Decarbonizing real estate portfolios considering optimal retrofit investment and policy conditions to 2050.

Retrofitting existing buildings is crucial for achieving Net Zero emissions. Institutional real estate owners play a key role because of their significant ownership, especially of large buildings. We utilize an interdisciplinary approach to evaluate cost-optimal decarbonization conditions for three Swiss real estate portfolios owned by a global institutional investor. We leverage a bottom-up optimization framework for building asset retrofitting, scaled to the portfolio-level, to study the effect of policy scenarios and implementations. Results indicate that achieving Net Zero necessitates significant investments, largely through thermal energy efficiency measures and low-CO2 energy systems, as early as possible to avoid locked-in emissions. Owners will be challenged to smooth long-term capital investments, pointing to a potential liquidity crisis. Consequently, hard-to-decarbonize assets are unable to reach regulatory benchmarks largely because of lingering embodied emissions. To lower transition risk, we recommend that policymakers move toward average CO2 benchmarks at the real estate portfolio-level, emulating automotive fleets.

The role of endoglin and its soluble form in pathogenesis of preeclampsia.

Preeclampsia remains till today a leading cause of maternal and fetal morbidity and mortality. Pathophysiology of the disease is not yet fully elucidated, though it is evident that it revolves around placenta. Cellular ischemia in the preeclamptic placenta creates an imbalance between angiogenic and anti-angiogenic factors in maternal circulation. Endoglin, a transmembrane co-receptor of transforming growth factor ß (TGF-ß) demonstrating angiogenic effects, is involved in a variety of angiogenesis-dependent diseases with endothelial dysfunction, including preeclampsia. Endoglin expression is up-regulated in preeclamptic placentas, through mechanisms mainly induced by hypoxia, oxidative stress and oxysterol-mediated activation of liver X receptors. Overexpression of endoglin results in an increase of its soluble form in maternal circulation. Soluble endoglin represents the extracellular domain of membrane endoglin, cleaved by the action of metalloproteinases, predominantly matrix metalloproteinase-14. Released in circulation, soluble endoglin interferes in TGF-ß1 and activin receptor-like kinase 1 signaling pathways and inhibits endothelial nitric oxide synthase activation, consequently deranging angiogenesis and promoting vasoconstriction. Due to these properties, soluble endoglin actively contributes to the impaired placentation observed in preeclampsia, as well as to the pathogenesis and manifestation of its clinical signs and symptoms, especially hypertension and proteinuria. The significant role of endoglin and soluble endoglin in pathophysiology of preeclampsia could have prognostic, diagnostic and therapeutic perspectives. Further research is essential to extensively explore the potential use of these molecules in the management of preeclampsia in clinical settings.

Soluble endoglin concentration in maternal blood as a diagnostic biomarker of preeclampsia: A systematic review and meta-analysis.

OBJECTIVE: Preeclampsia is a main cause of maternal and fetal morbidity and mortality. Research about maternal circulating diagnostic biomarkers is continuously performed, often with conflicting results that necessitate quantitative synthesis. Objective of this meta-analysis is to examine the value of soluble endoglin as predictor of preeclampsia separately at each pregnancy trimester, therefore exploring its potential usage as diagnostic biomarker in preeclampsia. STUDY DESIGN: This systematic review and meta-analysis adhered to PRISMA and MOOSE guidelines. MEDLINE, SCOPUS, Cochrane CENTRAL and ClinicalTrials.gov were searched up to April 20, 2020. Included studies were those comparing soluble endoglin levels in maternal serum or plasma at any pregnancy trimester, between women who subsequently developed preeclampsia and normotensive pregnant women being low-risk for preeclampsia development. Primary outcome was development of preeclampsia, while soluble endoglin levels in 1 st, 2nd and 3rd trimester of pregnancy were examined as possible predictors of preeclampsia. Subgroup analysis was performed regarding time of preeclampsia onset (early, late). Methodological quality of included studies was assessed using Newcastle-Ottawa scale. Overall quality of evidence for primary and secondary outcomes was evaluated using GRADEpro GD tool. RESULTS: There were overall 20 studies included in meta-analysis, enrolling 1146 preeclamptic and 1675 normotensive pregnant women. Soluble endoglin concentration (ng/mL) was significantly higher in preeclamptic women during 2nd (8 studies, MD:5.554, 95 %CI:2.671-8.436, P < .001, I2 = 97 %) and 3rd trimester (12 studies, MD:31.006, 95 %CI:24.734-37.278, P < .001, I2 = 98 %). Levels were also higher during 1st trimester; however, the difference was marginally not significant (MD:1.105, 95 %CI: -0.071 to 2.282, P = .06, I2 = 64 %). Furthermore, levels were significantly higher both in early-onset and late-onset preeclamptic vs normotensive pregnancies, (4 studies, MD:51.611, 95 %CI:2.250-100.972, P = .04, I2 = 97 %), (5 studies, MD:12.426, 95 %CI:7.863-16.989, P < .001, I2 = 98 %) respectively. However, when comparing directly early and late-onset preeclamptic women, no significant difference was detected (3 studies, MD:20.725, 95 %CI: -11.601 to 53.052, P = .209, I2 = 93 %). CONCLUSIONS: Soluble endoglin levels were consistently higher in preeclamptic compared to normotensive pregnant women almost throughout pregnancy. Our results firmly indicate soluble endoglin's potential use as predictor of preeclampsia. Further studies are required to support the use of soluble endoglin as a diagnostic tool for preeclampsia in clinical settings.

Oral contraceptives increase platelet microparticle levels in normal-weight women with polycystic ovary syndrome.

PURPOSE: Platelet microparticles (PMPs), which are microvesicles shed from platelets, participate in inflammation, vascular homeostasis, and thrombosis. PMPs are increased in obese women with polycystic ovary syndrome (PCOS). Agents that modulate hormonal aspects of PCOS could affect the levels of PMPs. The aim of the present study was to evaluate the effects of oral contraceptives (OCPs), antiandrogen, and metformin use for 6 and 12 months on PMPs in normal-weight women with PCOS. METHODS: Forty-five women with PCOS and 13 healthy women were recruited. Biochemical, hormonal, and clinical parameters were recorded. Women with PCOS received treatment with OCPs, OCPs+antiandrogens, or metformin, depending on their main complaint or clinical/biochemical findings. PMPs were measured at baseline and after 6 and 12 months. RESULTS: At baseline, patients with PCOS had higher levels of PMPs than controls (p = 0.017), which increased after 6-month treatment with OCPs (p = 0.006). Subsequently, they decreased after 12-month treatment (p = 0.046). Metformin had no effect on PMP levels. CONCLUSION: In conclusion, PMP levels are increased in PCOS and further increase with OCP use. This effect could possibly contribute to the increased risk of venous thromboembolism associated with OCP use. However, further studies are needed to elucidate the exact role of PMPs in PCOS.

Axillary web syndrome: Incidence, pathogenesis, and management.

Axillary web syndrome (AWS) refers to the development of fibrotic bands or "cords" in the axilla of patients who have undergone axillary lymph node dissection for breast cancer. We review the incidence, pathogenesis, risk factors, and management of AWS. AWS is a common complication in patients who undergo axillary lymph node dissection. Even though AWS is self-limited in most cases, it causes significant morbidity. The optimal management of AWS is unclear but physiotherapy appears to be beneficial. The widespread use of less invasive procedures to evaluate the presence of metastasis in the axillary lymph nodes (ie, sentinel lymph node biopsy) is expected to reduce the incidence of AWS. The close collaboration of surgeons, oncologists, and physiotherapists is necessary for the prevention and management of this frequent condition.

Novel insights in the prevention of perinatal transmission of hepatitis B.

Perinatal transmission of hepatitis B virus (HBV) infection is major contributor to the growing burden of chronic hepatitis B worldwide. Administration of HBV immunoglobulin and HBV vaccination as soon after pregnancy as possible are the mainstay of prevention of perinatal transmission of HBV infection. In women with high viral loads, antiviral prophylaxis also appears to be useful. Lamivudine, telbivudine and tenofovir have been shown to be both safe and effective in this setting but tenofovir is the first-line option due to its low potential for resistance and more favorable safety profile.

Active sacral neuromodulator during pregnancy: a unique case report.

Sacral neuromodulation with an implanted device is used in patients who experience urinary retention and malfunctioning overactive bladder where conservative treatment is not sufficient. The knowledge of its effect on pregnancy is not known. This article presents the case of a 34-year-old pregnant woman with an implanted device, the use of which was not discontinued during her pregnancy. Full-term pregnancy was achieved, and a healthy child was delivered by cesarean section. Sacral neuromodulation during pregnancy appears to be safe and may be preferable to intermittent bladder catheterizations that increase the chance of urinary infections.

Primary mesenteric smooth muscle tumor: an entity with unpredictable biologic behavior.

Smooth muscle tumors of the mesentery are rare lesions with unpredictable, usually malignant, biologic behavior irrespective of their histologic appearance. Such case is presented here. We present a case of a large smooth muscle tumor located in the mesentery of a 48 years old patient. The histopathologic features of the surgically excised tumor were that of a benign-appearing smooth muscle tumor, either a primary mesenteric smooth muscle tumor of unknown biologic behavior or a parasitic leiomyoma. The patient was discharged 4 days after from the hospital without any early postoperative complication. Close followup was further decided. Nine months after her primary therapy, our patient is alive and with no evidence of recurrent disease. Increased awareness must be considered for large mesenteric smooth muscle tumors, because even when they present indolent histologic features, they usually behave aggressively.

Diet, physical exercise and Orlistat administration increase serum anti-Müllerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS).

The present study investigates the combined effect of diet, physical exercise and Orlistat for 24 weeks, on serum anti-Müllerian hormone (AMH) levels in overweight and obese women with polycystic ovary syndrome (PCOS) and in overweight and obese controls. Sixty-one (61) selected women with PCOS and 20 overweight and obese controls followed an energy-restricted diet, physical exercise plus Orlistat administration (120 mg, 3 times per day) for 24 weeks. At baseline, week 12 and week 24, serum levels of AMH, FSH, LH, PRL, androgens, sex hormone-binding globulin (SHBG), glucose, and insulin were measured and Free Androgen Index (FAI) and Insulin Resistance (IR) indices were calculated. In PCOS women, serum AMH levels increased after 12 and 24 weeks of treatment. After 12 weeks LH and SHBG were increased, while Testosterone decreased. After 12 and 24 weeks, FAI was decreased and all indices of IR were significantly improved. We concluded that in overweight and obese women with PCOS Orlistat administration, combined with diet and physical exercise, for 24 weeks, resulted in significant weight loss, improvement of hyperandrogenism and insulin sensitivity, and increased serum AMH levels.

Case of prenatally diagnosed non-mosaic trisomy 20 with minor abnormalities.

Non-mosaic trisomy 20 is a rare trisomy and almost all affected fetuses do not survive past the first trimester of the pregnancy. Severe abnormalities are frequently present in these embryos. We report the case of prenatally diagnosed non-mosaic trisomy 20 with only minor anomalies in the fetus. At external examination of the fetus we detected only low-set ears and no other abnormalities. Internally, all organs appeared normal macroscopically.

Current contraceptive awareness and use in Greek dental school students.

AIMS: We conducted a pilot study in female dental school students in Northern Greece in order to assess their awareness and practice of contraception. METHODS: The study population consisted of 88 female graduating students of the dental school. A self-administered, anonymous questionnaire was designed to explore students' awareness and use of contraceptive methods. RESULTS: Condoms were the most widely used contraceptive method (they were used by 52.3% of the students); 20.5% of the students were using condoms in alternation or together with coitus interruptus, and 6.8% were using only coitus interruptus. The oral contraceptive pill (OC) was used as the only contraceptive method by 4.5% of the students and in combination with condoms by 9.1% of them. The majority (53.4%) considered condoms as the most effective contraceptive method; 9.1% of the students answered "sterilization" and the same percentage stated "intrauterine contraceptive device (IUD)." Overall, 20.5% of the students believed that the OC increases the risk of cancer, and 36.4% did not know if there is an association between OC use and risk of cancer. Among students not using OC, the respective percentages were 23.7% and 42.1%. among the students, 59.1% had asked their gynecologist about contraception. The contraceptive method used and the perception regarding the most effective contraceptive method did not differ significantly between those who had consulted their gynecologist and those who had not. CONCLUSIONS: Dental school students in Greece appear to have inaccurate knowledge on important contraceptive issues, and this is reflected in their contraceptive practices. There is a pressing need to provide scientifically based sexual education if we are to avoid unwanted pregnancies.

Current caesarean delivery rates and indications in a major public hospital in northern Greece.

BACKGROUND: Over the past 25 years, there has been a sustained increase in caesarean section (CS) rates around the world. However, there is a paucity of data regarding the current CS rates and particularly the trends of CS indications in Greece. AIM: To assess the overall CS rates and indications in a major Greek teaching hospital over the last five years. METHODS: All deliveries that took place in our Department between January of 2002 and December of 2006 were retrospectively analysed through manual medical chart review to record CS rates and indications. RESULTS: During the study period, 4964 deliveries took place in our department; among them, 1831 were CS (36.9%). The overall caesarean delivery rate has remained stable during these five years (36.7% during 2002 vs 35.5% during 2006; P = 0.633). The primary indications were previous caesarean delivery (30.9%), non-reassuring or pathological fetal heart rate trace by cardiotocography (12.3%) and dystocia (10.4%). The only indication whose rate significantly increased was previous caesarean delivery (+47.3%; P = 0.002), whereas a significant decrease was found for non-reassuring or pathological fetal heart rate trace by cardiotocography (-39.1%; P = 0.008). CONCLUSIONS: It is quite difficult to reduce the proportion of caesarean deliveries, particularly in a teaching hospital with a considerable number of high-risk pregnancies. The dominant role of previous caesarean delivery among CS indications stresses the importance of performing more vaginal birth after CS if we are to avoid the self-perpetuation of the CS epidemic.

Uneventful cesarean delivery with administration of factor XI concentrate in a patient with severe factor XI deficiency.

Factor XI (FXI) is a procoagulant factor and antifibrinolytic agent, and its absence causes a bleeding tendency. FXI deficiency is autosomal in inheritance, with severe FXI deficiency in homozygotes and partial deficiency in heterozygotes. A 24-year-old primigravida with an uneventful pregnancy and no history of bleeding manifestations was admitted to our department at 38 weeks of gestation. Her blood count and serum biochemistry findings were normal except for a coagulation screen, which revealed a prolonged activated partial thromboplastin time (APTT) of 63 seconds (normal range, 24-35 seconds). The measured FXI coagulant activity of 8 IU/dL (reference range, 70-150 IU/dL) established a diagnosis of severe FXI deficiency. The breech presentation of the fetus prompted the decision for cesarean delivery under general anesthesia. We administered a single dose of FXI concentrate (15 IU/kg), which corrected the APTT to 34 seconds. The cesarean delivery was uncomplicated, and postpartum recovery of the mother and her baby was uneventful with no bleeding complications. The finding of an isolated prolonged APTT should prompt obstetricians to consider FXI deficiency. The appropriate use of factor FXI concentrate in managing obstetric patients with FXI deficiency can minimize potential bleeding complications and ensure an optimal outcome for both mother and neonate.

Pregnancy and oral health: utilisation of dental services during pregnancy in northern Greece.

BACKGROUND: Recent studies have shown that gingivitis and periodontal infection during pregnancy represent an independent risk factor for pre-term birth. However, little is known about the prevalence and correlates of dental attendance during pregnancy. METHODS: During the first 3 days postpartum, an anonymous questionnaire was administered to 425 women in order to explore their dental condition and utilisation of dental health services during pregnancy, as well as their perceptions on the potential associations between dental care during pregnancy and pregnancy outcomes. RESULTS: Almost half of the respondents (46.8%) reported symptoms of gingivitis during their pregnancy. Pregnancy gingivitis was independently associated with non-Greek ethnicity (p=0.008), multiparity versus primiparity (p<0.005), lower economic class versus middle and upper classes (p=0.001), and the lack of routine primary dental care (p=0.005). Some 27.3% reported a visit to the dentist during their pregnancy. The majority (72.2%) believed that dental treatment during pregnancy might have a negative affect on pregnancy outcome. The presence of pregnancy gingivitis and the belief that dental treatment during pregnancy is safe were both independently associated with visiting a dentist during pregnancy (p<0.0005 for both). CONCLUSIONS: Despite the increased prevalence of dental problems among pregnant women, few women seek dental services in this population, which can be primarily attributed to women's erroneous beliefs regarding the safety of dental examination. Therefore, there is an imperative need to offer oral health education and develop preventive programs for women of reproductive age.

Do characteristic spermatozoal morphological abnormalities exist in patients who have undergone unilateral orchiectomy and preventive radiotherapy?

DESIGN: We examined 16 men who had been subjected to unilateral orchiectomy owing to seminoma and to preventive radiotherapy, in order to investigate the morphologic abnormalities of the spermatozoa (headless and small-round-headedness) that may contribute to infertility. RESULTS: The same morphologic abnormalities of the head and neck found in the semen samples of fertile men were also found in the semen samples of the patients, albeit in higher percentages; the morphologic abnormalities of the tail in the semen samples of the patients were similar to those of the fertile men, both qualitatively and quantitatively. CONCLUSION: No specifically characteristic morphologic abnormalities of the spermatozoa were detected in men who were subjected to unilateral orchiectomy and to preventive radiotherapy in comparison with fertile men. The percentage rate of morphologic tail abnormalities is not affected by preventive radiotherapy.