Menstrual changes after COVID-19 vaccine administration: a systematic review.

OBJECTIVE: During the mass vaccination campaign for COVID-19, cases of menstrual cycle changes in women emerged, so it was thought that the COVID-19 vaccine could affect the menstrual cycle. Over time, these observations have become more frequent, which strengthens the idea. This systematic review aims to show changes in the menstrual cycle after COVID-19 vaccination. MATERIALS AND METHODS: This study was carried out following the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. RESULTS: A suitable bibliography on PubMed/Medline and Scopus was searched by combining text, words, and titles of medical topics. After completing the search, a total of 42 articles were included in this systematic review. CONCLUSIONS: The COVID-19 vaccines may have an impact on the quality of life of women. The changes in the menstrual cycle tend to resolve within 2-3 months of vaccination and the symptoms are mild to moderate and tend to self-limit over time.

Hysteroscopic resection vs dilation and evacuation for treatment of caesarean scar pregnancy: study protocol for a randomised controlled trial.

Background: Caesarean scar pregnancy (CSP) is a type of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section. Management options for women who opted for termination of CSP include sharp curettage, dilation and evacuation (D&E), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolisation with curettage and/or methotrexate administration. Recently hysteroscopic resection has also been proposed as an alternative option. Objective: To compare the surgical outcome of hysteroscopic resection with dilation and evacuation (D&E) for the treatment of caesarean scar pregnancy (CSP). Methods: Parallel-group, non-blinded, randomised clinical trial conducted at a single centre in Italy. Eligible women are those with singleton gestations at less than 9 weeks of gestation, and with thickness of myometrial layer ≥1 mm at the level of the ectopic. Inclusion criteria are women with CSP with positive embryonic/fetal heart activity who opted for termination of pregnancy. Patients will be randomised 1:1 to receive either hysteroscopic resection (i.e. intervention group) or D&E (i.e. control group). In both groups, 50 mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) will be injected intramuscularly at the time of randomisation (day 1) and another dose at day 3. A third dose of MTX is planned in case of persistence of fetal heart activity on day 5. Participants will receive either D&E or hysteroscopic resection from 3 to 7 days after the last dose of MTX. A sample size of 54 women is planned. Main outcome measures: The primary outcome is the success rate of the treatment protocol, defined as no requirement for further treatment until complete resolution of the CSP as demonstrated by negative beta hCG levels and absence of residual gestational material on ultrasound examination.. Study hypothesis: Hysteroscopic surgery is superior to D&E for the treatment of CSP. What is new?: The results of the trial will provide information on the best treatment for CSP.

Higher serum levels of a cathepsin K-generated periostin fragment are associated with fractures in postmenopausal women with primary hyperparathyroidism: a pilot study.

The only difference between fractured and non-fractured postmenopausal women with PHPT of same sex, age, and BMI was a significantly mean higher serum k-periostin level. K-periostin value was associated with fracture at any site (odds ratio 1.044, 95% CI 1.005-1.091, p = 0.03). INTRODUCTION: To assess serum k-periostin fragment levels in patients with primary hyperparathyroidism (PHPT), fractured and non-fractured matched for sex, age, and body mass index. METHODS: Twenty-five Caucasian fractured postmenopausal women with PHPT (group Fx) and 25 PHPT non-fractured (group NFx) were enrolled. Each patient underwent DXA scan at lumbar, hip, and forearm, spine X-ray, and biochemical evaluation of calcium metabolism. For k-periostin analyses, we utilized a specific ELISA test that detects CatK-generated fragment levels in the bloodstream. RESULTS: We found no difference in mean BMD and bone turnover marker values between Fx and NFx groups. Prevalence of osteoporosis was not significantly different in Fx vs NFx (72% vs 60%, p = 0.55). Among Fx, 16% reported multiple fractures, 28% morphometric vertebral fractures, 4% femoral fractures, 28% non-vertebral non-femoral fractures, and 8% wrist fractures. The only detectable difference between Fx and NFx group was a significantly mean higher k-periostin serum level (46.2 ± 21.4 vs 34.7 ± 13.5 ng/ml, p = 0.02). K-periostin was associated with fracture at any site (odds ratio 1.044, 95% CI 1.005-1.091, p = 0.03). No difference in mean k-periostin values was found between patients with vertebral fracture vs those with non-vertebral fracture, and between those with multiple fractures vs those with single fracture. CONCLUSION: Serum k-periostin is significantly associated with fracture in PHPT. If confirmed by further studies, k-periostin could be considered a new marker of bone fragility in PHPT, independently of BMD.

Autonomous Self-Healing Strategy for Stable Sodium-Ion Battery: A Case Study of Black Phosphorus Anodes.

Autonomic self-healing (SH), namely, the ability to repair damages from mechanical stress spontaneously, is polarizing attention in the field of new-generation electrochemical devices. This property is highly attractive to enhance the durability of rechargeable Li-ion batteries (LIBs) or Na-ion batteries (SIBs), where high-performing anode active materials (silicon, phosphorus, etc.) are strongly affected by volume expansion and phase changes upon ion insertion. Here, we applied a SH strategy, based on the dynamic quadruple hydrogen bonding, to nanosized black phosphorus (BP) anodes for Na-ion cells. The goal is to overcome drastic capacity decay and short lifetime, resulting from mechanical damages induced by the volumetric expansion/contraction upon sodiation/desodiation. Specifically, we developed novel ureidopyrimidinone (UPy)-telechelic systems and related blends with poly(ethylene oxide) as novel and green binders alternative to the more conventional ones, such as polyacrylic acid and carboxymethylcellulose, which are typically used in SIBs. BP anodes show impressively improved (more than 6 times) capacity retention when employing the new SH polymeric blend. In particular, the SH electrode still works at a current density higher than 3.5 A g-1, whereas the standard BP electrode exhibits very poor performances already at current densities lower than 0.5 A g-1. This is the result of better adhesion, buffering properties, and spontaneous damage reparation.

Structural Characterization of TssL from Acinetobacter baumannii: a Key Component of the Type VI Secretion System.

The type VI secretion system (T6SS) is a complex molecular nanomachine used by Gram-negative bacteria to deliver diverse effectors into adjacent cells. A membrane complex (MC) anchors this transport system to the bacterial cell wall. One of the proteins forming the MC is TssL, a cytoplasmic protein bound to the inner membrane through a single transmembrane helix. Here, we report the structure of the cytoplasmic N-terminal region of TssL from Acinetobacter baumannii, a bacterium encoding in a single locus a secretion system that is a special case among other T6SSs. The protein structure, consisting of two antiparallel alpha-helical bundles connected by a short loop, reveals several interesting particularities compared with homologous proteins from other organisms. In addition, we demonstrate the structural significance of residues Asp98 and Glu99, which are strongly conserved among T6SS-encoding Gram-negative bacteria. Mutations in these two residues strongly impact protein dynamics, expression, and functionality. Our results improve our understanding of the T6SS of A. baumannii, which remains largely understudied compared with that of other pathogens.IMPORTANCE Several Acinetobacter species carry one functional type VI secretion system (T6SS). The T6SS is encoded in a single locus containing 16 conserved genes, most of which code for proteins essential to T6SS activity. One of these key components is TssL, a cytoplasmic protein bound to the inner membrane. Despite its importance and its particular characteristics, the structure of T6SS in A. baumannii remains understudied. Here, we present structural, in silico, and in vivo studies of TssL, highlighting the importance of two well-conserved residues and improving our understanding of this secretion system in this bacterium.

Estimating late spring frost-induced growth anomalies in European beech forests in Italy.

Weather extremes and extreme climate events, like late spring frosts, are expected to increase in frequency and duration during the next decades. Although spring phenology of European beech is well adapted to escape freeze damages on longer time scales, the effects of occasional late spring frosts (LSF) are among the main climatic damages to these forests to such an extent that they limit beech distribution and elevation range, especially at its southern margin. The aim of this work was to evaluate the short-term effects of two consecutive LSF events occurred in 2016 and 2017 in Italy on the beech forest vegetation activity. Remotely sensed land surface temperature (LST) data were used to detect the pixels where LSF occurred, while enhanced vegetation index (EVI) data were used to quantify LSF effects by computing a spring vegetation activity anomaly index (sAI). In 2016 and 2017, the LSF covered, respectively, about 29% and 32% of the total Italian beech-dominated area. The two LSF widely differed in their spatial patterns and their effects. In 2016, the pixels belonging to the sAI classes with the highest spring anomalies were also those where prolonged LSF occur, while, in 2017, the pixels belonging to the highest sAI classes were those that underwent the shorter (but probably more intense) LSF events. Under scenarios of increased frequency risk of repeated LSF, the proposed methodology may represent an automatic and low-cost tool both for monitoring and predicting European beech growth patterns.

Patients' reasons for adhering to long-term alendronate therapy.

We aimed to determine patients' reasons for continuing alendronate therapy over 5 years by administering a questionnaire. Bone mineral density, fractures, drugs, Charlson comorbidity index, and lifestyle factors were also considered. Education and awareness of the disease appeared highly associated with good alendronate adherence while worsening health status with discontinuation. INTRODUCTION: Aim of this study was to investigate patients' reasons for adhering to long-term alendronate therapy (more than 5 years), as data is not available in the current literature regarding the reasons behind long-term adherence. METHODS: We studied 204 long-term adherent alendronate users: 65 postmenopausal outpatients still adherent (group C, years on treatment = 8.70 ± 1.31) were compared to 139 age-matched patients who discontinued therapy (group S, years on treatment = 8.64 ± 1.43). We evaluated main biochemical parameters, BMD values, fractures, and Charlson comorbidity index (CCI). A questionnaire was administered to analyze the reasons for long-term adherence. RESULTS: There were no significant differences between groups concerning baseline DXA values, number of fractures, and CCI. A higher education level was observed in group C (C 54% vs S 35% of patients, p = 0.001). At the time of interview, there was a significantly higher number of patients with a CCI of two in group S compared to the beginning of treatment (56% vs 43%, p = 0.04), together with a higher number of patients taking more than 3 drugs (22% vs 11%, p = 0.01) compared to basal evaluation. Forty-seven percent of patients reported new diseases during the treatment as the main reason for stopping alendronate. A multivariate, stepwise logistic regression analysis showed that awareness of the disease was highly associated with adherence (OR = 0.20; 95% CI 0.045-0.93, p = 0.04) followed by higher education (OR = 0.526, 95% CI 0.345-0.801, p = 0.003). Worsening of CCI was associated with discontinuation (OR = 2.75, 95% CI 1.033-7.324, p = 0.04). CONCLUSIONS: Education and disease awareness are associated with long-term alendronate adherence while competing health problems negatively impact adherence.

School-age dental screening: oral health and eating habits.

AIM: the study has the purpose to evaluate the association between clinical data collected from dental screening carried out on children and their eating habits. Materials and methods: The dental screening was carried out on a sample of eight-year-old children attending the third grade of the elementary schools of Gaeta (Latina). Clinical data and periodontal status indexes were recorded. The descriptive statistics (mean, standard deviation, frequency) of all data were calculated and anova analysis and chi square test have been performed. RESULTS: On the sample of 70 children the results showed an average of 1.4 decayed teeth per child (sd ± 2.3) with a slightly higher average in females. More than 68% of the sample had poor or insufficient oral hygiene conditions with plaque presence in 64% of cases. Moreover, 57% of children had class II malocclusion with increased overjet and oral breathing respectively in 37% and 30% of cases. Only 24% were breastfed in the first months of life and more than 40% maintained a bad habit for over two years of age. About eating habits, more than 80% of the sample consumed sweets or sweet drinks every day. The analysis of the data showed as children consume several snacks throughout the day, and 47% eat them watching TV. CONCLUSIONS: The results of this study showed how prevention program carried out through the School is more effective on children for learning of content especially when the acquisition of knowledge follows the application and verification of theoretical and practical skills in terms of oral health.

Improving the efficacy of municipal solid waste collection with a communicative approach based on easily understandable indicators.

The main aim of the study was to propose a useful methodological approach to define easily understandable indicators to use in communication campaigns organized to improve the efficacy of municipal solid waste collection. For this purpose, six economic-environmental indicators were defined, combining life cycle thinking and environmental communication. The indicators make it possible to obtain several combinations that can follow a variety of communication channels. Three indicators (quantity of recyclable materials recoverable from unsorted residual waste; total potential economic saving; number of jobs for young people as communicators) are expressed in absolute value and therefore refer to the whole community even if they are also good for single-targeted messages. The other three indicators (potential economic saving for each citizen; per capita saving of carbon dioxide equivalent; per capita saving of Disability Adjusted Life Years) are normalized with respect to the number of inhabitants and therefore refer to the individual citizen, but can also be used for global messages. As a case example, the methodology was applied to the collection of paper and cardboard in twelve Southern Italy cities obtaining very promising results. For example, the maximum quantity of paper and cardboard recoverable from unsorted waste would allow Naples and Palermo to recover more than €15 million. The maximum potential economic saving for each citizen was 25 €/capita. The economic saving obtained for Naples and Palermo could be translated in more than one thousand positions as young environmental communicators. Catania was the city with both the highest per capita potential saving of carbon dioxide (>60 kg CO2eq./capita) and maximum hypothetical per capita 'life-time recovery' (almost an hour). The innovative communication method used ('Greenopoli') assumed that school is the starting point to obtain a change of mindset because speaking with students (all potential communicators) means indirectly communicating with all other targets.

Mechanisms associated with the effects of urea on the micellar structure of sodium dodecyl sulphate in aqueous solutions.

We used simulations by Molecular Dynamics to characterize the mechanism whereby the variations in the urea concentration modifies the micellar structure of sodium dodecyl sulfate monomers in water. From a self-assembled micellar system, we observed that increasing urea concentration leads to a decrease in aggregation number. Likewise, when increasing urea concentration, the micelles increase their nonpolar surface exposed to solvent, while the polar surface exposed to solvent decreases. This rearrangement process of SDS micelles in presence of urea is mainly due to the fact that the ions of Na+ that stabilize the micellar structure increase its interaction with urea. In this process, the SDS hydrophilic head and Na+ ions increases its solvation by urea, destabilizing micellar structure and exponing the hydrophobic core to the solvent.

Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review.

OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidity, preserve fertility, and predict possible complications. METHODS: The reported treatment has been expectant management, operative hysteroscopy approach, and intramuscular injection of 50 mg methotrexate (MTX), followed by cervical dilation and manual vacuum aspiration (D&S) with a Karman cannula under ultrasound guidance, uterine artery embolization (UAE), and manual vacuum aspiration under ultrasound guidance and uterine artery embolization before surgical laparotomic resection. RESULTS: Complications were more frequent in women with a history of three or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm. MTX and D&S treatment appear to be most effective and safe at the early age of pregnancy, while UAE and D&S are related to the highest risk of complication in any age of pregnancy. CONCLUSION: An appropriate preoperative diagnostic evaluation, the identification of cases at higher risk, and those eligible for a conservative treatment are fundamental to reduce complications.

Long-term treatment of phenylketonuria with a new medical food containing large neutral amino acids.

This corrects the article DOI: 10.1038/ejcn.2016.166.

Dynamics and structural behavior of water in large confinement with planar amorphous walls.

We study the structure and dynamics of liquid water confined between planar amorphous walls using molecular dynamics (MD) simulations. We report MD results for systems of more than 23 000 SPC/E water molecules confined between two hydrophilic or hydrophobic walls, separated by distances of about 15 nm. We find that the walls induce ordering of the liquid and slow down the dynamics, affecting the properties of the confined water up to distances of about 8 nm at 275 K. We quantify this influence by computing dynamic and static penetration lengths and studying their temperature dependence. Our results indicate that in the temperature range considered, hydrophobic walls perturb static properties over larger lengths compared to hydrophilic walls. We also find opposite temperature trends in the dynamic penetration lengths, with hydrophobic walls increasing their range of influence on increasing the temperature.

Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome: results of a pilot study.

AIM: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive procedure which has been demonstrated to be effective in faecal/urinary incontinence but has never been tested in low anterior resection syndrome (LARS). The severity of LARS may be evaluated by the LARS score, but rectal cancer treatments may also affect urinary and sexual function, which are not explored by the LARS score. The Three Axial Perineal Evaluation (TAPE) score is a new validated index addressing the overall pelvic floor functions. This study aims to assess the efficacy of PTNS in LARS patients and to evaluate the results by the LARS and TAPE scores. METHODS: Twenty-one patients operated on for rectal cancer between 2009 and 2014 complaining of LARS underwent PTNS (12 sessions of 30 min each). Six patients reported urinary incontinence and all except two (men) were sexually inactive. The LARS score and the TAPE score questionnaires were administered at baseline and after 6 months of follow-up. RESULTS: At 6 months' follow-up, nine patients reported a significant improvement of faecal incontinence and 3/6 an improvement of urinary incontinence after PTNS. Median LARS score significantly decreased from 32 to 27 (P = 0.009), while the median TAPE score improved significantly from 55 to 58 (P = 0.004). CONCLUSIONS: PTNS may be a further option in the treatment of selected patients with LARS and in addition may improve associated urinary incontinence. The severity of LARS can be detected by the LARS score; however, the adoption of the TAPE score is preferred in the case of concomitant urinary and/or sexual problems not explored by the LARS score.

The effect of parathyroid hormone (1-84) treatment on serum bone morphogenetic protein 4 and vascular endothelial growth factor in postmenopausal women with established osteoporosis.

PURPOSE: To investigate the effect of 18 months' parathyroid hormone 1-84 (PTH 1-84) treatment on serum levels of bone morphogenetic protein 4 (BMP4) and vascular endothelial growth factor (VEGF), in postmenopausal women with established osteoporosis. METHODS: Thirty-seven postmenopausal women with osteoporosis (mean age 72.9 ± 8.1 years old) and 23 healthy controls (mean age 68.9 ± 9.9 years old) were enrolled. Patients were treated with daily subcutaneous injections of PTH (1-84) 100 mcg for 18 months, plus calcium 1 gr and vitamin D 800 IU per os daily. Blood samples were taken every 6 months during the study. RESULTS: At baseline, there were no differences considering anthropometric parameters, co-morbidities, current medications used between patients and controls. Mean serum VEGF levels were significantly higher in osteoporotic patients compared to controls (436.7 ± 259.7 vs. 260.3 ± 184.3 pg/ml, p = 0.006), while there were no differences in mean serum values of BMP4 (5.3 ± 1.7 vs. 5.7 ± 1.6 pg/ml, p = 0.40). Serum VEGF levels increased by approximately 20% after 12 months of PTH (1-84) treatment compared to baseline (p = 0.03) and by 22% after 18 months (p = 0.01). A significant increase of 10% in mean serum BMP4 levels was observed after 18 months of PTH (1-84) treatment compared to baseline (p = 0.02). In the control group we found no differences after 18 months compared to baseline in BMP4 (5.7 ± 1.6 vs. 6.0 ± 1.5 pg/ml, p = 0.53) and VEGF (260.3 ± 184.3 vs. 257.4 ± 107.1 pg/ml, p = 0.94). CONCLUSIONS: PTH (1-84) treatment increased serum levels of VEGF and BMP4 in postmenopausal women with severe osteoporosis.

Use of self-collected capillary blood samples for islet autoantibody screening in relatives: a feasibility and acceptability study.

AIMS: To evaluate the feasibility of using self-collected capillary blood samples for islet autoantibody testing to identify risk in relatives of people with Type 1 diabetes. METHODS: Participants were recruited via the observational TrialNet Pathway to Prevention study, which screens and monitors relatives of people with Type 1 diabetes for islet autoantibodies. Relatives were sent kits for capillary blood collection, with written instructions, an online instructional video link and a questionnaire. Sera from capillary blood samples were tested for autoantibodies to glutamic acid decarboxylase, islet antigen-2, insulin and zinc transporter 8. 'Successful' sample collection was defined as obtaining sufficient volume and quality to provide definitive autoantibody results, including confirmation of positive results by repeat assay. RESULTS: In 240 relatives who returned samples, the median (range) age was 15.5 (1-49) years and 51% were male. Of these samples, 98% were sufficient for glutamic acid decarboxylase, islet antigen-2 and zinc transporter 8 autoantibody testing and 84% for insulin autoantibody testing and complete autoantibody screen. The upper 90% confidence bound for unsuccessful collection was 4.4% for glutamic acid decarboxylase, islet antigen-2 and/or zinc transporter 8 autoantibody assays, and 19.3% for insulin autoantibodies. Despite 43% of 220 questionnaire respondents finding capillary blood collection uncomfortable or painful, 82% preferred home self-collection of capillary blood samples compared with outpatient venepuncture (90% of those aged <8 years, 83% of those aged 9-18 years and 73% of those aged >18 years). The perceived difficulty of collecting capillary blood samples did not affect success rate. CONCLUSIONS: Self-collected capillary blood sampling offers a feasible alternative to venous sampling, with the potential to facilitate autoantibody screening for Type 1 diabetes risk.

Investigation of the environmental impacts of municipal wastewater treatment plants through a Life Cycle Assessment software tool.

This paper investigates the total and per capita environmental impacts of municipal wastewater treatment in the function of the population equivalent (PE) with a Life Cycle Assessment (LCA) approach using the processes of the Ecoinvent 2.2 database available in the software tool SimaPro v.7.3. Besides the wastewater treatment plant (WWTP), the study also considers the sewerage system. The obtained results confirm that there is a 'scale factor' for the wastewater collection and treatment even in environmental terms, in addition to the well-known scale factor in terms of management costs. Thus, the more the treatment plant size is, the less the per capita environmental impacts are. However, the Ecoinvent 2.2 database does not contain information about treatment systems with a capacity lower than 30 PE. Nevertheless, worldwide there are many sparsely populated areas, where it is not convenient to realize a unique centralized WWTP. Therefore, it would be very important to conduct an LCA study in order to compare alternative on-site small-scale systems with treatment capacity of few PE.

Long-term treatment of phenylketonuria with a new medical food containing large neutral amino acids.

BACKGROUND/OBJECTIVES: Phenylketonuria (PKU) is an autosomal recessive disease caused by deficient activity of phenylalanine hydroxylase. A low phenylalanine (Phe) diet is used to treat PKU. The diet is very restrictive, and dietary adherence tends to decrease as patients get older. Methods to improve dietary adherence and blood Phe control are continuously under investigation. SUBJECTS/METHODS: A new formula Phe-neutral amino acid (PheLNAA) has been tested in this study with the purpose of improving the compliance and lowering blood phenylalanine. The formula has been tested for nitrogen balance, and it is nutritionally complete. It is fortified with more nutritional additives that can be deficient in the PKU diet, such as B12, Biotin, DHA, Lutein and increased levels of large neutral amino acids to help lower blood Phe. The new formula has been tested on 12 patients with a loading test of 4 weeks. RESULTS: Fifty-eight percent of patients had a significant decline in blood Phe concentration from baseline throughout the study. The PheLNAA was well tolerated with excellent compliance and without illnesses during the study. CONCLUSIONS: In conclusion, the new formula is suitable for life-long treatment of PKU, and it offers the PKU clinic a new choice for treatment.

Spinodals and critical point using short-time dynamics for a simple model of liquid.

We have applied the short-time dynamics method to the gas-liquid transition to detect the supercooled gas instability (gas spinodal) and the superheated liquid instability (liquid spinodal). Using Monte Carlo simulation, we have obtained the two spinodals for a wide range of pressure in sub-critical and critical conditions and estimated the critical temperature and pressure. Our method is faster than previous approaches and allows studying spinodals without needing equilibration of the system in the metastable region. It is thus free of the extrapolation problems present in other methods, and in principle could be applied to systems such as glass-forming liquids, where equilibration is very difficult even far from the spinodal. We have also done molecular dynamics simulations, where we find the method again able to detect the both spinodals. Our results are compared with different previous results in the literature and show a good agreement.