Characteristics of obstetric patients referred to intensive care in an Australian tertiary hospital

Background: The low mortality rate of 8.4 deaths per 100 000 women giving birth in Australia is well described; however, less is known about the spectrum of morbidity evident in pregnant and postpartum women admitted to an intensive care unit. Aim: A detailed description of the demographics, comorbidities, diagnoses and interventions of pregnant and postpartum women admitted to an Australian intensive care unit (ICU). Materials and Methods A retrospective observational study was conducted in a large metropolitan hospital co-located with a quaternary-level maternity hospital. The participants were women admitted to intensive care between 1 January 2007 and 30 June 2009 who were pregnant at any gestational age, or within 6 weeks postpartum. Results Two hundred and forty-nine women were admitted to ICU within the study period constituting 19% of all ICU admissions. The main reasons for admission were hypertensive disease of pregnancy and obstetric haemorrhage. The median (range) age was 32 (17–51) years, and ICU duration was 32 (8–228) h. The median APACHE III-J severity of illness score was 32 (8–80). Almost one-quarter of admissions could be classified as primarily observational. The most common interventions in ICU were invasive arterial pressure monitoring, central venous access with pressure monitoring and magnesium infusions. One-fifth of admissions were invasively ventilated. Conclusion A substantial number of pregnant and postpartum women admitted to ICU did not receive interventions typical of other critical illness, such as mechanical ventilation, inotropes or renal replacement therapy. This confounds the use of an ICU admission as a measure of maternal morbidity

Crónicas del signo XI en Hispânia. Crónica de Sampiro (S. XI).

95 Jan.-Dez. 1985, p. 151-155

Explicit processing of verbal and spatial features during letter-location binding modulates oscillatory activity of a fronto-parietal network.

The present study investigated the binding of verbal and spatial features in immediate memory. In a recent study, we demonstrated incidental and asymmetrical letter-location binding effects when participants attended to letter features (but not when they attended to location features) that were associated with greater oscillatory activity over prefrontal and posterior regions during the retention period. We were interested to investigate whether the patterns of brain activity associated with the incidental binding of letters and locations observed when only the verbal feature is attended differ from those reflecting the binding resulting from the controlled/explicit processing of both verbal and spatial features. To achieve this, neural activity was recorded using magnetoencephalography (MEG) while participants performed two working memory tasks. Both tasks were identical in terms of their perceptual characteristics and only differed with respect to the task instructions. One of the tasks required participants to process both letters and locations. In the other, participants were instructed to memorize only the letters, regardless of their location. Time–frequency representation of MEG data based on the wavelet transform of the signals was calculated on a single trial basis during the maintenance period of both tasks. Critically, despite equivalent behavioural binding effects in both tasks, single and dual feature encoding relied on different neuroanatomical and neural oscillatory correlates. We propose that enhanced activation of an anterior–posterior dorsal network observed in the task requiring the processing of both features reflects the necessity for allocating greater resources to intentionally process verbal and spatial features in this task

Mechanistic Aspects and Effects of Selected Tank-Mix Partners on Herbicidal Activity of a Novel Fatty Acid Ester

[EN] Only a limited number of contact herbicides exist in agricultural production. While systemic herbicides are more efficient also at suboptimum spray coverage with long-lasting weed control, contact herbicides provide several advantages. There is no translocation to fruits or roots of plantation and other crop, low risk for resistance development, and minor risk for spray-drift damage. Besides, synthetic products that often have toxicological or residues issues, natural fatty acids, particularly pelargonic acid (PA), have contact activity and are safer for home and garden use. We recently described a methyl capped polyethylene glycol ester of pelargonic acid (PA-MPEG) that acts independent of acid formation. Both, PA-MPEG and PA are applied at high rates per hectare to achieve excellent weed control. Here, we report about potential additives to increase PA-MPEG efficacy. The herbicidal active, 1-decanol, and the non-phytotoxic alkylated seed oil-based adjuvant, HastenTM, improved performance and outperformed a commercial PA herbicide. Both, PA-MPEG and PA appear to mainly act by the disintegration of bio-membranes besides having effects on transpiration. The main suggested effect is desiccation due to cutting the water continuum at the site of evaporation in the intercellular spaces. The synergistic action of the adjuvant HastenTM and its practical uses are also discussedThis work was supported by ClariantCampos, J.; Bodelon, L.; Verdeguer Sancho, MM.; Baur, P. (2022). Mechanistic Aspects and Effects of Selected Tank-Mix Partners on Herbicidal Activity of a Novel Fatty Acid Ester. Plants. 11(3):1-16. https://doi.org/10.3390/plants11030279S11611

Oscillatory activity in prefrontal and posterior regions during implicit letter-location binding.

Many cognitive abilities involve the integration of information from different modalities, a process referred to as “binding.” It remains less clear, however, whether the creation of bound representations occurs in an involuntary manner, and whether the links between the constituent features of an object are symmetrical. We used magnetoencephalography to investigate whether oscillatory brain activity related to binding processes would be observed in conditions in which participants maintain one feature only (involuntary binding); and whether this activity varies as a function of the feature attended to by participants (binding asymmetry). Participants performed two probe recognition tasks that were identical in terms of their perceptual characteristics and only differed with respect to the instructions given (to memorize either consonants or locations). MEG data were reconstructed using a current source distribution estimation in the classical frequency bands. We observed implicit verbal–spatial binding only when participants successfully maintained the identity of consonants, which was associated with a selective increase in oscillatory activity over prefrontal regions in all frequency bands during the first half of the retention period and accompanied by increased activity in posterior brain regions. The increase in oscillatory activity in prefrontal areas was only observed during the verbal task, which suggests that this activity might be signaling neural processes specifically involved in cross-code binding. Current results are in agreement with proposals suggesting that the prefrontal cortex function as a “pointer” which indexes the features that belong together within an object

PopHumanScan : the online catalog of human genome adaptation

Since the migrations that led humans to colonize Earth, our species has faced frequent adaptive challenges that have left signatures in the landscape of genetic variation and that we can identify in our today-s genomes. Here, we (i) perform an outlier approach on eight different population genetic statistics for 22 non-admixed human populations of the Phase III of the 1000 Genomes Project to detect selective sweeps at different historical ages, as well as events of recurrent positive selection in the human lineage; and (ii) create PopHumanScan, an online catalog that compiles and annotates all candidate regions under selection to facilitate their validation and thoroughly analysis. Well-known examples of human genetic adaptation published elsewhere are included in the catalog, as well as hundreds of other attractive candidates that will require further investigation. Designed as a collaborative database, PopHumanScan aims to become a central repository to share information, guide future studies and help advance our understanding of how selection has modeled our genomes as a response to changes in the environment or lifestyle of human populations. PopHumanScan is open and freely available at https://pophumanscan.uab.cat

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial.

BACKGROUND: Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. METHODS: We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. RESULTS: Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7-3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6-5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9-1.7). CONCLUSIONS: Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

Background Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking. Objectives To determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use. Design Individually randomised controlled, multicentre trial with cost-effectiveness analysis. Treatment was not blinded. Setting A total of 26 UK obstetric units. Participants Out of 3054 women recruited between June 2013 and April 2016, we randomly assigned 3028 women at risk of haemorrhage to cell salvage or routine care. Randomisation was stratified using random permuted blocks of variable sizes. Of these, 1672 had emergency and 1356 had elective caesareans. We excluded women for whom cell salvage or donor blood transfusion was contraindicated. Interventions Cell salvage (intervention) versus routine care without salvage (control). In the intervention group, salvage was set up in 95.6% of the women and, of these, 50.8% had salvaged blood returned. In the control group, 3.9% had salvage deployed. Main outcome measures Primary – donor blood transfusion. Secondary – units of donor blood transfused, time to mobilisation, length of hospitalisation, mean fall in haemoglobin, fetomaternal haemorrhage (FMH) measured by Kleihauer–Betke test, and maternal fatigue. Analyses were adjusted for stratification factors and other factors that were believed to be prognostic a priori. Cost-effectiveness outcomes – costs of resources and service provision taking the UK NHS perspective. Results We analysed 1498 and 1492 participants in the intervention and control groups, respectively. Overall, the transfusion rate was 2.5% in the intervention group and 3.5% in the control group [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42 to 1.01; p = 0.056]. In a planned subgroup analysis, the transfusion rate was 3.0% in the intervention group and 4.6% in the control group among emergency caesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 1.8% in the intervention group and 2.2% in the control group among elective caesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46, suggesting that the difference in effect between subgroups was not statistically significant). Secondary outcomes did not differ between groups, except for FMH, which was higher under salvage in rhesus D (RhD)-negative women with RhD-positive babies (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14; p = 0.013). No case of amniotic fluid embolism was observed. The additional cost of routine cell salvage during caesarean was estimated, on average, at £8110 per donor blood transfusion avoided. Conclusions The modest evidence for an effect of routine use of cell salvage during caesarean section on rates of donor blood transfusion was associated with increased FMH, which emphasises the need for adherence to guidance on anti-D prophylaxis. We are unable to comment on long-term antibody sensitisation effects. Based on the findings of this trial, cell salvage is unlikely to be considered cost-effective. Future work Research into risk of alloimmunisation among women exposed to cell salvage is needed. Trial registration Current Controlled Trials ISRCTN66118656. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 2. See the NIHR Journals Library website for further project information