Predictors of intraoperative pain during cesarean delivery under regional anesthesia.

It is unclear why some patients experience pain during cesarean delivery despite receiving appropriate regional anesthesia. Our primary aim was to determine what demographic and clinical variables predict intraoperative pain during cesarean delivery with neuraxial anesthesia. From July 2019 through March 2020, we administered a previously validated patient satisfaction survey to parturients who had a cesarean delivery under regional anesthesia for nonemergent obstetric indications. We performed a post hoc analysis restricted to subjects who had single injection spinal and combined spinal-epidural anesthesia. Parturients who did and did not report pain differed in height, intrathecal hyperbaric bupivacaine dose, and the time from incision to wound closure. We performed an ordinal logistic regression analysis on the 168 subjects with complete data using the aforementioned variables along with the time of day of cesarean delivery. Incision to wound closure time (P < 0.01) predicted intraoperative pain. The multivariate logistic regression model was statistically significant (P < 0.01) and had a receiver operator curve value of 0.74. The duration of time from incision to wound closure predicted intraoperative pain during cesarean delivery under regional anesthesia.

Two new miniature silverside fishes of the genus Membras Bonaparte (Atheriniformes, Atherinopsidae) from the Tropical North Atlantic Ocean.

Two new species of miniature silverside fishes are described from coastal habitats in the tropical Atlantic: Membras pygmaea sp. nov., from Brus Lagoon, Honduras, and M. procera sp. nov., from the Gulf of Urabá, Colombia. These new species belong to the martinica species-group within the genus Membras Bonaparte. The monophyletic martinica species-group (see below) contains four additional species, all coastal, marine that extend from the east coast of North America to São Paolo State, Brazil. Within the martinica species-group, all but M. martinica are miniature species, ranging from 41-60 mm SL. The smallest species, M. pygmaea sp. nov., is mature at 24 mm SL. A geometric morphometric analysis shows: (i) each species of the martinica species-group occupies its own portion of shape space; and (ii) none of the miniature species possess the shapes of small immature M. martinica. While some of the literature suggests that miniaturization may involve paedomorphosis, our results show that the miniatures accelerate to adult body forms.

The History of Estrogen Therapy.

INTRODUCTION: Menopausal hormone therapy (MHT) has proven an effective treatment for the amelioration of symptoms of menopause. The idea that a substance was the missing factor in a woman's body after menopause dates to the 1800s, when cow ovarian tissue was injected into German women in a successful attempt to reverse the sexual symptoms of menopause. The early 1900s saw the rise of commercialized menopause "treatments" that ranged in substance and even theoretical efficacy. The role of estrogen was first accurately described in Guinea pigs in 1917 by Dr. Papanicolaou. AIM: To tell the detailed history of how estrogen was discovered and the controversy surrounding MHT. METHODS: A literature search was conducted using PubMed to identify relevant studies and historical documents regarding the history of estrogen therapy. RESULTS: The history of estrogen supplementation and its controversies are interesting stories and relevant to today's ongoing investigation into hormone replacement. CONCLUSION: The controversy of MHT remained until the first randomized trials examining MHT in the early 1990s that suggested MHT is cardioprotective in postmenopausal women, although this conclusion was contradicted in subsequent trials. In the present day, MHT is approved only for short-term use for the symptomatic treatment of menopause. Kohn GE, Rodriguez KM, Hotaling J, et al. The History of Estrogen Therapy. Sex Med Rev 2019;7:416-421.