The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines.

INTRODUCTION: Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS: As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES: The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates

Electronic Structure Calculations and Experimental Studies on the Thermal Initiation of the Twin Polymerization Process

Presented here is a combined computational and experimental study on the thermal initiation process of the twin polymerization. Although thermally initiated twin polymerization offers a versatile scheme for obtaining hybrid organic/inorganic nanocomposite materials, the mechanism for its initiation is very different from the proton‐initiated twin polymerization. In this study, the basic mechanism of the early steps of the polymerization process of 4 H,4 H′‐2,2′‐spirobi[benzo[d][1,3,2]dioxasiline] was investigated by using electronic structure calculations in conjunction with experimental differential scanning calorimetry studies. This way, the influences on the thermally initiated twin polymerization process could be analyzed in detail. The previous mechanistic hypotheses are systematically assessed herein to show that, based on the results, a new hypothesis for an initiation mechanism can be formulated that is in agreement with all experimental observations. These results suggest that, before the formation of the polymer networks, the thermal initiation starts with the formation of low‐molecular‐weight fragments that react to yield acidic groups. If a sufficient amount of these form, the reaction is ultimately funneled into a mechanism similar to that of proton‐initiated twin polymerization

Spirocyclic tin salicyl alcoholates – a combined experimental and theoretical study on their structures, ¹¹⁹Sn NMR chemical shifts and reactivity in thermally induced twin polymerization

The spirocyclic tin salicyl alcoholate, 4H,4′H-2,2′-spirobi[benzo[d][1,3,2]dioxastannine] (1), and its 6,6′-dimethoxy (2) and 8,8′-di-tert-butyl-6,6′-dimethyl derivative (3) were synthesized and thermally induced twin polymerization of precursor 2 was performed to give a SnO2-containing hybrid material. Studies on the molecular structures of 1–3 were carried out using 119Sn{1H} CP MAS NMR spectroscopy and DFT calculations. Crystallization of compound 3 from dimethyl sulfoxide solution provided the Lewis acid–base adduct 3(dmso)2 exhibiting a hexacoordinated tin atom in the solid state, in agreement with the results of the spectroscopic and DFT calculation data. 119Sn NMR spectroscopy of the compounds 1–3 and 3(dmso)2 revealed equilibria among the diverse oligomers in solution phase pointing at hexacoordinated tin atoms

The systematics of a small spineless Desmodesmus species, D. Costato-Granulatus (Sphaeropleales, Chlorophyceae) based on ITS2 rDNA sequence analyses and cell wall morphology

Desmodesmus species taxonomy is one of the most long-standing issues in green microalgal systematics due to problems associated with phenotypic plasticity. Whereas more recent species descriptions and identifications are mainly based on cell wall structures and the use of cultures, comparisons with molecular phylogenies are largely lacking. In this study, the phylogenetic relationships between 22 clones identified as Desmodesmus costato-granulatus (Skuja) E. H. Hegew. were assessed using ITS2 rDNA sequence data in combination with cell wall morphology. The unrooted ITS2 phylogeny showed that the clones cluster into five groups, which also differ in their cell wall structures. Therefore, the taxon is split into five species: D. costato-granulatus, D. elegans, D. fennicus, D. regularis, and D. ultrasquamatus. Compared with other Desmodesmus species, intraspecific sequence variation is extensive and may contain additional (pseudo)cryptic diversity. Compensatory base changes were near-absent within the species and varied from one to 11 between species. Relationships among the species were unresolved. Despite this, they clustered together with the two other Desmodesmus species having a combination of small and large warts in a well-supported lineage. Remarkably, ITS2 sequence variation in this lineage is as high as between all other included Desmodesmus species, even though the morphology of its members is rather uniform

Inflammation in children with chronic kidney disease linked to gut dysbiosis and metabolite imbalance

BACKGROUND: Chronic kidney disease (CKD) is characterized by a sustained proinflammatory response of the immune system, promoting hypertension and cardiovascular disease. The underlying mechanisms are incompletely understood, but may be linked to gut dysbiosis. Dysbiosis has been described in adults with CKD; however, comorbidities limit CKD-specific conclusions. METHODS: We analyzed the fecal microbiome, metabolites, and immune phenotypes in 48 children (normal kidney function, CKD stage G3-G4, G5 treated by hemodialysis (HD) or kidney transplantation) with a mean age of 10.6 ± 3.8 years. RESULTS: Serum TNF-α and sCD14 were stage-dependently elevated, indicating inflammation, gut barrier dysfunction, and endotoxemia. We observed compositional and functional alterations of the microbiome, including diminished production of short-chain fatty acids. Plasma metabolite analysis revealed a stage-dependent increase of tryptophan metabolites of bacterial origin. Serum from HD patients activated the aryl hydrocarbon receptor and stimulated TNF-α production in monocytes, corresponding to a proinflammatory shift from classical to non classical and intermediate monocytes. Unsupervised analysis of T cells revealed a loss of mucosa-associated invariant T (MAIT) cells and regulatory T cell subtypes in HD patients. CONCLUSIONS: Gut barrier dysfunction and microbial metabolite imbalance apparently mediate the pro-inflammatory immune phenotype, thereby driving the susceptibility to cardiovascular disease. The data highlight the importance of the microbiota-immune axis in CKD, irrespective of confounding comorbidities