Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features.

To analyze the differences in risk factors and pregnancy outcomes between recurrent and initial pre-eclampsia(PE) with severe features. Data from recurrent (n = 128) and initial (n = 904) PE with severe features who terminated their pregnancy or gave birth at 20 weeks of gestation or later at the tertiary teaching hospital (Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital) from January 2016 to December 2022 were collected. Risk factors for recurrent PE with severe features and differences in pregnancy outcomes between the two groups were assessed using the chi-square test, student t-test, or nonparametric test. Independent risk factors for recurrent PE with severe features were further analyzed by logistic regression. (1) Logistic regression analysis identified 3 independent risk factors for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. In addition, assisted reproductive technology (ART) is an independent risk factor for initial PE with severe features; (2) The incidence of oligohydramnios, chorioamnionitis, preterm birth, stillbirth, fetal growth restriction (FGR) and abnormal umbilical blood flow was higher in the recurrent PE with severe features group than in the initial PE with severe features group(P < 0.05). In contrast, the incidence of premature rupture of membrane (PROM) and postpartum hemorrhage (PPH) was higher in the group of initial PE with severe features(P < 0.05); (3) In the recurrent PE with severe features group, gestational age(GA) of birth and birth weight were lower than those in the initial PE with severe features group(P < 0.05). Also, the incidence of mild asphyxia, the rate of neonatal intensive care unit (NICU) hospitalization, length of stay in NICU, and the rate of abandoning treatment in the recurrent PE with severe features group were higher than those in the initial PE with severe features group(P < 0.05). 3 independent risk factors was identified for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. Women with recurrent PE with severe features are more likely to have adverse perinatal outcomes than those with initial PE with severe features.

Selective Electrified Propylene-to-Propylene Glycol Oxidation on Activated Rh-Doped Pd.

Renewable-energy-powered electrosynthesis has the potential to contribute to decarbonizing the production of propylene glycol, a chemical that is used currently in the manufacture of polyesters and antifreeze and has a high carbon intensity. Unfortunately, to date, the electrooxidation of propylene under ambient conditions has suffered from a wide product distribution, leading to a low faradic efficiency toward the desired propylene glycol. We undertook mechanistic investigations and found that the reconstruction of Pd to PdO occurs, followed by hydroxide formation under anodic bias. The formation of this metastable hydroxide layer arrests the progressive dissolution of Pd in a locally acidic environment, increases the activity, and steers the reaction pathway toward propylene glycol. Rh-doped Pd further improves propylene glycol selectivity. Density functional theory (DFT) suggests that the Rh dopant lowers the energy associated with the production of the final intermediate in propylene glycol formation and renders the desorption step spontaneous, a concept consistent with experimental studies. We report a 75% faradic efficiency toward propylene glycol maintained over 100 h of operation.

Association between circulating unsaturated fatty acid and preeclampsia: a two-sample Mendelian randomization study.

OBJECTIVE: In recent years, several studies have reported an association between unsaturated fatty acids (UFAs) and the risk of developing preeclampsia; however, its exact causal effect is unclear. This study assessed the causal association between circulating UFAs and preeclampsia. METHODS: A two-sample Mendelian randomization (MR) study using publicly available genome-wide association study (GWAS) summary data for circulating UFA s (N = 114,999) and preeclampsia (N = 118,291) was performed. Single nucleotide polymorphisms (SNPs) significantly associated with exposure was selected as instrumental variables (IVs). The inverse variance weighted (IVW) test was used as the primary method for estimating causality in MR analysis, while MR pleiotropy residual sum and outlier (MR-PRESSO) and MR-Egger regression methods were used to assess horizontal pleiotropy. Cochran's Q test was used to evaluate heterogeneity among SNPs, and leave-one-out sensitivity analysis was used to determine the effect of individual SNPs on the results of the MR analysis. Bonferroni correction was used as a correction for multiple corrections. RESULTS: Two-sample MR analysis suggested that the ratio of monounsaturated fatty acids (MUFAs) to total fatty acids (OR 1.150, 95% CI 1.006-1.315, p = 0.041), the ratio of polyunsaturated fatty acids (PUFAs) to total fatty acids (OR 0.805, 95% CI 0.658-0.986, p = 0.036) and the ratio of PUFAs to MUFAs (OR 0.807, 95% CI 0.694-0.938, p = 0.005) were causally associated with preeclampsia. After Bonferroni correction, the causal association between the ratio of polyunsaturated to MUFAs and preeclampsia remained statistically different. CONCLUSIONS: This MR analysis provides evidence for a genetic causal association between circulating UFAs and preeclampsia.

Aspirin for the prevention of preeclampsia: A systematic review and meta-analysis of randomized controlled studies.

Background: The results of randomized controlled studies on aspirin for the prevention of preeclampsia (PE) are conflicting, and some of the related meta-analyses also have limitations or flaws. Data sources: A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, with no time or language restrictions. Study eligibility criteria: Randomized controlled studies comparing aspirin for the prevention of PE were conducted. Methods: Systematic reviews were performed according to the Cochrane Manual guidelines. A fixed-effects model or a random-effects model was chosen to calculate pooled relative risks with 95% confidence intervals based on the heterogeneity of the included studies. The study aimed to investigate the effect of aspirin on the development of PE in high-risk and general populations of women. Publication bias was assessed by funnel plots. All included studies were assessed for bias by the Cochrane Manual of Bias Assessment. Subgroup analyses were conducted on the aspirin dose, time of initial aspirin intervention, and the region in which the research was conducted, to explore the effective dose of aspirin and time of initial aspirin intervention and to try to find sources of heterogeneity and publication bias. Results: A total of 39 articles were included, including 29 studies involving pregnant women at high risk for PE (20,133 patients) and 10 studies involving a general population of pregnant women (18,911 patients). Aspirin reduced the incidence of PE by 28% (RR 0.72, 95% CI 0.62-0.83) in women at high risk for PE. Aspirin reduced the incidence of PE by 30% in the general population (RR 0.70, 95% CI 0.52-0.95), but sensitivity analyses found that aspirin in the general population was not robust. A subgroup analysis showed that an aspirin dose of 75 mg/day (RR 0.50, 95% CI 0.32-0.78) had a better protective effect than other doses. Starting aspirin at 12-16 weeks (RR 0.62, 95% CI 0.53-0.74) of gestation or 17-28 weeks (RR 0.62, 95% CI 0.44-0.89) reduced the incidence of PE by 38% in women at high risk for PE, but the results were more reliable for use at 12-16 weeks. Heterogeneity and publication bias of the included studies may be mainly due to the studies completed in Asia. Conclusion: Aspirin is recommended to be started at 12-16 weeks of pregnancy in women at high risk for PE. The optimal dose of aspirin to use is 75 mg/d. Systematic review registration: [www.ClinicalTrials.gov], identifier [CRD42022319984].

Analysis of risk factors related to extremely and very preterm birth: a retrospective study.

BACKGROUND: Preterm birth is one of the main causes of perinatal morbidity and mortality and imposes a heavy burden on families and society. The aim of this study was to identify risk factors and analyze birth conditions and complications of newborns born at < 32 gestational weeks for extremely preterm (EP) and very preterm (VP) birth in the clinic to further extend the gestational period. METHODS: We performed a retrospective cohort study and collected data from 1598 pregnant women and 1660 premature newborns (excluding 229 premature babies who died due to severe illness and abandonment) admitted to the Obstetrics and Gynecology Hospital Affiliated with Nanjing Medical University in China from 2016 to 2020. We compared women's and newborns' characteristics by t-tests and Chi-square tests for continuous and categorical variables, respectively. Multivariable logistic regression was performed to estimate the effects of risk factors on EP and VP birth. RESULTS: We identified 3 independent risk factors for EP birth: cervical incompetency (P < 0.001); multiple pregnancy (P < 0.01), primipara (P < 0.001). Additionally, we identified 4 independent risk factors for VP birth: gestational diabetes mellitus (GDM) (P < 0.05), preterm premature rupture of membrane (PPROM) (P < 0.01), fetal intrauterine distress (P < 0.001), and hypertensive disorder complicating pregnancy (HDCP) (P < 0.001). In addition, pairwise comparisons revealed statistically significant differences in the incidence rates of neonatal pneumonia, bronchopulmonary dysplasia (BPD) and sepsis between the 28-28 + 6 and 29-29 + 6 weeks of gestation groups (P < 0.05). Compared with 28-28 + 6 weeks of gestation, neonatal complications were significantly more common at < 26 weeks of gestation (P < 0.05). The incidence rates of neonatal intracranial hemorrhage(NICH), patent ductus arteriosus(PDA), patent foramen ovale(PFO), pneumonia, BPD and sepsis were significantly higher in the 26-26 + 6 and 27-27 + 6 gestational weeks than in the 28-28 + 6 gestational weeks (P < 0.05). CONCLUSION: PPROM, is the most common risk factor for EP and VP birth, and cervical insufficiency, multiple pregnancy, and primipara are independent risk factors for EP birth. Therefore, during pregnancy, attention should be devoted to the risk factors for PPROM, and reproductive tract infection should be actively prevented to reduce the occurrence of PPROM. Identifying the risk factors for cervical insufficiency, actively intervening before pregnancy, and cervical cervix ligation may be considered to reduce the occurrence of EP labor. For iatrogenic preterm birth, the advantages and disadvantages should be carefully weighed, and the gestational period should be extended beyond 28 weeks to enhance the safety of the mother and child and to improve the outcomes of preterm birth.

Correlation of placental thickness and placenta percreta in patients with placenta previa: findings from MRI.

INTRODUCTION: This study aimed to identify if placental thickness measured from MRI images correlated with placenta percreta in patients with placenta previa. METHODS: Placental thickness was retrospectively measured in 161 patients from July 2018 to August 2020. The measurements were performed at the thickest part of the placenta in the lower uterine segment on the mid-sagittal plane MR images by two independent radiologists. Intraoperative and pathologic findings were the standard of reference. Univariate and multivariate analyses were performed to identify the relationship between clinical features, placental thickness, and placenta percreta. The predictive ability of placental thickness was demonstrated using receiver operating characteristic curve analysis. RESULTS: Placental thickness in patients with placenta percreta was significantly higher than in patients with placenta increta, placenta accreta, and normal placentas (p < 0.05). Multivariate analysis revealed that placental thickness was the only independent risk factor for placenta percreta. The cutoff value of placental thickness was 4.35 cm for differentiating placenta percreta in patients with placenta previa. DISCUSSION: Patients with placenta percreta had the highest placental thickness. Placental thickness was correlated with placenta percreta.

The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders.

INTRODUCTION: This study aims to identify whether placental thickness and cervical length measured by MRI correlate with postpartum hemorrhage (PPH) in patients at high risk for placenta accreta spectrum (PAS) disorders. METHODS: The placental thickness and cervical length of 200 patients from October 2017 to October 2021 were retrospectively measured. The mid-sagittal plane of the placentas was measured by 2 independent radiologists using MRI. Partial correlation analysis was used to characterize the correlation between placental thickness, cervical length and estimated blood loss during surgery. The correlation between clinical features, placental thickness, cervical length and PPH was evaluated with univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. RESULTS: Placental thickness was positively correlated with the estimated blood loss during delivery, while cervical length had a negative correlation with it, based on the adjustment for gestational age. Multivariate analyses revealed that prior cesarean section, placenta previa, increased placental thickness(≧4.35 cm) and short cervical length（< 3.05 cm） were independent risk factors for PPH. When the 4 risk factors were combined together, the AUC was the highest, 0.773 (95%CI 0.707-0.840). DISCUSSION: Placental thickness and cervical length correlated with PPH. The nomogram constructed based on prior cesarean section, placenta previa, placental thickness and cervical length can be used to recognize patients with a higher risk of PPH.

Diffusion and perfusion MRI parameters in the evaluation of placenta accreta spectrum disorders in patients with placenta previa.

OBJECTIVES: To evaluate the placental function by monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in patients with placenta previa. METHODS: A total of 62 patients with placenta accreta spectrum (PAS) disorders and 11 patients with normal placentas were retrospectively enrolled, who underwent conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, mean kurtosis (MK), and diffusion coefficient (MD) from DKI, and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. RESULTS: Comparisons between patients with PAS disorders and patients with normal placentas demonstrated that MD mean, D mean, and D* mean values in patients with PAS disorders were significantly higher than those in patients with normal placentas (p < 0.05). Comparisons between patients with accreta, increta, and percreta, and patients with normal placentas showed that the D mean was significantly higher in patients with placenta increta and percreta than in patients with normal placentas (p < 0.05). CONCLUSION: The accreta lesions in PAS disorders had deceased cellularity and increased blood movement. The alteration of placental cellularity was more prominent in placenta increta and percreta.

Correlation of placental thickness and PAS disorders: findings from MRI.

OBJECTIVE: To identify if placental thickness measured from MRI images correlates with placenta accreta spectrum (PAS) disorders. METHODS: Placental thickness of 245 patients was retrospectively measured from October 2016 to March 2020. The measurement was made at the thickest portion of the placenta on the mid-sagittal plane of the placenta from MRI by two independent radiologists. Surgical report and pathology of the delivered placenta were used as a reference standard. Association between clinical features, placental thickness, and PAS disorders was evaluated with univariate and multivariate analyses. The inter-reader and intra-reader reproducibility of the measurements and receiver operating characteristic curve analysis were also performed. RESULTS: Placental thickness was significantly higher in patients with PAS disorders (3.45 cm) than that in patients without PAS disorders (2.90 cm) (p < 0.05). Multivariate analyses revealed that prior cesarean section, placenta previa, and placental thickness > 4 cm were independent risk factors for PAS disorders. The inter-reader and intra-reader reproducibility of placental thickness measurement were 0.979 (95% CI 0.960-0.989) and 0.981 (95% CI 0.9640-0.990), respectively. CONCLUSION: The reproducibility of the measurement made from MRI images was high between two radiologists. Patients with PAS disorders had increased placental thickness. Placental thickness > 4 cm correlated with PAS disorders.

Leaching characteristics and stability assessment of sequestered arsenic in flue dust based glass.

Arsenic (As), a toxicant, present in flue dust, tailings, and mine drainages generated from mineral processing and smelting processes represents high environmental risk due to its high mobility. Around 42-50% As is found in flue dust in the form of As2O3. The vitrification of As results in the formation of stable inert glass material and supposed to reduce the risk of As release to the environment. In this study, a glass material produced by vitrification of As bearing flue dust via DST GlassLock™ Process was received from Dundee Sustainable Technologies, Canada and was subjected for As stability assessment using United States Environmental Protection Agency (EPA) leaching methods-1311,1312,1313,1314,1315 and 1316. The released arsenic concentration was found to be less than the recommended TCLP hazardous waste limit for arsenic i.e., 5 mg/L in most of the test conditions. The experimental data were analyzed using LeachXS Lite™, a data management software that showed the goodness of the DST GlassLock™ Process for As stabilization and safe landfill deposition of the resulting product.

Green catalytic process for in situ oxidation of Arsenic(III) in concentrated streams using activated carbon and oxygen gas.

Arsenic(III) oxidation is a critical pre-treatment step for overall arsenic immobilization in concentrated industrial arsenic streams. Activated carbon (AC) catalysis is a green, economical and efficient method to oxidize As(III) from waters with high arsenic concentration prior to its removal through precipitation or adsorption. This research investigates AC-catalyzed oxidation process for oxidizing aqueous solutions of As(III) and proposed the possible reaction pathway. Batch tests were performed and efficient oxidation of 2.0 g/L acidic As(III) solution have been induced on AC surfaces in the presence of oxygen. The in-situ formation of reactive oxygen species on carbon surfaces and arsenic adsorption onto AC play important roles in As(III) oxidation. The kinetics of adsorption and catalyzed oxidation has been studied and the samples were characterized using ICP-OES, Zeta potential, TEM coupled with EDX and XPS techniques. A systematic reaction pathway was proposed, and reusability of AC has confirmed the economic viability of the proposed green process. This study offers a promising and facile solution for As(III) oxidation from waste water, mining and metal industrial waste streams under ambient conditions for arsenic immobilization.