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Persistent fetal occiput posterior (OP) position is a topic of interest with implications for intrapartum management. Although studies report a low incidence of persistent OP position, anecdotal evidence suggests an increase in prevalence given changes in maternal demographics. Clinicians are often familiar with interventions such as position changes and the use of props and a rebozo to address persistent OP position in early labor; however, midwives remain uncomfortable with the techniques of digital and manual rotation. This article reviews current evidence and recommendations for the management of persistent OP position in the second stage of labor. Further research is needed to guide clinicians on the optimal timing and techniques for digital and manual rotation.Since December 2019, coronavirus disease 2019 (COVID‐19) has spread worldwide to become a pandemic. Multiple skin manifestations related to the infection have been described progressively. Recalcati1 asserted that 20.4% of infected patients developed cutaneous manifestations and Galván‐Casas et al2 have recently proposed 5 clinical patterns (pseudo‐chilblain, vesicular, urticarial, maculopapular and livedo/necrosis). We report a case of COVID‐19 with retiform purpura and its histopathological correlation.Objective To investigate whether the use of intrauterine vs. external tocodynamometry (IT vs. ET) during labour reduces operative deliveries and improves newborn outcome. As IT provides more accurate information on labour contractions, the hypothesis was that it may more appropriately guide oxytocin use than ET. Design Randomised controlled trial. Setting Two labour wards, in a university tertiary hospital and a central hospital. Population 1504 parturients with singleton pregnancies, gestational age ≥ 37 weeks and fetus in cephalic position 269 women with uterine scars, 889 nulliparas and 346 parous women with oxytocin augmentation. Methods Participants underwent IT (n=736) or ET (n=768) during the active first stage of labour. Main outcome measures Primary outcome rate of operative deliveries. Secondary outcomes duration of labour, amount of oxytocin given, adverse neonatal outcomes. Results Operative delivery rates were 26.9% (IT) and 25.9% (ET) (OR 1.05, 95% CI 0.84-1.32, P=0.663). The ET to IT conversion rate was 31%. We found no differences in secondary outcomes (IT vs. ET). IT reduced oxytocin use during labours with signs of fetal distress, and TOLAC. Conclusions IT did not reduce the rate of operative deliveries, use of oxytocin, or adverse neonatal outcomes, and it did not shorten labour duration.Objective To describe a postcaruncular approach for transorbital endoscopy as an alternative, minimally invasive technique to access the orbital apex. Irbinitinib cost Study design Ex vivo and prospective clinical case report. Animals A 12-year-old male castrated cocker spaniel and three cadaver heads (one large breed dolichocephalic, one medium-sized breed mesocephalic, and one small breed brachycephalic). Methods Transorbital endoscopy was performed to obtain biopsies of an orbital apex mass by using a postcaruncular approach. A 2.7-mm 30° rigid endoscope fitted with a cystoscope working sheath was used with the aid of a blunt suction-dissector and fluid ingress. This procedure was first performed on three cadavers to assess feasibility and later performed in a clinical case. Results By using a transorbital postcaruncular approach, it was possible to visualize and obtain biopsies from structures within the orbital apex with minimal perioperative morbidity. Dissection and expansion of the working space was facilitated with the aid of fluid ingress; however, judicious use of fluids is recommended because secondary orbital edema and chemosis can occur. Conclusion Transorbital endoscopy via a postcaruncular approach is feasible. Clinical significance This technique should be considered in cases in which a histological diagnosis is required prior to definitive treatment as a method to obtain biopsy samples of the orbital apex region without major surgical dissection.Background Identifying individuals at risk of developing Parkinson's disease (PD) is critical to define target populations for future neuroprotective trials. Objective The objective of this study was to apply the PREDICT-PD algorithm of risk indicators for PD in a prospective community-based study (the Bruneck study), representative of the general elderly population. Methods PREDICT-PD risk scores were calculated based on risk factor assessments obtained at baseline (2005, n = 574 participants). Cases of incident PD were identified at 5-year and 10-year follow-ups. link2 Participants with PD or secondary parkinsonism at baseline were excluded (n = 35). We analyzed the association of log-transformed risk scores with the presence of well-established markers as surrogates for PD risk at baseline and with incident PD at follow-up. Results A total of 20 participants with incident PD were identified during follow-up (11 after 5 years and 9 after 10 years). Baseline PREDICT-PD risk scores were associated with incident PD with odds ratios of 2.09 (95% confidence interval, 1.35-3.25; P = 0.001) after 5 years and of 1.95 (1.36-2.79; P less then 0.001) after 10 years of follow-up per doubling of risk scores. In addition, higher PREDICT-PD scores were significantly correlated with established PD risk markers (olfactory dysfunction, signs of rapid eye movement sleep behavior disorder and motor deficits) and significantly associated with higher probability for prodromal PD according to the Movement Disorder Society research criteria at baseline. Conclusions The PREDICT-PD score was associated with an increased risk for incident PD in our sample and may represent a useful first screening step in future algorithms aiming to identify cases of prodromal PD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.Palladium complexes of corrole and sapphyrin were prepared in high yield and fully characterized. The corrole provides a tetradentate/trianionic square planar coordination sphere for Pd(II), charge balanced by pyridinium. Both one and two Pd(II) ions may be accommodated by the pentapyrrolic skeleton of the sapphyrin and in each case the macrocycle acts as bidentate/monoanionic ligand and the inner-sphere square planar geometry is completed by allyl anions coordinated in an eta-3 fashion. NMR spectroscopy and X-ray crystallography data analysis uncovered the presence of interesting stereoisomers due to the flexibility of the ally ligands and also the pyrrole ring(s) that is/are not involved in metal binding.Background There are several bioengineering solutions aimed at improving human health and welfare. Smart electrodes based on textile substrates have met the growing demand for comfort, reliability, and robustness when acquiring physiological signals. Objectives Given the importance of good quality electrocardiograms (ECG) in equine sports medicine, this study focuses on the validation of smart textile electrodes to acquire ECG signals in horses during treadmill exercise. Study design The performance of the smart textile electrodes is compared with standard silver/silver chloride (Ag/AgCl) electrodes in terms of signal quality. Methods Five healthy Standardbred mares were fitted with two identical electronic systems for the simultaneous recording of ECGs during a Standardised Exercise Test (SET) on a treadmill. One system was equipped with smart textile electrodes, whereas the second was equipped with standard Ag/AgCl electrodes. The Ag/AgCl electrodes were positioned on shaved skin with self-adhesive pads, and without (SET1) or with glue (SET2). The textile electrodes were positioned without shaving the skin. The Kurtosis (k) value for each ECG trace recorded was calculated as an index of ECG signal quality. Results For the textile electrodes, k values were higher, and closer to ideal compared to Ag/AgCl electrodes. The median values of the Signal Quality Indexes (kSQI) were higher for textile compared to Ag/AgCl electrodes. These differences were significant in SET 2 (p less then 0.001), but not in SET 1 (p = 0.08). Main limitations This study was limited to treadmill exercise that did not include a rider or harness. Conclusions During treadmill exercise, textile electrodes are a practical solution for collecting good quality ECG traces.Aim To assess the Canadian Occupational Performance Measure's (COPM) ability to document change over 3 years in children with cerebral palsy (CP). Method This was a prospective study with ambulatory children with CP, aged 2 to 6 years. Caregivers set one to three COPM goals which were rescored annually over 3 years. A ceiling effect for performance goals was operationalized as a score of 8. A Wald χ2 generalized estimating equations model adjusted for age, sex, and Gross Motor Function Classification System (GMFCS) level, evaluated change over time. Results In total, 124 children (47 [37.9%] females, 77 [62.1%] males; mean age 3y 11mo [SD 1y 1mo]; GMFCS level I [n=78, 62.9%], II [n=21, 16.9%], and III [n=25, 20.2%]) were set 345 COPM goals at baseline. By Year 3, 106 participants (85.5%) rescored 287 of the goals (83.2%). Performance scores increased between baseline mean (SD) 2.93 (0.56), Year 1 5.98 (0.58) with 34.8% at ceiling; Year 2 6.74 (0.60) 48.3% at ceiling; and Year 3 7.37 (0.60) 59.6% at ceiling (Wald χ2 [3]=607.18, p less then 0.001). Satisfaction scores increased between baseline 4.42 (0.59), Year 1 6.82 (0.60) with 48% at ceiling; Year 2 7.53 (0.60) with 62.2% at ceiling (Wald χ2 [3]=208.48, p less then 0.001); with no significant increase by Year 3 7.82 (0.62) with 66.9% at ceiling. Interpretation COPM performance scores increased steadily over 3 years. link3 By Year 2, a ceiling effect was seen in about half of the goals. The COPM may have utility to measure change over 3 years; periodic resetting of the descriptors of goal success are required to minimize ceiling.Inflammation and oxidative stress play a key role in mediating the pathophysiology of hypoxic-ischemic (HI) brain injury. Nrf2 is a transcriptional factor that contributes to the innate defense of the body against oxidative stress and inflammation. The current study investigated the effect of Nrf2 in neonatal HI brain injury using Nrf2-/- mice. Nrf2-/- and wild-type Nrf2+/+ mice on a C57BL/6J background at postnatal day 9 underwent unilateral common carotid artery ligation, followed by hypoxia. Brain damage was determined by infarct size measurement. Apoptosis was evaluated by measuring the expression of Bax and Bcl-2. The levels of inflammatory cytokines and mediators involved in oxidative stress were measured. Nrf2 knockout exacerbated HI injury-induced brain infarct and cell apoptosis in the brain. Nrf2-/- mice showed increased inflammatory cytokines and MDA, and reduced activities of antioxidant enzymes including CAT, GSH-Px and SOD. Nrf2-/- mice showed reduced HO-1 expression after HI injury compared with wildtype mice. This study supported a protective effect of Nrf2 in neonatal HI brain injury.Purpose Multi-echo gradient-recalled echo acquisitions for QSM enable optimizing the SNR for several tissue types through multi-echo (TE) combination or investigating temporal variations in the susceptibility (potentially reflecting tissue microstructure) by calculating one QSM image at each TE (TE-dependent QSM). In contrast with multi-echo QSM, applying Laplacian-based methods (LBMs) for phase unwrapping and background field removal to single TEs could introduce nonlinear temporal variations (independent of tissue microstructure) into the measured susceptibility. Here, we aimed to compare the effect of LBMs on the QSM susceptibilities in TE-dependent versus multi-echo QSM. Methods TE-dependent recalled echo data simulated in a numerical head phantom and gradient-recalled echo images acquired at 3 T in 10 healthy volunteers. Several QSM pipelines were tested, including four distinct LBMs sophisticated harmonic artifact reduction for phase data (SHARP), variable-radius sophisticated harmonic artifact reduction for phase data (V-SHARP), Laplacian boundary value background field removal (LBV), and one-step total generalized variation (TGV).