Evaluation of the impact of vegan-vegetarian diets on maternal-fetal health in pregnancy: our experience

La dieta mediterranea e la dieta vegana-vegetariana hanno riscosso un interesse crescente negli ultimi anni, soprattutto per i loro effetti benefici sulle malattie cardiovascolari, sulla sindrome metabolica e sulle malattie oncologiche. L'Accademia di nutrizione e dietetica nel 2009 ha stabilito che le diete vegetariane opportunamente pianificate, comprese le diete vegetariane o totalmente vegane, sono salutari, adeguate dal punto di vista nutrizionale e possono fornire benefici per la salute nella prevenzione e nel trattamento di alcune malattie. Le diete vegetariane ben pianificate sono appropriate per gli individui durante tutte le fasi del ciclo di vita, compresa la gravidanza, l'allattamento, l'infanzia e l'adolescenza, e per gli atleti. La gravidanza è una situazione unica e particolare poiché l'organismo deve far fronte non solo alle esigenze nutrizionali della madre ma anche alla crescita regolare del feto. Un'alimentazione adeguata è quindi uno degli aspetti più importanti per vivere al meglio questo momento. Il crescente utilizzo di diete vegane-vegetariane nelle popolazioni "ricche" richiede la necessità di valutarne rischi e benefici durante la gravidanza poiché i dati in letteratura sono piuttosto scarsi ed eterogenei con risultati molto contrastanti. Nord et al. nel 2000, dopo aver arruolato circa 8.000 bambini, ha riportato un aumento del rischio di ipospadia nei figli di madri vegetariane (odds ratio aggiustato, aOR 4,99, intervallo di confidenza 95%, IC 95% 2,1-11,88). Pertanto il rischio di ipospadia necessita di ulteriori indagini per identificare potenziali fattori confondenti e dovrebbe essere menzionato nella consulenza con i pazienti. Inoltre, le donne vegetariane possono soffrire di carenza di calcio, zinco, DHA, vitamina B12 e ferro. Il DHA contribuisce al normale sviluppo del cervello e degli occhi nel feto e nel neonato allattato al seno e il suo fabbisogno in gravidanza è aumentato di 100-200 mg al giorno. Le donne che decidono di seguire queste abitudini alimentari anche durante la gravidanza devono essere seguite da esperti e monitorate durante la gravidanza e durante l'allattamento per essere integrate con nutrienti carenti.The Mediterranean diet and vegan-vegetarian diets have gained increasing interest in recent years, especially for their beneficial effects on cardiovascular diseases, metabolic syndrome and cancer diseases. The Academy of Nutrition and Dietetics in 2009 established that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. Pregnancy is a unique and particular situation since the body has to cope not only with the nutritional needs of the mother but also with the regular growth of the fetus. Adequate nutrition is therefore one of the most important aspects to better enjoy this moment. The growing use of vegan-vegetarian diets in "rich" populations requires the need to evaluate their risks and benefits during pregnancy since the data in the literature are rather scant and heterogeneous with very contrasting results. North et al. in 2000, after enrolling about 8,000 children, reported an increased risk of hypospadias in children of vegetarian mothers (adjusted odds ratio, aOR 4.99, 95% confidence interval, 95% CI 2.1-11.88). Therefore the risk of hypospadias needs further investigation to identify potential confounding factors, and should be mentioned in counselling with patients. Also, vegetarian women can suffer from calcium, zinc, DHA, vitamin B12 and iron deficiency. DHA contributes to normal brain and eye development in the fetus and breast-fed infant and its requirement in pregnancy is increased by 100-200 mg per day. Women who decide to follow these eating habits even during pregnancy must be followed by experts and monitored during pregnancy and during breastfeeding to be supplemented with deficient nutrients

Comparison between rocking analysis and kinematic analysis for the dynamic out-of-plane behavior of masonry walls

This paper provides a contribution to the rocking analysis of masonry walls by making a comparison with the kinematic analysis suggested by the Italian code. It is shown that the latter approach is generally over-conservative and therefore potentially inappropriate for historic buildings, where rehabilitation can be expensive and can affect their cultural value. The equation of motion given by the Housner formulation, corresponding to the movement of a rigid block, is here modified to account for different boundary conditions at different heights of the wall. These boundary conditions, or horizontal restrainers, can represent vaults, transverse walls or retrofitting devices such as steel tie-rods. A systemic analysis of walls having different dimensions and slenderness is performed, and the results from the Italian code and rocking analysis are compared. Finally, the improvement in the response offered by retrofitting devices is discussed in terms of reduction of amplitude ratio

First assessment on suspension parameter optimization for a solar-powered vehicle

Optimization of suspension parameters with respect to comfort and road holding is a challenging issue for solar-powered cars, due to in-wheel electric engines on very light vehicles, carrying payloads which can exceed their total mass. The solar-powered car considered in this study was designed and manufactured for racing by the University of Bologna; with a mass of 300 kg and a payload of 320 kg due to four occupants, using 5 m2 of monocrystalline silicon photovoltaic panel on the roof, 64 kg of lithium-ion batteries and two electric engines coupled directly to the rear wheels, it can achieve either a range of 600 km at cruising speed, or velocity peaks of 120 km/h. In this contribution, equivalent vertical stiffness and equivalent damping coefficients are optimized for both axles, achieving results that in terms of comfort and road holding are comparable to those of standard passenger cars

Identification of lumped stiffness parameters for a motorcycle model in investigating weave and wobble

In motorcycle dynamics, great importance is attributed to the study of the weave and wobble vibration modes and, in particular, to the effects of the flexibility of structural components on their stability. Therefore, appropriate motorcycle models for studying weave and wobble should include flexible elements for describing the flexural behavior of components such as the main frame, front assembly, and rear swingarm. Different approaches are possible formodeling flexibilities: the most common among them are the lumped stiffness and the flexible multibody approaches. While the latter certainly provides higher accuracy, the former has advantages in terms of computational load, but, above all, it makes it easier to understand in the design phase how technical parameters, such as torsional and bending stiffness of a given structural component, can influence the stability of weave and wobble. The accuracy of lumped stiffness models strongly depends on parameter identification. In this study, a general method is proposed to determine appropriate lumped stiffness parameters for any given motorcycle component. The proposed method is tested and validated by comparing the weave and wobble modal behavior with the results of flexible multibody analysis. The lumped stiffness model is then adopted to carry out a sensitivity analysis aimed at identifying the effects on the weave and wobble stability of the torsional and bending stiffness of specific structural components of the motorcycle to optimize their design

The use of hysteroscopic metroplasty with diode laser to increase endometrial volume in women with septate uterus: preliminary results

Background: Septate uterus is a common Mullerian ducts anomaly. The aim of our pilot study was the evaluation of diode laser hysteroscopic metroplasty efficacy to increase endometrial volume in women with septate uterus. Results: We prospectively enrolled 10 consecutive patients with septate uterus undergoing office hysteroscopic metroplasty with diode laser between February and November 2019. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients, the endometrial volume increased at 3 months follow-up (the median increase was 1.9 cm3 (range 1.7– 2.1), and there was a complete removal of septum with no intrauterine synechiae at follow-up hysteroscopy. Conclusions: Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume. The increase in endometrial volume by 3D-TV US could be used as a prognostic factor for the reproductive outcomes

Hysteroscopic Removal of Intrauterine Device in Pregnancy: A Scoping Review to Guide Personalized Care

Background and objectives: Pregnancies that occur with an intrauterine device (IUD) in situ are at increased risk for developing severe conditions which may affect the fetus and the mother. The incidence of such adverse consequences significantly drops after device removal. A scoping review of the literature was performed to highlight the risks, benefits, and outcomes of hysteroscopic removal of intrauterine devices in early pregnancy. Materials and Methods: PubMed, Scopus, and Web of Science were searched. The review included all reports from 1990 to October 2022. The research strategy adopted included different combinations of the following terms: (“hysteroscopy”) AND (“pregnancy”) AND (“intrauterine device” or “IUD”) AND (“intrauterine system” or “IUS”). A scoping review of the hysteroscopic removal of IUDs during pregnancy was performed. All studies identified were listed by citation, title, authors, and abstract. Duplicates were identified by an independent manual screening performed by two researchers and then removed. For the eligibility process, two authors independently screened the titles and abstracts of all non-duplicated papers and excluded those not pertinent to the topic. Results: PRISMA guidelines were followed. Nine manuscripts were detected, accounting for 153 patients. Most IUD removals occurred during the first trimester of pregnancy. Most of the time, the procedure was safe and without consequences. Conclusions: This review highlights the safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy. We recommend using a 3 to 5 mm hysteroscope, avoiding cervical dilation, and maintaining low infusion pressure during the procedure to avoid potential damage to the gestational sac and IUD fragment displacement. Heating the distension media to 30 ◦C should be considered

Cesarean scar pregnancy treated by artery embolisation combined with diode laser: a novel approach for a rare disease

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE-hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment

Shake table testing of a low-impact technology for the seismic protection of stone masonry

This paper presents a novel low-impact technique for the seismic protection of fair-face masonry walls. The proposed strengthening solution involves the use of carbon-fibre reinforced polymer (CFRP) connectors installed from the outside by perforating the stone elements, combined with grout injections. The connectors cover ¾ of the wall thickness, so as to leave the inner surface undisturbed. Once the work is completed, they are also substantially invisible. Shake table tests were carried out under natural accelerograms on two full-scale irregular multi-leaf stone masonry wall specimens. In order to replicate materials and construction technique of the Apennine historical buildings, the prototypes were made from stones recovered from the debris of a settlement in the municipality of Accumoli (RI, Italy), and the mortar was designed to reproduce lime-poor mortars surveyed in the field. The experimental setup was designed to induce out-of-plane vertical bending under base seismic motion, while allowing the vertical displacement of the wall top. One specimen was tested “as-built” and the other one was tested strengthened, to investigate the gain in seismic performance, the limitation of progressive damage accumulation and the effects on dynamic properties

Scar-Free Laparoscopy in BRCA-Mutated Women

Background and Objectives: BRCA 1 and 2 mutations have a cumulative risk of developing ovarian cancer at 70 years of 41% and 15%, respectively, while a cumulative risk of breast cancer by 80 years of age was 72% for BRCA1 mutation carriers and 69% for BRCA2 mutation carriers. The NCCN recommends risk-reducing salpingo-oophorectomy (RRSO), typically between 35 and 40 years, and upon completion of childbearing in BRCA1 mutation, while it is reasonable to delay RRSO for management of ovarian cancer risk until age 40–45 years in patients with BRCA2. In recent years there have been two main lines of evolution in laparoscopy. The former concerning the development of a single-site laparoscopic and the latter concerning the miniaturisation of laparoscopic instruments (mini/micro-laparoscopy). Materials and Methods: In this case report, we show our experience in prophylactic adnexectomy, on a mutated-BRCA patient, using the MiniLap® percutaneous surgical system. Results: This type of technique is safe and effective and does not require a particular learning curve compared to single-port laparoscopy. Conclusions: The considerable aesthetic advantage of the scars, we believe, albeit to a lesser extent, is useful to find in these patients burdened by an important stress loa

Design of Shake Table Tests of Multi-Leaf Masonry Walls Before and After Retrofitting

A significant proportion of the built heritage in historic centres is constituted by rubble stone masonry structures. Collapses by leaf separation and disaggregation observed after earthquakes highlight their dramatic vulnerability, especially under out-of-plane loads. Nevertheless, their dynamic response still needs to be fully investigated and their capacity may be overestimated by assessment approaches based on rigid-body mechanics. Effective retrofitting solutions are also needed to protect human lives and safeguard the built heritage, while ensuring the conservation of its architectural value. This paper describes the design of a shake table investigation on stone masonry walls, whose materials and arrangement reproduce those surveyed in the villages of central Italy struck by the 2016-2017 earthquake sequence. The test setup was conceived to induce out-of-plane vertical bending under earthquake base motion and investigate the dynamic response of multi-leaf rubble stone masonry and the gain in seismic capacity that can be achieved with mortar-based composite reinforcements, designed to prevent the leaf separation and disaggregation of the wall without compromising its fair face