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

Fungos endofíticos em folhas de Erva-mate (Ilex paraguariensis A. St.-Hill.).

Este estudo teve como objetivo analisar o efeito da idade de folhas de erva-mate, colhidas em ervas cultivadas e nativas, sobre a população de fungos endofíticos. Como resultado verificou-se que ocorre uma maior diversidade de fungos endofíticos em folhas adultas de erva-mate do que em folhas jovens. A diversidade foi maior nas plantas nativas, com uma microbiota mais abundante, decorrente de um ambiente sombreado e úmido, mais propício para o seu desenvolvimento, diferente de um agroecossistema. Plantas de erva-mate nativa apresentaram fungos endofíticos de gêneros com potencial de biocontrole que deveriam ser testados quanto à capacidade de induzir proteção contra pragas e doenças.Notas técnicas

Molecular structures of gas‐phase polyatomic molecules determined by spectroscopic methods

Spectroscopic data related to the structures of polyatomic molecules in the gas phase have been reviewed, critically evaluated, and compiled. All reported bond distances and angles have been classified as equilibrium (re), average (rz), substitution (rs), or effective (ro) parameters, and have been given a quality rating which is a measure of the parameter uncertainty. The surveyed literature includes work from all of the areas of gas‐phase spectroscopy from which precise quantitative structural information can be derived. Introductory material includes definitions of the various types of parameters and a description of the evaluation procedure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87746/2/619_1.pd

The microwave spectrum and structure of krypton--phosphorus trifluoride

The rotational spectrum of the weak complex between krypton and phosphorus trifluoride has been observed using a Fourier transform microwave spectrometer with a pulsed supersonic nozzle molecular beam source. The complex is an asymmetric top. The distance rcm between the krypton atom and the center of mass of the PF3 molecule is 4.0722 A and the angle between the rcm vector and the C3 axis of the PF3 is 68.25[deg]. Based on the centrifugal distortion constant DJ and a pseudodiatomic model, the binding energy of the complex is estimated to be 218 cm-1.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27096/1/0000087.pd

The chlorine nuclear quadrupole coupling tensor in chlorotrifluoroethylene

The 273 hyperfine components from 56 rotational transitions of chlorotrifluoroethylene were measured with a Fourier transform microwave spectrometer. A global least-squares fit was made to the rotational constants, quartic distortion constants, and 35Cl quadrupole coupling constants; the RMS deviation of the fit was 1.6 kHz. It is shown that such high-resolution measurements enable [chi]ab to be determined without the near degeneracies usually necessary with less precise data. The principle tensor quadrupole coupling constants are x[chi]zz = -77.46(10), xxx = 38.85(10), and [chi]yy = xcc = 38.614(3) MHz. The values are comparable to other vinyl chlorides, removing some anomalies from previous studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27550/1/0000594.pd

The microwave spectrum, structure and dipole moment of 1,4-pentadiyne

The microwave spectra of 1,4-pentadiyne and 1,4-pentadiyne-1,5-d2 are assigned and rotational and centrifugal distortion constants obtained. A unique structure could not be determined. However, analysis of the moments of inertia indicates that the bond distances in C5H4 are close to typical values found in other related compounds. An interaction involving the acetylene moieties is evidenced by the derived bond angles. The data are consistent with either the central CCC angle being close to the tetrahedral value with the acetylene groups pushed away from linearity by approximately 3-4[deg] or opening of the central CCC angle to about 113[deg] along with linear acetylene groups. A range of structures between these two is also possible. The dipole moment is determined to be 0.516(5) D.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24440/1/0000713.pd

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

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

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

Caffeine Reduces 11β-Hydroxysteroid Dehydrogenase Type 2 Expression in Human Trophoblast Cells through the Adenosine A2B Receptor

Maternal caffeine consumption is associated with reduced fetal growth, but the underlying molecular mechanisms are unknown. Since there is evidence that decreased placental 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) is linked to fetal growth restriction, we hypothesized that caffeine may inhibit fetal growth partly through down regulating placental 11β-HSD2. As a first step in examining this hypothesis, we studied the effects of caffeine on placental 11β-HSD2 activity and expression using our established primary human trophoblast cells as an in vitro model system. Given that maternal serum concentrations of paraxanthine (the primary metabolite of caffeine) were greater in women who gave birth to small-for-gestational age infants than to appropriately grown infants, we also studied the effects of paraxanthine. Our main findings were: (1) both caffeine and paraxanthine decreased placental 11β-HSD2 activity, protein and mRNA in a concentration-dependent manner; (2) this inhibitory effect was mediated by the adenosine A2B receptor, since siRNA-mediated knockdown of this receptor prevented caffeine- and paraxanthine-induced inhibition of placental 11β-HSD2; and (3) forskolin (an activator of adenyl cyclase and a known stimulator of 11β-HSD2) abrogated the inhibitory effects of both caffeine and paraxanthine, which provides evidence for a functional link between exposure to caffeine and paraxanthine, decreased intracellular levels of cAMP and reduced placental 11β-HSD2. Taken together, these findings reveal that placental 11β-HSD2 is a novel molecular target through which caffeine may adversely affect fetal growth. They also uncover a previously unappreciated role for the adenosine A2B receptor signaling in regulating placental 11β-HSD2, and consequently fetal development