Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes: A randomized controlled trial post hoc analysis

Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 \u3c20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p \u3c 0.01), and a higher rate of caesarean section (38% vs. 27% p \u3c 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p \u3c 0.05). A post hoc comparison among women from the five sites with a GWG difference \u3e3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24(0/7) to 31(6/7) weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. Results For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. Conclusions In most countries, mortality decreased whereas BPD increased for neonates born very preterm

A Viscoelastic Model for the Long-Term Deflection of Segmental Prestressed Box Girders

Most of segmental prestressed concrete box girders exhibit excessive multidecade deflections unforeseeable by past and current design codes. To investigate such a behavior, mainly caused by creep and shrinkage phenomena, an effective finite element (FE) formulation is presented in this article. This formulation is developed by invoking the stationarity of an energetic principle for linear viscoelastic problems and relies on the Bazant creep constitutive law. A case study representative of segmental prestressed concrete box girders susceptible to creep is also analyzed in the article, that is, the Colle Isarco viaduct. Its FE model, based on the aforementioned energetic formulation, was successfully validated through the comparison with monitoring field data. As a result, the proposed 1D FE model can effectively reproduce the past behavior of the viaduct and predict its future behavior with a reasonable run time, which represents a decisive factor for the model implementation in a decision support system

Load monitoring of aerospace structures utilizing micro-electro-mechanical systems for static and quasi-static loading conditions

The National Research Council Canada (NRC) has worked on the development of structural health monitoring (SHM) test platforms for assessing the performance of sensor systems for load monitoring applications. The first SHM platform consists of a 5.5m cantilever aluminum beam that provides an optimal scenario for evaluating the ability of a load monitoring system to measure bending, torsion and shear loads. The second SHM platform contains an added level of structural complexity, by consisting of aluminum skins with bonded/riveted stringers, typical of an aircraft lower wing structure. These two load monitoring platforms are well characterized and documented, providing loading conditions similar to those encountered during service. In this study, a micro-electro-mechanical system (MEMS) for acquiring data from triads of gyroscopes, accelerometers and magnetometers is described. The system was used to compute changes in angles at discrete stations along the platforms. The angles obtained from the MEMS were used to compute a second, third or fourth order degree polynomial surface from which displacements at every point could be computed. The use of a new Kalman filter was evaluated for angle estimation, from which displacements in the structure were computed. The outputs of the newly developed algorithms were then compared to the displacements obtained from the linear variable displacement transducers connected to the platforms. The displacement curves were subsequently post-processed either analytically, or with the help of a finite element model of the structure, to estimate strains and loads. The estimated strains were compared with baseline strain gauge instrumentation installed on the platforms. This new approach for load monitoring was able to provide accurate estimates of applied strains and shear loads. \ua9 2012 IOP Publishing Ltd.Peer reviewed: YesNRC publication: Ye

Donor pool expansion in liver transplantation

The shortage of donors has made it necessary to consider older subjects, those with mild or moderate steatosis, and those who are HBcAb- or hepatitis C virus (HCV)-positive as marginal donors

Analisi e ricostruzione delle lesività scheletriche mediante indagini radiologiche

Il ricorso in ambito forense a tecniche di imaging per l’analisi e ricostruzione delle lesività scheletriche, è oggetto di crescente interesse, in ragione delle indiscutibili prerogative offerte dalla “virtopsy”. L’Istituto di Medicina Legale di Bari, in collaborazione con la Radiologia di Bari, già da diversi anni riconosce l’efficacia delle tecniche eidologiche nell’ambito della localizzazione di proiettili e frammenti ritenuti in ambito balistico, nonché nella valutazione dei complessi lesivi derivanti da grandi traumatismi o nei cadaveri “preziosi”. Dopo la disamina delle possibilità applicative individuate in letteratura medico-legale, gli Autori discutono i limiti e le prospettive della virtopsy, con particolare riferimento alle esperienze maturate su casistica rilevante

An experimental pilot study on controlled portal vein arterialization with an extracorporeal device in the swine model of partial liver resection and ischemia

To determine whether the physiologically oxygenated arterial blood reversed in the portal system by means of portal vein arterialization (PVA) through an extracorporeal device which we have called L.E.O2.NARDO (Liver Extracorporeal Oxygen. NARDO) is effective in treating swine with subtotal hepatectomy leading to acute liver failure (ALF)

Donor pool expansion in liver transplantation

INTRODUCTION: The shortage of donors has made it necessary to consider older subjects, those with mild or moderate steatosis, and those who are HBcAb- or hepatitis C virus (HCV)-positive as marginal donors. MATERIALS AND METHODS: From April 1986 to January 2002, 690 orthotopic liver transplantations (OLTs) were performed in 603 patients. In this series we used 68 donors older than 70 years, 51 with steatosis (38 mild, 12 moderate, and 1 severe), 44 were HBcAb-positive and 6 were HCV-positive. RESULTS: Of 68 grafts from donors older than 70 years, 65 were used as a first OLT. These grafts showed 3 PNF, 11 arterial complications, 12 re-OLTs, and 14 deaths with graft survival of 72.3% and 61.34% at 1 and 3 years, respectively. All patients who received the other 3 grafts, which were used for re-OLT, died between postoperative day 21 and 720. Among the 51 grafts with steatosis, we observed 2 PNF of those within the mild steatosis group and graft survival rates of 76.8% and 70.9% at 1 and 3 years, respectively. Forty-four grafts from HBcAb-positive subjects were used in 18 HBsAg-negative and 26 HBsAg-positive recipients. Among the untreated patient group, 1 patient demonstrated hepatitis B virus (HBV) reinfection and 1 patient had de-novo HBV. No reinfection or de novo infections were observed in the 13 patients treated with immunoglobulin or in the 19 patients treated with lamivudine plus immunoglobulin, or in the only patient treated with lamivudine. Graft survival rates were 64.1% and 54.7% at 1 and 3 years, respectively. Among who received 6 patients transplants from HCV-positive donors, we observed 1 recurrence of chronic hepatitis, 1 re-OLT for hepatic vein stenosis, and 1 PNF. CONCLUSION: Old donors, those with moderate steatosis, or those who are HBcAb- and HCV-positive can be safely used in selected recipients to reduce waiting list mortality

Octogenarian livers successfully transplanted in patients with fulminant hepatic failure

Although octogenarian livers have been transplanted successfully in elective settings, their safety in the case of fulminant hepatic failure has not yet been reported. From November 1998 to June 2003, we transplanted 3 livers from 80-, 82-, and 86-year-old donors. The donors were hemodynamically stable with an intensive care unit stay ranging from 24-48 hours. Cold ischemia time was from 260 minutes to 526 minutes. Mild macrosteatosis was present in 2 donors. Donor and recipient characteristics as well as posttransplantation evolution were evaluated. Two cases had uneventful courses and all recipients are well at 39, 21, and 5 months, respectively. The second recipient underwent retransplantation at 15 days due to technical complications. Livers from octogenarian donors may be safely used in an emergency to save patients. Age does not represent a limit for individually assessed and highly selected donors