Prevalence of low antithrombin levels in preeclamptic women and perinatal outcome

Objective. The aim of this study is to evaluate the prevalence of low antithrombin levels in our population in order to assess an intervention trial feasibility. Methods. This is a retrospective study. A database was created by using queries to find out medical records of patients requiring hospitalization for preeclampsia or gestational hypertension or superimposed preeclampsia to chronic hypertension at Modena University Hospital between June 2015 and July 2019. Results. We screened 11845 deliveries. Overall, 221 (1.9%) cases of preeclampsia were identified. Antithrombin level was available for 201 women, thus included in the analysis. Median antithrombin value was 87% (IQ range: 77-98). The prevalence of low antithrombin levels was 9%. Antithrombin < 80% was found in 21% of the subjects. The remnant showed normal values. Median antithrombin was significantly lower in severe respect with mild preeclampsia (83% ± 14 vs 89% ± 14, p = 0.003). The rate of small for gestational age was significantly higher in low antithrombin levels group (44.4% vs 22.4%, p = 0.042). Considering mean values, antithrombin levels were also significantly lower in case of small for gestational age (84% ± 14 vs 89% ± 14; p = 0.040). Conclusions. In our population, low antithrombin levels (1 in 10 patients) were associated with severity of preeclampsia, namely with small for gestational age babies. Data suggest this subpopulation as a better target for trials assessing the efficacy of antithrombin supplementation

Vaginal alpha-lipoic acid shows an anti-inflammatory effect on the cervix, preventing its shortening after primary tocolysis. A pilot, randomized, placebo-controlled study

Introduction: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis. Materials and methods: Singleton pregnancies between 24–30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400 mg (active ingredient 10 mg) daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment. Results: The % changes of pro-inflammatory cytokines do not differ between treatment groups, while IL4 significantly increases by vaginal ALA in comparison to placebo (118.0 ± 364.3% versus 29.9 ± 103.5%, p = 0.012). Combined anti-inflammatory cytokines show same trend (292.5 ± 208.5% versus 64.5 ± 107.4, p = 0.03). CL remains similar in vaginal ALA group (from 23.1 ± 6.6 to 20.80 ± 7.9 mm), while it significantly decreased in placebo group (from 20.4 ± 6.5 to 13.8 ± 7.5 mm, p < 0.001 versus Baseline; p = 0.003 versus vaginal ALA). Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the CL

Acceleration-based condition monitoring of track longitudinal level using multiple regression models

In this paper, a condition monitoring system for railway track geometry is presented. The methodology has been designed for high-speed application, where the train travels at the maximum allowed speed for most of the trip. The system is designed to rely on acceleration data recorded by in-service vehicles to provide estimations of the track longitudinal level, based on pre-built regression models. It exploits synthetic indicators sampled over predefined track sections 100 m long. Different predictors are considered, computed both from acceleration data and from track geometry measured by the diagnostic train. The proposed modelling strategy allows distinguishing between isolated and distributed defects that populate the railway track as well as reproducing the evolution over time of the maximum longitudinal level registered in the considered track section; moreover, also accurate predictions of the defect amplitude are made. The results have been validated against track geometry data recorded by the diagnostic train during a monitoring period of 2 years. It is proven that the proposed system could support current maintenance strategies, providing a continuous flow of data to monitor the track infrastructure

An application of the Unknown Input Observer algorithm for the identification of vertical railway track irregularity

In this paper, a model-based solution for the identification of the railway track irregularity from simulation data is presented. The proposed methodology relies on the application of the Unknown Input Observer algorithm. A Simpack railway vehicle model is adopted to simulate the acceleration levels that vehicle-mounted sensors (for instance on the bogies and carbody) would measure during operation. A vehicle running at constant speed on a straight track is considered, considering different type of track irregularity (longitudinal level, cross-level) to test the algorithm capability to identify the input irregularity. In the analysed cases, satisfactory results are achieved both in terms of signal histories and corresponding frequency content, proving the methodology suitable for the identification of the track irregularity for monitoring purposes, adopting an instrumented vehicle

A methodology for track geometry estimation using inertial measurements: compensation of bogie filtering

In this paper, a methodology for the estimation of track longitudinal level based on the double integration of acceleration measurements is presented. The method is meant to be implemented on vehicles in-service along main line, where trains run at various speed depending on the line characteristics. The system relies on the information coming from a single sensor, mounted at the centre of the bogie frame. A suitable strategy to account for the filtering action introduced by the bogie, that makes the system blind to specific wavelengths, is proposed. To monitor the track conditions, the standard deviation and the peak value of the longitudinal level computed over a 100 m windows are adopted as synthetic indicators. Linear regression models relating the indicators sampled from the direct measurements taken by a diagnostic vehicle and those computed by double integration of the acceleration signals are realized. Both regression models, fed with the data gathered during a long-term monitoring, are finally adopted to estimate the track longitudinal level from the instrumented commercial vehicle, showing satisfactory results

Mode of Delivery in Women with Stillbirth: Results of an Area-Based Italian Prospective Cohort Study

Introduction: The choice of the mode of delivery, in case of stillbirth (SB) (fetus non-viable >22 weeks' gestation), should consider maternal preference, gestational age, bishop score, the clinical condition of the woman, and her previous obstetric history. However, despite these clear indications, data on the effective implementation of the latter are lacking. The aim of our study is to evaluate the different modes of delivery in an Italian population of SBs, according to gestational age, parity, causes of death, obstetric history, and maternal characteristics. Material and Methods: This is an area-based, prospective cohort study conducted in Emilia Romagna, Italy between January 2014 to December 2020. Data included all cases of SB (>22 weeks). Results: From 2014 to 2020, 783 SB occurred out of a total of 232.506 births, with a SB rate of 3.3 per 1000. Labor was spontaneous in 85 (11%). Of remnant, 567 (73.6%) were induced and 118 (15.3%) had no labor. The mode of delivery was vaginal in most of the cases (649/770, 84.3%) and by cesarean section in 121/770 (15.7%) of cases. Emergency CS was most frequent and performed in 89/121 (73.5%) of total CS, representing 11.5% of SB deliveries. Mode of induction did not differ in relation to gestational age at stillbirth, while vaginal delivery was significantly higher in women induced with prostaglandins (p = 0.000) respect to other methods. Nulliparous women had a significantly higher need for multiple methods of induction (p = 0.000) respect multiparous and obese women used more frequently prostaglandins (p = 0.03) than other methods. Women with a history of previous CS presented a significantly higher rate of repeated elective CS (p = 0.000). Moreover, emergency CS was performed more frequent in obese (p = 0.02), diabetic (p = 0.04) and hypertensive (p = 0.04) women and in SB caused by placenta disorders, namely in abruptio placentae (p = 0.000). In the case of chorioamnionitis and funisitis women significantly were induced with prostaglandin (p = 0.000) and delivered vaginally (p = 0.000). Conclusions: The method of induction of labor and the mode of delivery in case of SB did not depend on gestational age at the diagnosis of death, while they are related to placenta disorders representing a relevant condition leading to emergency CS also after diagnosis of fetal death. These data could help obstetric providers in managing the deliveries of stillborn infants

Aqueye optical observations of the Crab Nebula pulsar

We observed the Crab pulsar in October 2008 at the Copernico Telescope in Asiago - Cima Ekar with the optical photon counter Aqueye (the Asiago Quantum Eye) which has the best temporal resolution and accuracy ever achieved in the optical domain (hundreds of picoseconds). Our goal was to perform a detailed analysis of the optical period and phase drift of the main peak of the Crab pulsar and compare it with the Jodrell Bank ephemerides. We determined the position of the main peak using the steepest zero of the cross-correlation function between the pulsar signal and an accurate optical template. The pulsar rotational period and period derivative have been measured with great accuracy using observations covering only a 2 day time interval. The error on the period is 1.7 ps, limited only by the statistical uncertainty. Both the rotational frequency and its first derivative are in agreement with those from the Jodrell Bank radio ephemerides archive. We also found evidence of the optical peak leading the radio one by ~230 microseconds. The distribution of phase-residuals of the whole dataset is slightly wider than that of a synthetic signal generated as a sequence of pulses distributed in time with the probability proportional to the pulse shape, such as the average count rate and background level are those of the Crab pulsar observed with Aqueye. The counting statistics and quality of the data allowed us to determine the pulsar period and period derivative with great accuracy in 2 days only. The time of arrival of the optical peak of the Crab pulsar leads the radio one in agreement with what recently reported in the literature. The distribution of the phase residuals can be approximated with a Gaussian and is consistent with being completely caused by photon noise (for the best data sets).Comment: 7 pages, 7 figures. Accepted for publication in Astronomy and Astrophysic

Hardware Implementation of the Spot Payload for Orbiting Objects Detection Using Star Sensors

Space debris issue has become an attractive challenge for many applications in the framework of Space Situational Awareness (SSA) and Space Surveillance and Tracking (SST). The Star sensor image on-board Processing for orbiting Objects deTection (SPOT) fits in this field as an innovative space based autonomous and versatile system for Resident Space Objects’ optical detection via star sensors and for different Earth orbits scenarios. This system is planned to be a payload for an In-Orbit Validation (IOV) activity in the next future. The purpose of this paper is to show the architecture of the SPOT system together with its implementation on a System on Chip (SoC)/Field Programmable Gate Array (FPGA) space representative board. The SPOT algorithms involve several layers of filters which are relatively expensive in terms of computational latency, limiting their applicability to real-time image processing applications. This work presents the design and implementation of SPOT algorithm on the Zynq-7000 SoC using Xilinx FPGA and ARM CPU. Algorithms have been modelled with Simulink and implemented on FPGA using Xilinx system generator with aiming to optimize both processing time and area usage. A Hardware-In-the-Loop (HIL) setup was developed as well, to verify the performances and robustness of the SPOT algorithms and simulating critical scenario by using real night sky images from acquisition campaig

Adverse Perinatal Outcome in Subsequent Pregnancy after Stillbirth by Placental Vascular Disorders

Objective: To evaluate outcome in the pregnancy following a stillbirth (SB) by a placental vascular disorders. Study Design: A prospective, observational, multicenter study was conducted in woman with a history of stillbirth (> 22 weeks) between 2005 and June 2013, in 3 Italian University Hospitals. Causes of SB were previously identified after extensive investigations. Pregnant women were enrolled within the first trimester. The main outcome was "adverse neonatal outcome", including perinatal death, fetal growth restriction, early preterm birth <33+6 weeks, hypoxicischemic encephalopathy, intracranial hemorrhage or respiratory distress. Results: Out of 364 index pregnancies, 320 women (87.9%) had a subsequent pregnancy during the study period. Forty-seven had an early pregnancy loss. Out of 273 babies, 67 (24.5%) had an adverse perinatal outcome, including 1 SB and 1 early neonatal death (3.7/1000). Women who had a SB related to placental vascular disorders (39.6%), were at higher risk of an adverse neonatal outcome compared with women whose SB was unexplained or resulted from other causes (Adj. OR = 2.1, 95%CI: 1.2-3.8). Moreover, also obesity independently predicts an adverse perinatal outcome (Adj OR = 2.1, 95%CI: 1.1-4.3). Conclusion: When previous SB is related to placental vascular disorders there is a high risk for adverse neonatal outcomes in the subsequent pregnancy. Maternal obesity is an additional risk factor

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

Background: Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. Case presentation: A 39-year-old Caucasian woman presented at 38&nbsp;+&nbsp;4&nbsp;weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. Conclusion: Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes