Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia.

OBJECTIVES: To evaluate the risk of emergent cesarean delivery with the use of neuraxial anesthesia for external cephalic version in a single practice. BACKGROUND: Randomized trials have shown increased external cephalic version success when neuraxial anesthesia is used, without additional risk. We hypothesized that in our actual clinical practice, outside the confines of randomized trials, neuraxial anesthesia could be associated with an increased risk of emergent cesarean delivery. METHODS: This retrospective cohort study included all women who underwent external cephalic version at a single institution with and without neuraxial anesthesia. The primary outcome was the incidence of emergent cesarean delivery (defined as delivery within 4hours of version). Secondary outcomes were version success and ultimate mode of delivery. RESULTS: A total of 135 women underwent external cephalic version procedures; 58 with neuraxial anesthesia (43.0%) and 77 without (57.0%). Location of the procedure, tocolytic therapy, and gestational age were different between groups. An increased rate of emergent cesarean delivery was found in procedures with neuraxial anesthesia compared to procedures without (5/58 (8.6%) compared to 0/77 (0.0%); 95% CI for difference, 1.4 to 15.8%; P=0.013). CONCLUSION: In this single hospital's practice, patients who may be at higher risk of complications and have a lesser likelihood of success were provided NA for ECV. As a result, the use of neuraxial anesthesia for external cephalic version was associated with a higher rate of emergent cesarean delivery. Obstetric and anesthetic practices should evaluate their patient selection and procedure protocol for external cephalic version under neuraxial anesthesia.

Solar UVB-induced DNA damage and photoenzymatic DNA repair in antarctic zooplankton.

The detrimental effects of elevated intensities of mid-UV radiation (UVB), a result of stratospheric ozone depletion during the austral spring, on the primary producers of the Antarctic marine ecosystem have been well documented. Here we report that natural populations of Antarctic zooplankton also sustain significant DNA damage [measured as cyclobutane pyrimidine dimers (CPDs)] during periods of increased UVB flux. This is the first direct evidence that increased solar UVB may result in damage to marine organisms other than primary producers in Antarctica. The extent of DNA damage in pelagic icefish eggs correlated with daily incident UVB irradiance, reflecting the difference between acquisition and repair of CPDs. Patterns of DNA damage in fish larvae did not correlate with daily UVB flux, possibly due to different depth distributions and/or different capacities for DNA repair. Clearance of CPDs by Antarctic fish and krill was mediated primarily by the photoenzymatic repair system. Although repair rates were large for all species evaluated, they were apparently inadequate to prevent the transient accumulation of substantial CPD burdens. The capacity for DNA repair in Antarctic organisms was highest in those species whose early life history stages occupy the water column during periods of ozone depletion (austral spring) and lowest in fish species whose eggs and larvae are abundant during winter. Although the potential reduction in fitness of Antarctic zooplankton resulting from DNA damage is unknown, we suggest that increased solar UV may reduce recruitment and adversely affect trophic transfer of productivity by affecting heterotrophic species as well as primary producers.

Deduced amino acid sequence of a putative sodium channel from the scyphozoan jellyfish Cyanea capillata.

Members of the phylum Cnidaria are the lowest extant organisms to possess a nervous system and are the first that are known to contain cells that produce action potentials carried exclusively by Na+ ions. They thus occupy an important position in the evolution of Na+ channels. A cDNA encoding a 198-kDa protein with high sequence identity to known Na+ channels was isolated from the scyphozoan jellyfish Cyanea capillata. The similarity between this and other Na+ channels is greatest in the transmembrane segments and the putative pore region and less so in the cytoplasmic loops that link the four domains of the protein. Phylogenetic analysis of the deduced protein reveals that it is closely related to known Na+ channels, particularly those of squid and Drosophila, and more distantly separated from Ca2+ channels. Scrutiny of the Cyanea channel in regions corresponding to those purported to form the tetrodotoxin receptor and selectivity filter of Na+ channels in higher animals reveals several anomalies that suggest that current models of the location of the tetrodotoxin binding site and Na+ channel selectivity filter are incomplete.

Presentation modality and proactive interference in short-term retention using a mixed-morality distractor task.

Two experiments investigated the release from PI following a shift in mode of presentation of the study words. In each experiment, the interpolated task required processing of both auditory (A) and visual (V) information. The results were the same with mixed lists (Experiment I) and with independent groups (Experiment II): A release from PI was obtained following an A to V shift but not following a V to A shift. It was concluded that the mixed-modality filler task has functional characteristics very similar to those of an A filler and that the filler task influences the memory code for study items.