Trade Credit, Collateral Liquidation and Borrowing Constraints

The paper proposes a model of collateralized bank and trade credit. Firms use a two-input technology. Assuming that the supplier is better able to extract value from existing assets and has an information advantage over other creditors, the paper derives a series of predictions. (1) Financially unconstrained firms (with unused bank credit lines) take trade credit for a liquidation motive. (2) The reliance on trade credit does not depend on credit rationing, if inputs are liquid enough. (3) Firms buying goods make more purchases on account than those buying services, while suppliers of services offer more trade credit than those of standardized goods. (4) Suppliers lend inputs to their customers but not cash. (5) Greater reliance on trade credit is associated with more intensive use of tangible inputs. (6) Better creditor protection decreases both the use of trade credit and input tangibility.trade credit, collateral, financial constraints, asset tangibility, creditor protection ibility

Trade credit, collateral liquidation, and borrowing constraints

Assuming that firms' suppliers are better able to extract value from the liquidation of assets in default and have an information advantage over other creditors, the paper derives six predictions on the use of trade credit. (1) Financially unconstrained firms (with unused bank credit lines) take trade credit to exploit the supplier's liquidation advantage. (2) If inputs purchased on account are sufficiently liquid, the reliance on trade credit does not depend on credit rationing. (3) Firms buying goods make more purchases on account than those buying services, while suppliers of services offer more trade credit than those of standardized goods. (4) Suppliers lend inputs to their customers but not cash. (5) Greater reliance on trade credit is associated with more intensive use of tangible inputs. (6) Better creditor protection decreases both the use of trade credit and input tangibility

Implementation of guidelines about women with previous cesarean section through educational/motivational interventions in providers

Objective: The study reports the effect of a quality improvement project with an educational/motivational intervention, in northern Italy on the implementation of the trial of labor after Caesarean Section (CS). Method: A pre-post study design was used. Every birth center (23) of the Emilia-Romagna region was included. Gynecologists' opinion leaders were first trained about CS Italian recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected in 2 periods, before (2012-2014) and after (2017-2019) the intervention (2015-2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes. Results: A total of 20,496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (p<0.001). The likelihood of VBAC, adjusted for age ≥40, Caucasian, BMI ≥30, previous vaginal delivery, and labor induction, was increased by the intervention of 42% (OR=1.42, 95% CI 1.31-1.54). Neonatal well-being was improved by intervention, indeed neonates requiring resuscitation decreased from 2.1% to 1.6% (p=0.001). Conclusion: Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well-being

Cytotoxic properties of Marrubium globosum ssp. libanoticum and its bioactive components

Marrubium globosum Montbr. et Auch. ex Benth. ssp. libanoticum Boiss. (Lamiaceae) is a medicinal plant used in Lebanon for the treatment of inflammatory diseases, asthma, coughs and other pulmonary and urinary problems. The goal of our study was to assess the biological activity of M. globosum by testing different extracts of the aerial parts for their antiproliferative activity against human melanoma cells using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The chloroform fraction showed the greatest activity. The compounds isolated from the extracts were also tested: the mixture of (13 S)-9α,13α-epoxylabda-6β(19),16(15)-diol dilactone and (13 R)-9α,13α-epoxylabda-6β(19),16(15)-diol dilactone was the most active fraction, with an IC50 value of 29.2 ± 0.06 μg/mL

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01). Conclusion Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications

The appropriate counseling on prenatal screening test for foreign women in Emilia-Romagna

Objective: The increase in the migratory phenomenon entails the need to adapt obstetric care to the population which includes foreign pregnant women. In this context, it emerged a little adherence to the prenatal screening test among foreign women compared to Italian women, which is assumed to be attributable to an inadequate counseling. This study aims to evaluate midwife's perception of the  counseling effectiveness in foreign women for the combined test and subsequently assess its adequacy through an external evaluation. Methods: this is a cross-sectional study conducted from September to November 2019. An ad hoc questionnaire was administered to midwives working in the territorial district of the Emilia-Romagna Region, investigating their counseling skills. Then an external evaluation of the counseling was conducted by observing the interview between the midwives and the patients (N = 10), to analyze its appropriateness. Results: Seventy-five midwives completed the questionnaire with a positive response rate of 57.2%. In general, 69.3% of midwives are satisfied with the training received from the regional course, but 85% found many difficulties in counseling foreign women. The 14% of midwives state that they always have the cultural and linguistic mediator available and 44% of them state that they use brochures translated into several foreign languages. In the interviews observed, the counseling to foreign women was found to be shorter and more limited than that provided to Italian women. Conclusions: Most of the consulting midwives declare that they feel prepared to perform a correct prenatal counseling also for foreign women, but the external evaluation of the interviews, and the regional data on adherence to the antenatal screening of foreign women, show many critical points. It becomes necessary to carry out further studies that investigate not only the counseling skills of midwives, but also the needs of assisted women about prenatal diagnosis

Integrazione con inositoli in gravidanze complicate da sindrome metabolica. Effetti sul sistema metabolico e cardiovascolare nell'unità materno-fetale.

La sindrome metabolica (SM), l'obesità e l'ipertensione in gravidanza creano un ambiente intrauterino avverso, che porta ad un'alterazione della programmazione fetale in utero, predisponendo il feto all'insorgenza della malattia in età adulta. Gli inositoli (INO) hanno dimostrato di migliorare la resistenza all'insulina nelle donne con obesità, diabete gestazionale e con SM. Ipotesi: La somministrazione di INO in gravidanza migliora il profilo metabolico e cardiovascolare materno e della prole riducendo il danno agli organi materni e modulando le vie dell'omeostasi del glucosio placentare, migliorando quindi la salute materna e fetale a breve e lungo termine. Disegno dello studio: Topi femmine eterozigoti eNOS–/+ con ipertensione moderata sono stati sottoposti ad una dieta ricca di grassi (HFD) per 4 settimane per indurre un fenotipo della SM o alimentati con una dieta regolare per ottenere il fenotipo ipertensivo. Allo stesso modo, i topi wild-type (WT) sono stati nutriti con HFD per 4 settimane per ottenere il modello di obesità murina. Dopo l'accoppiamento con maschi WT, le femmine gravide sono state assegnate casualmente a ricevere INO o acqua come controllo. Al termine della gravidanza (giorno di gestazione 18) sono stati misurati: peso materno, pressione sanguigna sistolica (SBP) ed è stato effettuato il test di tolleranza al glucosio (GTT). Quindi le gravide sono state sacrificate, pesati e raccolti gli organi materni, il sangue, le placente e i feti. I livelli sierici dei biomarcatori, rilevanti per la fibrosi, sono stati misurati mediante un test multiplex di immunoassorbimento enzimatico. L'istologia dei tessuti cardiaci, epatici e renali è stata eseguita per la valutazione del danno d'organo. Le placente di ciascun gruppo di madri sono state genotipizzate per l'allele eNOS ed il sesso per valutare il livello di proteine coinvolte nell'omeostasi del glucosio. In particolare, l'assorbimento del glucosio, la sintesi del glicogeno e la produzione di ATP sono stati misurati mediante Western blot, e l’immagazzinamento del glicogeno mediante test ELISA. Per valutare il danno agli organi materni, i tessuti cardiaci, renali ed epatici sono stati colorati con la tricromia di Masson valutando la deposizione di tessuto connettivo. Il livello sierico di biomarcatori fibrogenici e di collagene è stato misurato tramite ELISA. Un sottogruppo delle madri con SM che ricevevano INO o placebo, è stato lasciato partorire per valutare i profili vascolari e metabolici nella prole sviluppata in un ambiente uterino anormale a causa della SM materna. Nella prole sono stati valutati GTT e SBP a 9-10 settimane di età. Le arterie carotidi sono state isolate per la valutazione delle risposte vascolari alla fenilefrina, in presenza e assenza di un inibitore aspecifico dell'ossido nitrico, del vasodilatatore acetilcolina e del nitroprussiato di sodio. Risultati: Il trattamento con INO durante la gravidanza ha migliorato i livelli di SBP, glucosio e leptina nelle madri gravide con fenotipo di SM. Inoltre, ha migliorato l'uso del glucosio placentare verso la produzione di energia in modo indipendente dal genere nella prole nata da madri con SM. Inoltre, il trattamento materno con INO ha ridotto significativamente la fibrosi cardiaca e renale a livello materno indotta dalla SM stabilita prima della gravidanza, riducendo i livelli sierici di TGF-β e collagene di tipo 3 nelle madri con SM. Infine, l'INO ha migliorato la tolleranza al glucosio, la SBP e le risposte vascolari nei figli nati da madri con SM che non hanno ereditato i fattori genetici alterati (eNOS). Conclusione: Le malattie metaboliche e cardiovascolari in gravidanza hanno gravi conseguenze sulla salute materna e fetale. L'integrazione di inositolo durante la gravidanza è una strategia promettente per contrastare i danni del dismetabolismo sia nella madre che nel feto, mostrando un miglioramento degli esiti metabolici e cardiovascolari a breve e lungo termine.Background: Metabolic syndrome (MS), obesity and hypertension in pregnancy set an adverse intrauterine environment, leading to an altered fetal programming in utero, predisposing the fetus to later onset of adult disease. On this ground, Inositols (INO) are insulin sensitizing agents that have been shown to improve insulin resistance in women with obesity, gestational diabetes and with MS. Hypothesis: We hypothesized that INO in pregnancy improve maternal and offspring metabolic and cardiovascular profile by reducing maternal end-organ damage and modulating placental glucose homeostasis pathways therefore improving maternal and fetal short and long-term health. Study design: Female heterozygous for endothelial nitric oxide synthase (eNOS–/+) mice with moderate hypertension were either placed on a high-fat diet (HFD) for 4 weeks to induce a MS phenotype or fed with regular diet to obtain the hypertensive phenotype. Similarly, wild-type (WT) mice were placed on a HFD for 4 weeks to induce a murine obesity model. Female mice were then bred with WT males. On gestational day 1, dams were randomly allocated to receive either INO or plain water as control. To evaluate pregnancy outcomes, pregnant dams were assessed at term (gestational day 18). Maternal weights, systolic blood pressure (SBP), and a glucose tolerance test (GTT) were obtained. Then dams were sacrificed, and maternal organs, blood, placentas, and pups were weighed and collected. Serum levels of biomarkers, relevant to fibrosis pathway, were measured by a multiplex enzyme-linked immunosorbent assay. Cardiac, liver and kidney tissues histology was perfroemd for fibrosis deposition as organ damage. Placentas per each group of dams were processed to obtain offspring genotyped for eNOS allele and gender to evaluate the level of proteins involved in glucose homeostasis. Specifically, glucose uptake (GLUT4 and IR-b), glycogen synthesis (Akt, pAktT-308and GSK3), and ATP production (pPDH) were measured using Western blot, while glycogen storage was measured by ELISA assay. To evaluate maternal organ damage, cardiac, renal and liver tissues were stained with Masson’s trichrome to assess connective tissue deposition. ELISA was used to measure serum level of fibrogenic and collagen biomarkers. A subgroup of the previously mentioned MS pregnant dams receiving INO or placebo, were let deliver to evaluate vascular and metabolic profiles in their offspring. The offspring developed in an abnormal uterine environment due to maternal MS underwent a GTT and SBP measurement at 9-10 weeks of age, then were sacrificed, and the carotid arteries were isolated for evaluation of vascular responses. Responses to phenylephrine, in the presence and absence of a nonspecific nitric oxide inhibitor, the vasodilator acetylcholine, and sodium nitroprusside were assessed. Results: INO treatment during pregnancy improved SBP, glucose and leptin levels in pregnant dams with MS phenotype. Moreover, it enhanced placental glucose use toward energy production in a gender-independent manner in offspring born to MS dams. Moreover, maternal INO treatment significantly decreased maternal cardiac and renal organ fibrosis induced by the MS established before pregnancy by reducing serum levels of TGF-β and collagen-type 3 in MS dams. Lastly, adult offspring born to dams with MS benefit more of maternal INO treatment if exposed to environmental factors in utero, and less if they inherited the altered genetic factors (eNOS). Indeed, inositol supplementation improved glucose tolerance, SBP, and vascular responses in those mice. Conclusion: Metabolic and cardiovascular disease in pregnancy have serious consequences on maternal and fetal health. Inositol supplementation during pregnancy is a promising strategy to counteract the damages of dysmetabolism in both the mother and the fetus, acting on different pathways, showing improvement of short and long term metabolic and cardiovascular outcomes