Seahorse brood pouch morphology and control of male parturition in Hippocampus abdominalis.

INTRODUCTION: Syngnathids (seahorses, pipefishes and seadragons) are among the few vertebrates that display male pregnancy. During seahorse pregnancy, males incubate developing embryos embedded in a placenta within a fleshy brood pouch, before expelling fully developed neonates at parturition. The mechanisms underpinning seahorse parturition are poorly understood. METHODS: We examined the morphology of the brood pouch using microcomputed tomography and histological techniques, in combination with physiological assays, to examine how male pot-bellied seahorses (Hippocampus abdominalis) control labour. In female-pregnant vertebrates, nonapeptide hormones (such as vasopressin- and oxytocin-like hormones) produce contractions of gestational smooth muscle to produce labour. RESULTS: Histological analysis of the seahorse brood pouch reveals only scattered small smooth muscle bundles in the brood pouch, and in-vitro application of isotocin (a teleost nonapeptide hormone) to the brood pouch do not produce measurable muscle contractions. Micro-computed tomography shows differences in size and orientation of the anal fin assembly between male and female pot-bellied seahorses, and histological analysis reveals large skeletal muscle bundles attached to the anal fin bones at the male brood pouch opening. DISCUSSION: We conclude that seahorse parturition may be facilitated by contraction of these muscles, which, in combination with body movements, serves to gape open the pouch and expel the neonates. Future biomechanical studies are needed to test this hypothesis.

Mycotoxins in raw materials, beverages and supplements of botanicals: A review of occurrence, risk assessment and analytical methodologies.

Over recent years, consumer interest in natural products, such as botanicals has increased considerably. One of the factors affecting their quality is the presence of mycotoxins. This review focuses on exploring the mycotoxin occurrence in botanicals (raw material and ready-to-eat forms such as infusions or tablets) and the risk assessment due to their ingestion. Aflatoxins, Ochratoxin A, and Fumonisins are the most commonly studied mycotoxins and data in the literature report levels ranging from traces to 1000 µg/kg in raw materials. In general, the highest contents observed in raw materials decreased to unconcerning levels after the preparation of the infusions, reaching values that generally do not exceed 100 µg/L. Regarding botanical dietary supplements, the levels observed were lower than those reported for other matrices, although higher levels (of up to 1000 µg/kg) have been reported in some cases. Risk assessment studies in botanicals revealed a higher risk when they are consumed as tablets compared to infusions. Analytical methodologies implied in mycotoxin determination have also been contemplated. In this sense, liquid chromatography coupled to fluorescence detection has been the most frequently employed analytical technique, although in recent years tandem mass spectrometry has been widely used.

Multi-mycotoxin occurrence in feed, metabolism and carry-over to animal-derived food products: A review.

The world requests for raw materials used in animal feed has been steadily rising in the last years driven by higher demands for livestock production. Mycotoxins are frequent toxic metabolites present in these raw materials. The exposure of farm animals to mycotoxins could result in undesirable residues in animal-derived food products. Thus, the potential ingestion of edible animal products (milk, meat and fish) contaminated with mycotoxins constitutes a public health concern, since they enter the food chain and may cause adverse effects upon human health. The present review summarizes the state-of-the-art on the occurrence of mycotoxins in feed, their metabolism and carry-over into animal source foodstuffs, focusing particularly on the last decade. Maximum levels (MLs) for various mycotoxins have been established for a number of raw feed materials and animal food products. Such values are sometimes exceeded, however. Aflatoxins (AFs), fumonisins (FBs), ochratoxin A (OTA), trichothecenes (TCs) and zearalenone (ZEN) are the most prevalent mycotoxins in animal feed, with aflatoxin M1 (AFM1) predominating in milk and dairy products, and OTA in meat by-products. The co-occurrence of mycotoxins in feed raw materials tends to be the rule rather than the exception, and the carry-over of mycotoxins from feed to animal source foods is more than proven.

Ochratoxin A: occurrence and carry-over in meat and meat by-products. A Review

Mycotoxins are common toxic metabolites present in cereals and vegetal raw materials, which are commonly included in animal feed. Ochratoxin A (OTA) has generally been detected in plant origin foodstuffs such as cereals, coffee, dried fruits, nuts, among others. However, it has been also detected in meat and meat by-products, especially those derived from pork, which is the most sensitive specie to OTA exposure. The exposure of farm animals to mycotoxins could lead to undesirable residues in food products of animal origin, which constitute an important part of daily diets. Thus, although contents reported in animal by-products are lower than those reported in products of vegetal origin, there is also a public health concern about the possible ingestion of edible animal products contaminated by mycotoxins, as their entry into the food chain may cause adverse effects on human health. No maximum levels have been set for OTA in animal by-products, although its presence in meat and meat products made from contaminated raw materials has been widely reported, reaching high levels in some cases. This review summarizes the state-of-the-art on the occurrence and the carry-over of OTA in meat products, especially focused on the last years

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Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm.

OBJECTIVE: To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). METHODS: This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. RESULTS: Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5-3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1-2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00-3.44) and aOR, 2.78 (95% CI, 1.42-5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63-2.17) and aOR, 1.45 (95% CI, 0.71-2.96), respectively). CONCLUSIONS: Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Dietary exposure to mycotoxins through fruits juice consumption / Exposición a micotoxinas a través del consumo de zumo de frutas

A study on fruit juice products (apple, pineapple, apricot, orange and pear) was carried out to determine the natural occurrence of fifteen mycotoxins by gas chromatography coupled to tandem mass spectrometry (MS/MS). A developed multi-mycotoxin procedure was carried out by dispersive liquid-liquid microextraction (DLLME). 36% of the analyzed samples presented mycotoxin contamination. PAT was detected in orange, apple, mixed fruits and pineapple juices with prevalence of 86%, 60%, 29%, 14% at mean concentrations of 34.57 µg/L, 33.41 µg/L, 8.59 µg/L, 8.02 µg/L, respectively. One orange juice sample, exceeded the maximum level (ML) established by EU for PAT (50 µg/L). HT-2 toxin was found in mixed juice (43%) at mean level of 22.38 µg/L. Overall no toxicological concern was associated to mycotoxins exposure for children and adult population and the results obtained highlight the necessity for rigorous monitoring studies on HT-2 in fruit juice

Se presenta un estudio sobre zumos de frutas a base de manzana, piña, albaricoque, naranja y pera para determinar la presencia natural de quince micotoxinas mediante cromatografía de gases acoplada a espectrometría de masas en tándem (EM/EM). El procedimiento desarrollado de multi-micotoxinas se llevó a cabo mediante micro-extracción líquida-líquida dispersiva (DLLME). El 36% de las muestras analizadas presentaron contaminación con micotoxinas y una muestra de jugo de naranja, superó el nivel máximo (ML) establecido por la UE para PAT (50 μg/L). Se detectó PAT en naranja, manzana, frutas mezcladas y jugos de piña con una prevalencia de 86%, 60%, 29%, 14% a concentraciones promedio de 34.57 μg/L, 33.41 μg/L, 8.59 μg/L, 8.02 μg/L, respectivamente. La toxina HT-2 estaba presente en el jugo mixto (43%) a un nivel medio de 22.38 μg/L. En general, ninguna preocupación toxicológica se asoció con la exposición a micotoxinas en la población de niños y adultos, los resultados ponen de relieve la necesidad de estudios rigurosos de monitoreo de HT-2 en el zumo de fruta

Maternal and neonatal demographics of macrosomic infants admitted to the neonatal intensive care unit.

OBJECTIVE: The objective of this study is to determine the incidence, significance, associated demographics and impact of macrosomic infants (⩾4 kg) admitted to the Neonatal Intensive Care Unit (NICU) on NICU census and resources. STUDY DESIGN: A retrospective cohort review was performed from 2010 to 2015. Descriptive statistical analyses were used. RESULTS: Of 19 308 deliveries, 1823 were infants ⩾4000 g and 213 were admitted to the NICU. Cesarean delivery occurred in 70% of the admitted infants, most (74.1%) were Grade 1 macrosomia and male (63%). Preterm birth occurred in 4%. The incidence of maternal diabetes was 25%. Primary admitting diagnoses were respiratory distress, suspected sepsis, hypoglycemia and perinatal depression. The average length of stay was 8±6 days for all macrosomic infants admitted, increased to 22±13 days for infants with Grade 3 macrosomia. CONCLUSION: Macrosomic infants are a growing population, who increase the demand on existing NICU resources. A larger multi-centered study is needed to determine the overall relevance of these findings in other populations.

Mitigation of enniatins in edible fish tissues by thermal processes and identification of degradation products.

Emerging mycotoxins, such as enniatins and beauvericin, are common contaminants in vegetal matrices, but recently, the occurrence of mycotoxins in foodstuffs from animal origin has been also reported as they can be present in edible tissues of animals fed with contaminated feedstuffs. Sea bass, sea bream, Atlantic salmon and rainbow trout from aquaculture analyzed in the present survey showed contamination by emerging Fusarium mycotoxins enniatins (ENs). ENs were extracted from raw and cooked fish with acetonitrile and analyzed by Liquid Chromatography coupled to Mass Spectrometry. In this study, the stability of ENs was evaluated during food processing by the application of different cooking methods (broiling, boiling, microwaving and baking treatments). All treated samples showed a reduction in mycotoxin levels with different percentages depending on the type of EN and the fish species. Thus, the reduction obtained ranged from 30 to 100%. The thermal treatments have shown to be a good strategy to mitigate ENs content in edible fish tissues. On the other hand, some ENs degradation products originated during the application of thermal treatments were identified.

Multimycotoxin analysis in water and fish plasma by liquid chromatography-tandem mass spectrometry.

High performance liquid chromatography-mass spectrometry was used for the determination of 15 mycotoxins in water and fish plasma samples, including aflatoxins, fumonisins, ochratoxin A, sterigmatocistin, fusarenon-X and emerging Fusarium mycotoxins. In this work, dispersive liquid-liquid microextraction (DLLME) was assessed as a sample treatment for the simultaneous extraction of mycotoxins. Results showed differences in recovery assays when different extraction solvents were employed. Ethyl acetate showed better recoveries for the major part of mycotoxins analyzed, except for aflatoxins B2, G1 and G2, which showed better recoveries when employing chloroform as extractant solvent. Fumonisins and beauvericin exhibited low recoveries in both water and plasma. This method was validated according to guidelines established by European Commission and has shown to be suitable to be applied in dietary and/or toxicokinetic studies in fish where is necessary to check mycotoxin contents in rearing water and fish plasma.

The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study.

OBJECTIVE: To determine whether ß2 -adrenoceptor (ß2 AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester. DESIGN: A case-control ancillary study to a multicentre randomised controlled trial. SETTING: Fourteen participating centres of the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. POPULATION: Four hundred thirty-nine women, including 315 with short cervix and 124 with normal cervical length. METHODS: Nulliparous women with cervical length <30 mm upon a 16-22-week transvaginal sonogram and controls frequency-matched for race/ethnicity with cervical lengths ≥40 mm were studied. ß2 AR genotype was determined at positions encoding for amino acid residues 16 and 27. MAIN OUTCOME MEASURES: Genotype distributions were compared between case and control groups. Within the short cervix group, pregnancy outcomes were compared by genotype, with a primary outcome of PTB <37 weeks. RESULTS: Genotype data were available at position 16 for 433 women and at position 27 for 437. Using a recessive model testing for association between short cervix and genotype, and adjusted for ethnicity, there was no statistical difference between cases and controls for Arg16 homozygosity (OR 0.7, 95% CI 0.4-1.3) or Gln27 homozygosity (OR 0.9, 95% CI 0.3-2.7). Among cases, Arg16 homozygosity was not associated with protection from PTB or spontaneous PTB. Gln27 homozygosity was not associated with PTB risk, although sample size was limited. CONCLUSIONS: ß2 AR genotype does not seem to be associated with short cervical length or with PTB following the second-trimester identification of a short cervix. Influences on PTB associated with ß2 AR genotype do not appear to involve a short cervix pathway.

Can changes in angiogenic biomarkers between the first and second trimesters of pregnancy predict development of pre-eclampsia in a low-risk nulliparous patient population?

OBJECTIVE: To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women. DESIGN: A nested case-control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls. SETTING: A multicentre study in 16 academic medical centres in the USA. POPULATION: Low-risk nulliparous women. METHODS: Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9-12, 15-18 and 23-26 weeks of gestation. Rate of change of analyte between first and either early or late second trimester was calculated with and without adjustment for baseline clinical characteristics. MAIN OUTCOME MEASURES: Change in PlGF, sFlt-1 and sEng. RESULTS: Rates of change of PlGF, sEng and sFlt-1 between first and either early or late second trimesters were significantly different in women who developed pre-eclampsia, severe pre-eclampsia or early-onset pre-eclampsia compared with women who remained normotensive. Inclusion of clinical characteristics (race, body mass index and blood pressure at entry) increased sensitivity for detecting severe and particularly early-onset pre-eclampsia but not pre-eclampsia overall. Receiver operating characteristics curves for change from first to early second trimester in sEng, PlGF and sFlt-1 with clinical characteristics had areas under the curve of 0.88, 0.84 and 0.86, respectively, and for early-onset pre-eclampsia with sensitivities of 88% (95% CI 64-99), 77% (95% CI 50-93) and 77% (95% CI 50-93) for 80% specificity, respectively. Similar results were seen in the change from first to late second trimester. CONCLUSION: Change in angiogenic biomarkers between first and early second trimester combined with clinical characteristics has strong utility for predicting early-onset pre-eclampsia.

The endogenous retroviral envelope protein syncytin-1 inhibits LPS/PHA-stimulated cytokine responses in human blood and is sorted into placental exosomes.

OBJECTIVES: To examine whether syncytin-1 has immune regulatory functions and is carried by human placental exosomes. Further, to examine whether corticotropin-releasing hormone (CRH) can induce the production of syncytin-1. STUDY DESIGN: Human placental exosomes were isolated from placental explant, primary trophoblast and BeWo cell cultures. The presence of exosomes was confirmed by transmission electron microscopy and western blotting. Exosomal protein was probed with 3 separate antibodies targeting syncytin-1. Syncytin-1 immunosuppression was tested, using either a syncytin-1 recombinant ectodomain protein or a synthetic peptide with the human syncytin-1 immunosuppressive domain sequence, in an in vitro human blood culture system immune challenged with LPS or PHA. The inhibition of cytokine production by syncytin-1 was determined by ELISA of TNF-α, IFN-γ and CXCL10. BeWo cells were stimulated with CRH or vehicle for 24 h. mRNA and Protein was extracted from the cells for real-time PCR and western blotting analysis while exosomes were extracted from conditioned media for analysis by western blotting. RESULTS: Protein expression of syncytin-1 was detected in exosomes isolated from placental explants, primary trophoblast and BeWo cell cultures. Syncytin-1 recombinant ectodomain was also shown to inhibit the production of the Th1 cytokines TNF-α and IFN-γ as well as the chemokine, CXCL10 in human blood cells. Finally, this study showed that syncytin-1 can be stimulated by CRH. CONCLUSIONS: The presence of syncytin-1 in placental exosomes provides a mechanism for syncytin-1 to reach and interact with target cells of the maternal immune system and represents a novel mechanism of endogenous retroviral mediated immunosuppression that may be relevant for maternal immune tolerance.

IFPA Meeting 2010 Workshop Report I: Immunology; ion transport; epigenetics; vascular reactivity; epitheliochorial placentation; proteomics.

Workshops are an important part of the IFPA annual meeting. At IFPA Meeting 2010 there were twelve themed workshops, six of which are summarized in this report. 1. The immunology workshop focused on normal and pathological functions of the maternal immune system in pregnancy. 2. The transport workshop dealt with regulation of ion and water transport across the syncytiotrophoblast of human placenta. 3. The epigenetics workshop covered DNA methylation and its potential role in regulating gene expression in placental development and disease. 4. The vascular reactivity workshop concentrated on methodological approaches used to study placental vascular function. 5. The workshop on epitheliochorial placentation covered current advances from in vivo and in vitro studies of different domestic species. 6. The proteomics workshop focused on a variety of techniques and procedures necessary for proteomic analysis and how they may be implemented for placental research.

[Application of a critical incident reporting and analysis system in an anesthesiology department]. / Utilización de un sistema de comunicación y análisis de incidentes críticos en un servicio de anestesia.

OBJECTIVES: To ascertain the changes in anesthesia-related morbidity and mortality after application of a scheme for reporting critical incidents and to assess the effect of implementing preventive measures against the detected errors. PATIENTS AND METHODS: We defined a critical incident to be any situation in which the margin of safety for the patient was reduced or might have been reduced. We analyzed data from the period between January 1999 and December 2004. RESULTS: The number of critical incidents was 547 (0.79% of 68627 anesthetic procedures). Human error was identified in 279 incidents (51%). The most frequent factors underlying errors were wrong diagnosis of the situation, communication problems, and failure to check equipment and drugs. The patient suffered no adverse effect in 81.8% of the incidents; 78.9% were considered preventable. Introducing an equipment checklist before anesthesia reduced the number of incidents from 90 events in 21809 cases in 31 months to 34 events out of 22064 cases in 29 months; chi2 test, P < 0.05; odds ratio (OR), 2.68; 95% confidence interval (CI), 1.80-3.98). Labeling syringes reduced errors in the administration of medications from 45 errors in 21 809 cases in 31 months to 27 in 22064 cases in 29 months; chi2, P < 0.05; OR, 1.68; 95% CI, 1.04-2.72. CONCLUSIONS: Corrective measures were adopted as a result of the incident reporting scheme. Some of the measures led to a statistically significant reduction in equipment and drug administration errors.

[Incident reporting systems and patient safety in anesthesia]. / Sistemas de comunicación de incidentes y seguridad del paciente en anestesia.

Incident reporting schemes collect information on adverse events, errors, complications, or problems with the aim of analyzing their causes and suggesting changes to prevent recurrence. Such schemes are currently part of clinical safety programs in various countries. Although the ideal form for a reporting system is debated, an essential part of its success will be the establishment of a culture of safety within an organization. The underlying assumption is that even though errors are an inherent part of a process that relies on human beings, they are nearly always favored by a chain of system failures. Therefore, reporting is intended to stimulate a culture of learning rather than assigning blame. The main limitations of such schemes are under reporting, the use of different terms and concepts, the lack of resources for research and development, and the scarcity or lack of legislation to guarantee the proper use of information without legal consequences.

Sistemas de comunicación de incidentes y seguridad del paciente en anestesia / Incident reporting systems and patient safety in anesthesia

Los sistemas de comunicación de incidentes recogeninformación sobre sucesos adversos, errores, complicacioneso problemas con el objetivo de analizar sus causasy sugerir cambios para evitar su repetición. Actualmenteson parte de los programas de seguridad clínica en diversospaíses. Aunque existe controversia acerca de cuálesserían las características del sistema de comunicaciónideal, para que éste tenga éxito se necesita una cultura deseguridad asentada en la organización. El planteamientode base asume que aunque los errores son inherentes alproceso humano casi siempre los propicia una cadena defallos en el sistema, por lo que los sistemas de comunicaciónse diseñan para estimular una cultura de aprendizajey no de culpabilización. Sus principales limitacionesson la posibilidad de infracomunicación, las diferentesterminologías y conceptos utilizados, la falta de recursospara su investigación y desarrollo, y la escasa o nulalegislación que permita su buen uso sin implicacioneslegales

Incident reporting schemes collect information onadverse events, errors, complications, or problems withthe aim of analyzing their causes and suggesting changesto prevent recurrence. Such schemes are currently partof clinical safety programs in various countries. Althoughthe ideal form for a reporting system is debated,an essential part of its success will be the establishmentof a culture of safety within an organization. The underlyingassumption is that even though errors are aninherent part of a process that relies on human beings, theyare nearly always favored by a chain of system failures.Therefore, reporting is intended to stimulate a culture oflearning rather than assigning blame. The main limitationsof such schemes are under reporting, the use of differentterms and concepts, the lack of resources for researchand development, and the scarcity or lack oflegislation to guarantee the proper use of informationwithout legal consequences

Utilización de un sistema de comunicación y análisis de incidentes críticos en un servicio de anestesia / Application of a critical incident reporting and analysis system in an anesthesiology department

OBJETIVOS: Conocer los cambios en la morbi-mortalidad anestésica con la utilización de un sistema de comunicación de incidentes críticos y valorar los efectos de la resolución de los factores de error detectados. PACIENTES Y MÉTODOS: Consideramos incidente crítico toda situación en la que se redujo o pudo haberse reducido el margen de seguridad del paciente. Analizamos el periodo entre enero de 1999 y diciembre de 2004. RESULTADOS: Se realizaron 68.627 procedimientos anestésicos y se comunicaron 547 incidentes críticos (0,79%). En 279 incidentes (51%) se identificó un error activo. Los factores latentes asociados con mayor frecuencia fueron el error de diagnóstico de la situación, los problemas de comunicación y la falta de comprobación del equipamiento y de los fármacos. El 81,8% de los incidentes no tuvieron ningún efecto sobre el paciente. En el 78,9% el incidente se consideró evitable. La introducción de una lista de comprobación del equipamiento antes de la anestesia redujo los incidentes de 90 por 21809 casos en 31 meses a 34 por 22.064 casos en 29 meses; χ, p<0,05; odds ratio [OR]= 2,68; intervalo de confianza [IC] del 95%= 1,80-3,9811. El etiquetado de jeringas redujo los errores en la administración de medicación de 45 por 21.809 casos en 31 meses a 27 por 22.064 casos en 29 meses; χ, p<0,05; OR= 1,68; IC del 95%= 1,04-2,72. CONCLUSIONES: Como consecuencia del análisis sistemático de los incidentes se adoptaron distintas medidas correctoras, algunas de las cuales demostraron una reducción estadísticamente significativa en los incidentes de equipamiento y los incidentes farmacológicos

OBJECTIVES: To ascertain the changes in anesthesiarelated morbidity and mortality after application of a scheme for reporting critical incidents and to assess the effect of implementing preventive measures against the detected errors. PATIENTS AND METHODS: We defined a critical incident to be any situation in which the margin of safety for the patient was reduced or might have been reduced. We analyzed data from the period between January 1999 and December 2004. RESULTS: The number of critical incidents was 547 (0.79% of 68627 anesthetic procedures). Human error was identified in 279 incidents (51%). The most frequent factors underlying errors were wrong diagnosis of the situation, communication problems, and failure to check equipment and drugs. The patient suffered no adverse effect in 81.8% of the incidents; 78.9% were considered preventable. Introducing an equipment checklist before anesthesia reduced the number of incidents from 90 events in 21809 cases in 31 months to 34 events out of 22064 cases in 29 months; χ2 test, P<0.05; odds ratio (OR), 2.68; 95% confidence interval (CI), 1.80-3.98). Labeling syringes reduced errors in the administration of medications from 45 errors in 21 809 cases in 31 months to 27 in 22064 cases in 29 months; χ2, P<0.05; OR, 1.68; 95% CI, 1.04-2.72. CONCLUSIONS: Corrective measures were adopted as a result of the incident reporting scheme. Some of the measures led to a statistically significant reduction in equipment and drug administration errors

Pneumococcal vaccination during pregnancy for preventing infant infection.

BACKGROUND: Each year at least one million children worldwide die of pneumococcal infections. The development of bacterial resistance to antimicrobials adds to the difficulty of treatment of diseases and emphasizes the need for a preventive approach. Newborn vaccination schedules could substantially reduce the impact of pneumococcal disease in immunized children, but does not have an effect on the morbidity and mortality of infants less than three months of age. Pneumococcal vaccination during pregnancy may be a way of preventing pneumococcal disease during the first months of life before the pneumococcal vaccine administered to the infant starts to produce protection. OBJECTIVES: To assess the effect of pneumococcal vaccination during pregnancy for preventing infant infection. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to June 2004), EMBASE (January 1985 to June 2004), and reference lists of articles. SELECTION CRITERIA: Randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality and extracted data using a data collection form. Study authors were contacted for additional information. MAIN RESULTS: Three trials (280 participants) were included. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41). Although the data suggest an effect in reducing pneumococcal colonisation in infants by 16 months of age (one trial, 56 pregnancies, RR 0.33; 95% CI 0.11 to 0.98), there was no evidence of this effect in infants at two months of age (RR 0.28; 95% CI 0.02 to 5.11) or by seven months of age (RR 0.32; 95% CI 0.08 to 1.29). AUTHORS' CONCLUSIONS: There is insufficient evidence to support whether pneumococcal vaccination during pregnancy could reduce infant infections.

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy.

BACKGROUND: Twin pregnancies are associated with a high risk of neonatal mortality and morbidity due to an increased rate of preterm birth. Betamimetics can decrease contraction frequency or delay preterm birth in singleton pregnancies by 24 to 48 hours. The efficacy of oral betamimetics in women with a twin pregnancy is unproven. OBJECTIVES: To assess the effects of prophylactic oral betamimetics administered to women with twin pregnancies. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), and reference lists. SELECTION CRITERIA: Randomized controlled trials in twin pregnancies comparing oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. DATA COLLECTION AND ANALYSIS: Standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Trials were independently assessed for methodological quality by at least two authors, who extracted data using a data collection form. MAIN RESULTS: Five trials (344 twin pregnancies) were included. All trials compared oral betamimetics to placebo. Betamimetics reduced the incidence of preterm labour (one trial, 50 twin pregnancies, relative risk (RR) 0.40; 95% confidence interval (CI) 0.19 to 0.86). However, betamimetics did not reduce preterm birth less than 37 weeks' gestation (four trials, 276 twin pregnancies, RR 0.85; 95% CI 0.65 to 1.10) or less than 34 weeks' gestation (one trial, 144 twin pregnancies, RR 0.47; 95% CI 0.15 to 1.50). Mean neonatal birthweight in the betamimetic group was significantly higher than in the placebo group (three trials, 478 neonates, weighted mean difference 111.2 grams; 95% CI 22.2 to 200.2). Nevertheless, there was no evidence of an effect of betamimetics in reduction of low birthweight (two trials, 366 neonates, RR 1.19; 95% CI 0.77 to 1.85) or small-for-gestational age neonates (two trials, 178 neonates, RR 0.92; 95% CI 0.52 to 1.65). Two trials (388 neonates) showed that betamimetics significantly reduced the incidence of respiratory distress syndrome but the difference was not significant when the analysis was adjusted for correlation of babies from twins. Three trials (452 neonates) showed no evidence of an effect of betamimetics in reducing neonatal mortality (RR 0.80; 95% CI 0.35 to 1.82). AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy.