Infraestructura de acogida portuaria. Terminal marítima del Turia

En una apuesta por recuperar el puerto de Valencia y la desembocadura del antiguo río Turia, la intervención se inicia enlazando una infraestructura verde como nexo de unión entre la ciudad y el puerto; una propuesta que nace del paisaje, el lugar y las personas. En este reto de abrirse al mar, se proyecta un nuevo complejo portuario en el que la protagonista es una nueva estación marítima, la cual se complementa con un programa de carácter público y abierto: restaurante, oficina de acogida y información, y diversos espacios de encuentro y de relación. Espacios que permitan la convivencia de los visitantes a la ciudad y sus habitantes; lugares de acogida, aprendizaje, cultura y ocio. Una intervención que devuelva este ámbito portuario a la ciudad de Valencia, eliminando la barrera que existe actualmente entre la ciudad y su puerto. La nueva terminal marítima revitaliza una zona que actualmente se puede considerar una mera zona de paso, al darle un valor arquitectónico, paisajístico y cultural. Cuidando la integración paisajística de las infraestructuras y bordes urbanos, se pretende mejorar y revitalizar el puerto para todos.In an attempt to regain the port of Valencia and the old Turia's river mouth, a green infrastructure is designed as a joint between the city and its port; an approach that is inspired by landscape, the surroundings and its people. In this challenge of regaining the relationship with the sea, a new port complex is designed, where the protagonist is a new maritime terminal, complemented with a public and open use program, consisting of: a restaurant, a welcome and information offce, and other places for encounter and exchange. Spaces that will allow the city s visitors and residents to coexist; places of welcome, learning, culture and leisure. An intervention that will give back this port area to the city of Valencia, eliminating the barrier that currently exists between the city and its port. The new maritime terminal revitalises an area that can currently be considered merely an area of transit, giving it architectural, landscape and cultural value. Keeping in mind the infrastructures landscape integration and urban limits, the intention is to improve and revitalize the port for all its users.Youssef Pavón, L. (2018). Infraestructura de acogida portuaria. Terminal marítima del Turia. http://hdl.handle.net/10251/110401TFG

Contrast media volume is significantly related to patient lung volume during CT pulmonary angiography when employing a patient-specific contrast protocol

Aim: The purpose of this study is to investigate the relationship between contrast media volume and patient lung volume when employing a patient-specific contrast media formula during pulmonary computed tomography angiography (CTA). Materials and methods: IRB approved this retrospective study. CTA of the pulmonary arteries was performed on 200 patients with suspected pulmonary embolism (PE). The contrast media volume (CMV) was calculted by employing a patient-specific contrast formula. Lung volume was quantified employing semi-automated lung software that calculated lung volumes (intellispace -Philips). The mean cross-sectional opacification profile of central and peripheral pulmonary arteries and veins were measured for each patient and arteriovenous contrast ratio (AVCR) calculated for each lung segment.  Mean body mass index (BMI) and lung volume were quantified. Receiver operating (ROC) and visual grading characteristics (VGC) measured reader confidence in emboli detection and image quality respectively. Inter and intra-observer variations were investigated employing Cohen’s kappa methodology. Results: Results showed that the mean pulmonary arterial opacification of the main pulmonary circulation (343.88±73HU), right lung; upper (316.51±23HU), middle (312.5±39HU) and lower (315.23±65HU) lobes and left; upper (318.76±83HU), and lower (321.91±12HU) lobes. The mean venous opacification of all pulmonary veins was below 182±72HU. AVCR was observed at all anatomic locations (p<0.0002) where this ratio was calculated. Moreover, larger volumes of contrast significantly correlated with larger lung volumes (r=0.89, p<0.03) and radiation dose (p<0.03). VGC and ROC analysis demonstrated increased area under the curve: 0.831 and 0.99 respectively (p<0.02). Inter-observer variation was observed as excellent (κ = 0.71). Conclusion: We conclude that increased CMV is significantly correlated to increased patient lung volume and radiation dose when employing a patient-specific contrast formula. The effects patient habitus is highlighted

Hemopexin and α1-microglobulin heme scavengers with differential involvement in preeclampsia and fetal growth restriction

Hemopexin and α1-microglobulin act as scavengers to eliminate free heme-groups responsible for hemoglobin-induced oxidative stress. The present study evaluated maternal and fetal plasma concentrations of these scavengers in the different phenotypes of placenta-mediated disorders. Singleton pregnancies with normotensive fetal growth restriction [FGR] (n = 47), preeclampsia without FGR (n = 45) and preeclampsia with FGR (n = 51) were included prospectively as well as uncomplicated pregnancies (n = 49). Samples were collected at delivery and ELISA analysis was applied to measure the hemopexin and α1-microglobulin concentrations. In maternal blood in preeclampsia with and without FGR, hemopexin was significantly lower (p = 0.003 and p<0.001, respectively) and α1-microglobulin was significantly higher (p<0.001 in both) whereas no difference existed in normotensive FGR mothers compared to controls. In contrast, in fetal blood in growth restricted fetuses with and without preeclampsia, both hemopexin and α1-microglobulin were significantly lower (p<0.001 and p = 0.001 for hemopexin, p = 0.016 and p = 0.013 for α1-microglobulin, respectively) with no difference in fetuses from preeclampsia without FGR in comparison to controls. Thus, hemopexin and α1-microglobulin present significantly altered concentrations in maternal blood in the maternal disease -preeclampsia- and in cord blood in the fetal disease -FGR-, which supports their differential role in placenta-mediated disorders in accordance with the clinical presentation of these disorders

Maternal proteomic profiling reveals alterations in lipid metabolism in late-onset fetal growth restriction

Fetal growth restriction defined as the failure to achieve the fetal genetic growth potential is a major cause of perinatal morbidity and mortality. The role of maternal adaptations to placental insufficiency in this disorder is still not fully understood. We aimed to investigate the biological processes and protein-protein interactions involved in late-onset fetal growth restriction in particular. We applied 2D nano LC-MS/MS proteomics analysis on maternal blood samples collected at the time of delivery from 5 singleton pregnancies with late-onset fetal growth restriction and 5 uncomplicated pregnancies. Data were analyzed using R package 'limma' and Ingenuity Pathway Analysis. 25 proteins showed significant changes in their relative abundance in late-onset fetal growth restriction (p value < 0.05). Direct protein-protein interactions network demonstrated that Neurogenic locus notch homolog protein 1 (NOTCH1) was the most significant putative upstream regulator of the observed profile. Gene ontology analysis of these proteins revealed the involvement of 14 canonical pathways. The most significant biological processes were efflux of cholesterol, efflux of phospholipids, adhesion of blood cells, fatty acid metabolism and dyslipidemia. Future studies are warranted to validate the potential role of the detected altered proteins as potential therapeutic targets in the late-onset form of fetal growth restriction

EEG oscillatory power and complexity for epileptic seizure detection

Monitoring patients at risk of epileptic seizure is critical for optimal treatment and ensuing the reduction of seizure risk and complications. In general, seizure detection is done manually in hospitals and involves time-consuming visual inspection and interpretation by experts of electroencephalography (EEG) recordings. The purpose of this study is to investigate the pertinence of band-limited spectral power and signal complexity in order to discriminate between seizure and seizure-free EEG brain activity. The signal complexity and spectral power are evaluated in five frequency intervals, namely, the delta, theta, alpha, beta, and gamma bands, to be used as EEG signal feature representation. Classification of seizure and seizure-free data was performed by prevalent potent classifiers. Substantial comparative performance evaluation experiments were performed on a large EEG data record of 341 patients in the Temple University Hospital EEG seizure database. Based on statistically validated criteria, results show the efficiency of band-limited spectral power and signal complexity when using random forest and gradient-boosting decision tree classifiers (95% of the area under the curve (AUC) and 91% for both F-measure and accuracy). These results support the use of these automatic classification schemes to assist the practicing neurologist interpret EEG records more accurately and without tedious visual inspection

Distinctive patterns of placental lesions in preeclampsia versus fetal growth restriction and their association with fetoplacental Doppler

OBJECTIVES: The aim of this study was to describe placental histopathological findings in a large cohort of pregnancies complicated by preeclampsia and/or fetal growth restriction, and to investigate its association with fetoplacental Doppler. METHODS: This was a prospective observational study including pregnancies complicated by: 1) normotensive FGR defined as birthweight 95th centile for uterine and umbilical artery, or <5th centile for middle cerebral artery and CPR. Placental lesions were categorized to vascular (maternal/fetal side), inflammatory and other lesions according to the 2014 Amsterdam Placental Workshop Group Consensus Statement. Univariate and multiple regression analysis were performed for the comparison between the study groups. Logistic regression was used to determine abnormal Doppler association with placental lesions. RESULTS: Maternal side vascular lesions are significantly higher in PE compared to controls and normotensive FGR (PE&FGR: 73%, PE: 46%, FGR: 38% vs. controls: 31%; p=0.01) including 2 types of lesions: developmental (PE&FGR: 13%, PE: 5%, FGR: 3% vs. controls: 2%, p<0.001) and malperfusion (PE&FGR: 70%, PE: 39%, FGR: 32% vs. controls: 25%, p=0.001). In contrast, fetal side developmental lesions are significantly higher in normotensive FGR compared to controls and PE (PE&FGR: 0%, PE: 3%, FGR: 8% vs. controls 2%, p=0.001). All cases displayed lower prevalence of infectious lesions, with a high prevalence of immune lesions in PE&FGR (PE&FGR: 17.5%, PE: 7.8%, FGR: 9.8% vs. controls 9.4%, p=0.001). All fetoplacental Doppler parameters are associated with maternal side vascular lesions -mainly malperfusion- [uterine arteries mean PI (Odds ratio(OR)=2.45, 95% confidence interval (CI): 1.51 - 3.97), umbilical artery PI (OR=2.05, 95% CI: 1.02 - 4.47), middle cerebral artery PI (OR=2.75, 95% CI: 1.4 - 5.42), CPR (OR=1.75, 95% CI: 1.04 - 2.95)]. This association was evident mainly in the FGR groups -with and without PE-, being nonsignificant in controls or PE without FGR. No significant associations were observed between fetoplacental Doppler parameters and other placental lesions in any of the study groups. CONCLUSIONS: PE and FGR exhibit different patterns of placental histopathological lesions in accordance with the clinical manifestation of the placental disorder (maternal vs. fetal). Fetoplacental Doppler shows an association with placental malperfusion lesions in the maternal side, reinforcing its use as a surrogate of placental insufficiency

Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial

The information available on the effects of maternal dietary habits on systemic inflammation and adverse maternal outcomes is limited. We aimed to evaluate whether Dietary Inflammatory Index (DII) score during pregnancy is associated with maternal body mass index (BMI), Mediterranean diet (MD) adherence, and perinatal outcomes. At 19-23 weeks' gestation, 1028 pregnant women were recruited. Dietary information was assessed using a 17-item dietary score to evaluate MD adherence and a validated 151-item food frequency questionnaire. DII score was established according to 33 food and nutritional proinflammatory and anti-inflammatory items. Participants were distributed into tertiles according to the DII score, where a lower DII score (first tertile) represented an anti-inflammatory diet and the third tertile represented the more proinflammatory diet. Maternal characteristics and perinatal outcomes were collected, and newborns' birthweight percentiles were calculated. Adjusted logistic regression models were used to assess the association of the DII score with maternal and perinatal characteristics, setting the third tertile as the reference group. Women in the third tertile showed lower adherence to MD score compared to the first tertile: median (25th to 75th percentile) 9 (7 to 11) vs. 6 (4.25 to 8), p < 0.001. The proinflammatory diet was significantly associated with a higher maternal pre-pregnancy BMI (adjusted β = 0.88; 95% CI: 0.31 to 1.45) and lower newborn's birthweight percentile (adjusted β = −9.84th; 95% CI: −19.6 to −0.12). These data show that a proinflammatory diet profile may be associated with maternal overweight and fetal undergrowth

Dominant Mutations in GRHL3 Cause Van der Woude Syndrome and Disrupt Oral Periderm Development

Mutations in interferon regulatory factor 6 (IRF6) account for ∼70% of cases of Van der Woude syndrome (VWS), the most common syndromic form of cleft lip and palate. In 8 of 45 VWS-affected families lacking a mutation in IRF6, we found coding mutations in grainyhead-like 3 (GRHL3). According to a zebrafish-based assay, the disease-associated GRHL3 mutations abrogated periderm development and were consistent with a dominant-negative effect, in contrast to haploinsufficiency seen in most VWS cases caused by IRF6 mutations. In mouse, all embryos lacking Grhl3 exhibited abnormal oral periderm and 17% developed a cleft palate. Analysis of the oral phenotype of double heterozygote (Irf6+/−;Grhl3+/−) murine embryos failed to detect epistasis between the two genes, suggesting that they function in separate but convergent pathways during palatogenesis. Taken together, our data demonstrated that mutations in two genes, IRF6 and GRHL3, can lead to nearly identical phenotypes of orofacial cleft. They supported the hypotheses that both genes are essential for the presence of a functional oral periderm and that failure of this process contributes to VWS

Complement and coagulation cascades activation is the main pathophysiological pathway in early-onset severe preeclampsia revealed by maternal proteomics

Preeclampsia is a pregnancy-specific multisystem disorder and a leading cause of maternal and perinatal morbidity and mortality. The exact pathogenesis of this multifactorial disease remains poorly defined. We applied proteomics analysis on maternal blood samples collected from 14 singleton pregnancies with early-onset severe preeclampsia and 6 uncomplicated pregnancies to investigate the pathophysiological pathways involved in this specific subgroup of preeclampsia. Maternal blood was drawn at diagnosis for cases and at matched gestational age for controls. LC-MS/MS proteomics analysis was conducted, and data were analyzed by multivariate and univariate statistical approaches with the identification of differential pathways by exploring the global human protein-protein interaction network. The unsupervised multivariate analysis (the principal component analysis) showed a clear difference between preeclamptic and uncomplicated pregnancies. The supervised multivariate analysis using orthogonal partial least square discriminant analysis resulted in a model with goodness of fit (R2X = 0.99, p < 0.001) and a strong predictive ability (Q2Y = 0.8, p < 0.001). By univariate analysis, we found 17 proteins statistically different after 5% FDR correction (q-value < 0.05). Pathway enrichment analysis revealed 5 significantly enriched pathways whereby the activation of the complement and coagulation cascades was on top (p = 3.17e-07). To validate these results, we assessed the deposits of C5b-9 complement complex and on endothelial cells that were exposed to activated plasma from an independent set of 4 cases of early-onset severe preeclampsia and 4 uncomplicated pregnancies. C5b-9 and Von Willbrand factor deposits were significantly higher in early-onset severe preeclampsia. Future studies are warranted to investigate potential therapeutic targets for early-onset severe preeclampsia within the complement and coagulation pathway

Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial

Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19-23 weeks' gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34-36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34-36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation. Keywords: Mediterranean diet; pregnancy; anxiety; well-being; sleep qualit