Efficiency of the cerebroplacental ratio in Identifying high-risk late-term pregnancies

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40–42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40–42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes

Implicación del estrés oxidativo en las enfermedades neurodegenerativas y posibles terapias antioxidantes

El sistema nervioso central es fundamental en el control de la homeostasis y mantenimiento de las funciones fisiológicas del organismo. Sin embargo, sus características bioquímicas hacen que sea especialmente vulnerable al daño oxidativo, lo que compromete su correcto funcionamiento, desencadenando neurodegeneración y muerte neuronal

Simposi sobre Tribunals i Mediació : nous camins per a la Justicia : comunicacions : 18-19 de juny/junio de 2009 CosmoCaixa, Barcelona, España

Aquest volum conté les Comunicacions presentades al Simposi sobre Tribunals i Mediació celebrat a Barcelona els dies 18 i 19 de Juny del 2009. Però, en realitat, aquests treballs són en la seva gran majoria contribucions al Projecte de Llibre Blanc de la mediació a Catalunya. Es per aquesta raó que hem optat per efectuar-ne una edició no intrusiva, on cada autor aporta el seu gra de sorra lliurement des de la perspectiva que ha triat. El lector trobarà sens dubte una gran varietat d'apropaments al tema: hi ha reflexions conceptuals, estudis jurídics, experiències de implantació ciutadana, reflexions dels equips tècnics de professionals, experiències de psicòlegs, juristes, advocats i magistrats, i, fins i tot, treballs preliminars. Hi ha escrits de recerca d'una gran qualitat; d'altres, en canvi, són una aportació d'autors més primerencs.El presente volumen comprende las Comunicaciones presentadas en el Simposio sobre Tribunales y Mediación celebrado en Barcelona durante los días 18 y 19 de Junio de 2009. Pero, en realidad, estos trabajos son en su gran mayoría contribuciones al Proyecto de Libro Blanco de la mediación en Cataluña. Por esta razón, hemos optado por efectuar una edición no intrusiva, en la que cada autor aporta libremente su grano de arena desde la perspectiva que le es propia. El lector encontrará sin duda una gran variedad de aproximaciones al tema: hay reflexiones conceptuales, estudios jurídicos, experiencias de implantación ciudadana, reflexiones de los equipos técnicos de profesionales, experiencias de psicólogos, juristas, abogados y magistrados, y trabajos aún muy preliminares. Algunas comunicaciones poseen una gran calidad investigadora; otros, en cambio, constituyen la primera apor- tación al tema de su autor

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure.

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of "extra-target" RAS suggests the need for RAS screening in all three DAA target regions