A Blockchain and Fingerprinting Traceability Method for Digital Product Lifecycle Management.

The rise of digitalization, sensory devices, cloud computing and internet of things (IoT) technologies enables the design of novel digital product lifecycle management (DPLM) applications for use cases such as manufacturing and delivery of digital products. The verification of the accomplishment/violations of agreements defined in digital contracts is a key task in digital business transactions. However, this verification represents a challenge when validating both the integrity of digital product content and the transactions performed during multiple stages of the DPLM. This paper presents a traceability method for DPLM based on the integration of online and offline verification mechanisms based on blockchain and fingerprinting, respectively. A blockchain lifecycle registration model is used for organizations to register the exchange of digital products in the cloud with partners and/or consumers throughout the DPLM stages as well as to verify the accomplishment of agreements at each DPLM stage. The fingerprinting scheme is used for offline verification of digital product integrity and to register the DPLM logs within digital products, which is useful in either dispute or violation of agreements scenarios. We built a DPLM service prototype based on this method, which was implemented as a cloud computing service. A case study based on the DPLM of audios was conducted to evaluate this prototype. The experimental evaluation revealed the ability of this method to be applied to DPLM in real scenarios in an efficient manner.

Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica / Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin

Introducción: Existen pocos estudios en España acerca del síndrome de hiperémesis cannabinoide (SHC), así como sobre el uso de capsaicina tópica para su tratamiento.Métodos:Estudio retrospectivo de pacientes mayores de 14 años atendidos en un servicio de urgencias hospitalario durante 2018 y 2019 con diagnóstico de SHC con base en los siguientes criterios: cuadro clínico compatible, consumo de cannabis menor de 48h y test de cannabis en orina positivo. Se recogieron variables epidemiológicas, clínicas, tiempos asistenciales y tratamiento (incluyendo el uso de capsaicina tópica al 0,075%).Resultados:Se estudiaron 59 asistencias de 29 pacientes (4,4 casos/10.000 visitas, IC 95% 2,8-4,7). Un 50% volvieron a urgencias por SHC, diferenciándose estos solo en más consumo de tabaco (p=0,01) y cocaína (p=0,031). En un 74,6% de las visitas se utilizó capsaicina. El tiempo medio de resolución de los vómitos tras su aplicación fue de 17,87min.Conclusiones:Aunque probablemente esté infradiagnosticado, el SHC presenta una incidencia baja en las urgencias en España, y con alta reincidencia de los pacientes. El uso de pomada de capsaicina es eficiente y seguro. (AU)

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment.Methods:Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected.Results:Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min.Conclusions:Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe. (AU)

Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin. / Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica.

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment. METHODS: Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected. RESULTS: Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min. CONCLUSIONS: Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Prenatal diagnosis of Greig Cephalopolysyndactyly Syndrome. When to suspect it.

Greig Cephalopolysyndactyly Syndrome (GCPS) is a very rare multiple congenital anomaly with an estimated incidence of 1-9:1,000,000 in newborns with principal findings of macrocephaly, ocular hypertelorism, and polysyndactyly (preaxial or mixed preaxial and postaxial). Very few cases of prenatal diagnoses have been reported. The postnatal diagnosis is based on clinical findings and family background. GLI3, the only gene associated with this anomaly, is altered in more than 75% of cases. Deletions over 1 Mb and involving other genes yield severe clinical cases, which are known collectively as Greig Cephalopolysyndactyly-contiguous gene Syndrome. We report a case in which, despite early polydactyly findings on week 16, the diagnosis was established during the third trimester of pregnancy due to the late presentation of other anomalies corresponding to this syndrome.

Maternal Thinness and Obesity and Customized Fetal Weight Charts.

OBJECTIVE: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5-25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. MATERIAL AND METHODS: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5-25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. RESULTS: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5-25) than in LGAonly by CC. In SGAonly by CC(18.5-25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5-25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34-193]) vs. (13.5%; OR = 0.84, [0.66-1.07]), and in SGA only by CC(18.5-25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25-2.10] vs. 6.3%; OR = 1.18, [0.85-1.66]). CONCLUSION: The use of CC(18.5-25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

Rotational forceps: a retrospective study evaluating anatomical and functional consequences for the pelvic floor.

INTRODUCTION AND HYPOTHESIS: The use of Kielland's rotational forceps is considered to involve greater technical difficulty and may be associated with a higher rate of pelvic floor trauma. Our main objective was to evaluate the association between avulsion of the levator muscle and rotational and non-rotational forceps. METHODS: This was an observational study carried out at a tertiary hospital that recruited singleton cephalic vaginally primiparous women with previous Kielland's forceps delivery between March 2012 and May 2017. Patients were retrieved from a local database, contacted consecutively and blinded to all clinical data. Power calculations determined a sample of n = 160 patients. All women underwent a urogynecological interview, clinical examination and 4D translabial ultrasound (TLUS). The 4D TLUS volumes were stored and analyzed offline by an experienced ultrasound examiner who was blinded to all clinical data. RESULTS: A total of 165 patients were available for analysis. Rotational forceps accounted for 27.3% (45 out of 165) of the study sample. Avulsion was present in 41.8% (69 out of 165) of all forceps deliveries. On multivariate analysis, rotational forceps was associated with avulsion, with an adjusted odds ratio (OR) of 2.57 (CI 95% 1.20-5.62, p = 0.016). Body mass index at the beginning of gestation was found to be a protective factor, with an adjusted OR of 0.918 (CI 95% 0.847-0.986, p = 0.025). CONCLUSION: Rotational forceps is associated with a higher avulsion rate than non-rotational forceps, with an adjusted OR of over 2.5. Obstetricians need to consider the potential long-term consequences of performing a rotational forceps for mothers.

Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies.

OBJECTIVE: Establish reference ranges for the Elecsys® soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) immunoassay ratio in twin pregnancies. METHODS: Data analyzed were from 3 prospective studies: Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia (PE) (PROGNOSIS), Study of Early-onset PE in Spain (STEPS), and a multicenter case-control study. Median, 5th, and 95th percentiles for sFlt-1, PlGF, and the sFlt-1/PlGF ratios were determined for normal twin pregnancies for 7 gestational windows and compared with the previous data for singleton pregnancies. RESULTS: The reference range analysis included 269 women with normal twin pregnancies. Before 29 weeks' gestation, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios did not differ between twin and singleton pregnancies. From 29 weeks' gestation to delivery, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios were substantially higher in twin versus singleton pregnancies. sFlt-1 values were higher in women with twin pregnancies across all gestational windows. PlGF values were similar or higher in twin versus singleton pregnancies; PlGF concentrations increased from 10 weeks + 0 days to 28 weeks + 6 days' gestation. CONCLUSIONS: Reference ranges for the sFlt-1/PlGF ratio are similar in women with twin and singleton pregnancies until 29 weeks' gestation but appear higher in twin pregnancies thereafter.

Feasibility and Accuracy of Early Fetal Echocardiography Performed at 13+0-13+6 Weeks in a Population with Low and High Body Mass Index: a Prospective Study.

PURPOSE: The earlier the detection and diagnosis of congenital heart diseases (CHD), the greater the clinical benefit; however, early fetal cardiac examination can be a challenge. The aim of our study is to demonstrate that the fetal cardiac examination at 13+0-13+6 weeks can be as adequately assessed as the examination performed at 16 weeks in patients with low and high body mass index (BMI). METHODS: The study was a prospective observational cohort study. One hundred pregnant women at low risk of congenital heart anomalies were divided into two groups: 49 women with low BMI (<25) and 51 women with high BMI (≥ 25). A complete fetal cardiac scan was performed on each patient at 13+0-13+6 weeks, via the transvaginal and transabdominal approaches, and at 16 weeks by the transabdominal approach. RESULTS: The examination at 13+0-13+6 weeks was adequately assessed in at least one of the two routes in 97 patients, as opposed to 87 patients at 16 weeks. A significantly higher adequate assessment rate was obtained at 13+0-13+6 weeks than at 16 weeks (p=0.017). The transvaginal approach showed the best resolution of the three examinations in 42% of women with BMI ≥35. No CHD were overlooked. CONCLUSIONS: Early fetal echocardiography is feasible and accurate at 13+0-13+6 weeks. Within patients with high BMI, early fetal echocardiography may be performed two weeks in advance, since it allows visualization of the fetal heart through the transvaginal route with a higher resolution in a large number of women, which is not feasible at 16 weeks.

First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes.

OBJECTIVE: To report reference ranges for fetal cerebral posterior fossa measurements and to describe the sonographic findings, karyotype results, and pregnancy outcomes in fetuses presenting with cystic posterior fossa (CPF) in the first trimester of pregnancy. METHODS: Two groups of patients undergoing first-trimester sonographic screening at 11-13 weeks' gestation were studied. The first (control group) consisted of 253 consecutive fetuses with normal posterior fossa, in which the brainstem (BS), fourth ventricle, cisterna magna, and BS-occipital bone (BS-OB) diameter were prospectively measured and the BS/BS-OB diameter ratio was calculated. The second (study group) consisted of 14 fetuses in which a CPF was detected. Information on sonographic findings, prenatal karyotype results, and pregnancy outcomes was obtained by reviewing ultrasound reports and medical records. The results from the two groups were then compared. RESULTS: In the control group, the size of all posterior fossa structures increased and the BS/BS-OB diameter ratio slightly decreased as the pregnancy progressed. In the study group, the BS diameter did not differ significantly from the measurements obtained in the control group. However, the BS-OB diameter and the fourth ventricle were significantly larger (p < .05 and p < .001, respectively) in the study group than in the control group. Additionally, the cisterna magna was not identified in 13 of the 14 fetuses (93%) in the study group, in comparison to zero out of the 253 fetuses in the control group (p < .001). Finally, the BS/BS-OB diameter ratio was significantly smaller in the study group when compared with the control group (p < .05). Regarding pregnancy outcomes, 12 of the 14 (86%) affected pregnancies underwent elective termination (n = 11) or ended in an early intrauterine demise (n = 1) due to the associated chromosomal abnormalities or structural defects. The two fetuses with isolated CPF had a normal second-trimester scan and resulted in the delivery of healthy newborn infants. CONCLUSIONS: The detection of a CPF in the first trimester is associated with a high rate of chromosomal and structural defects. By using normative data, early sonographic screening and detection of mildly and moderately abnormal cases is possible. Fetuses with isolated CPF require further study with a detailed second-trimester scan. This is essential in order to differentiate cases with poor and good perinatal outcomes. Finally, our data also demonstrate that the main sonographic tool when screening for CPF in the first trimester is the assessment of the fourth ventricle, which is significantly larger in abnormal cases as the result of the wide communication between the fourth ventricle and the cisterna magna.

Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series.

Objective: To analyze the effectiveness of pain relief with transcutaneous electrical nerve stimulation (TENS) dispositive during labor in breech vaginal delivery and also to describe its tolerance and satisfaction.Design: A randomized, double-blind, and placebo-controlled trial was conducted.Setting: Labor room of Complejo Hospitalario Universitario Insular-Materno Infantil (Spain).Participants: Ten women who met the inclusion criteria of the clinical trial and also had a fetus breech presentation were randomly assigned to three groups.Interventions: A portable TENS, Cefar Rehab 2pro®, unit was used to apply the experimental intervention, with different doses in the three groups in women during labor. The device intensity (amplitude) was individually adjusted to each participant's maximum sensory level. The pain was evaluated with visual analog scale (VAS). COMFORTS scale was used to measure women's satisfaction.Results: A significant association of VAS was detected depending on the type of TENS over time. Active TENS2 was the only group that obtained an improvement with clinically significant results. In connection with women satisfaction, active TENS2 group was also the group that presented higher values.Conclusions: We can recommend the use of TENS dispositive to relieve pain during labor, also in those women with breech presentation.

Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life.

OBJECTIVES: To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. STUDY DESIGN: In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. RESULTS: A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. CONCLUSION: The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.

A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial.

BACKGROUND: The COVID-19 pandemic has become a public health emergency of international concern; it has not only threatened people's physical health but has also affected their mental health and psychological well-being. It is necessary to develop and offer strategies to reduce the psychological impact of the outbreak and promote adaptive coping. OBJECTIVE: This study protocol aims to describe a self-administered web-based intervention (Mental Health COVID-19) based on the principles of positive psychology supported by elements of cognitive behavioral therapy and behavioral activation therapy to reduce the symptoms of anxiety and depression and increase positive emotions and sleep quality during and after the COVID-19 outbreak through a telepsychology system. METHODS: A randomized controlled clinical superiority trial with two independent groups will be performed, with intrasubject measures at four evaluation periods: pretest, posttest, 3-month follow-up, and 6-month follow-up. Participants will be randomly assigned to one of two groups: self-administered intervention with assistance via chat or self-administered intervention without assistance via chat. The total required sample size will be 166 participants (83 per group). RESULTS: The clinical trial is ongoing. This protocol was approved by the Research Ethics Board of the Free School of Psychology-University of Behavioral Sciences (Escuela libre de Psicología-Universidad de Ciencias del Comportamiento). The aim is to publish the preliminary results in December 2020. A conservative approach will be adopted, and the size effect will be estimated using the Cohen d index with a significance level (α) of .05 (95% reliability) and a conventional 80% power statistic. CONCLUSIONS: The central mechanism of action will be to investigate the effectiveness of an intervention based on positive psychology through a web platform that can be delivered through computers and tablets, with content that has been rigorously contextualized to the Mexican culture to provide functional strategies to help the target users cope with the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/ct2/show/NCT04468893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23117.

Interactive Effects of the Potassium and Nitrogen Relationship on Yield and Quality of Strawberry Grown Under Soilless Conditions.

K and N are the nutrients with the highest influence on yield and fruit quality. From this perspective, the aim of this study was to determine the effect of N as NO3-, K+ and their interactions on the yield and quality of strawberries grown under soilless conditions. A solution comprised of micronutrients based on an amended Steiner's Universal Nutrient Solution was mixed with 4 levels of K+ (5, 7, 9 and 11 mol m-3) and 3 levels of NO3- (9, 12, and 15 mol m-3) to obtain 12 treatments. The results suggest that 15 mol m-3 of NO3- in the nutrient solution produced the highest yield, but fruit with low nutraceutical quality. On the other hand, 11 mol m-3 of K+ in the nutrient solution produced the highest yield and fruit with the best nutraceutical quality. The ionic concentration of the Universal Steiner's Nutrient Solution proved to be the best nutritional option to maximize the yield and nutraceutical quality of strawberry fruit. The increase in NO3- concentration in the nutrient solution produced a higher yield of strawberries, while a higher concentration of K+ improved fruit quality, thus reaffirming the significance of nutrients within the plant functioning of this crop.

Características ecocardiográficas de la mesocardia fetal: un corazón diferente / Echocardiographic features of fetal mesocardiac: a different heart

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Nefropatía fetal por Valsartán / Fetal nephropathy due to Valsartan

La hipertensión arterial afecta aproximadamente al 7% de mujeres en edad reproductiva. Más de la mitad de estas mujeres quedarán gestantes mientras toman medicación antihipertensiva. Los inhibidores de la enzima convertidora de angiotensina y los antagonistas de los receptores de angiotensina II son fármacos antihipertensivos ampliamente utilizados en la población adulta, especialmente si tienen comorbilidades como diabetes o enfermedad renal, habiéndose descrito resultados perinatales adversos cuando se usan durante el embarazo. Presentamos el caso de una mujer en tratamiento con Valsartán que quedó gestante inadvertidamente, desarrollando el feto una nefropatía funcional no malformativa diagnosticada a las 22 semanas

Hypertension affects aproximately 7% of women in reproductive age. More than half will get pregnant while taking antihypertensive drugs. Renin angiotensine system blockers and angiotensin II receptor blockers are antihypertensive drugs broadly used in adult population, specially in patients with co-morbidities like diabetes or renal disease. Adverse perinatal outcomes have been reported in patients taking these drugs. We present a case report about a woman taking Valsartan whose pregancy was diagnosed at 22 weeks, with a fetal non malformative nephropathy

Tumor maligno de la vaina del nervio periférico primario de mama / Malignant peripheral nerve sheath tumor of the breast

Los tumores malignos de la vaina del nervio periférico representan del 5 al 10% del total de tumores malignos de tejidos blandos y frecuentemente se asocian con la neurofibromatosis tipoI. Su presentación en la glándula mamaria es poco frecuente, y el diagnóstico es muy difícil por su rareza y por la ausencia de características clínicas y/o radiológicas específicas, siendo preciso una adecuada interpretación del estudio inmunohistoquímico y su correlación con los hallazgos morfológicos. Presentamos un caso clínico y su revisión bibliográfica

Malignant peripheral nerve sheath tumours represent 5-10% of all malignant soft tissue tumours and are frequently associated with neurofibromatosis typeI. Their presentation in the mammary gland is rare. Because of this rarity, as well as the absence of specific clinical and/or radiological features, their diagnosis very difficult. It is therefore essential to correctly interpret immunohistochemical analysis and its correlation with morphological findings. We present a clinical case and literature review