Risk of urinary tract infection following vaginal delivery: a comparison between intermittent and indwelling bladder catheterization.

OBJECTIVES: The primary objective of the study was to determine the risk of postpartum urinary tract infection (UTI) in women exposed to intermittent versus indwelling catheterization in labor. The secondary objective was to identify risk factors for development of postpartum UTI. METHODS: A case-control study was conducted between 1 January 2013 and 31 December 2016. Cases were defined as patients who were diagnosed with UTI and controls were not diagnosed with UTI. Obstetrical, infectious, and catheterization variables were collected. Univariate and multivariate analyses were performed. RESULTS: A total of 26,517 full-term vaginal deliveries occurred during the study period with a rate of postpartum UTI of 0.7%. There were 166 cases and 695 controls included in the analysis. There was no significant difference in the rate of UTI between patients who underwent indwelling versus intermittent (reference) catheterization (OR 1.05, 95% CI: 0.67-1.64, p = .826). On multivariate analysis, significant risk factors for UTI included the relationship between use of catheterization and duration of labor (p = .026) and history of UTI during the pregnancy (p < .001). CONCLUSION: In this study, there was no difference in the rate of postpartum UTI based on catheterization method. Further studies are needed to determine the optimal method of catheterization during labor and to enable providers to implement quality improvement strategies aimed at decreasing the risk of infection.

Fetal myelomeningocele diagnosed in the antenatal period: Maternal-fetal characteristics and their relationship with pregnancy decision-making.

BACKGROUND: Spina bifida is the most common fetal anomaly of the central nervous system, which affects approximately 1:1000 live births in the United States. Myelomeningocele (MMC) is the most common presentation of spina bifida, representing half of these cases. Given the deformation to the spinal cord and the nerve roots, this defect may result in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed MMC. We hypothesized that the level of the defect would correlate with patient's decision to continue the pregnancy. METHODS: A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005-2017. RESULTS: Our data showed 36% of patients with antenatal diagnosis of MMC elected for second trimester terminations versus 64% who chose to continue their pregnancy and deliver either by cesarean section or vaginal delivery. Based on ultrasound findings, there were no significant differences between these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p = 0.036). In addition, the fetal diagnostic methods chosen by patients were significantly different. Those who elected to terminate were more likely to pursue amniocentesis (p = 0.03) and less likely to opt for MRI characterization of the fetus (p = 0.007). CONCLUSION: We conclude, in the setting of fetal MMC diagnosed during pregnancy, patients often rely less on the associated ultrasonographic findings. Personal decisions likely influence the choice of other fetal diagnostic modalities. Other than BMI, we did not see an association between maternal factors and decisions regarding second trimester pregnancy termination.

Mind the gap: mechanisms regulating the endothelial barrier.

The endothelial barrier consists of intercellular contacts localized in the cleft between endothelial cells, which is covered by the glycocalyx in a sievelike manner. Both types of barrier-forming junctions, i.e. the adherens junction (AJ) serving mechanical anchorage and mechanotransduction and the tight junction (TJ) sealing the intercellular space to limit paracellular permeability, are tethered to the actin cytoskeleton. Under resting conditions, the endothelium thereby builds a selective layer controlling the exchange of fluid and solutes with the surrounding tissue. However, in the situation of an inflammatory response such as in anaphylaxis or sepsis intercellular contacts disintegrate in post-capillary venules leading to intercellular gap formation. The resulting oedema can cause shock and multi-organ failure. Therefore, maintenance as well as coordinated opening and closure of interendothelial junctions is tightly regulated. The two principle underlying mechanisms comprise spatiotemporal activity control of the small GTPases Rac1 and RhoA and the balance of the phosphorylation state of AJ proteins. In the resting state, junctional Rac1 and RhoA activity is enhanced by junctional components, actin-binding proteins, cAMP signalling and extracellular cues such as sphingosine-1-phosphate (S1P) and angiopoietin-1 (Ang-1). In addition, phosphorylation of AJ components is prevented by junction-associated phosphatases including vascular endothelial protein tyrosine phosphatase (VE-PTP). In contrast, inflammatory mediators inhibiting cAMP/Rac1 signalling cause strong activation of RhoA and induce AJ phosphorylation finally leading to endocytosis and cleavage of VE-cadherin. This results in dissolution of TJs the outcome of which is endothelial barrier breakdown.

Albumin modulates S1P delivery from red blood cells in perfused microvessels: mechanism of the protein effect.

Removal of plasma proteins from perfusates increases vascular permeability. The common interpretation of the action of albumin is that it forms part of the permeability barrier by electrostatic binding to the endothelial glycocalyx. We tested the alternate hypothesis that removal of perfusate albumin in rat venular microvessels decreased the availability of sphingosine-1-phosphate (S1P), which is normally carried in plasma bound to albumin and lipoproteins and is required to maintain stable baseline endothelial barriers (Am J Physiol Heart Circ Physiol 303: H825-H834, 2012). Red blood cells (RBCs) are a primary source of S1P in the normal circulation. We compared apparent albumin permeability coefficients [solute permeability (Ps)] measured using perfusates containing albumin (10 mg/ml, control) and conditioned by 20-min exposure to rat RBCs with Ps when test perfusates were in RBC-conditioned protein-free Ringer solution. The control perfusate S1P concentration (439 ± 46 nM) was near the normal plasma value at 37 °C and established a stable baseline Ps (0.9 ± 0.4 × 10(-6) cm/s). Ringer solution perfusate contained 52 ± 8 nM S1P and increased Ps more than 10-fold (16.1 ± 3.9 × 10(-6) cm/s). Consistent with albumin-dependent transport of S1P from RBCs, S1P concentrations in RBC-conditioned solutions decreased as albumin concentration, hematocrit, and temperature decreased. Protein-free Ringer solution perfusates that used liposomes instead of RBCs as flow markers failed to maintain normal permeability, reproducing the "albumin effect" in these mammalian microvessels. We conclude that the albumin effect depends on the action of albumin to facilitate the release and transport of S1P from RBCs that normally provide a significant amount of S1P to the endothelium.

The database dbEST correctly predicts gene expression in colon cancer patients.

This study aims to test the predictive power of gene expression data derived from NIH's database dbEST, which collects gene expression results from a large number and variety of DNA array experiments. The motivation of this study is to make comparable experimental studies, which are usually performed only for one or a few tissues or organs, with a wide variety of other tissues. Confirmation of a good predictive power of dbEST would put a number of interesting and partially surprising recent findings, solely based on data mining, on a more solid basis than available so far. The expression of nine genes (eIF4E, DDX6, HAT1, USP28, HSP90(beta, PKM2, PLK1, COX2 and OPN) plus two calibration genes in paired normal and cancer colon tissues of eight individual patients was investigated by quantitative RT-PCR and compared with the predictions made by the data-base. GUS and beta-actin reveal only little variation among different patients, making them good internal calibration standards. In normal colon tissue, data mining correctly predicts the expression of all nine genes, which covers two orders of magnitude. In cancer, dbEST is somewhat less precise, but still valuable for the comparison with clinical results.

Electroporation of cell membranes supporting penetration of photodynamic active macromolecular chromophore dextrans.

The aim is to demonstrate that macromolecular chromophore dextrans (Cibacron-dextran) acting as photosensitizers can be transported easily into cancer cells by electroporation of their membranes (short electric pulses on cell suspension between electrodes). There are two possibilities, either:(A)irradiation starts with the electropulse-showed with easily penetrating thiopyronin-yielding nearly 100% dead cells;(B)irradiation starts after a resealing time of membrane pores during which macromolecular photosensitizers can penetrate into cells. In this way, fractions of Cibacron-dextran with molecular weights (Mw) 3300, 10,900 and 500,000 are now able to kill. This combination of bioelectrochemistry and photobiology will be suitable also for other biopolymers, connected with photodynamic active chromophores (e.g. chromopeptides) to transport them through cell walls and membranes into cells and tissues. The human cancer cells U-935 and K-562 (pulsed by 1.15 kV/cm field strength) additionally or synergistically reach high rates of necrotic cells (colored by trypan blue) by this combination.

Glomerulometric data in experimental toxicological investigations.

Glomerulometric quantitative investigations from rat kidney during chronic attempt with the substances Deta-20 and Polystabil VZ on paraffin sections were carried out. These substances are utilized in textile and food industry. Data, obtained by means of a graduated eyepiece-micrometer for light microscope, were plotted on histograms. This work is an attempt to introduce lightoptical morphometric measurements for nuclei and cells as well as for other structures (glomeruli).

[Alkaline phosphatase in human lymphocytes. I. Cytochemical detection of alkaline phosphatase in normal human peripheral blood lymphocytes]. / Die alkalische Phosphatase der Lymphozyten des Menschen. I. Zytochemischer Nachweis der alkalischen Phosphatase in den Lymphozyten aus dem peripheren Blut gesunder Menschen.

The present paper deals with a sensitive cytochemical method of identifying alkaline phosphatase (AP) in rosette-forming lymphocytes gained from the peripheral blood of healthy human beings. The percentage of AP-positive lymphocytes amounts to 5%, with all cells comprising B- and O-lymphocyte population and with T-lymphocytes being negative. In a group of healthy test persons, recently, however, having undergone various inflammatory processes or virus diseases, the number of AP-positive lymphocytes is significantly higher, from 41-73% in B- and O-lymphocytes and from 6-38% in T-lymphocytes. This observation indicates that AP in lymphocytes may have a clinical significance in reactive lymphoproliferative processes, which must be elucidated by further investigations.

[Potential teratogenic action of the mycelium of the higher fungus, Polyporellus squamosus]. / Prouchvane ne vuzmozhnoto teratogenno deistvie na mitsel ot visshata guba Polyporellus squamosus.

The influence on the embryonic development of food with only source of protein derived from the mycelium of the higher fungus Polyporellus squamosus, was studied in a group of 90 pregnant rats. Animals fed caseine and standard food pressed into briquettes as source of protein served as controls. On the 17-th and 18-th gestation day 8 animals were examined and the number of of lutein bodies and fetuses was checked up. Anomalies were serched in the fetuses, by use of the method of Dawson and Wilson. The progeny of rats treated during gestation was examined on the 21-st day of life, by using a number of blood, integral and biochemical parameters (GOT, GPT, AP, SDH, catalase, sulfhydryl groups, soluble, protein). Proceeding from the results obtained, the authors rule out any teratogenic and embryotoxic activity of the mycelium of Polyporellus squamosus, under the aforegoing experimental conditions.

[Action of the sera from acute leukemia patients on lymphocytic transformation]. / Deistvie na serumi ot bolni s ostra levkoza vurkhu limfotsitnata transformatsiia

The authors examined in vitro the action of sera, obtained from patients with acute leucosis during the first attack and relapse on PHA (phytoheagglutinins)-M-reactivity of lymphocytes, obtained from healthy donors and olymphocytes obtained from leucemic patients. They found that sera inhibited in vitro the effects of PHA-M both on lymphocytes of patients and of healthy donors. There was stimulating effect of sera in vitro in single cases under autologic conditions.