Understanding the Effects of Anode Catalyst Conductivity and Loading on Catalyst Layer Utilization and Performance for Anion Exchange Membrane Water Electrolysis.

Anion exchange membrane water electrolysis (AEMWE) is a promising technology to produce hydrogen from low-cost, renewable power sources. Recently, the efficiency and durability of AEMWE have improved significantly due to advances in the anion exchange polymers and catalysts. To achieve performances and lifetimes competitive with proton exchange membrane or liquid alkaline electrolyzers, however, improvements in the integration of materials into the membrane electrode assembly (MEA) are needed. In particular, the integration of the oxygen evolution reaction (OER) catalyst, ionomer, and transport layer in the anode catalyst layer has significant impacts on catalyst utilization and voltage losses due to the transport of gases, hydroxide ions, and electrons within the anode. This study investigates the effects of the properties of the OER catalyst and the catalyst layer morphology on performance. Using cross-sectional electron microscopy and in-plane conductivity measurements for four PGM-free catalysts, we determine the catalyst layer thickness, uniformity, and electronic conductivity and further use a transmission line model to relate these properties to the catalyst layer resistance and utilization. We find that increased loading is beneficial for catalysts with high electronic conductivity and uniform catalyst layers, resulting in up to 55% increase in current density at 2 V due to decreased kinetic and catalyst layer resistance losses, while for catalysts with lower conductivity and/or less uniform catalyst layers, there is minimal impact. This work provides important insights into the role of catalyst layer properties beyond intrinsic catalyst activity in AEMWE performance.

Alternariol Monomethyl-Ether Induces Toxicity via Cell Death and Oxidative Stress in Swine Intestinal Epithelial Cells.

Alternariol monomethyl-ether (AME), together with altenuene and alternariol, belongs to the Alternaria mycotoxins group, which can contaminate different substrates, including cereals. The aim of the present study was to obtain a deeper understanding concerning the effects of AME on pig intestinal health using epithelial intestinal cell lines as the data concerning the possible effects of Alternaria toxins on swine are scarce and insufficient for assessing the risk represented by Alternaria toxins for animal health. Our results have shown a dose-related effect on IPEC-1 cell viability, with an IC50 value of 10.5 µM. Exposure to the toxin induced an increase in total apoptotic cells, suggesting that AME induces programmed cell death through apoptosis based on caspase-3/7 activation in IPEC-1 cells. DNA and protein oxidative damage triggered by AME were associated with an alteration of the antioxidant response, as shown by a decrease in the enzymatic activity of catalase and superoxide dismutase. These effects on the oxidative response can be related to an inhibition of the Akt/Nrf2/HO-1 signaling pathway; however, further studies are needed in order to validate these in vitro data using in vivo trials in swine.

Protocol for assembling and operating bipolar membrane water electrolyzers.

Renewable energy-driven bipolar membrane water electrolyzers (BPMWEs) are a promising technology for sustainable production of hydrogen from seawater and other impure water sources. Here, we present a protocol for assembling BPMWEs and operating them in a range of water feedstocks, including ultra-pure deionized water and seawater. We describe steps for membrane electrode assembly preparation, electrolyzer assembly, and electrochemical evaluation. For complete details on the use and execution of this protocol, please refer to Marin et al. (2023).1.

PolyID: Artificial Intelligence for Discovering Performance-Advantaged and Sustainable Polymers.

A necessary transformation for a sustainable economy is the transition from fossil-derived plastics to polymers derived from biomass and waste resources. While renewable feedstocks can enhance material performance through unique chemical moieties, probing the vast material design space by experiment alone is not practically feasible. Here, we develop a machine-learning-based tool, PolyID, to reduce the design space of renewable feedstocks to enable efficient discovery of performance-advantaged, biobased polymers. PolyID is a multioutput, graph neural network specifically designed to increase accuracy and to enable quantitative structure-property relationship (QSPR) analysis for polymers. It includes a novel domain-of-validity method that was developed and applied to demonstrate how gaps in training data can be filled to improve accuracy. The model was benchmarked with both a 20% held-out subset of the original training data and 22 experimentally synthesized polymers. A mean absolute error for the glass transition temperatures of 19.8 and 26.4 °C was achieved for the test and experimental data sets, respectively. Predictions were made on polymers composed of monomers from four databases that contain biologically accessible small molecules: MetaCyc, MINEs, KEGG, and BiGG. From 1.4 × 106 accessible biobased polymers, we identified five poly(ethylene terephthalate) (PET) analogues with predicted improvements to thermal and transport performance. Experimental validation for one of the PET analogues demonstrated a glass transition temperature between 85 and 112 °C, which is higher than PET and within the predicted range of the PolyID tool. In addition to accurate predictions, we show how the model's predictions are explainable through analysis of individual bond importance for a biobased nylon. Overall, PolyID can aid the biobased polymer practitioner to navigate the vast number of renewable polymers to discover sustainable materials with enhanced performance.

Using In Silico Approach for Metabolomic and Toxicity Prediction of Alternariol.

Alternariol is a metabolite produced by Alternaria fungus that can contaminate a variety of food and feed materials. The objective of the present paper was to provide a prediction of Phase I and II metabolites of alternariol and a detailed ADME/Tox profile for alternariol and its metabolites using an in silico working model based on the MetaTox, SwissADME, pKCMS, and PASS online computational programs. A number of 12 metabolites were identified as corresponding to the metabolomic profile of alternariol. ADME profile for AOH and predicted metabolites indicated a moderate or high intestinal absorption probability but a low probability to penetrate the blood-brain barrier. In addition to cytotoxic, mutagenic, carcinogenic, and endocrine disruptor effects, the computational model has predicted other toxicological endpoints for the analyzed compounds, such as vascular toxicity, haemato-toxicity, diarrhea, and nephrotoxicity. AOH and its metabolites have been predicted to act as a substrate for different isoforms of phase I and II drug-metabolizing enzymes and to interact with the response to oxidative stress. In conclusion, in silico methods can represent a viable alternative to in vitro and in vivo tests for the prediction of mycotoxins metabolism and toxicity.

Natural Antioxidant By-Product Mixture Counteracts the Effects of Aflatoxin B1 and Ochratoxin A Exposure of Piglets after Weaning: A Proteomic Survey on Liver Microsomal Fraction.

Mycotoxins are toxic compounds produced by certain strains of fungi that can contaminate raw feed materials. Once ingested, even in small doses, they cause multiple health issues for animals and, downstream, for people consuming meat. It was proposed that inclusion of antioxidant-rich plant-derived feed might diminish the harmful effects of mycotoxins, maintaining the farm animals' health and meat quality for human consumption. This work investigates the large scale proteomic effects on piglets' liver of aflatoxin B1 and ochratoxin A mycotoxins and the potential compensatory effects of grapeseed and sea buckthorn meal administration as dietary byproduct antioxidants against mycotoxins' damage. Forty cross-bred TOPIGS-40 hybrid piglets after weaning were assigned to three (n = 10) experimental groups (A, M, AM) and one control group (C) and fed with experimental diets for 30 days. After 4 weeks, liver samples were collected, and the microsomal fraction was isolated. Unbiased label-free, library-free, data-independent acquisition (DIA) mass spectrometry SWATH methods were able to relatively quantify 1878 proteins from piglets' liver microsomes, confirming previously reported effects on metabolism of xenobiotics by cytochrome P450, TCA cycle, glutathione synthesis and use, and oxidative phosphorylation. Pathways enrichment revealed that fatty acid metabolism, steroid biosynthesis, regulation of actin cytoskeleton, regulation of gene expression by spliceosomes, membrane trafficking, peroxisome, thermogenesis, retinol, pyruvate, and amino acids metabolism pathways are also affected by the mycotoxins. Antioxidants restored expression level of proteins PRDX3, AGL, PYGL, fatty acids biosynthesis, endoplasmic reticulum, peroxisome, amino acid synthesis pathways, and, partially, OXPHOS mitochondrial subunits. However, excess of antioxidants might cause significant changes in CYP2C301, PPP4R4, COL18A1, UBASH3A, and other proteins expression levels. Future analysis of proteomics data corelated to animals growing performance and meat quality studies are necessary.

Grape seed meal by-product is able to counteract oxidative stress induced by lipopolysaccharide and dextran sulphate in IPEC cells and piglets after weaning.

Oxidative stress is a pivotal factor in the pathogenesis of intestinal inflammation, leading to cellular damage and tissue injury. Natural antioxidants compounds found in agro-industrial by-products have proven their effectiveness in treatment of intestinal inflammation and oxidative stress, exhibiting many favourable effects. The aim of this study was to evaluate the capacity of a grape seed meal byproduct (GSM) to counteract the effects induced by E. coli lipopolysaccharide (LPS, 5µg/ml) in vitro on IPEC-1 cells and by dextran sulphate sodium (DSS, 1g/b.w./day) in vivo on piglets after weaning. Reactive oxygen species (ROS), pro-oxidant markers (malondialdehyde MDA, thiobarbituric acid reactive substances TBARS, protein carbonyl, DNA oxidative damage) antioxidant enzymes (catalase -CAT, superoxide dismutase -SOD, glutathione peroxidase -GPx, endothelial and inducible nitric oxide synthases -eNOS and iNOS) and several important components of Keap1/Nrf2 signalling pathway were analysed in IPEC-1 cells as well as in piglet's colon and lymph nodes. Our results demonstrated that GSM extract or 8% dietary GSM showed anti-oxidant properties counteracting the pro-oxidant response (ROS, MDA-TBARS, protein carbonyl, DNA/RNA damage) induced by LPS or DSS and restoring the levels of endogenous antioxidant enzymes, including CAT, SOD, GPx, eNOS and iNOS in colon and mesenteric lymph nodes. These beneficial effects were modulated via Nrf2 signalling pathway in both in vitro and in vivo studies.

Effects of Exposure to Low Zearalenone Concentrations Close to the EU Recommended Value on Weaned Piglets' Colon.

Pigs are the most sensitive animal to zearalenone (ZEN) contamination, especially after weaning, with acute deleterious effects on different health parameters. Although recommendations not to exceed 100 µg/kg in piglets feed exists (2006/576/EC), there are no clear regulations concerning the maximum limit in feed for piglets, which means that more investigations are necessary to establish a guidance value. Due to these reasons, the present study aims to investigate if ZEN, at a concentration lower than the EC recommendation for piglets, might affect the microbiota or induce changes in SCFA synthesis and can trigger modifications of nutritional, physiological, and immunological markers in the colon (intestinal integrity through junction protein analysis and local immunity through IgA production). Consequently, the effect of two concentrations of zearalenone were tested, one below the limit recommended by the EC (75 µg/kg) and a higher one (290 µg/kg) for comparison reasons. Although exposure to contaminated feed with 75 µg ZEN/kg feed did not significantly affect the observed parameters, the 290 µg/kg feed altered several microbiota population abundances and the secretory IgA levels. The obtained results contribute to a better understanding of the adverse effects that ZEN can have in the colon of young pigs in a dose-dependent manner.

Time series analysis of in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery in the regions of Brazil, 2010-2019. / Análise temporal da letalidade materna hospitalar no pós-parto segundo risco gestacional e via de parto, nas regiões do Brasil, 2010-2019.

OBJECTIVE: to analyze in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery, within the Brazilian National Health System, Brazil and macro-regions, 2010-2019. METHODS: this was an ecological time-series study, using data from the Hospital Information System; in-hospital maternal case fatality ratio in the postpartum period took into consideration maternal hospitalizations with outcome 'death' over the total number of hospitalizations per year, according to pregnancy risks and route of delivery, in the regions. RESULTS: there were 19,158,167 hospitalizations for childbirth and 5,110 deaths in the period analyzed; maternal case fatality ratio increased from 1.1 (2010) to 1.9 death/10,000 hospitalizations (2019), in usual-risk pregnancies after vaginal deliveries, and decreased from 10.5 (2010) to 7.0 deaths/10,000 hospitalizations (2019) in high-risk pregnancies after cesarean sections; the Midwest region presented the highest and the South region the lowest case fatality ratio for high-risk pregnancies. CONCLUSION: in-hospital case fatality ratio was higher for high-risk pregnancies, showing differences according to route of delivery and regions.

Trastornos de la deglución en niños menores de 3años con condiciones médicas complejas, abordaje interdisciplinario / Interdisciplinary approach in swallowing disorders in children under 3years old with complex medical conditions

Los problemas de alimentación ocurren en el 80% de niños que presentan algún retraso del desarrollo debido a condiciones médicas crónicas, y pueden presentarse en diferentes grados y formas. Los niños con trastornos de la deglución (TD) pueden manifestar síntomas en todo momento de la alimentación. Objetivo: Diagnosticar e intervenir TD y/o trastornos de conducta alimentaria (TCA) en niños con patología médica crónica compleja, derivados a un equipo interdisciplinario, durante el año 2017, en un hospital de alta complejidad. Material y métodos: Estudio analítico, prospectivo y longitudinal con intervención de un equipo interdisciplinario. Se realizó evaluación clínica fonoaudiológica de la deglución, ofreciendo pautas de estimulación y modificación de consistencias. Resultados: Se evaluaron 139 pacientes de entre 2meses y 3años; el 38% eran mujeres, y el 77% con soporte nutricional enteral (SNE). El 73% presentaron TD exclusivamente o asociado a un TCA. El 38% que ingresaron con SNE lograron el destete (sin diferencia significativa entre los que tenían o no TD [p=0,85] y los que tenían o no traqueotomía [p=0,88]), y del grupo que no logró el destete, un 54% aumentaron el aporte por vía oral. Se observó una diferencia estadísticamente significativa en el destete de los pacientes que concurrieron al espacio de la clínica con respecto a los que no (p=0,016) y un mayor tiempo de intervención entre quienes lograron el destete y quienes no: 5,2±3,1 vs 3,45±3,1meses (p=0,0099). El 70% continuqron seguimiento por el fonoaudiólogo. Conclusión: En niños con condiciones médicas complejas es esencial el trabajo interdisciplinario y especializado en esta temática. En los casos de TD, la intervención fonoaudiológica se asume como fundamental para la detección precoz y el correcto abordaje de la disfagia.(AU)

Children with swallowing disorders (SD) may manifest symptoms at all times during feeding. This clinical entity can present itself in different grades and forms. Objective: To diagnose and intervene in SD and/or eating behavior (EB) in children with complex chronic medical conditions referred to an interdisciplinary team, during 2017, in a high complexity hospital. Material and methods: Analytical, prospective and longitudinal study with the intervention of an interdisciplinary team. Clinical phonoaudiological evaluation of swallowing was performed, offering guidelines for stimulation and consistency modification. Results: 139 patients, between 2 month and 3 years old, 38% women, 77% with enteral nutritional support (ENS) were evaluated, 73% presented SD exclusively or associated with an EB. The 38% who entered with ENS achieved weaning (without significant difference between those who had or not SD, P=.85, and those who had or not tracheotomy, P=.88), and of the group that did not achieve weaning, oral contribution increased in 54% of cases. A statistically significant difference was observed in weaning of patients who attended the interdisciplinary space with respect to those who did not (P=.016) and longer intervention time between those who achieved weaning and those who did not, 5.2±3.1 vs 3.45±3.1 months (P=.0099). And 70% off patients continued follow with the speech therapist. Conclusion: Interdisciplinary and specialized work in this subject is essential in children with complex medical conditions. In cases of SD, speech therapy intervention, it is assumed as essential for early detection and correct approach to dysphagia.

Yeast-Fermented Rapeseed Meal Extract Is Able to Reduce Inflammation and Oxidative Stress Caused by Escherichia coli Lipopolysaccharides and to Replace ZnO in Caco-2/HTX29 Co-Culture Cells.

(1) The present study tested in vitro the capacity of a fermented rapeseed meal extract to reduce medicinal ZnO, which will be banned at the EU level from 2023 onwards because of its potential to cause environmental pollution and the development of Zn resistance in gut bacteria. Rapeseed meal could be an important ZnO substitute as it has antioxidant/radical scavenging properties due to its content of bioactive compounds (e.g., polyphenols). (2) Protein array and flow cytometry were used to detect apoptosis, oxidative stress production, and inflammatory and signaling-related molecules in Caco-2 and goblet HT29-MTX co-culture cells challenged with Escherichia coli lipopolysaccharides and treated with ZnO and FRSM. (3) LPS induced cell death (21.1% vs. 12.7% in control, p < 0.005); apoptosis (16.6%); ROS production; and overexpression of biomarkers related to inflammation (63.15% cytokines and 66.67% chemokines), oxidative stress, and signaling proteins when compared to untreated cells. ZnO was effective in counteracting the effect of LPS, and 73.68% cytokines and 91.67% of chemokines were recovered. FRSM was better at restoring normal protein expression for 78.94% of cytokines, 91.67% of chemokines, and 61.11% of signaling molecules. FRSM was able to mitigate negative effects of LPS and might be an alternative to ZnO in pig diets.

The Yeast Fermentation Effect on Content of Bioactive, Nutritional and Anti-Nutritional Factors in Rapeseed Meal.

The aim of this study was to evaluate the changes in the content of bioactive, nutritional and anti-nutritional factors in rapeseed meal that was fermented with Saccharomyces cerevisiae or Saccharomyces boulardii yeasts at two different periods of time, for improvement of nutritional characteristics in piglets' feeding. The fermentation has reduced the content of two anti-nutritional factors, intact glucosinolates and 3-butyl isothiocyanate, by 51.60-66.04% and 55.21-63.39%, respectively, by fermentation with either Saccharomyces cerevisiae or Saccharomyces boulardii for 24 h. The fermentation by these yeasts also lowered the content of total polyphenolic compounds by 21.58-23.55% and antioxidant activity (DPPH) by 17.03-21.07%. Furthermore, the content of carbohydrates and organic acids has dramatically decreased between 89.20 and 98.35% and between 31.48 and 77.18%, respectively. However, the content of some individual phenolic acids (gallic, p-coumaric, sinapic) and crude protein content (10-13%) has been increased. Thus, the results showed that fermentation with Saccharomyces cerevisiae or Saccharomyces boulardii has reduced the content of antinutritive factors and increased the protein content of the rapeseed meal, without major adverse effects on its overall nutritive value.

Time series analysis of Postpartum maternal lethality according to pregnancy risk and the mode of delivery in regions of Brazil, 2010-2019 / Análisis de series temporales de letalidad materna posparto según riesgo gestacional y forma de parto en regiones del Brasil, 2010-2019 / Análise temporal da letalidade materna hospitalar no pós-parto segundo risco gestacional e via de parto, nas regiões do Brasil, 2010-2019

Objective: to analyze temporal series of postpartum maternal lethality according to gestational risk and mode of delivery by the Unified Health System in Brazil and regions, 2010-2019. Methods: ecological time series study with data from the Hospital Information System; the hospital postpartum maternal lethality rate considered maternal hospitalizations with hospital discharge due to death, by the total hospitalizations, per year according to gestational risk and mode of delivery, in the regions of Brazil. Results: there were 19.158.167 admissions for childbirth and 5.110 deaths in the period; maternal lethality rose from 1.10 in 2010 to 1.9 deaths/10.000 in 2019 in low-risk pregnancies after vaginal deliveries and decreased from 10,5 to 7,0 deaths/10.000 in high-risk pregnancies after cesarean sections; Midwest expressed the highest and the South the lowest fatality rate for high-risk pregnancies. Conclusion: Hospital lethality was higher in high-risk pregnancies, with differences according to mode of delivery and regions of Brazil.

Objetivo: analizar la letalidad materna hospitalaria posparto según riesgo gestacional y modalidad de parto por el Sistema Único de Salud en Brasil y regiones, 2010-2019. Métodos: estudio de serie temporal ecológica con datos del Sistema de Información Hospitalario; la tasa de letalidad materna hospitalaria posparto consideró las hospitalizaciones maternas con resultado de muerte, por el total de hospitalizaciones por año. Resultados: hubo 19.158.167 admisiones por parto y 5.110 óbitos en el período; la letalidad materna aumentó de 1,10 (2010) a 1,9 muertes/10.000 (2019) en embarazos de riesgo habitual posparto vaginal y disminuyó de 10,5 a 7,0 muertes/10.000 en embarazos de alto riesgo después de cesáreas; Medio Oeste expresó la tasa de letalidad más alta y el Sur la más baja para embarazos de alto riesgo. Conclusión: la letalidad hospitalaria fue mayor en los embarazos de alto riesgo, con diferencias según el modo de parto y las regiones de Brasil.

Objetivo: analisar a letalidade materna hospitalar pós-parto segundo risco gestacional e via de parto, no Sistema Único de Saúde, Brasil e regiões nacionais, 2010-2019. Métodos: estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares; a taxa de letalidade materna hospitalar pós-parto considerou internações maternas com desfecho 'óbito' sobre o total de internações/ano, segundo risco gestacional e via de parto, nas regiões. Resultados: foram 19.158.167 internações para parto e 5.110 óbitos no período analisado; a letalidade materna subiu de 1,1 (2010) para 1,9 óbitos/10 mil internações (2019), em gestações de risco habitual após partos vaginais, e reduziu-se de 10,5 (2010) para 7,0 óbitos/10 mil internações (2019) em gestações de alto risco após cesarianas; Centro-Oeste expressou a maior e Sul a menor taxa de letalidade para gestações de alto risco. Conclusão: a letalidade hospitalar foi maior em gestações de alto risco, com diferenças segundo via de parto e regiões.

Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic? / Aumento da taxa de mortalidade materna entre as admissões para parto em gestantes de baixo risco gestacional no Brasil: Efeito da pandemia do COVID-19?

Abstract Objective To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. Methods An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). Results In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). Conclusion Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

Resumo Objetivo Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. Métodos Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. Resultados Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39-185) quanto em cesáreas (RR = 1.18; IC95%: 1.04-1.34). Conclusão A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?

OBJECTIVE: To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. METHODS: An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). RESULTS: In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). CONCLUSION: Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

OBJETIVO: Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. MéTODOS: Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. RESULTADOS: Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39­185) quanto em cesáreas (RR = 1.18; IC95%: 1.04­1.34). CONCLUSãO: A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

Maternal mortality in South region of Brazil: an analysis from 2000 to 2018.

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact StatementWhat is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births.What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years.What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

Degradation Behavior and Mechanical Integrity of a Mg-0.7Zn-0.6Ca (wt.%) Alloy: Effect of Grain Sizes and Crystallographic Texture.

The microstructural characteristics of biodegradable Mg alloys determine their performance and appropriateness for orthopedic fixation applications. In this work, the effect of the annealing treatment of a Mg-0.7Zn-0.6Ca (ZX11) alloy on the mechanical integrity, corrosive behavior, and biocompatibility-osteoinduction was studied considering two annealing temperatures, 350 and 450 °C. The microstructure showed a recrystallized structure, with a lower number of precipitates, grain size, and stronger basal texture for the ZX11-350 condition than the ZX11-450. The characteristics mentioned above induce a higher long-term degradation rate for the ZX11-450 than the ZX11-350 on days 7th and 15th of immersion. In consequence, the mechanical integrity changes within this period. The increased degradation rate of the ZX11-450 condition reduces 40% the elongation at failure, in contrast with the 16% reduction for the ZX11-350 condition. After that period, the mechanical integrity remained unchanged. No cytotoxic effects were observed for both treatments and significant differentiation of mesenchymal stem cells into the osteoblast phenotype was observed.

Providing Environmental Enrichment without Altering Behavior in Male and Female Wistar Rats (Rattus norvegicus).

In research using animal models, subjects are commonly maintained under standard housing conditions, mainly because of the idea that enhancing welfare conditions could alter experimental data. Another common practice in many laboratories relates to the preponderant use of males. Several reasons justifying this practice include the rapid hormonal and endocrine change in females, which may require a higher number of female animals to achieve more homogenous groups, thereby creating a dilemma with the reduction principle in animal research. In past decades, a relationship between enriched environments and enhanced cognitive functions has been reported in rats, but many of those enriched environmental protocols were not systematically or rigorously studied, leading to unexpected effects on behavior. Here we report the effects of 4 types of housing conditions (standard, structural changes, exercise, and foraging) in Wistar rats on anxiety (elevated plus maze), exploratory (open field), and stress vulnerability (forced swim test) responses. Sex was used as a blocking factor. Data show no effect of housing conditions on anxiety and exploratory behaviors, but do show an effect on stress responses. These results suggest the possibility of using a protocol for environmental enrichment without concern about altering experimental data. From this stand, new ways to enhance animal welfare in research laboratories could be designed and implemented.

Ampullary GIST tumor as an incidental finding after a cephalic duodenopancreatectomy due to a suspicion of a nonfunctional neuroendocrine tumor.

The case of a patient who had a cephalic duodenopancreatectomy performed because of a nonfunctional neuroendocrine tumour located in the pancreatic head is reported. Such tumour was diagnosed by a CT scan, an echoendoscopy and some punctures of the tumour to take some samples for cytology. The final anatomopathological study informed about the presence of an ampullary GIST tumour, which is a very infrequent entity, so a bibliographical search and a revision of the cases published up to this day was done.