Pelvic bone surgery and natural delivery: absolute and relative contraindications

Objective. The gynecologist often involves the orthopaedic surgeon in the evaluation of pregnant women with previous medical history of pelvic surgery who will give birth. Young women can receive pelvic surgery for proximal femoral fractures, sacro-iliac or pelvic ring fractures, avascular necrosis of the femoral head, hip dysplasia and severe ankylosing spondylitis. The aim of this study is to determine whether such women can accomplish a natural delivery or should have caesarean delivery (C-section). Methods. Pubmed and the Cochrane Database of Reviews were searched for manuscripts including the years 1970 to present. Results. It is important to discriminate between pathological and/or post-surgical conditions affecting the coxo-femoral joint which constitute an absolute contraindication to vaginal delivery from other circumstances that may have a relative contraindication. Orthopaedic relative indications for C-section may include coxo-femoral pathologies where coxo-femoral joint range of motion is limited and women cannot assume a given position that is deemed necessary by the obstetric specialist for natural delivery. Conditions requiring C-section are those producing an insufficient width of the bony birth canal; when the transverse mid-pelvis diameter is <9.5 cm, then the probability of C-section is increased. Conclusions. It is not mandatory to perform a C-section in all women with a past medical history of pelvic surgery; accurate medical history collection, imaging technologies and ultrasound make it possible decide if a C-section is compulsory

The Color of Water from Space: A Case Study for Italian Lakes from Sentinel-2

Lakes are inestimable renewable natural resources that are under significant pressure by human activities. Monitoring lakes regularly is necessary to understand their dynamics and the drivers of these dynamics to support effective management. Remote sensing by satellite sensors offers a significant opportunity to increase the spatiotemporal coverage of environmental monitoring programs for inland waters. Lake color is a water quality attribute that can be remotely sensed and is independent of the sensor specifications and water type. In this study we used the Multispectral Imager (MSI) on two Sentinel-2 satellites to determine the color of water of 170 Italian lakes during two periods in 2017. Overall, most of the lakes appeared blue in spring and green-yellow in late summer, and in particular, we confirm a blue-water status of the largest lakes in the subalpine ecoregion. The color and its seasonality are consistent with characteristics determined by geomorphology and primary drivers of water quality. This suggests that information about the color of the lakes can contribute to synoptic assessments of the trophic status of lakes. Further ongoing research efforts are focused to extend the mapping over multiple years

Early season weed mapping in rice crops using multi-spectral UAV data

In this article, we propose an automatic procedure for classification of UAV imagery to map weed presence in rice paddies at early stages of the growing cycle. The objective was to produce a weed map (common weeds and cover crop remnants) to support variable rate technologies for site-specific weed management. A multi-spectral ortho-mosaic, derived from images acquired by a Parrot Sequoia sensor mounted on a quadcopter, was classified through an unsupervised clustering algorithm; cluster labelling into â weed/no weed classes was achieved using geo-referenced observations. We tested the best set of input features among spectral bands, spectral indices and textural metrics. Weed mapping performance was assessed by calculating overall accuracy (OA) and, for the weed class, omission (OE) and commission errors (CE). Classification results were assessed under an alarmist approach in order to minimise the chance of overestimating weed coverage. Under this condition, we found that best results are provided by a set of spectral indices (OA= 96.5%, weed CE = 2.0%). The output weed map was aggregated to a grid layer of 5 x 5 m to simulate variable rate management units; a weed threshold was applied to identify the portion of the field to be subject to treatment with herbicides. Ancillary information on weed and crop conditions were derived over the grid cells to support precision agronomic management of rice crops at the early stage of growth

Epithelial ovarian cancer is infiltrated by activated effector T cells co-expressing CD39, PD-1, TIM-3, CD137 and interacting with cancer cells and myeloid cells

IntroductionDespite predicted efficacy, immunotherapy in epithelial ovarian cancer (EOC) has limited clinical benefit and the prognosis of patients remains poor. There is thus a strong need for better identifying local immune dynamics and immune-suppressive pathways limiting T-cell mediated anti-tumor immunity.MethodsIn this observational study we analyzed by immunohistochemistry, gene expression profiling and flow cytometry the antigenic landscape and immune composition of 48 EOC specimens, with a focus on tumor-infiltrating lymphocytes (TILs).ResultsActivated T cells showing features of partial exhaustion with a CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ surface profile were exclusively present in EOC specimens but not in corresponding peripheral blood or ascitic fluid, indicating that the tumor microenvironment might sustain this peculiar phenotype. Interestingly, while neoplastic cells expressed several tumor-associated antigens possibly able to stimulate tumor-specific TILs, macrophages provided both co-stimulatory and inhibitory signals and were more abundant in TILs-enriched specimens harboring the CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ signature.ConclusionThese data demonstrate that EOC is enriched in CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ T lymphocytes, a phenotype possibly modulated by antigen recognition on neoplastic cells and by a combination of inhibitory and co-stimulatory signals largely provided by infiltrating myeloid cells. Furthermore, we have identified immunosuppressive pathways potentially hampering local immunity which might be targeted by immunotherapeutic approaches

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis

Objective: This study was undertaken to analyze the frequency and the determinants of long-term clinically detectable recurrence rate of deep, ovarian, and pelvic endometriosis. Study design: The clinical data of 1106 women with first diagnosis of endometriosis observed between 1979 and 2001 were collected. Results: The 4-year recurrence rate was 24.6%, 17.8%, 30.6% and 23.7%, respectively, for cases of ovarian, pelvic, deep, and ovarian and pelvic endometriosis (P < .05). The recurrence rates decreased in all groups (with the exception of ovarian endometriosis) in the class age 34 years or older, these findings were significant (P < .05). Radicality was associated with lower recurrence rates in all the groups. A pregnancy after diagnosis was associated with a reduced risk of recurrence. Conclusion: The study shows that the recurrence rates of endometriosis were higher in case of deep endometriosis and that the risk factors for recurrence were similar among women with endometriosis at different sites

Fibronectin promotes elastin deposition, elasticity and mechanical strength in cellularised collagen-based scaffolds

One of the tightest bottlenecks in vascular tissue engineering (vTE) is the lack of strength and elasticity of engineered vascular wall models caused by limited elastic fiber deposition. In this study, flat and tubular collagen gel-based scaffolds were cellularised with vascular smooth muscle cells (SMCs) and supplemented with human plasma fibronectin (FN), a known master organizer of several extracellular matrix (ECM) fiber systems. The consequences of FN on construct maturation was investigated in terms of geometrical contraction, viscoelastic mechanical properties and deposition of core elastic fiber proteins. FN was retained in the constructs and promoted deposition of elastin by SMCs as well as of several proteins required for elastogenesis such as fibrillin-1, lysyl oxidase, fibulin-4 and latent TGF-beta binding protein-4. Notably, gel contraction, tensile equilibrium elastic modulus and elasticity were strongly improved in tubular engineered tissues, approaching the behaviour of native arteries. In conclusion, this study demonstrates that FN exerts pivotal roles in directing SMC-mediated remodeling of scaffolds toward the production of a physiological-like, elastin-containing ECM with excellent mechanical properties. The developed FN-supplemented systems are promising for tissue engineering applications where the generation of mature elastic tissue is desired and represent valuable advanced in vitro models to investigate elastogenesis. (C) 2018 Elsevier Ltd. All rights reserved

Endometriosis and Impaired Placentation: A Prospective Cohort Study Comparing Uterine Arteries Doppler Pulsatility Index in Pregnancies of Patients with and without Moderate-Severe Disease

The aim of this study was to evaluate if moderate-severe endometriosis impairs uterine arteries pulsatility index (UtA-PI) during pregnancy when compared to unaffected controls. In this prospective cohort study, pregnant women with stage III–IV endometriosis according to the revised American Fertility Society (r-AFS) classification were matched for body mass index and parity in a 1:2 ratio with unaffected controls. UtA-PIs were assessed at 11–14, 19–22 and 26–34 weeks of gestation following major reference guidelines. A General Linear Model (GLM) was implemented to evaluate the association between endometriosis and UtA-PI Z-scores. Significantly higher third trimester UtA-PI Z-scores were observed in patients with r-AFS stage III–IV endometriosis when compared to controls (p = 0.024). In the GLM, endometriosis (p = 0.026) and maternal age (p = 0.007) were associated with increased third trimester UtA-PI Z-scores, whereas conception by in-vitro fertilization with frozen-thawed embryo transfer significantly decreased UtA-PI measures (p = 0.011). According to these results, r-AFS stage III–IV endometriosis is associated with a clinically measurable impaired late placental perfusion. Closer follow-up may be recommended in pregnant patients affected by moderate-severe endometriosis in order to attempt prediction and prevention of adverse pregnancy and perinatal outcomes due to a defective late placental perfusion

Evaluation of Hybrid Models to Estimate Chlorophyll and Nitrogen Content of Maize Crops in the Framework of the Future CHIME Mission

In the next few years, the new Copernicus Hyperspectral Imaging Mission (CHIME) is foreseen to be launched by the European Space Agency (ESA). This mission will provide an unprecedented amount of hyperspectral data, enabling new research possibilities within several fields of natural resources, including the “agriculture and food security” domain. In order to efficiently exploit this upcoming hyperspectral data stream, new processing methods and techniques need to be studied and implemented. In this work, the hybrid approach (HYB) and its variant, featuring sampling dimensionality reduction through active learning heuristics (HAL), were applied to CHIME-like data to evaluate the retrieval of crop traits, such as chlorophyll and nitrogen content at both leaf (LCC and LNC) and canopy level (CCC and CNC). The results showed that HYB was able to provide reliable estimations at canopy level (R2 = 0.79, RMSE = 0.38 g m−2 for CCC and R2 = 0.84, RMSE = 1.10 g m−2 for CNC) but failed at leaf level. The HAL approach improved retrieval accuracy at canopy level (best metric: R2 = 0.88 and RMSE = 0.21 g m−2 for CCC; R2 = 0.93 and RMSE = 0.71 g m−2 for CNC), providing good results also at leaf level (best metrics: R2 = 0.72 and RMSE = 3.31 μg cm−2 for LCC; R2 = 0.56 and RMSE = 0.02 mg cm−2 for LNC). The promising results obtained through the hybrid approach support the feasibility of an operational retrieval of chlorophyll and nitrogen content, e.g., in the framework of the future CHIME mission. However, further efforts are required to investigate the approach across different years, sites and crop types in order to improve its transferability to other contexts