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A real-time 3D Telemedicine system – leveraging Microsoft's Holoportation™ communication technology – enabled an international multidisciplinary team meeting (MDT) to consult with complex reconstructive patients before, during, and after an overseas surgical collaboration. A proof-of-concept international 3D MDT clinic took place in November 2022, between the Canniesburn Plastic Surgery Unit, UK, and the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana. The 3D system was utilised 1) previsit to assess patients and enable logistical planning, 2) on-site in Ghana to further allow patients to see themselves and proposed operations in 3D, and 3) post visit to debrief the team and patients. Four Ghana patients were followed through their patient journey (mandibular ameloblastoma, sarcoma thigh, maxillary tumour, sarcoma back). Thirteen participants (four patients, four Ghana clinicians, and five UK clinicians) completed feedback on the 3D MDT. Outcome measures were rated highly with satisfaction 84.31/100, perceived benefit 4.54/5, overall quality 127.3/147 (Telehealth Usability Questionnaire), and usability 83.2/100 (System Usability Scale). These data show close alignment with that previously published on high-income countries. This novel technology has the potential to enhance the delivery of overseas surgical visits to low-to-middle-income countries, by improving planning, informed discussion with patients, expert consensus on complex cases, and fostering engagement with professionals who may be thousands of miles away. This is the first demonstration that real-time 3D Telemedicine can both work, and enhance care within an international MDT clinic, and may thus enable change in the approach to overseas surgical collaborations. [Display omitted] [ABSTRACT FROM AUTHOR]

There is little documented evidence of midwives' perspectives regarding the use of nitrous oxide in the peripartum period. Nitrous oxide is an inhaled gas used widely in the peripartum period; usually offered and managed by midwives. Explore midwives' knowledge, perceptions, and practices of facilitating women's use of nitrous oxide in the peripartum period. An exploratory cross-sectional survey design was used. Quantitative data were analysed using descriptive and inferential statistics; open-ended responses underwent template analysis. Midwives (n = 121) working in three Australian settings reported regularly recommending the use of nitrous oxide and high levels of knowledge and confidence supporting its use. There was a significant association between midwifery experience, and perspectives on women's capacity to use nitrous effectively (p = 0.004); and desire for refresher education (p < 0.001). Midwives working in continuity models were more likely to support women using nitrous oxide in any situation (p = 0.039). Midwives demonstrated expertise in facilitating nitrous oxide use, citing utility to relieve anxiety and distract women from pain or discomfort. Nitrous oxide was identified as an important adjunct to the provision of supportive care requiring midwifery therapeutic presence. This study provides novel insight into midwives' support of nitrous oxide use in the peripartum setting revealing high levels of knowledge and confidence. Recognition of this unique expertise held by midwives is important to ensure transfer and development of professional knowledge and skills and emphasises the need for midwifery leadership in clinical service provision, planning and policy. [ABSTRACT FROM AUTHOR]

An understanding of the anatomy of the orbit is essential for performing regional anaesthesia for ophthalmic surgery. This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles. [ABSTRACT FROM AUTHOR]

Introduction: Placental dysfunction and inefficiency, is important in understanding fetal growth restriction and low birth weight. Two recent studies have examined the relationship between antidepressant use in pregnancy and placental weight ratios; one found lower placental weight ratio associated with antidepressant use and the other found a higher ratio.Methods: This study examined 342 women recruited in early pregnancy, including 75 taking antidepressants, 29 with current depression and 238 controls. Antidepressant use was measured through self-report in early and late pregnancy, hospital records at delivery and drug concentrations in umbilical cord and maternal blood obtained at delivery. Maternal depression was measured using the Structured Clinical Interview for the DSM IV (SCID) at recruitment. Placentas were collected at delivery and weighed, and infant birth weight recorded. Placental efficiency was measured using standardised placental weight residuals and included as the outcome in general linear models (ANOVA/ANCOVA) to test hypotheses.Results: While placental weight was higher for those on antidepressants compared to controls (z=.30 c.f. Z=-0.08, p=.012), there were no significant differences between the three groups after adjusting for maternal body mass index at recruitment. When comparing antidepressant groups separately there were small-to-moderate positive associations between (SSRI) concentrations and placental weight (rho's > 0.20, p's > 0.05), which did not reach significance.Conclusion: Antidepressant use in pregnancy was not associated with significant changes in placental efficiency after adjustment for confounding variables. Future research should expand on this to examine other aspects of placental function and include a wide range of potential confounding variables to draw clinically meaningful conclusions. [ABSTRACT FROM AUTHOR]

This article examines the drawbacks of the organizational learning method and introduces the Communities of Practice model. The author argues that the Communities of Practice model provides a group with values and taps into a history of shared learning by steering away from the utilization of plans and models and drawing on discussion and personal narratives.

Motor development underlies many aspects of education and learning. There has been uncertainty about the impact of exposure of antidepressant medication in pregnancy on child motor outcomes. This paper examines whether exposure to antidepressants in utero increases the risk of poorer motor development in two areas: sensorimotor and visuospatial processing. Data were obtained from 195 women and children across 3 groups: women with untreated depression in pregnancy, women treated with antidepressants and control women. Data were collected across pregnancy, postpartum and until 4 years for mother and child. Maternal depression was established at baseline with the Structured Clinical Interview for DSM-IV. Antidepressant exposure, including type, dose and timing, was measured through repeated self-report across pregnancy and the postpartum, medical records at delivery and in cord blood samples collected at delivery. Child sensorimotor and visuospatial outcomes were assessed at 4 years of age with four subtests from the NEPSY-II. Our study found for sensorimotor development, visuomotor precision completion time was associated with better performance for antidepressant-exposed children compared to those with mothers with untreated depression. Yet another measure of sensorimotor development, motor manual sequences, was poorer in those exposed to antidepressants. One subtest for visuospatial processing, block construction, was associated with poorer performance in antidepressant-exposed children who had poor neonatal adaptation and those exposed to a higher dose of antidepressant. These findings suggest an inconsistent association between sensorimotor development and antidepressant use in pregnancy. However, the findings for visuospatial processing would support further exploration of antidepressant associated poor neonatal adaption and later motor development. [ABSTRACT FROM AUTHOR]

Humans are distinctive in their dependence upon products of culture for survival, products that have evolved cumulatively over generations such that many cannot now be created by a single individual. Why the cultural capacity of humans appears unrivalled in the animal kingdom is a topic of ongoing debate. Here we explore whether innovation and/or social learning propensities may constrain the ability of one of our closest living relatives, chimpanzees (Pan troglodytes), to master an extractive foraging and tool-use task designed to afford opportunities for cumulative culture to develop. We further explore the potential demographic characteristics associated with novel task solutions. Chimpanzees (N = 53) were inventive, flexibly exploring the novel task, albeit complex inventions were rare and shaped by prior individual experience with similar tool-use tasks. However, they displayed no evidence of cumulative cultural learning. Communities displayed richer behavioral repertoires and had greater task success than chimpanzees tested in an asocial control condition, but their solution complexity did not surpass what individuals invented. The lack of social transmission of complex and beneficial solutions in contexts like those we studied provides one explanation for the limited cumulative culture observed in this species. [ABSTRACT FROM AUTHOR]

Nitrous oxide is widely used in the provision of quality maternity care; despite this, there is little to no literature examining midwives' perspectives on its use. We aimed to explore midwives' understanding and experience of nitrous oxide use in the maternity setting. We used a cross-sectional approach to explore midwives' knowledge, perspectives and practices regarding nitrous oxide. Western Australian midwives (n=121) working in primary, secondary, and tertiary settings were invited to participate in our research. Quantitative data were analysed using descriptive and inferential statistics, qualitative responses were analysed through template analysis. Midwives reported high levels of knowledge and confidence in initiating and supporting nitrous oxide use. Years of experience was associated with greater confidence in supporting nitrous oxide use (p = 0.004). Those working in continuity models reported an increased likelihood to support women to use nitrous oxide in any situation (p = 0.039). Midwives recognised the importance of continuous midwifery presence to support women's use in the perinatal setting. They reported confidence in utilising nitrous oxide in combination with adjunct analgesic modalities. Midwives identified a range of benefits of nitrous oxide use in labour and procedural care, noting safety for both mother and baby, acceptability and ease of use, and autonomous control via self-administration. Our novel study reports Australian first data on midwives' perspectives of nitrous oxide use in perinatal care, highlighting the integral role midwifery support plays in effective nitrous oxide administration. Midwives display expertise in nitrous oxide pharmacodynamics, use and utility within the perinatal setting, citing usefulness in recognition of its analgesic and anxiolytic properties and role in the provision of quality maternity care. Our findings provide important benchmarking evidence on the depth of midwifery knowledge and skill in nitrous oxide administration and use across labour and procedural care. [ABSTRACT FROM AUTHOR]

Oxytocin has been a hormone of interest in understanding both depression and parenting. Here, the role of oxytocin has been explored in understanding the interaction between perinatal depression, history of trauma and subsequent longer-term child socio-emotional outcomes. Data were obtained from 203 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a pregnancy cohort study with data collected across pregnancy, postpartum and until 4 years for mother and child. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) together with the Childhood Trauma Questionnaire to measure maternal trauma history. Maternal oxytocin levels were measured by enzyme immunoassay following extraction at four time points across pregnancy and the postpartum. The offspring consisted of 203 children followed up from birth until 4 years of age when they were assessed for DSM 5 depression and anxiety disorders (emotional disorders) using the Preschool Age Psychiatric Assessment. Maternal oxytocin levels increased over pregnancy and the postpartum in both control and depressed women with no difference between groups. Maternal childhood trauma and antenatal antidepressant use was also not associated with maternal oxytocin levels. Lower gestational age, maternal depression and early childhood trauma, and late pregnancy oxytocin concentrations were associated with later childhood emotional disorders; together they predicted 10% of variance for emotional disorders. Oxytocin is a hormone whose role in understanding intergenerational risk from pregnancy to child emotional disorders is dependent on relational context. Future research can expand on understanding these important early predictors of childhood mental health. [ABSTRACT FROM AUTHOR]

An understanding of the anatomy of the orbit is essential for performing regional anaesthesia for ophthalmic surgery. This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles. [ABSTRACT FROM AUTHOR]

Access to maternity care changed during the Covid-19 pandemic, the impact of lock downs, and transitioning to virtual maternity health care have had unexpected consequences. We analysed global survey data with an aim to understand how changes to health care during the COVID-19 Pandemic were experienced by pregnant women internationally. A global cross-sectional survey served from April 2020 to Oct 2022. Using multinomial and binary logistic regression models, we present associations (odds ratios) between several self-report measures of health care service changes and women's engagement with services with country income (low, lower-middle and upper-middle compared to high). OR's were adjusted for Universal Health Care Service Coverage Index (SCI) and maternal education, parity, gestation, and perceived pregnancy risk. Survey respondents were 2,651 women from 147 countries. Compared to women from high income countries, women in low and low-middle income countries had higher odds of reporting the following: their in-person visits had reduced; they were not allowed to keep in-person appointments; that some services had become obsolete; and, they had both delayed and avoided accessing health care services. Interestingly, higher SCI across country income groups was associated with significantly higher odds of reporting that in-person visits had reduced compared to remaining the same. Stopping or changing access to maternity services can result in women delaying or avoiding accessing maternity health care services. Unintended consequences of this kind of avoidance could include increased risk of outcomes that can be detected during in person visits but more difficult to detect if the pregnancy is not monitored in person such as Fetal Growth restriction. When planning for any future disruption to maternity care provision by wide-scale health events, the impact of women delaying or avoiding care should be balanced against risks and benefits associated with strategies such as 'lock-downs'. [ABSTRACT FROM AUTHOR]

This longitudinal study examines the association between fetal Selective Serotonergic Reuptake Inhibitor antidepressant exposure and infant sleep behaviours at six and 12 months of age and focus on three of the most commonly prescribed antidepressants in pregnancy. This study utilises data on 698 women recruited at less than 20 weeks of pregnancy and are followed up at six and 12 months postpartum. Women were recruited into one of three groups: those taking either sertraline, citalopram or escitalopram antidepressants in pregnancy (n = 85); women with a depressive disorder who were not taking antidepressants (non-medicated depressed, NMD ; n = 82); and, and a control group of women (n = 531). At six and 12 months, data were collected on breastfeeding and sleep location and infant sleep was measured using the Brief Infant Sleep Questionnaire. Antidepressants sertraline, escitalopram and citalopram were not associated with increased infant waking or time awake. However, sertraline was associated with longer time for an infant to go to sleep. This study provides reassurance that SSRI antidepressants and, in particular, sertraline, escitalopram and citalopram are not associated with infant sleep behaviours that are commonly regarded as problematic including night waking. Further replication of these findings, including with direct measures of infant sleep, are recommended. • Infant sleep development begins in utero and continues over the first year of life. • There is increasing rates of antidepressant use in pregnancy. • Sertraline, citalopram and escitalopram are not associated with increased infant waking or time awake overnight. • Sertraline was associated with longer time to go to sleep at 6 and 12 months postpartum. • Infants exposed to antidepressants were more likely to share a sleep surface at 6 months of age. [ABSTRACT FROM AUTHOR]

Objective: Since the potential mental health benefits of exercise during pregnancy remain unclear, this study examined longitudinally the bidirectional relationship between exercise and maternal mental health symptoms during the perinatal period, and included adjustment for both depression and antidepressant treatment.Methods: Data were collected across pregnancy (first and third trimesters) and the postpartum (six and 12 months) for 258 women drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). The women were assessed for depression using the EPDS, anxiety using the STAI and a clinical diagnostic interview (SCID-IV), and self-reported use of antidepressants. Exercise was measured using self-reported weekly frequency of 30-min bouts of moderate to vigorous exercise, and data were analyzed using parallel process growth curve modelling.Results: On average, women's weekly exercise frequency declined during pregnancy, returning to first trimester levels by 12 months postpartum. Women with depression and taking antidepressants reported lower first trimester exercise compared to control women. However, where non-medicated depressed women remained lower and continued to decline to 12 months, women taking antidepressants reported increasing levels of exercise during the perinatal period. Notably, a steeper decline in exercise frequency during the perinatal period was associated with a faster rate of increase in depressive and anxiety symptoms.Conclusions: This study is the first to examine the longitudinal interaction between exercise and mental health symptoms across the perinatal period. These preliminary findings demonstrate potential benefits for depressive and anxious symptoms when maintaining levels of early-pregnancy exercise throughout pregnancy and the postpartum. [ABSTRACT FROM AUTHOR]

This review analyzes various algal biofilm reactors used for integrated wastewater treatment and biofuel production to overcome the current challenges for algal biofuel production. Various reactor configurations, support materials and operation strategies of algal biofilm reactors are discussed and compared with conventional suspended culture systems in terms of algal biomass productivity, nutrient removal, biomass harvest and biofuel production. The rotating biofilm reactor among various types of biofilm reactors was found to be a promising option to provide high biomass productivity and efficient utilization of nutrients in wastewater. Some materials such as stainless steel, nylon and natural fibers among various materials were found to be highly effective for supporting microalgal biofilm. To date mainly municipal wastewater has been integrated with algal bioreactors while only a few agricultural wastewater have been used for algal bioreactors due to inhibition of algal growth with high ammonium concentrations in animal manure and poor light delivery with high turbidity of animal manure. Overall, the algal biofilm reactors integrated with wastewater would have great potential for high productivity of algal biomass and efficient wastewater treatment if various conditions are optimized. [ABSTRACT FROM AUTHOR]

A glucose-based auto-inducible medium (glucose-AIM) has been developed to enhance both growth and expression of lac operon-linked carbonic anhydrase (CA) expression in a recombinant strain of Escherichia coli . When the E. coli expressing CA was grown on various media, the glucose-based auto-inducible medium (glucose AIM) resulted in a CA activity of 1022 mU OD 600 nm − 1 mL − 1 at 24 h and a specific growth rate of 0.082 h − 1 . The CA activity was four to fourteen times higher than those by LB-IPTG. The E. coli expressing CA grown on the glucose-AIM showed highest activity at pH 8.5 while it kept high stability up to 40 °C and an inlet CO 2 concentration of 6%. These findings indicate that the glucose-AIM would be a cost-effective medium to support high cell growth, CA activity and stability for effective CO 2 capture. [ABSTRACT FROM AUTHOR]

In examining maternal depression, placental 11β-HSD2 mRNA expression and offspring cortisol regulation as a potential fetal programming pathway in relation to later child emotional disorders, it has become clear that sex differences may be important to consider. This study reports on data obtained from 209 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) recruited before 20 weeks of pregnancy. Maternal depressive disorders were diagnosed using the SCID-IV and maternal childhood trauma using the Childhood Trauma Questionnaire. Placental 11β-HSD2 mRNA was measured using qRT-PCR. For assessment of stress-induced cortisol reactivity, salivary cortisol samples were taken at 12 months of age. At 4 years of age, measurement of Childhood Emotional Disorders (depression and anxiety) was based on maternal report using the Preschool Age Psychiatric Assessment (PAPA) and internalizing symptoms using the Child Behavior Checklist (CBCL). Maternal depression in pregnancy and postpartum, and infant cortisol reactivity, was associated with internalizing symptoms for females only. For female offspring only, increased 12-month cortisol reactivity was also associated with increased emotional disorders at 4 years of age; however, there was no association with placental 11β-HSD2 mRNA expression. In females only, the combination of lower placental 11β-HSD2 mRNA expression and higher cortisol reactivity at 12 months of age predicted increased internalising problems. These findings suggest there may be sex differences in prenatal predictors and pathways for early childhood depression and anxiety symptoms and disorder. • There is increasing evidence for sex difference in early life predictors of affective disorders. • Placental 11β-HSD2 and cortisol reactivity are part of a potential programming pathway for emotional disorders in girls. • Stress-induced infant cortisol reactivity was associated with emotional disorder of 4 years old girls only. • Internalizing problems in girls was predicted by placental 11β-HSD2 mRNA expression and infant cortisol reactivity. [ABSTRACT FROM AUTHOR]

Background: Deficits in neuropsychological performance are found in patients with bipolar disorder and represent a potential treatment target for novel therapeutic strategies. We have previously demonstrated a beneficial effect on spatial working memory (SWM) of treatment for 1 week with the progesterone and glucocorticoid receptor antagonist mifepristone, evident 2 weeks after the cessation of treatment. Methods: We examined the longer-term efficacy of 600 mg/day of mifepristone as an adjunctive treatment, for 1 week, in a placebo-controlled, randomized, double-blind trial in 60 patients with bipolar depression, with SWM as the primary outcome measure. A comparator group of healthy control subjects was also recruited. Results: At baseline, neuropsychological performance of patients was impaired, but hypothalamic-pituitary-adrenal axis function did not differ from that of control subjects. Mifepristone treatment was associated with a time-limited increase in cortisol awakening response and with a sustained improvement in SWM performance, which was evident 7 weeks after the cessation of treatment. The magnitude of this neuropsychological response was predicted by the magnitude of the cortisol response to mifepristone. The response occurred in the absence of a significant improvement in depressed mood. Conclusions: These data accord with the findings of animal studies and demonstrate that brief treatment with mifepristone is associated with a sustained improvement in SWM, an effect that might be mediated by a persistent enhancement in hippocampal mineralocorticoid receptor function. [ABSTRACT FROM AUTHOR]

Abstract: Our understanding of the neurobiology of mood disorders is advancing rapidly. Despite the initial enthusiasm for the monoamine theory of depression, it has been unable to explain the complex actions of antidepressant drugs or to provide a comprehensive explanation of the pathophysiology of the manifold biological, cognitive, and psychological symptoms of mood disorders. In recent years, attention has turned to models of mood disorders that focus on adaptations to stress. Considerable experimental and clinical evidence supports a role for hypothalamic–pituitary–adrenal (HPA) axis dysfunction in the pathogenesis of major depression and bipolar disorders. [Copyright &y& Elsevier]

Abstract: Recent pre-clinical and clinical studies have examined the potential use of anti-glucocorticoid drug augmentation – including glucocorticoid receptor (GR) antagonists – as a method of improving treatment response in severe psychiatric illness. However, the direct and persistent effects such drugs exert on the hypothalamic–pituitary–adrenal (HPA) axis are unclear. We examined afternoon cortisol levels in 39 patients (19 with bipolar disorder, 20 with schizophrenia) at baseline, following treatment with mifepristone (600mg/day for 7 days) or placebo and at +21 days. Following treatment with mifepristone (day +7) there was a significant increase in cortisol levels from baseline (mean change=60,434nmol/L×min, 95%CI=44,755–76,112; t =7.803, df=38, p <0.0001) which significantly decreased from this point by day +21 (mean change=−64,487nmol/L×min, 95%CI=−49,974 to −79,001; t =8.995, df=38, p <0.0001). Cortisol levels at day +21 were significantly lower than they were at baseline (mean change=−4054nmol/L×min, 95%CI=−456 to −7652; t =2.281, df=38, p =0.028). No significant changes occurred following placebo. These results provide preliminary evidence that subtle but significant reductions in HPA axis activity (measured by peripheral cortisol levels) are evident 14 days after cessation of treatment with the GR-antagonist mifepristone. This may in part underlie the putative therapeutic effects of such drugs. [Copyright &y& Elsevier]

Summary: The impact of lithium on arginine vasopressin (AVP) release has implications for our understanding of the pathophysiology and treatment of mood disorders and for the interpretation of neuroendocrine studies. In this secondary analysis of neuroendocrine, data from 23 patients with chronic major depressive disorder, 41 patients with bipolar disorder and 18 healthy controls, we examine the relationship between lithium therapy, AVP levels and the cortisol response to the dexamethasone/corticotropin-releasing hormone (dex/CRH) test. These data demonstrate that patients taking lithium have elevated post-dexamethasone AVP levels compared to both healthy controls and patients not on lithium. [Copyright &y& Elsevier]

Summary: The dexamethasone suppression test (DST), frequently abnormal in mood disorder patients, is considered to measure glucocorticoid receptor-mediated negative feedback. We examined the hypothesis that the, apparently more sensitive, dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test unveils subtle hypothalamic–pituitary–adrenal axis disturbance not detected by the DST in 82 patients with mood disorders and 28 controls. There was a close correlation between the cortisol responses on the two tests (r s=0.73, p<0.0005). However, ROC analysis revealed that the dex/CRH test had better diagnostic performance than the DST (p=0.031). The sensitivity of delta cortisol (from the dex/CRH) was 61.9% and the specificity 71.4%. The sensitivity of 1500h cortisol (the DST) was 66.6% and the specificity was 47.6%. This suggests that the two tests measure common pathology but that the dex/CRH test has better diagnostic utility. [Copyright &y& Elsevier]

Abstract: There appears to be an allostatic shift in the hypothalamic-pituitary-adrenal (HPA) axis of animals exposed to chronic stress, such that vasopressinergic regulation of the HPA axis becomes critical for sustaining corticotroph responsiveness in the presence of high circulating glucocorticoid levels. It has been hypothesised that this is also a feature of patients with mood disorders and is mediated by a shift in hypothalamic drive in favour of arginine vasopressin (AVP) rather than corticotrophin releasing hormone (CRH), by up-regulation of AVP receptors in the pituitary and by a relatively reduced impact of glucocorticoid induced negative feedback on AVP release. We examined the latter, by comparing AVP levels after pretreatment with the glucocorticoid, dexamethasone in 41 bipolar patients (21 of whom were in full remission), 23 patients with chronic major depressive disorder and 21 healthy controls. We found that, as hypothesised, post-dexamethasone AVP levels were significantly elevated in patients with bipolar disorder and chronic depression compared with controls and also that there was no difference between symptomatic and remitted bipolar patients. The data shows that post-dexamethasone AVP levels are a sensitive measure of HPA axis function, that HPA axis dysfunction persists into euthymia in bipolar disorder and that, in contrast to previous reports, patients with chronic depression have a dysfunctional HPA axis. [Copyright &y& Elsevier]

Abstract: Mood disorders rank among the leading causes of disability worldwide, and are characterized by biological, emotional, psychological and cognitive symptoms. The monoamine hypothesis of depression fails to provide a comprehensive theory to account for this complex symptomatology, or the therapeutic action of drugs currently available for the treatment of mood disorders. Alternative theories have focused on the function of the hypothalamic–pituitary–adrenal (HPA) axis, and particularly on the deleterious effects of hypercortisolemia on mood, cognition and neuronal architecture. This article reviews the evidence suggesting that HPA axis dysfunction and maladaptive responses to stress may have a central role in the pathophysiology of mood disorders. Recent novel therapeutic strategies that target the HPA axis are also discussed. [Copyright &y& Elsevier]

Background: It has been suggested that hypercortisolemia may cause or exacerbate both neurocognitive impairment and symptoms in schizophrenia. We hypothesized that antiglucocorticoid treatments, particularly glucocorticoid receptor (GR) antagonists, would improve neurocognitive functioning and clinical symptoms in this disorder. Method: Twenty patients with schizophrenia were treated with 600 mg/day of the GR-antagonist mifepristone (RU-486) or placebo for 1 week in a double-blind, crossover design. Neurocognitive function was evaluated at baseline and 2 weeks after each treatment. Neuroendocrine profiling was performed at these times and also immediately after each treatment. Symptoms were evaluated weekly. Results: Mifepristone administration resulted in a temporary two- to threefold increase in plasma cortisol levels (p < .0001). No significant effects were observed on any measure of neurocognitive function, including the primary outcome measures of spatial working memory and declarative memory. Minor changes in symptoms occurred in both arms of the study and were indicative of a general improvement over time, irrespective of treatment. Conclusions: In contrast to our earlier report of positive effects in bipolar disorder, these data suggest that the GR-antagonist mifepristone has no effect on neurocognitive function or symptoms in this group of patients with schizophrenia. Future studies in schizophrenia should examine patients with demonstrable hypothalmic-pituitary-adrenal axis dysfunction. [Copyright &y& Elsevier]

Antidepressant treatment of perinatal depression is increasingly common and accepted in clinical guidelines. It has been suggested that serotonergic antidepressants may effect changes in the oxytocinergic system, including oxytocin levels, and that this may be one of the beneficial mechanisms of action for these drugs. Furthermore, oxytocin has been associated with the quality of the parent-child relationship, which may be important in treatment of perinatal depression. This study will explore if there is a relationship between antidepressant use over the perinatal period and oxytocin levels. Data from a pregnancy cohort study are used from 279 women across three groups: women taking antidepressants in pregnancy (n = 48), women with untreated depression (n = 31) and healthy control women (n = 200). Data included antidepressant use, maternal depression and oxytocin plasma concentrations in pregnancy and up to 12 months postpartum. We found that concurrent oxytocin blood concentrations were not associated with perinatal antidepressant use. However, oxytocin blood concentrations increased more steeply in those on antidepressants across the perinatal period compared to control women. A steeper increase for Selective Serotonergic Reuptake Inhibitors was observed, however, this effect was on the boarder of statistical significance. In conclusion, although antidepressant use and oxytocin was not associated at any time point, women taking antidepressants during pregnancy had larger increases in oxytocin over the perinatal period. Future research could examine specific agents and class of antidepressant and the relationship to parenting. • Animal studies have suggested that SSRI antidepressants may be associated with increased oxytocin levels • Oxytocin levels increased for women from early pregnancy to 12 months postpartum • Differences in cross-sectional perinatal oxytocin blood concentrations were not associated with antidepressant use • Antidepressant blood concentrations and oxytocin blood concentrations were not associated • Antidepressants across pregnancy and the postpartum were assocaited with a steeper increase in levels of oxytocin [ABSTRACT FROM AUTHOR]

Placental 11β-HSD2 has been a focus of research for understanding potential fetal programming associated with maternal emotional disorders. This study examined the pathway from antenatal mental health via placental 11β-HSD2 mRNA to cortisol regulation in the infant offspring. This study reports on data obtained from 236 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). At term, placental tissue was collected within 30 min of birth from 52 participants meeting current criteria for a depressive disorder, and 184 control participants. Depressive disorders were diagnosed using the SCID-IV. In addition, antidepressant use, depressive and anxiety symptoms were measured in early and late pregnancy. Placental 11β-HSD2 mRNA expression was measured using qRT-PCR. Infant salivary cortisol samples were taken at 12 months of age. Women on antidepressant medication and with higher trait anxiety had higher placental 11β-HSD2 expression compared to women not taking medication. Furthermore, the offspring of women taking an antidepressant and who also had a current depressive disorder and high trait anxiety had high cortisol reactivity at 12 months of age and this was mediated through 11β-HSD2 mRNA expression. In contrast, offspring of women not taking antidepressant medication with depressive disorder and high anxiety there was low cortisol reactivity observed. Our findings suggest that the relationship between maternal antenatal depression and anxiety and infant cortisol reactivity is mediated through placental 11β-HSD2 mRNA expression. Furthermore, the direction differed for women taking antidepressants, where infant cortisol reactivity was high whereas when compared to those with unmedicated depression and anxiety, where infant cortisol reactivity was low. • There has been substantial research understanding placental role in fetal programming pathways for maternal mental health. • Placental 11β-HSD2 has one area of focus given the role in cortisol regulation across the placenta. • Placental 11β-HSD2 mRNA expression in this study was found to be lower in those with depression and anxiety. • This study also found that antidepressant use increased placental 11β-HSD2 mRNA expression. • Infant cortisol reactivity was mediated through 11β-HSD2 mRNA expression and this differed by mental health and antidepressants use. [ABSTRACT FROM AUTHOR]

Summary: Neonatal limb ischaemia (NLI) is a rare but potentially catastrophic condition. Although medical therapy remains as first-line treatment, surgery has an important role when limb-threatening events are present. In this paper we outline the milking technique for open thrombectomy used by the senior author in the treatment of 5 NLI cases. We also present the use of Integra and it's specific benefits in the management of wounds in these challenging situations. Skin grafts over the Integra can be avoided by staged excision of the silicone layer from the margins. We believe this is a novel approach to the use of Integra. [Copyright &y& Elsevier]

• Maternal depression is associated with lower infant cortisol reactivity. • Early pregnancy depression is associated with reduced placental NR3C2 DNA methylation. • No association of maternal depression and cortisol with placental or infant buccal NR3C1 DNA methylation. • No association of antidepressant use with cortisol and placental or infant buccal NR3C1 and NR3C2 DNA methylation. • Association between infant cortisol reactivity and maternal depression was suppressed by placental NR3C2 DNA methylation. Understanding fetal programming pathways that underpin the relationship between maternal and offspring mental health necessitates an exploration of potential role of epigenetic variation in early development. Two genes involved in stress response regulation, the glucocorticoid and mineralocorticoid receptors (NR3C1 and NR3C2) have been a focus in understanding stressful exposures and mental health outcomes. Data were obtained from 236 pregnant women from the Mercy Pregnancy Emotional Wellbeing Study (MPEWS), a selected pregnancy cohort, recruited in early pregnancy. Depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) and repeated measures of the Edinburgh Postnatal Depression Scale (EPDS). Antidepressant use, stressful events and anxiety symptoms were measured. NR3C1 and NR3C2 DNA methylation was measured in placental and infant buccal samples. Infant cortisol was measured in repeat saliva samples across a task. This study found maternal early pregnancy depressive disorder and symptoms were associated with lower DNA methylation at NR3C2 CpG_24 in placental tissue. There were no significant differences for depression or antidepressant use for DNA methylation of NR3C1. Antenatal depression was associated with lower infant cortisol reactivity at 12 months. DNA methylation in CpG_24 site in NR3C2 in placental samples suppressed the relationship between early maternal depressive symptoms and infant cortisol reactivity. These findings show a relationship between antenatal depression, NR3C2 DNA methylation and infant cortisol response providing support for a specific fetal programming pathway. Further research is required to examine the stability of this epigenetic mark across childhood and long-term mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression.Methods: 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models.Results: There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability.Limitations: Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings.Conclusion: Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability. [ABSTRACT FROM AUTHOR]