Cervical Length and Perinatal Outcome

Prematurity nowadays has taken on significant dimensions. It is a complex medical issue with socio-economic consequences. The estimation of cervical length, assessed during the second trimester of pregnancy, using transvaginal ultrasound, may help to reduce rates of prematurity. By predicting the risk of preterm birth and identifying women who are at high risk of preterm birth, certain practices could be implemented, such as the use of progesterone or cerclage placement. Nonetheless, it remains unsolved the question of certain strategies, such as the use of progesterone in pregnant women with shortened cervical lengths. This work examines the relationship of cervical length during pregnancy to the perinatal outcome

Vaginal Seeding in Term Cesarean Section Is a Mandatory Condition for Improvement of Neonatal Health

The human vaginal microbiota is an important component of the defense system to fight microbial and viral infections. During pregnancy, a significant decrease in overall diversity is observed in the vaginal flora, and there is an increase in stability as the composition of the vaginal flora changes gradually. These alterations are linked to a decrease in vaginal pH and an augmentation in vaginal secretions. The composition of the vaginal microbiome changes according to gestational age, with its composition in advanced weeks of pregnancy resembling that of nonpregnant women. There is supporting evidence for the existence of differences in the neonate’s microbiome between those born via C-section and those delivered vaginally. The evidence suggests that this difference is a result of the changes that occur in the mother’s microbiome, particularly in the vagina. The vaginal microbiome serves as a crucial barrier between the external environment and the intra-amniotic cavity. The vaginal microbiome appears to play a significant role as an additional defense mechanism of the mother and, consequently, the fetus. Any abnormalities in this microbiome can potentially impact the pregnancy and perinatal outcome

Acute Liver Failure: From Textbook to Emergency Room and Intensive Care Unit With Concomitant Established and Modern Novel Therapies.

Acute liver failure is a rare hepatic emergent situation that affects primarily young people and has often a catastrophic or even fatal outcome. Definition of acute liver failure has not reached a universal consensus and the interval between the appearance of jaundice and hepatic encephalopathy for the establishment of the acute failure is a matter of debate. Among the wide variety of causes, acetaminophen intoxication in western societies and viral hepatitis in the developing countries rank at the top of the etiology list. Identification of the clinical appearance and initial management for the stabilization of the patient are of vital significance. Further advanced therapies, that require intensive care unit, should be offered. The hallmark of treatment for selected patients can be orthotopic liver transplantation. Apart from well-established treatments, novel therapies like hepatocyte or stem cell transplantation, additional new therapeutic strategies targeting acetaminophen intoxication and/or hepatic encephalopathy are mainly experimental, and some of them do not belong, yet, to clinical practice. For clinicians, it is substantial to have the alertness to timely identify the patient and transfer them to a specialized center, where more treatment opportunities are available

The Conundrum of Prematurity and Pregnancy Outcomes after Fertility Sparing Treatment Modalities for Early Stage Cervical Cancer: A Systematic Review of the Literature

Advances in modern medicine have allowed patients with early stage cervical cancer (stages Ia - IIai) to preserve their fertility with oncologic efficacy comparable to previous radical treatments. A variety of conservative-fertility sparing procedures, also known as Fertility Sparing Surgeries (FSS) have been proposed. The present review aimed to provide the current evidence on obstetric outcomes and the prematurity rates as well as to discuss the management modalities of these high-risk pregnancies. Our review of the literature included 3042 women with early cervical cancer, of whom 2838 underwent FSS (204 excluded for oncologic reasons). Almost half of these patients attempted to become pregnant and about two thirds of them achieved at least one pregnancy either spontaneously or with the help of Assisted Reproduction Technologies. Data revealed that 63.9% of these pregnancies resulted in live births, whereas 37.6% of them were preterm. The main cause of preterm births in this subpopulation is the postoperative cervical length restriction that consequently leads to cervical incompetence and ascending infections that eventually lead to (clinical or subclinical) chorioamnionitis. Radical operations such as ART, VRT and MIRT presented with higher prematurity rates. The lack of standardized protocols for the management of pregnancies after FSS precluded reaching to firm results with regards to the efficacy of them in achieving favourable obstetrical outcomes. Further large volume studies are warranted with the intent to acquire standardized guidelines for pregnancies achieved after FSS for early stage cervical cancer

Evaluating the Degradation of Natural Resources in the Mediterranean Environment Using the Water and Land Resources Degradation Index, the Case of Crete Island

Natural resources degradation poses multiple challenges particularly to environmental and economic processes. It is usually difficult to identify the degree of degradation and the critical vulnerability values in the affected systems. Thus, among other tools, indices (composite indicators) may also describe these complex systems or phenomena. In this approach, the Water and Land Resources Degradation Index was applied to the fifth largest Mediterranean island, Crete, for the 1999–2014 period. The Water and Land Resources Degradation Index uses 11 water and soil resources related indicators: Aridity Index, Water Demand, Drought Impacts, Drought Resistance Water Resources Infrastructure, Land Use Intensity, Soil Parent Material, Plant Cover, Rainfall, Slope, and Soil Texture. The aim is to identify the sensitive areas to degradation due to anthropogenic interventions and natural processes, as well as their vulnerability status. The results for Crete Island indicate that prolonged water resources shortages due to low average precipitation values or high water demand (especially in the agricultural sector), may significantly affect Water and Land degradation processes. Hence, Water and Land Resources Degradation Index could serve as an extra tool to assist policymakers to improve their decisions to combat Natural Resources degradation

Evaluating the Degradation of Natural Resources in the Mediterranean Environment Using the Water and Land Resources Degradation Index, the Case of Crete Island

Natural resources degradation poses multiple challenges particularly to environmental and economic processes. It is usually difficult to identify the degree of degradation and the critical vulnerability values in the affected systems. Thus, among other tools, indices (composite indicators) may also describe these complex systems or phenomena. In this approach, the Water and Land Resources Degradation Index was applied to the fifth largest Mediterranean island, Crete, for the 1999–2014 period. The Water and Land Resources Degradation Index uses 11 water and soil resources related indicators: Aridity Index, Water Demand, Drought Impacts, Drought Resistance Water Resources Infrastructure, Land Use Intensity, Soil Parent Material, Plant Cover, Rainfall, Slope, and Soil Texture. The aim is to identify the sensitive areas to degradation due to anthropogenic interventions and natural processes, as well as their vulnerability status. The results for Crete Island indicate that prolonged water resources shortages due to low average precipitation values or high water demand (especially in the agricultural sector), may significantly affect Water and Land degradation processes. Hence, Water and Land Resources Degradation Index could serve as an extra tool to assist policymakers to improve their decisions to combat Natural Resources degradation

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field