Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review

The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.

Caesarean Section. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/084, June 2020)

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography - a cohort study

We aimed to examine to what extent a lateral infraclavicular brachial plexus block affected the axillary and the suprascapular nerve. We included patients undergoing hand surgery anaesthetised with a lateral infraclavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography during maximum voluntary isometric contraction of the medial deltoid muscle (axillary nerve) and the infraspinatus muscle (suprascapular nerve) from baseline to 30 min after the block procedure. A reduction in electromyography of > 50% defined a successful block. The impact of the block on the shoulder nerves was compared with the surgical target nerves of the arm and hand (musculocutaneous, radial, median and ulnar nerves). Twenty patients were included. The medians of the relative changes in the surface electromyography were significantly reduced (both p < 0.001) with 92% for the deltoid muscle and 30% for the infraspinatus muscle, respectively. In total, 18 out of 20 patients had reductions > 50% for the deltoid muscle, which was significantly different from the infraspinatus muscle, where the proportion was 5 out of 20 (p < 0.001). The medians of the relative reductions in electromyography for the arm and hand muscles were 90-96%, similar to the effect on the deltoid muscle. Our results suggest that a lateral infraclavicular block provides block of the axillary nerve comparable to the block of the surgical target nerves. The suprascapular nerve is blocked to a lesser degree. Combining a lateral infraclavicular brachial plexus block with a selective suprascapular block for shoulder surgery warrants further studies.

A checkpoint-independent mechanism delays entry into mitosis after UV irradiation

When cells are exposed to stress they delay entry into mitosis. The most extensively studied mechanism behind this delay is the DNA-damage-induced G2/M checkpoint. Here, we show the existence of an additional stress-response pathway in Schizosaccharomyces pombe that is independent of the classic ATR/Rad3-dependent checkpoint. This novel mechanism delays entry mitosis independently of the spindle assembly checkpoint and the mitotic kinases Fin1, Ark1 and Plo1. The pathway delays activation of the mitotic cyclin-dependent kinase (CDK) Cdc2 after UV irradiation. Furthermore, we demonstrate that translation of the mitotic cyclin Cdc13 is selectively downregulated after UV irradiation, and we propose that this downregulation of Cdc13 contributes to the delayed activation of Cdc2 and the delayed mitosis.

Consequences of abnormal CDK activity in S phase

Cyclin Dependent Kinases (CDKs) are important regulators of DNA replication. In this work we have investigated the consequences of increasing or decreasing the CDK activity in S phase. To this end we identified S-phase regulators of the fission yeast CDK, Cdc2, and used appropriate mutants to modulate Cdc2 activity. In fission yeast Mik1 has been thought to be the main regulator of Cdc2 activity in S phase. However, we find that Wee1 has a major function in S phase and thus we used wee1 mutants to investigate the consequences of increased Cdc2 activity. These wee1 mutants display increased replication stress and, particularly in the absence of the S-phase checkpoint, accumulate DNA damage. Notably, more cells incorporate EdU in a wee1(-) strain as compared to wildtype, suggesting altered regulation of DNA replication. In addition, a higher number of cells contain chromatin-bound Cdc45, an indicator of active replication forks. In addition, we found that Cdc25 is required to activate Cdc2 in S phase and used a cdc25 mutant to explore a situation where Cdc2 activity is reduced. Interestingly, a cdc25 mutant has a higher tolerance for replication stress than wild-type cells, suggesting that reduced CDK activity in S phase confers resistance to at least some forms of replication stress.

Analyzing Schizosaccharomyces pombe DNA Content by Flow Cytometry

Flow cytometry can be used to measure the DNA content of individual cells. The data are usually presented as DNA histograms that can be used to examine the cells' progression through the cell cycle. Under standard growth conditions, fission yeast cells do not complete cytokinesis until after G1 phase; therefore, DNA histograms show one major peak representing cells in G1 (2×1C DNA) and G2 phase (1×2C DNA). By analysis of the duration of the fluorescence signal as well as the intensity of the DNA-related signal, it is possible to discriminate between cells in M/G1, S, and G2 This protocol describes how to prepare cells for flow cytometry and analyze them. We also describe the application of barcoding for more accurate comparison of samples.

A novel suture method to place and adjust peripheral nerve catheters

We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in‐plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial placement and then attempted to return them to their original positions. We used ultrasound to evaluate the initial and secondary catheter placements and the spread of injectate around the nerves. In 10 cases, we confirmed catheter position by magnetic resonance imaging. We judged 43/45 initial placements successful and 42/43 secondary placements successful by ultrasound, confirmed in 10/10 cases by magnetic resonance imaging.

Ultrasound-guided block of the axillary nerve: a volunteer study of a new method

BACKGROUND

Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block.

METHODS

After initial investigations, 12 healthy volunteers were included. We performed an in-line ultrasound-guided specific axillary nerve block by injecting 8 ml local anesthetic (lidocaine 20 mg/ml) after placing the tip of a nerve stimulation needle cranial to the posterior circumflex humeral artery in the neurovascular space bordered by the teres minor muscle, the deltoid muscle, the triceps muscle and the shaft of the humerus. Needle placement was aided by simultaneous nerve stimulation. We assessed sensory (pinprick and cold stimulation) and motor (active resistive force) block of the axillary nerve before, 15, 30, 60, 90 and 120 min after performing the block and every 30 min until termination of the block.

RESULTS

All 12 volunteers demonstrated sensory block of the axillary nerve and 10 volunteers demonstrated complete motor block. Even though it was difficult to directly visualize the axillary nerve, the block was easy to perform with easily recognizable ultrasonographic landmarks. Block duration was approximately 120 min.

CONCLUSIONS

We describe a new ultrasound-guided technique to specifically block the axillary nerve. The potential clinical role of this new block remains to be determined.

Cell-cycle analysis of fission yeast cells by flow cytometry

The cell cycle of the fission yeast, Schizosaccharomyces pombe, does not easily lend itself to analysis by flow cytometry, mainly because cells in G(1) and G(2) phase contain the same amount of DNA. This occurs because fission yeast cells under standard growth conditions do not complete cytokinesis until after G(1) phase. We have devised a flow cytometric method exploiting the fact that cells in G(1) phase contain two nuclei, whereas cells in G(2) are mononuclear. Measurements of the width as well as the total area of the DNA-associated fluorescence signal allows the discrimination between cells in G(1) and in G(2) phase and the cell-cycle progression of fission yeast can be followed in detail by flow cytometry. Furthermore, we show how this method can be used to monitor the timing of cell entry into anaphase. Fission yeast cells tend to form multimers, which represents another problem of flow cytometry-based cell-cycle analysis. Here we present a method employing light-scatter measurements to enable the exclusion of cell doublets, thereby further improving the analysis of fission yeast cells by flow cytometry.

Direct measurement of the singlet generation yield in polymer light-emitting diodes

In this study, the singlet and triplet exciton generation yields of a representative blue-emitting conjugated polymer are directly compared using simultaneous optical and electrical excitation measurements. After carefully accounting for bimolecular triplet annihilation and knowing the independently measured solid state inter-system-crossing yield of the polymer, a singlet generation yield of 44% is obtained, in the working device, which is clearly in excess of the simple quantum statistical 25% limit.

Femtosecond ground state recovery: Measuring the intersystem crossing yield of polyspirobifluorene

Measurement of the quantum yield of triplet formation has been made for the prototypical conjugated polymer polyspirobifluorene in solution and solid state. An updated method has been described based on femtosecond time resolved ground state recovery following photoexcitation of the polymer. The two components to the recovery of the ground state due to the decay of the singlet and triplet excited states are clearly visible and from these it is possible to calculate Phi(T)=0.05+/-0.01 in solution, this gives k(isc)=5.4 x 10(7) s(-1) which compares favorably with other conjugated polymers. In polymer films an increased triplet yield of Phi(T)=0.12+/-0.02 is found to be independent of temperature, the increased yield is attributed to triplet recombination from charged states.

Violation of the exponential-decay law at long times

First-principles quantum mechanical calculations show that the exponential-decay law for any metastable state is only an approximation and predict an asymptotically algebraic contribution to the decay for sufficiently long times. In this Letter, we measure the luminescence decays of many dissolved organic materials after pulsed laser excitation over more than 20 lifetimes and obtain the first experimental proof of the turnover into the nonexponential decay regime. As theoretically expected, the strength of the nonexponential contributions scales with the energetic width of the excited state density distribution whereas the slope indicates the broadening mechanism.

Effects of triplet exciton confinement induced by reduced conjugation length in polyspirobifluorene copolymers

Using gated optical spectroscopy at low temperatures, a polyspirobifluorene has been compared with an alternating carbazole-spirobifluorene copolymer in which the backbone conjugation is interrupted due to meta coupling of the carbazole moieties. In the copolymer both singlet and triplet energy levels are blueshifted by 130 meV with respect to the homopolymer, resulting in an unaltered singlet-to-triplet splitting. Though the barrier for triplet exciton migration increases from 4.4 to 6.0 meV for the copolymer compared to the homopolymer, it still remained low enough to ensure efficient triplet diffusion at ambient temperature.

Association study of serotonin-2A receptor gene polymorphism and panic disorder in patients from Canada and Germany

The T102C serotonin-2A (5-HT2A) receptor gene polymorphism has been studied extensively in a number of complex psychiatric conditions with mixed results. Recently a genetic association has been described between this polymorphism and panic disorder in a Japanese sample. To evaluate the impact of the T102C polymorphism in panic disorder we genotyped triad families (panic disorder patient and parents), and cases with controls in Canadian and German samples. No significant transmission disequilibrium was observed between the alleles of the T102C 5-HT2A receptor gene polymorphism and panic disorder, nor was a significant excess of either allele found in the case control analysis. Our data suggest thus that this polymorphism is unlikely to play a major role in the pathogenesis of panic disorder.

Electrophosphorescence and delayed electroluminescence from pristine polyfluorene thin-film devices at low temperature

Intrinsic long-lived electrophosphorescence and delayed electroluminescence from a conjugated polymer (polyfluorene) thin film is observed for the first time at low temperature. From bias offset voltage dependent measurements, it is concluded that the delayed fluorescence is generated via triplet-triplet annihilation. A fast and efficient triplet exciton quenching by charge carriers is found to occur in the active polymer layer of the working devices.

Allelic variation in 5-HT1A receptor expression is associated with anxiety- and depression-related personality traits

The 5-HT1A receptor plays a critical role in the pathophysiology of anxiety and depression as well as in the mode of action of anxiolytic and antidepressant drugs. Human 5-HT1A gene transcription is modulated by a common C-1016G single nucleotide polymorphism (SNP) in its upstream regulatory region. In the present study, we evaluated the role of the HTR1A-1019 polymorphism in the modulation of individual differences in personality traits by an association study of a sample of healthy volunteers. Personality traits were assessed with two different methods, NEO personality inventory (NEO-PI-R) and Tridimensional Personality Questionnaire (TPQ). There was a significant effect of the HTR1A-1019 polymorphism on NEO Neuroticism with carriers of the G allele showing higher scores than individuals homozygous for the C variant. The effect was primarily due to associations with the Neuroticism facets Anxiety and Depression. Carriers of the G allele also exhibited higher TPQ Harm Avoidance scores. Our findings indicate a role of allelic variation in 5-HT1A receptor expression in the development and modulation of anxiety- and depression-related personality traits.

High-throughput generation and engineering of recombinant human antibodies

The first version of the Human Combinatorial Antibody Library (HuCAL) is a single-chain Fv-based phage display library (HuCAL-scFv) with 2x10(9) members optimised for high-throughput generation and targeted engineering of human antibodies. 61% of the library genes code for functional scFv as judged by sequencing. We show here that since HuCAL-scFv antibodies are expressed in high levels in Escherichia coli, automated panning and screening in miniaturised settings (96- and 384-well format) have now become feasible. Additionally, the unique modular design of HuCAL-genes and -vectors allows the distinctly facilitated conversion of scFv into Fab, miniantibody and immunoglobulin formats, and the fusion with a variety of effector functions and tags not only convenient for therapeutic applications but also for high-throughput purification and detection. Thus, the HuCAL principle enables the rapid and high-throughput development of human antibodies by optimisation strategies proven useful in classical low molecular weight drug development. We demonstrate in this report that HuCAL is a very convenient source of human antibodies for various applications.

Sorting of invertase signal peptide mutants in yeast dependent and independent on the signal-recognition particle

There is growing evidence that yeast contains two efficient pathways of protein translocation across the endoplasmic reticulum membrane, one dependent on the signal-recognition particle (SRP) and the other independent. Their specificity, however, is largely obscure. For higher eukaryotes it has been shown that a high average hydrophobicity of the core region with a minimal length around six or seven amino acids, as well as a stabilized alpha-helix, are decisive structural features for translocation. Using yeast invertase as a secretory model protein, we have found that mutated signal sequences with Pro or Gly in the core, or having only four hydrophobic amino acids, are not functional in translocation across microsomal membranes of dog pancreas because they do not interact with the SRP. Expression of these mutant variants in Saccharomyces cerevisiae revealed that they are sorted independently of the SRP since translocation was not impaired in an SRP-deficient yeast strain. In contrast to this, wild-type invertase is translocated SRP-dependently in wild-type cells and shows a decreased translocation in SRP-deficient cells. By overexpression of Srp54p, but not of Hsc70p, the translocation defect of wild-type invertase in an SRP54 disruptant is restored. The data indicate that targeting of proteins to the endoplasmic reticulum in Saccharomyces cerevisiae seems to be more flexible than in higher eukaryotes as far as the structural requirements of signal sequences are concerned, and that the route taken is specified by the sequence.