To cut or not to cut? Episiotomy in vacuum extraction

BACKGROUND AND AIMS Obstetric anal sphincter injury (OASIS) may cause anal incontinence, as well as sexual dysfunction and psychological trauma. Mediolateral and lateral episiotomy have been shown to be protective against OASIS in nulliparous women delivered by vacuum extraction (VE). The technique and trigonometric properties of an episiotomy may be important for its protective effect. The aim of the thesis was to explore episiotomy in Sweden. Firstly, we aimed at investigating the effect of episiotomy in nulliparous women at VE. Secondly, we aimed at exploring the attitudes towards, and knowledge about, episiotomy among doctors. Finally, we wanted to find out if an episiotomy might cause injury to the levator ani muscles (LAM). The impact of advanced maternal age on delivery outcome was also explored. METHODS AND MAIN RESULTS Study I and II are register-based cohort studies based on data from the Swedish Medical Birth Register. In study I delivery outcome in women ≥40 years was explored. We compared nulliparous women ≥40 years (n=7796) with nulliparous women 25-29 years (n=264 262) after spontaneous onset and induction of labor between 1992-2011. The rate of OASIS, episiotomy, and low Apgar score was also investigated. We found a significantly higher rate of intrapartum cesarean section among women ≥40 years, both after spontaneous onset of labor (adjusted odds ratio (aOR) 3.07, 95%CI 2.81-3.35) and induction of labor (aOR 2.51, 95%CI 2.24-2.81). The risk of VE was also increased in women ≥40 years, both after spontaneous onset (aOR 1.71 95%CI 1.59-1.85), and induction of labor (aOR 1.45, 95%CI 1.28-1.65). We found no significant difference in rate of OASIS, episiotomy or low Apgar score. Overall, 79% of women ≥40 years had a vaginal delivery compared with 93% of women 25-29 years. In study II nulliparous women delivered by VE between 2000-2011 were included. Women without episiotomy (n=43 853) were compared to women with a lateral or mediolateral episiotomy (n=19 801). After statistical balancing using propensity score, episiotomy was associated with a reduction in OASIS from 15.5% to 11.8%, ie an average treatment effect -3.7% (95% CI -4.3 to -3.0). The numbers needed to treat (NNT) to prevent one OASIS was 27. The third-degree perineal injuries alone were reduced from 14.0% to 10.9% (-3.1, 95% CI -3.7 to -2.4) with NNT 32. The fourth-degree perineal injuries alone were reduced from 1.6% to 1.0 % (-0.6%, 95% CI -0.8 to -0.4). Fourth-degree perineal injuries required NNT 172. Study III was a web-based questionnaire sent to the members of the Swedish Society of Obstetrics and Gynecology with a registered email in 2019 (n=2140). The response rate was 25% (n=432). The questionnaire addressed different aspects of VE and episiotomy and contained a picture of a crowning fetal head in which the respondents were asked to depict the episiotomy they would perform in the delivery room. The drawn episiotomies were translated into coordinates in a diagram. The episiotomies were categorized as lateral, mediolateral, midline or unclassifiable. In total, 57.8% (n=222) doctors reported performing episiotomy in less than 50% of VE deliveries. We found that only 54% of the doctors drew what could be considered a protective episiotomy. Furthermore, doctors in Sweden rated episiotomy as the least important measure to prevent OASIS in VE. Study IV was a descriptive prospective cohort study, examining if lateral episiotomy causes an iatrogenic LAM injury. Sixty-three women delivered by VE who received a standardized lateral episiotomy were examined by 3D endovaginal ultrasound about one year after delivery. Five images were not possible to retrieve due to a broken hard drive, thus 58 women were included. Of these 58 women, 12 had a visible LAM injury (20.7%, 95%CI 10.9-32.9). This is a significantly lower proportion than the stipulated 50% (p<0.001) of women. Two (16.7%, 95% CI 2.1-48.4) of 12 women had an ipsilateral LAD (p=0.02, compared with the stipulated proportion of 50%). CONCLUSION In conclusion, trial of labor may be worthwhile in women ≥ 40 years. Episiotomy seems to have a protective effect of OASIS in a Swedish population of nulliparous women with VE. A small majority of doctors in Sweden could depict a protective episiotomy. Our studies support that doctors are able to continue performing lateral episiotomies without risk of cutting the LAM

Urtica dioica, a weed with many possibilities

The aim of this study was to investigate the nutritional value of Urtica dioica and suggest the application of U. dioica as part of a healthy diet. U. dioica, or commonly known as stinging nettle, is a perennial plant growing almost all over the world. It prefers moist soils with a high nitrogen content. When the plant comes in contact with the skin it releases small tubes which contain irritative substances which penetrates the skin giving a rash and a burning feeling. For cultivation it can be grown with low input and can give a relatively good yield for many years. It has been used for centuries as a food source and in folk medicine. In Sweden U. dioica is traditionally picked in spring and used to make “nettle soup”. U. dioica can be purchased dried as powder, in capsules or as tea for example. According to the EAT Lancet report, the consumption of meat products should be decreased whereas fruits and vegetables should be consumed in higher portions. With its highly nutritious content, U. dioica can be included in such a diet. It contains vitamins, minerals, essential fatty acids and has a relatively high protein content. Nine carotenoids have been detected in U. dioica. Pigment from U. dioica can be extracted and used for food coloring (E140). Nitrate has a tendency to accumulate in the plant and therefore it should not be picked on soils which have high nitrogen levels. Water extraction from U. dioica is a good source of antioxidants which are health promoting in different ways. The anti-oxidant properties of U. dioica are probably due to presence of phenolic compounds. U. dioica have antibacterial properties against certain bacteria such as Staphylococcus aureus. S. aureus bacterium have strains that are antibiotic resistant which particularly causes problems in hospitals. Therefore, it is important to develop alternatives to the traditional antibiotics. U. dioica even contains substances with anticarcinogenic properties. As used externally, it can be applied fresh to relieve joint pain. U. dioica as a part of the diet has therefore many advantages but more studies need to be done to confirm its properties and elucidate the mechanism responsible for them.Syftet med den här rapporten var att undersöka hur man kan använda Urtica dioica och granska dess näringsinnehåll och visa på dess roll i en hälsosam kost. U. dioica, eller brännässla, är en perenn växt som finns mer eller mindre över hela världen. Den föredrar att växa i fuktiga jordar med mycket nitrat. När växten kommer i kontakt med huden släpper den små rörliknande strukturer som penetrerar huden och ger upphov till utslag och en brännande känsla. Den är enkel att kultivera och kan ge en relativt bra skörd i många år. Den har använts i århundraden till mat och inom folkmedicin. I Sverige plockar man traditionellt U. dioica på våren och gör nässelsoppa. Man kan köpa U. dioica som pulver, kapslar eller te till exempel. Enligt EAT Lancet rapporten behöver människor äta en diet som är mindre köttbaserad och mer växtbaserad. Med sitt höga näringsinnehåll kan U. dioica inkluderas i en mer växtbaserad diet. U. dioica innehåller vitaminer, mineralser, essentiella fettsyror och har ett relativt högt proteininnehåll. Nio karotenoider har detekterats i U. dioica. Pigment från U. dioica kan extraheras och användas som färgämne i mat (E140). Nitrat har en tendens att ackumuleras i växten och därför bör den inte plockas på nitratrika jordar. Vattenextraktion från U. dioica är en bra källa till antioxidanter som är hälsofrämjande på olika sätt. Antioxidantegenskaperna är troligen främst på grund av fenolföreningar. U. dioica kan verka antibakteriellt mot vissa bakterier såsom Staphylococcus aureus. Inom S. aureus släktet finns vissa antibiotikaresistenta stammar vilka speciellt kan ge problem på sjukhus. Därför är det viktigt att ta fram alternativ till traditionella antibiotika. U. dioica innehåller också substanser som hämmar cancer. Utvärtes kan U. dioica appliceras färska där en person har ledvärk vilket kan lindra smärtan. U. dioica som del av dieten har många fördelar men fler studier behövs för att bekräfta dess egenskaper och tydliggöra mekanismerna ansvariga för dem

Tro, hopp och konsumtion - inom skönhetsindustrin

Syftet med arbetet var att utforska den sakrala delen av skönhetskonsumtionen, förhållandet mellan konsumtion och teologi; vilken betydelse tro, hopp, och därigenom önskan om mirakel har för dagens konsumenter vad det gäller skönhetsprodukter. Vi har därmed valt en abduktiv ansats, då den kombinerar induktion och deduktion med den ytterligare aspekten av tolkning. Vidare har vi valt en kvalitativ metod för datainsamling, där 10 semistrukturerade djupintervjuer legat till grund för vårt empiriska material. Genom denna studie har vi kunnat konstatera att vi förr lade mycket tro och hopp i vår religion medan vi idag snarare vänder oss till konsumtionen då vi vill ha hjälp eller att en förändring ska ske. Det har visat sig att vi lägger särskilt mycket tro och hopp i produkter likt skönhetsprodukter, vilka vi inte kan se resultatet av innan köpet, och därmed endast kan hoppas ge önskat resultat. Att namnge en skönhetsprodukt med tro eller hopp har gett negativa reaktioner då tro och hopp är något som finns inom oss, inget vi vill ska uttalas eller allra minst stå utskrivet på en burk med ansiktskräm. Det är media och konsumtionssamhället som triggar igång vår tro och vårt hopp med lovord och förhärligande bilder, samtidigt är det vår tro och vårt hopp som gör att vi från början köper varor som skönhetsprodukter, då vi ser dem som medel för att uppnå och bevara vårt ideala jag

The hypothetical amyloid transformation of transthyretin

Conceptual diagram presenting linear propagation of (gray) bands with varying hydrophobicity. If this linear pattern is joined by fragments marked in red (initially not fitting to linear propagation), the protein is at risk of undergoing amyloid transformatio

Amyloid Β-Peptide Increases Mitochondria-Endoplasmic Reticulum Contact Altering Mitochondrial Function and Autophagosome Formation in Alzheimer's Disease-Related Models.

Recent findings have shown that the connectivity and crosstalk between mitochondria and the endoplasmic reticulum (ER) at mitochondria-ER contact sites (MERCS) are altered in Alzheimer's disease (AD) and in AD-related models. MERCS have been related to the initial steps of autophagosome formation as well as regulation of mitochondrial function. Here, the interplay between MERCS, mitochondria ultrastructure and function and autophagy were evaluated in different AD animal models with increased levels of Aβ as well as in primary neurons derived from these animals. We start by showing that the levels of Mitofusin 1, Mitofusin 2 and mitochondrial import receptor subunit TOM70 are decreased in post-mortem brain tissue derived from familial AD. We also show that Aβ increases the juxtaposition between ER and mitochondria both in adult brain of different AD mouse models as well as in primary cultures derived from these animals. In addition, the connectivity between ER and mitochondria are also increased in wild-type neurons exposed to Aβ. This alteration in MERCS affects autophagosome formation, mitochondrial function and ATP formation during starvation. Interestingly, the increment in ER-mitochondria connectivity occurs simultaneously with an increase in mitochondrial activity and is followed by upregulation of autophagosome formation in a clear chronological sequence of events. In summary, we report that Aβ can affect cell homeostasis by modulating MERCS and, consequently, altering mitochondrial activity and autophagosome formation. Our data suggests that MERCS is a potential target for drug discovery in AD

Biodegradable Spheres Protect Traumatically Injured Spinal Cord by Alleviating the Glutamate-Induced Excitotoxicity

New treatment strategies for spinal cord injury with good therapeutic efficacy are actively pursued. Here, acetalated dextran (AcDX), a biodegradable polymer obtained by modifying vicinal diols of dextran, is demonstrated to protect the traumatically injured spinal cord. To facilitate its administration, AcDX is formulated into microspheres (approximate to 7.2 mu m in diameter) by the droplet microfluidic technique. Intrathecally injected AcDX microspheres effectively reduce the traumatic lesion volume and inflammatory response in the injured spinal cord, protect the spinal cord neurons from apoptosis, and ultimately, recover the locomotor function of injured rats. The neuroprotective feature of AcDX microspheres is achieved by sequestering glutamate and calcium ions in cerebrospinal fluid. The scavenging of glutamate and calcium ion reduces the influx of calcium ions into neurons and inhibits the formation of reactive oxygen species. Consequently, AcDX microspheres attenuate the expression of proapoptotic proteins, Calpain, and Bax, and enhance the expression of antiapoptotic protein Bcl-2. Overall, AcDX microspheres protect traumatically injured spinal cord by alleviating the glutamate-induced excitotoxicity. This study opens an exciting perspective toward the application of neuroprotective AcDX for the treatment of severe neurological diseases.Peer reviewe

Essential versus accessory aspects of cell death: recommendations of the NCCD 2015

Cells exposed to extreme physicochemical or mechanical stimuli die in an uncontrollable manner, as a result of their immediate structural breakdown. Such an unavoidable variant of cellular demise is generally referred to as ‘accidental cell death’ (ACD). In most settings, however, cell death is initiated by a genetically encoded apparatus, correlating with the fact that its course can be altered by pharmacologic or genetic interventions. ‘Regulated cell death’ (RCD) can occur as part of physiologic programs or can be activated once adaptive responses to perturbations of the extracellular or intracellular microenvironment fail. The biochemical phenomena that accompany RCD may be harnessed to classify it into a few subtypes, which often (but not always) exhibit stereotyped morphologic features. Nonetheless, efficiently inhibiting the processes that are commonly thought to cause RCD, such as the activation of executioner caspases in the course of apoptosis, does not exert true cytoprotective effects in the mammalian system, but simply alters the kinetics of cellular demise as it shifts its morphologic and biochemical correlates. Conversely, bona fide cytoprotection can be achieved by inhibiting the transduction of lethal signals in the early phases of the process, when adaptive responses are still operational. Thus, the mechanisms that truly execute RCD may be less understood, less inhibitable and perhaps more homogeneous than previously thought. Here, the Nomenclature Committee on Cell Death formulates a set of recommendations to help scientists and researchers to discriminate between essential and accessory aspects of cell death

Guidelines on experimental methods to assess mitochondrial dysfunction in cellular models of neurodegenerative diseases

Neurodegenerative diseases are a spectrum of chronic, debilitating disorders characterised by the progressive degeneration and death of neurons. Mitochondrial dysfunction has been implicated in most neurodegenerative diseases, but in many instances it is unclear whether such dysfunction is a cause or an effect of the underlying pathology, and whether it represents a viable therapeutic target. It is therefore imperative to utilise and optimise cellular models and experimental techniques appropriate to determine the contribution of mitochondrial dysfunction to neurodegenerative disease phenotypes. In this consensus article, we collate details on and discuss pitfalls of existing experimental approaches to assess mitochondrial function in in vitro cellular models of neurodegenerative diseases, including specific protocols for the measurement of oxygen consumption rate in primary neuron cultures, and single-neuron, time-lapse fluorescence imaging of the mitochondrial membrane potential and mitochondrial NAD(P)H. As part of the Cellular Bioenergetics of Neurodegenerative Diseases (CeBioND) consortium ( www.cebiond.org ), we are performing cross-disease analyses to identify common and distinct molecular mechanisms involved in mitochondrial bioenergetic dysfunction in cellular models of Alzheimer's, Parkinson's, and Huntington's diseases. Here we provide detailed guidelines and protocols as standardised across the five collaborating laboratories of the CeBioND consortium, with additional contributions from other experts in the field