A Systematic Review on Materno-Foetal Outcomes in Pregnant Women with IgA Nephropathy: A Case of “Late-Maternal” Preeclampsia?

Background: IgA nephropathy is the most common primary glomerulonephritis in pregnancy and shares with other immunologic diseases and kidney diseases a relationship with adverse maternal outcomes, whose entity and pattern is only partially quantified. Recent studies provide new information and a systematic review regarded progression of kidney disease. The discussion of the outcomes with respect to low-risk pregnancies may help to perfect the estimation of the risks, and to identify specific research needs. Methods: A search strategy was built on Medline, EMBASE and the Cochrane review for the period January 2000-April 2017, aimed at retrieving both case series (defined as with at least 6 pregnancies in women with IgA nephropathy) and case reports, to look into rare occurrences. All papers, with or without control groups, were selected if they reported on at least one pregnancy outcome, or on long-term kidney function. Search strategy, paper selection and data extraction were done in duplicate (PROSPERO N 42016042623). Meta-analysis of case series was performed with Metanalyst Beta 3.13. Case reports were analysed narratively. Results: The search retrieved 556 papers, of which 27 were included (13 series and 14 case-reports). The case series report on 581 women with 729 pregnancies. The analysis was performed in comparison to the available control groups: 562 non-pregnant controls were available for the analysis of progression of kidney disease. As for pregnancy related outcomes (preeclampsia (PE), pregnancy induced hypertension (PIH), preterm birth, small babies), we meta-analyzed the data with respect to the only series of low-risk pregnancies (1418 pregnancies). When compared with women who never got pregnant after diagnosis of IgA nephropathy, in the present meta-analysis pregnancy in women with IgA nephropathy was not associated with a higher risk of progression of kidney disease, possibly due to the overall preserved kidney function at baseline: end-stage kidney disease (OR 0.68; CI 0.28-1.65). Conversely, the incidence of adverse pregnancy-related outcomes was increased compared to low-risk controls: PE and PIH were more than ten-fold increased (OR 11.80; CI 7.53-18.48 and OR 10.39; CI 5.45-19.80), while the increase in risk of preterm birth and "low birth weight babies" was less marked (OR 3.37; CI 1.91-5.95 and OR 2.36; CI 1.52-3.66), a discrepancy suggesting the occurrence of "late" or "maternal" PE, that may affect less severely foetal growth or shorten gestation. In conclusion, in the present meta-analysis IgA nephropathy was not associated with an increased progression of kidney disease. The more than ten-fold increased risk of PIH and PE, in combination with a doubled risk of small babies, suggests the occurrence of "late" or "maternal" PE, usually less affecting early foetal growth. This finding may be of help in defining control policies, while further research is needed to guide clinical management

Alterações químicas, bioquímicas e da qualidade do café submetido a diferentes formas de processamento de secagem.

Devido ao elevado teor de umidade em que é colhido, o café requer secagem adequada a fim de preservar sua qualidade. Nesta etapa, o teor de umidade é reduzido de aproximadamente 60% (b.u.) para 11% (b.u.), sendo que o processo de secagem em terreiros, em secadores mecânicos ou a combinação destes são os métodos mais utilizados. Pesquisas recentes têm indicado várias alterações na integridade das membranas celulares, processo de germinação, conteúdo de ácidos e açúcares, devido ao estresse provocado aos grãos, ao longo do processamento e secagem. A elevação da temperatura de secagem promove danos aos grãos, o que reduz sensivelmente a qualidade da bebida. Este trabalho teve como objetivo verificar a influência da secagem lenta e secagem rápida sobre alguns parâmetros físicoquímicos do grão e sobre a qualidade do café. Os cafés utilizados neste experimento foram da cultivar Catuaí Vermelho IAC 44 produzidos na Fazenda Experimental de Machado-FEMA, da EPAMIG. Foram avaliadas três formas de preparo: café natural, desmucilado e despolpado. Após a obtenção destas três formas de preparo os cafés foram então submetidos à secagem lenta, sendo secados em telados suspensos à sombra ou secados por meio de secagem rápida em secadores de camada fixa com controle de temperatura de secagem de 35ºC, até atingirem cerca de 11% de umidade (b.u.). Depois do processo de secagem (lenta ou rápida), os cafés foram beneficiados e submetidos às seguintes análises: condutividade elétrica, lixiviação de potássio, atividade enzimática da polifenoloxidase, acidez total titulável e análise sensorial. Por meio dos resultados observados, verificam-se menores valores de condutividade elétrica, lixiviação de potássio, acidez total titulável, maior atividade enzimática da polifenoloxidase e melhor qualidade nos cafés submetidos à secagem lenta, ou seja, secagem à sombra, independente da forma de preparo utilizada. Em relação ao tipo de preparo, observa-se que os cafés naturais apresentaram maiores valores de condutividade elétrica e lixiviação de potássio quando submetidos à secagem rápida, ou seja, em secadores mecânicos, o que denota uma maior probabilidade desses cafés de perderem qualidade

Instability of Quark Matter Core in a Compact Newborn Neutron Star With Moderately Strong Magnetic Field

It is explicitly shown that if phase transition occurs at the core of a newborn neutron star with moderately strong magnetic field strength, which populates only the electron's Landau levels, then in the $\beta$-equilibrium condition, the quark core is energetically much more unstable than the neutron matter of identical physical condition.Comment: Six pages REVTEX file, one .eps file (included

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature.

Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE–angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy

Correction to: Bone metabolism in patients with anorexia nervosa and amenorrhoea.

Unfortunately, the sixth author name was incorrectly spelled as "S. Fassio" instead of "A. Fassio" in the original publication

Major Allergen Content in Allergen Immunotherapy Products: The Limited Value of Numbers

The prevalence of allergic disorders has increased drastically over the last 50 years to the extent that they can be considered epidemic. At present, allergen-specific immunotherapy (AIT) is the only therapy that targets the underlying cause of allergic disorders, and evidence of its superiority is based on data accumulated from clinical trials and observational studies demonstrating efficacy and safety. However, several aspects remain unresolved, such as harmonization and standardization of manufacturing and quantification procedures across manufacturers, homogeneous reporting of strength, and the establishment of international reference standards for many allergens. This article discusses issues related to the measurement of major allergen content in AIT extracts, raising the question of whether comparison of products from different manufacturers is an appropriate basis for selecting a specific AIT product. Allergen standardization in immunotherapy products is critical for ensuring quality and, thereby, safety and efficacy. However, lack of harmonization in manufacturing processes, allergen quantification (methodologies and references), national regulatory differences, clinical practice, and labeling shows that the comparison of AIT products based solely on major allergen amounts is not rational and, in fact, impossible. Moreover, when rating the information given for a specific product, it is necessary to take into account further inherent characteristics of products and their application in clinical practice, such as the state of extract modification, addition of adjuvant or adjuvant system, route of administration (sublingual/ subcutaneous), and cumulative dose as per posology (including the volume per administration). Finally, only convincing clinical data can serve as the basis for product-specific evaluation and cross-product comparability of individual products

Belief, Credence and Statistical Evidence

According to the Rational Threshold View, a rational agent believes p if and only if her credence in p is equal to or greater than a certain threshold. One of the most serious challenges for this view is the problem of statistical evidence: statistical evidence is often not sufficient to make an outright belief rational, no matter how probable the target proposition is given such evidence. This indicates that rational belief is not as sensitive to statistical evidence as rational credence. The aim of this paper is twofold. First, we argue that, in addition to playing a decisive role in rationalizing outright belief, non-statistical evidence also plays a preponderant role in rationalizing credence. More precisely, when both types of evidence are present in a context, non-statistical evidence should receive a heavier weight than statistical evidence in determining rational credence. Second, based on this result, we argue that a modified version of the Rational Threshold View can avoid the problem of statistical evidence. We conclude by suggesting a possible explanation of the varying sensitivity to different types of evidence for belief and credence based on the respective aims of these attitudes

Weak reaction freeze-out constraints on primordial magnetic fields

We explore constraints on the strength of the primordial magnetic field based upon the weak reaction freeze-out in the early universe. We find that limits on the strength of the magnetic field found in other works are recovered simply by examining the temperature at which the rate of weak reactions drops below the rate of universal expansion ($\Gamma_{w} \le$ H). The temperature for which the $n/p$ ratio at freeze-out leads to acceptable helium production implies limits on the magnetic field. This simplifies the application of magnetic fields to other cosmological variants of the standard big-bang. As an illustration we also consider effects of neutrino degeneracy on the allowed limits to the primordial magnetic field.Comment: Submitted to Phys. Rev. D., 6 pages, 2 figure