Arginine Regulates Zygotic Genome Activation in Porcine Embryos through Promoting Polyamine Synthesis☆

Background:Arginine has a positive effect on preimplantation development in pigs. However, the exact mechanism by which arginine promotes embryonic development to the blastocyst stage is not undefined. Here, single-cell RNA-sequencing technology was applied to porcine in vivo pre-implantation embryos from zygote to morula to determine transcription patterns of arginine metabolism-related genes during preimplantation embryonic development.Results:Transcriptome sequencing showed that arginine metabolism-related genes clearly changed from the 2-cell stage to the 4-cell stage, where zygotic genome activation (ZGA) occurred in porcine embryos. Further analysis of the correlation between arginine metabolism and ZGA shows that arginine metabolism-related genes are significantly correlated with key ZGA genes such as ZSCAN4, DPPA2 and EIF1A, indicating that arginine metabolism may be an indicator of porcine ZGA. To explore the correlation between arginine metabolism and ZGA, embryos cultured in the medium that removes all the amino acids, proteins and pyruvate in the PZM3 medium were employed to generate the ZGA blocked embryo model. The 4-cell arrest rate significantly increased at 72 h after activation, indicating impeded embryonic development. Meanwhile, results of immunofluorescent staining showed that the expression of SIRT1 protein during ZGA was significantly inhibited. Results of quantitative PCR showed that the expression of zygotic genes (ZSCAN4, DPPA2 and EIF1A) was significantly decreased. The above results indicate that the ZGA blocked embryo model was successfully established. Adding of arginine recovered embryonic development, SIRT1 and zygotic genes expression levels and initiated the ZGA. In addition, ROS content significantly increased when ZGA was blocked, and the GSH, ATP and lipid droplet content significantly decreased. After the addition of arginine in the block group, the ROS content significantly decreased, and the GSH, ATP and lipid droplet content significantly increased. Moreover, the ornithine decarboxylase (ODC) inhibitor difluoromethylornithine (DFMO) and arginine were added to the block group at the same time, and the effect of arginine was found to be inhibited. Conclusions: Arginine is essential for ZGA in porcine embryos. Arginine contributes to porcine ZGA by promoting polyamine synthesis in porcine embryos.

Comparison of Two Protocols for the Treatment of Class 2 Malocclusion

Purpose: The purpose of this study was to compare the outcomes of the treatment with the twin block and modified twin block appliances in growing patients with Class 2 malocclusion. Materials and Methods: A cephalometric analysis was performed in 51 patients. The twin block sample consisted of 23 patients, 10-girls and 13-boys (mean age 10.46±0.71 years at the start of treatment, T1, and 12.84±0.78 years at the end of active treatment, T2). The modified twin block sample consisted of 28 patients, 18 girls and 15 boys (mean age 11.78±0.91 years at T1, and 13.32±0.56 years at T2). The twin block activators were used during the day, except for eating time, and the modified ones were used only at night. Duration of the treatment was 16-20 months. The changes from T2 to T1 and the differences between the groups were compared with the analysis of variance. Results: SNB angle in the twin block group showed 1.25±1.39 degrees change and in the modified twin block group, it exhibited 3.69±1.01 degrees change. Overjet in the group with twin block decreased 4.58±1.59 mm, and in the group with modified twin block it decreased 4.43±1.41 mm. In the modified twin block group, there was more retrusion of upper incisors in comparison with the twin block group. Accordingly, under the effect of modified twin block, retrusion of the upper lip was observed. Conclusion: Through modifying the twin block appliance, it is possible to ensure the comfort of the patients by reducing the daily usage, to reposition the mandibula forward and to correct overjet and sagittal dento-skeletal relationships without increasing facial height and to improve positions of upper incisors and lips.

A Spatial Analysis of Robbery Rate in the City of Detroit using Exploratory Data Analysis Approach

Many U.S. cities have experienced rising crime rates in recent years. Crime has inherent geographic quality and tend to concentrate in certain places within the city. To prioritize public safety and crime prevention strategies, it is important to identify where crime is occurring and with what severity. Using spatial statistics including the average nearest neighbour index, Moran’s I, Getis-Ord Gi* statistic, and Anselin Cluster and Outlier Analysis, this study investigates robbery locations within the city of Detroit over 5-year period, 2016 to 2020 to identify hot spots, cold spots and spatial patterns across two different spatial scale – block group and census tracts. The study seeks to understand the effect of data aggregation on each spatial scale on the outcome of the analysis to determine the most optimum spatial scale to study robbery rates. The study concludes that, spatial analysis at small scale like block group level is most informative. Policy implications and areas for further research are provided.

Impact of Neighborhood Socioeconomic Disadvantage on Staffing Hours in US Nursing Homes

Severe socioeconomic disadvantage in neighborhoods where nursing homes (NH) are located may be an important contributor to disparities in resident quality of care. Disadvantaged neighborhoods may have undesirable attributes (e.g., poor public transit) that make it challenging to recruit and retain qualified staff. Lower NH staffing could subsequently leave residents vulnerable to adverse events. Thus, the purpose of this study was to evaluate whether NHs located in socioeconomically disadvantaged neighborhoods had lower healthcare provider staffing levels. We linked publicly available NH data geocoded at the Census block-group level with the Area Deprivation Index, a measure of neighborhood socioeconomic factors including poverty, employment, and housing quality (percentiles: 1-100). Consistent with prior literature on threshold effects of neighborhood poverty on outcomes, we characterized NHs as being located in a disadvantaged neighborhood if the census-block group ADI score was ≥85/100. We used generalized estimating equations clustered at the county level with fixed effects for state and rural location to evaluate relationships between ADI score and staffing. NHs located in socioeconomically disadvantaged neighborhoods had 12.1% lower levels of staffing for registered nurses (mean: 5.8 fewer hours/100 resident-days, 95% CI: 4.4-7.1 hours), 1.2% lower for certified nursing assistants (2.9 fewer hours/100 resident days; 95% CI 0.6-5.1 hours), 20% lower for physical therapists (1.4 fewer hours/100 resident-days; 95% CI 1.1-1.8 hours), and 19% lower for occupational therapists (1.3 fewer hours/100 resident-days; 95% CI 1.0-1.6 hours). These findings highlight disparities that could be targeted with policy interventions focused on recruiting and retaining staff in socioeconomically disadvantaged neighborhoods.

Comparison of Ultrasound Guided Ankle Block versus Anatomical Landmark Guided Ankle Block in Minor Ankle and Foot Surgeries

Background: Regional anesthesia has increasingly expanded its role in perioperative care of patients undergoing foot and ankle surgery. The use of regional anesthesia has been widely implemented among anesthesiologists and pain providers. Multiple approaches for sephanous nerve blockade have been used including nerve stimulation, anatomical landmarks and ultrasound. It has been observed in previous studies that USG ankle block is more successful as compared to conventional anatomical landmark guided nerve block; so this study was planned to get precise and reliable results regarding both techniques in our local population. Objective: To compare the methods of surgical anesthesia of Ultrasound-guided ankle block versus conventional anatomic landmark-guided techniques in lower limb surgery under regional anesthesia. Materials and methods: This randomized control was carried out at Department of Anesthesia Mayo Hospital Lahore. After meeting the inclusion and exclusion criteria 50 patients (25 in each group ) were enrolled. Patients were randomly divided into two groups using lottery method. Group A patients underwent USG ankle block while group B patients underwent conventional anatomic landmark guided ankle block. Results: Mean age of patients was 46.96±11.578 years; 40(80%) patients were male and 10(20%) patients were females. Successful anesthesia was achieved in 42 (84%) patients; in which in USG block group the successful anesthesia was achieved in 22(88%) patients and in ALG block group successful anesthesia was achieved in 20(80%) patients (p value =0.702) Conclusion : Findings of this study conclude that both techniques have statistically insignificant difference in terms of success rate , however USG ankle block for surgical anesthesia showed higher success rate as compared to anatomic landmark guided technique in lower limb surgery under regional anesthesia. Keywords: Ultrasound-guided Ankle Block, Anatomic Landmark-guided Ankle Block, Lower limb surgery.

Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients

BackgroundWe evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion.MethodsA retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019–July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0–10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects.ResultsOf 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006).ConclusionsErector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.

Evaluation of the Postoperative Analgesic Effect of 2 Different Blocks after Pediatric Circumcision Surgery

<b><i>Background:</i></b> Circumcision is a painful day-case surgery. Regional anesthesia techniques are used effectively for anesthesia and postoperative analgesia after pediatric circumcision surgery. <b><i>Objective:</i></b> Our prospective observational study aimed to compare postoperative analgesic efficiency of a dorsal penile nerve (DPN) block with a transversus abdominis plane (TAP) block after male pediatric circumcision surgery and complications related to each block. <b><i>Study Design:</i></b> We enrolled 80 male children under the age of 10 years with American Society of Anesthesiologists I–II status scheduled for circumcision in this prospective observational study. A TAP or DPN block was performed after induction of general anesthesia before surgery with ultrasound (US) guidance. Postoperative pain was assessed with Faces Pain Scale-Revised and the Faces, Legs, Activity, Cry and Consolability scale. <b><i>Results:</i></b> There was no statistically significant difference between the groups regarding 30-min pain score levels (<i>p</i> &#x3e; 0.05). But, the 1st hour, 2nd hour, 6th hour, 12th hour, and 24th-hour pain score levels in the TAP block group were statistically significantly higher than those of the DPN block group (<i>p</i> &#x3c; 0.05). The 1st rescue analgesic requirement in the TAP block group was at the 6th hour postoperative. There was no need for rescue analgesia in the DPN block group during the postoperative 24-h follow-up. <b><i>Discussion:</i></b> A US-guided DPN block provided effective and long-lasting postoperative analgesia for circumcision surgery with statistically significantly lower pain score levels than a US-guided TAP block. <b><i>Conclusion:</i></b> This study found that a TAP block alone was insufficient to provide adequate postoperative analgesia for circumcision surgery compared to DPN block.

The Analgesic Efficacy of Ultrasound-guided Bilateral Transversus Thoracic MusclePlane Block after Open-Heart Surgeries: A Randomized Controlled Study

Background: We aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral Transversus Thoracic Muscle Plane Block after Open-Heart Surgeries. Methods: 70 patients aged above 18 years and scheduled for valve replacement or adult congenital via median sternotomy were enrolled in this study. Patients were divided into two groups, randomized by computer-generated random numbers: the block group, which had the ultrasound-guided bilateral transversus thoracic muscle plane block, and the control group, which had a sham block. The primary outcome was total fentanyl consumption in the first 24-hours. The secondary outcomes were pain score, time to the first analgesic request, time to extubation , ICU stays, and hospital stay. Results: The total fentanyl consumption in the first 24 hours was significantly lower in the block group, with a mean difference of -158.286 (95% CI = (-179.271 to -137.300; p=<0.0001). The time to the first analgesic request was statistically significantly shorter in the non-block group (median 3 hours) than the block group (median 14 hours). During the postoperative period (0.5-24 hours), at-rest pain scores were 1.86 units lower in the block group (the estimate was -1.80, 95% CI = -2.14 to -1.45, t = -10.323 with p <0.0001). Likewise, pain scores with cough were 3.29 units lower in the block group (the estimate was -3.29, 95% CI = -3.80 to -2.77, t = -12.703, p <0.0001).Conclusion: Bilateral Transversus Thoracic Muscle Plane Block is a promising and effective technique in reducing opioid consumption and controlling post-sternotomy pain after open-heart surgery via median sternotomy.Trial Registration: This study is registered on ClinicalTrials.gov (NCT04116554; principal investigator: Mohamed Ahmed Hamed; date of registration: October 4, 2019).

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery

BackgroundHousing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.MethodsWe used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.ResultsIndividuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.ConclusionOur results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.