Emotions in labour: Italian obstetricians' experiences of presence during childbirth.

OBJECTIVE: The present study represents a qualitative research aimed to explore the obstetricians' psychological experiences of birth. BACKGROUND: During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman's and midwife's points of view. The obstetricians' psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed. METHODS: Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted. FINDINGS: The results were divided into three different core themes: obstetricians' approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians' feelings and emotions in the delivery room. Each theme was subdivided into different subthemes. CONCLUSION: The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians' training and work.

Effect of mechanical extraction parameters on the yield and quality of tobacco (Nicotiana tabacum L.) seed oil.

The aim of this study was to investigate how the combination of extraction parameters, such as extraction temperature seeds preheating and screw rotation speed, influenced the yield and chemical quality of tobacco seed oil (TSO). For its peculiar properties, TSO can be used for several purposes, as raw material in the manufacturing of soap, paints, resins, lubricants, biofuels and also as edible oil. TSO was obtained using a mechanical screw press and the quality of the oil was evaluated by monitoring the free fatty acids (FFA), the peroxide value (PV), the spectroscopic indices K232, K270 and ΔK and the fatty acid composition. The maximum extraction yield, expressed as percent of oil mechanically extracted respect to the oil content in the seeds, determined by solvent extraction, was obtained with the combination of the highest extraction temperature, the slowest screw rotation speed and seeds preheating. Under these conditions yield was 80.28 ± 0.33% (w/w), 25% higher than the lowest yield obtained among investigated conditions. The extraction temperature and seed preheating showed a significant effect on FFA, on spectroscopic indices K232, K270 and ΔK values. The average values of these parameters slightly increased rising the temperature and in presence of preheating, the screw rotation speed did not affect the chemical characteristic tested. In the extraction conditions investigated no significant changes in PV and fatty acids composition of oil were observed.

Method of using increasing levels of substitution of the basal diet by test feedstuffs in pig digestibility trials / Metodologia de uso de níveis crescentes de substituição da ração referência pelo alimento teste em ensaios de digestibilidade com suínos

Two experiments were carried out to study the methodology of using increasing levels of substitution of the basal diet with fibrous test feedstuffs (sticky coffee hull - SCH) in digestibility trials with pigs. In Experiment 1, a digestibility trial was conducted using 30 crossbred barrows, allotted in a randomized block design. In Experiment 2, 42 growing and 42 finishing pigs were used, allotted in a completely randomized design, with six diets and seven replicates, with one animal per experimental unit. The six diets consisted of: a control diet, four diets using SCH ME values as obtained in Experiment 1 plus a diet using SCH ME value estimated by linear regression equation for 15% substitution. The digestibility study indicated that the use of increasing levels of substitution (7, 14, 21 and 28%) reduced SCH digestibility. ME values, as-fed basis, were 2,456, 2,377, 2,247 and 1,945kcal/kg. The overall results indicate that higher levels of substitution overestimate the energy value and that the method of increasing levels of substitution of the basal diet with feedstuffs test can be used to more accurately estimate the energy values of fibrous feedstuffs for pigs. For growing and finishing pigs respectively, up to 28% and 15% of sticky coffee hull can be used without impairing pig performance and economic feasibility.

Dois experimentos foram realizados para se estudar a metodologia de uso de porcentagens crescentes de substituição da ração referência pelo alimento teste fibroso (casca de café melosa - CCM), em ensaios de digestibilidade com suínos. No Experimento I, foi realizado um ensaio de digestibilidade utilizando 30 machos castrados, distribuídos em delineamento de blocos ao acaso. No Experimento II, foram utilizados 42 suínos na fase de crescimento e 42 suínos na fase de terminação, distribuídos em delineamento inteiramente ao acaso, com seis rações, sete repetições e um animal por unidade experimental. As seis rações foram: uma ração controle, quatro rações usando os valores de energia metabolizável (EM) da CCM obtidos no Experimento I e uma ração com EM da CCM estimada por equação de regressão linear para 15% de substituição. Os estudos de digestibilidade indicaram que o uso de porcentagens crescentes de substituição - 7, 14, 21 e 28% - reduziu a digestibilidade da CCM. Os valores de EM, na matéria natural, obtidos para a CCM foram 2.456, 2.377, 2.247 e 1.945kcal/kg. Os resultados indicam que porcentagens mais elevadas de substituição superestimam o valor energético e que a crescente substituição da ração referência pelo alimento teste pode ser utilizada para estimar, de forma mais precisa, os valores energéticos de alimentos fibrosos para suínos. Para suínos em crescimento e em terminação, pode-se usar, respectivamente, até 28% e 15% de casca de café melosa sem prejudicar o desempenho e a viabilidade econômica.

Avaliação nutricional de soja integral desativada e desempenho de leitões na fase de creche / Nutritional evaluation of disabled whole soybean and performance of piglets on nurse phase

Dois experimentos foram realizados para determinar o valor nutricional e verificar o desempenho de leitões dos 6 aos 15kg, alimentados com dietas que continham dois tipos de soja integral desativada, caracterizada pela presença (SC) ou não de casca (SS). No ensaio de digestibilidade total, foram utilizados 15 leitões machos, castrados, com média de peso inicial de 7,36±1,71kg, alojados em gaiolas de metabolismo. Exceto para energia bruta (EB), não foram observadas diferenças entre tratamentos nos coeficientes de digestibilidade da matéria seca, da proteína bruta, do extrato etéreo e da matéria orgânica, e no coeficiente de metabolização da EB entre as duas sojas avaliadas. Os teores de energia digestível e energia metabolizável na matéria natural para SC e SS foram: 3.979 e 4.300kcal/kg; 3.768 e 4.111kcal/kg, respectivamente. No experimento de desempenho, foram utilizados 56 leitões, desmamados aos 21 dias de idade, com média de peso inicial de 6,19±0,67kg. Neste experimento, os leitões receberam os dois tipos de soja integral desativada em três porcentagens de inclusão. Não foram observadas diferenças para as variáveis de desempenho com a inclusão da soja desativada às dietas. Concluiu-se que os tipos e as porcentagens de inclusão da soja podem ser utilizados na dieta de leitões.

Two experiments were carried out to determine the nutritional value and to verify the piglets performance from 6 to 15kg, fed diets with two types of disabled whole soybeans characterized by shell presence (CS) or not (SS). In the digestibility assay 15 castrated male piglets were used, with average weight of 7.36±1.71kg, housed in metabolism cages. Except for gross energy (EB), no differences between treatments were observed for the dry matter digestibility, crude protein, ether extract and organic matter, and for the coefficient of metabolism of EB between the two soybeans evaluated. The values of digestible energy (DE), as well the metabolizable energy (ME) on fed basis for SC and SS were: 3,979 and 4,300kcal/kg, 3,768 and 4,111kcal/kg, respectively. In the performance experiment 56 weaned piglets were used, at 21 days of age with initial body weight of 6.19±0.67kg. No differences were observed in the performance variables with the inclusion of SS and SC disabled soybeans in the diets, concluding that the studied soybeans can be used for piglet diets.

Female adnexal tumor of probable wolffian origin: clinicopathological, immunohistochemical and cytofluorimetric analyses of a 22-year-old virgin. case report.

The term female adnexal tumor of probable Wolffian origin "FATWO" designs this tumor wich arises by the rare persisting remnants of the mesonephric duct (Wolffian duct). About 40 cases have been reported in literature. Few cases of recurrence have been reported, FATWO usually shows no signs of hormonal activity. We report a case of the youngest patient affected by FATWO in October 2002. At laparotomy the left adnexa were deformed by a well-capsulated mass, totally removed and sent to the pathologist with a specimen of peritoneal fluid and of the omentum. The histological examination showed a prevalent tubular structure with focal retiform area, without intraluminal mucines. Immunohistochemical findings of the case reported are similar to those described by other authors, except for inhibin which has not been detected by us. The cytofluorimetry showed the low presence of aneuploid cells, with a very low prolifing component (< 1%).

AGUS and ASCUS: different incidence in pre- and postmenopausal women.

PURPOSE OF INVESTIGATION: The aim of this study was to determine the incidence of AGUS (atypical glandular cells of undetermined significance), ASCUS (atypical squamous cells of undetermined significance) and SIL (squamous intraepithelial lesion) in the cytologic diagnosis in pre- and postmenopausal women. METHODS: We did a retrospective study selecting 183 patients who were screened for cervical pathology. Ninety-six patients were in postmenopausal age. We determined the incidence of cytologic abnormalities defined as ASCUS, SIL, and AGUS in pre- and postmenopausal women. RESULTS: We expected a marked incidence of low-grade SILs in the fertile population, while the postmenopausal group was thought to be affected more by AGUS and ASCUS. We obtained different results. In our population study, premenopausal women presented more AGUS and ASCUS; the two subgroups presented the same incidence of low-grade SILs; postmenopausal women were more affected by high-grade SILs. CONCLUSIONS: The significance of the new categories introduced by the Bethesda System is still uncertain for different authors. As we look to the future new markers that more specifically identify individuals at-risk can be expected.

Second-line therapy of advanced ovarian cancer with GnRH analogs.

Ovarian cancer is still the first cause of death among female malignancies. The standard treatment adopted in ovarian cancer is a radical surgical treatment or cytoreduction, followed by six courses of platinum-based chemotherapy; second-line regimens are associated with severe side effects. GnRH analogs could represent an alternative therapeutical approach. The aim of our study was to evaluate the role of GnRH analogs in the management of platinum-resistant ovarian cancers. We enrolled 12 patients affected by advanced ovarian cancer, previously treated with six courses of platinum-paclitaxel. In second-line therapy, we used leuprolide on 1, 8, and 28 days of treatment. CA 125 levels were recorded for each patient. One case of clinical partial response was obtained (8.3%). Stable disease was diagnosed in three patients (25%). Progression was recorded in eight cases (66.7%). Progression-free survival was 6 months. The treatment was well tolerated by patients. The high tolerability and the results obtained with leuprolide versus platinum in second-line therapy might permit a better use of the analogs for advanced ovarian cancer.

Creative thinking in nursing education: preparing for tomorrow's challenges.

The present health care environment requires creative change, a thought that evokes both excitement and apprehension and offers a clear challenge for the contemporary nurse. In this era of capitation, re-engineering, and redesign in the health care system, nursing programs must prepare nurses who can successfully perform in an environment that demands innovative problem solving. Integrating creative problem solving into this BSN program has (1) provided students with information and experience in the creative process, (2) fostered the personal creative development of nurses, (3) challenged students to use creative thinking in solving nursing problems, and most important, (4) further established and reinforced a new, higher level of nursing practice--a level that appropriately sees the nurse as a creative and innovative member of the health care team.

Transport and metabolism of double-labelled CDPcholine in mammalian tissues.

Double-labelled [methyl-14C,5-3H]CDPcholine has been synthesized and subjected to a pharmacokinetic analysis in several biological systems. In transport experiments with intact human erythrocytes no incorporation of radioactivity is observable. On the other hand the results obtained with perfused rat liver suggest a rapid cleavage of the pyrophosphate bridge of the molecule, followed by a rapid uptake of the hydrolytic products. The plasma half-lives of intravenously injected CDPcholine and of its metabolites have been evaluated within 60 sec range. Renal and fecal excretion of the injected radioactivity is negligible: only 2.5% of administered 14C- and 6.5% of the 3H- is excreted up to 48 hr after administration. Liver and kidney are the major CDPcholine metabolizing organs, characterized by a fast and extensive uptake of choline metabolites, followed by a slow release; conversely the rate of uptake of both 3H and 14C-labelled moieties by rat brain is significantly slower, reaching a steady-state level after 10 hr. The characterization of the labelled compounds detectable in the investigated organs provides some insights on the metabolism of the drug: the 3H-cytidine moiety in all the examined organs appears to be incorporated into the nucleic acid fraction via the cytidine nucleotide pool; the [14C]choline moiety of the molecule is in part converted, at the mitochondrial level, into betaine which accounts for about 60% of the total 14C-radioactivity associated with liver and kidney 30 min after administration; [14C]betaine in turn acts as methyl donor to homocysteine yielding [14C]methionine subsequently incorporated into proteins; the time dependent increase in labelled phospholipids is indicative of a recycling of the choline methyl-groups in this lipid fraction via CDPcholine and/or S-adenosylmethionine; the rather extensive amount of labelled methionine detectable in brain probably arises from its uptake from the blood stream, since the enzyme catalyzing the conversion of betaine into methionine is lacking in brain.

Studies on enzyme-substrate interactions of cholinephosphotransferase from rat liver.

In order to elucidate the reaction mechanism and the substrate-binding sites, CDPcholine:1,2-diacylglycerol cholinephosphotransferase (EC 2.7.8.2), prepared from rat liver microsomal fraction, has been subjected to kinetic analysis and substrate specificity studies. Kinetic evidence supports the hypothesis of a Bi-Bi sequential mechanism, involving a direct nucleophilic attack of diacylglycerol on CDPcholine during the reaction. To investigate the substrate requirements for recognition and catalysis, several CDPcholine analogs, modified in the nitrogen base or in the sugar or in the pyrophosphate bridge, have been synthesized, characterized and assayed as substrates and/or inhibitors of the reaction. The amino group on the pyrimidine ring, the 2'-alcoholic function of the ribose moiety as well as the pyrophosphate bridge have been identified as critical sites for enzyme-substrates interactions.