004), and remifentanil maintenance (p < 0.001). Vasopressor infusion use was significantly higher with propofol (64.9% v . 8.5%, p < 0.001). Propofol maintenance and angiotensin-converting enzyme inhibitor/angiotensin II receptor-blocker use were the only variables identified as risk factors for vasopressor use (p < 0.001 and p = 0.009).
 
  For patients undergoing TAVR with conscious sedation, remifentanil was associated with more hypoxemia while propofol was associated with a higher rate of vasopressor use.
 For patients undergoing TAVR with conscious sedation, remifentanil was associated with more hypoxemia while propofol was associated with a higher rate of vasopressor use.Intrauterine hypoxia is a feature of pregnancy complications, both at high altitude and sea level. To understand the placental response to reduced oxygen availability, small animal models of maternal inhalation hypoxia (MIH) or reduced uterine perfusion pressure (RUPP) may be utilised. The aim of this review was to compare the findings of those studies to identify the role of oxygen availability in adapting placental structural and functional phenotypes in relation to fetal outcome. It also sought to explore the evidence for the involvement of particular genes and protein signalling pathways in the placenta in mediating hypoxia driven alterations. The data available demonstrate that both MIH and RUPP can induce placental hypoxia, which affects placental structure and vascularity, as well as glucose, amino acid, calcium and possibly lipid transport capacity. In addition, changes have been observed in HIF, VEGF, insulin/IGF2, AMPK, mTOR, PI3K and PPARγ signalling, which may be key in linking together observed phenotypes under conditions of placental hypoxia. Many different manipulations have been examined, with varied outcomes depending on the intensity, timing and duration of the insult. Some manipulations have detrimental effects on placental phenotype, viability and fetal growth, whereas in others, the placenta appears to adapt to uphold fetal growth despite the challenge of low oxygen. Together these data suggest a complex response of the placenta to reduced oxygen availability, which links to changes in fetal outcomes. However, further work is required to explore the role of fetal sex, altered maternal physiology and placental molecular mechanisms to fully understand placental responses to hypoxia and their relevance for pregnancy outcome.
  Aneurysmal subarachnoid hemorrhage (aSAH) and traumatic subarachnoid hemorrhage (tSAH) differ significantly in their mortality and management. Although computed tomography angiography (CTA) is critical to guide timely interventions in aSAH, it lacks recognized benefit in assessing tSAH. Despite this, CTA commonly is included in tSAH evaluation.
 
  Determine if any clinically significant cerebral aneurysms are identified on CTA in emergency department (ED) patients with a tSAH.
 
  Retrospective observational study of consecutive blunt head trauma patients ages ≥ 16 years with Glasgow Coma Scale score (GCS) ≥ 13 who presented to an academic ED (100,000 annual visits) over a 7-year period. Those included had a CT-diagnosed SAH and underwent head CTA. The primary endpoint was the detection of any clinically significant brain aneurysms.
 
  There were 297 patients that met the inclusion criteria. Twenty-six patients (8.8%) had an incidental aneurysm discovered; one underwent elective outpatient intervention. Aneurysm-positive patients were more likely to be female (69.2% vs. 46.9%, p = 0.003), age 60 years or older (80.8% vs. 52.4%, p = 0.005), and be on anticoagulation (42.3% vs. 28.0%, p = 0.03). There were no differences between the aneurysm-positive and -negative patients with respect to GCS, history of hypertension, or mechanism of injury.
 
  In this 7-year retrospective chart review, CTA in patients with tSAH and GCS ≥ 13 did not reveal any clinically relevant cerebral aneurysms. One incidental aneurysm later underwent outpatient neurovascular intervention. In the absence of specific clinical concerns, CTA has minimal value in well-appearing patients with a tSAH.
 In this 7-year retrospective chart review, CTA in patients with tSAH and GCS ≥ 13 did not reveal any clinically relevant cerebral aneurysms. One incidental aneurysm later underwent outpatient neurovascular intervention. In the absence of specific clinical concerns, CTA has minimal value in well-appearing patients with a tSAH.Since 2003, highly pathogenic avian influenza (HPAI) viruses of the H5 subtype have been maintained in poultry, periodically spilling back into wild migratory birds and spread to other geographic regions, with re-introduction to domestic birds causing severe impacts for poultry health, production and food sustainability. Successive waves of infection have also resulted in substantial genetic evolution and reassortment, enabling the emergence of multiple clades and subtypes within the H5 2.3.4.4 HPAI viruses. Control of AI is principally through either culling or through vaccination using conventional vaccines. Here, we antigenically and genetically characterise the emerging 2020/21 H5NX clade 2.3.4.4 strains and assess cross-reactivity to putative vaccine strains using chicken antisera. We demonstrate significant antigenic differences between commercially available poultry vaccines and currently circulating viruses suggesting that vaccination options might be suboptimal in the current outbreaks.
  In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM)≤26years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization.
 
  Engage is a cohort study among GBM aged 16+years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS).  https://www.selleckchem.com/products/BI-2536.html  Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26years old=eligible for vaccination, ≥27years old=ineligible), we described HPV vaccine uptake (initiation=1+dose, completion=3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator.
 
  Across the three cities, 26-35% and 14-21% of men≤26years and 7-26% and 2-9% of men≥27years initiated and completed HPV vaccination, respectively.