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OBJECTIVE To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. STUDY DESIGN We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP] 130-139/80-89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (

An international study about implementation of the World Health Organization Surgical Safety Checklist showed that use of the checklist reduced complication and death rates in adult surgical patients. Clinicians at Children's Hospital Boston, Massachusetts, modified the Surgical Safety Checklist for pediatric populations. We pilot tested the Pediatric Surgical Safety Checklist and created a large checklist poster for each OR to allow the entire surgical team to view the checklist simultaneously and to promote shared responsibility for conducting the time out. Results of the pilot test showed improvements in teamwork, communication, and adherence to process measures. Parallel efforts were made in other areas of the hospital where invasive procedures are performed. Compliance with the checklist at our facility has been good, and team members have expressed satisfaction with the flow and content of the checklist.

Importance Although seroepidemiological studies indicate that greater than 50% of the population has been infected with John Cunningham virus (JCV), the sites of JCV persistence remain incompletely characterized. Objective To determine sites of JCV persistence in immunologically healthy individuals. Design, Setting, and Participants Tissue specimens from multiple sites including brain, renal, and nonrenal tissues were obtained at autopsy performed in the Department of Pathology at the University of Kentucky from 12 immunologically healthy patients between February 9, 2011, and November 27, 2012. Quantitative polymerase chain reaction was performed on the tissue specimens and urine. Serum JCV antibody status was determined by enzyme-linked immunosorbent assay. Main Outcomes and Measures The detection and quantification of JCV from the tissues by quantitative polymerase chain reaction illuminated sites of viral persistence. These results were correlated with JCV antibody levels. Results Autopsies were performed on 12 individuals, 10 men and 2 women, ranging in age from 25 to 75 years (mean, 55.3 years). Seven of 12 individuals were JCV antibody seropositive based on absorbance units. Serostatus was associated with amounts of JCV DNA in urine and its tissue distribution. John Cunningham virus DNA was found in 75% of genitourinary tissue samples from donors (18 of 24) with high JCV antibody levels, 13.3% of donors with low levels i(4 of 30), and 0% of seronegative persons (0 of 32). In nongenitourinary tissues, JCV DNA was detected in 45.1% of tissue samples of donors (32 of 71) with high JCV, 2.2% of donors with low JCV serostatus (2 of 93), and 0% of seronegative persons (0 of 43). Genitourinary tissues had higher copy numbers than other sites. John Cunningham virus DNA was detected in urine of seronegative individuals in a research-grade assay. Conclusions and Relevance Persistent (latent or actively replicating) JCV infection mostly predominates in genitourinary tissues but distributes in other tissues at low copy number. The distribution and copy numbers of the virus appear to correlate with urinary JCV shedding and serostatus.

Background Despite mounting evidence that use of surgical checklists improves patient morbidity and mortality, compliance among surgical teams in executing required elements of checklists has been low. Recognizing that clinicians' receptivity is a major determinant of checklist use, we conducted a survey to investigate how mandated use of a surgical checklist impacts its operating room clinicians' attitudes about and perceptions of operating room safety, efficiency, teamwork, and prevention of medical errors. Methods Operating room clinicians at 1 pediatric hospital were surveyed on their attitudes and perception of the novel Pediatric Surgical Safety Checklist and the impact the checklist had on efficiency, teamwork, and prevention of medical errors 1 year after its implementation. The survey responses were compared and classified by multidisciplinary perioperative clinical staff. Results Most responses reflected positive attitudes toward checklist use. The respondents felt that the checklist reduced complications and errors and improved patient safety, communication among team members, teamwork in complex procedures, and efficiency in the operating room. Many operating room staff also reported that checklist use had prevented or averted an error or a complication. Perceptions varied according to perioperative clinical discipline, reflecting differences in perspectives. For example, the nurses perceived a higher rate of consent-related errors and site marking errors than did the physicians; the surgeons reported more antibiotic timing and equipment errors than did others. Conclusions The surgical staff at 1 pediatric hospital who responded viewed the novel Pediatric Surgical Safety Checklist as potentially beneficial to operative patient safety by improving teamwork and communication, reducing errors, and improving efficiency. Responses varied by discipline, indicating that team members view the checklist from different perspectives.

Infection of glial cells by the human polyomavirus JC (JCV) causes progressive multifocal leukoencephalopathy (PML). JCV Encephalopathy (JCVE) is a newly identified disease characterized by JCV infection of cortical pyramidal neurons. The virus JCVCPN associated with JCVE contains a unique 143 base pair deletion in the agnogene. Contrary to most JCV brain isolates, JCVCPN has an archetype-like regulatory region (RR) usually found in kidney strains. This provided us with the unique opportunity to determine for the first time how each of these regions contributed to the phenotype of JCVCPN. We characterized the replication of JCVCPN compared to the prototype virus JCVMad-1 in kidney, glial and neuronal cell lines. We found that JCVCPN is capable of replicating viral DNA in all cell lines tested, but is unable to establish persistent infection seen with JCVMad-1. JCVCPN does not have an increased ability to replicate in the neuronal cell line tested. To determine whether this phenotype results from the archetype-like RR or the agnogene deletion, we generated chimeric viruses between JCVCPN of JCVMad-1. We found that the deletion in the agnogene is the predominant cause of the inability of the virus to maintain a persistent infection, with the introduction of a full length agnogene, either with or without agnoprotein expression, rescues the replication of JCVCPN. Studying this naturally occurring pathogenic variant of JCV provides a valuable tool for understanding the functions of the agnogene and RR form in JCV replication.

Natalizumab, a monoclonal antibody directed against α4 integrins, has, to date, been associated with 399 cases of progressive multifocal leukoencephalopathy (PML) worldwide in patients receiving treatment for multiple sclerosis (MS). Because of the limited number of histologic studies, the possible interplay between MS and PML lesions has not been investigated. We report the clinical, radiologic, and histologic findings of an MS patient who developed PML after 32 months of natalizumab monotherapy. After withdrawal of natalizumab, she received plasma exchange, mefloquine, and mirtazapine but died soon thereafter. Postmortem examination was restricted to examination of the brain and spinal cord. Extensive PML lesions, characterized by the presence of JC virus DNA were found in the cerebral white matter and neocortex. Sharply demarcated areas of active PML lesions contained prominent inflammatory infiltrates composed of approximately equal numbers of CD4-positive and CD8-positive T cells, consistent with an immune reconstitution inflammatory syndrome. Conversely, all MS lesions identified were hypocellular, long-standing inactive plaques characterized by myelin loss, relative axonal preservation, and gliosis and, importantly, were devoid of JC virus DNA and active inflammation. Chronic inactive MS lesions were separate and distinct from nearby PML lesions. This case demonstrates the coexistence and apparent lack of interplay between chronic inactive MS and PML lesions, and that immune reconstitution inflammatory syndrome seems to affect the shape and appearance of PML but not MS lesions.

Background Mass cytometry has recently emerged as a promising tool for clinical research. However, few studies have demonstrated its benefit for patient stratification and biomarker identification. Primary Sjogren's syndrome (pSS) is a prototype of chronic autoimmune disease, the pathogenesis of which remains unclear and for which treatment does not exist. Objective This observational case-control study was designed to discover new cellular biomarkers and therapeutic targets in patients with pSS. Methods Forty-nine patients with pSS and 45 control subjects were enrolled for clinical evaluation and mass cytometry quantification of 34 protein markers in blood. For a third of these subjects, matched labial salivary gland biopsy specimens were also analyzed by mass cytometry and immunohistochemistry. Results In salivary gland biopsy specimens from patients with pSS, we identified a high number of activated CD8 + T cells, terminally differentiated plasma cells, and activated epithelial cells, pointing to new pathogenic mechanisms for future clinical intervention. In blood, we identified a 6-cell disease signature defined by decreased numbers of CD4 and memory B lymphocytes, decreased plasmacytoid dendritic cell numbers, and increased representation of activated CD4 and CD8 T cells and plasmablasts. These blood cellular components correlated with clinical parameters and, when taken together, clustered patients into subsets with distinct disease activity and glandular inflammation. Conclusion This first application of mass cytometry to a well-stratified clinical cohort and small biopsy tissues establishes the benefits of such an approach for the discovery of new biomarkers and therapeutic targets. Similar high-dimensional immunophenotyping strategies could be implemented in longitudinal and interventional clinical settings in this and other disease areas.

During the 2007 meeting of the Child Health Corporation of America Operating Room Director's Forum, members identified two major discrepancies in surgical count policies among the member hospitals: variations for instrument counts in pediatrics and exceptions to radiographic verification when needle counts were incorrect. The group agreed to collaboratively develop a pediatric count policy based on directors' expertise and current literature to help improve count practices. The task force members reviewed the literature as well as count policies from 30 member hospitals to identify and combine best practices and to create a single, standardized count policy. The project exemplifies a successful nurse-led, national group effort. The outcome is a policy that represents best practice in pediatrics and is a first step toward future opportunities to improve patient safety.

Retained surgical items were the most frequently reported sentinel event in 2010, according to The Joint Commission. Perioperative nurse leaders at Children's Hospital Boston, a pediatric teaching hospital, conducted a quality improvement initiative to reduce or eliminate incorrect counts and count discrepancies, which increase the risk of an item being unintentionally retained after surgery. Work included educating the perioperative staff members, standardizing count practices, formally reviewing every reported count discrepancy with the nursing team, and reviewing and revising the count policy for prevention of retained surgical items. The initiative reduced the number of incorrect counts and count discrepancies by 50% between 2009 to 2010. These initiatives continue to be expanded, and the results have been sustained on an ongoing basis.

Introductory note by Cynthia Spry, RN, MA, MSN, CNOR, column coordinator: Since 1956, the People to People Citizen Ambassador Programs have offered unique travel opportunities that foster local and global networking and provide opportunities for professionals from around the world to interact and engage in cultural activities, seminars, and humanitarian efforts. Since the 1980s, several AORN leaders have led perioperative nurses on People to People trips to China, Russia, and other countries where they have shared and learned much about perioperative practice and once again confirmed that, despite differences in available resources, perioperative nurses around the world have much in common. Just as perioperative nurses in the United States are proud of their contributions to patient safety, the ongoing movement to evidence-based practice, and their commitment to advancing the profession, nurses in less developed countries are too. This is the second of a two-part column about a People to People experience shared by several AORN members who traveled to Russia and Poland. The experience in Russia was detailed in the July 2009 AORN Journal . This column focuses on the experience in Poland.

Introductory note by Cynthia Spry, RN, MA, MSN, CNOR, column coordinator: Since 1956, the People to People Citizen Ambassador Programs have offered unique travel opportunities that foster local and global networking and provide opportunities for professionals from around the world to interact and engage in cultural activities, seminars, and humanitarian efforts. Since the 1980s, several AORN leaders have led perioperative nurses on People to People trips to China, Russia, and other countries where they have shared and learned much about perioperative practice and once again confirmed that, despite differences in available resources, perioperative nurses around the world have much in common. Just as perioperative nurses in the United States are proud of their contributions to patient safety and the ongoing movement to evidence-based practice and their commitment to advancing the profession, nurses in less developed countries are, too. The authors of this article had an opportunity to represent perioperative nursing colleagues in the United States while participating in a People to People trip to Russia and Poland. In this article, the authors provide a snapshot of perioperative nursing, as well as nursing in general, in Russia. September's column will cover the experience in Poland. Nursing is a rewarding and demanding profession, particularly in Russia where salaries are low and working conditions are sometimes harsh, but the nurses are dedicated, committed to advancing nursing education, and are making a difference. They recognize they have a difficult road to travel but are proud of the steps they have taken on this journey.

Although scientists have provided mounting evidence in the past few years that new neurons can be produced in some areas of the adult brain, the neocortex--the region most concerned with such higher brain functions as memory and learning--did not seem capable of such regeneration. Now, in the 22 June issue of Nature, neuroscientists report that when they induced certain neurons in the neocortex of adult mice to self-destruct, the loss triggered the formation of replacement neurons by brain stem cells. If similar regeneration of brain neurons can be triggered in humans, the findings could open the door for treatments that might restore memory in Alzheimer9s disease, for example, or undo the damage wreaked by spinal cord injury.