Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome.

OBJECTIVE: To investigate the potential value of biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. METHODS: This was a screening study in 3953 singleton pregnancies at 35-37 weeks' gestation. Estimated fetal weight (EFW), uterine artery pulsatility index (UtA-PI), umbilical artery (UA)-PI, fetal middle cerebral artery (MCA)-PI, mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured. The detection rate (DR) and false-positive rate (FPR) of screening by each biomarker were estimated for pre-eclampsia (PE), delivery of small-for-gestational-age (SGA) neonates, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU). RESULTS: Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF, sFlt-1 and MAP, with a DR of 73% at a 10% FPR. Prediction of SGA was provided by EFW, PlGF and UtA-PI, with a DR of 63% at a 10% FPR. Prediction of Cesarean section for fetal distress before labor was provided by EFW and UA-PI with DR of 100% at 10% FPR. Prediction of fetal distress in labor was provided by EFW and sFlt-1, with a DR of 15% at a 10% FPR. There were no significant differences between those with a normal outcome and those with low cord blood pH, low Apgar score or NNU admission for any of the biomarkers assessed. CONCLUSION: At 35-37 weeks' gestation biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE, SGA and fetal distress before labor, but poor or no prediction of adverse events in labor or after birth.

Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.

OBJECTIVE: To investigate the potential value of biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. METHODS: This was a screening study in 8268 singleton pregnancies at 30-34 weeks' gestation. Estimated fetal weight (EFW), uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, fetal middle cerebral artery (MCA) PI, mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured. The detection rate (DR) and false-positive rate (FPR) of screening by each biomarker were estimated for stillbirth, pre-eclampsia, delivery of small-for-gestational-age (SGA) neonate, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤7.0 or umbilical venous cord blood pH ≤7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU). RESULTS: Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF, sFlt-1, MAP and MCA-PI, with a DR of 98% for PE delivering < 37 weeks' gestation and 56% for those delivering ≥ 37 weeks, at a 10% FPR. Prediction of SGA was provided by EFW, PlGF, sFlt-1, UtA-PI, UA-PI and MCA-PI, with a DR of 88% for SGA delivering < 37 and 51% for those delivering ≥ 37 weeks' gestation, at a 10% FPR. Prediction of stillbirth was provided by EFW, UtA-PI and MCA-PI, with DR of 30% at 10% FPR. Prediction of Cesarean section for fetal distress before labor was provided by EFW, sFlt-1, UtA-PI and UA-PI, with a DR of 90% at a 10% FPR. Prediction of fetal distress in labor was provided by EFW and sFlt-1, with a DR of 16% at a 10% FPR. There were no significant differences from the normal outcome group in any of the biomarkers for low cord blood pH, low Apgar score or NNU admission for cases other than those with PE and/or SGA. CONCLUSION: At 30-34 weeks' gestation, biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE, SGA and fetal distress before labor, but poor or no prediction of stillbirth and adverse events in labor or after birth.

Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.

OBJECTIVE: To investigate the potential value of uterine artery (UtA) Doppler at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. METHODS: This was a screening study in 30 780 singleton pregnancies at 30-34 weeks. UtA pulsatility index (UtA-PI) was measured and the values were converted to multiples of the median (MoM) after adjustment for variables relating to maternal characteristics and medical history that affect the measurements. Multivariable logistic regression analysis was used to determine if measuring UtA-PI improved the prediction of adverse perinatal outcome provided by screening with maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by UtA-PI were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1 and 5-min Apgar score < 7. RESULTS: The incidence of adverse perinatal outcome was higher in small-for-gestational-age (SGA) fetuses than in non-SGA fetuses, but the majority of cases with each adverse outcome were in the non-SGA group, including about 70% of stillbirths and more than 80% with Cesarean section for fetal distress, low cord blood pH and low Apgar score. The performance of UtA-PI > 95(th) percentile in screening for each adverse outcome was poor with DR of 6-16% and a FPR of 5-6%. The DR of adverse outcome when screening by high UtA-PI was greater in pregnancies complicated by SGA than in non-SGA pregnancies; 24% vs 13% for stillbirth, 15% vs 5% for Cesarean section for fetal distress, 30% vs 9% for low cord blood pH and 20% vs 3% for low 5-min Apgar score, respectively. CONCLUSION: High UtA-PI at 30-34 weeks' gestation may be useful in the prediction of adverse perinatal outcome in pregnancies with a SGA fetus, however, in the absence of SGA, UtA-PI is a poor predictor of adverse outcome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

UK NHS pilot study on cell-free DNA testing in screening for fetal trisomies: factors affecting uptake.

OBJECTIVE: This study reports on the clinical implementation of cell-free DNA (cfDNA) testing, contingent on the results of the combined test, in screening for fetal trisomies 21, 18 and 13 in two UK National Health Service hospitals. Women with a combined-test risk of ≥ 1:100 (high risk) were offered the options of chorionic villus sampling (CVS), cfDNA testing or no further testing and those with a risk of 1:101 to 1:2500 (intermediate risk) were offered cfDNA or no further testing. The objective of the study was to examine the factors affecting patient decisions concerning their options. METHODS: Combined screening was performed in 6651 singleton pregnancies in which the risk for trisomies was high in 260 (3.9%), intermediate in 2017 (30.3%) and low in 4374 (65.8%). Logistic regression analysis was used to determine which factors among maternal characteristics, fetal nuchal translucency thickness (NT) and risk for trisomies were significant predictors of opting for CVS in the high-risk group and opting for cfDNA testing in the intermediate-risk group. RESULTS: In the high-risk group, 104 (40.0%) women opted for CVS; predictors for CVS were increasing fetal NT and increasing risk for trisomies, while the predictor against CVS was being of Afro-Caribbean racial origin (r = 0.366). In the intermediate-risk group, 1850 (91.7%) women opted for cfDNA testing; predictors for cfDNA testing were increasing maternal age, increasing risk for trisomies and university education, while predictors against cfDNA testing were being of Afro-Caribbean racial origin, smoking and being parous (r = 0.105). CONCLUSIONS: This study has identified factors that can influence the decision of women undergoing combined screening in favor of or against CVS and in favor of or against cfDNA testing.

Multiscale modelling of heterogeneous fillers in polymer composites: the case of polyisoprene and carbon black.

The dispersion of inorganic particles within polymeric materials is an extensively used method to enhance their mechanical properties. One of the major challenges in the simulation of polymer composites is to model the uneven surface of the fillers which strongly affects the dynamics of the adsorbed polymers and consequently the macroscopic mechanical properties of the final composite. Here we propose a new multiscale approach that, using experimental adsorption data, constructs the filler surface to statistically reproduce the surface defects. We use this approach to analyse the structure and dynamics of highly entangled polyisoprene melt in contact with different realistic carbon black samples. We show that the presence of the heterogeneous surface has a negligible influence on the structure of the polymer chains but a major effect on their dynamics and the surface wettability.

Low adiponectin levels in primary hypertriglyceridemic male patients.

BACKGROUND AND AIMS: Adiponectin is an adipokine highly and specifically expressed by adipose cells with antiatherogenic and antiinflammatory activities. The aim of the present study was to evaluate plasma adiponectin concentration in patients with primary hypertriglyceridemia and its relationship with metabolic parameters. METHODS AND RESULTS: Male patients with primary hypertriglyceridemia and without the metabolic syndrome (n=22) were compared with normotriglyceridemic individuals (n=25). Plasma adiponectin concentration was measured by standardised enzyme-linked immunosorbent assay. Body mass index, waist circumference, glucose, insulin and non-esterified fatty acid levels, lipoprotein profile, and CETP activity were evaluated. Adiponectin levels were significantly decreased in hypertriglyceridemic patients in comparison with normotriglyceridemic subjects (4292+/-1717 vs. 6939+/-3249 ng/ml, p<0.005, respectively). Adiponectin was negatively associated with glucose (r=-0.44, p<0.01), insulin (r=-0.37, p<0.01), HOMA (r=-0.40, p<0.01), triglycerides (r=-0.36, p<0.01), VLDL-C (r=-0.34, p<0.05), and CETP (r=-0.47, p<0.001). Positive and significant correlations were observed with QUICKI (r=0.49, p<0.001) and HDL-C (r=0.33, p<0.05). In the multiple linear regression analysis, considering waist circumference, QUICKI, Log-triglycerides, HDL-C, and CETP as independent variables, Log-adiponectin showed a positive correlation with QUICKI, with an r(2)=0.229 and p<0.001. Therefore, the independent variable QUICKI explained the 23% of the variance in Log-adiponectin concentration. CONCLUSIONS: We found low adiponectin levels in a population of primary hypertriglyceridemic men without the metabolic syndrome and an independent relationship between adiponectin concentration and insulin resistance. A reduction in insulin sensitivity and its impact on adiponectin concentration could be linked to high non-esterified fatty acid levels, increased triglyceride synthesis in the liver and impaired catabolism of triglyceride-rich lipoproteins.

The application of a trajectory classification procedure to interpret air pollution measurements in the urban area of Naples (Southern Italy).

In this work we apply a trajectory classification approach, aiming at identifying the role exerted by meteorology on air quality in the Naples urban area (Southern Italy). Towards that end, the HYSPLIT (HYbrid Single-Particle Lagrangian Integrated Trajectory) model was used; backward trajectories were calculated for the period 1995-2004 and classified, based on a combination of the k-means and PCA (Principal Component Analysis) approaches. The robustness of the classification was strengthened using an ensemble approach, based on back-trajectories calculated for different (in the horizontal and vertical directions) arrival points around Naples and different arrival time. Eight clusters were identified, and the effects on air quality were evaluated. We focused on ozone and PM10 concentration, and evaluated to what extent the prevailing meteorological conditions were associated with different levels and temporal profiles of these two pollutants. We found that ozone and PM10 profiles share some similarities since they both load high during anti-cyclonic, subsiding conditions, a common situation during the summer months. During these days stagnation and recirculation effects enhance the concentration of locally emitted air pollutant. We also found that ozone exhibits a marked seasonal cycle, whose maxima appears during the summer season, but the discrimination with respect to the area of origin indicated the presence of a second relative maxima, appearing early during the spring season. PM10 pollution levels often exceed the annual limit of 50 microg/m(3). The days associated with a significant exogenous contribution from the North African countries were identified.

[Vigilance on health surveillance in wood sector]. / Vigilanza sulla sorveglianza sanitaria nel settore legno.

OBJECTIVES: A program to promote occupational health among wood dust workers in the district of Civitavecchia. METHODS: In recent years, occupational health physicians charged of medical surveillance of wood workers (Competent Physicians, CPs) had been invited to perform a peer-review of their methods and activities. In the present phase, CPs have been invited to show the result of their medical surveillance. RESULTS: One hundred forty seven wood workers were submitted to rhinoscopic examination. The prevalence of woodwork-related rhinitis and other pathologic signs, including nasal adenocarcinoma (one case), was 32.7%. The prevalence of rhinitis in woodworkers increased with years of working as a woodworker. CONCLUSION: Wood dust and chemical exposures in wood workers represent a serious risk of disease for the nasal cavity and paranasal sinuses.

Saturday night burns: an increasing problem?

In Italy the economic crisis has caused changes in behavior in daily as well as leisure activities. For instance, night clubs have changed both their scenography and what they can offer. From simply providing a place to dance, they can now offer more complex scenography with spectacular fireworks and lit cocktails. While this can be amazing for all of us it can also be another cause of burn injuries. We conducted a retrospective study of all burns patients admitted to the Accident and Emergency Department at CTO Hospital in Turin from 2009 to 2013, after a night clubbing. A total of five patients were identified with an average age of 20 years old: four were burned by flaming cocktails and one was burned by a firework. Two received outpatient treatment, while orotracheal intubation and admission were needed for three, and two required surgical debridement and resurfacing with split skin graft. All patients had permanent sequelae caused by pathologic scarring and/or dyschromia. Our findings show that the risk of burn injuries is higher at weekends, mainly in summer, if all correct safety procedures are not followed. Meanwhile it is important to highlight that the promotion of inappropriate behavior at night clubs during firework displays and the passing of flaming cocktails should be avoided.

En Italie la crise économique a entraîné des changements dans le comportement de tous les jours ainsi que des activités de loisirs. Par exemple, les boîtes de nuit ont changé à la fois leur scénographie et ce qu'ils peuvent offrir. D'abord ils fournissaient simplement un endroit pour danser, mais ils peuvent désormais offrir une scénographie plus complexe avec des feux d'artifice spectaculaires et des cocktails éclairés. Même si cela peut être amusant pour nous tous, il peut aussi être une autre cause de brûlures. Nous avons mené une étude rétrospective de tous les patients brûlés admis à l'hôpital CTO de Turin de 2009 à 2013, après une nuit dans une boîte. Les patients identifiés étaient cinq jeunes avec un âge moyen de 20 ans: quatre ont été brûlés par des cocktails enflammés et un a été brûlé par un feu d'artifice. Deux ont reçu un traitement ambulatoire, trois ont reçu l'intubation orotrachéale et l'admission de prévention, et deux ont reçu un débridement chirurgical et avec les greffes de peau. Tous les patients avaient des séquelles permanentes causées par la cicatrisation et / ou dyschromie pathologique. Nos résultats montrent que le risque de brûlure est plus élevé le week-end, surtout en été, si toutes les procédures de sécurité appropriées ne sont pas suivies. Il est important de souligner que la promotion d'un comportement inapproprié dans les boîtes de nuit pendant les feux d'artifice et le passage de cocktails flambés doit être évitée.

Effects of prolonged picotamide therapy on platelet activity in patients with peripheral arterial disease.

An open study was carried out in 14 patients with peripheral arterial disease to investigate the effects of prolonged therapy with picotamide on platelet activity. Patients received daily oral doses of 900 mg picotamide for 1 month, 600 mg per day during the second month and 300 mg per day from the third to the sixth month of the study. Measurements were made before and during therapy of blood coagulation parameters and factors influencing platelet function, i.e. plasma beta-thromboglobulin and serum thromboxane B2. The results showed that there were no significant variations in platelet count, prothrombin time, partially activated thromboplastin time, presence and amount of fibrinogen in blood, and antithrombin III. Examination for fibrinogen degradation products was constantly negative and unaltered during therapy. Although plasma beta-thromboglobulin values did not vary significantly, there was a significant and progressive reduction throughout treatment in serum levels of thromboxane B2.

Fully "Recombinant Enzyme-Linked Immunosorbent Assays" Using Genetically Engineered Single-Chain Antibody Fusion Proteins for Detection of Citrus tristeza virus.

ABSTRACT Recombinant single-chain variable fragment antibodies (scFv) that bind specifically to Citrus tristeza virus (CTV), which cause the most detrimental viral disease in the citrus industry worldwide, were obtained from the hybridoma cell lines 3DF1 and 3CA5. These scFv were genetically fused with dimerization domains as well as with alkaline phosphatase, respectively, and diagnostic reagents were produced by expressing these fusion proteins in bacterial cultures. The engineered antibodies were successfully used for CTV diagnosis in plants by tissue print enzyme-linked immunosorbent assay (ELISA) and double antibody sandwich-ELISA. The fully recombinant ELISAs were as specific and sensitive as conventional ELISAs performed with the parental monoclonal antibodies, showing the usefulness of recombinant antibodies for routine detection of a virus in woody plants for the first time.

Fatal septicaemia due to Listeria monocytogenes in a patient with systemic lupus erythematosus receiving cyclosporin and high prednisone doses.

Cyclosporin A is widely used in organ transplantation, preventing the rejection of multiple types of organ allografts. It is also being increasingly used as an immunosuppressive agent to treat various autoimmune diseases in patients refractory to more commonly used immunosuppressive therapy. Several trials are currently evaluating the utility of this drug associated with corticosteroids in the treatment of systemic lupus erythematosus. This case, describing a lethal septicaemia caused by Listeria monocytogenes in a patient receiving this treatment, seems to indicate that the use of these "cocktails" of immunosuppressive drugs should be particularly cautious to prevent fatal infectious complications.

Estimation of global motion parameters by complex linear regression.

Global motion is very likely to occur in image sequences analysis. For example, it arises if the observer is moving during the sequence acquisition (ego-motion). Our aim is to get a simple method to estimate in a reliable may a set of parameters that can take into account the presence of a global motion component, using only local information. The novelty of our approach is in regarding spatial shift, change of scale, and rotation (corresponding to usual camera effects such as pan and zoom) as a two-dimensional (2-D) Doppler effect. The mathematical treatment is carried on in the complex plane, so that the results can be easily deduced as an extension of the one-dimensional (1-D) case; in this way, we obtain simple expressions, well suited for a practical realization of the estimate. The method has been experimentally validated by both real pictures with a synthetic motion and real image sequences.

Femoral nerve palsy secondary to anticoagulant induced iliacus hematoma. A case report.

A case of femoral neuropathy from iliac muscle hematoma occurring in a patient treated with urokinase, subcutaneous heparin and aspirin for myocardial infarction is reported. Diagnosis of this complication was suspected on the basis of clinical signs and on the fact that the patient had received anticoagulants. Computed tomography allowed direct and clear visualization of the hematoma. Anticoagulant suspension followed by an early surgical decompression seems to be the ideal treatment for this neuropathy; however, our patient died for a reinfarction after stopping heparinic administration. This may indicate that, in some patients "at risk", it is better to reduce rather than stop anticoagulant therapy.

[Myocardial damage and pheochromocytoma. Description of 2 cases and review of the literature]. / Danno miocardico e feocromocitoma. Descrizione di due casi e revisione della letteratura.

The usual presentation of phaeochromocytoma is well known. It is a catecholamine producing tumor of the sympathochromaffin system that typically cause sustained hypertension or hypertensive crisis. Rarely it has an uncommon clinical presentation with or without arterial hypertension and so the most significant symptoms are episodes of left ventricular failure, arrhythmias, ischemic ECG changes, angina pectoris, myocardial infarction, hypertrophic or dilated cardiomyopathy. On report two cases of uncommon presentation of phaeochromocytoma and a few cases of myocardial damage from the literature are reviewed.

[A rare case of recurrent meningitis: intranasal encephalocele]. / Una rara causa di meningiti recidivanti: l'encefalocele intranasale.

Intranasal meningoencephalocele is a rare malformation characterized by a protrusion of brain tissue and meninges out of the cranial cavity into the nose, through a discontinuity of the ethmoidal cribriform plate. It is a congenital anomaly but it may be also due to trauma or to chronic intracranial hypertension. It is clinically apparent as a small mass that may be confused with nasal polyp. A cerebrospinal fluid leakage may be present. In a few cases it gives no symptoms until adulthood, but usually recurrent meningitis may occur. A case of young woman with intranasal encephalomeningocele who suffered from 18 episodes of meningitis is reported. Nevertheless she is at present without neurological consequences.

[Recovery from from Listeria monocytogenes meningitis in an adult]. / Meningite da Listeria monocytogenes ad esito in guarigione in adulto.

The authors describe a case of meningitis by Listeria monocytogenes from which the patient, an adult suffering from a chronic lymphatic leukosis, recovered completely. Both the immune-suppressor treatment and the basic lymphoproliferative disease may have given rise to this infective disease. The diagnosis has been obtained by isolating the germ in liquor-cultures. We want to point out the importance of a specific and early antibiotic treatment.

Millimetric cover test--a linear strabismometric technique.

In ten normal subjects we measured the angular rotations of the globe, both in adduction and in abduction, corresponding to limbus shifts from 1 to 7 mm. Our study demonstrated that to each millimeter of temporal limbus shift corresponds an average adduction of about 4.6 degrees and to each millimeter of nasal limbus shift an average abduction of about 4.8 degrees. These experimental results give a sound foundation to the clinical evaluation of the strabismic angle by measuring, with a millimeter ruler, the limbus shift of the nonfixating eye by assuming fixation. This technique appears particularly useful as a substitute for the simultaneous prism and cover test, in the evaluation of a squint with a variable angle, and in measurements in other positions of gaze.

[Acute gastric volvulus]. / Il volvolo gastrico acuto.

Gastric volvulus is an uncommon condition in which a torsion of the stomach results in acute or chronic gastrointestinal symptoms. We report a case of an intrathoracic organo-axial gastric volvulus secondary to a hiatal hernia. The patient died after surgery. Even though it was a surgical emergency, the patient was admitted to a Medical Department because she was regularly examined by the Digestive Endoscopy Unit for a hiatal hernia. The Authors emphasize the contribution of endoscopy to the preoperative recognition of this condition.

[The evaluation of in-hospital precoronary times. The experience of a department of emergency medicine]. / Valutazione dei tempi precoronarici intraospedalieri. Esperienza di un dipartimento di medicina d'urgenza.

The above study was aimed at evaluating the "in-hospital precoronary times" of patients with acute myocardial infarction presenting to the Emergency Department of Policlinico Umberto I, Rome. From April to August 1993, 58 cases of acute myocardial infarction were admitted. In six of these, over 24 hrs had elapsed before admission. In 24 of the remaining cases thrombolysis was indicated. Mean time before admission to the coronary unit was 5 hrs for 52 patients. Mean in-hospital delay before starting thrombolysis was 40 +/- 20 minutes; mean delay before admission to the coronary unit was 3 h/45 min. In-hospital time before thrombolysis was one of the lowest in the literature and shows the efficient organization of the department. Delay until transfer to the coronary unit was long and is a sign of the paucity of these specialized beds. Therefore, the possibility to perform thrombolytic therapy immediately in the emergency department becomes even more essential.