Intrapartum sonography of fetal head in second stage of labor with neuraxial analgesia: a literature review and possible medicolegal aftermath

Intrapartum ultrasound (IU) is a valid support to obstetric management of fetal head progression in the second stage of labor in nulliparous with neuraxial labor analgesia (NLA). Nulliparous with NLA may have a prolonged the second stage of labor. The aim of this literature review was to evaluate the mode of delivery, as well as maternal and fetal morbidities associated with missed progression of fetal head detected with IU in the second stage of labor in nulliparous women with NLA.MATERIALS AND METHODS: The literature review was performed using PubMed, Cochrane, Medline, EMBASE, Scopus, Google Scholar and book chapters searches to identify relevant articles from 2001 to 2019, evaluating the mode of delivery and morbidities of the second stage of labor. Search terms used were “Intrapartum ultrasound”, “dystocia”, “prolonged labor”, “neuraxial analgesia”, “persistent occiput posterior position”, “asynclitism”, “second stage of labor”, “medico-legal aftermath”. Prolonged second stage was defined as three hours and more. Retrospective case series of women with prolonged second stage of labor with NLA were identified. The primary outcome was the incidence of operative vaginal delivery (OVD) and cesarean delivery (CS). RESULTS: The use of NLA may determine a prolonged second stage of labor (PSSL). IU when compared to the traditional vaginal digital examination (VDE) demonstrated the highest degree of diagnostic accuracy. CONCLUSIONS: The use of IU during NLA can aid in the diagnosis of fetal head progression, station or malposition and malrotation, alerts obstetrician on the possibility of dystocic labor, indicating to stop the drug administration in NLA and shift to OVD or CS. Extending the second stage of labor beyond current American College of Obstetricians and Gynecologists (ACOG) recommendations is beneficial. The ISUOG guidelines recommended the clinical application of IU to diagnose the persistent occiput posterior position (POPP) and asynclitism (A) in dystocic labor and produce photographic evidence of the case. Maternal and neonatal complications, medicolegal consequences and litigation can decrease if the IU device is used as good practice

Körner’s septum (petrosquamosal lamina): the anatomical variant or clinical problem?

Körner’s septum (KS) or petrosquamosal lamina is a bony lamina beginning at the articular fossa, extending above the middle ear, and running inferiorly and laterally to the facial nerve canal as it proceeds to the mastoid apex. This septum marks the junction of petrous and squamous bones. The paper presents details of the anatomical structure of KS, which is most often present at the level of the head of the malleus and/or the anterior semicircular canal. Attention is paid to embryological aspects of temporal bone development that lead to the formation of KS. Two imaging techniques most frequently used to diagnose KS are described, high resolution computed tomography (HRCT) and cone-beam computed tomography. Also presented is a case report of a 6-year-old patient suffering from chronic otitis media who developed a cholesteatoma due to presence of KS, illustrated with HRCT images and intraoperative capture. The authors describe diagnostic difficulties associated with this anatomical variant in the middle ear. The article also discusses the more frequent occurrence of this clinical problem in ears operated on due to chronic inflammation, retraction pocket or tympanosclerosis in comparison to healthy ears

Microwave spectrum and structure of ethylene ozonide: Effects of large axes rotations in structure calculations

Rotational spectra for 14 isotopic species of ethylene ozonide have now been assigned. The consistency of the Kraitchman substitution structure was checked by calculating the Op---Op bond distance six ways; the values ranged from 1.458 to 1.502 A. This variation was attributed to an amplification of residual vibrational effects by large axes rotations upon isotopic substitution. Estimates of errors produced from this effect were made and a procedure was developed for choosing rs parameters in which the effect is minimized. This gave the following ring parameters: d(COe) = 1.416 A, d(COp) = 1.412 A, d(OO) = 1.461 A, eC = 104.8[deg], eCOp = 105.5[deg], pOp = 99.3[deg].Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21905/1/0000312.pd

Chicken Anti-Campylobacter Vaccine – Comparison of Various Carriers and Routes of Immunization

Campylobacter spp, especially the species Campylobacter jejuni, are important human enteropathogens responsible for millions of cases of gastro-intestinal disease worldwide every year. C. jejuni is a zoonotic pathogen, and poultry meat that has been contaminated by microorganisms is recognized as a key source of human infections. Although numerous strategies have been developed and experimentally checked to generate chicken vaccines, the results have so far had limited success. In this study, we explored the potential use of non-live carriers of Campylobacter antigen to combat Campylobacter in poultry. First, we assessed the effectiveness of immunization with orally or subcutaneously delivered GEM (Gram-positive Enhancer Matrix) particles carrying two Campylobacter antigens: CjaA and CjaD. These two immunization routes using GEMs as the vector did not protect against Campylobacter colonization. Thus, we next assessed the efficacy of in ovo immunization using various delivery systems: GEM particles and liposomes. The hybrid protein CjaAD, which is CjaA presenting CjaD epitopes on its surface, was employed as a model antigen. We found that CjaAD administered in ovo at embryonic development day 18 by both delivery systems resulted in significant levels of protection after challenge with a heterologous Campylobacter jejuni strain. In practice, in ovo chicken vaccination is used by the poultry industry to protect birds against several viral diseases. Our work showed that this means of delivery is also efficacious with respect to commensal bacteria such as Campylobacter. In this study, we evaluated the protection after one dose of vaccine given in ovo. We speculate that the level of protection may be increased by a post-hatch booster of orally delivered antigens

The structures and dipole moments of Ar–PF3 and Kr–PF3

The complexes of PF3 with Ar and Kr, were studied by Fourier transform microwave spectroscopy. The force constants and amplitudes of vibration for the van der Waals modes of the complexes and the average moments of inertia and structural parameters were estimated from the centrifugal distortion constants. The distance (Rc.m. )ave between the rare‐gas atom and the center of mass of PF3 is 3.959 Å for the Ar complex and 4.077 Å for Kr while the angle (θc.m. )ave between the Rc.m. vector and the C3 axis of the PF3 is 69.30° and 67.25°, respectively. The dipole moments of both complexes and of free PF3 were determined. The induced dipole components estimated for the rare gas using electric fields from ab initio calculations of PF3 agree with the experimental values for a conformation with the rare gas over a PF2 face. The PF2 face conformation is also consistent with the observed and ab initio estimates of the 83 Kr nuclear quadrupole coupling constant for the 83 Kr–PF3 species.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/70747/2/JCPSA6-90-12-6949-1.pd

In vitro characteristics of Lactobacillus spp. strains isolated from the chicken digestive tract and their role in the inhibition of Campylobacter colonization

Campylobacter jejuni/coli infections are the leading cause of bacterial diarrheal illnesses in humans. Many epidemiological studies indicate that improperly prepared meat from chickens that carry a high load of Campylobacter in their intestinal tracts is the key source of human infections. LAB, mainly members of the Lactococcus and Lactobacillus genera, increasingly have been tested as vehicles for the delivery of heterologous bacterial or viral antigens to animal mucosal immune systems. Thus, the objective of this study was to isolate, identify, and characterize Lactobacillus spp. strains isolated from chickens bred in Poland. Their ability to decrease the level of bird gut colonization by C. jejuni strain was also analyzed. First, the influence of the different chicken rearing systems was evaluated, especially the effect of diets on the Lactobacillus species that colonize the gut of chickens. Next, selected strains were analyzed in terms of their anti-Campylobacter activity in vitro; potential probiotic traits such as adhesion properties, bile and low pH tolerance; and their ability to grow on a defined carbon source. Given that improperly prepared chicken meat is the main source of human infection by Campylobacter, the selected strains were also assessed for their ability to inhibit Campylobacter colonization in the bird's intestine. These experiments revealed enormous physiological diversity among the Lactobacillus genus strains. Altogether, our results showed that L. plantarum strains isolated from the digestive tracts of chickens bred in Poland displayed some probiotic attributes in vitro and were able to decrease the level of bird gut colonization by C. jejuni strain. This suggests that they can be employed as vectors to deliver Campylobacter immunodominant proteins to the bird's immune system to strengthen the efficacy of in ovo vaccination

The Phylogenetic Structure of Reptile, Avian and Uropathogenic Escherichia coli with Particular Reference to Extraintestinal Pathotypes

The impact of the Gram-negative bacterium Escherichia coli (E. coli) on the microbiomic and pathogenic phenomena occurring in humans and other warm-blooded animals is relatively well-recognized. At the same time, there are scant data concerning the role of E. coli strains in the health and disease of cold-blooded animals. It is presently known that reptiles are common asymptomatic carriers of another human pathogen, Salmonella, which, when transferred to humans, may cause a disease referred to as reptile-associated salmonellosis (RAS). We therefore hypothesized that reptiles may also be carriers of specific E. coli strains (reptilian Escherichia coli, RepEC) which may differ in their genetic composition from the human uropathogenic strain (UPEC) and avian pathogenic E. coli (APEC). Therefore, we isolated RepECs (n = 24) from reptile feces and compared isolated strains’ pathogenic potentials and phylogenic relations with the aforementioned UPEC (n = 24) and APEC (n = 24) strains. To this end, we conducted an array of molecular analyses, including determination of the phylogenetic groups of E. coli, virulence genotyping, Pulsed-Field Gel Electrophoresis-Restriction Analysis (RA-PFGE) and genetic population structure analysis using Multi-Locus Sequence Typing (MLST). The majority of the tested RepEC strains belonged to nonpathogenic phylogroups, with an important exception of one strain, which belonged to the pathogenic group B2, typical of extraintestinal pathogenic E. coli. This strain was part of the globally disseminated ST131 lineage. Unlike RepEC strains and in line with previous studies, a high percentage of UPEC strains belonged to the phylogroup B2, and the percentage distribution of phylogroups among the tested APEC strains was relatively homogenous, with most coming from the following nonpathogenic groups: C, A and B1. The RA-PFGE displayed a high genetic diversity among all the tested E. coli groups. In the case of RepEC strains, the frequency of occurrence of virulence genes (VGs) was lower than in the UPEC and APEC strains. The presented study is one of the first attempting to compare the phylogenetic structures of E. coli populations isolated from three groups of vertebrates: reptiles, birds and mammals (humans).</jats:p

Pregnancy, prescription medicines and the potential risk of herb-drug interactions:a cross-sectional survey

Funding All funding was from institutional resource. JSM, AS are employed by the University of Aberdeen. DS is employed by the Robert Gordon University. BP and CR are employed by NHS Scotland. ARP and MAH are employed by the Hamad Medical Corporation. Qatar. NI is a postgraduate student at the University of Aberdeen.Peer reviewedPublisher PD

Analysis of obstetric complications and uterine connective tissue in tenascin-X-deficient humans and mice

Tenascin-X (TNX) is a large, multi-domain, extracellular matrix glycoprotein. Complete deficiency of TNX in humans leads to a recessive form of Ehlers-Danlos syndrome (EDS), and TNX haploinsufficiency is a cause of hypermobility type EDS. EDS patients appear to have a higher risk of several complications during pregnancy, such as pelvic instability, premature rupture of membranes, and postpartum hemorrhage. Here, we present a study of genitourinary and obstetric complications in TNX-deficient women of reproductive age. We have found complications, such as uterus prolapses, that are in agreement with previous findings in other EDS types. In TNX knockout (KO) mice, we have observed mild pregnancy-related abnormalities. Morphological and immunohistological analysis of uterine tissues has not revealed obvious quantitative or spatial differences between TNX KO and wildtype mice with respect to collagen types I, III, V, and XII or elastic fibers. We conclude that TNX-deficient women are at risk of obstetric complications, but that TNX KO mice show only a mild phenotype. Furthermore, we show that TNX is involved in the stability of elastic fibers rather than in their initial deposition

Tandem application of C-C bond-forming reactions with reductive ozonolysis

Several variants of reductive ozonolysis, defined here as the in situ generation of aldehydes or ketones during ozonolytic cleavage of alkenes, are demonstrated to work effectively in tandem with a number of C-C bond-forming reactions. For reactions involving basic nucleophiles (1,2- addition of Grignard reagents, Wittig or Horner-Emmons olefinations, and directed Aldol reactions of lithium enolates) the one-pot process offers a rapid and high-yielding alternative to traditional two-step protocols