ABSTRACT
Objective: Single-cell RNA-sequencing (scRNA-seq) and spatial transcriptomics have identified novel cell subtypes and microenvironments which compartmentalize diverse functions at the maternal-fetal interface. We aimed to combine these high-resolution technologies with a rigorous classification of transcription alterations associated with diabetes subtypes in pregnancy. We hypothesized characteristic transcriptome profiles in specific cell populations would be linked to these classifications. Study Design: We clinically validated gestational diabetes mellitus type 1 (GDMA1), GDMA2, and type 2 diabetes (T2DM) classes within a cohort of placentae and compared them to healthy controls by bulk RNA-seq (N=53). We then integrated our non-diabetic term placentae spatial transcriptomics data (N=12) with 273,944 publicly available transcriptomes from term placenta scRNA-seq or single-nuclei RNA-seq (snRNA-seq) datasets (accessions phs001886, GSE173193, EGAS00001002449) with control, GDM, or SARS-CoV-2 positive subjects to create a placental transcriptomic catalog. Result(s): In bulk, we identified 104 significantly differentially expressed transcripts (-2< log2fold-change >2,p< 0.05) in our GDMA1 samples, 102 with GDMA2, and 121 with T2DM (Fig. 1a). Comparisons revealed 88 transcripts uniquely marking GDMA1, 68 for GDMA2, and 85 for T2DM, while FGA and CYP1A1 perturbations were shared across diabetes classes (Fig. 1b). We then compared these bulk GDM subtype markers with the 5,211 significantly differentially expressed transcripts associated with 22 cell-type clusters in our term placenta atlas (Fig. 2), and 20 unique GDM bulk markers aligned with extravillous trophoblast, stromal, endometrial epithelia, endothelial, NK, and dendritic single-cell placental markers. Conclusion(s): Together, these results detail the gene expression profiles and the cell types in the maternal-fetal milieu of pregnancies affected by diabetes. Consistent with their distinct clinical outcomes, GDM and T2DM have unique cellular transcriptomes and would thus be targets for new therapeutics. [Formula presented] [Formula presented] Copyright © 2022
ABSTRACT
One of the effects of COVID-19 has been the increase in the number of people who telework. Against this background, the Spanish government, trade unions and employers' association adopted a new provision regulating this way of working. Based on these considerations, this paper provides an overview of telework in Spain. To this end, Law No. 10/2021 will be analyzed, particularly its scope of application and teleworker's rights. This analysis will be carried out to assess the legal value of this new piece of legislation.
ABSTRACT
Background: The incidence of AKI in COVID 19 is very variable across the world. In New York City it was as high as 36% in a large series in early 2020. However, the incidence of AKI during the second surge between Oct of 2020 to early 2021 is unknown. In this study, we compared these two COVID-19 periods for the incidence of AKI amongst hospitalized patients. Methods: This was a multi-center, retrospective cohort study of patients hospitalized with COVID-19 between March 1st and July 16th 2020 (n=1,719), and between October 15th 2020 and February 28th 2021(n=997) in two NYC public hospitals, (total n= 2,716). Patients < 18 years, with End Stage Kidney Disease or a kidney transplant were excluded. Chi-squared test and Fisher's exact test were used to compare the clinical characteristics of the patients. A p-value less than 0.05 was considered statistically significant. Results: The baseline clinical characteristics and demographics of the two surges were similar. The incidence of AKI as defined by KDIGO criteria, during admission decreased from 28.7% in the first surge to 18.6% in the second surge (p<0.0001). This trend was seen both at encounter level too as shown below. For laboratory characteristics, more patients with hypernatremia and with peak CRP > 50 (Ref range: <50) presented in the first surge than the second surge (p<0.0001). No differences in the peak potassium and peak D-Dimer, or ICU admission rates were seen between two surges. However, significantly more AKI patients in the first surge were on mechanical ventilation as compared to the second surge (p=0.0196). Conclusions: To our knowledge this is the first comparison reported between rates of AKI in hospitalized patients with COVID-19 during two different surge periods. The difference may be related to less severe disease during the second surge, though ICU admission rate was the same. Better care established by the time of the second surge and improved therapeutics such as early use of anti-viral agents, corticosteroids, and anticoagulation may have contributed to better outcomes. Improvement in care of COVID-19 in the second surge may have contributed to a decline in the incidence of AKI. Future studies are needed to see if this trend towards lower AKI incidence continues.