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Consumers are increasingly claiming to prioritize environmental considerations in their product selections, and, accordingly, manufacturers of luxury items are integrating environmentally-friendly features into their products. Yet, thus far, research has produced contradictory findings with regard to whether consumers actually evaluate eco-friendly luxury products more favorably. The current research attempts to reconcile past inconclusive evidence by investigating the centrality of the eco-friendly attribute (i.e., the extent that it is integral to the product's essence) as a determining factor. Three controlled experiments that manipulated attribute centrality, coupled with an internal meta-analysis, find that central (rather than peripheral) eco-friendly attributes, positively influence consumers' interest in and evaluations of a luxury product. Furthermore, results show that this effect is mediated by perceived manufacturer sincerity. Specifically, when a product's eco-friendly attribute is central (vs. peripheral), consumers are more likely to perceive the manufacturing firm as possessing sincere environmental intentions, and this perception, in turn, enhances product evaluations. This research is the first to integrate attribute centrality and perceptions of manufacturer sincerity, and in so doing, helps explain consumer evaluations of eco-friendly luxury products. • Research presents mixed findings regarding the effects of eco-friendly attributes on evaluations of luxury products. • This research examines how the centrality of eco-friendly attributes impacts luxury product evaluations. • Results show that when the eco-friendly attribute is central, consumers hold favorable attitudes toward the luxury product. • Central eco-friendly attributes also lead consumers to perceive the manufacturer's environmental intentions as more sincere. • In practice, these findings can help manufacturers frame their luxury products to increase product attractiveness. [ABSTRACT FROM AUTHOR]

Background: Adherent and invasive placenta, termed Placenta Creta Spectrum (PCS), is associated with increased maternal morbidity and mortality. Incidence and risk factors for Placenta Creta are on the rise and call to optimize the obstetric care for this condition.Objectives: We sought to compare maternal and neonatal outcomes between a ProActive Peripartum Multidisciplinary Approach (PAMA) as compared to the urgent management of the Placenta Creta Spectrum patients.Study Design: We conducted a single-center prospective observational study between 2005-2016. PCS patients registered with the implementation of a PAMA protocol 2014-2016 epoch(E2) were compared with the pre-PAMA 2005-2013 epoch(E1), managed by urgent team recruitment. The PAMA protocol is grounded on a continuum of care; A. Antenatal: PCS risk assessment based on clinical history and imaging, surgical, anesthesia, urological consults and designation of a dedicated team to be present at planned surgery; B. Delivery: planned at 34-35 weeks, massive transfusion protocol activation, insertion of ureteral catheters, vertical uterine incision, placement of vessel loops on the iliac vessels, avoidance of active placenta delivery, followed by the decision of hysterectomy or uterine repair; C. Post-operative care: intensive care admission. We evaluated maternal and neonatal outcomes.Results: During the study period 158,438 deliveries were registered in our institution; we identified a total of 72 PCS cases (0.05%): 50(69.4%) in E1 and 22 (30.6%) in E2. Patient characteristics were comparable among epochs. Significantly, patients in E2 vs. E1 had fewer events of massive blood transfusion 36.0% vs. 13.6%, p = 0.05; were transfused less RBC units: median 4 vs. 1.5, p = 0.012, had no transfusion-related respiratory complications and hemorrhage control re-laparotomies. Hysterectomy and hollow visceral injury rates were comparable (72% vs. 63.7%, 26% vs. 22%; respectively). The hysterectomy pathology assessment was available for the majority of the cases in both epochs; percreta diagnosis rate significantly increased in E2. The neonatal outcome was similar among the epochs.Conclusions: Institution of a PAMA protocol for PCS resulted in eliminating the urgent deliveries and in reducing the associated significant hemorrhagic related maternal morbidity, with no increase in the rate of hysterectomy or adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Purpose: Preterm birth (PTB) is a complex trait with strong genetic background, whose etiology is not fully understood. It was recently suggested that pregnancy duration is affected by fetal genetic variation even more than by the maternal genome. Vitamin D receptor (VDR) is involved in embryonic implantation and fertility. We studied the association between both maternal and neonatal vitamin D receptor (VDR) genetic variation and PTB.Methods: Maternal and fetal (umbilical cord) DNA was isolated from Jewish Israeli idiopathic preterm newborns (24-36 weeks, n = 146) and control term newborns (>37 weeks, n = 229). Maternal and fetal VDR polymorphisms (FokI, ApaI, BsmI, TaqI) were analyzed by restriction fragment length polymorphism analysis. Using SPSS analysis to correlate VDR genotypes with phenotypic variation: pregnancy duration, preterm birth and spontaneous miscarriages, adjusted for gravidity, parity and gender of newborn.Results: Women homozygous to VDR ApaI (AA) genotype had significant twofold increase risk for PTB [OR 1.973, (CI) 1.183-3.289, p = 0.009] compared to heterozygous women. Male newborns had significant (p < 0.05) 1.73-fold increase of PTB. Women with history of previous (≥1) spontaneous miscarriage had a significant increased risk for PTB if their newborn carried either of the VDR BsmI homozygous (BB or bb) genotypes compared to the heterozygous (Bb) genotype [OR 6.857, (CI) 1.273-36.934, p = 0.018 and OR 9.231, (CI) 1.753-48.618, p = 0.008, respectively], or VDR ApaI homozygous (AA or aa) genotype compared to heterozygous (Aa) genotype [OR 4.33, (CI) 1.029-18.257, p = 0.046 and OR 7.2, (CI) 1.34-38.917, p = 0.021, respectively].Conclusions: We show association between maternal and fetal VDR genotype variants with PTB. [ABSTRACT FROM AUTHOR]

Background Recurrent pregnancy loss (RPL) has been associated with impaired maternal–fetal communication. Protease-activated-receptor 1 (PAR1) is critical for trophoblast invasion and establishment unrelated to its role in vascular biology. Objectives To analyze whether polymorphisms of PAR1 [-1426C/T], [-506I/D], and/or IVS[-14A/T] are associated with unexplained RPL. Patients/methods A case-control pilot study conducted in 39 healthy women with history of unexplained RPL and 98 women with a full-term, uncomplicated deliveries and no history of RPL. Results Women with RPL were significantly more likely to be heterozygous for [-1426C/T] (12.8% versus 3.2%; p = 0.049); the heterozygous state for IVS[-14A/T] was also more common (15.4% versus 4.4%; p = 0.064). There was no difference between groups for [-506I/D] genotypes. The functional consequence for [-1426C/T] and IVS[-14A/T] polymorphisms is underscored by the markedly low PAR1 mRNA levels in those women. Bioinformatics indicate generation of a new consensus motif for repressor Kruppel-like factor 3 (KLF3) in [-1426T]. Moreover, chromatin immunoprecipitation (ChIP) analysis confirmed a physical association between KLF3 protein and the hPar1 DNA obtained from women with the [-1426C/T] polymorphism. Conclusions We hypothesize that the significantly low PAR1 levels impact placenta establishment and consequently pregnancy outcome, thereby profiling a novel risk factor for unexplained RPL. [ABSTRACT FROM AUTHOR]

As patients with osteosarcoma become long-term survivors, increasing attention revolved around the burden of late effects. Recent studies showed an increase in the incidence of secondary malignant neoplasms in patients with osteosarcoma compared with the general population. The risk of developing leukaemia was reported to be in an increasing rate in the last decade. [1] Case report. In this report we present the case of a 19 year old patient diagnosed in the Haematology Department of Colentina Clinical Hospital in February 2015 with Acute Myeloid Leukaemia following the treatment (chemo- and radiotherapy) for an osteogenic osteosarcoma performed 3 years earlier. The cytogenetic examination revealed an abnormal karyotype with 91 chromosomes (XXY). The molecular biology exam did not find mutations in the FLT3ITD, FLT3D835 and NPM1 A genes. After the first induction course of chemotherapy the patient achieved complete remission, which was consolidated by 3 more courses of chemotherapy and an allogeneic stem cell transplant. Conclusion. Taking into consideration the prior treatment for osteosarcoma consisting in radiotherapy and chemotherapy we identified a secondary Acute Myeloid Leukaemia, this representing a major negative prognostic factor, along with the cytogenetic abnormalities found. These factors strongly indicate that the first complete remission should be consolidated by allogeneic stem cell transplant. Particularities of this case are the association of the two malignancies in a young patient, the presence of an abnormal karyotype (hyperploid), and also a good response to the induction therapy, thus achieving complete remission after the first induction course, and of course, sustaining that response. [ABSTRACT FROM AUTHOR]

Background: Observational studies should not be used to infer causation as they are prone to confounding factors, selection bias, and reverse causality. Many observational studies of labor analgesia treated epidurals as an independent exposure and concluded that "epidurals" cause dystocia, despite multiple randomized controlled trials showing no effect. We highlight this problem using reductio ad absurdum. We explore whether people request reading glasses when their progressively increasing focal length equals or exceeds their fixed arm length., Methods: We designed a cross-sectional retrospective and prospective observational study to assess whether there is an association between arm length and age when first requesting reading glasses in presbyopia. We evaluated individuals aged 38-55 receiving their first reading glasses for presbyopia (either currently or within the past year). We recorded age at first request for reading glasses, the refractive correction (additions) in each eye, and we measured arm length., Results: Seventy subjects were included in the study. No association was found between arm length and the age at request for reading glasses or the severity of presbyopia at presentation., Conclusions: Even if this observational study had demonstrated a strong correlation between age at request for reading glasses and arm length, it would have been absurd to conclude that spectacles somehow cause our arms to shrink. Similarly, women in obstructed labor with a narrow pelvis are more likely to request neuraxial labor analgesia, but "epidurals" do not make their pelvis shrink. Making far-reaching causal inferences based on retrospective or observational data is very shortsighted., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Morbidly adherent placentation (MAP) increases the risk for obstetric hemorrhage. Cesarean hysterectomy is the prevalent perioperative approach. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive and relatively simple endovascular procedure to temporarily occlude the aorta and control below diaphragm bleeding in trauma. It has been effectively used to reduce obstetric hemorrhage., Objectives: To evaluate whether REBOA during cesarean delivery (CD) in women with morbidly adherent placentation is a safe and effective treatment modality., Methods: We introduced REBOA for CD with antepartum diagnosis of MAP in 2019 and compared these patients (RG) to a standard approach group (SAG) treated in our center over the preceding year, as a control. All relevant data were collected from patient electronic files., Results: Estimated blood loss and transfusion rates were significantly higher in SAG; 54.5% of SAG patients received four RBC units or more vs. one administered in RG. No fresh frozen plasma, cryoprecipitate, or platelets were administered in RG vs. mean 3.63, 6, and 3.62 units, respectively in SAG. Ten SAG patients (90.9%) underwent hysterectomy vs. 3 RG patients (30%). Five SAG patients (45%) required post-surgical intensive care unit (ICU) admission vs. no RG patients. Bladder injury occurred in five SAG cases (45%) vs. 2 RG (20%). One RG patient had a thromboembolic event. Perioperative lactate levels were significantly higher in SAG patients., Conclusions: Use of REBOA during CD in women with MAP is safe and effective in preventing massive bleeding, reducing the rate of hysterectomy, and improving patient outcome.

Background: Maternal and neonatal outcomes of trial of labor after cesarean delivery of twins are similar to those of singleton trials of labor after cesarean delivery. However, previous studies did not stratify outcomes by second-twin presentation on admission to labor., Objective: To examine maternal and neonatal outcomes following trial of labor after cesarean delivery in twins with vertex-nonvertex presentation., Study Design: A retrospective multicenter study was conducted including data on deliveries occurring between the years 2005 and 2020. We included trials of labor after a previous cesarean delivery (at ≥32 0/7 weeks' gestation) of twin gestations with a vertex-presenting first twin on admission to labor. The exposed group was defined as deliveries with a nonvertex second twin at admission to labor, whereas the comparison group included deliveries with a vertex second twin at admission. Only parturients who attempted vaginal delivery were included. Cases of prelabor fetal death of either twin or major fetal anomalies were excluded. The primary outcome was uterine rupture., Results: A total of 236 twin trials of labor after cesarean delivery were included, of which 128 involved nonvertex second twins and 108 a second vertex twin. Uterine rupture rates were comparable between the groups (1/128 [0.9%] vs 1/108 [0.8%]; P=1.000). Successful trial of labor after cesarean delivery of both twins occurred in 76.6% of the exposed group vs 81.5% of the comparison group, whereas cesarean delivery of both twins was performed in 21.9% of the exposed group vs 17.6% of the comparison group (P=.418; odds ratio, 1.32; confidence interval, 0.7-2.5). Two cases of cesarean delivery of the second twin occurred in the exposed group and 1 in the comparison group (1.6% vs 0.9%, respectively, P=1.000). There was no difference between the groups in maternal outcomes, including rates of postpartum hemorrhage, blood transfusion, placental abruption, thromboembolic events, and maternal fever. Neonatal outcomes were also comparable between the groups, including rates of intensive care admission and low (≤7) 5-minute Apgar scores., Conclusion: Our data show that trial of labor after cesarean delivery of noncephalic second twins holds favorable maternal and neonatal outcomes, comparable with those of vertex-vertex trials of labor after cesarean delivery. Second-twin noncephalic presentation should not discourage parturients and caregivers from considering trial of labor after cesarean delivery if desired., (Copyright © 2022 Elsevier Inc. All rights reserved.)