Abstract The tailings dump of Barraxiutta (Sardinia, Italy) contains considerable concentrations of heavy metals and, consequently, is scarcely colonized by plants. However, wild populations of the ...liverwort Lunularia cruciata (L.) Dum. form dense and healthy‐looking carpets on this tailing dump. L. cruciata colonizing the tailing dump was compared with a control population growing in a pristine environment in terms of: (i) pollutant content, (ii) photochemical efficiency, and (iii) volatile secondary metabolites in thalli extracts. L. cruciata maintained optimal photosynthesis despite containing considerable amounts of soil pollutants in its thalli and had higher sesquiterpene content compared to control plants. Sesquiterpenes have a role in plant stress resistance and adaptation to adverse environments. In the present study, we propose enhanced sesquiterpenes featuring Contaminated L. cruciata as a defence strategy implemented in the post‐mining environment.
The lock and key hypothesis assumes that male and female genitalia match in a unique system to prevent interspecific crosses. This hypothesis is largely investigated in animals, while there is a ...distinct lack of studies on plants. Nevertheless, we expect the lock and key hypothesis could apply to plants with complex floral morphologies, such as orchids.
Here we apply a comparative approach to examine the variation of floral functional traits in food‐ and sex‐deceptive orchids. To understand if a specific deception strategy is related to a specific variation in floral traits evaluated the variation in sterile and fertile traits among species and subsequently examined the correlations between male and female reproductive organs of the same species with the aim of investigating the role of the lock and key hypothesis in deceptive orchids.
Our results show that the functional morphology of fertile traits plays a pivotal role in limiting gene flow in species that grow in sympatry. In particular, it was observed that the Reproductive Standardisation Index (RSI) is significantly different in the two pollination strategies and that the correlation between pollinarium length and stigmatic cavity length is stronger in food‐deceptive species when compared to the sex‐deceptive species.
These results reveal that the lock and key hypothesis contributes to maintain boundaries in plants with very complex floral morphology.
Many technological advances have entered the clinical routine of Computed Tomography (CT) imaging. The new CT scanners have specific solutions in gantry design to bear the mechanical solicitations. ...The X-ray tubes have been improved for faster acquisitions at low radiation exposure, while the innovations in CT detectors provide a better image quality. The optimization of image quality and contrast, and the reduction of radiation dose, cannot be achieved without the implementation of adequate reconstruction software, such as Iterative Reconstructions (IR) and Artificial Intelligence (AI). In recent years, dual-energy (DECT) technology has expanded the indications of CT. In this narrative review, a panoramic overview of the technological novelties in CT imaging will be provided for optimal utilization of CT technology.
We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors.
...We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the Kaplan–Meier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients.
LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients hazard ratio (HR) = 1.345, HR = 1.312, and HR = 1.415, respectively; P < 0.0001, which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with AC-treated luminal A-like tumors.
The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy.
•In a study of 17 322 early BC patients, LVI had a significant independent negative prognostic impact on survival.•LVI negatively impacted survival in almost every patient category and cancer subtype, with and without AC.•LVI did not have a negative survival impact in patients with ER+ grade 3 or with luminal A-like tumors with chemotherapy.•Results suggest a possible benefit of AC in LVI-positive luminal A-like patients.
Objective
To develop a core outcome set (COS) for randomised controlled trials (RCTs) evaluating the effectiveness of interventions for the treatment of pregnant women with pregestational diabetes ...mellitus (PGDM).
Design
A consensus developmental study.
Setting
International.
Population
Two hundred and five stakeholders completed the first round.
Methods
The study consisted of three components. (1) A systematic review of the literature to produce a list of outcomes reported in RCTs assessing the effectiveness of interventions for the treatment of pregnant women with PGDM. (2) A three‐round, online eDelphi survey to prioritise these outcomes by international stakeholders (including healthcare professionals, researchers and women with PGDM). (3) A consensus meeting where stakeholders from each group decided on the final COS.
Main outcome measures
All outcomes were extracted from the literature.
Results
We extracted 131 unique outcomes from 67 records meeting the full inclusion criteria. Of the 205 stakeholders who completed the first round, 174/205 (85%) and 165/174 (95%) completed rounds 2 and 3, respectively. Participants at the subsequent consensus meeting chose 19 outcomes for inclusion into the COS: trimester‐specific haemoglobin A1c, maternal weight gain during pregnancy, severe maternal hypoglycaemia, diabetic ketoacidosis, miscarriage, pregnancy‐induced hypertension, pre‐eclampsia, maternal death, birthweight, large for gestational age, small for gestational age, gestational age at birth, preterm birth, mode of birth, shoulder dystocia, neonatal hypoglycaemia, congenital malformations, stillbirth and neonatal death.
Conclusions
This COS will enable better comparison between RCTs to produce robust evidence synthesis, improve trial reporting and optimise research efficiency in studies assessing treatment of pregnant women with PGDM.
Tweetable
165 key stakeholders have developed #Treatment #CoreOutcomes in pregnant women with #diabetes existing before pregnancy.
Tweetable
165 key stakeholders have developed #Treatment #CoreOutcomes in pregnant women with #diabetes existing before pregnancy.
Abstract Background Normal menstrual periods last 3–6 days and involve blood loss of up to 80 ml. Menorrhagia is defined as menstrual periods lasting more than 7 days and/or involving blood loss ...greater than 80 ml. The prevalence of abnormal uterine bleeding (AUB) is estimated at 11–13% in the general population and increases with age, reaching 24% in those aged 36–40 years. Investigation A blood count for red cells + platelets to test for anemia is recommended on a first-line basis for women consulting for AUB whose history and/or bleeding score justify it. A pregnancy test by an hCG assay should be ordered. A speculum examination and Pap smear, according to the French High Health Authority guidelines should be performed early on to rule out any cervical disease. Pelvic ultrasound, both abdominal (suprapubic) and transvaginal, is recommended as a first-line procedure for the etiological diagnosis of AUB. Hysteroscopy or hysterosonography can be suggested as a second-line procedure. MRI is not recommended as a first-line procedure. Treatment In idiopathic AUB, the first-line treatment is medical, with efficacy ranked as follows: levonorgestrel IUD, tranexamic acid, oral contraceptives, either estrogens and progestins or synthetic progestins only, 21 days a month, or NSAIDs. When hormone treatment is contraindicated or immediate pregnancy is desired, tranexamic acid is indicated. Iron must be included for patients with iron-deficiency anemia. For women who do not wish to become pregnant in the future and who have idiopathic AUB, the long-term efficacy of conservative surgical treatment is greater than that of oral medical treatment. Placement of a levonorgestrel IUD (or administration of tranexamic acid by default) is recommended for women with idiopathic AUB. If this fails, a conservative surgical technique must be proposed; the choices include second-generation endometrial ablation techniques (thermal balloon, microwave, radiofrequency), or, if necessary, first-generation techniques (endometrectomy, roller-ball). A first-line hysterectomy is not recommended in this context. Should a hysterectomy be selected for functional bleeding, it should be performed by the vaginal or laparoscopic routes.
The goal of this study was to evaluate the predictive factors of mortality in patients after liver transplantation in an intensive care unit from the University Hospital.
This observational study was ...conducted by using a database analysis of University Hospital. The sample consisted of patients after liver transplantation registered in the database. The study variables of Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Disease Classification II (APACHE II), Model for End-Stage Liver Disease, and Child-Pugh scores, and the days of hospitalization in intensive care unit, mechanical ventilation time, and reintubation rate, were correlated. Statistical analysis was performed by using the χ2 test or Fisher exact test, the Mann-Whitney test, and logistic regression analysis.
Fifty-eight individuals were analyzed. In the death group, the days of hospitalization in the intensive care unit were within 12 ± 14 days, the time of mechanical ventilation was 180 ± 148 hours, the APACHE II value was 17.6 ± 7.3, the Sequential Organ Failure Assessment score was 8.2 ± 2.7, and reintubation was 40%. In the multivariate regression, the predictive indexes of mortality were the mortality given by APACHE II (odds ratio, 1.1; CI, 1.03–1.17; P = .004), mechanical ventilation time (odds ratio, 1.02; CI, 1.01–1.04; P = .001), and reintubation (odds ratio, 9.06; CI, 1.83–44.9; P = .007). An increase of 1 unit in APACHE II mortality increases the risk of death by 10.2%, and each hour of mechanical ventilation increases the risk of death by 2.6%.
The time of mechanical ventilation, orotracheal reintubation, and the mortality given by APACHE II were the variables that best predicted death in this study.
•The literature is sparse reporting on factors or predictors of mortality in intensive care units after liver transplantation.•The research may help in the weaning of mechanical ventilation and multidisciplinary intensive care after liver transplantation.•The research shows the need for protocols for weaning and extubation of the patient after the transplant procedure, and there are no studies that report specific protocols for this research group.•Given the main factors and scores that can best predict mortality, the team and care planning could be differentiated in an attempt to reduce mortality after liver transplantation.
The definition of hydrological alert systems for rainfall-induced landslides is strongly related to a deep knowledge of the geological and geomorphological features of the territory. Climatic ...conditions, spatial and temporal evolution of the phenomena and characterization of landslide triggering, together with propagation mechanisms, are the key elements to be considered. Critical steps for the development of the systems consist of the identification of the hydrological variable related to landslide triggering and of the minimum rainfall threshold for landslide occurrence. In this paper we report the results from a process-based model to define a hydrological alert system for the Val di Maso Landslide, located in the northeastern Italian Alps and included in the Vicenza Province (Veneto region, NE Italy). The instability occurred in November 2010, due to an exceptional rainfall event that hit the Vicenza Province and the entire NE Italy. Up to 500 mm in 3-day cumulated rainfall generated large flood conditions and triggered hundreds of landslides. During the flood, the Soil Protection Division of the Vicenza Province received more than 500 warnings of instability phenomena. The complexity of the event and the high level of risk to infrastructure and private buildings are the main reasons for deepening the specific phenomenon occurred at Val di Maso. Empirical and physically-based models have been used to identify the minimum rainfall threshold for the occurrence of instability phenomena in the crown area of Val di Maso landslide, where a retrogressive evolution by multiple rotational slides is expected. Empirical models helped in the identification and in the evaluation of recurrence of critical rainfall events, while physically-based modelling was essential to verify the effects on the slope stability of determined rainfall depths. Empirical relationships between rainfall and landslide consist of the calculation of rainfall Depth-Duration-Frequency (DDF) curves, which allow one to determine rainfall depth (or intensity) as a function of duration for given return periods or probabilities of exceedance (frequencies). Physically-based modelling was performed through coupled seepage and slope stability analyses. Combining results from empirical and physically-based modelling, the minimum alert threshold for a reactivation of the phenomenon was found in rainfall cumulated up to 60 days with a return period of 2 yr. These results were used to set up a hydrological alert system based on the calibration of DDF curves which can be used as a sort of abacus to plot in real time rainfall depths and to set increasing levels of alert on the basis of the degree of exceptionality of rainfall. The alert system for Val di Maso was successfully tested by the rainfall events that produced displacements which have been recorded by extensometers placed in the crown area after the November 2010 landslide. However, further tests are recommendable to improve the process-based model that led to the implementation of the alert system. To this end, a monitoring system is currently being realized. In the near future, monitoring data will help in testing and improving landslide evolution and alert models. The proposed hydrological alert system proves to be effective mainly because it can be applied to different scales of investigation and geological and geomorphological contexts. In fact, it might also be applicable to territorial scale analyses, as showed by the brief example provided in this paper on how the alert system could be used for landslide early warning in the area surrounding Val di Maso. Furthermore, it is easy to set up. The needed components are a rain gauge station, a software that compares rainfall data to rainfall events with different return periods and degree of alert, and a transmission system of the warning levels to authorities.
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