Preconceptional care: opportunities and challenges

The aim of the study was to identify the opportunities required for straightening of preconceptional health and care, according to medical literature. Benefits and potential risks were mentioned. Some international experiences related to preconceptional care management were analyzed, by making references especially to those from US, including the actions initiated by Centers for Disease Control and Prevention (CDC). In this article the WHO position is mentioned which develops a global consensus on preconceptional care to reduce maternal and childhood mortality and morbidity, proving a "menu of interventions" which lists the health problems, behavioral problems and risk factors in thirteen domains, evidence-based interventions to address them and mechanisms of delivering them. A special section is dedicated to some controversies in preconceptional care management, priority at the medical primary care. The WHO recommendations and the international experience represent a good support for health care systems from different countries to improve the access to the care before getting pregnant and overcoming inequalities. In this context, authors consider that the improving of preconceptional care in each country depends, first of all, on the wish of governors and health care providers. In conclusion, the hypothesis to review the family planning concept is suggested, considering that it has equally to include two main components - contraception and preconceptional care. It will provide real opportunities for people to achieve their reproductive life plan to have not only wanted, but also healthy children

Оценка менеджмента случаев послеродового кровотечения завершенных гистерэктомией

2Catedra Obstetrică şi ginecologie nr. 2, USMF „NicolaeTestemiţanu”, Catedra Anesteziologie şi reanimatologie nr. 2, USMF “NicolaeTestemiţanu”, IMSP Spitalul Clinic Municipal nr. 1, IMSP Institutul Mamei şi Copilului, Policlinica MAI, Chişinău, Republica MoldovaPost-partum hemorrhage (HPP) is a current problem, being a direct cause of maternal deaths in 27% globally, especially in developing countries. The purpose of the conducted descriptive retrospective study was to evaluate the management of 45 cases with HPP finalized by hysterectomy, which was located at the Institute of Mother and Child and Municipal Clinical Hospital no.1 during 2014-2016. In 24 cases (53,3%), a complicated obstetrical history was determined and 16 patients (35,5%) had scars on the uterus. In 33 cases (57,9%), patients presented complicated somatic history. In 33 cases (57,9%), patients presented complicated somatic history. In 33 cases (73,3%) the pregnancy was completed by caesarean section. Causes related to placental pathology were confirmed in 11 (24,4%) cases by placenta accreta, in 8 (17,8%) cases by placenta praevia, and in 5 (11,1%) cases by abruptio placentae. HPP due to uterine atony was identified in 2 cases (4,4%). Other 9 patients (20%) suffered deep vaginal lacerations and in one case (2,2%) there was a rupture of the uterus. The estimated volume of hemorrhage was: 3000 ml – in 4 (8,9%) cases. The underestimation of the bleeding volume was 500 ml in 4 cases (8,9%), between 500-1000 in 6 cases (13,3%), and ≥1000 ml – in 2 cases (4,4%). DIC syndrome was established in 29 patients (64,4%). In conclusion, it can be mentioned that HPP, in almost half of the cases, is favored by the pathology of placenta insertion, the latter being determined by the increase of the rate of births by caesarean section. Mortality and maternal morbidity can be reduced if birth is done by a competent multidisciplinary team that provides specialized health care through a standardized approach.Послеродовое кровотечение (ПРК) представляет собой актуальную проблему, являясь прямой причиной материнской смертности в 27% во всем мире, в особенности в развивающихся странах. Было проведено ретроспективное исследование 45 случаев родов, с ПРК и гистерэктомией, ведение которых проводилось в условиях Института Матери и Ребенка и Муниципальной Клинической больницы N1 в период 2014-2016 гг. В 24 случаях (53,3%) был выявлен осложненный акушерский анамнез. Рубец на матке встречался у 16 женщин (35,5%). В 33 случаях (57,9%) у пациенток наблюдался осложненный соматический анамнез. В 33 случаях (73,3%) было проведено кесарево сечение. Патология плаценты также являлась причиной ПРК: 11 случаев (24,4%) – приращение плаценты, 8 (17,8%) – предлежание плаценты и 5 случаев (11,1%) преждевременная отслойка нормально расположенной плаценты. ПРК также наблюдалось в результате задержки частей последа в полости матки в 4 случаях (9%) и в двух случаях (4,4%) ПРК было следствием атонии матки. У остальных 9 пациенток (20%) роды осложнились глубокими разрывами влагалища, а у одной пациентки (2,2%) – разрывом матки. Среди плацентарной патологии наблюдалось 11 случаев (24,4%) приращения плаценты к мышечному слою (placenta accretа). Объем кровопотери был подсчитан следующим образом: ≥2000 мл – в 16 случаях (35,6%); 2000-2500 мл – в 18 случаях (40%); 2501-3000 мл – в 7 случаях (15,6%) и более 3000 мл – 4 случая (8,8%). А вот объем кровопотери 500 мл наблюдался у 4 пациенток (8,9%), 500-1000 мл – у 6 (13,3%) и ≥1000 мл – у одной пациентки (2,2%). У 29 пациенток (64,4%) был диагностирован ДВС-синдром. В заключении необходимо отметить, что ПРК практически в половине случаев вызвано патологией прикрепления плаценты, что является следствием роста частоты повышения процента оперативного родоразрешения путем кесарева сечения. Материнскую заболеваемость и смертность в результате ПРК возможно снизить, если роды будет координировать мультидисциплинарная, компетентная команда, которая оказывает специализированную медицинскую помощь посредством стандартизированного подхода

Sandy contourite drift in the late Miocene Rifian Corridor (Morocco):Reconstruction of depositional environments in a foreland-basin seaway

The Rifian Corridor was a seaway between the Atlantic Ocean and the Mediterranean Sea during the late Miocene. The seaway progressively closed, leading to the Messinian Salinity Crisis in the Mediterranean Sea. Despite the key palaeogeographic importance of the Rifian Corridor, patterns of sediment transport within the seaway have not been thoroughly studied. In this study, we investigated the upper Miocene sedimentation and bottom current pathways in the South Rifian Corridor. The planktic and benthic foraminifera of the upper Tortonian and lower Messinian successions allow us to constrain the age and palaeo-environment of deposition. Encased in silty marls deposited at 150–300 m depth, there are (i) 5 to 50 m thick, mainly clastic sandstone bodies with unidirectional cross-bedding; and (ii) 50 cm thick, mainly clastic, tabular sandstone beds with bioturbation, mottled silt, lack of clear base or top, and bi-gradational sequences. Furthermore, seismic facies representing elongated mounded drifts and associated moat are present at the western mouth of the seaway. We interpret these facies as contourites: the products of a westward sedimentary drift in the South Rifian Corridor. The contourites are found only on the northern margin of the seaway, thus suggesting a geostrophic current flowing westward along slope and then northward. This geostrophic current may have been modulated by tides. By comparing these fossil examples with the modern Gulf of Cadiz, we interpret these current-dominated deposits as evidence of late Miocene Mediterranean overflow into the Atlantic Ocean, through the Rifian Corridor. This overflow may have affected late Miocene ocean circulation and climate, and the overflow deposits may represent one of the first examples of mainly clastic contourites exposed on land

Evidence-based psychotherapeutic interventions for young people with mood disorders: a systematic review

INTRODUCTION: Mood disorders are amongst the most common groups of mental disorders in young people (YP). Depression may affect 8-20% of all YP and may result in a cascade of negative developmental outcomes predicting long-term morbidity and poor functioning. In view of this, the COST action ‘European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders’ (TREATme) was set up to help improve mental health services in YP.OBJECTIVES: One of the overarching aims of TREATme is to carry out a systematic review to assess for the effectiveness of psychotherapeutic interventions in YP. In this study, we present results from the systematic review of treatment effectiveness of youth interventions for mood disorders.[excerpt]peer-reviewe

Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

This paper presents measurements of the $W^+ \rightarrow \mu^+\nu$ and $W^- \rightarrow \mu^-\nu$ cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

Search for chargino-neutralino production with mass splittings near the electroweak scale in three-lepton final states in √s=13 TeV pp collisions with the ATLAS detector

A search for supersymmetry through the pair production of electroweakinos with mass splittings near the electroweak scale and decaying via on-shell W and Z bosons is presented for a three-lepton final state. The analyzed proton-proton collision data taken at a center-of-mass energy of √s=13  TeV were collected between 2015 and 2018 by the ATLAS experiment at the Large Hadron Collider, corresponding to an integrated luminosity of 139  fb−1. A search, emulating the recursive jigsaw reconstruction technique with easily reproducible laboratory-frame variables, is performed. The two excesses observed in the 2015–2016 data recursive jigsaw analysis in the low-mass three-lepton phase space are reproduced. Results with the full data set are in agreement with the Standard Model expectations. They are interpreted to set exclusion limits at the 95% confidence level on simplified models of chargino-neutralino pair production for masses up to 345 GeV

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

MicroRNA Fingerprints Identify miR-150 as a Plasma Prognostic Marker in Patients with Sepsis

BACKGROUND: The physiopathology of sepsis continues to be poorly understood, and despite recent advances in its management, sepsis is still a life-threatening condition with a poor outcome. If new diagnostic markers related to sepsis pathogenesis will be identified, new specific therapies might be developed and mortality reduced. Small regulatory non-coding RNAs, microRNAs (miRNAs), were recently linked to various diseases; the aim of our prospective study was to identify miRNAs that can differentiate patients with early-stage sepsis from healthy controls and to determine if miRNA levels correlate with the severity assessed by the Sequential Organ Failure Assessment (SOFA) score. METHODOLOGY/PRINCIPAL FINDINGS: By using genome-wide miRNA profiling by microarray in peripheral blood leukocytes, we found that miR-150, miR-182, miR-342-5p, and miR-486 expression profiles differentiated sepsis patients from healthy controls. We also proved by quantitative reverse transcription-polymerase chain reaction that miR-150 levels were significantly reduced in plasma samples of sepsis patients and correlated with the level of disease severity measured by the SOFA score, but were independent of the white blood counts (WBC). We found that plasma levels of tumor necrosis factor alpha, interleukin-10, and interleukin-18, all genes with sequence complementarity to miR-150, were negatively correlated with the plasma levels of this miRNA. Furthermore, we identified that the plasma levels ratio for miR-150/interleukin-18 can be used for assessing the severity of the sepsis. CONCLUSIONS/SIGNIFICANCE: We propose that miR-150 levels in both leukocytes and plasma correlate with the aggressiveness of sepsis and can be used as a marker of early sepsis. Furthermore, we envision miR-150 restoration as a future therapeutic option in sepsis patients

Transplantul hepatic ortotopic de la donator decedat la adult. Experienţa Centrului de Chirurgie Generală şi transplant hepatic Fundeni

Studiul de faţă analizează experienţa Centrului de Chirurgie Generală şi Transplant Hepatic din Institutul Clinic Fundeni în transplantul hepatic ortotopic cu ficat întreg de la donator decedat la adult (THO), din aprilie 2000 până în aprilie 2006. În această perioadă au fost realizate 45 de THO – 20 femei şi 25 de bărbaţi, cu vârste cuprinse între 19-57 de ani (medie de 45 ani).Indicaţiile pentru transplantare au fost: ciroză VHB – 11, ciroză VHB VHD – 6, ciroză VHC – 13 (2 cu hepatocarcinom), ciroză VHB VHC – 2, ciroză VHB VHD etanol – 1, ciroză biliară primitivă – 5, boala Wilson – 2, ciroză toxic-nutriţională – 2, ciroza toxică non-alcoolică – 1, ciroză autoimună – 1, colangită sclerogenă primitivă – 1. Cu trei excepţii, la care s-a folosit tehnica clasică de transplantare, ficatul a fost grefat după tehnica Belghiti. Complicaţiile postoperatorii locale au survenit la 19 bolnavi (42,22%), iar generale la 19 (42,22%); complicaţiile tardive au fost înregistrate la 20 pacienţi (44,44%), iar recidiva bolii la 7 pacienţi (15,55%). Mortalitatea intraoperatorie şi postoperatorie imediată a fost de 6,66% (3 din 45 pacienţi). La peste 30 de zile de la TH, au decedat alţi cinci pacienţi (11,11%). Patru pacienţi (8,88%) au decedat la distanţă de momentul transplantului prin boală venoocluzivă, prin cancer bronho-pulmonar şi prin infarct miocardic -2. Patruzeci si doi de pacienţi au supravieţuit perioadei postoperatorii (93,33%) şi 33 peste un an (73,33%). THO reprezintă metoda principală de transplantare hepatică, cu o morbiditate şi mortalitate acceptabile

Contourite depositional system after the exit of a strait: Case study from the late Miocene South Rifian Corridor, Morocco

Idealized facies of bottom current deposits (contourites) have been established for fine-grained contourite drifts in modern deep-marine sedimentary environments. Their equivalent facies in the ancient record however are only scarcely recognized due to the weathered nature of most fine-grained deposits in outcrop. Facies related to the erosional elements (i.e. contourite channels) of contourite depositional systems have not yet been properly established and related deposits in outcrop appear non-existent. To better understand the sedimentary facies and facies sequences of contourites, the upper Miocene contourite depositional systems of the South Rifian Corridor (Morocco) is investigated. This contourite depositional system formed by the dense palaeo-Mediterranean Outflow Water. Foraminifera assemblages were used for age-constraints (7.51 to 7.35 Ma) and to determine the continental slope depositional domains. Nine sedimentary facies have been recognized based on lithology, grain-size, sedimentary structures and biogenic structures. These facies were subsequently grouped into five facies associations related to the main interpreted depositional processes (hemipelagic settling, contour currents and gravity flows). The vertical sedimentary facies succession records the tectonically induced, southward migration of the contourite depositional systems and the intermittent behaviour of the palaeo-Mediterranean Outflow Water, which is mainly driven by precession and millennial-scale climate variations. Tides substantially modulated the palaeo-Mediterranean Outflow Water on a sub-annual scale. This work shows exceptional examples of muddy and sandy contourite deposits in outcrop by which a facies distribution model from the proximal continental slope, the contourite channel to its adjacent contourite drift, is proposed. This model serves as a reference for contourite recognition both in modern environments and the ancient record. Furthermore, by establishing the hydrodynamics of overflow behaviour a framework is provided that improves process-based interpretation of deep-water bottom current deposits