First-time mothers’ experiences of early labour in Italian maternity care services

OBJECTIVE: The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment.SETTING: The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women.PARTICIPANTS: The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home.DESIGN: A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth.FINDINGS: Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women?s satisfaction when advised either to return home or to stay at the hospital during early labour.CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: During antenatal classes and clinics, midwives should provide clear information and advice about early labour in order to increase women?s confidence and self-efficacy, and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during early labour

Emulsifying properties of sugar-based surfactants prepared by chemoenzymatic synthesis

Sugar Fatty Acid Esters (SFAEs) are a class of non-ionic surfactants that can be synthesized from inexpensive natural resources. Depending on carbon chain length and nature of the sugar head group, SFAEs cover a wide range of hydrophilic–lipophilic balance (HLB) values, which result in tunable tenside properties and in turn relevant for a wide variety of industrial applications. Three sugar-based surfactants (6-O-lauroyl-, 6-O-palmitoyl- and 6-O-stearoyl-1-O-butyl glucopyranosides) have been prepared by a lipase-catalyzed esterification of isomeric mixture of n-butyl glucosides. Specifically, their interfacial features together with W/O emulsifying properties and stability over time have been finely evaluated (interfacial tension (IFT) values, W/O emulsion turbidity water droplet size distribution, first order kinetic constants of de-emulsification)

Comorbidities in Dravet Syndrome and Lennox–Gastaut Syndrome

AbstractThis study aims to describe the main cognitive and behavioral comorbidities of Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS), their impact on the health-related quality of life (QOL) of patients and their caregivers, and provide a summary of the neuropsychological tools available for the evaluation of these comorbidities. The cognitive and behavioral comorbidities in patients with DS and LGS have a profound effect on the QOL of affected individuals and their caregivers and, as patients grow, tend to surpass the impact of the seizures. DS is a genetic condition associated with loss-of-function mutations in the SCNA1 sodium channel gene; LGS is an etiologically heterogeneous condition that is often secondary to structural brain abnormalities. The first seizures associated with DS typically present in the first year of life, and developmental delay becomes progressively evident thereafter. LGS usually starts between the ages of 3 and 8 years, with cognitive impairment becoming clinically evident in most patients within 5 years from the onset. In both DS and LGS, cognitive impairment is generally moderate to severe and is often accompanied by behavioral problems such as hyperactivity and inattention. In addition to optimal seizure control, regular assessment and active management of cognitive and behavioral comorbidities are required to meet the complex needs of patients with DS or LGS

Language Delay in Patients with CLN2 Disease: Could It Support Earlier Diagnosis?

Neuronal ceroid lipofuscinosis type 2 (CLN2 disease) is a rare pediatric disorder associated with rapid neurodegeneration, and premature death in adolescence. An effective enzyme replacement therapy (cerliponase alfa) has been approved that can reduce this predictable neurological decline. The nonspecific early symptoms of CLN2 disease frequently delay diagnosis and appropriate management. Seizures are generally recognized as the first presenting symptom of CLN2 disease, but emerging data show that language delay may precede this. An improved understanding of language deficits in the earliest stage of CLN2 disease may support the early identification of patients. In this article, CLN2 disease experts examine how language development is affected by CLN2 disease in their clinical practices. The authors' experiences highlighted the timings of first words and first use of sentences, and language stagnation as key features of language deficits in CLN2 disease, and how deficits in language may be an earlier sign of the disease than seizures. Potential challenges in identifying early language deficits include assessing patients with other complex needs, and recognizing that a child's language abilities are not within normal parameters given the variability of language development in young children. CLN2 disease should be considered in children presenting with language delay and/or seizures to facilitate earlier diagnosis and access to treatment that can significantly reduce morbidity

Current Use of Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation: Results from an Italian Multicenter Prospective Study-The ISNEP Study

Background: Atrial fibrillation (AF) is the most common heart arrhythmia, and its prevalence increases with age. Oral Anticoagulant Therapy (OAT) with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) is essential to avoid thromboembolic events in AF. However, this treatment is associated with a high risk of bleeding and low adherence in elderly patients. Aim: The aim was to evaluate the real-world use of OAT in a population of patients aged >= 80 years in twenty-three Italian centers and to investigate the tolerance of and patient satisfaction with this therapy. Methods: The ISNEP Study is a multicenter cross-sectional study enrolling patients with AF and aged >= 80 years and treated with either NOACs or VKAs. A written questionnaire was administered to each patient to evaluate the adherence to and patient satisfaction with this therapy. Results: The study included 641 patients with a mean age of 85 (82-87) years. The use of NOACs was reported in 93.0% of cases, with the remaining 7.0% treated with VKAs. A history of stroke events was reported in five (11.1%) and one (0.2%) patients in the VKA and NOAC groups, respectively. The rate of referred ecchymosis/epistaxis was significantly higher in the VKA group compared to the NOAC group (p < 0.001). Patients receiving NOACs reported a substantial improvement in their quality of life compared to the VKA group. Conclusions: A small, but not negligible, proportion of elderly AF patients is still treated with VKAs. Patients treated with NOAC have a higher level of satisfaction with the therapy and complete adherence

Insights into cognitive and behavioral comorbidities of SLC6A1-related epilepsy: five new cases and literature review

IntroductionSLC6A1 pathogenic variants have been associated with epilepsy and neurodevelopmental disorders. The clinical phenotype includes different seizure types, intellectual disability, and psychiatric symptoms affecting mood and behavior. Few data regarding neuropsychological features have been described, and details on cognitive profiles are often missing due to the lack of standardized tests.MethodsWe retrospectively reviewed the neuropsychological assessments of five subjects carrying heterozygous missense genetic variants in SLC6A1. We also collected data on epileptic features, EEGs, and brain MRIs. Additionally, we reviewed neuropsychological data from 204 previously reported patients with SLC6A1 pathogenic variants.ResultsIn our series, at the last evaluation (median 12.6 years), three patients had borderline intellectual functioning, one patient had mild cognitive impairment, and one patient presented with a moderate cognitive disability. Three out of five patients underwent at least two neuropsychological evaluations, which revealed a worsening of cognitive functions over time. We detected attention deficits in all patients. In addition, we observed anxiety, disruptive behavior disorder, emotional instability, and hetero aggressiveness. We also performed a literature review that highlighted that most of the patients with SLC6A1 pathogenic variants have mild-to-moderate intellectual disability and that one-third of cases have autistic traits.DiscussionBased on the literature review and the detailed description of our cases, we conclude that patients with SLC6A1-related epilepsy mostly present with mild-to-moderate intellectual disability, often associated with attention disorders. Such symptoms may worsen over time. Periodic standardized neuropsychological tests may be useful tools to follow development over time, and patient-specific rehabilitation programs could be tailored consistently

Cell-Cycle Inhibition by Helicobacter pylori L-Asparaginase

Helicobacter pylori (H. pylori) is a major human pathogen causing chronic gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. One of the mechanisms whereby it induces damage depends on its interference with proliferation of host tissues. We here describe the discovery of a novel bacterial factor able to inhibit the cell-cycle of exposed cells, both of gastric and non-gastric origin. An integrated approach was adopted to isolate and characterise the molecule from the bacterial culture filtrate produced in a protein-free medium: size-exclusion chromatography, non-reducing gel electrophoresis, mass spectrometry, mutant analysis, recombinant protein expression and enzymatic assays. L-asparaginase was identified as the factor responsible for cell-cycle inhibition of fibroblasts and gastric cell lines. Its effect on cell-cycle was confirmed by inhibitors, a knockout strain and the action of recombinant L-asparaginase on cell lines. Interference with cell-cycle in vitro depended on cell genotype and was related to the expression levels of the concurrent enzyme asparagine synthetase. Bacterial subcellular distribution of L-asparaginase was also analysed along with its immunogenicity. H. pylori L-asparaginase is a novel antigen that functions as a cell-cycle inhibitor of fibroblasts and gastric cell lines. We give evidence supporting a role in the pathogenesis of H. pylori-related diseases and discuss its potential diagnostic application

Le chiavi del Paradiso. Primato petrino e devozione mariana di Sisto IV tra Cappella Sistina e S. Maria della Pace

Il volume è strutturato in due parti distinte con una postfazione, un indice dei nomi e n. 55 Tavole a colori fuori testo, valide per entrambe le parti del volume. I. PARTE (di Lorenzo Cappelletti) A partire dalla esplicita indicazione che l’ignoto architetto, collocato sul fianco destro dell’affresco sistino della Consegna delle chiavi di Perugino, fa dell’edificio a pianta centrale che campeggia sullo sfondo, viene operata una completa rilettura iconografica e iconologica dell’intero affresco. Tenendo conto di tutta la migliore bibliografia sul tema e grazie anche alla considerazione di fonti inedite o mai considerate in relazione a tale affresco –– vengono riletti in particolare i due episodi evangelici sullo sfondo, la teoria dei dodici apostoli e dei personaggi dell’attualità di fine Quattrocento e soprattutto il gesto della consegna delle chiavi a Simon Pietro da parte di Gesù. La rilettura si allarga necessariamente anche alla Punizione di Core, Datan e Abiram, l’affresco di Botticelli posto in chiave tipologica dirimpetto alla Consegna delle chiavi, e alla serie dei 30/32 papi affrescati nel cleristorio. Lo studio non manca di offrire inoltre spunti per una comprensione più adeguata anche degli altri affreschi quattrocenteschi della sistina. II PARTE (di Simona Benedetti) Nell’ambito della revisione di lettura iconologica e iconografica dell’affresco della Consegna delle chiavi di Perugino nella Cappella Sistina, svolta da Lorenzo Cappelletti, si torna a riflettere anche sul significato dell’architettura dell’edificio rappresentato al centro dell’affresco. In questo senso nel contributo di Simona Benedetti, in primo luogo, si ripercorrono i riferimenti alla trattatistica quattrocentesca in materia di edifici sacri, che possono aver influito nella determinazione dell’edificio ottagonale. In seconda istanza, si considerano le principali fabbriche a pianta ottagonale costruite precedentemente all’edificio dipinto, che possono aver costituito un fondato riferimento per il Perugino nella Consegna delle chiavi. In particolare tra le architetture, che possono avere avuto un’influenza determinante nella definizione iconografica della fabbrica ottagonale presente nell'affresco, la chiesa di S. Maria della Pace è quella su cui si concentra il presente studio. L'opera si realizzò nel cuore pulsante della Roma rinascimentale proprio contemporaneamente all’affresco in esame, con esso trova degli innegabili punti di tangenza e corrispondenze, sia storiche che figurative. A questo riguardo interessantissima risulta la connessione tra il motivo dell’edificazione della fabbrica e i fatti storici, i personaggi, gli eventi prodigiosi e le pratiche devozionali, che condizionarono lo svolgersi del cantiere del Templum Pacis negli ultimi anni del pontificato di Sisto IV. La storicità del gesto della consegna delle chiavi a Pietro - avvenimento che si protrae nel tempo ad ogni elezione pontificia nello spazio fisico della Cappella Sistina - costituisce la centralità del messaggio iconografico dell'affresco del Perugino in cui, anche l’architettura, insieme ai personaggi rappresentati, strutturano una narrazione reale, estranea alle simbologie decontestualizzate dall’epoca propriamente sistina. Segue una postfazione di Francesco Andreani dal titolo Enigma del Quattrocento, saggio nel quale si sviluppano considerazioni sulle personalità degli architetti e maestranze attive nella Roma del tardo Quattrocento e negli anni di inizio della fabbrica di S. Maria della Pace. Il volume si conclude con l'indice dei nomi (a cura di Gemma Fusciello)I (of Lorenzo Cappelletti) Starting from the unknown architect’s forefinger pointed to the central plan building found in the background of the Sistine Perugino’s fresco The Keys of the Kingdom of Heaven, the author offers a new interpretation of the entire fresco at both an iconographical and iconological level. Having considered the most important studies about this fresco and taking into account a number of unpublished and unconsidered sources, the author rereads in particular the meaning of the central plan building, as well as the two Gospel episodes in the background; and he rereads also the grouping of the Twelve, along with the fifteenth century historical personages painted among them, in the foreground. The author’s vision necessarily broodens also to comprehend Botticelli’s fresco named The Punishment of Corah, Dathan and Abiram which is placed on the opposite wall as a typological prefiguration of The Keys of the Kingdom of Heaven; and it broodens moreover to reconsider the series of 30/32 popes frescoed in the upper register of the Sistine Chapel. The essay also offers hints for a more complete comprehension of the other fifteenth century frescoes of the Sistine Chapel. II. (of Simona Benedetti) As part of the review of iconological and iconographic reading about the fresco of the “Delivery of the keys” by Perugino in the Sistine Chapel, conducted by Lorenzo Cappelletti, you go back and think about the significance of the building architecture depicted in the center of the fresco. In this sense, the contribution of Simona Benedetti, first, retraces the references to the fifteenth-century treatises concerning sacred buildings, which may have affected the determination of the octagonal building. Secondly, we consider the main factories octagonal building constructed previously painted, that may have been an established reference for the Perugino in the “Delivery of the keys”. Especially between architectures, which may have had a decisive influence in defining the iconographic factory octagonal present in the fresco, the church of St. Mary of Peace is the one on which this study focuses. The work was realized in the heart of Renaissance Rome just simultaneously fresco concerned, although it is undeniable points of contact and correspondence, both historical and figurative. In this regard are interesting connections between the reason of building the factory, the historical facts, the characters and the miraculous events and devotional, which has conditioned the unfolding of the construction site of the Templum Pacis in the last years of the pontificate of Sixtus IV. The historicity of the act of handing over the keys to Peter, that continues over time in the physical space of the Sistine Chapel, is the centrality of the iconographic message of the fresco by Perugino; so even the architecture, along with the characters represented, the real narrative structure, far from to the symbolism belonging to the Sistine period properly

Il personaggio di Mozart nella letteratura d\u2019invenzione

Il volume raccoglie saggi che si occupano di autori italiani, francesi e tedeschi che hanno reso Mozart protagonista delle loro opere