PURPOSE OF REVIEW Preeclampsia remains an important cause of maternal and neonatal morbidity and mortality. Recent interest in angiogenic biomarkers as a prognostic indicator is reviewed, together with analgesic, anaesthetic and critical-care management of the preeclamptic patient. RECENT FINDINGS There has been recent interest in the angiogenic biomarkers placental growth factor and soluble fms-like tyrosine kinase-1 in establishing the diagnosis of preeclampsia and guiding its management. Neuraxial blocks are recommended for both labour and operative delivery if not contraindicated by thrombocytopenia or coagulopathy, although a safe lower limit for platelet numbers has not been established. For spinal hypotension phenylephrine is noninferior to ephedrine in preeclamptic parturients and may offer some benefits. When general anaesthesia is required, efforts must be made to blunt the hypertensive response to laryngoscopy and intubation. Transthoracic echocardiography has emerged as useful technique to monitor maternal haemodynamics in preeclampsia. SUMMARY Improvements in the diagnosis of preeclampsia may lead to better outcomes for mothers and babies. Peripartum care requires a multidisciplinary team approach with many preeclamptic women receiving neuraxial analgesia or anaesthesia. Women with severe preeclampsia may require critical-care support and this should meet the same standards afforded to other acutely unwell patients.BACKGROUND To investigate the potential utility of serum uncoupling protein-2 (UCP2) level as a biomarker in septic patients. METHODS Critically ill patients with diagnoses of sepsis – sepsis non-shock group (n = 20) and septic shock group (n = 53), and a control group (n = 15) were enrolled within 24 h of entry into the ICU. Serum levels of UCP2 were measured by enzyme-linked immunosorbent assay (ELISA) at ICU admission for all the groups and at ICU discharge for septic shock group. Clinical parameters and laboratorial tests (APACHE II, SOFA, lactate, etc.) were also collected. RESULTS Serum UCP2 concentrations on ICU admission were significantly increased in septic shock group and sepsis non-shock group, compared with control subjects (263.21 ± 29.99 vs 115.96 ± 32.99 vs 60.56 ± 10.05 pg/ml, P 246.52 pg/mL) had significantly increased 28-day mortality compared with those with lower UCP2 levels ( less then 246.52 pg/mL). CONCLUSION Serum UCP2 levels at admission were markedly increased in patients with sepsis, which is useful for early diagnose and prognostic prediction. UCP2 is a potential biomarker for sepsis, or even a subtype of sepsis.INTRODUCTION Inflammasomes are recognized as key components of the innate immune response in sepsis. We aimed to describe the transcriptional expression of nucleotide-binding domain, leucine-rich repeat-containing receptor, pyrin domain-containing-3 (NLRP3) and serum interleukin-1β (IL-1 β) in critically ill patients, their changes over the first week and their prognostic value in septic patients. METHODS Prospective study including patients with sepsis based on Sepsis-3 definitions and a control group of critically ill patients without sepsis. We measured the circulating levels of IL-1β as well as the transcriptional expression of NLRP3 at admission and on days 3 and 7. Caspase-1 and caspase-3 activation was analyzed in a matched cohort of patients with septic shock (4 dead and 4 survivors). RESULTS Fifty-five septic patients and 11 non-septic patients were studied. Levels on day 0 and 3 of IL-1 β and NLRP3 inflammasome expression were significantly higher in patients with sepsis than in controls. NLRP3 was significantly higher in septic patients who survived at day 7 without significant difference between survivors and non-survivors at baseline and on day 3. In survivors, an increased caspase-1 protein expression with reduced expression caspase-3 was observed with the opposite pattern in those who died. Selleck BKM120 CONCLUSIONS NLRP3 is activated in critically ill patients but this up-regulation is more intense in patients with sepsis. In sepsis, a sustained NLRP3 activation during the first week is protective and sepsis. An increased caspase-1 protein expression with reduced expression caspase-3 is the pattern observed in septic shock patients who survive.BACKGROUND It is important to be able to estimate the anticipated net population benefit if the performance of hospitals is improved to specific standards. OBJECTIVE The objective of this study was to show how G-computation can be used with random effects logistic regression models to estimate the absolute reduction in the number of adverse events if the performance of some hospitals within a region was improved to meet specific standards. RESEARCH DESIGN A retrospective cohort study using health care administrative data. SUBJECTS Patients hospitalized with acute myocardial infarction in the province of Ontario in 2015. RESULTS Of 18,067 patients hospitalized at 97 hospitals, 1441 (8.0%) died within 30 days of hospital admission. If the performance of the 25% of hospitals with the worst performance had their performance changed to equal that of the 75th percentile of hospital performance, 3.5 deaths within 30 days would be avoided [95% confidence interval (CI) 0.4-26.5]. If the performance of those hospitals whose performance was worse than that of an average hospital had their performance changed to that of an average hospital, 6.0 deaths would be avoided (95% CI 0.7-47.0). If the performance of the 75% of hospitals with the worst performance had their performance changed to equal that of the 25th percentile of hospital performance, 11.0 deaths would be avoided (95% CI 1.2-79.0). CONCLUSION G-computation can be used to estimate the net population reduction in the number of adverse events if the performance of hospitals was improved to specific standards.BACKGROUND Starting in 2014, the Affordable Care Act mandated that Medicare Advantage (MA) contracts spend at least 85% of total revenue on claims and quality improvement [ie, the medical loss ratio (MLR)] and submit revenue and cost data annually in MLR reports. These reports can improve transparency of the financial performance of MA contracts. However, little is known about revenues and costs of insurers that participate in MA and its impacts on status changes in the following year. OBJECTIVE To characterize revenues and costs of MA contracts in 2014, with a focus on MLRs and gross margins, and to assess heterogeneity in subsequent-year plan renewal and termination rates by gross margins. RESEARCH DESIGN Cross-sectional data from MLR reports submitted in 2014 by MA contracts and from 2015 Part C & D Plan Crosswalk Files regarding plan renewal, termination, and other status changes from 2014 to 2015. SUBJECTS Three hundred eighty-nine MA contracts. MEASURES Primary outcomes are MLRs and gross margins. RESULTS MLRs averaged 93% in 2014; 11% of contracts reported MLRs of at least 100%.