Early- and late-onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

Objectives: To evaluate the natural history and outcome of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancy, according to gestational age at onset and various reported diagnostic criteria, and to quantify the risk of superimposed twin-to-twin transfusion syndrome (TTTS). Methods: This was a cohort study of MCDA twin pregnancies that had their routine antenatal care from the first trimester at St George's Hospital, London, UK. Pregnancies had ultrasound examinations every 2 weeks at 16–24 weeks and then every 2–3 weeks until delivery. The diagnostic criteria for sFGR were estimated fetal weight (EFW) of one twin < 10th centile and intertwin EFW discordance ≥ 25%. We also applied other diagnostic criteria reported in a recent Delphi consensus. Pregnancies in which the diagnosis of TTTS was made before that of sFGR were not included in the analysis. Pregnancies that underwent fetal intervention for sFGR were excluded. The incidence of sFGR was compared between the different diagnostic criteria, overall and according to gestational age at onset. In all subsequent analyses, cases of sFGR included those diagnosed according to any of the criteria. The Gratacós classification of sFGR was applied (Type I, II or III). Pregnancy outcomes included miscarriage, intrauterine death, neonatal death and admission to the neonatal unit. Comparisons between groups were carried out using the Mann–Whitney U-test for continuous variables and the chi-square or Fisher's exact test for categorical variables. Results: The analysis included 287 MCDA twin pregnancies. According to the International Society of Ultrasound in Obstetrics and Gynecology diagnostic criteria, the incidence of early (< 24 weeks) sFGR was 4.9%, while that of late sFGR was 3.8%. When applying the various diagnostic criteria, the incidence of early sFGR varied from 1.7% to 9.1% and that of late sFGR varied from 1.1% to 5.9%. In early-onset cases, the incidence of Type I sFGR was 80.8%, that of Type II was 15.4% and that of Type III was 3.8%. The corresponding figures in late-onset cases were 94.4%, 5.6% and 0%. The incidence of superimposed TTTS was 26.9% in cases affected by early-onset sFGR and 5.6% in those affected by late-onset sFGR. The incidence of perinatal death was 8.0% in early-onset sFGR and 5.6% in late-onset sFGR (P = 0.661). Admission to the neonatal unit occurred in 61.0% and 52.9% of cases, respectively (P = 0.484). Conclusions: In MCDA twin pregnancies, early-onset sFGR is slightly more common than is late-onset sFGR, although this difference was not significant, and is associated with worse perinatal outcome. The incidence of Types II and III sFGR is higher in early-onset sFGR. The incidence also varies according to the diagnostic criteria used, which supports the use of standardized international diagnostic criteria. Superimposed TTTS is more common in early- than in late-onset sFGR. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd

Vision based robot-to-robot object handover

This paper presents an autonomous robot-to-robot object handover in the presence of uncertainties and in the absence of explicit communication. Both the giver and receiver robots are equipped with an eye-in-hand depth camera. The object to handle is roughly positioned in the field of view of the giver robot's camera and a deep learning based approach is adopted for detecting the object. The physical exchange is performed by recurring to an estimate of the contact forces and an impedance control, which allows the receiver robot to perceive the presence of the object and the giver one to recognize that the handover is complete. Experimental results, conducted on a couple of collaborative 7 DoF manipulators in a partially structured environment, demonstrate the effectiveness of the proposed approach

VP26.02: Outcomes of fetal intracranial hemorrhage: a systematic review and meta‐analysis

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Multi-Scale Monitoring of Rupestrian Heritage: Methodological Approach and Application to a Case Study

Most of the artistic heritage in the Mediterranean basin is hosted in rupestrian hypogeum whose peculiarity is given by the presence of at least one open side, which makes them particularly sensitive to meteorological conditions. This makes mandatory the monitoring of both indoor and outdoor environmental parameters to analyze the cause–effect relationship between microclimatic inside and outside the hypogeum. The paper proposes a spatial and temporal multi-scale methodological approach applied to a rupestrian church in Matera, which hosts precious wall paintings, particularly vulnerable to the effects of environmental parameters. The approach is based on the analysis of data acquired by three platforms: indoor, close-range outdoor, and outdoor data from a meteorological station and weather forecast from the COSMO 5 model. The method allowed to characterize the relationships between the indoor and outdoor parameters at different spatial and temporal scales. The results showed a significant correlation between the parameters, thus opening new opportunities for the monitoring of the rupestrian heritage based on the use of data systematically available, such as those from meteorological stations and meteorological forecast

Non-immune fetal hydrops: etiology and outcome according to gestational age at diagnosis.

OBJECTIVE: Fetal hydrops is associated with increased perinatal morbidity and mortality. The etiology and outcome of fetal hydrops may differ according to the gestational age at diagnosis. The aim of this study was to evaluate the cause, evolution and outcome of non-immune fetal hydrops (NIFH), according to the gestational age at diagnosis. METHODS: This was a retrospective cohort study of all singleton pregnancies complicated by NIFH, at the Fetal Medicine Unit at St George's University Hospital, London, UK, between 2000 and 2018. All fetuses had detailed anomaly and cardiac ultrasound scans, karyotyping and infection screening. Prenatal diagnostic and therapeutic intervention, gestational age at diagnosis and delivery, as well as pregnancy outcome, were recorded. Regression analysis was used to test for potential association between possible risk factors and perinatal mortality. RESULTS: We included 273 fetuses with NIFH. The etiology of the condition varied significantly in the three trimesters. Excluding 30 women who declined invasive testing, the cause of NIFH was defined as unknown in 62 of the remaining 243 cases (25.5%). Chromosomal aneuploidy was the most common cause of NIFH in the first trimester. It continued to be a significant etiologic factor in the second trimester, along with congenital infection. In the third trimester, the most common etiology was cardiovascular abnormality. Among the 152 (55.7%) women continuing the pregnancy, 48 (31.6%) underwent fetal intervention, including the insertion of pleuroamniotic shunts, fetal blood transfusion and thoracentesis. Fetal intervention was associated significantly with lower perinatal mortality (odds ratio (OR), 0.30 (95% CI, 0.14-0.61); P  0.05). CONCLUSIONS: An earlier gestational age at diagnosis of NIFH was associated with an increased risk of aneuploidy and worse pregnancy outcome, including a higher risk of perinatal loss. Fetal therapy was associated significantly with lower perinatal mortality. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology

Integrated use of multi-temporal multi-sensor and multiscale Remote Sensing data for the understanding of archaeological contexts: the case study of Metaponto, Basilicata

This paper is focused on the archaeological area of Metaponto (Μεταπόντιον) and its territory, located in southern Italy. The area played an important role for the agricultural economy and the traffic of goods and people, from the south of Italy towards the central regions, starting from the Neolithic period, and reaching the zenith with the Greek polis of Metaponto and its hinterland. The site is herein analyzed through an integrated use of several Earth observation and remote sensing technologies and ancillary data produced over the years by archaeologists and scholars. The aim was to identify new buried elements of archaeological interest, for the reconstruction of the historical-archaeological landscape. Through the combined use of optical and radar satellite images, high-resolution images obtained by Unmanned Aerial System (visible, multispectral, and thermal infrared), geophysical data, and archival data, it was possible to deepen the knowledge of the area, in particular the “Castrum” area, identifying new buried evidence (structures, roads, and elements of the ancient landscape)

Cholesterol Serum Levels and Use of Statins in Graves' Orbitopathy: A New Starting Point for the Therapy.

Graves' Orbitopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease (GD). Its ultimate cause remains unclear, but it is commonly considered an autoimmune disorder due to self recognition of autoantigens constitutively expressed by orbital fibroblasts (OFs), and thyroid epithelial cells. High dose intravenous glucocorticoids (ivGC) are the most commonly used treatment for moderately severe and active GO. However, based on the complex pathogenesis of GO, a number of factors may have a protective and maybe a therapeutic role. The use of other medications improving the effect of GC may increase the overall effectiveness of the therapy and reduce GC doses, thereby limiting side effects. Recently, a possible protective role of 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, the so-called statins, and perhaps of lowering cholesterol levels, has been proposed. Thus, statins have been reported to be associated with a reduced frequency of GO in GD patients and in recent cross-sectional and retrospective studies a significant correlation was found between the occurrence of GO and both total and LDL-cholesterol in patients with a GD of relatively recent onset, suggesting a role of cholesterol in the development of GO. Moreover, a correlation was found between the GO clinical activity score and total as well as LDL-cholesterol in untreated GO patients, depending on GO duration, indicating a role of cholesterol on GO activity. Therefore, statin treatment may be beneficial for GO. Here we review this subject, which offers new therapeutic perspectives for patients with GO