M. Herraiz

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria. RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes. RESULTS The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: −14.6%, P < 0.021), prematurity (6.4 to 5.7%: −10.9%, P < 0.039), cesarean section (25.4 to 19.7%: −23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: −6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: −20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: −9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: −24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC. CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.

EFFECTS ON THE IONOSPHERE DUE TO PHENOMENA OCCURRING BELOW IT

The terrestrial thermosphere and ionosphere form the most variable part of theEarths atmosphere. Because our society depends on technological systems thatcan be affected by thermospheric and ionospheric phenomena, understanding,monitoring and ultimately forecasting the changes of the thermosphere–ionosphere system are of crucial importance to communications, navigation and the exploration of near-Earth space. The reason for the extreme variability of the thermosphere–ionosphere system isits rapid response to external forcing from various sources, i.e., thesolar ionizing flux, energetic charged particles and electric fields imposed via the interaction between the solar wind, magnetosphere and ionosphere, as well as coupling from below (“meteorological influences”) by the upward propagating, broad spectrum,internal atmospheric waves (planetary waves, tides, gravity waves) generated in thestratosphere and troposphere. Thunderstorms, typhoons, hurricanes, tornadoes andeven seismological events may also have observable consequences in the ionosphere.The release of trace gases due to human activity have the potential to cause changes inthe lower and the upper atmosphere.A brief overview is presented concerning the discoveries and experimentalresults that have confirmed that the ionosphere is subject to meteorologicalcontrol (especially for geomagnetic quiet conditions and for middle latitudes).D-region aeronomy, the winter anomaly of radiowave absorption, wave-liketravelling ionospheric disturbances, the non-zonality and regional peculiaritiesof lower thermospheric winds, sporadic-E occurrence and structure, spread-Fevents, the variability of ionospheric electron density profiles and Total ElectronContent, the variability of foF2, etc., should all be considered in connection withtropospheric and stratospheric processes. “Ionospheric weather”, as a part of spaceweather, (i.e., hour-to-hour and day-to-day variability of the ionospheric parameters)awaits explanation and prediction within the framework of the climatological, seasonal,and solar-cycle variations.

Inslab Earthquakes of Central Mexico: Peak Ground-Motion Parameters and Response Spectra

We developed equations to predict pseudoacceleration response spectra (5% damping), peak ground acceleration, and peak ground velocity at free-field rock sites for intermediate-depth, normal-faulting inslab earthquakes of Central Mexico. The data set comprises 16 earthquakes (5.2 ≤ M w ≤ 7.4; 35 ≤ H ≤ 138 km) recorded at local and regional distances ( R ≤ 400 km). It represents a homogeneous catalog with respect to tectonic regime, fault mechanism, and soil class. Our results show larger amplitudes in the epicentral area from inslab events than from interplate events, a consequence of higher stress drops during the former type of earthquakes. Peak ground accelerations from moderate to large ( M w >6.0) inslab events significantly exceed those from interplate events with similar magnitude, reaching almost three times for the largest events. The ground motion due to inslab events, however, decays faster than for the thrust events. Our results are in reasonable agreement with other studies based on Japanese and the worldwide data.

AN APPROACH TO THE MEASUREMENT OF THE POTENTIAL STRUCTURAL DAMAGE OF EARTHQUAKE GROUND MOTIONS

SUMMARY The quantification and prediction of damage due to di⁄erent seismic actions to structure types of di⁄erent strength is an important problem not yet solved in the Earthquake Engineering field. In addition, owing to the fact that macroseismic information cannot be used directly in dynamic calculations, a new problem appears when these are the only kind of data available. Thus, there is a need to estimate a parameter to relate the energy of the ground motion and the damage occurrence, and eventually achieve a better seismic risk assessment. After the study and review of some representative potential damage parameters, attention has been paid to the Arias intensity (unfiltered and filtered in certain frequency ranges) and the Cumulative Absolute velocity (CAV) as the parameters to evaluate the energy of movement, and to relate them with the observed damage. The data used to infer these correlations have been provided by the ENEA-ENEL (Italy). The information consists of strong motion records from the Campano Lucano (1980), Umbria (1984) and Lazio-Abruzzo (1984) earthquakes, and data of damage to buildings in the vicinity of recording instruments (within a maximum radius of 300 m, where the soil conditions remain constant). In this paper, some relations have been obtained to quantify the damage level for di⁄erent seismic inputs. The results suggest that unfiltered Arias intensity and CAV (for calculation threshold 20 cm/s2) correlate well with the macroseismic information used. Best fits are obtained between the quoted parameters and the observed damage in type A structures.

Inslab Earthquakes of Central Mexico: Q, Source Spectra, and Stress Drop

We analyze 17 intermediate-depth, normal-faulting, inslab earthquakes of Mexico (4.1 M w 7.4; 35 km H 118 km), recorded on hard sites at local and regional distances (R 600 km), to study spectral attenuation of seismic waves, quality factor Q, source spectra, and Brune stress drop. Assuming 1/R geometrical spreading, the quality factor is given by Q(f ) 251f 0.58 . Although there is consid- erable uncertainty in Q due to the trade-off between geometrical spreading and Q, this uncertainty does not influence strongly the estimation of source spectra and stress drops. We find that source spectra of nine events (4.1 Mw 6.4) follow the x 2 model, while those of the other eight (5.8 Mw 7.4) significantly deviate from it. Interpreting the high-frequency level of the source spectra with the x 2 model yields a nearly constant stress drop, Dr, with a median value of 304 bars. This is more than 4 times greater than the corresponding value for interplate earthquakes in central Mexico. The observed source acceleration spectra, S(f ), is, however, better fit by an empirical source spectrum characterized by two corner frequencies, f a and f b, such that S(f ) f 2 M0/({1 (f /f a) 2 } • {1 (f /f b) 2 }) 1/2 , where f a 4.962 10 10 /M0 0.454 , f b 4.804 10 5 /M0 0.213 , and M0 is in dyne centimeters. This empirical source spectrum may be useful in predicting ground-motion parameters using sto- chastic methods.

Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer

OBJECTIVE To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy. STUDY DESIGN We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features. RESULTS Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p=0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p=0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3g/dl, -2.3g/dl and -2.5 g/dl respectively, p=0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p=0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p=0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p=0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p=0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p=0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p=0.566). CONCLUSION Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.

Risk Factors for Gestational Diabetes Mellitus in a Large Population of Women Living in Spain: Implications for Preventative Strategies

The aim of this study is to establish a risk appraisal model for GDM by identifying modifiable factors that can help predict the risk of GDM in a large population of 2194 women living in Spain. They were recruited between 2009-2010 when screening for GDM was performed. Participants completed a questionnaire on socio-demographic, anthropomorphic and behavioral characteristics, and reproductive and medical history. A total of 213 (9.7%) women were diagnosed as having GDM. Age, pregestational body weight (BW) and body mass index (BMI), and number of events of medical, obstetric and family history were significantly associated with GDM. After logistic regression model, biscuits and pastries intake <4 times/week, red and processed meats intake <6 servings/week, sugared drinks <4 servings/week, light walking >30 minutes/day, and 30 minutes/day of sports at least 2 days/week, compared with opposite consumption, was associated with less GDM risk. Our study identified several pregestational modifiable lifestyle risk factors associated with an increase in the risk of developing GDM. This may represent a promising approach for the prevention of GDM and subsequent complications. Further intervention studies are needed to evaluate if this appraisal model of risk calculation can be useful for prevention and treatment of GDM.

Heterogeneous expression of HLA-G1, -G2, -G5, -G6, and -G7 in myeloid and plasmacytoid dendritic cells isolated from umbilical cord blood

Human leukocyte antigen (HLA)-G is a human nonclassic major histocompatibility complex (MHC) molecule characterized by a limited polymorphism and a low, restricted cell surface expression. HLA-G is constitutively expressed on trophoblasts, fetal endothelial, and epithelial cells, conferring alloimmune protection during pregnancy. HLA-G is also expressed in some malignancies and on macrophages and dendritic cells (DC) in tumoral and inflammatory diseases. Because DC constitute an important component in the immune response and umbilical cord blood has a different immune behavior than peripheral blood, the HLA-G protein profile and mRNA expression were investigated on the different DC subsets present in cord blood. Surface and intracellular expression have been reported on DC and HLA-G1, -G2, -G5, -G6, and -G7 transcripts were present. Different levels of soluble HLA-G were obtained from serum and correlated with gene expression. These data are in contrast with the data previously described for adult peripheral blood, where a limited pattern of HLA-G transcripts was reported; only in the maturation process were more isoforms present. These results demonstrate that DC from cord blood have a different behavior than DC in peripheral blood and could be in accordance with the results obtained in cord blood transplantation, where a lesser effect of graft-versus-host disease exists than in bone marrow transplantation.

Comparison of perioperative outcomes and cost between robotic-assisted and conventional laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL).

STUDY OBJECTIVE To compare perioperative outcomes and cost of robotic-assisted and laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) for treatment of gynecologic malignant conditions. DESIGN Prospective non-randomized study (Canadian Task Force classification II-2). SETTING Tertiary center for womens health. PATIENTS Sixty-two patients with gynecologic cancer operated on by the same surgical team. INTERVENTIONS Thirty-two patients underwent TIPAL via robotic-assisted laparoscopy, and 30 via conventional laparoscopy. Comparison analyses of perioperative outcomes and estimated costs were performed. MEASUREMENTS AND MAIN RESULTS There were no differences between robotic-assisted and laparoscopy insofar as age, body mass index, presurgical morbidity, operating time (92.5 minutes for robotics vs 96.6 minutes for laparoscopy), number of aortic nodes (12 vs. 12), hospitalization stay (2 vs. 2 days), or rate of complications (12.5% vs. 13.3%). Blood loss tended to be lower in the robotic group (75.0 vs. 92.5 mL; p = .08). Surgical cost was higher in the robotic group (

Ionospheric Bubble Seeker: A Java Application to Detect and Characterize Ionospheric Plasma Depletion From GPS Data

3.42 vs.