAP is not only placental but also expressed in other fetal organs, suggesting that PLAP + ve EVs are not only a functional indicator of placental function alone. We evaluated PLAP in the placenta, fetal membranes, maternal decidua, myometrial cells, and the EVs derived from them. Various bioanalytical techniques were used to detect PLAP expressions in the cells and EVs. The EVs were characterized by size/quantity, PLAP as a cargo, and canonical EV protein markers. PLAP expression was determined in the chorion trophoblast cells (CTCs) of the fetal membranes and the placental trophoblasts; however, it was absent in the amnion layer of the fetal membranes and the maternal uterine cells used in this study. Using multiple experimental approaches, we further verified the cellular sources of PLAP and confirmed that the EVs from the chorion and placental trophoblasts contain PLAP. Our studies suggest that PLAP is not truly placental. Instead, cells of trophoblast lineage in both fetal membranes and the placenta express PLAP in cells and their EVs. Although PLAP + ve EVs for biomarkers are not exclusively placental, they still represent real-time fetal-specific tissues conditions during pregnancy. • PLAP carrying EVs cannot be considered as placental origin. • The cells of trophoblast lineage in both fetal membranes and the placenta express PLAP in cells and their EVs. • Maternal upper and lower uterine cells do not express PLAP and the EVs are negative for PLAP. [ABSTRACT FROM AUTHOR]

Bees are essential pollinators for many plant species, but multiple threats exist to both managed and wild bee populations. Since bee nutrition is critical for hive and colony health, their innate foraging behaviors and food preferences are the subject of extensive study. Multiple approaches have been developed to assess bee foraging behavior and associated preferences, but these approaches are often labor-intensive and provide data on a limited number of parameters. In this manuscript, we present an improved method to quantify bee foraging preferences, including the design, build, and implementation of an inexpensive and automated feeding apparatus capable of recording (1) environmental conditions, (2) species and behavior through photos and videos, (3) foraging activity, and (4) food consumption. The efficacy of this apparatus is demonstrated through preference tests with artificial nectars, while also acknowledging the limitations of this approach. [ABSTRACT FROM AUTHOR]

The pathophysiology of Crohn's-like disease of the pouch (CDP) in patients with a history of ulcerative colitis (UC) is unknown. We examined mucosal cells from patients with and without CDP using single-cell analyses. Endoscopic samples were collected from pouch body and prepouch ileum (pouch/ileum) of 50 patients with an ileal pouch-anal anastomosis. Single-cell RNA sequencing was performed on pouch/ileal tissues of patients with normal pouch/ileum and CDP. Mass cytometry was performed on mucosal immune cells from patients with UC with normal pouch/ileum, CDP, pouchitis, and those with familial adenomatous polyposis after pouch formation. Findings were independently validated using immunohistochemistry. The cell populations/states in the pouch body differed from those in the prepouch ileum, likely secondary to increased microbial burden. Compared with the familial adenomatous polyposis pouch, the UC pouch was enriched in colitogenic immune cells even without inflammation. CDP was characterized by increases in T helper 17 cells, inflammatory fibroblasts, inflammatory monocytes, TREM1+ monocytes, clonal expansion of effector T cells, and overexpression of T helper 17 cells–inducing cytokine genes such as IL23 , IL1B , and IL6 by mononuclear phagocytes. Ligand-receptor analysis further revealed a stromal-mononuclear phagocytes-lymphocyte circuit in CDP. Integrated analysis showed that up-regulated immune mediators in CDP were similar to those in CD and pouchitis, but not UC. Additionally, CDP pouch/ileum exhibited heightened endoplasmic reticulum stress across all major cell compartments. CDP likely represents a distinct entity of inflammatory bowel disease with heightened endoplasmic reticulum stress in both immune and nonimmune cells, which may become a novel diagnostic biomarker and therapeutic target for CDP. [Display omitted] The pathophysiology of Crohn's-like disease of the pouch in patients with a prior history of ulcerative colitis is revealed and new targets to better treat this challenging condition are identified. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What is the accuracy of DeltaScan; a portable brain state monitor that offers real-time automated artifact rejection and analysis, delivering a probability score for both acute encephalopathy and delirium in both ICU and non-ICU patients? • What is the main finding of this study? The device can detect acute encephalopathy and delirium with good discrimination statistics especially in older patients, regardless of their postoperative state, psycho-active medication use, or prior psychiatric history. • What is the meaning of the finding? The study suggests that the DeltaScan could be a valuable tool for improving delirium monitoring practices, given that delirium is often overlooked, difficult to differentiate from other psychiatric disorders, and current questionnaire-based monitoring tools suffer from inter-rater variability. To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs). Prospective cross-sectional study. Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals. 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious. DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets. Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus. DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity. DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes. [ABSTRACT FROM AUTHOR]

The Paris System (TPS) provides a uniform reporting system of urine cytology based on well-defined cytologic criteria. Due to their rarity, there are limited data on the utility of TPS in upper urinary tract (UUT) lesions and follow-up histology of cases with abnormal cytology. We aimed to evaluate the utility of TPS for UUT lesions by correlating the cytologic diagnoses using TPS criteria with subsequent histology. Additionally, the diagnostic utility of UroVysion (Abbott) fluorescence in situ hybridization (FISH) was assessed. A total of 148 UUT cytology specimens were retrospectively identified (2018-2022). Cytologic interpretation was performed using TPS, and then correlated with the findings of concurrent or subsequent histologic specimens. The performance of UroVysion FISH was analyzed. Sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade urothelial carcinoma (HGUC) were determined. Among 83 patients who had concurrent or subsequent histologic specimens, cyto-histologic discrepancy was seen in 7 cases (8.4%). The sensitivity, specificity, PPV, and NPV using TPS criteria for detecting HGUC were 87%, and 92%, 96.4%, and 73%, respectively. UroVysion FISH was performed in 21 patients with atypical cytologic findings. The sensitivity and specificity of UroVysion for detecting HGUC was 75% and 86%, respectively, while PPV and NPV were 86% and 75%, respectively. In our experience, the application of TPS criteria for reporting upper urinary cytology was reliable at detecting UUT lesions, especially HGUC. UroVysion FISH was a valuable ancillary test for detecting HGUC of UUT. • The Paris System (TPS) for reporting urinary cytology is a standardized, evidence-based reporting system and particularly focuses on the detection of high grade urothelial carcinoma. However, limited studies on the utility of TPS in upper urinary tract (UUT) lesions and follow-up histology of cases with abnormal cytology are available. • In this 5-year retrospective study, we described our experience of upper urinary tract cytology specimens with cytologic interpretation using TPS, and further correlated with histology findings and UroVysion FISH test. • A total of 83 patients had concurrent or subsequent histologic specimens and cyto-histologic discrepancy was seen in 9 cases (10.8%). The sensitivity and specificity using TPS criteria for detecting HGUC were 82% and 92%, respectively. • UroVysion FISH was performed in 21 patients with atypical cytologic findings. The sensitivity and specificity of UroVysion for detecting HGUC of UUT was 75% and 86%, respectively. [ABSTRACT FROM AUTHOR]

MicroRNA-19 (miR-19) plays a critical role in cardiac development and cardiovascular disease (CVD). We examined whether change in circulating miR-19 was associated with change in CVD risk during weight loss. This study included 509 participants with overweight or obesity from the 24-month weight-loss diet intervention study (the POUNDS Lost trial) and with available data on circulating miR-19a-3p and miR-19b-3p at baseline and 6 months. The primary outcome for this analysis was the change in atherosclerotic CVD (ASCVD) risk at 6 and 24 months, which estimates the 10-year probability of hard ASCVD events. Secondary outcomes were the changes in ASCVD risk score components. Circulating miR-19a-3p and miR-19b-3p levels significantly decreased during the initial 6-month dietary intervention period (P = 0.008, 0.0004, respectively). We found that a greater decrease in miR-19a-3p or miR-19b-3p was related to a greater reduction in ASCVD risk (β[SE] = 0.33 [0.13], P = 0.01 for miR-19a-3p; β[SE] = 0.3 [0.12], P = 0.017 for miR-19b-3p) over 6 months, independent of concurrent weight loss. Moreover, we found significant interactions between change in miR-19 and sleep disturbance on change in ASCVD risk over 24 months of intervention (P interaction = 0.01 and 0.008 for miR-19a-3p and miR-19b-3p, respectively). Participants with a greater decrease in miR-19 without sleep disturbance had a greater reduction of ASCVD risk than those with slight/moderate/great amounts of sleep disturbance. In addition, change in physical activity significantly modified the associations between change in miR-19 and change in ASCVD risk over 24 months (P interaction = 0.006 and 0.004 for miR-19a-3p and miR-19b-3p, respectively). A greater decrease in miR-19 was significantly associated with a greater reduction in ASCVD risk among participants with an increase in physical activity, while non-significant inverse associations were observed among those without an increase in physical activity. In conclusion, decreased circulating miR-19 levels during dietary weight-loss interventions were related to a significant reduction in ASCVD risk, and these associations were more evident in people with no sleep disturbance or increase in physical activity. ClinicalTrials.gov NCT00072995. [ABSTRACT FROM AUTHOR]

Pre-eclampsia with severe features (severe PreE) is associated with heart dysfunction, yet the impact beyond pregnancy, including its association with cardiomyopathic genetic polymorphisms, remains poorly understood. We aimed to characterize the temporal impact of severe PreE on heart function through the 4th trimester in women with and without deleterious cardiomyopathic genetic variants. Pregnant women were enrolled to undergo transthoracic echocardiography (TTE) in late pregnancy and 3 months postpartum. In women with severe PreE a targeted approach to identify pathogenic cardiomyopathic genetic polymorphisms was undertaken, and heart function was compared in carriers and noncarriers. Pregnant women (32 ± 4 years old, severe PreE = 14, control = 8) were enrolled between 2019 - 2021. Women with severe PreE displayed attenuated myocardial relaxation (mitral e' = 11.0 ± 2.2 vs 13.2 ± 2.3 cm/sec, P <.05) in late pregnancy, and on in-silico analysis, deleterious cardiomyopathic variants were found in 58%. At 103 ± 33 days postpartum, control women showed stability in myocardial relaxation (Mitral e' Entry: 13.2 ± 2.3 vs Postpartum: 13.9 ± 1.7cm/sec, P =.464), and genetic negative severe PreE women (G−) demonstrated recovery of diastolic function to control level (Mitral e' Entry: 11.0 ± 3.0 vs Postpartum 13.7 ± 2.8cm/sec, P <.001), unlike their genetic positive (G+) counterparts (Mitral e' Entry: 10.5 ± 1.7 vs Postpartum 10.8 ± 2.4cm/sec, P =.853). Postpartum recovery of heart function after severe PreE is attenuated in women with deleterious cardiomyopathic genetic polymorphisms. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Gill lice Salmincola spp. are among the most widely reported parasites of freshwater salmonids and have been associated with recent declines in native Brook Trout Salvelinus fontinalis populations. Effective gill lice surveillance is vital for salmonid conservation success, but current survey approaches are often inadequate or problematic. We developed an environmental DNA (eDNA)‐based approach to detect the gill louse Salmincola edwardsii and explored the viability of this approach as a management tool for rapid, large‐scale gill lice surveillance at Fort McCoy, Wisconsin, USA. Methods: Reference sequences were generated from gill lice specimens collected at Fort McCoy to confirm their identify as S. edwardsii and used to design a quantitative polymerase chain reaction (qPCR) assay that targets S. edwardsii mitochondrial cytochrome c oxidase I (COI). Assay validation included in silico and in vitro sensitivity and nontarget specificity testing, and assay performance was validated in situ by sampling eDNA at sites characterized via electrofishing. Result: Molecular analysis of reference sequences confirmed S. edwardsii identity while also providing the first multi‐population assessment of genetic variation for North American Salmincola and the most taxonomically comprehensive molecular phylogeny of Lernaeopodidae to date. Salmincola edwardsii eDNA was detected at 14 of 38 sites, including 12 of 14 sites with known active infestations, with no evidence that the odds of detecting gill lice via electrofishing was greater than the odds of detections from eDNA analysis. Brook Trout presence was highly predictive of gill lice eDNA site occupancy, concordant with S. edwardsii being an obligate parasite of Salvelinus fishes. However, by expanding survey coverage via eDNA analysis, we were able to identify an isolated drainage with Brook Trout where S. edwardsii is apparently absent, confirming electrofishing observations. Conclusion: These results suggest that eDNA analysis is equivalent to electrofishing for detecting gill lice in terms of performance yet offers substantial gains in survey efficiency. Further, this study demonstrates how eDNA analysis can provide valuable intel for directing management efforts, especially when used to expand survey coverage and prioritize follow‐up conventional surveys to assess host–parasite abundance, demographics, and status. Impact statementEnvironmental DNA analysis can accurately detect gill lice, providing fisheries managers with a rapid, cost‐effective, and non‐invasive survey tool to improve understanding and management of gill lice epizootics and their impacts on vulnerable freshwater salmonids. [ABSTRACT FROM AUTHOR]

Background: Optimization of perioperative pain interventions in lumbar spine surgery could reduce the incidence of acute and persistent postoperative pain and opioid consumption. Standardization in early outcome measurement provides a solid foundation for future clinical and research practices and should be integrated in core outcome sets for long-term treatment outcome evaluations. This scoping review provides an overview of outcomes used when evaluating early perioperative pain interventions after lumbar spine surgery.Objectives: To create an overview of outcome domains and measurement instruments previously used in research on perioperative pain management for degenerative lumbar spine surgery.Evidence Review: A scoping review was performed to identify articles comprising outcome evaluations in adult patients who undergo degenerative lumbar spine surgery, mentioning perioperative pain interventions. 75 articles were included for review. Data on study characteristics, outcome domains and measurement instruments were extracted and structured using the three-tiered hierarchy of Porter.Findings: 12 outcome domains were identified: pain intensity (93.3%), adverse events (76%), analgesic consumption (70.7%), length of stay (52%), patient satisfaction (24%), daily functioning (22.7%), (early) mobilization (22.7%), quality of life (12%), mortality (9.3%), quality of recovery (6.7%), physical function (4%), and quality of sleep (2.7%). 63 corresponding measurement instruments were found.Conclusions: This review portrays an extensive overview of outcome measurements used in perioperative pain management in lumbar spine surgery. A lack of consensus on the set of indicators exists. This scoping review is a call for action to create consensus on how to evaluate perioperative pain interventions in degenerative lumbar spine surgery. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia is associated with maternal and perinatal morbidity. Besides acute therapy for severe hypertension, best practices are lacking for intrapartum hypertension management. Our objective was to test the hypothesis that intrapartum initiation of extended-release nifedipine in individuals with preeclampsia with severe features prevents severe hypertension. Methods: Randomized, triple-blind, placebo-controlled trial of individuals with preeclampsia with severe features undergoing labor induction between 220/7 and 416/7 weeks gestation. Participants were randomized to oral extended-release nifedipine 30 mg or identical placebo every 24 hours. Primary outcome is defined as receipt of ≥1 dose of acute hypertension therapy for severe blood pressure (≥160/110 mm Hg) sustained ≥10 minutes. Secondary outcomes included route of delivery, neonatal intensive care unit admission, and a composite of adverse neonatal outcomes. Results: Of 365 individuals screened, 55 were randomized to nifedipine and 55 to placebo. Primary outcome was observed in 34.0% of individuals in nifedipine group versus 55.1% in placebo group (relative risk [RR] 0.62 [95% CI, 0.39–0.97]); number needed to treat to prevent receipt of acute treatment was 4.7 (95% CI, 2.5–44.3). Fewer individuals in nifedipine group required cesarean delivery compared with placebo group (20.8% versus 34.7%, RR, 0.60 [95% CI, 0.31–1.15]). Neonatal intensive care unit admission rate was lower in nifedipine group compared with placebo (29.1% versus 47.1%; RR 0.62 [95% CI, 0.37–1.02]). Neonatal composite was similar between groups (35.8% versus 41.2%, RR, 0.83 [95% CI, 0.51–1.37]). Conclusions: Initiation of extended-release nifedipine is effective in reducing intrapartum acute hypertensive therapy among individuals with preeclampsia with severe features. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04392375. [ABSTRACT FROM AUTHOR]

This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population. Semi-structured focus groups were conducted with eight survivors in Southern California who interacted with the healthcare system while being sex trafficked. Interviews were audio- and/or video-recorded and transcribed verbatim. The analysis utilized a grounded theory approach, where researchers reviewed the data collected, then inductively generated codes and themes based on the findings from the interviews. The focus group interviews revealed the following themes: unequal treatment, barriers to patient care, risk identifiers, support, and survivor recommendations. Youth survivors seeking healthcare reported multiple barriers based on their interaction with healthcare providers, such as the lack of provider awareness, education, training, feelings of shame, judgment, fear, racial biases, and lack of empathy. Improving patient outcomes relies on understanding the complexities of human trafficking and implementing an approach to decrease barriers to care. This study resulted in invaluable survivor recommendations with practical solutions on addressing human trafficking and exploitation in the healthcare system. The solutions proposed by participants included strengthening relationships and experiences with healthcare providers by increasing awareness, establishing rapport, creating a safe space, asking questions about their safety and situation, using a non-judgmental approach, and providing resources. • Youth survivors reported multiple barriers to healthcare. • Accurate education and training are essential to identification and response. • Survivors recommended a non-judgmental approach and assurance of safety. • Survivors emphasized the need for more questioning about their experiences. • Access to mental health resources is needed both during and after exploitation. [ABSTRACT FROM AUTHOR]

Peripartum care coordination for the obstetric patient on medications for opioid use disorder (OUD) can be challenging and is best accomplished by a multidisciplinary team. The benefits of buprenorphine, methadone, or naltrexone initiation or continuation in pregnancy are well established and beyond the scope of this commentary; instead, we narrow the focus on planning for sufficient pain management in labor and during recovery from cesarean delivery. Conversations about postoperative pain management should begin in the antepartum period, and likely do for the 15%–20% of individuals with a history of cesarean delivery who schedule a repeat cesarean. Nevertheless, 18%–20% of pregnant individuals deliver via primary cesarean delivery, underscoring the need for universal antepartum counseling on the possibility of undergoing and recovering from an unanticipated major abdominal surgery. The optimal intrapartum and postpartum pain regimen for individuals with OUD remains incompletely characterized as research on this topic is limited. Enhanced understanding of the unique needs of postpartum individuals with OUD will aid in closing knowledge gaps and elevate the standard of care in this population. [ABSTRACT FROM AUTHOR]

Objective: To compare healthcare and productivity costs between patients with mild traumatic brain injury (mTBI) who received verbal discharge instructions only and patients who received an additional flyer with or without video instructions. Setting: Emergency departments (EDs) of 6 hospitals in the Netherlands. Participants: In total, 1155 adult patients with mTBI (384 with verbal instructions; 771 with additional flyer with or without video instructions) were included. Design: Cost study with comparison between usual care and intervention. Methods: Medical and productivity costs up to 3 months after presentation at the ED were compared between mTBI patients with usual care and mTBI patients who received the intervention. Results: Mean medical costs per mTBI patient were slightly higher for the verbal instructions–only cohort (€337 vs €315), whereas mean productivity costs were significantly higher for the flyer/video cohort (€1625 vs €899). Higher productivity costs were associated with higher working age, injury severity, and postconcussion symptoms. Conclusion: This study showed that the implementation of flyer (and video) discharge instructions for patients with mTBI who present at the ED increased reports of postconcussion symptoms and reduced medical costs, whereas productivity costs were found to be higher for the working population in the first 3 months after the sustained head injury. [ABSTRACT FROM AUTHOR]

Background: Untreated opioid misuse in pregnancy is associated with adverse outcomes. Limited information is available on maternal and perinatal outcomes in subsequent pregnancies for individuals initiated on medication for opioid use disorder (MOUD) in a prior pregnancy. Objective: Evaluate maternal and neonatal outcomes in subsequent pregnancies for individuals initiated on MOUD in prior pregnancy. Methods: Historical cohort study including individuals with opioid use disorder with ≥2 pregnancies between 2013 and 2020, received care in our colocated multidisciplinary clinic for >1 pregnancy, and delivered at our institution. Primary outcome was rate of preconception MOUD. Secondary outcomes included rate of neonatal opioid withdrawal syndrome requiring pharmacologic treatment and length of hospital stay. Results: Forty-two individuals with opioid use disorder in their index pregnancies (n = 42) and 46 subsequent pregnancies were identified. Individuals were more likely to receive long-acting reversible contraception in subsequent pregnancies (35% vs 14%, P = 0.04). No differences in tobacco use, gestational age at initiation of prenatal care or delivery was noted. Individuals in their subsequent pregnancies were 6 times more likely to be on MOUD preconception (78% vs 36%; OR, 6.48; [95% CI, 2.52–16.64]) and 67% less likely to have positive illicit urine drug screen upon initiation of care (36% vs 64%; OR, 0.33; 95% [CI, 0.14–0.78]). Neonates had similar rates of neonatal abstinence withdrawal syndrome requiring pharmacological treatment, positive illicit toxicology results, and neonatal length of stay. Conclusions: Participation in multidisciplinary obstetric and opioid use disorder program increases rate of MOUD in subsequent pregnancy with decrease in illicit drug use. [ABSTRACT FROM AUTHOR]

Managing pregnant individuals with acute respiratory disease secondary to COVID-19 has been a challenge. Most professional societies including the Society for Maternal-Fetal Medicine recommend keeping O2 saturation at ≥95% in pregnant individuals. Reaching this target has been increasingly difficult in some patients, especially during the latest wave of infections attributed to the delta variant of SARS-CoV-2. In the absence of adequate supporting data, and in the setting of a reassuring fetal status, we propose that maternal O2 saturation should be maintained between 92% and 96% for admitted patients with acute respiratory failure who require supplemental O2. This may prevent unnecessary invasive interventions that might not hold maternal or fetal benefit, specifically at very preterm gestational ages. [ABSTRACT FROM AUTHOR]