Este trabajo estudia la asociación que existe entre el nivel educativo y la interrupción legal del embarazo mediante la implementación de una serie de modelos del tipo logit. Utilizando una muestra de más de 70,000 mujeres de entre 11 y 53 años de edad para el periodo comprendido entre enero 2016 y mayo 2020, se encuentra que las mujeres más educadas son más propensas a abortar por convicción y no por necesidad y/o presión social. Además, se muestra que existen otros factores relacionados al aborto inducido, tales como el acceso a los servicios de salud, la remuneración en el trabajo, así como el uso de anticonceptivos, la edad de inicio de la vida sexual, el número de hijos, el número de abortos previos y la religión. El análisis confirma varios de los resultados obtenidos previamente en la literatura empírica y documental y aporta al debate sobre la despenalización sobre el aborto en México.

A document by Alexander Sokolov. Click on the document to view its contents.

Potential cancer risk with omalizumab? A disproportionality analysis of the WHO’s VigiBase pharmacovigilance database

Background: Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess post-operative and long-term outcomes of patients receiving either pericardial or synthetic repairs.Methods: We conducted a single center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N=38) with either autologous pericardium (n=30) or CorMatrix (n=8) between April 2009 and July 2016. Short and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, post-operatively, and at outpatient follow-up.Results: At five years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (P = 0.01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between pre- and post-operative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) post-operatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, 8 (100%) had moderate to severe AR which improved to 3 (38%) post-operatively and increased to 7 (88%) at time of follow-up.Conclusion: In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.

Background: Sedation for lumbar punctures (LPs) in pediatric acute lymphoblastic leukemia (ALL) patients has been the standard for decades to reduce pain and anxiety. Recent studies on the potential long-term neurocognitive effects of cumulative propofol exposure has raised concerns about this practice. The recent pandemic introduced additional burdens to patients, with the requirement of a negative COVID-19 test prior to each sedated procedure. Procedure: These factors prompted a quality improvement intervention at our institution where we aimed to reduce post-Induction sedated lumbar punctures (LPs) by 50%. Our intervention included patient and family education followed by a simulation of the procedure for selected patients. Those converted to unsedated LPs were queried for their preference. Comparative cost, clinical time and LP success rates were collected for sedated and unsedated LPs. Results: Following the intervention, the percentage of LPs performed with sedation dropped from 100% to 48.1%. All LPs were successful using both techniques. Most patients who experienced the unsedated LP technique, and their guardians, strongly preferred this approach. Unsedated LPs significantly reduced clinical time (169 vs 83 minutes) for families, decreased expenditures ($5,736.16 reduction per procedure) and improved institutional opportunity cost due to a decrease in last-minute cancellations. Conclusion: We have shown that it is feasible to significantly reduce the use of sedation for LPs in patients with ALL, which has the potential to improve health and patient experience at a lower cost.

Vaccination is a critical tool in the prevention of COVID-19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently in North America only the BNT162b2 (Pfizer-BioNTech) mRNA vaccine is approved individuals 12 to 17 years of age. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive Peg-asparaginase and 10-30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG-asparaginase allergy.

Management of patients with coagulation disorder is a challenge to any surgical specialty. However, fresh diagnosis of a coagulation disorder as result of complications following routine dental treatment is uncommon. We report a case of congenital Factor 13 deficiency diagnosed in a patient presenting with post-dental extraction bleeding.

Objective: To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission. Design: A retrospective cohort study of culture-proven pregnancy-related GAS infections. Setting and population: a tertiary university-affiliated hospital between 1/2008-7/2020. Methods: Review patient’s electronic records of patients. Main outcome measures: Incidence of pregnancy associated GAS, proportion given prophylaxis and admission to ICU. Results: Of the 143,750 who delivered during the study period, 66 (0.04%) were diagnosed as having a pregnancy associated GAS infection. Fifty-seven of them (86.3%) presented postpartum, and nine (13.6%) had septic abortions. The most common presenting signs and symptoms among puerperal GAS, were postpartum pyrexia (72%), abdominal pain and/or tenderness (33%), and tachycardia (>100 bpm, 22%). Thirteen women (19.6%) developed streptococcal toxic shock syndrome (STSS): 10 of them delivered vaginally, two had caesarean deliveries. Predictors for STSS and ICU admission were: antibiotic administration >24 hours from presentation postpartum, tachycardia, and a C-reactive protein level >200 mg/L. Women that received antibiotic prophylaxis during labour had a significantly lower rate of STSS (0 vs 10, 22.7%; P = 0.04), as evidenced by the delayed interval from delivery to the first presentation of infection among those who received prophylaxis during labour (8 ± 4.8 vs 4.8 ± 4.2 hours, P = 0.008). Conclusion: Deferral of medical intervention >24 hours from the first registered abnormal sign had the most important impact on deterioration of women with invasive puerperal GAS. Antibiotic prophylaxis during labour in women with GAS may reduce complications

Whole genomes are commonly assembled into a collection of scaffolds and often lack annotations of autosomes, sex chromosomes and, and organelle genomes (i.e., mitochondrial and chloroplast). As these chromosome types can have highly disparate evolutionary histories, it is imperative to take this information into account when analyzing genomic variation. Here we assessed the accuracy of four methods for identifying the homogametic sex chromosome using two whole genome sequenced (WGS) and 133 RAD sequenced white-tailed eagles (Haliaeetus albicilla): i) difference in read depth per scaffold, ii) heterozygosity per scaffold in a male and female bird, iii) mapping to a reference genome of a related species (chicken) with identified sex chromosomes, and iv) an analysis of SNP-loadings from a principal components analysis (PCA), based on low-depth RADseq data from 133 individuals. In i and ii, the WGS were mapped to a reference genome consisting of 1142 assembled scaffolds from the golden eagle (Aquila chrysaetos) with no identified chromosomes. The read depth per scaffold identified 86.41% of the homogametic sex chromosome (Z) with few false positives. The SNP-loading scores found 78.6% of the Z-chromosome but had a false positive discovery rate of more than 10%. The heterozygosity per scaffold did not provide clear results due to a lack of diversity in both the Z and autosomal chromosomes, and potential interference from the heterogametic sex chromosome (W).

Objective To determine the prevalence of genital mycoplasma infection and the risk of spontaneous preterm birth (sPTB) in asymptomatic pregnant women. Design Prospective cohort. Setting Public and private health services in Ribeirão Preto-SP, Brazil. Population 1.349 asymptomatic women with a singleton pregnancy at 20-25 weeks of gestation (WG) recruited between 2010 and 2011. Methods Baseline data was assessed using a questionnaire, in addition to cervicovaginal fluid and blood samples, to analyze lower reproductive tract infections (RTIs) and immune mediators, respectively. The association between variables and the risk of sPTB was evaluated using logistic regression analysis to estimate the odds ratios (ORs). Main outcome measures Genital mycoplasma infection and prematurity. Results The prevalence of the sPTB and genital mycoplasma was 6.8% and 18%, respectively. The infection was not a risk factor for sPTB (aOR 0.66; 95% CI 0.32-1.35), even when associated with bacterial vaginosis (BV). However, it was associated with a low socioeconomic status (p=0.0470), cigarette use (p=0.0009), number of sexual partners (p=0.0019), and BV (p<.0001). Regarding the risk factors associated with sPTB, previous history of PTB (aOR 12.06; 95% CI 6.21-23.43) and a cervical length ≤ 2.5 cm (aOR 3.97; 95% CI 1.67-9.47) were significant. Conclusions The risk of sPTB was independently associated with the history of PTB and the cervical length but not with the genital mycoplasma infection. Funding: This work was founded by CNPq, FAPESP and CAPES. Keywords: Preterm birth, pregnancy, genital mycoplasma, bacterial vaginosis, risk factor

The present study aimed to present two cases with a history of hyperthyroidism who had symptoms of a thyroid storm along with COVID-19 infection. Therefore, the diagnosis and treatment of these special cases along with COVID-19 should be considered important.

Runs of homozygosity (ROH) occur when offspring inherit haplotypes that are identical by descent from each parent. Length distributions of ROH are informative about population history; specifically the probability of inbreeding mediated by mating system and/or population demography. Here, we investigate whether variation in killer whale (Orcinus orca) demographic history is reflected in genome-wide heterozygosity and ROH length distributions, using a global dataset of 26 genomes representative of geographic and ecotypic variation in this species, and two F1 admixed individuals with Pacific-Atlantic parentage. We first reconstruct demographic history for each population as changes in effective population size through time using the pairwise sequential Markovian coalescent (PSMC) method. We find a subset of populations declined in effective population size during the Late Pleistocene, while others had more stable demography. Genomes inferred to have undergone ancestral declines in effective population size, were autozygous at hundreds of short ROH (<1Mb), reflecting high background relatedness due to coalescence of haplotypes deep within the pedigree. In contrast, longer and therefore younger ROH (>1.5 Mb) were found in low latitude populations and populations of known conservation concern, including a Scottish population, for which 37.8% of the autosomes comprised of ROH >1.5 Mb in length.

Rosai-Dorfman disease (RDD) is referred to as Sinus Histiocytosis Massive Lymphadenopathy (SHML) of unknown origin. We are reporting a rare case of Rosai Dorfman disease, a case of 6 years old male with a history of multiple painless bilateral submandibular and cervical lymphadenopathy.

A young girl post-stick injury presented with traumatic cataract and lens neovascularization in OS and iris coloboma, key whole pupil, and cataractous changes in OD. Fundoscopy revealed chorioretinal coloboma OD and retinal detachment on B scan OS. In view of guarded visual prognosis, the patient was advised observation in OU

In theory, genomic erosion can be reduced in fragile “recipient” populations by translocating individuals from genetically diverse “donor” populations. However, recent simulation studies have argued that such translocations can, in principle, serve as a conduit for new deleterious mutations to enter recipient populations. A reduction in evolutionary fitness is associated with a higher load of deleterious mutations and thus, a better understanding of evolutionary processes driving the empirical distribution of deleterious mutations is crucial. Here, we show that genetic load is evolutionarily dynamic in nature and that demographic history greatly influences the distribution of deleterious mutations over time. Our analyses, based on both demographically explicit simulations as well as whole genome sequences of potential donor-recipient pairs of Montezuma Quail (Cyrtonyx montezumae) populations, indicate that all populations tend to lose deleterious mutations during bottlenecks, but that genetic purging is pronounced in smaller populations with stronger bottlenecks. Despite carrying relatively fewer deleterious mutations, we demonstrate how small, isolated populations are more likely to suffer inbreeding depression as deleterious mutations that escape purging are homogenized due to drift, inbreeding, and ineffective purifying selection. We apply a population genomics framework to showcase how the phylogeography and historical demography of a given species can enlighten genetic rescue efforts. Our data suggest that small, inbred populations should benefit the most when assisted gene flow stems from genetically diverse donor populations that have the lowest proportion of deleterious mutations.

Biological invasions represent a natural rapid evolutionary process in contemporary time scale, and the invasive species may present a major threat to biodiversity and ecosystem integrity. Analyzing the genetic structure and demographic history of invasive populations is critical for the effective management of invasive species. The spotted alfalfa aphid (SAA) Therioaphis trifolii is indigenous in the Mediterranean region of Europe and Africa and has invaded other continents, causing severe damages to the alfalfa industry; however, little is known about its genetic structure and invasion history. In this study, we obtained 167 complete mitochondrial genome sequences from 23 SAA populations across China based on high-throughput sequencing and performed population genetic and phylogenomic analyses. High haplotype diversity and low nucleotide diversity were found in SAA populations in China with distinct genetic structures, i.e., all population samples diverged into three phylogenetic lineages with possible different invasion sources. Demographic history analyses showed a recent expansion of the SAA population, consistent with the rapid invasion history. Our study supported that SAA populations in China were possibly derived from multiple introduction events through commercial trades of alfalfa.

Human–wildlife conflicts have intensified by many folds and at different levels in the recent years. The same is true in the case of the Hindu Kush Himalaya (HKH), the roof of the world and a region known for its wealth in biodiversity. We present systematic literature review (SLR) using the search, appraisal, synthesis, and analysis (SALSA) framework; and for spatial and network analysis, we employed the VOSviewer software. The review – covering 240 peer- articles within a span of 27 years (from 1982 to 2019) – revealed that in the last decade of that period, there was a 57 per cent increase in publications but with disproportionate geographical and thematic focus. About 82 per cent of the research concentrated on protected areas large carnivores and mega herbivores played a big role in such conflicts. About 53 per cent of the studies were based on questionnaires based and the main driver was reported was the habitat disturbance of the animals due to land-cover change, urbanization, and increase in human population. On the management front, the studies reported the use of traditional protection techniques like guarding and fencing. Our analysis of 681 keywords revealed prominent focus on ‘human-wildlife conflict’, ‘Nepal’, ‘Bhutan’, ‘Snow Leopard’ and ‘Leopard’ indicating the issue are linked with these species and countries. The involvement of 640 authors from 36 countries indicates increasing interest and Nepal and India are playing key role from the region. As for the spatial and network analysis that was conducted, while it showed variations in terms of localities, there were conspicuous limitations in terms of having a transboundary focus. Thus, particular attention ought to be paid to building transboundary partnerships and improving management interventions; there is also a pressing need to understand the patterns of human–wildlife convergence, especially involving meso mammals.

The purpose of this case report was to present a combination of two procedures in the treatment of gingival recessions after implant placement in the anterior maxilla. Decision making process and step-by-step execution of the treatments were presented to describe the clinical and surgical management of the reported case.

A document by Shigehiro Kuraku. Click on the document to view its contents.

Title: The clinical use of serum Mas-Related G Protein-Coupled Receptor-X2 as a diagnostic biomarker is questionableAuthors: Grzegorz Porebski (1), Alicja Dziadowiec (2), Mateusz Kwitniewski (2)Affiliations: (1) Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow; (2) Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, KrakowTo the Editor,Mas-related G protein-coupled receptor-X2 (MRGPRX2) is mainly expressed in the skin mast cells (MCs) and in the sensory neurons.1,2 It’s activated by basic neuropeptides (e.g. Substance P, vasoactive intestinal peptide), by antimicrobial host defense peptides, by eosinophil granule proteins, or by a number of commonly used small-molecule drugs (e.g. neuromuscular blocking agents, fluoroquinolones, vancomycin).1-4 MCs are key effector cells in a number of diseases, and MRGPRX2 has been considered to play an important role in non-IgE-mediated degranulation of MCs. Therefore, the contribution of MRGPRX2 in allergic reactions in mastocytosis and in mast cell activation syndromes, in those for instance induced by hymenoptera venom, has been postulated.1 The expression of MRGPRX2 has been shown to be up-regulated in skin-derived MCs in patients with severe chronic urticaria.4Furthermore, research carried out by An and colleagues have demonstrated that MRGPRX2 is present in the serum of healthy individuals (12.9 ng/mL), that MRGPRX2 serum levels are elevated in nonallergic asthmatics (79.8 ng/mL), and that there is an even more elevated serum level in the subgroup of patients with allergic asthma (102.4 ng/mL). The receptor concentrations were also positively associated with a dose of inhaled corticosteroids and a level of asthma control.5 In conclusion, the authors of the research proposed that serum MRGPRX2 levels can be used as a potential independent biomarker for monitoring treatment outcomes in allergic asthma.Based on the research findings presented above, we attempted to validate the utility of MRGPRX2 serum levels as a biomarker in a pilot group of patients presenting medical conditions of interest in comparison to healthy controls (n=4). The patients’ group involved: (a) three individuals under hymenoptera venom immunotherapy due to venom-triggered anaphylaxis, with the accompanying increased levels of serum tryptase (one of them with systemic mastocytosis); (b) three individuals with severe atopy confirmed by high levels of allergen-specific IgE to five or more common inhalant allergens, and who also were suffering from allergic asthma (n=2) and chronic urticaria (n=1). The detailed characteristic of analyzed subjects is summarized in the supplementary Table S1. MRGPRX2 serum levels were determined by ELISA (Abbexa) according to the manufacturer’s protocol. Unexpectedly, we noted neither any significant increase in MRGPRX2 serum levels in patients, nor significant differences between subgroups (a) and (b), and between patients and controls. The recorded results remained in the range 0-0,49 ng/ml (Fig. 1A), and fluctuated around the detection limit of the ELISA. To clarify any discrepancies between our results and the data published by An, we reevaluated the same serum samples with the kit used by An and colleagues.5 (MyBioSource). We used human dermis and human dermal fibroblast homogenates as MRGPRX2 positive, and negative controls, respectively. The presence of MRGPRX2 transcript was determined by means of PCR (Fig. 2). In contrast to Abbexa, high serum MRGPRX2 levels were detected in all of the samples (Fig. 1B). Interestingly, there were no differences in MRGPRX2 levels between the positive and negative controls as well as between the patients’ subgroups and the healthy controls. Moreover, in diluted samples, the receptor concentrations were higher (mean range 33-133 ng/mL), which may indicate the presence of non-specific binding of detecting antibody. Details of laboratory methods are presented in the supplementary materials.To conclude, our data suggest that MRGPRX2 serum levels measured by ELISA are not increased, neither in the healthy, nor in the patients with common disorders with mast cells involvement. This observation is in line with the findings of Ding et al. which showed that MRGPRX2 is present in whole blood, but not in human serum.3 In turn, the presence of MRGPRX2 in whole blood is supported by results reported recently by Wedi and colleagues on the receptor expression on peripheral blood basophils and eosinophils.2 Moreover, caution should be exercised while selecting ELISA kit targeting MRGPRX2 because of the potential risk of the occurrence of unspecific bindings since positive and negative control samples did not reveal any a differences when MyBioSource kit was used.1. Porebski G, Kwiecien K, Pawica M, Kwitniewski M. Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2) in Drug Hypersensitivity Reactions. Front Immunol. 2018;9:3027.2. Wedi B, Gehring M, Kapp A. The pseudoallergen receptor MRGPRX2 on peripheral blood basophils and eosinophils: Expression and function. Allergy. 2020;75:2229-2242.3. Ding Y, Zhang T, Liu R, Che D, Wang N, He L. A novel ELISA method to determine human MrgX2 in chronic urticaria. Clin Transl Allergy. 2020;10:61.4. Fujisawa D, Kashiwakura J, Kita H, et al. Expression of Mas-related gene X2 on mast cells is upregulated in the skin of patients with severe chronic urticaria. J Allergy Clin Immunol. 2014;134:622-633.e9.5. An J, Lee JH, Won HK, et al. Clinical significance of serum MRGPRX2 as a new biomarker in allergic asthma. Allergy. 2020;75:959-962.

Excavation of regolith is the enabling process for many of the in-situ resource utilization (ISRU) efforts that are being considered to aid in the human exploration of the moon and Mars. Most proposed planetary excavation systems are integrated with a wheeled vehicle, but none yet have used a screw-propelled vehicle which can significantly enhance the excavation performance. Therefore, CASPER, a novel screw-propelled excavation rover is developed and analyzed to determine its effectiveness as a planetary excavator. The excavation rate, power, velocity, cost of transport, and a new parameter, excavation transport rate, are analyzed for various configurations of the vehicle through mobility and excavation tests performed in silica sand. The optimal configuration yielded a 30 kg/hr excavation rate and 10.2 m/min traverse rate with an overall system mass of 3.4 kg and power draw of less than 30 W. These results indicate that this architecture shows promise as a planetary excavation because it provides significant excavation capability with low mass and power requirements. Corresponding author(s) Email:   hmarvi@asu.edu  

Background: During non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction. Methods: Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. Results: A total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. Conclusions: We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

Nanomaterial drug delivery systems have become one of the most important targeted therapy technologies. Although great efforts have been made to study the self-assembled mesoscopic structure of nanoparticles and understand drug loading and release mechanisms, the interaction between nanoparticles and cell membranes has not yet been clearly studied. Moreover, the research of experimental methods in this field has been greatly restricted due to its special time-space scale, so it is necessary to apply computer simulations to visualize the cell internalization of the nanoparticle. This review covers modelling methods and the current status and viewpoints of research on the influencing factors of the nanoparticle-biomembrane interaction mechanism. In particular, we discussed in detail the positive and negative effects of various nanoparticle properties. This article may assist researchers in rationally optimize the nanoparticle structure to improve therapeutic efficiency.

A patient with internal carotid artery (ICA) rupture due to multiple irradiations underwent revascularization with high-flow bypass under the condition that endovascular treatment could not be performed. It was possible to safely remove necrotic tissues and reconstruct the skull base using trapping of the ruptured ICA.