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1.
J Child Adolesc Trauma ; 17(2): 349-362, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38938939

ABSTRACT

Traumatic events during childhood are crucial to consider when addressing children's social and emotional development, as childhood trauma is associated with negative impacts, including academic achievement. Additionally, positive classroom environments and teachers' trauma-informed attitudes and behavior play a role in supporting recovery from children's trauma-related experiences. Aspire, Connect, Thrive (ACT) is a trauma-informed school-based intervention that examined students' Social Emotional Competence (SEC) and resilience for K-8th grade students in a disadvantaged, urban elementary school in Connecticut contending with the effects of students' exposure to trauma. The present study examines the experience of ACT teachers who received professional development and subsequently implemented learned content in the classroom (N = 17; 70.6% female, mean age = 44 years; 47.1% racial/ethnic minority; mean years teaching = 15.6) through qualitative evidence of trauma sensitivity (observed and self-reported) and clinician-ratings of teachers' positive classroom environment. Quantitative results indicate significant change over time in teachers' attitudes and trauma-informed classroom responses. Interview themes suggest (1) teachers learned from and implemented the intervention content in their classrooms dependent upon the support the teacher was given, (2) teachers' perspectives on the connections between the student-teacher relationship and trauma-informed attitudes or practices influenced teacher behavior, and (3) teachers' own emotions and experiences implementing trauma-informed practices were key to classroom management.

2.
Am J Perinatol ; 2024 May 27.
Article in English | MEDLINE | ID: mdl-38802080

ABSTRACT

OBJECTIVE: This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success. STUDY DESIGN: This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. RESULTS: A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (ß = -0.06, p-value 0.01) and required more time at each breastfeeding session (ß = 0.08, p-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (ß = 0.06, p = 0.008). CONCLUSION: Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic-pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period. KEY POINTS: · Women who experience PPH after vaginal delivery have decreased breastfeeding success.. · Further work is needed to elicit the mechanism behind this association.. · These women may require additional support for successful breastfeeding initiation postpartum..

3.
J Assist Reprod Genet ; 41(5): 1193-1202, 2024 May.
Article in English | MEDLINE | ID: mdl-38472563

ABSTRACT

PURPOSE: To evaluate the impact of a single-step (SS) warming versus standard warming (SW) protocol on the survival/expansion of vitrified blastocysts and their clinical outcomes post-frozen embryo transfer (FET). METHODS: Retrospective analysis was performed on 200 vitrified/warmed research blastocysts equally divided amongst two thawing protocols utilizing the Fujifilm Warming NX kits (Fujifilm, CA). SW utilized the standard 14-minute manufacturer's guidelines. SS protocol required only a one-minute immersion in thaw solution (TS) before the embryos were transferred to culture media. A time-interrupted study was performed evaluating 752 FETs (SW: 376 FETs, SS 376 FETs) between April 2021-December 2022 at a single academic fertility clinic in Boston, Massachusetts. Embryologic, clinical pregnancy, and live birth outcomes were assessed using generalized estimated equation (GEE) models, which accounted for potential confounders. RESULTS: There was 100% survival for all blastocysts (n = 952 embryos) with no differences in blastocyst re-expansion regardless of PGT status. Adjusted analysis showed no differences in implantation, clinical pregnancy, spontaneous abortion, or biochemical pregnancy rate. A higher odds of multiple gestation [AdjOR(95%CI) 1.06 (1.01, 1.11), p = 0.019] were noted, even when adjusting for number of embryos transferred [AdjOR(95%CI) 1.05 (1.01, 1.10)]. Live birth outcomes showed no differences in live birth rates or birthweight at delivery. CONCLUSIONS: The study found equivalent outcomes for SS and SW in all parameters except for a slight rise in the rate of multiple gestations. The results suggest that SS warming is an efficient, viable alternative to SW, reducing thaw times without adverse effects on live birth rates or neonatal birth weights.


Subject(s)
Birth Rate , Blastocyst , Cryopreservation , Embryo Transfer , Live Birth , Pregnancy Rate , Vitrification , Humans , Female , Pregnancy , Live Birth/epidemiology , Blastocyst/physiology , Cryopreservation/methods , Embryo Transfer/methods , Adult , Embryo Culture Techniques/methods , Fertilization in Vitro/methods , Retrospective Studies , Embryo Implantation , Pregnancy Outcome
4.
Neuropsychology ; 38(4): 368-378, 2024 May.
Article in English | MEDLINE | ID: mdl-38300579

ABSTRACT

OBJECTIVE: Although early diagnosis and treatment prevent the severe impairments associated with untreated phenylketonuria (PKU), individuals with early treated PKU (ETPKU) nonetheless experience significant neurocognitive and psychological sequelae, including difficulties in working memory (WM) and increased risk of anxiety. The primary objective of the present study was to examine the extent to which anxiety may moderate the relationship between ETPKU and WM performance. METHOD: A sample of 40 adults with ETPKU and a demographically comparable sample of 40 healthy adults without PKU completed a comprehensive assessment of WM performance and anxiety symptomatology. Data were collected using a variety of remote assessment methods (e.g., web-based neurocognitive tests, semistructured interview, report-based measures). RESULTS: The ETPKU group demonstrated significantly poorer WM performance as compared to the non-PKU group. The groups did not differ significantly in anxiety; however, high anxiety was more common in the ETPKU group (53% of sample) than the non-PKU group (33%). A significant interaction between anxiety, metabolic control (as reflected by Phe levels), and WM performance was observed for the ETPKU group. Individuals with high anxiety and/or high Phe levels (> 360 µmol/L) performed poorer than the non-PKU group. Individuals with low anxiety and relatively low Phe levels (< 360 µmol/L) performed comparably to the non-PKU group. CONCLUSIONS: Anxiety was found to moderate the relationship between Phe levels and WM performance in individuals with ETPKU. This finding underscores the importance of accounting for anxiety when evaluating neurocognitive performance in individuals with ETPKU whether for research or clinical purposes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Subject(s)
Anxiety , Memory, Short-Term , Phenylketonurias , Humans , Phenylketonurias/psychology , Phenylketonurias/complications , Male , Memory, Short-Term/physiology , Female , Adult , Anxiety/etiology , Young Adult , Neuropsychological Tests , Adolescent
5.
Sch Psychol ; 39(3): 302-311, 2024 May.
Article in English | MEDLINE | ID: mdl-38407111

ABSTRACT

Educators' high levels of stress have been well documented in existing literature, though little research has directly looked at comparisons of stress experiences and needs for support based on school level. The present study included 33 teachers (19 elementary and 14 middle school) from one school district who participated in semistructured interviews. Responses to questions regarding their primary source(s) of stress and their ideal solution(s) to relieve that stress revealed distinctions between elementary and middle school teachers. Elementary teachers described stress related to a sense of responsibility or need to care for students and meet their social, emotional, behavioral, and academic needs. Their ideal solution primarily involved receiving more emotional support and more support staff in the classroom to help meet all students' needs. In contrast, middle school teachers reported the majority of their stress as stemming from external demands or pressures such as test scores, high or unattainable expectations from administrators or parents, and not having enough time. Middle school teachers' ideal solutions largely entailed a shift in the use of their time, specifically to remove tasks (e.g., unnecessary staff meetings) and be able to focus their time on what matters the most (e.g., teaching students). These findings indicate that although almost all of these teachers reported being highly stressed, their sources of stress and perceived needs for support varied based on school level. Efforts to promote teacher well-being must consider school level and teachers' own perspectives on what they need in order to provide the most beneficial supports. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Subject(s)
School Teachers , Humans , Female , Male , Adult , Middle Aged , Qualitative Research , Schools , Occupational Stress/psychology , Stress, Psychological/psychology , Social Support
7.
Am J Physiol Heart Circ Physiol ; 326(3): H636-H647, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38156886

ABSTRACT

As females age, they transition through menopause, experiencing a decrease in estrogen and an increase in cardiovascular and neurodegenerative disease risk. Most standard rodent chows contain phytoestrogen-rich soybean meal, which can mimic the effects of estrogen. Understanding the impact of this soybean meal on vascular outcomes is crucial to proper experimental design. Thus, this study aimed to compare the effects of standard and soy-free chows on cerebral artery endothelial function and cognitive function in ovariectomized mice. Young female C57Bl/6J mice (n = 43; ∼6 mo) were randomly assigned to three groups: sham, ovariectomy (OVX), or ovariectomy on a diet containing soy (OVX + Soy). In posterior cerebral arteries, the OVX mice had a 27% lower maximal response to insulin compared with the sham mice. The OVX + Soy mice had a 27% greater maximal vasodilation to insulin compared with the OVX mice and there were no differences in vasodilation between the OVX + Soy and sham groups. The group differences in vasodilation were mediated by differences in nitric oxide bioavailability. The OVX + Soy mice also had greater insulin receptor gene expression in cerebral arteries compared with the OVX mice. However, no differences in aortic or cerebral artery stiffness were observed between groups. Interestingly, the OVX + Soy group scored better on nesting behavior compared with both sham and OVX groups. In summary, we found that ovariectomy impairs insulin-mediated vasodilation in cerebral arteries, but a diet containing soy mitigates these effects. These findings highlight the importance of considering dietary soy when performing vascular and behavioral tests in mice, particularly in females.NEW & NOTEWORTHY To properly design experiments, we must consider how variables like diet impact our outcomes, particularly the effects of soy on females. We found that cerebral artery vasodilation in response to insulin was impaired in ovariectomized female mice compared with intact shams. However, ovariectomized mice fed a soy diet had a preserved cerebral artery insulin-mediated vasodilation. These results highlight that the effects of diet on vascular function may explain inconsistencies found between studies.


Subject(s)
Insulins , Neurodegenerative Diseases , Mice , Female , Animals , Humans , Diet , Estrogens , Cerebral Arteries , Ovariectomy
9.
MedEdPublish (2016) ; 13: 32, 2023.
Article in English | MEDLINE | ID: mdl-37753389

ABSTRACT

Background:  Amyloidosis is a complex multi-systemic disease. Lack of knowledge about amyloidosis and subsequent mis- or under-diagnosis are major obstacles to treatment, which result in life-threatening organ damage, morbidity, and mortality. Hence, the purpose of this study is to explore the effectiveness of amyloidosis patients' narratives on medical students. Methods:  The Amyloidosis Speakers Bureau (ASB) arranges for amyloidosis patients to speak about their diagnostic and treatment experiences with medical students. Using a randomized post-test only experiment, we compared the effectiveness of patients' narratives between two groups (treatment and control). Outcome measures included medical students' intent to actively communicate with patients, acquire knowledge about amyloidosis, and reconsider diagnoses when warranted. Results:  The treatment group (those who listened to an ASB patient speaker) had higher mean differences on all measures, including the desire to improve communication with patients, acquire and apply knowledge of amyloidosis, and willingness to reconsider diagnoses when symptoms are puzzling. Conclusions:  ASB patient educators widened awareness of an under-diagnosed disease. Listening to a patient's narrative was associated with positive attitudes toward communication with patients, interest in acquiring and applying knowledge of amyloidosis, and humility about diagnosis. Narrative and persuasion theory are used to explain this quantitative evidence of the power of patient narratives.

11.
Obstet Gynecol ; 142(5): 1019-1027, 2023 11 01.
Article in English | MEDLINE | ID: mdl-37769303

ABSTRACT

OBJECTIVE: To evaluate the utility of office hysteroscopy in diagnosing and treating retained products of conception in patients with infertility who experience early pregnancy loss (EPL) after in vitro fertilization (IVF). METHODS: We evaluated a retrospective cohort of 597 pregnancies that ended in EPL in patients aged 18-45 years who conceived through fresh or frozen embryo transfer at an academic fertility practice between January 2016 and December 2021. All patients underwent office hysteroscopy after expectant, medical, or surgical management of the EPL. The primary outcome was presence of retained products of conception at the time of office hysteroscopy. Secondary outcomes included incidence of vaginal bleeding, presence of intrauterine adhesions, treatment for retained products of conception, and duration of time from EPL diagnosis to resolution. Log-binomial regression and Poisson regression were performed, adjusting for potential confounders including oocyte age, patient age, body mass index, prior EPL count, number of prior dilation and curettage procedures, leiomyomas, uterine anomalies, and vaginal bleeding. RESULTS: Of the 597 EPLs included, 129 patients (21.6%) had retained products of conception diagnosed at the time of office hysteroscopy. The majority of individuals with EPL were managed surgically (n=427, 71.5%), in lieu of expectant management (n=140, 23.5%) or medical management (n=30, 5.0%). The presence of retained products of conception was significantly associated with vaginal bleeding (relative risk [RR] 1.72, 95% CI 1.34-2.21). Of the 41 patients with normal pelvic ultrasonogram results before office hysteroscopy, 10 (24.4%) had retained products of conception detected at the time of office hysteroscopy. When stratified by EPL management method, retained products of conception were significantly more likely to be present in individuals with EPL who were managed medically (adjusted RR 2.66, 95% CI 1.90-3.73) when compared with those managed surgically. Intrauterine adhesions were significantly less likely to be detected in individuals with EPL who underwent expectant management when compared with those managed surgically (RR 0.14, 95% CI 0.04-0.44). Of the 127 individuals with EPL who were diagnosed with retained products of conception at the time of office hysteroscopy, 30 (23.6%) had retained products of conception dislodged during the office hysteroscopy, 34 (26.8%) chose expectant or medical management, and 63 (49.6%) chose surgical management. The mean number of days from EPL diagnosis to resolution of pregnancy was significantly higher in patients who elected for expectant management (31 days; RR 1.18, 95% CI 1.02-1.37) or medical management (41 days; RR 1.54, 95% CI 1.25-1.90) when compared with surgical management (27 days). CONCLUSION: In patients with EPL after IVF, office hysteroscopy detected retained products of conception in 24.4% of those with normal pelvic ultrasonogram results. Due to the efficacy of office hysteroscopy in diagnosing and treating retained products of conception, these data support considering office hysteroscopy as an adjunct to ultrasonography in patients with infertility who experience EPL after IVF.


Subject(s)
Abortion, Spontaneous , Infertility , Uterine Diseases , Pregnancy , Female , Humans , Hysteroscopy/methods , Abortion, Spontaneous/epidemiology , Retrospective Studies , Uterine Diseases/diagnosis , Uterine Diseases/surgery , Fertilization in Vitro/methods , Tissue Adhesions , Uterine Hemorrhage
12.
Nature ; 620(7972): 116-121, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37407821

ABSTRACT

Granites are nearly absent in the Solar System outside of Earth. Achieving granitic compositions in magmatic systems requires multi-stage melting and fractionation, which also increases the concentration of radiogenic elements1. Abundant water and plate tectonics facilitate these processes on Earth, aiding in remelting. Although these drivers are absent on the Moon, small granite samples have been found, but details of their origin and the scale of systems they represent are unknown2. Here we report microwave-wavelength measurements of an anomalously hot geothermal source that is best explained by the presence of an approximately 50-kilometre-diameter granitic system below the thorium-rich farside feature known as Compton-Belkovich. Passive microwave radiometry is sensitive to the integrated thermal gradient to several wavelengths depth. The 3-37-gigahertz antenna temperatures of the Chang'e-1 and Chang'e-2 microwave instruments allow us to measure a peak heat flux of about 180 milliwatts per square metre, which is about 20 times higher than that of the average lunar highlands3,4. The surprising magnitude and geographic extent of this feature imply an Earth-like, evolved granitic system larger than believed possible on the Moon, especially outside of the Procellarum region5. Furthermore, these methods are generalizable: similar uses of passive radiometric data could vastly expand our knowledge of geothermal processes on the Moon and other planetary bodies.

13.
Pharmacol Biochem Behav ; 227-228: 173582, 2023 06.
Article in English | MEDLINE | ID: mdl-37302663

ABSTRACT

Withdrawal from opioids can induce a state of anxiety and irritability. This negative state can facilitate continued drug taking, as the administration of opioids can alleviate unpleasant symptoms associated with acute and protracted withdrawal. It is, therefore, of interest to investigate factors that can contribute to the severity of anxiety during periods of abstinence. One such factor is the fluctuation of ovarian hormones. Evidence from a non-opioid drug indicates that estradiol increases, while progesterone decreases anxiety during withdrawal. However, no work has yet studied how ovarian hormones might influence the severity of anxiety during withdrawal from opioids. To explore this, we ovariectomized female rats and provided a four-day repeating cycle of ovarian hormone administration (Day 1: estradiol, Day 2: estradiol, Day 3: progesterone, Day 4: peanut oil). Male rats were given sham surgeries and administered peanut oil daily in lieu of hormone replacement. All rats received twice daily injections of morphine (or 0.9 % saline) for 10 days total at a dose that doubled every two days (2.5 mg/kg, 5 mg/kg, 10 mg/kg, 20 mg/kg, 40 mg/kg). Rats underwent spontaneous withdrawal and were tested for anxiety-like behaviors 12 and 108 h after the last morphine treatment. At 12 h, morphine-withdrawn female rats treated with estradiol on the day of testing displayed significantly more anxiety-like behavior in light-dark box testing than female morphine-withdrawn and (marginally) male morphine-withdrawn rats receiving vehicle that day. Somatic withdrawal behaviors (wet dog shakes, head shakes, writhing) were also taken every 12 h through 108 h. We found no meaningful contribution of sex or hormones for these measures. This study is the first of its kind to provide evidence that ovarian hormones influence anxiety-like behavior during morphine withdrawal.


Subject(s)
Morphine , Substance Withdrawal Syndrome , Rats , Male , Female , Animals , Morphine/adverse effects , Estradiol/pharmacology , Estradiol/therapeutic use , Progesterone/pharmacology , Analgesics, Opioid/pharmacology , Peanut Oil , Anxiety/chemically induced , Anxiety/drug therapy , Substance Withdrawal Syndrome/drug therapy
14.
Am J Obstet Gynecol MFM ; 5(7): 100989, 2023 07.
Article in English | MEDLINE | ID: mdl-37127208

ABSTRACT

BACKGROUND: Compassion fatigue is secondary traumatic distress experienced by providers from ongoing contact with patients who are suffering. Compassion satisfaction is emotional fulfillment from caring for others. Burnout is distress related to dissonance between job demands and available resources. Although burnout is well-studied, compassion satisfaction and compassion fatigue are neglected components of physician well-being. Because of recurrent exposure to adverse outcomes, maternal-fetal medicine providers may be at particular risk for compassion fatigue. OBJECTIVE: This study aimed to better characterize both clinical and nonclinical drivers of work-related distress vs satisfaction. STUDY DESIGN: The modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional and personal characteristics were distributed electronically to maternal-fetal medicine providers nationally. Multivariable regression models were constructed for compassion fatigue, burnout, and compassion satisfaction as a function of potential predictors. RESULTS: The survey response rate was 24% (n=366), primarily consisting of White physicians working in academic medical centers. Significant predictors of lower burnout scores included employment at 1 institution for >20 years, discussing work-related distress with friends, and having one's most recent involvement in decision-making for a periviable fetus >6 months ago; distress because of coworkers and personal factors predicted higher scores. Female sex, self-report of significant emotional depletion, use of mental health services, and having other maternal-fetal medicine physicians as part of the care team for a fetus with severe anomalies were significant predictors of higher compassion fatigue scores, whereas White race and having social work as part of the care team for a maternal mortality predicted lower scores. Personal spiritual practice was a significant predictor of higher compassion satisfaction score, whereas employment at current institution for <5 years predicted lower scores. CONCLUSION: Compassion fatigue, compassion satisfaction, and burnout are associated with several modifiable risk factors, such as practice type, having a multidisciplinary team, and emotional support outside of the workplace; these are potential targets for intervention.


Subject(s)
Burnout, Professional , Compassion Fatigue , Physicians , Humans , Female , United States/epidemiology , Compassion Fatigue/diagnosis , Compassion Fatigue/epidemiology , Compassion Fatigue/psychology , Cross-Sectional Studies , Empathy , Perinatology , Job Satisfaction , Burnout, Professional/diagnosis , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Personal Satisfaction
16.
Front Cell Neurosci ; 17: 1094503, 2023.
Article in English | MEDLINE | ID: mdl-37187609

ABSTRACT

Introduction: Huntington's disease (HD) is a neurodegenerative disease that primarily affects the striatum, a brain region that controls movement and some forms of cognition. Neuronal dysfunction and loss in HD is accompanied by increased astrocyte density and astrocyte pathology. Astrocytes are a heterogeneous population classified into multiple subtypes depending on the expression of different gene markers. Studying whether mutant Huntingtin (HTT) alters specific subtypes of astrocytes is necessary to understand their relative contribution to HD. Methods: Here, we studied whether astrocytes expressing two different markers; glial fibrillary acidic protein (GFAP), associated with astrocyte activation, and S100 calcium-binding protein B (S100B), a marker of matured astrocytes and inflammation, were differentially altered in HD. Results: First, we found three distinct populations in the striatum of WT and symptomatic zQ175 mice: GFAP+, S100B+, and dual GFAP+S100B+. The number of GFAP+ and S100B+ astrocytes throughout the striatum was increased in HD mice compared to WT, coinciding with an increase in HTT aggregation. Overlap between GFAP and S100B staining was expected, but dual GFAP+S100B+ astrocytes only accounted for less than 10% of all tested astrocytes and the number of GFAP+S100B+ astrocytes did not differ between WT and HD, suggesting that GFAP+ astrocytes and S100B+ astrocytes are distinct types of astrocytes. Interestingly, a spatial characterization of these astrocyte subtypes in HD mice showed that while S100B+ were homogeneously distributed throughout the striatum, GFAP+ preferentially accumulated in "patches" in the dorsomedial (dm) striatum, a region associated with goal-directed behaviors. In addition, GFAP+ astrocytes in the dm striatum of zQ175 mice showed increased clustering and association with white matter fascicles and were preferentially located in areas with low HTT aggregate load. Discussion: In summary, we showed that GFAP+ and S100B+ astrocyte subtypes are distinctly affected in HD and exist in distinct spatial arrangements that may offer new insights to the function of these specific astrocytes subtypes and their potential implications in HD pathology.

17.
J Pediatr Pharmacol Ther ; 28(2): 161-166, 2023.
Article in English | MEDLINE | ID: mdl-37139250

ABSTRACT

Continuous ketamine infusions have been studied as an adjunctive agent for refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) in older children and adults. However, minimal information exists on the efficacy, safety, and dosing for continuous ketamine in young infants. We present the clinical course of 3 young infants with RSE and SRSE who received continuous ketamine in conjunction with other antiseizure medications. The condition of these patients was refractory to an average of 6 antiseizure medications before initiation of continuous ketamine infusion. For each patient, a continuous ketamine infusion was initiated at a rate of 1 mg/kg/hr with 1 patient requiring titration to a maximum of 6 mg/kg/hr. In 1 case, the concomitant use of continuous ketamine allowed for a reduction in the benzodiazepine continuous infusion rate. In all cases, ketamine was well tolerated especially in the setting of hemodynamic instability. Ketamine may provide a safe adjunct in the acute setting in severe RSE and SRSE. This is the first case series to document the use of continuous ketamine as a treatment modality in young infants with RSE or SRSE secondary to various underlying etiologies, without adverse events. Further studies are needed to evaluate the long-term safety and efficacy of continuous ketamine in this patient population.

18.
Org Lett ; 25(18): 3245-3248, 2023 May 12.
Article in English | MEDLINE | ID: mdl-37126729

ABSTRACT

The Pd-catalyzed coupling of 1,5-diene-2-yl triflates with amine nucleophiles affords exomethylenecyclobutanes bearing dialkylaminomethyl groups at C2. The strained carbocyclic products are obtained in moderate to excellent yields, with regioselectivities of up to >95:5 for four-membered ring formation. The mechanism of these reactions, which provides products resulting from anti-addition to alkenes, differs from related reactions involving malonate nucleophiles that provide syn-addition products.

19.
Obstet Gynecol ; 141(5): 964-966, 2023 05 01.
Article in English | MEDLINE | ID: mdl-37023445

ABSTRACT

External cephalic version (ECV) success correlates with numerous maternal and pregnancy factors. A prior study developed an ECV success prediction model based on body mass index, parity, placental location, and fetal presentation. We performed external validation of this model using a retrospective cohort of ECV procedures from a separate institution between July 2016 and December 2021. Four hundred thirty-four ECV procedures were performed, with a 44.4% success rate (95% CI 39.8-49.2%), which was similar to the derivation cohort (40.6%, 95% CI 37.7-43.5%, P =.16). There were significant differences in patients and practices between cohorts, including the rate of neuraxial anesthesia (83.5% derivation cohort vs 10.4% our cohort, P <.001). The area under the receiver operating characteristic curve (AUROC) was 0.70 (95% CI 0.65-0.75), which was similar to that in the derivation cohort (AUROC 0.67, 95% CI 0.63-0.70). These results suggest the published ECV prediction model's performance is generalizable outside the original study institution.


Subject(s)
Breech Presentation , Version, Fetal , Pregnancy , Humans , Female , Version, Fetal/methods , Placenta , Retrospective Studies , Breech Presentation/surgery , Parity
20.
Cell Rep ; 42(3): 112198, 2023 03 28.
Article in English | MEDLINE | ID: mdl-36867535

ABSTRACT

p53 and HSF1 are two major transcription factors involved in cell proliferation and apoptosis, whose dysregulation contributes to cancer and neurodegeneration. Contrary to most cancers, p53 is increased in Huntington's disease (HD) and other neurodegenerative diseases, while HSF1 is decreased. p53 and HSF1 reciprocal regulation has been shown in different contexts, but their connection in neurodegeneration remains understudied. Using cellular and animal models of HD, we show that mutant HTT stabilized p53 by abrogating the interaction between p53 and E3 ligase MDM2. Stabilized p53 promotes protein kinase CK2 alpha prime and E3 ligase FBXW7 transcription, both of which are responsible for HSF1 degradation. Consequently, p53 deletion in striatal neurons of zQ175 HD mice restores HSF1 abundance and decrease HTT aggregation and striatal pathology. Our work shows the mechanism connecting p53 stabilization with HSF1 degradation and pathophysiology in HD and sheds light on the broader molecular differences and commonalities between cancer and neurodegeneration.


Subject(s)
Huntington Disease , Neoplasms , Animals , Mice , Disease Models, Animal , Heat Shock Transcription Factors/genetics , Heat Shock Transcription Factors/metabolism , Heat-Shock Response , Huntington Disease/metabolism , Proteolysis , Tumor Suppressor Protein p53/genetics , Tumor Suppressor Protein p53/metabolism , Ubiquitin-Protein Ligases/metabolism
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