Edge Computing Resource Allocation for Dynamic Networks: The DRUID-NET Vision and Perspective.

The potential offered by the abundance of sensors, actuators, and communications in the Internet of Things (IoT) era is hindered by the limited computational capacity of local nodes. Several key challenges should be addressed to optimally and jointly exploit the network, computing, and storage resources, guaranteeing at the same time feasibility for time-critical and mission-critical tasks. We propose the DRUID-NET framework to take upon these challenges by dynamically distributing resources when the demand is rapidly varying. It includes analytic dynamical modeling of the resources, offered workload, and networking environment, incorporating phenomena typically met in wireless communications and mobile edge computing, together with new estimators of time-varying profiles. Building on this framework, we aim to develop novel resource allocation mechanisms that explicitly include service differentiation and context-awareness, being capable of guaranteeing well-defined Quality of Service (QoS) metrics. DRUID-NET goes beyond the state of the art in the design of control algorithms by incorporating resource allocation mechanisms to the decision strategy itself. To achieve these breakthroughs, we combine tools from Automata and Graph theory, Machine Learning, Modern Control Theory, and Network Theory. DRUID-NET constitutes the first truly holistic, multidisciplinary approach that extends recent, albeit fragmented results from all aforementioned fields, thus bridging the gap between efforts of different communities.

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis.

BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic agents can prevent PPH, and are routinely recommended. The current World Health Organization (WHO) recommendation for preventing PPH is 10 IU (international units) of intramuscular or intravenous oxytocin. There are several uterotonic agents for preventing PPH but there is still uncertainty about which agent is most effective with the least side effects. This is an update of a Cochrane Review which was first published in April 2018 and was updated to incorporate results from a recent large WHO trial. OBJECTIVES: To identify the most effective uterotonic agent(s) to prevent PPH with the least side effects, and generate a ranking according to their effectiveness and side-effect profile. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (24 May 2018), and reference lists of retrieved studies. SELECTION CRITERIA: All randomised controlled trials or cluster-randomised trials comparing the effectiveness and side effects of uterotonic agents with other uterotonic agents, placebo or no treatment for preventing PPH were eligible for inclusion. Quasi-randomised trials were excluded. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved. DATA COLLECTION AND ANALYSIS: At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. Secondary outcomes included blood loss and related outcomes, morbidity outcomes, maternal well-being and satisfaction and side effects. Primary outcomes were also reported for pre-specified subgroups, stratifying by mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of administration. We performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available agents. MAIN RESULTS: The network meta-analysis included 196 trials (135,559 women) involving seven uterotonic agents and placebo or no treatment, conducted across 53 countries (including high-, middle- and low-income countries). Most trials were performed in a hospital setting (187/196, 95.4%) with women undergoing a vaginal birth (71.5%, 140/196).Relative effects from the network meta-analysis suggested that all agents were effective for preventing PPH ≥ 500 mL when compared with placebo or no treatment. The three highest ranked uterotonic agents for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, misoprostol plus oxytocin combination and carbetocin. There is evidence that ergometrine plus oxytocin (RR 0.70, 95% CI 0.59 to 0.84, moderate certainty), carbetocin (RR 0.72, 95% CI 0.56 to 0.93, moderate certainty) and misoprostol plus oxytocin (RR 0.70, 95% CI 0.58 to 0.86, low certainty) may reduce PPH ≥ 500 mL compared with oxytocin. Low-certainty evidence suggests that misoprostol, injectable prostaglandins, and ergometrine may make little or no difference to this outcome compared with oxytocin.All agents except ergometrine and injectable prostaglandins were effective for preventing PPH ≥ 1000 mL when compared with placebo or no treatment. High-certainty evidence suggests that ergometrine plus oxytocin (RR 0.83, 95% CI 0.66 to 1.03) and misoprostol plus oxytocin (RR 0.88, 95% CI 0.70 to 1.11) make little or no difference in the outcome of PPH ≥ 1000 mL compared with oxytocin. Low-certainty evidence suggests that ergometrine may make little or no difference to this outcome compared with oxytocin meanwhile the evidence on carbetocin was of very low certainty. High-certainty evidence suggests that misoprostol is less effective in preventing PPH ≥ 1000 mL when compared with oxytocin (RR 1.19, 95% CI 1.01 to 1.42). Despite the comparable relative treatment effects between all uterotonics (except misoprostol) and oxytocin, ergometrine plus oxytocin, misoprostol plus oxytocin combinations and carbetocin were the highest ranked agents for PPH ≥ 1000 mL.Misoprostol plus oxytocin reduces the use of additional uterotonics (RR 0.56, 95% CI 0.42 to 0.73, high certainty) and probably also reduces the risk of blood transfusion (RR 0.51, 95% CI 0.37 to 0.70, moderate certainty) when compared with oxytocin. Carbetocin, injectable prostaglandins and ergometrine plus oxytocin may also reduce the use of additional uterotonics but the certainty of the evidence is low. No meaningful differences could be detected between all agents for maternal deaths or severe morbidity as these outcomes were rare in the included randomised trials where they were reported.The two combination regimens were associated with important side effects. When compared with oxytocin, misoprostol plus oxytocin combination increases the likelihood of vomiting (RR 2.11, 95% CI 1.39 to 3.18, high certainty) and fever (RR 3.14, 95% CI 2.20 to 4.49, moderate certainty). Ergometrine plus oxytocin increases the likelihood of vomiting (RR 2.93, 95% CI 2.08 to 4.13, moderate certainty) and may make little or no difference to the risk of hypertension, however absolute effects varied considerably and the certainty of the evidence was low for this outcome.Subgroup analyses did not reveal important subgroup differences by mode of birth (caesarean versus vaginal birth), setting (hospital versus community), risk of PPH (high versus low risk for PPH), dose of misoprostol (≥ 600 mcg versus < 600 mcg) and regimen of oxytocin (bolus versus bolus plus infusion versus infusion only). AUTHORS' CONCLUSIONS: All agents were generally effective for preventing PPH when compared with placebo or no treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional desirable effects compared with the current standard oxytocin. The two combination regimens, however, are associated with significant side effects. Carbetocin may be more effective than oxytocin for some outcomes without an increase in side effects.

The effect of hormone therapy on biochemical and ultrasound parameters associated with atherosclerosis in 46,XY DSD individuals with female phenotype.

The aim of this study was to evaluate the effect of hormone therapy (HT) in the endothelial function of 46,XY disorders of sexual development (DSD) patients with female phenotype. Biochemical and ultrasound measurements were performed in 20 patients at initiation of oral 2 mg 17ß-estradiol/1 mg norethisterone acetate, and after 6 months of therapy. Lipid profile, including total cholesterol (TC), LDL, HDL, triglycerides (TG) and Atherogenic Index of Plasma (AIP), as well as levels of VE-Cadherin, E-Selectin, Thrombomodulin and vWf were determined. Ultrasonographic examinations included evaluation of flow-mediated dilatation (FMD) and measurement of Carotid and Femoral Intima Media Thickness (IMT). HT raised HDL (35.4 mg/dl versus 40.1 mg/dl, p = 0.019) while lowering TG (166 mg/dl versus 109 mg/dl, p = 0.026) and AIP (0.24 versus 0.04, p = 0.007). No changes were noted in TC and LDL (215.7 mg/dl versus 192.25 mg/dl and 87.46 mg/dl versus 76.35 mg/dl, respectively). There was significant reduction of VE-Cadherin (4.05 ng/ml versus 2.20 ng/ml, p = 0.002) and E-selectin (73.98 ng/ml versus 56.73 ng/ml, p = 0.004). No change was observed in Thrombomodulin and vWf (11.76 ng/ml versus 13.90 ng/ml and 80.75% versus 79.55%, respectively). FMD improved significantly (5.4% versus 8.15%, p = 0.003), while only carotid bulb IMT decreased significantly (0.65 mm versus 0.60 mm, p = 0.018). Overall, HT was found to improve biochemical and ultrasound markers of endothelial function in 46,XY DSD patients with female phenotype.

HPV infection: immunological aspects and their utility in future therapy.

High prevalence and mortality rates of cervical cancer create an imperative need to clarify the uniqueness of HPV (Human Papillomavirus) infection, which serves as the key causative factor in cervical malignancies. Understanding the immunological details and the microenvironment of the infection can be a useful tool for the development of novel therapeutic interventions. Chronic infection and progression to carcinogenesis are sustained by immortalization potential of HPV, evasion techniques, and alterations in the microenvironment of the lesion. Inside the lesion, Toll-like receptors expression becomes irregular; Langerhans cells fail to present the antigens efficiently, tumor-associated macrophages aggregate resulting in an unsuccessful immune response by the host. HPV products also downregulate the expression of microenvironment components which are necessary for natural-killer cells response and antigen presentation to cytotoxic cells. Additionally HPV promotes T-helper cell 2 (Th2) and T-regulatory cell phenotypes and reduces Th1 phenotype, leading to suppression of cellular immunity and lesion progression to cancer. Humoral response after natural infection is inefficient, and neutralizing antibodies are not adequate in many women. Utilizing this knowledge, new endeavors, such as therapeutic vaccination, aim to stimulate cellular immune response against the virus and alter the milieu of the lesion.

Bioinspired Temperature-Responsive Multilayer Films and Their Performance under Thermal Fatigue.

The structure of certain nonliving tissues determines their self-shaping and self-folding capabilities in response to a stimulus. Predetermined movements are realized according to changes in the environmental conditions due to the generated stresses of the multilayer anisotropic structure. In this study, we present bioinspired responsive anisotropic multilayer films and their fabrication process which comprises low-cost techniques. The anisotropic multilayer materials are capable of deforming their geometry caused by small temperature changes (<40 °C). The mismatch in the thermo-mechanical properties between three or more anisotropic thin layers creates responsive materials that alter their shape owing to the developed internal stresses. The movements of the material can be controlled by forming anisotropic homogenous metallic strips over an anisotropic thermoplastic layer. As a result, responsive multilayer films made of common materials can be developed to passively react to a temperature stimulus. We demonstrate the ability of the anisotropic materials to transform their geometry and we present a promising fabrication process and the thermal fatigue resistance of the developed materials. The thermal fatigue performance is strongly related to the fabrication method and the thickness of the strips. We studied the thermal fatigue performance of the materials and how the thermal cycling affects their sensitivity, as well as their failure modes and crack formation.

Potential prognostic biomarkers of cardiovascular disease in fetal macrosomia: the impact of gestational diabetes.

OBJECTIVE: Fetal macrosomia is associated with cardiac hypertrophy and increased cardiovascular risk. Cardiac biomarkers may play diagnostic/prognostic role in cardiovascular disease. We tested whether cardiac biomarkers are differentially expressed in cord blood samples of full-term singleton large-for-gestational-age (LGA), as compared to appropriate-for-gestational-age (AGA) pregnancies. METHODS: Cardiotrophin-1 (CT-1), Titin, pentraxin (PTX-3) and soluble CD36 (sCD36) concentrations were determined in 80 cord blood samples from a) LGA pregnancies due to maternal diabetes (n = 8), overweight/obese (n = 11), excessive weight gain (n = 7), without specific pathology (n = 14), b) AGA normal pregnancies (controls, n = 40). Neonates were classified as LGA or AGA based on customized birth weight (BW) standards. RESULTS: CT-1 and Titin concentrations were higher in LGA than AGA pregnancies (p < .001 and p = .023, respectively). A subgroup analysis (in the LGA group) showed increased CT-1 concentrations only in diabetic pregnancies. PTX-3 and sCD36 concentrations were similar in LGA and AGA fetuses. In the LGA group, PTX-3 concentrations positively correlated with birth-weight (r = .416, p = .008) and respective sCD36 concentrations (r = .443, p = .004). CONCLUSION: Higher Titin concentrations in LGAs possibly represent a candidate molecular mechanism underlying the association between fetal macrosomia and cardiomyocyte/diastolic dysfunction. CT-1 is up-regulated only in LGAs exposed to maternal diabetes. PTX-3 and sCD36 are probably not affected by excessive fetal growth.

Implication of the myokine irisin in maternal energy homeostasis in pregnancies with abnormal fetal growth.

OBJECTIVE: To prospectively investigate maternal concentrations of the myokine irisin in large for gestational age (LGA) and intrauterine growth restricted (IUGR) versus appropriate for gestational age (AGA) normal pregnancies and associate them with various perinatal parameters. METHODS: Plasma irisin and insulin concentrations were measured by enzyme-linked immunosorbent assay (ELISA) and immunoradiometric assay (IRMA), respectively, in a cohort of 80 mothers delivering LGA (n = 30), IUGR (n = 30) and AGA (n = 20) singleton full-term infants. RESULTS: Maternal irisin concentrations were similar among LGA, IUGR and AGA groups and did not correlate with respective insulin ones or maternal body mass index. In a combined group, maternal irisin concentrations decreased with advancing gestational age (p < 0.001) and were lower in multi-, compared to nulliparous women (p = 0.004). In the IUGR group, maternal irisin concentrations were higher in cases of smoking (p = 0.006). CONCLUSIONS: Irisin may not be differentially regulated in insulin resistance-associated pregnancy disorders resulting in fetal macrosomia and IUGR. Maternal irisin down-regulation with advancing gestation could possibly contribute to the observed maternal fat accumulation and progressive insulin resistance towards term. Similarly, lower maternal irisin concentrations in multiparous women may reflect the documented positive association between parity and fat deposition. Irisin up-regulation in cases of smoking may indicate the need for enhanced oxygen consumption to maintain energy production under conditions of hypoxia.

Continuous acidogenesis of sucrose, raffinose and vinasse using mineral kissiris as promoter.

The use of kissiris as promoter (culture immobilization carrier) in anaerobic acidogenesis of sucrose, raffinose and vinasse is reported. Initially, the effect of pH (4-8) and fermentation temperature (18-52 °C) on the accumulation of low molecular weight organic acids (OAs) during sucrose acidogenesis, was evaluated. The promoting effect of kissiris was confirmed compared to free cells, resulting in 80% increased OAs production. The optimum conditions (pH 8; 37 °C) were used during acidogenesis of sucrose/raffinose mixtures. A continuous system was also operated for more than 2 months. When sucrose and sucrose/raffinose mixtures were used, lactic acid type fermentation prevailed, while when vinasse was used, butyric acid type fermentation occurred. Total OAs concentrations were more than 14 g/L and ethanol concentrations were 0.5-1 mL/L. Culture adaptation in vinasse was necessary to avoid poor results. The proposed process is promising for new generation ester-based biofuel production from industrial wastes.

New generation biofuel: continuous acidogenesis of sucrose-raffinose mixture simulating vinasse is promoted by γ-alumina pellets.

BACKGROUND: This investigation comprises a contribution on the production of a new generation biofuel using the industrial liquid waste of bioethanol distilleries, known as vinasse. This study focuses on the exploitation of vinasse as an acidogenesis substrate for volatile fatty acids and simultaneous ethanol production. These products can be used for ester production, which is the new generation biofuel. Therefore, the aims of the present study are (i) to examine any promotional effect of γ-alumina on acidogenesis of a sucrose-raffinose mixture simulating vinasse, (ii) to study the operational stability of the continuous acidogenesis of sucrose and raffinose and subsequently of vinasse, and (iii) to determine the volatile fatty acid chemical composition and ethanol formation. RESULTS: Batch acidogenesis of sucrose and raffinose mixtures showed that γ-alumina promoted fermentation leading to an increase in the volatile fatty acid yield factor from 40% to 95% compared to free cells. The application of the system in continuous mode for more than 3 months showed that the continuous volatile fatty acid productivity obtained was higher than 7 g/L/day. Lactic acid was the predominant acid when sucrose and raffinose were used while butyric acid in the case of vinasse. The highest volatile fatty acid concentration reached was 19 g/L for vinasse. CONCLUSIONS: A promoting effect of γ-alumina in acidogenic fermentation of sucrose-raffinose and vinasse is reported. Continuous acidogenesis of sucrose-raffinose mixtures and vinasse using γ-alumina with immobilized cells showed high operational stability (more than 3 months). These findings result in easy scale up of the process that will produce a high annual added value of $11,000,000 in a daily bioethanol production plant of 50,000 L.

Application of Creatsas vaginoplasty after radical surgical treatment of sarcoma botryoides.

BACKGROUND: Sarcoma botryoides of the female genital tract is a rare malignancy. For many years, treatment consisted of radical procedures involving removal of the vagina, cervix, and uterus. Reconstructive surgery is essential for these patients, in order to achieve vaginal penetrative sexual intercourse. CASE: A 17-year-old adolescent, with medical history of surgical excision of uterus and vagina at the age of 2, due to sarcoma botryoides, underwent Creatsas vaginoplasty. A neovagina with adequate dimensions to allow comfortable sexual intercourse was created, without the need for postoperative dilations and without any complications. SUMMARY AND CONCLUSIONS: Creatsas vaginoplasty can be safely performed in patients with medical history of radical pelvic surgery, while other more invasive techniques may carry an increased risk of intra- or postoperative complications.

Evaluation and management of adolescent amenorrhea.

During the first years of menstruation it is not rare for a girl to present with an irregular menstrual pattern. The complete absence or cessation of menses, which is defined as amenorrhea, requires careful evaluation and management. It is divided into primary and secondary types that describe the occurrence of amenorrhea before and after menarche, respectively. The list of causes is long and includes anatomical or functional anomalies of the genital tract, hormonal disorders, and multifactorial reasons. The most common causes are hypothalamic amenorrhea, polycystic ovarian syndrome, hyperprolactinemia, and ovarian failure. A thorough medical history and careful clinical examination of the young girl is absolutely essential. The distinction between primary and secondary amenorrhea, together with the presence, or not, of secondary sexual characteristic development will guide the physician to the differential diagnosis of amenorrhea. Essential laboratory examinations include follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin measurements; while in the presence of acne or hirsutism, androgen levels should also be measured. Management should focus on the restoration of ovulatory cycles and the prevention of short- and long-term consequences of hormonal imbalance.