Three dimensional sonographic evaluation of the influence of epidural analgesia on fetal head descent

Introduzione: L'analgesia epidurale è stata messa in correlazione con l'aumento della durata del secondo stadio del travaglio e del tasso di utilizzo della ventosa ostetrica. Diversi meccanismi sono stati ipotizzati, tra cui la riduzione di percezione della discesa fetale, della forza di spinta e dei riflessi che promuovono la progressione e rotazione della testa fetale nel canale del parto. Tali parametri sono solitamente valutati mediante esame clinico digitale, costantemente riportato essere poco accurato e riproducibile. Su queste basi l'uso dell'ecografia in travaglio, con introduzione di diversi parametri ecografici di valutazione della discesa della testa fetale, sono stati proposti per supportare la diagnosi clinica nel secondo stadio del travaglio. Scopi dello studio: studiare effetto dell’analgesia epidurale sulla progressione della testa fetale durante il II stadio del travaglio valutata mediante ecografia intrapartum. Materiali e metodi: una serie di pazienti nullipare a basso rischio a termine (37+0-42+0) sono state reclutate in modo prospettico nella sala parto del nostro Policlinico Universitario. In ciascuna di esse abbiamo acquisito un volume ecografico ogni 20 minuti dall’inizio della fase attiva del secondo stadio fino al parto ed una serie di parametri ecografici sono stati ricavati in un secondo tempo (angolo di progressione, distanza di progressione distanza testa sinfisi pubica e midline angle). Tutti questi parametri sono stati confrontati ad ogni intervallo di tempo nei due gruppi. Risultati: 71 pazienti totali, di cui 41 (57.7%) con analgesia epidurale. In 58 (81.7%) casi il parto è stato spontaneo, mentre in 8 (11.3%) e 5 (7.0%) casi rispettivamente si è ricorsi a ventosa ostetrica o taglio cesareo. I valori di tutti i parametri ecografici misurati sono risultati sovrapponibili nei due gruppi in tutti gli intervalli di misurazione. Conclusioni: la progressione della testa fetale valutata longitudinalmente mediante ecografia 3D non sembra differire significativamente nelle pazienti con o senza analgesia epidurale.Objectives: To assess the effect of epidural analgesia on sonographic progression of fetal head in second stage of labor. Methods: Nulliparous low-risk women at term (37+0-42+0) attending the labor ward of our University Hospital were recruited for the purpose of this study. A volume dataset was acquired by translabial ultrasound every 20 minutes from the beginning of the active second stage until delivery. A series of sonographic parameters were derived from offline analysis of each volume (angle of progression, progression distance, head symphysis distance and midline angle). All parameters were compared at each time interval between patients with or without elective epidural at the onset of labor. Results: 71 patients were recruited in the study; 41 (57.7%) of them in the epidural group. Spontaneous vaginal delivery was achieved in 58 (81.7%) cases. Vacuum delivery and Cesarean section were performed in 8 (11.3%) and 5 (7.0%) cases, respectively. All ultrasound parameters values were comparable at each time interval in the epidural and non-epidural group. Conclusions: Fetal head progression, longitudinally assessed by three-dimensional ultrasound, seems to be comparable in patients submitted or not to epidural administration

Sensibilità moderne. Storie di affetti, passioni e sensi (secoli XV-XVIII)

Sensi ed emozioni contribuiscono da anni ad arricchire la tavolozza della ricerca storica consentendo di rivisitare, con uno sguardo ispirato anche all’antropologia, l’esperienza di vita di donne e uomini del passato; un universo percettivo e affettivo che non è una costante biologica, ma in una varietà di contesti apre a diversi paesaggi sonori o olfattivi, così come a passioni dell’animo. Questo volume collettivo esplora tale campo per l’età moderna nello spazio italiano. Vi si esplorano la città come luogo di performance emotive, in occasioni rituali (come la festa o le processioni funebri) così come per le sollecitazioni sensoriali che la caratterizzano; le esperienze emotive di alcune figure chiave della modernità, quali condottieri, confessori, inquisitori; più specificamente per il Settecento, il vissuto degli autori di fronte a editoria e pubblico e il farsi strada dell’amicizia tra sessi in spazi non più confinati. Il volume è corredato da un’introduzione di carattere storiografico e da una bibliografia ragionata intesa a orientare chi legge nella varietà di campi di studio incrociati

Qualitative and quantitative assessment of viral contamination in bivalve molluscs harvested in Italy

Bivalve molluscs are a well documented source of viral infection. Further data on shellfish viral contamination are needed to implement European Regulations with sanitary measures more effective against viral pathogens. To this aim, 336 samples of bivalve molluscs (185 mussels, 66 clams, 23 oysters and 62 samples from other species) collected in harvesting areas of class A and B of four Italian Regions were analysed for qualitative and quantitative determination of hepatitis A virus (HAV) and Norovirus (NoV) GI and GII, using real time RT-PCR. The results showed a wide diffusion of viral contamination in the shellfish production areas considered. HAV prevalence was low (0.9%) with contamination levels that varied from 5 to 7x102 copies/g. On the contrary, NoV showed a high prevalence (51.5%), with a large variability according to the group considered (e.g. 47.8% for Crassostrea in Veneto, 79.7% for Mytilus in Campania, 84.6% for Tapes in Sardinia). NoV contamination affected class A and class B production areas to a different extent, with a statistically significant difference in both contamination prevalence (22.1% vs. 66.3%; p < 0.0001) and quantity (average contamination level of 3.1x102 vs. 1.9x103 copies/g; p < 0.05). The different species analysed from class B harvesting areas (Mytilus, Tapes/Ruditapes and Crassostrea) showed a NoV prevalence respectively of 70.3%, 66.0% and 47.8% but comparable NoV contamination levels (between 8.4x102 and 4.9x103 copies/g). Other two bivalve species considered in the study (Donax spp. and Solen spp.) showed a relevant NoV presence (40.0% and 34.4% of samples). Finally, samples analysed before and after commercial purification treatment showed a decrease of contamination prevalence after the treatment, but inconsistent results were recorded on NoV levels. The data obtained, together with other quantitative information to estimate consumer exposure, in association with studies on dose–response and on the effectiveness of post-harvest treatments, will provide a useful tool for the definition of microbiological criteria related to the different shellfish species

The distinctive role of executive functions in implicit emotion regulation

International audienceSeveral theoretical models stress the role of executive functions in emotion regulation (ER). However, most of the previous studies on ER employed explicit regulatory strategies that could have engaged executive functions, beyond regulatory processes per se. Recently, there has been renewed interest in implicit forms of ER, believed to be closer to daily-life requirements. While various studies have shown that implicit and explicit ER engage partially overlapping neurocognitive processes, the contribution of different executive functions in implicit ER has not been investigated. In the present study, we presented participants with negatively valenced pictures of varying emotional intensity preceded by short texts describing them as either fictional or real. This manipulation was meant to induce a spontaneous emotional down-regulation. We recorded electrodermal activity (EDA) and subjective reports of emotion arousal. Executive functions (updating, switching, and inhibition) were also assessed. No difference was found between the fictional and real condition on EDA. A diminished self-reported arousal was observed, however, when pictures were described as fictional for high- and mild-intensity material, but not for neutral material. The amount of down-regulation in the fictional condition was found to be predicted by interindividual variability in updating performances, but not by the other measures of executive functions, suggesting its implication even in implicit forms of ER. The relationship between down-regulation and updating was significant only for high-intensity material. We discuss the role of updating in relation to the consciousness of one's emotional state

Mode of delivery in the preterm gestation and maternal and neonatal outcome

Objective. To determine if the mode of delivery in preterm gestations is associated with changes in maternal and neonatal outcome. Methods.A retrospective cohort study that included all singleton deliveries occurring after spontaneous onset of labour between 250 and 326 weeks of gestation. Cases of early preterm delivery were identified from clinical records and classified according to the mode of delivery. The following outcomes were derived for each case and compared between caesarean and vaginal deliveries: perinatal death, cranial findings compatible with haemorrhage or white matter disease in the neonate, new-onset of maternal severe anaemia or pyrexia. Results.From 1990 to 2007, 109 cases of spontaneous preterm labour were retrospectively selected, including 50 (45.8) caesarean sections and 59 (54.2) vaginal deliveries. Perinatal death occurred in 10 infants (9.1), whereas among survivors abnormal cerebral findings were detected in 20, including 6 cases with haemorrhage, 12 with white matter findings and 2 with both. At multiple logistic regression, a birthweight lower than 1100g was the only predictor of all adverse outcomes, whereas male sex increased the risk of white matter findings. Caesarean section compared to vaginal delivery conferred a higher risk of maternal complications (23/50 or 46 vs. 6/59 or 10.2; OR: 11.9, CI 95: 4.2333; p<0.0005). Conclusions.In severely premature infants born after spontaneous onset of labour, the risk of adverse perinatal outcome does not seem to depend upon the mode of delivery, whereas the risk of maternal complications is significantly increased after Caesarean section

The paradox of fiction: Emotional response toward fiction and the modulatory role of self-relevance

International audienceFor over forty years, philosophers have struggled with the "paradox of fiction", which is the issue of how we can get emotionally involved with fictional characters and events. The few neuroscientific studies investigating the distinction between the processing of real and fictional entities have evidenced that midline cortical structures and lateral fronto-parietal regions are more engaged for real and fictional entities, respectively. Interestingly, the former network is engaged in autobiographical memory retrieval and self-reference, processes that are known to boost emotional reactivity, while the latter underpins emotion regulation. Thus, a possible modulation of the emotional response according to the nature (real or fictional) of the stimulus is conceivable. To test this hypothesis, we presented short emotional (negative and positive) and neutral video as fictional or real. For negative material, we found that subjective emotional experience, but not physiological arousal measured by electrodermal activity, was reduced in the fictional condition. Moreover, the amount of personal memories linked to the scenes counteracted this effect boosting the subjective emotional response. On the contrary, personal memories elicited by the scenes, but not fiction, modulate the emotional response for positive material. These results suggest that when a stimulus triggers a personal memory, the emotional response is less prone to be modulated by contextual factors, and suggest that personal engagement could be responsible for emotional reaction toward fiction. We discuss these results in the emotion regulation framework and underline their implications in informing theoretical accounts of emotion in the neuroscientific domain and the philosophical debate on the paradox of emotional response to fictio

Three-dimensional ultrasound is an accurate and reproducible technique for fetal crown-rump length measurement

Objective: The aim of the study was to evaluate the accuracy and reproducibility of fetal crown-rump length (CRL) measurement using three-dimensional ultrasound (3DUS). Methods: We included a series of women with singleton pregnancy at 6-13+6weeks. Following CRL measurement by the two-dimensional ultrasound (2DUS), a 3DUS volume was acquired. On the reconstructed midsagittal plane, CRL was measured twice by an operator and once by another. The correlation between CRL measured by 3DUS and 2DUS, as well as the intraobserver and interobserver agreement, was then calculated. Furthermore, the agreement between 2DUS and 3DUS CRL measurements together with intraobserver and interobserver agreement was calculated separately for the groups with a midsagittal acquisition plane (MSAP) and non-midsagittal acquisition plane (NMSAP). Results: Overall, 137 pregnancies were included in the analysis. CRL measurements performed using 3DUS showed excellent correlation with 2DUS [intraclass correlation coefficient (ICC)=0.992]. In addition, the 3DUS showed a high intraobserver and interobserver agreement (ICC=0.999 and 0.993, respectively). Finally, when we divided the acquired volumes according to the plane of acquisition, excellent 2DUS-3DUS, as well as intraobserver and interobserver agreement, was maintained for both MSAP and NMSAP. Conclusion: 3DUS is a highly accurate and reproducible tool for fetal CRL measurement regardless of the fetal position at the time of 3D volume acquisition

Significance of uteroplacental Doppler at midtrimester in patients with favourable obstetric history

Objective: To reassess the usefulness of midtrimester uterine Doppler in low-risk multiparous women. Methods: We prospectively recruited low-risk pregnant women at 20-22 weeks attending our clinic. Among those, women with a favourable obstetric history (group A) were distinguished from nulliparous (group B) and of each group we measured uterine artery Doppler (pulsatility index (PI)). We evaluated the accuracy of uterine artery Doppler in the prediction of preeclampsia and small for gestational age (SGA) neonates. Results: Between January 2009 and October 2010, 382 women were included in the study of which 147 in group A and 235 in group B. Overall, 26/382 (6.8%) women presented preeclampsia and SGA occurred in 59/382 (15.4%) cases. In our population, at a 10% false positive rate (FPR) uterine artery Doppler showed a detection rate (DR) of 19.2% for preeclampsia and of 37.3% for SGA, with a higher sensitivity for SGA neonates delivered 34 weeks (87% vs. 29.4%). The univariable receiver operating characteristics (ROC) curve by uterine artery PI yielded a significant prediction only for SGA in nulliparous women (areas under the curve (AUC) of 0.70; 95% CI 0.60-0.79). Conclusions: Our data confirmed that midtrimester uterine artery Doppler is not an efficient strategy in anticipating the risk of pregnancy complications among low-risk multiparous wome

Phenomenal, bodily and brain correlates of fictional reappraisal as an implicit emotion regulation strategy

International audienceThe ability to modulate our emotional experience, depending on our current goal and context, is of critical importance for adaptive behavior. This ability encompasses various emotion regulation strategies, such as fictional reappraisal, at stake whenever one engages in fictional works (e.g., movies, books, video games, virtual environments). Neuroscientific studies investigating the distinction between the processing of real and fictional entities have reported the involvement of brain structures related to self-relevance and emotion regulation, suggesting a threefold interaction between the appraisal of reality, aspects of the Self, and emotions. The main aim of this study is to investigate the effect of implicit fictional reappraisal on different components of emotion, as well as on the modulatory role of autobiographical and conceptual self-relevance. While recording electrodermal, cardiac, and brain activity (EEG), we presented negative and neutral pictures to 33 participants, describing them as either real or fictional. After each stimulus, the participants reported their subjective emotional experience, self-relevance of the stimuli, as well as their agreement with their description. Using the Bayesian mixed-modeling framework, we showed that stimuli presented as fictional, compared with real, were subjectively appraised as less intense and less negative, and elicited lower skin conductance response, stronger heart-rate deceleration, and lower late positive potential amplitudes. Finally, these phenomenal and physiological changes did, to a moderate extent, rely on variations of specific aspects of self-relevance. Implications for the neuroscientific study of implicit emotion regulation are discussed