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This study aimed to evaluate the feasibility of performing multiple testicular biopsies in rams using Tru-cut® needles, assessing histological structure, gene expression, and potential complications such as effects on semen quality, testicular blood flow, and ultrasonographic echotexture. In Exp. 1, six mature rams underwent testicular biopsies at intervals (0, 3, 6, 12, 24, and 48 h) using a 16 G Tru-cut® needle, with alternating testes for each collection. Benzathine benzylpenicillin and flunixin meglumine were administered for infection and inflammation control. Local anesthesia and post-biopsy care included lidocaine, digital pressure, and ice application. Testicular samples were analyzed for gene expression related to inflammation, oxidative stress, and steroidogenesis. Semen quality was assessed pre-biopsy and 28 days post-biopsy. Ultrasonographic evaluations of the scrotum and testes were conducted before biopsies and on days 5, 9, 13, 17, and 21 post-biopsies. In Exp. 2, a second group of six mature rams underwent biopsies using 14 G needles, with two samples taken from each testis. Samples were histologically examined for structural preservation. Scrotal skin temperature was measured using infrared thermography, and testicular blood flow was assessed via color Doppler ultrasonography, with measurements taken before and on days 1, 2, 4, 6, 8, 10, 25, 50, 75, and 100 post-biopsies. Semen collection followed the same schedule as in Exp. 1. In Exp. 3, biopsies were performed on different testicular regions (upper, middle, lower) using 12 G, 14 G, and 16 G needles to compare structural preservation. Samples were histologically analyzed. No clinical signs of injury, inflammation, or fluid accumulation were observed. Scrotal pain, increased temperature, swelling, and bleeding were absent, and behavioral signs indicative of pain were not detected. Gene expression remained unchanged, and no significant alterations in seminal characteristics or testicular echogenicity were observed. A slight increase in resistivity and pulsatility indices was noted in Exp. 2. Biopsies with 14 G and 16 G needles resulted in structural disruptions, while 12 G needles better preserved testicular parenchyma. Multiple testicular biopsies using Tru-cut® needles did not cause significant morphological changes, alter transcriptional profiles, or affect semen or ultrasonographic characteristics, demonstrating that this method is viable for monitoring acute molecular changes in the testes., Competing Interests: Declaration of competing interest The authors declare that no conflict of interest could be perceived as prejudicing the impartiality of the research reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare that they have no conflicts of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Introduction: Shock index and continuous non-invasive haemoglobin monitoring (SpHb) have both been proposed for the timely recognition of postpartum haemorrhage (PPH). We sought to determine, in parallel, the association of each of shock index and SpHb with blood loss after vaginal delivery., Methods: Sixty-six women were recruited to this prospective observational study. Shock index and SpHb were recorded postpartum for 120 min. The association between each of shock index and SpHb with quantitative blood loss (QBL) at 30, 60 and 120 min postpartum was determined using linear mixed models. Area-under-the-receiver-operator-characteristic (AUROC) curves were constructed to evaluate the diagnostic ability of shock index and SpHb to detect PPH (defined as QBL ≥1000 mL)., Results: Shock index trend was associated with QBL over the first 30 min (r=0.37, P=0.002), but not over 60 or 120 min. There was an association of SpHb trend with QBL over the first 30 min (P=0.06), but not over 60 min (r=-0.32, P=0.009) or 120 min (r=-0.26, P=0.03). Maximum shock index within 60 min correlated with QBL (r=0.54, P <0.001) and was a predictor of PPH (P=0.0012, AUROC 0.796). Maximum change in SpHb within 60 min negatively correlated with QBL (r=-0.4, P <0.001) and was a predictor of PPH (P=0.048, AUROC 0.761)., Conclusions: The trend of shock index and its peak values are associated with blood loss after vaginal delivery and are early indicators of PPH. Negative trend of SpHb is a late sign of PPH and has a weaker association with blood loss than shock index., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aims: Bisphenol A (BPA), an endocrine disruptor used in industrial applications, has been detected in both placenta and milk. We studied the effects of BPA exposure during pregnancy and lactation on body composition, palatable food intake, biochemical, hormonal and behavioral profiles of young and adult Wistar rat offspring., Main Methods: Female rats were divided into: control, BPA10 (10 μg/kg/day) and BPA50 (50 μg/kg/day). BPA was administered by gavage to dams from gestation until the end of lactation. Euthanasia occurred at weaning [postnatal day (PN) 21] or adulthood (PN180)., Key Findings: At weaning, BPA10 female pups had higher plasma cholesterol and triacylglycerol. BPA10 male pups showed lower plasma T3. BPA10 pups of both sexes had higher plasma progesterone, testosterone and estradiol. At adulthood, females of both BPA groups had lower food intake and higher insulinemia, whereas males had lower visceral fat, lower progesterone and testosterone concentrations. BPA10 females and males had lower T4 levels, while only males showed lower estradiol. BPA50 females showed lower fat mass, higher lean mass and lower corticosteronemia, while males had lower food intake. In the feeding study, BPA10 males ate more fat at 30 min, while BPA10 females and males ingested less fat after 12 h. BPA10 females showed hyperactivity while both groups showed less exploration., Significance: Maternal exposure to BPA during gestation and lactation, even at low doses, induces life-long changes in the regulation of metabolic homeostasis of the progeny, affects sex steroids and thyroid hormones levels, compromises behavior, but does not lead to obesity or dyslipidemia., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to determine the pattern of uterotonic drug usage in obstetric units of university-affiliated hospitals in Canada., Methods: This was a prospective observational study conducted in the form of an electronic survey. The target group consisted of chiefs or directors of Obstetrics and Anaesthesia at university-affiliated hospitals across Canada. The survey was sent out between November 2016 and January 2017, using the program 'SurveyMonkey'. Data on institutional obstetric practices and usage of uterotonic agents were collected., Results: The survey was sent to 92 obstetricians and anesthesiologists from 46 institutions, of which 33 clinicians from 24 institutions responded. About 65% of clinicians were unaware of the rate of postpartum hemorrhage in their institution. The first-line agent for vaginal deliveries was reported as oxytocin by 94% and carbetocin by 6% of physicians. For women at low-risk for postpartum hemorrhage when undergoing cesarean deliveries (CD), 66% reported oxytocin as the first-line uterotonic, while 34% reported carbetocin. For CDs at high-risk of postpartum hemorrhage, 60% of physicians reported oxytocin and 40% reported using carbetocin initially. The use of second-line uterotonics was also variable. The choice of uterotonic was mainly based on perceived efficacy and Society of Obstetricians and Gynaecologists of Canada guidelines., Conclusion: There is a lack of a unified approach to the use of uterotonic drugs for postpartum hemorrhage management in Canada. To improve the management of postpartum hemorrhage due to uterine atony, an evidence-based approach to usage and consensus between obstetricians and anesthesiologists is warranted., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: The present study appraises the construct validity of the Visible Occlusal Plaque Index (VOPI) along with its sub-types, convergent and discriminant validity., Methods: 618 10-15year old Brazilian adolescents were included. The VOPI has a four-point ordinal scale ranging from no plaque to heavy plaque. VOPI scores and caries status on permanent molars were mapped and recorded at individual anatomical sites of the groove-fossa-system and at surface level. Outcomes were presence of sound site/surface and site/surface with active or inactive caries lesions (non-cavitated or cavitated)., Results: Construct validity was assumed based on qualitative assessment as no plaque (score 0) and thin plaque (score 1) reflected the theoretical knowledge that a regular disorganization of the dental biofilm either maintains the caries process at sub-clinical levels or inactivate it clinically. The VOPI also showed convergent validity since the likelihood that anatomical sites with no or thin plaque had inactive lesions simultaneously with sites with thick plaque (score 2) or heavy plaque (score 3) having active lesions were overall significant (RR=1.0-7.8). At surface level, discriminant validity of the VOPI was evidenced with multivariable analysis (GEE), by its ability to discriminate between the groups of adolescents with different oral hygiene status; negative association between adolescents with thick and heavy plaque and those with sound occlusal surfaces was found (OR=0.3, p<0.001)., Conclusion: The VOPI has construct as well as convergent and discriminant validity and is therefore recommended as an additional clinical tool to estimate caries lesions activity and support treatment decisions., Clinical Significance: The Visible Occlusal Plaque Index is an additional clinical tool to the assessment of oral hygiene and caries lesion activity. The VOPI is recommended to standardize and categorize information on the occlusal biofilm, thus being suitable for direct application in research and clinical settings., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Infectious complications related to neuraxial anesthesia may result in adverse outcomes. There are no best practice guidelines regarding hand-sanitizing measures specifically for these procedures. The objective of this study was to compare the growth of microbial organisms on the operator's forearm between five common techniques of hand washing for labor epidurals., Methods: In this single blind randomized controlled trial, all anesthesiologists performing labor epidurals in a tertiary care hospital were randomized into five study groups: hand washing with alcohol gel only up to elbows (Group A); hand washing with soap up to elbows, sterile towel to dry, followed by alcohol gel (Group B); hand washing with soap up to elbows, non-sterile towel to dry, followed by alcohol gel (Group C); hand washing with soap up to elbows, non-sterile towel to dry (Group D) or hand washing with soap up to elbows, sterile towel to dry (Group E). The number of colonies for each specimen/rate per 100 specimens on one or both arms per group was measured., Results: The incidence of colonization was 2.5, 23.0, 18.5, 114.5, and 53.0 in Groups A, B, C, D and E, respectively. Compared to Group A, the odds ratio of bacterial growth for Group B was 1.52 (P=0.519), Group C 5.44 (P=0.003), Group D 13.82 (P<0.001), and Group E 8.65 (P<0.001)., Conclusion: Alcohol-based antiseptic solutions are superior in terms of reducing the incidence of colonization. The results will enable us to develop guidelines to standardize and improve hand-sanitizing practices among epidural practitioners., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Pulmonary aspiration of gastric contents in pregnant women undergoing general anaesthesia is one of the most feared complications in obstetric anaesthesia. Bedside gastric ultrasonography is a feasible imaging tool to assess the gastric content. The purpose of this study was to investigate the reliability of qualitative bedside assessment of the gastric content performed by anaesthesiologists on third trimester pregnant women., Methods: Pregnant women (≥32 weeks gestational age) were randomized to undergo ultrasound (US) assessments of their stomach in a fasting state (>8 h), or after ingestion of clear fluids only, or solid food. Three anaesthesiologists trained in gastric ultrasonography performed the assessments using a low-frequency curved-array US transducer (5-2 MHz). Primary outcome of the study was the consistency of raters in diagnosing the correct status of the gastric content, which was used to determine the interrater reliability among the three anaesthesiologists. Secondary outcomes were overall proportion of correct and incorrect diagnoses and the specific proportions of correct diagnosis across the three gastric content groups., Results: We analysed 32 pregnant women. The interrater reliability displayed a kappa statistic of 0.74 (bias corrected 95% CI: 0.68-0.84). The overall proportion of correct diagnosis was 87.5% (84 of 96). The odds of correct diagnosis for 'solid contents' were 16.7 times the odds for 'empty', and 14.3 times for 'clear fluid'., Conclusions: Our results show the consistency of the qualitative US assessment of gastric contents of pregnant women in the third trimester by anaesthesiologists. A kappa of 0.74 suggests substantial agreement in terms of interrater reliability for this diagnostic measurement., Clinical Trial Registration: ClinicalTrials.gov identifier: NCT01564030., (© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Epidural labor analgesia inclusive of high-dose fentanyl has been thought to affect breastfeeding in multiparous patients. In our experience, this effect is not as significant as quoted in the literature. This study was designed to evaluate breastfeeding success in women receiving epidural analgesia with fentanyl-containing solutions at our institution., Methods: Term multiparous women who received epidural analgesia for labor, had previously breastfed, and who intended to breastfeed, were recruited. Baseline demographics, as well as detailed epidural, obstetric and neonatal data, were collected. Epidural analgesia was achieved with a mixture of bupivacaine and fentanyl. Subjects were telephoned both 1 and 6 weeks after delivery, and a breastfeeding questionnaire was completed. Our primary outcome was breastfeeding cessation at 6 weeks., Results: One hundred and five women were recruited, with 18 exclusions. The median cumulative epidural fentanyl dose was 151.4 microg (30-570 microg). No neonates developed complications attributable to labor analgesia. Four women stopped breastfeeding because of issues related to the baby (4.6%); only one of them received a fentanyl dose >150 microg. The breastfeeding success rate was therefore >95%. The women had a median maternity leave of 12 months, and 69% received post-partum lactation support., Conclusions: The incidence of successful breastfeeding in multiparous women who undergo vaginal delivery with epidural analgesia inclusive of fentanyl is much greater at our institution than previously reported in the literature. This may be due to favorable conditions such as time off work and post-natal support., (2010 Elsevier Ltd. All rights reserved.)

Subdural injection may be associated with abnormally extensive or limited spread of local anesthetics during neuraxial anesthesia. This complication is difficult to diagnose clinically. Radiological imaging is the gold standard for confirming the location of subdural catheter, but electrical stimulation of the catheter has also been described as a useful diagnostic tool. We present the case of an obstetric patient with unintentional subdural catheter placement that presented as a failed epidural block associated with severe upper back and scapular pain on catheter injection. Electrical stimulation of the catheter did not elicit muscle contractions until a current of 4 mAmp was attained, which is the response pattern of epidural placement. Subdural location of the catheter was subsequently confirmed by contrast radiography. This case adds to the evidence that subdural catheters are difficult to identify clinically, and that electrical stimulation may not differentiate them from epidural catheters., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Background: The purpose of this trial was to determine the 95% effective dose (ED95) of phenylephrine by intermittent i.v. bolus, to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery., Methods: The study was conducted in a double-blinded fashion in 50 patients undergoing elective cesarean delivery under spinal anesthesia. The dose of phenylephrine was determined using up-down sequential allocation, modified by a variation of the Narayana rule. Systolic pressure and heart rate were assessed every minute until uterine incision. The first patient was assigned a 40-microg dose, and the dose to subsequent patients varied by 10-microg increments or decrements. An adequate response was defined as absence of hypotension (systolic pressure <80% of baseline) and nausea. The study solution was given immediately after spinal administration, without prior pressure measurement, and thereafter when the systolic pressure was 120% of baseline) was observed in 14 cases, immediately after intrathecal injection and prophylactic phenylephrine administration in all cases., Conclusion: The ED95 of phenylephrine, administered as intermittent boluses to prevent pre-delivery spinal-induced hypotension and/or nausea at elective cesarean delivery, is at least 122 microg (lower limit of the confidence interval). The safety of this dose warrants further studies.

Background: Combined spinal-epidural (CSE) analgesia is an effective technique for pain control in labor and is particularly useful in the active phase. Excessive doses of intrathecal bupivacaine may be associated with adverse effects. This study is designed to estimate the ED95 for intrathecal plain bupivacaine with fentanyl 15 microg in labor., Methods: Forty healthy women in active labor (cervical dilatation > or = 5 cm and verbal numeric pain score > or = 6/10) were given CSE for labor analgesia with intrathecal plain bupivacaine and fentanyl 15 microg. The initial dose of bupivacaine was 1.75 mg. Doses were varied in a 0.25-mg testing interval according to a method of sequential allocation designed to cluster the dose around the ED95. Effectiveness was defined as a verbal numeric pain score < or = 1 within 10 min of intrathecal injection., Results: There was a 100% response rate to the 1.75-mg dose (95% CI 84.6-100.0%) and an 85.0% response rate to 1.50 mg (95% CI 64.0-95.8%). The ED95 for intrathecal plain bupivacaine with fentanyl 15 microg in active labor was 1.66 mg (95% CI 1.50-482.5 mg). The incidence of fetal bradycardia was 7.5%. The incidence of pruritus was 55%. No patient experienced motor block., Conclusions: This is the first dose-finding study specifically designed to estimate the ED95 of intrathecal bupivacaine combined with a fixed amount of fentanyl for analgesia in active labor. The combination of bupivacaine 1.75 mg with fentanyl 15 microg rapidly and reliably alleviated pain in the active phase of labor.

A morbidly obese patient presented for elective cesarean section. This case demonstrates the technical difficulties and potentially life-threatening complications encountered in attempting to locate an epidural space at a distance of over 11 cm from the skin. Ultrasound was used to aid in locating the space. The resources required and the logistical problems that impact on staff members in managing a morbidly obese patient presenting for cesarean section are also highlighted.

Nausea and vomiting during regional anesthesia for cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include hypotension, vagal hyperactivity, visceral pain, i.v. opioid supplementation, uterotonic agents and motion. The obstetric anesthesia literature has addressed these causative factors for nausea and vomiting individually, making it difficult for the anesthesiologists to have a comprehensive understanding of these important complications. This review highlights the anesthetic and non-anesthetic causes of intraoperative nausea and vomiting during regional anesthesia for cesarean section and the appropriate prophylactic and therapeutic management. Intraoperative nausea and vomiting can be best prevented by controlling hypotension, optimizing the use of neuraxial and i.v. opioids, improving the quality of block, minimizing surgical stimuli and judicious administration of uterotonic agents. Although prophylactic antiemetics have been advocated during cesarean sections, strict adherence to these practices can effectively lower the incidence of intraoperative nausea and vomiting without the requirement of antiemetic agents. Antiemetics, therefore, should be reserved for the prevention of intraoperative nausea and vomiting in high-risk patients and for the treatment of nausea and vomiting not responding to routine measures.

The anti-inflammatory and antinociceptive effects of the acetylated (2), methylated (3) and aminated (4) derivatives of cubebin (1), obtained by its reaction with acetic anhydride, methyl iodide and dimethylethylamine chloride, respectively, were investigated, using different animal models. The compound (2) was the most effective anti-inflammatory one in the carrageenin-induced paw edema in rats and was the only one which showed dose-response correlation for this assay with r = 0.993 and Y = 64.58x + 0.22. Besides, compounds (2) and (4) were more effective than cubebin in inhibiting acetic acid-induced writhing in mice, producing dose-response correlation with doses of 10, 20 and 30 mg/kg, respectively. Regarding the hot plate and the cell migration tests in rats, none of the four tested compounds showed activity. Overall, the results showed that the acetylation and amination of cubebin were efficient in enhancing its analgesic activity, as well as its anti-inflammatory activity.

The present study evaluated the central activity of the essential oil and the ethanolic extract from Artemisia annua L. in animals as a part of a psychopharmacological screening of this plant. The extract was prepared with fresh leaves in ethanol (AEE) and the essential oil (AEO) was obtained by hidrodestilation. The ED(50) and the LD(50) obtained for the essential oil were 470mg/kg (correlation coefficient r=0.97333 and linear regression y=-26.52x+0.158) and 790mg/kg, and for the extract, 450mg/kg (correlation coefficient r=0.99266 and linear regression y=-27.34+0.156) and more than 2g/kg, respectively. The doses increased the latency time to convulsions induced by picrotoxin and pilocarpine but prevented the onset of pentylenotetrazol and strychnine induced seizures. In addition to, the products have caused marked inhibition in the Rota-rod assay. According to the results, the AEO has a high acute toxicity and a possible cholinergic action, and the AEE showed a possible central activity as dopaminergic and cholinergic agents, and did not present a significant acute toxicity. These differences should be due to chemical substances present in each product. These products had no significant effect as an anticonvulsant, while exhibited a strong depressant activity on the CNS.

Tibetan mushroom (TM) is a fermented beverage composed by a dozen of bacteria and yeasts living together into polysaccharide grains secreted by them. TM is similar to kefir, a probiotic beverage originated in the Caucasian mountains exhibiting some anti-bacterial, anti-mycotic, anti-neoplastic and immunomodulatory effects. Aiming to evaluate a plausible anti-inflammatory property of TM we conducted cotton-induced granuloma and paw edema assays in rats, the latter using carrageenin, dextran and histamine as stimuli. TM samples were thawed and continuously cultured during 15 days into molasses solutions (50 g/l). The experiments used TM suspensions after 24h fermentation and TM grains mechanically disintegrated. The results showed a significant inhibition on the formation of granuloma tissue for the test group as compared to the negative control group. TM suspensions presented an inhibition of 43% for the inflammatory process. Rat paw edema also showed significant decreases with the mediators. The edema induced by carrageenin was inhibited 62% at the 3rd hour. The edema dextran-induced was completely inhibited at 1h and antagonized the histamine edema 52% at 1h.

Ozonized water increases oxygen local tension. The ozone by itself produces inflammatory reactions in lung epithelium. The action of ozonized water during the inflammatory process was investigated. In rat paw edema induced by carrageenin, the inflammatory process was stimulated by ozonized water (1.2 microg, p.o.) when applied 30 min prior to the induction. In the inflammatory process induced by Freund's Complete Adjuvant, the ozonized water did not interfere in the inflammatory reaction. Furthermore, in gastric ulcers models induced by stress, there was a significant reduction in the incidence of ulcers types I, II and III (P<0.05, Student's t -test)., (Copyright 2000 Academic Press.)