Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case-control study.

AIM: To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge. MATERIALS AND METHODS: Prospectively enrolled case-control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0-10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann-Whitney U-test. A p-value of <0.05 defined significance. RESULTS: Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred. CONCLUSION: SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.

Maxwell tipping points: the hidden mechanics of an axially compressed cylindrical shell.

Numerical results for the axially compressed cylindrical shell demonstrate the post-buckling response snaking in both the applied load and corresponding end-shortening. Fluctuations in load, associated with progressive axial formation of circumferential rings of dimples, are well known. Snaking in end-shortening, describing the evolution from a single dimple into the first complete ring of dimples, is a recent discovery. To uncover the mechanics behind these different phenomena, simple finite degree-of-freedom cellular models are introduced, based on hierarchical arrangements of simple unit cells with snapback characteristics. The analyses indicate two fundamentally different variants to this new form of snaking. Each cell has its own Maxwell displacement, which are either separated or overlap. In the presence of energetic background disturbance, the differences between these two situations can be crucial. If the Maxwell displacements of individual cells are separated, then buckling is likely to occur sequentially, with the system able to settle into different localized states in turn. Yet if Maxwell displacements overlap, then a global buckling pattern triggers immediately as a dynamic domino effect. We use the term Maxwell tipping point to identify the point of switching between these two behaviours.

Saturn's near-equatorial ionospheric conductivities from in situ measurements.

Cassini's Grand Finale orbits provided for the first time in-situ measurements of Saturn's topside ionosphere. We present the Pedersen and Hall conductivities of the top near-equatorial dayside ionosphere, derived from the in-situ measurements by the Cassini Radio and Wave Plasma Science Langmuir Probe, the Ion and Neutral Mass Spectrometer and the fluxgate magnetometer. The Pedersen and Hall conductivities are constrained to at least 10-5-10-4 S/m at (or close to) the ionospheric peak, a factor 10-100 higher than estimated previously. We show that this is due to the presence of dusty plasma in the near-equatorial ionosphere. We also show the conductive ionospheric region to be extensive, with thickness of 300-800 km. Furthermore, our results suggest a temporal variation (decrease) of the plasma densities, mean ion masses and consequently the conductivities from orbit 288 to 292.

Detection and molecular characterization of urinary tract HIV-1 populations.

BACKGROUND: Identification of all possible HIV reservoirs is an important aspect in HIV eradication efforts. The urinary tract has however not been well studied as a potential HIV reservoir. In this pilot study we molecularly characterized HIV-1 viruses in urine and plasma samples to investigate HIV-1 replication, compartmentalization and persistence in the urinary tract. METHODS: Prospectively collected urine and blood samples collected over 12-36 months from 20 HIV-1 infected individuals were analysed including sampling points from prior to and after ART initiation. HIV-1 pol gene RNA and DNA from urine supernatant and urine pellets respectively were analysed and compared to plasma RNA viruses from the same individual. RESULTS: HIV-1 nucleic acid was detected in urine samples from at least one time point in 8/20 (40%) treatment-naïve subjects compared to 1/13 (7.7%) individuals on antiretroviral treatment (ART) during periods of plasma viral suppression and 1/7 (14.3%) individuals with virological failure. HIV-1 RNA was undetectable in urine samples after ART initiation but HIV-1 DNA was detectable in one patient more than 6 months after treatment initiation. There was co-clustering of urine-derived pol sequences but some urine-derived sequences were interspersed among the plasma-derived sequences. CONCLUSIONS: Suppressive ART reduces HIV-1 replication in the urinary tract but HIV-1 DNA may persist in these cells despite treatment. A larger number of sequences would be required to confirm HIV compartmentalization in the urinary tract.

Queer Youth, Intoxication and Queer Drinking Spaces.

Research on intoxicating substances and gender has developed considerably in the last 30 years, especially in the social sciences as feminist scholars highlighted the contradictory discourses about young women's intoxication. Nevertheless, there still remain significant gaps if we are to fully understand the role and meaning of intoxication for all young people and not merely for heterosexual, cisgender young people. As a way of exploring the possible limitations of this legacy, we will examine the qualitative data from 52 in-depth interviews with self-identified LGBTQ young people. Our analysis explores the relationships between meanings of intoxication and sexual and gender identities, drinking spaces, and the extent to which notions of masculinity and femininity influence alcohol consumption and drinking practices among LGBTQ youth. As gender expressions among young people, especially those who identify as LGBTQ, become increasingly nuanced and fluid, understanding the role of social and cultural practices of alcohol consumption in the performance of sexual and gender identities may increase our understanding of the ways in which sexuality and gender influence alcohol consumption.

Complexity in phase transforming pin-jointed auxetic lattices.

We demonstrate the complexity that can exist in the modelling of auxetic lattices. By introducing pin-jointed members and large deformations to the analysis of a re-entrant structure, we create a material which has both auxetic and non-auxetic phases. Such lattices exhibit complex equilibrium behaviour during the highly nonlinear transition between these two states. The local response is seen to switch many times between stable and unstable states, exhibiting both positive and negative stiffnesses. However, there is shown to exist an underlying emergent modulus over the transitional phase, to describe the average axial stiffness of a system comprising a large number of cells.

Characteristics of animal hoarding cases referred to the RSPCA in New South Wales, Australia.

OBJECTIVE: To describe the characteristics of animal hoarding in New South Wales, Australia. DESIGN: Cross sectional study of consecutive referred cases. METHODS: Files of animal hoarding cases referred to RSPCA NSW in 2013-15 were examined. Details concerning animal hoarding cases and supportive services, living conditions and factors believed to have contributed to animal accumulation were recorded. Data were analysed. RESULTS: Data were available regarding 48 properties where 50 persons (78% female) were found to be hoarding animals. Most were over 50 years of age; 40% lived alone; 15 (30%) had contact with mental health services and/or community social services. Animal hoarders were categorised as 'breeders' (30%), 'overwhelmed caregiver' (24%), 'rescuers' (22%), 'exploiters' (10%) or 'incipient hoarders' (14%); 24% were associated with animal rescue networks. Accumulation of animals was attributed most commonly to unplanned breeding (60% of properties) and collecting strays (38%). Other reasons for accumulation included receiving donations of animals and planned breeding; in 38% of cases there was only one identified reason. The median number of animals was 35 (range, 6-300), with cats hoarded on 75% of properties and dogs on 52%. In 75% of cases, the living conditions of animals were rated as 'very unsanitary' or 'filthy'. CONCLUSIONS: This study provides reasons for recommending increased regulatory control of companion animal breeding and management, and training and support for veterinarians to help reduce the human and animal suffering caused by animal hoarding. There is widespread agreement that psychiatric and personality problems underlie cases of animal hoarding. Closer links between animal welfare organisations and mental health services are desirable.

The low-frequency source of Saturn's kilometric radiation.

Understanding how auroral radio emissions are produced by magnetized bodies requires in situ measurements within their source region. Saturn's kilometric radiation (SKR) has been widely used as a remote proxy of Saturn's magnetosphere. We present wave and plasma measurements from the Cassini spacecraft during its ring-grazing high-inclination orbits, which passed three times through the high-altitude SKR emission region. Northern dawn-side, narrow-banded radio sources were encountered at frequencies of 10 to 20 kilohertz, within regions of upward currents mapping to the ultraviolet auroral oval. The kilometric waves were produced on the extraordinary mode by the cyclotron maser instability from 6- to 12-kilo-electron volt electron beams and radiated quasi-perpendicularly to the auroral magnetic field lines. The SKR low-frequency sources appear to be strongly controlled by time-variable magnetospheric electron densities.

Extinction risk in extant marine species integrating palaeontological and biodistributional data.

Extinction risk assessments of marine invertebrate species remain scarce, which hinders effective management of marine biodiversity in the face of anthropogenic impacts. To help close this information gap, in this paper we provide a metric of relative extinction risk that combines palaeontological data, in the form of extinction rates calculated from the fossil record, with two known correlates of risk in the modern day: geographical range size and realized thermal niche. We test the performance of this metric-Palaeontological Extinction Risk In Lineages (PERIL)-using survivorship analyses of Pliocene bivalve faunas from California and New Zealand, and then use it to identify present-day hotspots of extinction vulnerability for extant shallow-marine Bivalvia. Areas of the ocean where concentrations of bivalve species with higher PERIL scores overlap with high levels of climatic or anthropogenic stressors should be considered of most immediate concern for both conservation and management.

Understanding the structure and functioning of polar pelagic ecosystems to predict the impacts of change.

The determinants of the structure, functioning and resilience of pelagic ecosystems across most of the polar regions are not well known. Improved understanding is essential for assessing the value of biodiversity and predicting the effects of change (including in biodiversity) on these ecosystems and the services they maintain. Here we focus on the trophic interactions that underpin ecosystem structure, developing comparative analyses of how polar pelagic food webs vary in relation to the environment. We highlight that there is not a singular, generic Arctic or Antarctic pelagic food web, and, although there are characteristic pathways of energy flow dominated by a small number of species, alternative routes are important for maintaining energy transfer and resilience. These more complex routes cannot, however, provide the same rate of energy flow to highest trophic-level species. Food-web structure may be similar in different regions, but the individual species that dominate mid-trophic levels vary across polar regions. The characteristics (traits) of these species are also different and these differences influence a range of food-web processes. Low functional redundancy at key trophic levels makes these ecosystems particularly sensitive to change. To develop models for projecting responses of polar ecosystems to future environmental change, we propose a conceptual framework that links the life histories of pelagic species and the structure of polar food webs.

Pre-treatment minority HIV-1 drug resistance mutations and long term virological outcomes: is prediction possible?

BACKGROUND: Although the use of highly active antiretroviral therapy in HIV positive individuals has proved to be effective in suppressing the virus to below detection limits of commonly used assays, virological failure associated with drug resistance is still a major challenge in some settings. The prevalence and effect of pre-treatment resistance associated variants on virological outcomes may also be underestimated because of reliance on conventional population sequencing data which excludes minority species. We investigated long term virological outcomes and the prevalence and pattern of pre-treatment minority drug resistance mutations in individuals initiating HAART at a local HIV clinic. METHODS: Patient's records of viral load results and CD4 cell counts from routine treatment monitoring were used and additional pre-treatment blood samples for Sanger sequencing were obtained. A selection of pre-treatment samples from individuals who experienced virological failure were evaluated for minority resistance associated mutations to 1 % prevalence and compared to individuals who achieved viral suppression. RESULTS: At least one viral load result after 6 months or more of treatment was available for 65 out of 78 individuals followed for up to 33 months. Twenty (30.8 %) of the 65 individuals had detectable viremia and eight (12.3 %) of them had virological failure (viral load > 1000 RNA copies/ml) after at least 6 months of HAART. Viral suppression, achieved by month 8 to month 13, was followed by low level viremia in 10.8 % of patients and virological failure in one patient after month 20. There was potentially reduced activity to Emtricitabine or Tenofovir in three out of the eight cases in which minority drug resistance associated variants were investigated but detectable viremia occurred in one of these cases while the activity of Efavirenz was generally reduced in all the eight cases. CONCLUSIONS: Early viral suppression was followed by low level viremia for some patients which may be an indication of failure to sustain viral suppression over time. The low level viremia may also be representing early stages of resistance development. The mutation patterns detected in the minority variants showed potential reduced drug sensitivity which highlights their potential to dominate after treatment initiation. TRIAL REGISTRATION: Not applicable.

Influence of ceiling fan's speed and direction on efficacy of upperroom, ultraviolet germicidal irradiation: Experimental.

Increasing a ceiling fan's speed from its lowest setting of 61 rpm, which resulted in 0.77 m3/s of airflow, to its highest setting of 176 rpm, which resulted in 2.5 m3/s of airflow, or having the fan blow either upward or downward had no statistically significant effect on the efficacy of upper-room ultraviolet germicidal irradiation (UVGI). This outcome suggests that air circulation due to the ceiling fan was sufficient and that any additional increase would not improve efficacy. Numerous experimental studies on upper-room UVGI in which fans were used to provide air mixing have been published. However, none have quantified the air movement produced by these fans or described their tests in sufficient detail to allow results to be compared to predictions using computational fluid dynamics (CFD). The present work provides the required information. In addition to the usual boundary conditions needed for CFD, we made experimental measurements of UV susceptibility of the microorganisms used in the upper-room UVGI tests. We measured UV susceptibilities for Mycobacterium parafortuitum and Bacillus atrophaeus spores to be 0.074 and 0.018 m2/J, respectively. In a previous publication, we reported the spatial distribution of fluence rate, which is also needed for predicting efficacy from CFD. In a companion paper referred to as Part II, upper-room UVGI efficacy was predicted by both Eulerian and Lagrangian CFD and compared to the experimental results from the present study.

Regional Fos-expression induced by γ-hydroxybutyrate (GHB): comparison with γ-butyrolactone (GBL) and effects of co-administration of the GABAB antagonist SCH 50911 and putative GHB antagonist NCS-382.

γ-Hydroxybutyrate (GHB) has a complex array of neural actions that include effects on its own high-affinity GHB receptor, the release of neuroactive steroids, and agonist actions at GABAA and GABAB receptors. We previously reported partial overlap in the c-Fos expression patterns produced by GHB and the GABAB agonist, baclofen in rats. The present study extends these earlier findings by examining the extent to which GHB Fos expression and behavioral sedation are prevented by (2S)-(+)-5,5-dimethyl-2-morpholineacetic acid (SCH 50911), a GABAB antagonist, and NCS-382, a putative antagonist at the high-affinity GHB receptor. We also compare Fos expression caused by GHB and its precursor γ-butyrolactone (GBL), which is a pro-drug for GHB but lacks the high sodium content of the parent GHB molecule. Both GHB (1,000 mg/kg) and GBL (600 mg/kg) induced rapid sedation in rats that lasted over 90 min and caused similar Fos expression patterns, albeit with GBL causing greater activation of the nucleus accumbens (core and shell) and dentate gyrus (granular layer). Pretreatment with SCH 50911 (100mg/kg) partly reversed the sedative effects of GHB and significantly reduced GHB-induced Fos expression in only four regions: the tenia tecta, lateral habenula, dorsal raphe and laterodorsal tegmental nucleus. NCS-382 (50mg/kg) had no effect on GHB-induced sedation or Fos expression. When given alone, both NCS-382 and SCH 50911 increased Fos expression in the bed nucleus of the stria terminalis, central amygdala, parasubthalamic nucleus and nucleus of the solitary tract. SCH 50911 alone affected the Islands of Calleja and the medial, central and paraventricular thalamic nuclei. Overall, this study shows a surprising lack of reversal of GHB-induced Fos expression by two relevant antagonists, both of which have marked intrinsic actions. This may reflect the limited doses tested but also suggests that GHB Fos expression reflects mechanisms independent of GHB and GABAB receptors.

Eggcrate UV: a whole ceiling upper-room ultraviolet germicidal irradiation system for air disinfection in occupied rooms.

A novel whole ceiling upper-room ultraviolet germicidal irradiation (UVGI) system [eggcrate ultraviolet (UV)] has been developed that incorporates open-cell 'eggcrate'-suspended ceiling panels and bare UV lamps with a ceiling fan. Upper-room UVGI is more effective for air disinfection than mechanical ventilation at much lower installation and operating costs. Conventional upper-room UVGI fixtures employ multiple tightly spaced horizontal louvers to confine UV to the upper-room. These louvered fixtures protect occupants in the lower-room from UV-induced eye and skin irritation, but at a major cost to fixture efficiency. Using a lamp and ballast from a conventional upper-room UVGI fixture in the eggcrate UV system, the germicidal efficacy was markedly improved even though the UV radiation emitted by the lamp was unchanged. This fundamental change in the application of upper-room UVGI air disinfection should permit wider, more effective application of UVGI globally to reduce the spread of airborne infection.

The inheritance of extra-hepatic portosystemic shunts and elevated bile acid concentrations in Maltese dogs.

OBJECTIVES: To determine the heritability of extra-hepatic portosystemic shunts and elevated post-prandial serum bile acid concentrations in Maltese dogs. MATERIALS AND METHODS: Maltese dogs were recruited and investigated by a variable combination of procedures including dynamic bile acid testing, rectal ammonia tolerance testing, ultrasonography, portal venography, surgical inspection or necropsy. In addition, nine test matings were carried out between affected and affected dogs, and affected and unaffected dogs. RESULTS: In 135 variably related Maltese, shunt status could be confirmed in 113, including 19 with an extra-hepatic portosystemic shunt (17 confirmed at surgery, 2 at necropsy). Rectal ammonia tolerance testing results and post-prandial serum bile acid concentrations were retrievable for 50 and 88 dogs, respectively. Pedigree information was available for these 135 and an additional 164 related dogs. Two consecutive test matings were carried out between two affected animals (whose shunts had been attenuated), with 2 of 8 (25%) of offspring having an extra-hepatic portosystemic shunt. Six test matings were carried out between an affected and an unaffected animal, with 2 of 22 (9%) offspring affected. Heritability of extra-hepatic portosystemic shunt was 0·61 calculated using variance components analysis [95% confidence interval (CI) 0·14 to 1·0, P=0·001]. The best fitting model from segregation analysis was a common, partially penetrant, recessive model (allele frequency 0·34, penetrance 0·99, CI 0·09 to 1·0). The heritability of elevated post-prandial serum bile acid (and thus likely portal vein hypoplasia) was 0·81 (CI 0·43 to 1·0, P=0·2) after logarithmic transformation of post-prandial serum bile acid concentrations. CLINICAL SIGNIFICANCE: There is strong support for extra-hepatic portosystemic shunts and elevated post-prandial serum bile acid concentrations both being inherited conditions in Maltese.

Upper airway obstruction in Norwich Terriers: 16 cases.

BACKGROUND: Norwich Terriers have grown increasingly popular as show animals and pets, and awareness of respiratory problems within the breed is growing. OBJECTIVE: To describe components of obstructive upper airway syndrome in a nonbrachycephalic terrier breed. ANIMALS: Sixteen Norwich Terriers; 12 with and 4 without clinical signs of respiratory disease. METHODS: Prospective case series. Physical and laryngoscopic examinations were performed by 1 investigator in all dogs. Medical and surgical interventions were summarized and results of follow-up examination or owner reports were recorded. RESULTS: The study population was comprised of 9 females (6 intact) and 7 males (5 intact). Median age was 3.0 years (range, 0.5-11 years). Of 12 dogs presented for a respiratory complaint, physical examination was normal in 4 dogs. Laryngoscopic examination was abnormal in 11/12 dogs with redundant supra-arytenoid folds, laryngeal collapse, everted laryngeal saccules, and a narrowed laryngeal opening in most. Of 4 dogs lacking clinical signs, all had normal physical examination; however, 3/4 dogs had similar appearance of the larynx to dogs with clinical signs. Response to surgical intervention was minimal to moderate in all dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: Norwich Terriers suffer from an upper airway obstructive syndrome that differs from that encountered in brachycephalic breeds. Affected dogs are difficult to identify without laryngoscopic examination because of the lack of clinical signs and abnormalities in physical examination findings, despite severe airway obstruction. Care is warranted when anesthetizing Norwich Terriers because of the small size of the laryngeal opening.

On the nucleation and growth of kink and shear bands.

Similarities and differences between the phenomena of kink banding in compressed layered structures and shear banding in compressed granular media are explored. Simple models are introduced for both, and the focus is directed onto how they can nucleate from the perfectly flat state. A convincing scenario is found for each in which a mode develops from an initial bifurcation into a periodic state, followed by rapid localization under falling load, while retaining decaying but wavy tails. At a certain lower critical load, the tails lose their waviness, and the expected form of the kink or shear band appears. In each case, good numerical evidence is provided for the existence of this form of behaviour. A second potential instability for the layered case is also explored, linked to the appearance of a critical force dipole that overcomes bending stiffness locally at some point along the length. This mode, which should appear with non-wavy decaying tails at the lower of the two critical loads mentioned earlier, proves somewhat elusive. Evidence is found for its existence in the linearized approximation to the layered model, but the search for numerical solutions to the underlying nonlinear equation is hindered by a shortage of suitable boundary conditions.

Evaluation of hepatic steatosis in dogs with congenital portosystemic shunts using Oil Red O staining.

The aims of this prospective study were to quantify steatosis in dogs with congenital portosystemic shunts (CPS) using a fat-specific stain, to compare the amount of steatosis in different lobes of the liver, and to evaluate intra- and interobserver variability in lipid point counting. Computer-assisted point counting of lipid droplets was undertaken following Oil Red O staining in 21 dogs with congenital portosystemic shunts and 9 control dogs. Dogs with congenital portosystemic shunts had significantly more small lipid droplets (<6 µ) than control dogs (P = .0013 and .0002, respectively). There was no significant difference in steatosis between liver lobes for either control dogs and CPS dogs. Significant differences were seen between observers for the number of large lipid droplets (>9 µ) and lipogranulomas per tissue point (P = .023 and .01, respectively). In conclusion, computer-assisted counting of lipid droplets following Oil Red O staining of liver biopsy samples allows objective measurement and detection of significant differences between dogs with CPS and normal dogs. This method will allow future evaluation of the relationship between different presentations of CPS (anatomy, age, breed) and lipidosis, as well as the impact of hepatic lipidosis on outcomes following surgical shunt attenuation.

Surveillance of transmitted HIV-1 drug resistance in Gauteng and KwaZulu-Natal Provinces, South Africa, 2005-2009.

Surveillance of human immunodeficiency virus type 1 transmitted drug resistance (TDR) was conducted among pregnant women in South Africa over a 5-year period after the initiation of a large national antiretroviral treatment program. Analysis of TDR data from 9 surveys conducted between 2005 and 2009 in 2 provinces of South Africa suggests that while TDR remains low (<5%) in Gauteng Province, it may be increasing in KwaZulu-Natal, with the most recent survey showing moderate (5%-15%) levels of resistance to the nonnucleoside reverse transcriptase inhibitor drug class.