Objective We sought to evaluate the association between fetal cerebroplacental ratio (CPR) and intrapartum fetal compromise and admission to the neonatal unit (NNU) in term pregnancies. Study Design ...This was a retrospective cohort study in a single tertiary referral center over a 14-year period from 2000 through 2013. The umbilical artery pulsatility index, middle cerebral artery pulsatility index, and CPR were recorded within 2 weeks of delivery. The birthweight (BW) values were converted into centiles and Doppler parameters converted into multiples of median (MoM), adjusting for gestational age using reference ranges. Logistic regression analysis was performed to identify, and adjust for, potential confounders. Results The study cohort included 9772 singleton pregnancies. The rates of operative delivery for presumed fetal compromise and neonatal admission were 17.2% and 3.9%, respectively. Doppler CPR MoM was significantly lower in pregnancies requiring operative delivery or admission to NNU for presumed fetal compromise ( P < .01). On multivariate logistic regression, both CPR MoM and BW centile were independently associated with the risk of operative delivery for presumed fetal compromise (adjusted odds ratio OR, 0.67; 95% confidence interval CI, 0.52–0.87; P = .003 and adjusted OR, 0.994; 95% CI, 0.992–0.997; P < .001, respectively). The latter associations persisted even after exclusion of small-for-gestational-age cases from the cohort. Multivariate logistic regression also demonstrated that CPR MoM was an independent predictor for NNU admission at term (adjusted OR, 0.55; 95% CI, 0.33–0.92; P = .021), while BW centile was not (adjusted OR, 1.00; 95% CI, 0.99–1.00; P = .794). The rates of operative delivery for presumed fetal compromise were significantly higher for appropriate-for-gestational-age fetuses with low CPR MoM (22.3%) compared to small-for-gestational-age fetuses with normal CPR MoM (17.3%). Conclusion Lower fetal CPR, regardless of the fetal size, was independently associated with the need for operative delivery for presumed fetal compromise and with NNU admission at term. The extent to which fetal hemodynamic status could be used to predict perinatal morbidity and optimize the mode of delivery merits further investigation.
This paper deals with the probabilistic analysis of discrete first-order linear control models with uncertainties. For the sake of generality in our stochastic analysis, we assume that all model ...parameters (the initial and final states, the matrix containing the free dynamics part, and the control’s coefficient) are random variables with an arbitrary joint probability density function. We then combine some results from classical Control Theory with Probability Theory to obtain, under very general hypotheses, the first probability density function of the control and the solution, which are parametric stochastic processes. To illustrate our theoretical findings, we also show two numerical examples and a classical discrete macroeconomic model whose parameters are treated as random variables.
Abstract Background The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the fetal size, is independently ...associated with the need for operative delivery for presumed fetal compromise and with neonatal unit admission at term. Objective The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced fetal growth rate. The secondary aim was to investigate the relationship between low cerebroplacental ratio at term, reduced fetal growth velocity and adverse pregnancy outcome. Design: retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20-24 weeks’ gestation, and both abdominal circumference and fetal Dopplers recorded at or beyond 35 weeks, within two weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20-24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio, low abdominal circumference growth velocity (in the lowest decile), and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small for gestational age neonates. Results The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted OR 2.10; 95%CI 1.71-2.57, p<0.001) and small for gestational age (adjusted OR 3.60; 95%CI 3.04-4.25, p<0.001). After the exclusion of pregnancies resulting in small for gestational age neonates, low cerebroplacental ratio multiples of median remained significantly associated with both low abdominal circumference growth velocity (adjusted OR 1.76; 95%CI 1.34-2.30, p<0.001) and birthweight centile (adjusted OR 0.99; 95%CI 0.998-0.995, p<0.001). The need for operative delivery for fetal compromise was significantly associated with low cerebroplacental ratio (adjusted OR 1.40; 95%CI 1.10-1.78, p=0.006), even after adjusting for both the umbilical artery pulsatility index multiples of median and middle cerebral artery pulsatility index multiples of median. The results were similar even after the exclusion of pregnancies resulting in small for gestational age neonates (adjusted OR 1.39; 95%CI 1.06-1.84, p=0.018). Low cerebroplacental ratio multiples of median remained significantly associated with the risk of operative delivery for presumed fetal compromise (p<0.001), even after adjusting for the known antenatal and intrapartum risk factors. These associations persisted even after exclusion of small for gestational age births. In appropriate for gestational age sized fetuses, abdominal circumference growth velocity was significantly lower in those with low cerebroplacental ratio multiples of median than in those with normal cerebroplacental ratio multiples of median (p<0.001). Conclusion Cerebroplacental ratio is a marker of impaired fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.
Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life ...(QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC.
QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire.
Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery.
Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.
In this work, WO3 nanostructures were synthesized with different complexing agents (0.05 M H2O2 and 0.1 M citric acid) and annealing conditions (400 °C, 500 °C and 600 °C) to obtain optimal WO3 ...nanostructures to use them as a photoanode in the photoelectrochemical (PEC) degradation of an endocrine disruptor chemical. These nanostructures were studied morphologically by a field emission scanning electron microscope. X-ray photoelectron spectroscopy was performed to provide information of the electronic states of the nanostructures. The crystallinity of the samples was observed by a confocal Raman laser microscope and X-ray diffraction. Furthermore, photoelectrochemical measurements (photostability, photoelectrochemical impedance spectroscopy, Mott–Schottky and water-splitting test) were also performed using a solar simulator with AM 1.5 conditions at 100 mW·cm−2. Once the optimal nanostructure was obtained (citric acid 0.01 M at an annealing temperature of 600 °C), the PEC degradation of methylparaben (CO 10 ppm) was carried out. It was followed by ultra-high-performance liquid chromatography and mass spectrometry, which allowed to obtain the concentration of the contaminant during degradation and the identification of degradation intermediates. The optimized nanostructure was proved to be an efficient photocatalyst since the degradation of methylparaben was performed in less than 4 h and the kinetic coefficient of degradation was 0.02 min−1.
•Random nonlinear SI-epidemiological models under general hypotheses are proposed.•Random Variable Transformation method provides a probabilistic solution of SI-model.•First probability density ...function of the solution of random SI-model is determined.•Time until a certain proportion of susceptibles remain in the population is given.•Punctual and confidence estimates to model a real problem is shown.
This paper presents a full probabilistic description of the solution of random SI-type epidemiological models which are based on nonlinear differential equations. This description consists of determining: the first probability density function of the solution in terms of the density functions of the diffusion coefficient and the initial condition, which are assumed to be independent random variables; the expectation and variance functions of the solution as well as confidence intervals and, finally, the distribution of time until a given proportion of susceptibles remains in the population. The obtained formulas are general since they are valid regardless the probability distributions assigned to the random inputs. We also present a pair of illustrative examples including in one of them the application of the theoretical results to model the diffusion of a technology using real data.
•Random nonlinear SIS-epidemiological models under general hypotheses are proposed.•Random Variable Transformation method provides probabilistic solution of SIS-model.•First probability density of ...the solution of random SIS-model is determined.•Time until a certain proportion of susceptibles remains in the population is given.•A probabilistic meaning of the reproductive number R0 is provided.
This paper provides a complete probabilistic description of SIS-type epidemiological models where all the input parameters (contagion rate, recovery rate and initial conditions) are assumed to be random variables. By applying the Random Variable Transformation technique, the first probability density function, the mean and the variance functions, as well as confidence intervals associated with the solution of SIS-type epidemiological models, are determined. It is done under the general hypothesis that model random inputs have any joint probability density function. The distributions to describe the time until a given proportion of the population remains susceptible and infected are also determined. Finally, a probabilistic description of the so-called basic reproductive number is included. The theoretical results are applied to an illustrative example showing good fitting.
This paper deals with the explicit determination of the first probability density function of the solution stochastic process to random autonomous first-order linear systems of difference equations ...under very general hypotheses. This finding is applied to extend the classical stability classification of the zero-equilibrium point based on phase portrait to the random scenario. An example illustrates the potentiality of the theoretical results established and their connection with their deterministic counterpart.
This paper deals with the approximate computation of the first probability density function of the solution stochastic process to second-order linear differential equations with random analytic ...coefficients about ordinary points under very general hypotheses. Our approach is based on considering approximations of the solution stochastic process via truncated power series solution obtained from the random regular power series method together with the so-called Random Variable Transformation technique. The validity of the proposed method is shown through several illustrative examples.
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