Search

Summary: Background: Real-world data on gene addition therapy (GAT) with onasemnogene abeparvovec (OA), including all age groups and with or without symptoms of the disease before treatment are needed to provide families with evidence-based advice and realistic therapeutic goals. Aim of this study is therefore a population-based analysis of all patients with SMA treated with OA across Germany, Austria and Switzerland (D-A-CH). Methods: This observational study included individuals with Spinal Muscular Atrophy (SMA) treated with OA in 29 specialized neuromuscular centers in the D-A-CH-region. A standardized data set including WHO gross motor milestones, SMA validated motor assessments, need for nutritional and respiratory support, and adverse events was collected using the SMArtCARE registry and the Swiss-Reg-NMD. Outcome data were analyzed using a prespecified statistical analysis plan including potential predictors such as age at GAT, SMN2 copy number, past treatment, and symptom status. Findings: 343 individuals with SMA (46% male, 54% female) with a mean age at OA of 14.0 months (range 0–90, IQR 20.0 months) were included in the analysis. 79 (23%) patients were clinically presymptomatic at the time of treatment. 172 (50%) patients received SMN2 splice-modifying drugs prior to GAT (risdiplam: n = 16, nusinersen: n = 154, both: n = 2). Functional motor improvement correlated with lower age at GAT, with the best motor outcome in those younger than 6 weeks, carrying 3 SMN2 copies, and being clinically presymptomatic at time of treatment. The likelihood of requiring ventilation or nutritional support showed a significantly increase with older age at the time of GAT and remained stable thereafter. Pre-treatment had no effect on disease trajectories. Liver-related adverse events occurred significantly less frequently up to 8 months of age. All other adverse events showed an even distribution across all age and weight groups. Interpretation: Overall, motor, respiratory, and nutritional outcome were dependent on timing of GAT and initial symptom status. It was best in presymptomatic children treated within the first six weeks of life, but functional motor scores also increased significantly after treatment in all age groups up to 24 months. Additionally, OA was best tolerated when administered at a young age. Our study therefore highlights the need for SMA newborn screening and immediate treatment to achieve the best possible benefit-risk ratio. Funding: The SMArtCARE and Swiss-Reg-NMD registries are funded by different sources (see acknowledgements).

Abstract 3D ultrasound imaging of fetal faces has been predominantly confined to qualitative assessment. Many genetic conditions evade diagnosis and identification could assist with parental counselling, pregnancy management and neonatal care planning. We describe a methodology to build a shape model of the third trimester fetal face from 3D ultrasound and show how it can objectively describe morphological features and gestational-age related changes of normal fetal faces. 135 fetal face 3D ultrasound volumes (117 appropriately grown, 18 growth-restricted) of 24-34 weeks gestation were included. A 3D surface model of each face was obtained using a semi-automatic segmentation workflow. Size normalisation and rescaling was performed using a growth model giving the average size at every gestation. The model demonstrated a similar growth rate to standard head circumference reference charts. A landmark-free morphometry model was estimated to characterize shape differences using non-linear deformations of an idealized template face. Advancing gestation is associated with widening/fullness of the cheeks, contraction of the chin and deepening of the eyes. Fetal growth restriction is associated with a smaller average facial size but no morphological differences. This model may eventually be used as a reference to assist in the prenatal diagnosis of congenital anomalies with characteristic facial dysmorphisms.

An innovative solution for aluminium-glass partition walls that can withstand seismic actions without damage is presented. The key feature characterising the proposed innovation is a dissipative coupling between the components of the partition wall, i.e., the glass plates and the surrounding aluminium frame, accomplished through the interposition of high-damping rubber pads (HDRPs). Sliding mechanisms between glass panels and the aluminium frame are permitted through specific detailing solutions, which allow the partition wall to be unsensitive to the inter-storey drift imposed by the hosting structure. A detailed discussion of the system conception is illustrated, showing the main intermediate steps that led to the final solution. The implementation of a refined numerical model is illustrated, and its characteristic parameters are calibrated according to a set of experimental tests previously performed on materials and subcomponents. A numerical application to a case study consisting of a partition wall system installed within a three-storey building is provided to assess the performance of the proposed innovative solution under severe earthquakes.

The problem of a beam prestressed by means of a stretched cable slipping along a path rigidly linked to the beam is analyzed in a more general and unitary way than in previous formulations by considering nonlinear materials and generic cable paths. Moreover, the writers intend to show that the weak form of the problem, based on total potential energy minimization, is far more convenient than the strong form, based on local equilibrium, from both formal and numerical points of view. The weak form expresses global equilibrium conditions, and describes in a more natural way the physical behavior of this system in which the slipping cable joins the local equilibrium to the global deformation. A numerical method for the solution of the nonlinear problem is provided by using the Ritz approximation method, and results concerning a concrete beam are reported.

Video processing for structural monitoring has attracted much attention in recent years thanks to the possibility of measuring displacement time histories in the absence of stationary points close to the structure, using hardware that is simple to operate and with accessible costs. Experimental studies show a unanimous consensus on the potentialities of vision-based monitoring to provide accurate results that can be equivalent to those obtained from accelerometers and displacement transducers. However, past studies mostly involved steel bridges and footbridges while very few applications can be found for concrete bridges, characterised by a stiffer response with lower displacement magnitudes and different frequency contents of their dynamic behaviour. Accordingly, the attention of this experimental study is focused on the application of a vision-based structural monitoring system to a medium-span, post-tensioned, simply supported concrete bridge, a very common typology in many road networks. The objective is to provide evidence on the quality of the results that could be obtained using vision-based monitoring, understanding the role and influence on the accuracy of the measurements of various parameters relevant to the hardware settings and target geometry, highlighting possible difficulties, and providing practical recommendations to achieve optimal results.

Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the ‘foetal programming’ of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today’s management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.

The seismic response of base-isolated structures is notably influenced by mechanical properties of isolation devices due to their essential role in structural behavior. Consequently, the variability of such properties should be accounted for in the design process. The current seismic codes prescribe a simplified approach based on structural analyses in two extreme situations resulting from the upper and lower bound design properties of bearings (upper and lower bound analyses). In the case that experimental data are not provided by manufacturers, seismic codes provide the so-called “property modification factors” or “λ-factors”, i.e., modification coefficients to be applied to the nominal dynamic properties of bearings to obtain their upper or lower design properties. The aim of this paper is to provide a historical review of values provided for such factors by the main seismic codes by highlighting the limits, as well as some clerical errors, present in some codes. In particular, the European seismic codes are illustrated in detail, i.e., the Eurocode for bridges (EN 1998-2) and product standard on anti-seismic devices (EN 15129). Both these codes account for different sources of variability, such as the bearings production and the environmental and behavioral effects. For all these effects, the same λ-factor values are provided by the two codes, deriving from the second version of the AASHTO guide specifications for seismic isolation of bridges (AASHTO 1999), which are based on limited and/or old data, especially for high damping rubber bearings (HDRBs), and were never updated in the successive versions. More recent standards are also illustrated, providing different perspectives that deserve attention, even though they require further investigations to be applied in the design practice.

Early fetal growth restriction (FGR) remains a challenging entity associated with an increased risk of perinatal morbidity and mortality as well as maternal complications. Significant variations in clinical practice have historically characterized the management of early FGR fetuses. Nevertheless, insights into diagnosis and management options have more recently emerged. The aim of this review is to summarize the available evidence on monitoring, delivery and outcome in early-onset FGR.

Introduction Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years.Methods and analysis Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is

Positioning via outdoor fingerprinting, which exploits the radio signals emitted by cellular towers, is fundamental in many applications. In most cases, the localization performance is affected by the availability of information about the emitters, such as their coverage. While several projects aim at collecting cellular network data via crowdsourcing observations, none focuses on information about the structure of the networks, which is paramount to correctly model their topology. The difficulty of such a modeling is exacerbated by the inherent differences among cellular technologies, the strong spatio-temporal nature of positioning, and the continuously evolving configuration of the networks. In this paper, we first show how to synthesize a detailed conceptual schema of cellular networks on the basis of the signal fingerprints collected by devices. We turned it into a logical one, and we exploited that to build a relational spatio-temporal database capable of supporting a crowdsourced collection of data. Next, we populated the database with heterogeneous cellular observations originating from multiple sources. In addition, we illustrate how the developed system allows us to properly deal with the evolution of the network configuration, e.g., by detecting cell renaming phenomena and by making it possible to correct inconsistent measurements coming from mobile devices, fostering positioning tasks. Finally, we provide a wide range of basic, spatial, and temporal analyses about the arrangement of the cellular network and its evolution over time, demonstrating how the developed system can be used to reconstruct and maintain a deep knowledge of the cellular network, possibly starting from crowdsourced information only.

In recent years, new solutions have been studied in order to intervene on existing buildings made of load-bearing masonry or reinforced concrete, both from the seismic point of view and the energy one. In recent years, novel modern techniques using lightweight steel profiles made of steel or aluminium alloys, suitably coupled with heat-insulating panels, have been proposed for requalification of existing building stock. In this paper, the Resisto 5.9 system designed by the Progetto Sisma S.r.l. company was studied and applied as a retrofit system of an existing masonry building. First, this new system for seismic energy requalification of the build-up was presented, describing the basic components and the mounting phases. Subsequently, it has applied to a case study building made of full-brick masonry located in the municipality of Casalecchio di Reno, on the outskirts of Bologna in Northern Italy. Finally, the used coating system was designed for the examined building together with other seismic interventions applied to horizontal structures and foundations. The seismic benefits deriving from using the proposed envelope system and other seismic interventions were proved from the seismic viewpoint by linear dynamic and non-linear static analyses using the TreMuri analysis software. From modal analysis it was seen that the dynamic behaviour of the building with Resisto 5.9 is improved, with an increase of the participating mass (68% instead of 49% of the bare building) of the second mode in the longitudinal direction. Moreover, from pushover analysis it was noticed that the seismic safety factor has passed from 0.51 to 1.05 in the X-direction and from 0.78 to 1.27 in the Y-direction. In conclusion, it was demonstrated that Resisto 5.9, together with all the other planned interventions, is able to accomplish the seismic retrofitting of the studied building.

BackgroundSelf-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. ObjectiveIn this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire—a 10-item, mobile app–based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). MethodsThe content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach α was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS≥15 and MADRS≥15) from a nonrelapse (interepisode) state (YMRS

The seismic assessment of existing bridges is of the utmost importance to characterise the main structural deficiencies, estimate the risk, prioritise retrofit interventions, or estimate losses and repair costs in case of earthquakes. The above tasks require information on the damage mechanisms likely to occur as well as on the damage extent over the structure. Such types of information are generally not provided by classical fragility analysis, which is mainly focused on the evaluation of the global performance of the bridge. In this paper, a systematic probabilistic methodology for the evaluation of bridge fragility is proposed. The methodology aims at offering insight into the failure mechanisms most likely to occur and the evolution and extent of damage within the bridge structure. First, a mathematical description of the proposed analysis methods is given, then an application to a realistic case study—a reinforced concrete multi-span simply supported deck link-slab bridge—is provided to illustrate the applicability of the tool. A nonlinear 3D finite element model is developed, and a multiple-stripe (nonlinear dynamic) analysis is performed by using a stochastic bidirectional seismic input. The results highlight the suitability of the proposed methodology to reveal the main structural deficiencies, the relations among different failure mechanisms (involving piers, bearings, abutments, etc.), and the expected damage extent.

Pregnant women with GDM affected by COVID-19 seem to be at higher risk of adverse maternal and neonatal outcomes, especially those with overweight or obesity. Good glycemic control seems to be the most effective measure in reducing the risk of GDM and severe COVID-19. For such purposes, the Mediterranean diet, micronutrient supplementation, and physical activity are considered the first line of treatment. Failure to achieve glycemic control leads to the use of insulin, and this clinical scenario has been shown to be associated with an increased risk of adverse maternal and neonatal outcomes. In this review, we explore the current evidence pertaining to the pathogenesis of SARS-CoV-2 leading to the main complications caused by COVID-19 in patients with GDM. We also discuss the incidence of complications caused by COVID-19 in pregnant women with GDM according to their treatment.

The widespread availability of mobile communication makes mobile devices a resource for the collection of data about mobile infrastructures and user mobility. In these contexts, the problem of reconstructing the most likely trajectory of a device on the road network on the basis of the sequence of observed locations (map-matching problem) turns out to be particularly relevant. Different contributions have demonstrated that the reconstruction of the trajectory of a device with good accuracy is technically feasible even when only a sparse set of GNSS positions is available. In this paper, we face the problem of coping with sparse sequences of cellular fingerprints. Compared to GNSS positions, cellular fingerprints provide coarser spatial information, but they work even when a device is missing GNSS positions or is operating in an energy saving mode. We devise a new map-matching algorithm, that exploits the well-known Hidden Markov Model and Random Forests to successfully deal with noisy and sparse cellular observations. The performance of the proposed solution has been tested over a medium-sized Italian city urban environment by varying both the sampling of the observations and the density of the fingerprint map as well as by including some GPS positions into the sequence of fingerprint observations.

This paper analyses the new Research Centre designed for the University of Camerino and entirely financed by the national Civil Protection Department (DPC), following the seismic events in Central Italy in 2016. The building has been designed to guarantee speed of execution as well as a high level of safety, especially regarding seismic actions. The structural solution was to create an isolated system with a steel braced super-structure with pinned joints and r.c. sub-structures able to adapt to the complex morphology of the area. As described in the first part of the paper, design choices have been made to achieve a high level of resilience and robustness, i.e., to limit damage to structural and non-structural components and equipment under moderate and design seismic actions and to avoid disproportionate consequences in the event of extreme actions, larger than the design ones. In the second part of the paper, specific risk analyses have been carried out to evaluate the real performance of the building under increasing intensity levels, with reference to both serviceability and ultimate conditions. To this purpose a site-specific hazard study was first conducted, then non-linear analyses were performed using a hazard-consistent set of records with return periods ranging from TR = 60 years to TR = 10000 years. The main demand parameters of both the isolation system and the super-structure were recorded and capacity values corresponding to different ultimate and damage limit conditions were defined. The results obtained in terms of demand hazard curves show that the building performances in terms of robustness and resilience are very high, confirming the efficacy of the strategies adopted in the design.

This paper investigates the seismic design of fluid viscous dampers connecting adjacent structural systems. A simplified dampers design strategy is proposed, which relies on a linearized reduced order model of the coupled system. A stochastic linearization technique is adopted with the aim of extending the design method to non-linear viscous dampers. The effectiveness of the design method and of the coupling strategy are assessed via numerical analysis of two adjacent buildings with shear-type behavior connected by linear or non-linear viscous dampers and subjected to Gaussian stochastic base acceleration. Different dampers locations are analyzed. The accuracy of the reduced order model is assessed, by comparing the relevant response statistics to those provided by a refined multi degree of freedoms model. Finally, a parametric study is performed to assess the effectiveness of dissipative connection for different values of seismic intensity and dampers parameters (i.e., viscous coefficients and velocity exponents).

A technological system capable of automatically producing damage scenarios at an urban scale, as soon as an earthquake occurs, can help the decision-makers in planning the first post-disaster response, i.e., to prioritize the field activities for checking damage, making a building safe, and supporting rescue and recovery. This system can be even more useful when it works on densely populated areas, as well as on historic urban centers. In the paper, we propose a processing chain on a GIS platform to generate post-earthquake damage scenarios, which are based: (1) on the near real-time processing of the ground motion, that is recorded in different sites by MEMS accelerometric sensor network in order to take into account the local effects, and (2) the current structural characteristics of the built heritage, that can be managed through an information system from the local public administration authority. In the framework of the EU-funded H2020-ARCH project, the components of the system have been developed for the historic area of Camerino (Italy). Currently, some experimental fragility curves in the scientific literature, which are based on the damage observations after Italian earthquakes, are implemented in the platform. These curves allow relating the acceleration peaks obtained by the recordings of the ground motion with the probability to reach a certain damage level, depending on the structural typology. An operational test of the system was performed with reference to an ML3.3 earthquake that occurred 13 km south of Camerino. Acceleration peaks between 1.3 and 4.5 cm/s2 were recorded by the network, and probabilities lower than 35% for negligible damage (and then about 10% for moderate damage) were calculated for the historical buildings given this low-energy earthquake.

Since August 2015, an increasing number of Blue Crabs, Callinectes sapidus Rathbun, 1896, have been reported in the Marano and Grado Lagoon, Gulf of Trieste, in the northern Adriatic Sea. This species is not a new introduction and in fact the first record of C. sapidus in Italy and the entire Adriatic Sea dates back to 1949 in the Grado Lagoon. Interestingly, no other records of C. sapidus have been reported since the first record. Here, we note the re-appearance of C. sapidus in the Gulf of Trieste.

This paper deals with the seismic retrofit of existing frames by means of external passive dissipative systems. Available in different configurations, these systems allow high flexibility in controlling the structural behaviour and are characterized by some feasibility advantages with respect to dissipative devices installed within existing frames. In particular, this study analyzes and compares the performances of two external solutions using linear viscous dampers. The first is based on the coupling of the building with an external fixed-based steel braced frame by means of dampers placed horizontally at the floor levels. The second is an innovative one, based on coupling the building with a “dissipative tower,” which is a steel braced frame hinged at the foundation level, and activating the dampers through its rocking motion. The effectiveness of the two solutions is evaluated and compared by considering a benchmark existing reinforced concrete building, employing a stochastic dynamic approach, under the assumption of linear elastic behaviour for the seismic performance evaluation. This allows efficiently estimating the statistics of many response parameters of interest for the performance assessment and thus carrying out extensive parametric analyses for different properties of the external systems. The study results provide useful information regarding the design and the relative efficiency of the proposed retrofit solutions.

Cadherins are a large family of transmembrane calcium-dependent cell adhesion proteins that orchestrate adherens junction formation and are crucially involved in tissue morphogenesis. Due to their important role in cancer development and metastasis, cadherins can be considered attractive targets for drug discovery. A recent crystal structure of the complex of a cadherin extracellular portion and a small molecule inhibitor allowed the identification of a druggable interface, thus providing a viable strategy for the design of cadherin dimerization modulators. Here, we report on a structure-based virtual screening approach that led to the identification of efficient and selective modulators of E-cadherin-mediated cell−cell adhesion. Of all the putative inhibitors that were identified and experimentally tested by cell adhesion assays using human pancreatic tumor BxPC-3 cells expressing both E-cadherin and P-cadherin, two compounds turned out to be effective in inhibiting stable cell−cell adhesion at micromolar concentrations. Moreover, at the same concentrations, one of them also showed anti-invasive properties in cell invasion assays. These results will allow further development of novel and selective cadherin-mediated cell−cell adhesion modulators for the treatment of a variety of cadherin-expressing solid tumors and for improving the efficiency of drug delivery across biological barriers.

Deoxynivalenol (DON) is the most prevalent trichothecene in Europe and its occurrence is associated with infections of Fusarium graminearum and F. culmorum, causal agents of Fusarium head blight (FHB) on wheat. Resistance to FHB is a complex character and high variability occurs in the relationship between DON content and FHB incidence. DON conjugation to glucose (DON-3-glucoside, D3G) is the primary plant mechanism for resistance towards DON accumulation. Although this mechanism has been already described in bread wheat and barley, no data are reported so far about durum wheat, a key cereal in the pasta production chain. To address this issue, the ability of durum wheat to detoxify and convert deoxynivalenol into D3G was studied under greenhouse controlled conditions. Four durum wheat varieties (Svevo, Claudio, Kofa and Neodur) were assessed for DON-D3G conversion; Sumai 3, a bread wheat variety carrying a major QTL for FHB resistance (QFhs.ndsu-3B), was used as a positive control. Data reported hereby clearly demonstrate the ability of durum wheat to convert deoxynivalenol into its conjugated form, D3G.

A survey on the concentration of some metals and metalloids in soils of Veneto conducted on 2393 samples, of which 1363 topsoil (0-40 cm) and 1030 subsoil (70-100 cm), allowed to define the background values for the metals considered.Particularly for some metals and in areas of volcanic substrata these values were above certain threshold concentrations of contamination defined by the Italian environmental legislation. Some results of persistent organic pollutants monitoring inthe soils are reported and available.

Ettore Spalletti re-inventa nel 1996 l’obitorio dell’ospedale Raymond Poincaré a Garches - alle porte di Parigi. È uno spazio privo di simboli religiosi, in cui i corpi, posti nella bara, sono esposti all’ultimo sguardo dei familiari e degli amici. È la Salle des départs, sala delle partenze, in cui ogni uomo è chiamato a soggiornare - musulmano, cristiano, non credente – per il breve transito dal mondo della vita a quello della morte, verso una nuova vita. L’intento di Spalletti è quello di umanizzare un luogo che aiuti le persone a elaborare il lutto, infondendo pace e serenità. Da uno spazio anonimo, grazie alla forza espressiva del colore azzurro, come quello del manto di una Madonna che accoglie i suoi figli, l’artista ci fa immergere in un luogo che si presenta come l’incarnazione della purezza, diventando simbolo della promessa della trascendenza e dell’assoluto.

The present study concerns the environmental monitoring of a site that is close to the industrial area of Pederobba (Treviso province) which is characterized by the presence of a cement factory. Successively 43 soil samples were collected-including 26 surface samples and 17 deep ones. Each soil sample was analyzed and organic (PAHs, PCBs and PCDD/Fs) and inorganic (metals and metalloids) parameters were measured. Analytical results showed some values above contamination threshold levels in residential districts regarding PCDD/F, copper and cobalt.

In this paper we discuss the causes of non-adherence to reversible contraceptives, especially hormonal methods, among women in rural Santarém in the Brazilian Amazon. The analysis is based on questionnaires with 398 women and visits to health centers. We consider the motives reported by women who: never used contraception; used some method in the past; and who at the time of the survey were using a different method from the ones they used in the past. The results indicate a rejection of hormonal contraception and a preference for female sterilization, an option possibly influenced by the characteristics of health services in the region. The side effects of hormonal contraceptive use reported by part of the interviewees contribute to a generalized fear of the side effects even among women who have never used such methods. To improve women's health services in the Amazon, we recommend further studies of the relationship between reported side effects and available services and prescriptions, as well as an analysis of women's discourse and perceptions.Discutimos sobre as causas da não-adesão aos contraceptivos reversíveis, especialmente os métodos hormonais, entre moradoras rurais de Santarém, na Amazônia brasileira. A análise baseia-se em questionários aplicados a 398 mulheres e em visitas a centros de saúde. Consideramos os motivos relatados por mulheres que: nunca usaram contraceptivos; que usaram métodos no passado; que, no momento do levantamento, usavam método diferente dos utilizados no passado. Os resultados indicam rejeição aos contraceptivos hormonais e preferência pela esterilização feminina, opção possivelmente influenciada pelas características dos serviços de saúde na região. Efeitos colaterais do uso de contraceptivos hormonais relatados por parte das entrevistadas contribuem para o medo generalizado de efeitos colaterais, mesmo entre mulheres que nunca usaram métodos hormonais. Para aprimorar o serviço de saúde da mulher na Amazônia, recomendamos futuros estudos sobre o relacionamento entre os efeitos colaterais relatados, os serviços e medicamentos disponíveis, assim como uma análise dos discursos e das percepções das mulheres.

Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routine-clinical-practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH-therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes.A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (2000), duration of hydration therapy: (1 day, >1 day but 1 week), type of fluid administered (isotonic versus hypotonic versus combination).In isolated-oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonic-fluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH.Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH-therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).

In this paper we report examples of the Heck reaction in the new moisture stable ambient temperature ionic liquid 1-butyl-3-methylimidazolium hexafluorophosphate ([bmim]PF6). We have found that the yield of product is comparable with Heck reactions carried out in DMF, the conventional solvent for this reaction, and that the ionic liquid/catalyst mixture can be recycled several times.