Local cooling for relieving pain from perineal trauma sustained during childbirth

Background: Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. Objectives: To evaluate the effectiveness and side effects of localised cooling treatments compared with no treatment, other forms of cooling treatments and non-cooling treatments. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), CINAHL (1982 to January 2007) and contacted experts in the field. Selection criteria: Published and unpublished randomised and quasi-randomised trials (RCTs) that compared localised cooling treatment applied to the perineum with no treatment or other treatments applied to relieve pain related to perineal trauma sustained during childbirth. Data collection and analysis: At least two independent authors performed data extraction for each study. Analyses were performed on an intention-to-treat basis where data allowed. We sought additional information from the authors of three trials. Main results: Seven published RCTs were included, comparing local cooling treatments (ice packs, cold gel pads or cold/iced baths) with no treatment, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam [Epifoam] or warm baths. The RCTs reported on a total of 859 women. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.41 to 0.91). Women preferred the utility of the gel pads compared with ice packs or no treatment, although no differences in pain relief were detected between the treatments. None of our comparisons of treatments resulted in differences detected in perineal oedema or bruising. Women reported more pain (RR 5.60, 95% CI 2.35 to 13.33) and used more additional analgesia (RR 4.00, 95% CI 1.44 to 11.13) following the application of ice packs compared with PET. Authors' conclusions: There is only limited evidence to support the effectiveness of local cooling treatments (ice packs, cold gel pads, cold/iced baths) applied to the perineum following childbirth to relieve pain

Use of ERTS-1 data in identification, classification, and mapping of salt-affected soils in California

There are no author-identified significant results in this report

Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes

BACKGROUND: The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. The walls of the TCC have been indirectly shown to bear approximately 30 % of the plantar load. A new direct method to measure inside the TCC walls with capacitance sensors has shown that the anterodistal and posterolateral-distal regions of the lower leg bear the highest load. The objective of this study was to directly measure these two regions in patients with Diabetes and a plantar forefoot ulcer to further understand the mechanism of pressure reduction in the TCC. METHODS: A TCC was applied to 17 patients with Diabetes and a plantar forefoot ulcer. TCC wall load (contact area, peak pressure and max force) at the anterodistal and posterolateral-distal regions of the lower leg were evaluated with two capacitance sensor strips measuring 90 cm(2) (pliance®, novel GmbH, Germany). Plantar load (contact area, peak pressure and max force) was measured with a capacitance sensor insole (pedar®, novel GmbH, Germany) placed inside the TCC. Both pedar® and pliance® collected data simultaneously at a sampling rate of 50Hz synchronised to heel strike. The magnitude of TCC wall load as a proportion of plantar load was calculated. The TCC walls were then removed to determine the differences in plantar loading between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of interest). RESULTS: TCC wall load was substantial. The anterodistal lower leg recorded 48 % and the posterolateral-distal lower leg recorded 34 % of plantar contact area. The anterodistal lower leg recorded 28 % and the posterolateral-distal lower leg recorded 12 % of plantar peak pressure. The anterodistal lower leg recorded 12 % and the posterolateral-distal lower leg recorded 4 % of plantar max force. There were significant differences in plantar load between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of ulcer). Contact area significantly increased by 5 % beneath the whole foot, 8 % at the midfoot and 6 % at the forefoot in the shoe-cast (p < 0.05). Peak pressure significantly increased by 8 % beneath the midfoot and 13 % at the forefoot in the shoe-cast (p < 0.05). Max force significantly increased 6 % beneath the midfoot in the (shoe-cast p < 0.05). CONCLUSION: In patients with diabetes and a plantar forefoot ulcer, the walls of the TCC bear considerable load. Reduced plantar contact area in the TCC compared to the shoe-cast suggests that the foot is suspended by the considerable load bearing capacity of the walls of the TCC which contributes mechanically to the pressure reduction and redistribution properties of the TCC

A global review of Hf-Nd isotopes: New perspectives on the chicken-and-egg problem of ancient mantle signatures

Acknowledgements We are grateful to T. Morishita and C.J. Garrido for their support during the laborious elaboration of the database and writing of the manuscript. We thank A. Sanfilippo for providing data for the individual MOR segments. Constructive comments and suggestions by M. Bizimis, an anonymous reviewer and the editor C. Chauvel greatly improved the manuscript. Romain Tilhac acknowledges grant FJC2018-036729 funded by MCIN/AEI/10.13039/501100011033 and “ESF, Investing in your future” and grant AEI-PID2021-122792NA-I00 funded by MCIN/ AEI/10.13039/501100011033 and “ERDF, A way of making Europe”. This is contribution 1742 from the ARC Centre of Excellence for Core to Crust Fluid Systems (http://www.ccfs.mq.edu.au) and 1511 from the GEMOC Key Centre (http://www.gemoc.mq.edu.au).Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.chemgeo.2022.121039.We present the first global review on the Sm-Nd and Lu-Hf isotope systematics of the mantle; it includes all published data on peridotites and pyroxenites from all tectonic settings (>1100 combined Hf-Nd analyses), as well as previous compilations for oceanic basalts and material such as oceanic and continental sediments. We first provide a comprehensive overview of the main reservoirs and mechanisms accounting for the contrasting variability of radiogenic isotope systematics in the sub-oceanic mantle and the relative homogeneity of its volcanic products, highlighting the paradigm change promoted by the use of Hf isotopes. Secondly, we summarize the different models invoked to explain the decoupling/(re-)coupling of Hf and Nd isotopes. Decoupling above the mantle array is often related to melt-peridotite interaction involving ancient protoliths, whereas coupled Hf-Nd or decoupling below the array are shown to be insufficient criteria to exclude the involvement of such protoliths. The Hf-Nd isotope variability of the SCLM is then addressed using a tectono-thermal classification based on the Global Lithospheric Architecture Mapping (GLAM) project. The extreme variability that characterizes the cratonic SCLM reflects the long-term preservation of depleted signatures overprinted by ancient and recent metasomatic episodes. Refertilized SCLM domains fingerprinted by variably decoupled Hf-Nd isotope systematics record subduction-related processes, which also appears to be instrumental in the recycling of continental material into the convective mantle. We show that there is a critical “chicken-and-egg” question underpinning debates on the spatio-temporal evolution of the SCLM: whether ancient signatures are pre-existing in the lithosphere (e.g. “lithospheric memory” during refertilization) or introduced into the convective mantle (i.e. recycling). Importantly, our compilation shows that fertile lithologies such as pyroxenites can also carry extremely depleted isotopic signatures. In particular, delamination of gravitationally unstable, pyroxenite-rich arc roots represents a volumetrically significant flux of material characterized by ancient radiogenic Hf and basalt-like Nd-isotope compositions that can, once recycled, account for the Hf variability observed between MORB suites. In this context, the characteristic HIMU-like or coupled Hf-Nd signatures observed in garnet-pyroxenite layers from orogenic peridotite massifs probably reflects long-term processing (re-coupling) of recycled lithospheric material in the convective mantle. In contrast, continental dispersal during rifting (± plume-related processes) appears to be mostly limited to buoyant SCLM remnants in the oceanic lithosphere, and these are unlikely to be recycled unless previously refertilized. This work brings a new geodynamic perspective to the ancient signatures identified as chemical and isotopic heterogeneities in the oceanic lithosphere and convective mantle. These conclusions imply that (1) subduction is the main driver of mass transfer between lithosphere and asthenosphere and (2) the long-term evolution of the Earth's mantle and crust are directly linked to convergent plate-tectonic processes, at least since the Archean.Grant FJC2018-036729 funded by MCIN/AEI/10.13039/501100011033 and “ESF, Investing in your future”Grant AEI-PID2021-122792NA-I00 funded by MCIN/ AEI/10.13039/501100011033 and “ERDF, A way of making Europe

What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

The problem of obesity : is there a role for antagonists of the renin-angiotensin system?

Obesity is a major health problem worldwide; it is associated with more than 30 medical conditions and is a leading cause of unnecessary deaths. Adipose tissue not only acts as an energy store, but also behaves like an endocrine organ, synthesising and secreting numerous hormones and cytokines. Angiotensin II (ANG II) is the biologically active component of the renin-angiotensin system (RAS). The RAS is present in adipose tissue and evidence suggests that ANG II is intimately linked to obesity. Indeed, ANG II increases fat cell growth and differentiation, increases synthesis, uptake and storage of fatty acids and triglycerides and possibly inhibits lipolysis. Evidence obtained using genetically modified animals has shown that the amount of body fat is directly related to the amount of ANG II, i.e., animals with low levels of ANG II have reduced fat stores while animals with excessive ANG II have increased fat stores. In humans, epidemiological evidence has shown that body fat is correlated with angiotensinogen, a precursor of ANG II, or other components of the RAS. Furthermore, blocking the production and/or actions of ANG II with drugs or natural substances decreases body fat. The decrease in body fat caused by such treatments predominantly occurs in abdominal fat depots and appears to be independent of energy intake and digestibility. Clearly, ANG II has an important role in the accumulation of body fat and the possibility exists that treatment of obesity will be enhanced by the use of natural or synthetic substances that interfere with ANG II.<br /

Optimization of a whole blood gamma interferon assay for the detection of sheep infected with Mycobacterium avium subspecies paratuberculosis

The capacity of a commercially available gamma interferon (IFNγ) assay to detect infected sheep early in the pathogenesis of Johne's disease enables the removal of such animals from the flock before bacterial shedding and pasture contamination. However, nonspecific IFNγ responses in the assay have meant that to achieve high-test specificity, there has been a reduction in sensitivity. Although the optimal conditions for the use of the assay in cattle have been well documented, there have been few studies optimizing the assay for use in sheep. The current study details the effect of anticoagulant, duration of incubation, cell concentration, blood storage temperature, time of stimulation of cells with antigen relative to time of sample collection, and temperatures during transit on IFNγ synthesis. Maximal IFNγ synthesis occurred with incubation periods of 48 hr in blood collected into heparinized tubes. Decreasing the leukocyte population by diluting the total peripheral blood leukocyte concentration was associated with a decreasing IFNγ response. Conversely, concentrating the peripheral blood concentration 2-fold resulted in an increase in the IFNγ production. In field studies, immediate incubation of blood samples with antigen at 37°C resulted in larger IFNγ responses; however, significantly lower IFNγ values were obtained if the samples were transported at ambient temperature. The results of this study indicate that optimization of the IFNγ assay may enable increased synthesis of IFNγ during the stimulation phase of the assay and that future work may determine whether this translates to increased sensitivity of the assay in detecting early infections in sheep. Bovigam assay, gamma interferon, Johne's disease, paratuberculosis, sheepResearch was funded by Meat and Livestock Australia (MLA

CRACM/Orai ion channel expression and function in human lung mast cells

BackgroundInflux of extracellular Ca2+ into human lung mast cells (HLMCs) is essential for the FcεRI-dependent release of preformed granule-derived mediators and newly synthesized autacoids and cytokines. However, the identity of the ion channels underlying this Ca2+ influx is unknown. The recently discovered members of the CRACM/Orai ion channel family that carries the Ca2+ release–activated Ca2+ current are candidates.ObjectivesTo investigate the expression and function of CRACM channels in HLMCs.MethodsCRACM mRNA, protein, and functional expression were examined in purified HLMCs and isolated human bronchus.ResultsCRACM1, -2, and -3 mRNA transcripts and CRACM1 and -2 proteins were detectable in HLMCs. A CRACM-like current was detected following FcεRI-dependent HLMC activation and also in HLMCs dialyzed with 30 μM inositol triphosphate. The Ca2+-selective current obtained under both conditions was blocked by 10 μM La3+ and Gd3+, known blockers of CRACM channels, and 2 distinct and specific CRACM-channel blockers—GSK-7975A and Synta-66. Both blockers reduced FcεRI-dependent Ca2+ influx, and 3 μM GSK-7975A and Synta-66 reduced the release of histamine, leukotriene C4, and cytokines (IL-5/-8/-13 and TNFα) by up to 50%. Synta-66 also inhibited allergen-dependent bronchial smooth muscle contraction in ex vivo tissue.ConclusionsThe presence of CRACM channels, a CRACM-like current, and functional inhibition of HLMC Ca2+ influx, mediator release, and allergen-induced bronchial smooth muscle contraction by CRACM-channel blockers supports a role for CRACM channels in FcεRI-dependent HLMC secretion. CRACM channels are therefore a potential therapeutic target in the treatment of asthma and related allergic diseases

Chemical Tuning of Positive and Negative Magnetoresistances, and Superconductivity in 1222-type Ruthenocuprates

High critical-temperature superconductivity and large (colossal) magnetoresistances are two important electronic conducting phenomena found in transition metal oxides. High-Tc materials have applications such as superconducting magnets for MRI and NMR, and magnetoresistive materials may find use in magnetic sensors and spintronic devices. Here we report chemical doping studies of RuSr2(R2-xCex)Cu2O10-d ruthenocuprates which show that a single oxide system can be tuned between superconductivity at high hole dopings and varied magnetoresistive properties at low doping levels. A robust variation of negative magnetoresistance with hole concentration is found in the RuSr2R1.8-xY0.2CexCu2O10-d series, while RuSr2R1.1Ce0.9Cu2O10-d materials show an unprecedented crossover from negative to positive magnetoresistance with rare earth (R) ion radius