Clinical management of hypertensive disorders in postpartum women.

Hypertensive disorders of pregnancy (HDP) could persist post-partum, or appear for the first time after delivery and could require a pharmacological treatment. It was found no evidence in literature about which therapy should be used in puerperal hypertension. The aim of this review is to determine the most effective therapy and best in terms of risk-benefit ratio for the treatment of high postpartum systemic arterial blood pressure in women with pregnancy-induced hypertension (PIH) or in those with de-novo diagnosis of hypertension in the puerperium. Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CCRCT), Embase, Medline, and PubMed were searched. The main inclusion criterion was articles regarding postnatal women with hypertension, therapeutic treatment for the management of hypertension compared with placebo or no therapy, with the exclusion of preeclampsia/eclampsia. Twenty-three studies were included. This review highlights significant evidence gaps, demonstrating that further comparative research is required, particularly to clarify postpartum antihypertensive selection. In conclusion, there is insufficient evidence to recommend a particular therapy or model of care, but calcium channel blockers, beta-blockers, alpha-blockers and angiotensin-converting enzyme inhibitors (ACEIs) appeared variably effective.

Quantum gravitational decoherence from fluctuating minimal length and deformation parameter at the Planck scale.

Schemes of gravitationally induced decoherence are being actively investigated as possible mechanisms for the quantum-to-classical transition. Here, we introduce a decoherence process due to quantum gravity effects. We assume a foamy quantum spacetime with a fluctuating minimal length coinciding on average with the Planck scale. Considering deformed canonical commutation relations with a fluctuating deformation parameter, we derive a Lindblad master equation that yields localization in energy space and decoherence times consistent with the currently available observational evidence. Compared to other schemes of gravitational decoherence, we find that the decoherence rate predicted by our model is extremal, being minimal in the deep quantum regime below the Planck scale and maximal in the mesoscopic regime beyond it. We discuss possible experimental tests of our model based on cavity optomechanics setups with ultracold massive molecular oscillators and we provide preliminary estimates on the values of the physical parameters needed for actual laboratory implementations.

Caesarean Section on Maternal Request: An Italian Comparative Study on Patients' Characteristics, Pregnancy Outcomes and Guidelines Overview.

In recent years, the rate of caesarean sections has risen all over the world. Accordingly, efforts are being made worldwide to understand this trend and to counteract it effectively. Several factors have been identified as contributing to the selection of caesarean section (CS), especially an obstetricians' beliefs, attitudes and clinical practices. However, relatively few studies have been conducted to understand the mechanisms involved, to explore influencing factors and to clearly define the risks associated with the caesarean section on maternal request (CSMR). This comparative study was conducted to elucidate the factors influencing the choice of CSMR, as well as to compare the associated risks of CSMR to CS for breech presentation among Italian women. From 2015 to 2018, a total of 2348 women gave birth by caesarean section, of which 8.60% (202 women) chose a CSMR. We found that high educational attainment, use of assisted reproductive technology, previous operative deliveries and miscarriages within the obstetric history could be positively correlated with the choice of CSMR in a statistically significant way. This trend was not confirmed when the population was stratified based on patients' characteristics, obstetric complications and gestational age. Finally, no major complications were found in patients that underwent CSMR. We believe that it is essential to evaluate patients on a case-by-case basis. It is essential to understand the personal experience, to explain the knowledge available on the subject and to ensure a full understanding of the risks and benefits of the medical practice to guarantee the patients not only their best scientific preparation but also human understanding.

Casimir effect in quadratic theories of gravity.

In this paper, we study the Casimir effect in a curved spacetime described by gravitational actions quadratic in the curvature. In particular, we consider the dynamics of a massless scalar field confined between two nearby plates and compute the corresponding mean vacuum energy density and pressure in the framework of quadratic theories of gravity. Since we are interested in the weak-field limit, as far as the gravitational sector is concerned we work in the linear regime. Remarkably, corrections to the flat spacetime result due to extended models of gravity (although very small) may appear at the first-order of our perturbative analysis, whereas general relativity contributions start appearing at the second order. Future experiments on the Casimir effect might represent a useful tool to test and constrain extended theories of gravity.

Cardiomyopathies due to homoplasmic mitochondrial tRNA mutations: morphologic and molecular features.

Isolated hypertrophic cardiomyopathy may represent the sole clinical feature of a mitochondrial disorder in adult patients. The clinical outcome is characterized by a rapid progression to dilation and failure. A mitochondrial etiology in these cases is not obvious at clinical investigation and may represent an unexpected finding at autopsy or after cardiac transplant. We describe the morphologic, biochemical, and molecular features of hearts from 3 transplanted patients with isolated mitochondrial cardiomyopathy caused by homoplasmic mutations in the MTTI gene, coding for mitochondrial isoleucine tRNA (mt-tRNA(Ile)). On gross examination, the 3 hearts showed a symmetric pattern of hypertrophy. At histology, cardiomyocytes were hypertrophic and showed sarcoplasmic vacuoles filled with granules that stain with antimitochondrial antibodies. On frozen sections, the combined cytochrome c oxidase (COX)/succinate dehydrogenase stain showed a large prevalence of COX-deficient cardiomyocytes. Mitochondrially encoded COX subunit I was almost absent on immunohistochemistry, whereas the nuclear-encoded COX subunit IV was normally expressed. Ultrastructural analysis confirmed the marked mitochondrial proliferation. Biochemical studies of cardiac homogenates revealed a combined respiratory chain defect. Quantitative restriction fragment length polymorphism analysis of DNA from cardiac homogenate confirmed that the mt-tRNA mutations were also detected in the patient's blood. High-resolution Northern blot analysis showed a marked decrease in the steady-state level of mt-tRNA(Ile), confirming pathogenicity. In conclusion, pathologists play a major role in unraveling the mitochondrial etiology of isolated hypertrophic cardiomyopathies, provided that a detailed diagnostic flowchart is followed. Once the mitochondrial etiology is clearly defined, molecular analyses on the heart are an invaluable tool to assign mutation pathogenicity.