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To assess the effectiveness of the implementation of a multilevel institutional program to reduce the rate of emergency peripartum hysterectomy (EPH) secondary to postpartum haemorrhage (PPH) in a Western world referral centre for obstetrics.Women who delivered at a tertiary care regional obstetric hub in Milan between 2012 and 2020 were retrospectively reviewed to identify cases of EPH. During the study period, several measures aimed at preventing EPH were progressively implemented: reduction of primary and repeated caesarean, update of PPH treatment protocol, implementation of massive transfusion protocol, dedicated clinical pathway for high-risk patients, regular educational sessions, daily review of critical cases with senior consultant, and periodical review of near miss cases by quality improvement committee. To investigate the possible benefits, we divided the detected cases into two groups based on the historical period (Period I, 2012-2016 vs. Period II, 2017-2020) with the main aim of comparing the rate of EPH calculated as EPH ratio per 1000 deliveries.During Period I and II there were 30,241 and 21,270 births; a total of 60 and 25 EPH were performed, respectively. EPH incidence decreased from 2.0 to 1.2‰ across the study periods (p = 0.027). Between Period I and II, we observed a reduction of institutional caesarean section rate (44.4% vs. 40.4%, p 0.0001); among cases undergoing EPH, we reported a significant reduction of massive blood transfusion (83.3% vs. 52.2%, p = 0.002), increased use (56.7% vs. 96.0%, p = 0.0004) and appropriate administration (25.0% vs. 88.0%, p 0.0001) of tranexamic acid, increased use of non-invasive Bakri Balloon tamponade (3.3% vs. 32.0%, p = 0.0002) instead of surgical techniques (38.3% vs. 16.0%, p = 0.043).A reduction of EPH incidence as a severe outcome of obstetric haemorrhage is achievable through a multilevel institutional effort. Our study may inspire a larger-scale program to improve the safety of patients experiencing PPH.

BACKGROUND & AIMS: A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms. METHODS: Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidence-based statements. RESULTS: Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N = 627; P = .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n = 318; P 10 years), male sex, and younger age at diagnosis. CONCLUSIONS: These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC.

BACKGROUND & AIMS: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. METHODS: Asurvey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. RESULTS: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. CONCLUSIONS: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.

Thaumastocoris peregrinus è specie invasiva originaria dell’Australia in rapida diffusione nei Paesi del Mediterraneo. I dati sono stai raccolti presso il parco Urbano della Mostra d’Oltremare di Napoli. I rilievi relativi alla fenologia di T. peregrinus, al fine di determinare l’andamento annuale delle popolazioni, hanno consentito, posti a confronto con i dati climatici, l’individuazione di tre distinte fasi di evoluzione delle infestazioni e fra queste, di particolare interesse è la crescita esponenziale che si verifica dopo i caldi estivi e che raggiunge il suo massimo nel mese di ottobre per poi calare rapidamente. Per una migliore comprensione degli andamenti, sono state utilizzate le medie e le varianze delle popolazioni di adulti, stadi giovanili e uova vitali. La distribuzione di T. peregrinus sull’ospite è stata messa in relazione all’orientamento magnetico terrestre. La maggiore presenza del fitofago si è riscontrata, con una differenza statisticamente significativa, sul lato della pianta esposta a Sud, Sud-Est e per tutti gli stadi di sviluppo indipendentemente dai dati climatici. La valutazione della distribuzione verticale della popolazione ha individuato la predominanza di individui nella zona medio-alta confermata anche dallo studio delle distribuzioni di adulti, stadi giovanili e uova per foglia. La descrizione delle caratteristiche di disposizione della specie nello spazio, ha una notevole importanza ecologica per la scelta dei metodi di campionamento, la scelta degli indici per l’analisi dei dati e per consentire eventualmente una misura della popolazione utilizzando l’algoritmo del vicino più prossimo. La descrizione qualitativa dello stato in cui è una data popolazione consente inoltre, l’utilizzazione dei modelli di distribuzione matematici. Infine, nel corso dei campionamenti effettuati non si è mai riscontrata la presenza di antagonisti naturali specifici e di predatori autoctoni generalisti. L’assenza del controllo naturale, unitamente all’ampio range termico in cui il T. peregrinus è in grado di sopravvivere, spiegano la rapida espansione delle aree interessate dalla presenza del fitofago. Alla luce dei dati sin qui ottenuti, in considerazione delle conseguenze letali che un'infestazione massiccia comporta, alla mancanza di possibilità di controllo chimico su vasta scala e certamente non praticabile in ambiente urbano, si sta valutando la possibilità di introdurre, dall’Australia, il Mymaridae ooparassitoide specifico, Cleruchoides noackae.

Population synthesis models (PSMs) are fundamental tools to study the star formation history and IMF of unresolved stellar populations using spectral features. This work presents a new set of PSMs constructed using theoretical isochrones and two state-ofthe-art synthetic spectral libraries. The BT-Settl and Munari libraries were chosen for their ability to predict the observed values of Lick-type and IMF-sensitive indices in individual stars of the solar neighbourhood. The BT-Settl library was used to sample the cool main sequence stars and the Munari library for the rest of the evolutionary phases. The PSMs cover a range of metallicities with [Fe/H]= 0, –1.31 and –1.81 for scaled-solar and _-enhanced metal mixtures. \ud \ud The models were used to study the behaviour of the IMF indices defined in the literature and the results are in good agreement with what other PSMs have determined. The PSMs in this work predict a strong degeneracy between age, metallicity and IMF. I used the models to study which are the main evolutionary phases contributing to each IMF-sensitive index and found that most indices reach their final integrated values before the turn off. The post-main sequence stars contribute mainly to the continuum of these bands. Uncertainties in the the effective temperature of the isochrones can affect IMF estimates.\ud \ud The PSMs were applied to extragalactic globular clusters (GCs) and early-type galaxies (ETGs) using data from the literature. I determined the ages, metallicities and IMFs of these systems using index combinations in the optical and infrared. I explored how the morphology of the Horizontal Branch (HB) and dynamical evolution (which are key uncertainties in the modelling of GCs) can affect the IMF predictions. In a population with a Milky Way IMF, dynamical evolution can make the IMF indices mimic a bottom-light IMF. HB morphology has no impact on the IMF estimates at low [Fe/H]. In the IMF index-index diagrams for GCs, the results are significantly affected by the unknown sodium abundances of these systems. Using the PSMs in this work the best index combination to determine the IMF is CaH1 and TiO2. The ETGs and the [Fe/H]=0 GCs appear to have a bottom-heavy IMF with x _ 3:0. These results are discussed in the work.

Objective: The stability and composition of intestinal flora plays a vital role in human wellbeing throughout life from as early as birth. Over the past 50 years, several studies have been conducted to evaluate the effect of probiotic administration in pediatric gastroenterology. This document aims to provide a recommendation score on probiotic utilization in pediatric gastroenterology, together with a review of current knowledge concerning its benefits, tolerability, and safety. Study Design: Published literature was selected without study design restriction: clinical guidelines, meta-analyses, randomized controlled trials (RCTs), cohort studies, outcomes research and case–controlled studies were selected using the following MESH-validated terms: probiotics, diarrhea, acute diarrhea, antibiotic-associated diarrhea, traveler’s diarrhea, bacterial diarrhea, nosocomial diarrhea, prophylactic diarrhea, Helicobacter pylori infection, colic, infantile colic, necrotizing enterocolitis (NEC), inflammatory bowel disease, constipation, and allergy. Once the validity and the quality of results were evaluated, a recommendation score and level of evidence were assigned for pediatric gastrointestinal-related conditions, according to the updated Evidence-Based Medicine guidelines: 1a for systematic review (SR) of RCTs, 1b for individual RCT, 1c for SR and individual RCT, 2a for SR of cohort studies, 2b for individual cohort studies, 2c for outcomes research, and 3a for SR of case-control studies. Results and Conclusions: The Latin American Expert group consensus recommends the use of the following probiotics for pediatric gastrointestinal conditions: prevention of acute infectious diarrhea (AID): 1b for Bifidobacterium lactis, Lactobacillus rhamnosus GG (LGG), and L. reuteri; prevention of nosocomial diarrhea: 1 b for B. lactis Bb12, B. bifidum, LGG and Streptococcus thermophiles; treatment of AID: 1a for LGG and S. boulardii, 1b for L. reuteri; prevention of antibiotic-associated diarrhea: 1b for LGG and S. boulardii; prevention of traveler’s diarrhea: 1b for S. boulardii; prevention of infantile colic: 1a for L. reuteri DSM 17938; treatment of infantile colic: 1b for L. reuteri DSM 17938; prevention of NEC: 1a for B. breve, mixtures of Bifidobacterium and Streptococcus, LGG, L. acidophilus and L. reuteri DSM 17938; induction and maintenance of remission in ulcerative colitis: 1b for VSL#3; improving symptoms of irritable bowel syndrome: 2c for LGG and VSL#3.

A Cross-Cultural Quality of Life Comparison for Pediatric IBD Across 10 Countries.