Adverse pregnancy outcomes in women at increased risk of preterm pre-eclampsia on first-trimester combined screening.

OBJECTIVE: Uteroplacental dysfunction may not only result in pre-eclampsia (PE) but also in preterm birth (PTB), small-for-gestational-age (SGA) birth and stillbirth. The aim of this study is to evaluate the positive predictive value (PPV) of first-trimester combined PE screening for all of these placenta-mediated adverse pregnancy outcomes. DESIGN: Retrospective cohort study. SETTING: Tertiary referral maternity unit. SAMPLE: A total of 13 211 singleton pregnancies. METHODS: First-trimester combined screening for preterm PE using the Fetal Medicine Foundation (FMF) algorithm. MAIN OUTCOMES MEASURES: Hypertensive disorders of pregnancy (HDP), PTB, SGA birth and stillbirth were combined to assess composite adverse and severe adverse pregnancy outcomes (CAPO and CAPO-S). The PPVs for CAPO and CAPO-S were calculated for women with a combined risk for preterm PE of ≥1 in 50 and ≥1 in 100. RESULTS: First-trimester combined screening identified 2215 women (16.8%) with a risk of ≥1 in 100 for preterm PE. The PPVs for a risk of ≥1 in 100 for CAPO and CAPO-S were 38.8% and 18.2%, respectively. The equivalent PPVs for a risk of ≥1 in 50 were 45.1% and 21.1%, respectively. CONCLUSIONS: Women identified at high risk of preterm PE are also at increased risk of other placenta-mediated adverse pregnancy outcomes, such as PTB, SGA birth and stillbirth. Women at high risk for preterm PE after first-trimester screening may benefit from a higher surveillance care pathway, with interventions to mitigate all the adverse outcomes associated with placental dysfunction

Prenatal prediction of adverse outcome using different charts and definitions of fetal growth restriction.

OBJECTIVE: Fetal growth assessment by ultrasound aims to identify small babies that are at higher risk of perinatal morbidity and mortality. The current study explores if the association between suboptimal fetal growth and adverse perinatal outcome varies with different definitions of fetal growth restriction and weight charts/standards. METHODS: This was a retrospective cohort study of 17261 singleton non-anomalous pregnancies from 24+0 weeks' gestation at a tertiary referral hospital. Estimated fetal weight (EFW) and Doppler indices were converted into gestational age specific centiles using a growth reference standard (Intergrowth-21) and various reference charts (Hadlock, Fetal Medicine Foundation [FMF] and Swedish). Test characteristics were assessed using definitions of FGR according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), Society of Maternal and Fetal Medicine (SMFM) and Swedish criteria. Adverse perinatal outcome was defined as perinatal death, admission to the neonatal intensive care (NICU) at term, 5' Apgar score < 7, and therapeutic cooling for neonatal encephalopathy. The association between FGR according to different definitions and adverse perinatal outcome was compared. Multivariate logistic regression was used to investigate the strength of the associations between ultrasound parameters and adverse perinatal outcome. Ultrasound parameters were also tested for correlation. RESULTS: Intergrowth-21 (IG-21), Hadlock and FMF fetal size references classified 1.47%, 3.55% and 4.5% fetuses respectively as FGR using the ISUOG definition and 2.87%, 8.82% and 10.6% fetuses respectively using the SMFM definition. The sensitivity of each of the definition/chart combinations for adverse perinatal outcome varied from 4.4% (ISUOG definition with IG-21 charts) to 13.2% (SMFM definition with FMF charts). The concomitant specificity also varied from 89.4% (SMFM definition with FMF charts) to 98.6% (ISUOG definition with IG-21 charts). ISUOG and Swedish criteria showed the highest specificity, positive predictive value, and positive likelihood ratio in detecting adverse outcomes irrespective of which fetal size reference charts/standards were used. Conversely, the SMFM definition had the highest sensitivity across all investigated growth charts. Low estimated fetal weight, elevated uterine artery mean PI, abnormal umbilical artery PI and abnormal cerebro-placental ratio were all significantly associated with adverse perinatal outcome and there was positive correlation between the covariates. Multivariate logistic regression showed that uterine artery Doppler mean PI and smallness (EFW below the 5th centile) were the only parameters to be consistently associated with adverse outcome irrespective of definitions or fetal size growth charts used. CONCLUSIONS: The prevalence of FGR is variable based on the specific definition as well as the fetal size reference chart used to diagnose FGR. Irrespective of the method of classification, the sensitivity for the identification of adverse perinatal outcome remains low. Estimated fetal weight, uterine artery and fetal Dopplers are all significant predictors of adverse perinatal outcome. As these indices are correlated to each other, a prediction algorithm is advocated to overcome the limitations of using them in isolation. This article is protected by copyright. All rights reserved

Enzymatic transformation of biomass: Valorization of rice bran oil and protein

The valorization of rice bran, a by-product derived from the rice productive chain, has attracted the attention of the scientific community for the production of high added-value products, because of its great availability (around 700 million tons are produced per year). The composition of rice bran is 15-22% lipids, 34-52% carbohydrates, 7-11% fibers, 8-12% moisture and 10-16% highly nutritional proteins1. The fatty fraction of rice bran is rich in bioactive phytochemicals that have antioxidant and chemopreventive properties2. Also, the protein hydrolyzates of rice bran could be used as flavor enhancers; moreover, due to their highly nutritional value and according to some studies they have a therapeutic potential2,3. It is a challenge though to hydrolyze the rice bran and achieve the selective separation of its useful components. In this work, a combined process for the transformation of rice bran through enzymatic catalysis is studied

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Zen and well-being at the workplace

Purpose \u2013 The purpose of this paper is to evaluate connections between the practice of mindfulness meditation and individual and organisational well-being. Design/methodology/approach \u2013 A direct randomised study conducted on a groups of persons involved in various work activities through a programme of Zen meditation courses and a comparison between the situation of well-being found before and after taking part in the courses, assessed in the light of results obtained from a control group that had not taken part in the courses. Findings \u2013 The comparison and analysis of results showed that the group of participants taking part in the meditation training obtained a significant increase in certain indicators relating in particular to subjectively perceived well-being, as regards attention and concentration as well as in a physiological indicator measuring stress reduction. Originality/value \u2013 The study brought to the place of business a tool traditionally used almost exclusively in relation to the personal sphere, evaluating its potential in terms not only of individual well-being but also in terms of efficiency and productivity

Hybrid Renewable Power System for Radio Networks in Mission Critical Applications

The most frequent problem detected by the companies in the telecommunications sector is the loss of power supply in site, usually located in remote zones. This is more delicate when the radio network has the specific objective to guarantee 'mission critical' communications. The object of this study is to propose and evaluate a way to decrease the number of maintenance operations necessary to restore the correct functioning, aiming at previously defined critic and strategic sites in a wide and complex radio network. This to obtain an increased availability, longer continuity and technical and economic benefits. Finally, the developed methods and the algorithms are applied to a real 'mission critical' case study

Hybrid power system optimization in mission-critical communication

One of the common problems faced by Telecommunication (TLC) companies is the lack of power supply, usually for those appliances with scarce chances of grid connection often placed in remote zones. This issue is more and more critical if the radio network has the specific task of guaranteeing the so-called “mission-critical communications”. This manuscript aims to propose and assess a viable solution to optimize the power supply and maintenance operations required to assure the proper functionality in such critical and remote sites. In particular, the main goals are defining a method to select the critical sites in an extensive and composite radio system and designing the hybrid power system in a way to improve the service availability and technical-economic benefits of the whole mission-critical TLC system. Finally, the proposed method and related procedures are tested and validated in a real scenario

Energy efficiency for radio communication systems in mission-critical applications

The continuous rise in the levels of greenhouse gases due to energy consumption and the influence of the Information and Communication Technologies (ICTs) massive use is constantly increasing. In the sector of communication networks for mission critical, security and public safety applications the environmental issue becomes crucial even if traditionally underestimated to the advantage of data throughput, coverage and voice transmission properties. Actually, one of the fundamental requirements of public safety infrastructures is the total and continuous coverage throughout the day in the served area. This constant and high energy demand makes mission critical networks particularly interesting for a comparative study on the consumption of the systems and related different technologies. This work aims to investigate the current energy consumption of principal standards for the Professional Mobile Radio sector, in particular TETRA (Terrestrial Trunked Radio) and DMR (Digital Mobile Radio) technologies, providing new and ad-hoc performance indicators with respect to energy efficiency