Prediction of pre-eclampsia in twin pregnancy by maternal factors and biomarkers at 11-13 weeks' gestation: data from EVENTS trial.

OBJECTIVES: First, to validate a previously developed model for screening for pre-eclampsia (PE) by maternal characteristics and medical history in twin pregnancies; second, to compare the distributions of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A) in twin pregnancies that delivered with PE to those in singleton pregnancies and to develop new models based on these results; and, third, to examine the predictive performance of these models in screening for PE with delivery at < 32 and < 37 weeks' gestation. METHODS: Two datasets of prospective non-intervention multicenter screening studies for PE in twin pregnancies at 11 + 0 to 13 + 6 weeks' gestation were used. The first dataset was from the EVENTS (Early vaginal progesterone for the preVention of spontaneous prEterm birth iN TwinS) trial and the second was from a previously reported study that examined the distributions of biomarkers in twin pregnancies. Maternal demographic characteristics and medical history from the EVENTS-trial dataset were used to assess the validity of risks from our previously developed model. The combined data from the first and second datasets were used to compare the distributional properties of log10 multiples of the median (MoM) values of UtA-PI, MAP, PlGF and PAPP-A in twin pregnancies that delivered with PE to those in singleton pregnancies and develop new models based on these results. The competing-risks model was used to estimate the individual patient-specific risks of delivery with PE at < 32 and < 37 weeks' gestation. Screening performance was measured by detection rates (DR) and areas under the receiver-operating-characteristics curve. RESULTS: The EVENTS-trial dataset comprised 1798 pregnancies, including 168 (9.3%) that developed PE. In the validation of the prior model based on maternal characteristics and medical history, calibration plots demonstrated very good agreement between the predicted risks and the observed incidence of PE (calibration slope and intercept for PE < 32 weeks were 0.827 and 0.009, respectively, and for PE < 37 weeks they were 0.942 and -0.207, respectively). In the combined data, there were 3938 pregnancies, including 339 (8.6%) that developed PE and 253 (6.4%) that delivered with PE at < 37 weeks' gestation. In twin pregnancies that delivered with PE, MAP, UtA-PI and PlGF were, at earlier gestational ages, more discriminative than in singleton pregnancies and at later gestational ages they were less so. For PAPP-A, there was little difference between PE and unaffected pregnancies. The best performance of screening for PE was achieved by a combination of maternal factors, MAP, UtA-PI and PlGF. In screening by maternal factors alone, the DR, at a 10% false-positive rate, was 30.6% for delivery with PE at < 32 weeks' gestation and this increased to 86.4% when screening by the combined test; the respective values for PE < 37 weeks were 24.9% and 41.1%. CONCLUSIONS: In the assessment of risk for PE in twin pregnancy, we can use the same prior model based on maternal characteristics and medical history as reported previously, but in the calculation of posterior risks it is necessary to use the new distributions of log10 MoM values of UtA-PI, MAP and PlGF according to gestational age at delivery with PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Grafted nanocellulose and alkaline nanoparticles for the strengthening and deacidification of cellulosic artworks.

HYPOTHESIS: Strongly degraded cellulosic artworks usually need deacidification and consolidation. Alkaline nanoparticles are known to be effective in neutralizing the acidity, while cellulose nanocrystals have the potential to be used as compatible and effective strengthening agents. EXPERIMENTS: We have grafted cellulose nanocrystals with oleic acid using a 1'1-carbonyldiimidazole-mediated procedure, to increase their dispersibility in organic solvents, and synthesized Ca(OH)2 or CaCO3 nanoparticles via a solvothermal process. Grafted nanocellulose and alkaline nanoparticles were used to prepare ethanol-based "hybrids". Prior to the application, the physico-chemical properties of nanocellulose dispersions and "hybrids" were studied by rheology and small-angle X-ray scattering. FINDINGS: Cellulose nanocrystals were effectively grafted and stably dispersed in ethanol. It was shown that the use of ethanol as a dispersing medium, and the addition of alkaline nanoparticles act in a synergistic way, increasing the interactions between grafted cellulose nanocrystals, leading to the formation of clusters. These dispersions are thixotropic, a behavior particularly appealing to conservation purposes, since they can be applied in the liquid state, or, when a more confined application is required, they can be applied in a gel-like state. As a result of the application, an improvement in the mechanical properties of paper and an increase of pH were obtained.

Updated clinical overview on cardiac laminopathies: an electrical and mechanical disease.

Cardiac laminopathies, associated with mutations in the LMNA gene, encompass a wide spectrum of clinical manifestations, involving electrical and mechanical alterations of cardiomyocytes. Thus, dilated cardiomyopathy, bradyarrhythmias and atrial or ventricular tachyarrhythmias may occur in a number of combined phenotypes. Nowadays, some attempt has been made to identify clinical predictors for the most life-threatening complications of LMNA-associated heart disease, i.e. sudden cardiac death and end-stage heart failure. The goal of this manuscript is to combine the most recent evidences in an updated review to show the state-of-the-art of such a complex disease group. This is supposed to be the starting point to collect more data and design new ad hoc studies to identify clinically useful predictors to stratify risk in mutation carriers, including probands and their asymptomatic relatives.

[Usefulness of psychometric evaluation in the care of psychiatric patients: evaluation of the Italian version of "Nurses Observation Scale for Inpatient Observation" (N.O.S.I.S)]. / Utilità di una valutazione psicometrica nell'assistenza infermieristica del paziente psichiatrico: studio di validazione della versione italiana della "nurses' observation scale for in patient evaluation" (n.o.s.i.s.).

We carried out a validation study of the Italian version of the "Nurses' Observation Scale for Inpatient Evaluation" (It. v. N.O.S.I.E). The It. v. N.O.S.I.E. was administered to a heterogeneous department. Factor analysis revealed six factors underlying the scale structure (Social interest, Neatness, Irritability, Psychosis, Retardation, Competence): the result is similar to those of other previously published studies. The It. v. of N.O.S.I.E. can be considered a valid instrument useful for the nursing staff in the formulation of individual care plans for inpatients.