Prediction of gestational diabetes mellitus and perinatal outcomes by plasma zonulin levels.

PURPOSE: Zonulin has been shown to be associated with many metabolic disorders, including type 2 diabetes mellitus, metabolic syndrome, and obesity. In this study, we aimed to evaluate the association between maternal plasma zonulin levels and gestational diabetes mellitus (GDM) and its perinatal outcomes. MATERIALS: A total of 100 pregnant women, 56 with GDM and 44 controls, were included in this prospective case-control study. Maternal plasma zonulin levels were evaluated in each trimester. The association between zonulin levels and GDM, body mass index (BMI) and adverse perinatal outcomes was evaluated. The GDM predictability of zonulin levels for each trimester was analyzed with the receiver operator curve (ROC). RESULTS: Plasma zonulin levels were significantly higher in pregnant with GDM in all trimesters (p < 0.001; for all). Optimum cut-off values of plasma zonulin levels in predicting GDM: first trimester: 6.27 ng/mL, second trimester: 12.71 ng/mL, and third trimester: 18.38 ng/mL. BMI was significantly higher in pregnant women with GDM (30.5 vs 26.1; p < 0.001). Zonulin levels were significantly higher in pregnant women with GDM with overweight BMI [≥ 25-30 (kg/m2)] in all trimesters (p < 0.05; for all). Zonulin levels were significantly higher in pregnant women with composite adverse outcomes that included at least one of neonatal intensive care unit (NICU) admission, meconium-stained amniotic fluid, and 1st minute APGAR score < 7. CONCLUSION: Increased maternal plasma zonulin levels were associated with increased risk of GDM and adverse perinatal outcomes. Zonulin may be a potential marker to predict GDM risk and perinatal outcomes.

Microfluidic EDGE emulsification: the importance of interface interactions on droplet formation and pressure stability.

The fact that interactions of components with interfaces can influence processes is well-known; e.g. deposit accumulation on heat exchangers and membrane fouling lead to additional resistances against heat and mass transfer, respectively. In microfluidic emulsification, the situation is even more complex. Component accumulation at the liquid/liquid interface is necessary for emulsion stability, while undesired at the solid/liquid interface where it may change wettability. For successful emulsification both aspects need to be controlled, and that is investigated in this paper for o/w emulsification with microfluidic EDGE devices. These devices were characterised previously, and can be used to detect small wettability changes through e.g. the pressure stability of the device. We used various oil/emulsifier combinations (alkanes, vegetable oil, surfactants and proteins) and related droplet size and operational pressure stability to component interactions with the solid surface and liquid interface. Surfactants with a strong interaction with glass always favour emulsification, while surfactants that have week interactions with the surface can be replaced by vegetable oil that interacts strongly with glass, resulting in loss of emulsification. Our findings clearly show that an appropriate combination of construction material and emulsion components is needed to achieve successful emulsification in microfluidic EDGE devices.

Linking Findings in Microfluidics to Membrane Emulsification Process Design: The Importance of Wettability and Component Interactions with Interfaces.

In microfluidics and other microstructured devices, wettability changes, as a result of component interactions with the solid wall, can have dramatic effects. In emulsion separation and emulsification applications, the desired behavior can even be completely lost. Wettability changes also occur in one phase systems, but the effect is much more far-reaching when using two-phase systems. For microfluidic emulsification devices, this can be elegantly demonstrated and quantified for EDGE (Edge-base Droplet GEneration) devices that have a specific behavior that allows us to distinguish between surfactant and liquid interactions with the solid surface. Based on these findings, design rules can be defined for emulsification with any micro-structured emulsification device, such as direct and premix membrane emulsification. In general, it can be concluded that mostly surface interactions increase the contact angle toward 90°, either through the surfactant, or the oil that is used. This leads to poor process stability, and very limited pressure ranges at which small droplets can be made in microfluidic systems, and cross-flow membrane emulsification. In a limited number of cases, surface interactions can also lead to lower contact angles, thereby increasing the operational stability. This paper concludes with a guideline that can be used to come to the appropriate combination of membrane construction material (or any micro-structured device), surfactants and liquids, in combination with process conditions.

Partitioned EDGE devices for high throughput production of monodisperse emulsion droplets with two distinct sizes.

We present a novel microfluidic EDGE (Edge based Droplet GEneration) device with regularly spaced micron-sized partitions, which is aimed at upscaling of o/w emulsion preparation. By this means, remarkably higher pressure stability was obtained, and two orders of magnitude higher droplet formation frequency was achieved compared to regular EDGE devices. Interestingly, we observed two different monodisperse droplet formation regimes for plateaus that were 2 micrometres in height, and to the best of our knowledge, no other microfluidic device has this ability. The average diameters of the droplets were 9 and 28 µm, both with a coefficient of variation (CV) below 5%. Based on the experimental throughput and a plausible mass parallelization scenario, the amount of hexadecane that can be emulsified is estimated to be between 6 and 25 m(3) m(-2) h(-1) depending on the required droplet size. With its high throughput potential and ability to produce uniform droplets of two different sizes, the partitioned EDGE device is promising for industrial emulsion production.

Effect of surface wettability on microfluidic EDGE emulsification.

The effect of wettability on microfluidic EDGE emulsification was investigated at dispersed phase contact angles between 90° and 160°. The highest contact angle (160°) produced monodispersed emulsions with droplet size 5.0 µm and coefficient of variation <10%; however, pressure stability was very low. This was greatly enhanced at contact angles <150°; the plateaus filled completely, and the droplet generation frequencies increased up to a factor of 2.0 and 3.5 for Tween20 and Tween60 respectively at the same pressures. The emulsion became highly polydispersed at contact angles <100° due to wetting with the dispersed phase.

[Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure]. / Akut kalp yetersizligi nedeni ile kardiyoloji yogun bakim ünitesine yatirilan hastalarin klinik ve demografik özelliklerinin ve bu özelliklerin hastanede kalis süresi ile iliskisinin incelenmesi.

OBJECTIVE: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF) admitted to cardiac intensive care unit (ICU) are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population. METHODS: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA) was used to determine the factors affecting the length of hospital stay. RESULTS: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF). In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [ß=1.62; 95% CI 0.08-3.15; p=0.039)] and severe mitral regurgitation (ß=2.55; 95% CI 0.06-5.05; p=0.045) and systolic blood pressure (ß=-0.03; 95% CI -0.06 - -0.002; p=0.039) and blood urea nitrogen (ß=0.034; 95% CI 0.006 - 0.06; p=0.016) were the independent predictors of length of stay. CONCLUSION: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome.