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Septic abortion can lead to severe maternal morbidity and mortality. The management of septic abortion can be complicated by a history of radical trachelectomy and transabdominal cerclage placement. A 33-year-old G1P0 at 17 weeks and 6 days gestation presented in severe septic shock after being diagnosed 6 days prior with previable rupture of membranes at an outside hospital and managed expectantly. History was notable for cervical adenocarcinoma status post radical trachelectomy and transabdominal cerclage placement. Due to uterine occlusion from the cerclage, the patient underwent emergent uterine evacuation via an abdominal approach. The risks and benefits of expectant management of pre-viable rupture of membranes in patients with abdominal cerclage should be weighed very cautiously. Among women with abdominal cerclage for whom uterine evacuation is indicated, a transabdominal approach may be necessary.

A rare subclass of Type Ia supernovae (SNe Ia), named after the prototype SN 2003fg, includes some of the brightest SNe Ia, often called 'super Chandrasekhar-mass' SNe Ia. We calculate the |$\gamma$| -ray deposition histories and the |$^{56}$| Ni mass synthesized in the explosion, |$M_\mathrm{Ni56}$|⁠ , for eight 2003fg-like SNe. Our findings reveal that the |$\gamma$| -ray escape time, |$t_0$|⁠ , for these objects is |$t_0\approx 45\!-\!60 \,$| d, significantly higher than that of normal SNe Ia. 2003fg-like SNe are distinct from normal SNe Ia in the |$t_0$| – |$M_\mathrm{Ni56}$| plane, with a noticeable gap between the two populations. The observed position of 2003fg-like SNe in this plane poses a significant challenge for theoretical explosion models. We demonstrate that the merger of two white dwarfs (WDs) and a single star exceeding the Chandrasekhar limit fail to reproduce the observed |$t_0$| – |$M_\mathrm{Ni56}$| distribution. However, preliminary calculations of head-on collisions of massive WDs show agreement with the observed |$t_0$| – |$M_\mathrm{Ni56}$| distribution. [ABSTRACT FROM AUTHOR]

Background/Objective: Transcatheter aortic valve replacement (TAVR) is indicated for severe aortic stenosis patients with a prohibitive surgical risk. However, its use has been expanding in recent years to include intermediate- and low-risk patients. Thus, registry data describing changes in patient characteristics and outcomes are needed. The aim of this study was to analyse the temporal changes in patient profiles and clinical outcomes of all-comer TAVR. Methods: Baseline characteristics and VARC-3 outcomes of 1632 consecutive patients undergoing TAVR between 2008 and 2021 were analysed. Results: The annual rate of TAVR increased from 30 procedures in 2008–2009 to 398 in 2020–2021. Over the follow-up period, patient age decreased from 85 ± 4 to 80 ± 6.8 (p < 0.001) and the STS score decreased from 5.9% to 2.8% (p < 0.001). Procedural characteristics significantly changed, representing a shift into a minimally invasive approach: adoption of local anaesthesia (none to 48%, p < 0.001) and preference of transfemoral access (74% in 2011–2012 vs. 94.5% in 2020–2021, p < 0.001). The rates of almost all procedural complications decreased, including major vascular and bleeding complications, acute kidney injury (AKI) and in-hospital heart failure. There was a striking decline in rates of complete atrioventricular block (CAVB) and the need for a permanent pacemaker (PPM). PPM rates, however, remain high (17.8%). Thirty-day and one-year mortality significantly declined to 1.8% and 8.3%, respectively. Multivariable analysis shows that AKI, bleeding and stroke are strong predictors of one-year mortality (p < 0.001). Conclusions: The TAVR procedure has changed dramatically during the last 14 years in terms of patient characteristics, procedural aspects and device maturity. These shifts have led to improved procedural safety, contributing to improved short- and long-term patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: External beam radiotherapy is one of the treatment options for organ-confined prostate cancer. A total dose of 70 to 81 Gray (Gy) is given daily (1.8-2.5 Gy/d), with a dose rate of 3 to 6 Gy/min over 28 to 45 treatments during 8 to 9 weeks. We applied the latest technological development in linear accelerators for enabling a wide range of dose rates (from 0.2-21 Gy/min) to test the effect of different delivery dose rates on prostate tumor growth in an animal xenograft model. Materials and Methods: A prostate cancer xenograft model was established in CD1/nude mice by means of PC-3 and CL-1 cells. The animals were radiated by a TrueBeam linear accelerator that delivered 4 dose rates ranging from 0.6 to 14 Gy/min, and reaching a total dose of 20 Gy. The mice were weighed and monitored for tumor development twice weekly. A 2-way analysis of variance was used to compare statistical differences between the groups. Results: Tumor growth was inhibited by radiation at all 4 dose rates in the 20 study mice compared to no radiation (n = 5, controls). The most significant reduction in tumor volumes was observed when the same dose of radiation was delivered at a rate of 0.6 Gy/min ( P < .01). The animals’ weights were not affected by any dose rate. Conclusions: Delivery of radiation with a TrueBeam linear accelerator at the lowest possible rate was most effective in prostate cancer growth inhibition and might be considered a preferential treatment mode for localized prostate cancer.

The SH0ES collaboration Hubble constant determination is in a ∼5σ difference with the Planck value, known as the Hubble tension. The accuracy of the Hubble constant measured with extragalactic Cepheids depends on robust stellar-crowding background estimation. Riess et al. (R20) compared the light-curve amplitudes of extragalactic and MW Cepheids to constrain an unaccounted systematic blending bias, |$\gamma =-0.029\pm 0.037\, \rm {mag}$|⁠ , which cannot explain the required, |$\gamma =0.24\pm 0.05\, \rm {mag}$|⁠ , to resolve the Hubble tension. Further checks by Riess et al. demonstrate that a possible blending is not likely related to the size of the crowding correction. We repeat the R20 analysis, with the following main differences: (1) we limit the extragalactic and MW Cepheids comparison to periods |$P\lesssim 50\, \rm {d}$|⁠ , since the number of MW Cepheids with longer periods is minimal; (2) we use publicly available data to recalibrate amplitude ratios of MW Cepheids in standard passbands; (3) we remeasure the amplitudes of Cepheids in NGC 5584 and NGC 4258 in two Hubble Space Telescope filters (F 555 W and F 350 LP) to improve the empirical constraint on their amplitude ratio A 555/ A 350. We show that the filter transformations introduce an |${\approx }0.04\, \rm {mag}$| uncertainty in determining γ, not included by R20. While our final estimate, |$\gamma =0.013\pm 0.057\, \rm {mag}$|⁠ , is consistent with the value derived by R20 and is consistent with no bias, the error is somewhat larger, and the best-fitting value is shifted by |${\approx }0.04\, \rm {mag}$| and closer to zero. Future observations, especially with JWST , would allow better calibration of γ. [ABSTRACT FROM AUTHOR]

We present the discovery and analysis of SN 2022oqm, a Type Ic supernova (SN) detected <1 day after the explosion. The SN rises to a blue and short-lived (2 days) initial peak. Early-time spectral observations of SN 2022oqm show a hot (40,000 K) continuum with high ionization C and O absorption features at velocities of 4000 km s−1, while its photospheric radius expands at 20,000 km s−1, indicating a pre-existing distribution of expanding C/O material. After ∼2.5 days, both the spectrum and light curves evolve into those of a typical SN Ic, with line velocities of ∼10,000 km s−1, in agreement with the evolution of the photospheric radius. The optical light curves reach a second peak at t ≈ 15 days. By t = 60 days, the spectrum of SN 2022oqm becomes nearly nebular, displaying strong Ca ii and [Ca ii ] emission with no detectable [O i ], marking this event as Ca-rich. The early behavior can be explained by 10−3 M ⊙ of optically thin circumstellar material (CSM) surrounding either (1) a massive compact progenitor such as a Wolf–Rayet star, (2) a massive stripped progenitor with an extended envelope, or (3) a binary system with a white dwarf. We propose that the early-time light curve is powered by both the interaction of the ejecta with the optically thin CSM and shock cooling (in the massive star scenario). The observations can be explained by CSM that is optically thick to X-ray photons, is optically thick in the lines as seen in the spectra, and is optically thin to visible-light continuum photons that come either from downscattered X-rays or from the shock-heated ejecta. Calculations show that this scenario is self-consistent. [ABSTRACT FROM AUTHOR]

Botrytis cinerea is a necrotrophic fungal plant pathogen that causes grey mould and rot diseases in many crops. Here, we show that the B. cinerea BcCrh4 transglycosylase is secreted during plant infection and induces plant cell death and pattern‐triggered immunity (PTI), fulfilling the characteristics of a cell death‐inducing protein (CDIP). The CDIP activity of BcCrh4 is independent of the transglycosylase enzymatic activity, it takes place in the apoplast and does not involve the receptor‐like kinases BAK1 and SOBIR1. During saprophytic growth, BcCrh4 is localized in the endoplasmic reticulum and in vacuoles, but during plant infection, it accumulates in infection cushions (ICs) and is then secreted to the apoplast. Two domains within the BcCrh4 protein determine the CDIP activities: a 20aa domain at the N′ end activates intense cell death and PTI, while a stretch of 52aa in the middle of the protein induces a weaker response and suppresses the activity of the 20aa N′ domain. Deletion of bccrh4 affected fungal development and IC formation in particular, resulting in reduced virulence. Collectively, our findings demonstrate that BcCrh4 is required for fungal development and pathogenicity, and hint at a dual mechanism that balances the virulence activity of this, and potentially other CDIPs. Summary statement: 1.The Botrytis cinerea transglycosylase BcCrh4 is an apoplastic effector with weak and hyperactive cell death‐inducing domains. The protein is recognized and activates the plant defence system, but the perception and signalling do not involve the receptor‐like kinases BAK1 and SOBIR1 complex.2.Two domains within the BcCrh4 protein determine activation of cell death and pattern‐triggered immunity: a 20‐amino‐acid domain located at the N′ end activates intense cell death and plant immunity, while a stretch of 52 amino acids located in the middle of the protein has a weak cell death‐inducing activity. The two domains probably compete on the same plant target hence the full‐length protein has a milder cell death and plant immunity‐inducing activity than that of the 20 amino acids domain alone. [ABSTRACT FROM AUTHOR]

Background: Low serum magnesium (sMg) is associated with cardiovascular risk factors and atherosclerotic disease. Objective: To evaluate the association between sMg levels on admission and clinical outcomes in hospitalized non-ST-elevation myocardial infarction (NSTEMI) patients. Methods: A retrospective analysis of all patients admitted to a single tertiary center with a primary diagnosis of NSTEMI. Patients with advanced chronic kidney disease were excluded. Clinical data were collected and compared between lower sMg quartile patients (Q1; sMg < 1.9 mg/dL) and all other patients (Q2–Q4; sMg ≥ 1.9 mg/dL). Results: The study cohort included 4552 patients (70% male, median age 69 [IQR 59–79]) who were followed for a median of 4.4 (IQR 2.4–6.6) years. The median sMg level in the low sMg group was 1.7 (1.6–1.8) and 2.0 (2.0–2.2) mg/dL in the normal/high sMg group. The low sMg group was older (mean of 72 vs. 67 years), less likely to be male (64% vs. 72%), and had higher rates of comorbidities, including diabetes, hypertension, and atrial fibrillation (59% vs. 29%, 92% vs. 85%, and 6% vs. 5%; p < 0.05 for all). Kaplan–Meier survival analysis demonstrated significantly higher cumulative death probability at 4 years in the low sMg group (34% vs. 22%; p log rank <0.001). In a multivariable analysis model adjusted for sex, significant comorbidities, coronary interventions during the hospitalization, and renal function, the low sMg group exhibited an independent 24% increased risk of death during follow up (95% CI 1.11–1.39; p < 0.001). Conclusions: Low sMg is independently associated with higher risk of long-term mortality among patients recovering from an NSTEMI event. [ABSTRACT FROM AUTHOR]

The rust diseases, including leaf rust caused by Puccinia triticina (Pt), stem rust caused by P. graminis f. sp. tritici (Pgt), and stripe rust caused by P. striiformis f. sp. tritici (Pst), are major limiting factors in wheat production worldwide. Identification of novel sources of rust resistance genes is key to developing cultivars resistant to rapidly evolving pathogen populations. Aegilops longissima is a diploid wild grass native to the Levant and closely related to the modern bread wheat D subgenome. To explore resistance genes in the species, we evaluated a large panel of Ae. longissima for resistance to several races of Pt, Pgt, and Pst, and conducted a genome-wide association study (GWAS) to map rust resistance loci in the species. A panel of 404 Ae. longissima accessions, mostly collected from Israel, were screened for seedling-stage resistance to four races of Pt, four races of Pgt, and three races of Pst. Out of the 404 accessions screened, two were found that were resistant to all 11 races of the three rust pathogens screened. The percentage of all accessions screened that were resistant to a given rust pathogen race ranged from 18.5% to 99.7%. Genotyping-by-sequencing (GBS) was performed on 381 accessions of the Ae. longissima panel, wherein 125,343 single nucleotide polymorphisms (SNPs) were obtained after alignment to the Ae. longissima reference genome assembly and quality control filtering. Genetic diversity analysis revealed the presence of two distinct subpopulations, which followed a geographic pattern of a northern and a southern subpopulation. Association mapping was performed in the genotyped portion of the collection (n = 381) and in each subpopulation (n = 204 and 174) independently via a single-locus mixed-linear model, and two multi-locus models, FarmCPU, and BLINK. A large number (195) of markers were significantly associated with resistance to at least one of 10 rust pathogen races evaluated, nine of which are key candidate markers for further investigation due to their detection via multiple models and/or their association with resistance to more than one pathogen race. The novel resistance loci identified will provide additional diversity available for use in wheat breeding. [ABSTRACT FROM AUTHOR]

Calcium-rich supernovae (Ca-rich SNe) are faint, rapidly evolving transients whose progenitor system is yet to be determined. We derive the γ -ray deposition histories of five Ca-rich SNe from the literature in order to place constraints on possible progenitor systems. We find that the γ -ray escape time, t 0, of the Ca-rich SNe sample is |$\approx 35\!-\!65 \, \rm {d},$| within the unoccupied region between Type Ia SNe and stripped-envelope supernovae (SESNe). The t 0− M Ni56 distribution of these SNe, where M Ni56 is the synthesized 56Ni mass in the explosion, creates a continuum between the Type Ia and SESNe t 0− M Ni56 distribution, hinting at a possible connection between all the events. By comparing our results to models from the literature, we were able to determine that helium shell detonation models and core-collapse models of ultra-stripped stars are unlikely to explain Ca-rich SNe since the gamma-ray escape time in these models is smaller than the observed values. Models that agree with the observed t 0− M Ni56 distribution are explosions of low mass, |$M\approx 0.75\!-\!0.8\, \mathrm{M}_\odot,$| white dwarfs and core-collapse models of stripped stars with an ejecta mass of |$M\approx 1\!-\!3\, {\rm M}_{\odot}.$| [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate whether there is a difference in neonatal outcomes with general anesthesia (GA) versus regional anesthesia (RA) when induction of anesthesia to delivery time (IADT) is prolonged (≥10 minutes). Study Design This is a retrospective case–control study that included cases from July 2014 until August 2020. We reviewed all singleton pregnancies delivered between 24 and 42 weeks of gestation with IADT ≥ 10 minutes. Urgent deliveries, those who received RA for labor pain management or started cesarean delivery under RA and converted to GA, as well as cases with fetal anomalies, were excluded. The propensity score (PS) matching method was performed using age, ethnicity/race, body mass index, gestational age at delivery, preexisting maternal comorbidities, and pregnancy complications. Analyses were performed with SAS software version 9.4. Results During the study period, we identified 258 cases meeting inclusion criteria. After the PS matching was applied, the study sample was reduced to 60 cases in each group. The median IADT and uterine incision to delivery time were similar between groups (41.5 [30.5, 52] vs. 46 minutes [38, 53.5], p = 0.2 and 1.5 [1, 3] vs. 2 minutes [1, 3], respectively). There was no significant difference between groups with respect to arterial or venous cord pH (7.24 [7.21, 7.26] vs. 7.23 [7.2, 7.27], p = 0.7 and 7.29 [7.26, 7.33] vs. 7.3 [7.26, 7.33], p = 0.4, respectively). Nor were there any associations between maternal characteristics and Apgar's score at 5 minutes, except for Apgar's score at 1 minute (p < 0.001). No significant difference was identified in the rate of admission to the neonatal intensive care unit (NICU; 11 [52.4%] vs. 10 [47.6%], p = 0.8) or NICU length of stay between GA and RA (4 [3, 14] vs. 4.5 [3, 11], p = 0.9). Conclusion Our data indicate that even with prolonged IADT, favorable neonatal outcomes are seen with both GA and RA, in contrast with previous studies performed decades ago. Key Points Improving cesarean delivery safety, including the safety of anesthesia, is of paramount importance. Reappraisal of historical outcomes is warranted as advances in the medical field unfold. Favorable neonatal outcomes are seen with both general and regional anesthesia. [ABSTRACT FROM AUTHOR]

The dependence of the virulence of the deltacga1 mutants on host and environmental conditions was determined. The results suggest nutrient accessibility and the developmental and senescence status of the host might be important host characters for which data are transmitted by the fungal signaling pathway that contains CGA1.