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Candiani M, Vercellini P, Fedele F, Parma M, Salvatore S, Fedele L. Long-Term Follow-Up after Laparoscopic Uterovestibular Anastomosis in Patients with Cervical Atresia and Complete Absence of the Vagina. J Pediatr Adolesc Gynecol 2023; 36:72-78. [PMID: 35489472 DOI: 10.1016/j.jpag.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The surgical treatment of girls with cervical atresia and complete absence of the vagina remains a problem because of the rarity of cases and the controversial study results. OBJECTIVE To describe the surgical technique and long-term results of laparoscopically assisted uterovestibular anastomosis in patients with cervical atresia and complete absence of the vagina STUDY DESIGN: Sixteen consecutive patients with cervical atresia and complete absence of the vagina were conservatively treated with laparoscopically assisted uterovestibular anastomosis in 2 tertiary care referral centers. The follow-up assessments included clinical examination, determination of the presence and quality of sexual intercourse, and vaginoscopy. RESULTS All patients underwent laparoscopically assisted uterovestibular anastomosis. No perioperative complications occurred. The mean follow-up period was 8 ± 3.2 years. In all patients, the length of the neovagina was greater than 4 cm at 1 year after the surgery and approximately 6 cm after 2 years. After the start of sexual intercourse, the neovagina exceeded 7 cm in length in 2 of the 11 sexually active patients. At 12 months after the surgery, iodine-positive epithelium was present in all patients and was maintained over time. The continuity of the neovagina, neocervix, and uterine body was maintained without further interventions in 15 of the 16 patients. During the follow-up, 11 patients were sexually active, 5 were married, 4 were seeking conception, and 2 had spontaneous pregnancy. CONCLUSIONS Laparoscopically assisted uterovestibular anastomosis seems to be a safe and effective treatment for patients with cervical atresia and complete absence of the vagina, at least in terms of the recovery of menstrual function and sexual activity.
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Affiliation(s)
- Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vercellini
- Department of Obstetrics and Gynecology, Fondazione "Policlinico-Mangiagalli-Regina Elena" University of Milan, Italy
| | - Francesco Fedele
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Parma
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, Fondazione "Policlinico-Mangiagalli-Regina Elena" University of Milan, Italy.
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Fedele F, Parazzini F, Vercellini P, Bergamini V, Fedele L. Reconstructive surgery for congenital atresia of the uterine cervix: a systematic review. Arch Gynecol Obstet 2022:10.1007/s00404-022-06825-5. [DOI: 10.1007/s00404-022-06825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/11/2022] [Indexed: 11/02/2022]
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Candiani M, Vercellini P, Ferrero-Caroggio C, Fedele F, Salvatore S, Fedele L. Conservative treatment of Herlyn-Werner-Wunderlich syndrome: Analysis and long-term follow-up of 51 cases. Eur J Obstet Gynecol Reprod Biol 2022; 275:84-90. [PMID: 35763966 DOI: 10.1016/j.ejogrb.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/04/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the precise anatomical characteristics of a large group of patients with Herlyn-Werner-Wunderlich syndrome together with the long-term follow-up and the reproductive performance. STUDY DESIGN Retrospective analysis of prospectively collected data. In two tertiary medical centers, from 2008 to 2021, 51 patients with HWWS underwent surgery via the same technique. Presenting symptoms, preoperative investigations, operative management, and long-term follow-up with obstetric outcome were assessed. RESULTS The surgical procedure was successful in all cases with no major complications recorded. Postoperative course was uneventful. The median follow-up was 6,5 years, with a range from 6 months to 13 years. After surgery, among 14 patients who sought pregnancies, 12 (85,71%) were successful. Of these 11 patients had a total of 22 pregnancies, resulting in spontaneous miscarriage in 27% (6/22), premature birth (<37 weeks) in 36% (8/22) and full-term birth in 36% (8/22). Overall the pregnancies demonstrated had a good course. CONCLUSIONS Early diagnosis is essential in establishing prompt and correct surgical treatment.
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Affiliation(s)
- M Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Vercellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | | | - F Fedele
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Salvatore
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Fedele
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.
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Vanni VS, Alteri A, De Santis L, Cermisoni GC, Rabellotti E, Delprato D, Parma M, Papaleo E, Fedele L, Candiani M. Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome. J Vis Exp 2022. [DOI: 10.3791/63634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Limite LR, Baratto F, Mantica M, Sirico G, Rovaris G, MOntemerlo E, Pecora D, Pagani M, Fedele L, Augello G, Zuffada F, Rordorf R, Ambrosini F, Gigli L, De Filippo P, Pani A, Forleo G, Mitacchione G, Della Bella P, Mazzone P. [Leadless pacemakers: results of a survey from implanter centers in the Lombardy region]. G Ital Cardiol (Rome) 2022; 23:120-127. [PMID: 35343516 DOI: 10.1714/3735.37214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transvenous pacing is nowadays the cornerstone of interventional management of bradyarrhythmias. It is still associated, however, with significant complications, mostly related to indwelling transvenous leads or device pocket. In order to reduce these complications, leadless pacemakers have been recently introduced into clinical practice, but no guidelines are yet available to indicate who are those patients that might benefit the most and whether leadless pacing should be preferred in the old or young population. This survey aims to describe the use of leadless pacemaker devices in a real-world setting. METHODS Eleven arrhythmia centers in the Lombardy region (out of a total of 17 participating centers) responded to the proposed questionnaire regarding patient characteristics and indications to leadless pacing. RESULTS Out of a total of 411 patients undergoing leadless pacing during 4.2 ± 0.98 years, the median age was 77 years, with 0.18% of patients having less than 18 years, 29.9% 18-65 years, 34.3% 65-80 years and 35.6% >80 years. The most common indication was slow atrial fibrillation (49% of patients), followed by atrioventricular block and sinoatrial dysfunction. Two centers reported in-hospital complications. CONCLUSIONS Leadless pacemakers proved to be a safe pacing strategy actually destined mostly to elderly patients.
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Affiliation(s)
- Luca Rosario Limite
- U.O. Aritmologia ed Elettrofisiologia, Dipartimento Cardio-Toraco-Vascolare, IRCCS Ospedale San Raffaele, Milano
| | | | - Massimo Mantica
- Centro di Elettrofisiologia Cardiaca ed Elettrostimolazione, Istituto Clinico Sant'Ambrogio, Milano
| | - Giusy Sirico
- Centro di Elettrofisiologia Cardiaca ed Elettrostimolazione, Istituto Clinico Sant'Ambrogio, Milano
| | | | | | | | - Massimo Pagani
- U.O. Cardiologia, Ospedale Civile di Legnano, Legnano (MI)
| | - Luigi Fedele
- U.O. Cardiologia, Ospedale Civile di Legnano, Legnano (MI)
| | | | | | - Roberto Rordorf
- U.O. Aritmologia, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Francesco Ambrosini
- U.O. Malattie dell'Apparato Cardiovascolare, Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano
| | - Lorenzo Gigli
- U.O. Malattie dell'Apparato Cardiovascolare, Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano
| | - Paolo De Filippo
- U.O. Elettrofisiologia ed Elettrostimolazione Cardiaca, Ospedale Papa Giovanni XXIII, Bergamo
| | | | | | | | - Paolo Della Bella
- U.O. Aritmologia ed Elettrofisiologia, Dipartimento Cardio-Toraco-Vascolare, IRCCS Ospedale San Raffaele, Milano
| | - Patrizio Mazzone
- U.O. Aritmologia ed Elettrofisiologia, Dipartimento Cardio-Toraco-Vascolare, IRCCS Ospedale San Raffaele, Milano
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Maffei M, Montemiglio LC, Vitagliano G, Fedele L, Sellathurai S, Bucci F, Compagnone M, Chiarini V, Exertier C, Muzi A, Roscilli G, Vallone B, Marra E. The Nuts and Bolts of SARS-CoV-2 Spike Receptor-Binding Domain Heterologous Expression. Biomolecules 2021; 11:1812. [PMID: 34944456 PMCID: PMC8699011 DOI: 10.3390/biom11121812] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is a highly infectious disease caused by a newly emerged coronavirus (SARS-CoV-2) that has rapidly progressed into a pandemic. This unprecedent emergency has stressed the significance of developing effective therapeutics to fight the current and future outbreaks. The receptor-binding domain (RBD) of the SARS-CoV-2 surface Spike protein is the main target for vaccines and represents a helpful "tool" to produce neutralizing antibodies or diagnostic kits. In this work, we provide a detailed characterization of the native RBD produced in three major model systems: Escherichia coli, insect and HEK-293 cells. Circular dichroism, gel filtration chromatography and thermal denaturation experiments indicated that recombinant SARS-CoV-2 RBD proteins are stable and correctly folded. In addition, their functionality and receptor-binding ability were further evaluated through ELISA, flow cytometry assays and bio-layer interferometry.
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Affiliation(s)
- Mariano Maffei
- Evvivax Biotech, Via di Castel Romano 100, 00128 Rome, Italy;
| | - Linda Celeste Montemiglio
- Institute of Molecular Biology and Pathology (IBPM), National Research Council, c/o Department of Biochemical Sciences “Alessandro Rossi Fanelli”, Sapienza, University of Rome, P. le Aldo Moro, 5, 00185 Rome, Italy;
| | - Grazia Vitagliano
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Luigi Fedele
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Shaila Sellathurai
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Federica Bucci
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | | | - Valerio Chiarini
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Cécile Exertier
- Department of Biochemical Sciences “Alessandro Rossi Fanelli”, Sapienza, University of Rome, P. le Aldo Moro, 5, 00185 Rome, Italy; (C.E.); (B.V.)
| | - Alessia Muzi
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Giuseppe Roscilli
- Evvivax Biotech, Via di Castel Romano 100, 00128 Rome, Italy;
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
| | - Beatrice Vallone
- Department of Biochemical Sciences “Alessandro Rossi Fanelli”, Sapienza, University of Rome, P. le Aldo Moro, 5, 00185 Rome, Italy; (C.E.); (B.V.)
| | - Emanuele Marra
- Evvivax Biotech, Via di Castel Romano 100, 00128 Rome, Italy;
- Takis Biotech, Via di Castel Romano 100, 00128 Rome, Italy; (G.V.); (L.F.); (S.S.); (F.B.); (V.C.); (A.M.)
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Origoni M, Fedele F, Parma M, Di Fatta S, Bergamini V, Candiani M, Fedele L. The Peritoneal Neovagina after Davydov's Laparoscopic Procedure in Mayer-Rokitansky-Küster-Hauser Syndrome: Morphology and Ultrastructure Investigation of the New Epithelium. J Minim Invasive Gynecol 2021; 28:1795-1799. [PMID: 33852967 DOI: 10.1016/j.jmig.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/01/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To investigate the clinical appearance and morphologic and ultrastructural aspects of the mucosa of the peritoneal neovagina after laparoscopic Davydov neovaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome. DESIGN The study group was a prospective, observational, experimental cohort of cases treated in the same institution between 2015 and 2019. Patients were followed up at 3, 6, and 12 months after surgery and then every 12 months. SETTING Single-center academic institution and teaching hospital in Milan, Italy. PATIENTS Fifty-one consecutive subjects with clinical and imaging diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome surgically treated by the same team and postoperatively followed. INTERVENTIONS All the subjects underwent the same standardized surgical procedure and thereafter were followed up at 3, 6, and 12 months after surgery and then every 12 months; a minimum follow-up of 12 months was achieved in all cases. Vaginoscopy and Schiller test were performed at each follow-up visit, and a biopsy specimen of the neovagina was obtained in a limited number of patients (6 out of 51) for light microscopy (LM) and scanning electron microscopy (SEM) analysis of the tissue. MEASUREMENTS AND MAIN RESULTS In vaginoscopy, the neovaginal mucosa appeared homogeneous, smooth, and pink all along the neovaginal tract; the Schiller test detected iodine positivity at different degrees of extension upward from the hymenal ring, starting at 3 months postoperatively with almost complete positivity between 6 to 12 months in all cases. LM demonstrated adequate thickness and differentiation of the new mucosa along with the presence of glycogen storage; SEM revealed an ultrastructural surface appearance very close to normality. The main difference compared with a normal vagina was the reduced presence of vaginal mucosal folds. CONCLUSION Under different techniques (vaginoscopy, Schiller test, LM, and SEM), a minimum of 6 months after surgery, the peritoneal neovagina epithelium showed aspects comparable to the natal mucosa of the vagina.
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Affiliation(s)
- Massimo Origoni
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele).
| | - Francesco Fedele
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele)
| | - Marta Parma
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele)
| | - Simona Di Fatta
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele)
| | - Valentino Bergamini
- Department of Gynecology & Obstetrics B, Azienda Ospedaliera Universitaria Integrata Verona, Verona (Dr. Bergamini), Italy
| | - Massimo Candiani
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele)
| | - Luigi Fedele
- Department of Gynecology & Obstetrics, Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University School of Medicine, Milan (Drs. Origoni, Fedele, Parma, Di Fatta, Candiani, and Fedele)
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Vercellini P, Buggio L, Somigliana E, Barbara G, Viganò P, Fedele L. Retraction notice to “Attractiveness of women with rectovaginal endometriosis: a case-control study” [FNS 99 (2013) 212 - 218]. Fertil Steril 2020; 114:1123. [DOI: 10.1016/j.fertnstert.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Frigerio L, Sanzo A, Cornara S, Chieffo E, La Greca C, Sirico G, Scopinaro A, Solimene F, Fedele L, Augello G, Marrazzo N, Turreni F, Tritto M, Rordorf R. P1020Persistent AF patients with limited areas of low voltage have a similar benefit from pulmonary vein isolation as compared to paroxysmal AF patients: insight from the SMOP study. Europace 2020. [DOI: 10.1093/europace/euaa162.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) performed with radio-frequency catheter ablation (CA) is an effective therapy for atrial fibrillation (AF). However previous data have suggested that PVI is less effective in persistent (PER) vs. paroxysmal (PAR) AF. Atrial fibrosis and scar, indeed, are an important substrate involved in persistent AF, and some author correlate them to an increased rate of recurrences after CA. For this reason several adjunctive ablation strategies have been suggested for invasive treatment in PER AF pts. However, there is a lack of evidence on their effectivness in current literature.
Objective
the aim of our study was to assess the rate of AF recurrences in PAR and PER AF patients after a first pulmonary vein isolation (IVP) procedure, and their relationship with low voltage areas of the left atrium assessed by means of high density mapping performed before CA.
Methods
we analyzed 214 patients of the SMOP-AF study (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric registry enrolling patients with both PAR and PER AF undergoing a first radio-frequency CA procedure aimed to obtain permanent PVI . High-density mapping was performed in sinus rhythm using the CARTO system before PVI. Areas with less than 0,5 mV on mapping were defined as low voltage zone (LVZ); LVZ was indexed on the atrial area. Comparisons were made by cross-tables and Chi-square test or Student T test.
Results
Patients with PER AF (n = 44, 21%) were older (63 ± 9 vs 58 ± 10 yrs, p = 0.01), but notably with no difference in LVEF and atrial dimensions as compared to pts with PAR AF. In addition no statistical difference was observed in procedural variables, except for a greater LVZ area on atrial mapping (8 ± 18 % vs. 5 ± 15 %, p = 0.04) and a longer p wave duration (115 ± 21 msec vs. 103 ± 18 msec, p = 0.01) in pts with PER AF. The incidence of recurrence in the overall population was 15.3% at 3 months and 13.7% from 3 to 12 months: there was no statistical difference in success-rate between PER and PAR pts (respectively 79,5% vs 86% p value = 0.315 in blanking period and 85,3% vs 86,5% p value = 0.8 at 3-12 months follow-up). No statistical difference was observed for ablation variables (number of lesion, contact force, force time integral) in pts with vs. without recurrences.
Conclusion
Our study showed that pulmonary vein isolation alone seems to be as effective in paroxismal and persistent AF patients with low degree of left atrial fibrosis. Our data call into question the idea that PVI alone is not effective in PER AF. High density mapping of the LA could help to identify a subset of PER AF patients with a limited extension of low voltage areas (i.e around 10% of the overall LA surface) that could benefit from PVI without adjunctive ablation strategies. Our data needs to be confirmed in a longer follow-up.
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Affiliation(s)
- L Frigerio
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - A Sanzo
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - S Cornara
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - E Chieffo
- Maggiore Hospital of Crema, Cardiology, Crema, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - G Sirico
- S. Ambrogio Clinic, Cardiology, Milan, Italy
| | - A Scopinaro
- Ospedale SS. Antonio E Biagio E Cesare Arrigo, Cardiology, Alessandria, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Cardiology, Mercogliano, Italy
| | - L Fedele
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
| | - G Augello
- Città Studi Clinic, Cardiology, Milan, Italy
| | - N Marrazzo
- Fatebenefratelli Hospital of Benevento, Cardiology, Benevento, Italy
| | - F Turreni
- S.Pertini Hospital, Cardiology, Roma, Italy
| | - M Tritto
- Mater Domini Clinic, Cardiology, Castellanza, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
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Baruch Y, Nale R, Parma M, Di Fatta S, Fedele L, Candiani M, Salvatore S. Lower urinary tract symptoms in patients with Mayer-Rokitansky-Kuster-Hauser syndrome after neo-vagina creation by Davydov's procedure. Int Urogynecol J 2020; 31:2529-2533. [PMID: 32377800 DOI: 10.1007/s00192-020-04311-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) in subjects with Mayer-Rokitansky-Küster-Hauser syndrome treated by Davydov's laparoscopic neo-vaginoplasty were measured. METHODS Davydov's laparoscopic neo-vaginoplasty was undertaken at the Department of Obstetrics/gynecology, San Raffaele Hospital, Milan, Italy, from November 2015 to July 2017, by two highly qualified surgeons. All women completed the ICIQ-UI Short Form questionnaire before and after treatment. LUTS were scored at recruitment, hospitalization, and 1, 3, 6 and 12 months after surgery. RESULTS Twenty-one women (mean age 21 years ± 5.9) were operated on with no major complications. Mean surgery duration was 79 min (± 55 min). Before the operation, one patient (1/21; 4.8%) reported occasional urinary loss that persisted after surgery and throughout 12 months of follow-up. After the operation, one patient (1/21; 4.8%) had urinary retention, requiring self-catheterization for 2 weeks. One month after surgery, stress incontinence was recorded in one case (1/19; 5.2%) and urge incontinence in two cases (2/19; 10.5%). At 3-month follow-up, these three patients were free of symptoms. CONCLUSION The rate of LUTS is lower than that reported by others using alternative surgical procedures. To the best of our knowledge, this is the first report validating LUTS after Davydov's neo-vaginoplasty.
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Affiliation(s)
- Yoav Baruch
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy.
| | - Roberta Nale
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Marta Parma
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Simona Di Fatta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
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Rordorf R, Cornara S, Frigerio L, Sanzo A, Chieffo E, La Greca C, Sirico G, Scopinaro A, Solimene F, Fedele L, Augello G, Marrazzo N, Turreni F, Tritto M. P1896Single-procedure success-rate of pulmonary vein isolation using point-by-point tagging lesions algorithm based on contact force technology: preliminary results of the multicentric SMOP study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary veins isolation (PVI)is an effective therapy for atrial fibrillation (AF), recommended by current guidelines. However, recurrences after first radio-frequency (RF) catheter ablation (CA) are still high. PV reconnection could be due to ineffective transmural lesions; automated ablation lesion tags (the VisiTag algorithm) based on predefined parameters of catheter stability and contact force (CF) have been developed to allow the detection of ineffective ablation lesion, nevertheless there is a lack of multicenter studies exploring this technology.
Objective
the aim of our study was to assess the rate of recurrence after a first PVI procedure in a large, multicentric Italian population and to explore the efficacy of Visitag algorithm (CARTO 3) used to guide RF ablation of AF.
Methods
we analyzed 214 patients of the SMOP-AF study (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric study enrolling patients with paroxysmal and persistent AF undergoing a first PVI procedure after an high-density mapping during sinus rhythm. During the procedure, ablation was guided by an automated annotation system in which tag based on predefined parameters were displayed real-time in each lesion site on the electroanatomical map. Visitag settings for the catheter position stability were a 2,5 mm distance limit for at least 7 sec and a minimum CF of 5 g over 30% of the ablation and a FTI>400 g*s. Where available (n=106, 49.5%), Ablation Index (AI), which also incorporates information on delivered RF power, was used instead of FTI to guide RF ablation with a threshold range of 400–550 for anterior/roof and 330–420 for posterior/inferior segments. Minimum and mean contact force, time and power values for each RF-lesion were recorded while both FTI and AI values were calculated automatically by the CARTO system. Comparison between groups were made by cross-tables, Mann-Whitney or Student T test as appropriated.
Results
the mean age of the enrolled population was 59±9 years, left ventricular ejection fraction was 59±9%. AF was paroxysmal in 89.7%, persistent in 10.3% of the patients and refractory to at least one anti-arrhythmic drug in 86.4% of the population. At 3 months follow-up 85% of the patients were free from AF recurrences and the success rate increased to 90.8% at 3–6 months, and 86.3% at 3–12 months follow-up. The mean ablation time was shorter in AI-guided vs. FTI-guided procedures (31±9 vs 46±29 min; p<0.001). There was a trend toward a reduction in AF recurrences when AI vs. FTI was used, both at 6 and 12 months (respectively 5,4% vs 13.6%; p 0.06 and 9.6% vs 18.5%; p 0.08).
Conclusion
PVI isolation using dedicated algorithms developed to guide the effectiveness of RFCA leads to a very high success-rate after a single procedure. The use of AI, which integrates contact force information with delivered power, reduces the procedural time and increases the overall success-rate
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Affiliation(s)
- R Rordorf
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - L Frigerio
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - E Chieffo
- Maggiore Hospital of Crema, Cardiology, Crema, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - G Sirico
- Sant'Ambrogio Clinical Institute, Cardiology, Milan, Italy
| | - A Scopinaro
- Ospedale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Cardiology, Mercogliano, Italy
| | - L Fedele
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
| | - G Augello
- Istituto Clinico Città Studi, Cardiology, Milan, Italy
| | - N Marrazzo
- Fatebenefratelli Hospital of Benevento, Cardiology, Benevento, Italy
| | - F Turreni
- Ospedale S. Pertini, Cardiology, Rome, Italy
| | - M Tritto
- Clinical Institute Humanitas of Castellanza, Cardiology, Castellanza, Italy
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12
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Crovetto F, Cesano N, Rossi F, Acerboni S, Marinis SDE, Basso A, Martinez Portilla RJ, Acaia B, Fedele L, Ferrazzi E, Persico N. Intrapartum prediction of emergency delivery due to non-reassuring fetal status at 40 weeks' gestation in low-risk pregnancies: contribution of Doppler parameters, maternal history, and intrapartum clinical characteristics. J Matern Fetal Neonatal Med 2019; 34:2816-2824. [PMID: 31570021 DOI: 10.1080/14767058.2019.1671338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies. METHODS This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks' gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). RESULTS From 403 included pregnancies, 18.6% (n = 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 versus 1.30; p < .001, and 1.61 versus 1.78; p = .001, respectively). There was a higher incidence of small-for-gestational-age neonates (20 versus 10.1%; p = .017), lower Apgar scores at the 5th minute (9.7 versus 9.9; p = .006), and NICU admissions (9 versus 3%; p = .016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p = .008). CONCLUSIONS In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.
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Affiliation(s)
- Francesca Crovetto
- BC Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Nicola Cesano
- Università Degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Rossi
- Università Degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Acerboni
- Department of Obstetrics and Gynecology, Istituti Clinici Humanitas-S.Pio X, Humanitas University, Milan, Italy
| | | | - Annachiara Basso
- BC Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Department of Obstetrics and Gynecology, School of Medicine, Azienda Ospedaliera Universitaria Policlinico di Bari, Università Degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Raigam Jafet Martinez Portilla
- BC Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Barbara Acaia
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Fedele
- Università Degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Università Degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Persico
- Università Degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Rordorf R, Cornara S, Frigerio L, Sanzo A, Chieffo E, La Greca C, Sirico G, Scopinaro A, Solimene F, Fedele L, Augello G, Marrazzo N, Turreni F, Tritto M. P1037Relationship between left atrium low voltage areas and atrial fibrillation radiofrequency ablation success-rate: preliminary results of the SMOP study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
radio frequency catheter ablation (CA) is an effective therapy for atrial fibrillation (AF). Some authors have described a potential relationship between the presence of areas of fibrosis in the left atrium (LA) and the success of CA, nevertheless there is a lack of multicenter studies in this field.
Objective
the aim of our study was to assess the relationship between the of presence of low voltage areas of the LA detected during subtrate mapping at the time of the procedure and recurrences of AF after CA.
Methods
we analyzed 214 patients of the SMOP-AF (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric study enrolling patients with both paroxysmal and persistent AF undergoing a first radio-frequency CA procedure. High-density mapping was performed in sinus rhythm using the CARTO system before performing pulmonary vein isolation. Areas with less than 0,5 mV on mapping were defined as low voltage zone (LVZ), while between 0,5 mV and 1,5 mV intermediate voltage zone (IVZ). IVZ and LVZ were expressed as a percentage of the LA surface. Comparisons were made by Pearson correlation, cross-tables and Chi-square test or Student T test.
Results
the mean age of the enrolled population was 59±9 years, left ventricular ejection fraction was 59±9%, 86.4% of the pts had tested at least one anti-arrhythmic drug. Persistent atrial fibrillation was present in 10.3% of patients. The rate of documented AF recurrence at 3 months was 15,3% (n=29). There was a statistical significant correlation between the presence of IVZ and the rate of recurrences at 3 months (r=0.16, p value 0.03). Patients with IVZ greater than 4% of the left atrium surface showed a higher risk of recurrences (19.5% vs. 8,7%, p value 0.04). No statistical difference was observed in other procedural variables (number of lesions, contact force, force-time integral) among patients with or without recurrences.
Conclusion
Our study showed a relationship between CA short-term success rate and the presence of areas of intermediate voltage zone detected with high-density substrate mapping at the time of the procedure. The presence of areas of intermediate voltage zone greater than 4% of the LA determines a 2.5 folds increased risk of short-term recurrence. Our data needs to be confirmed in a longer follow-up.
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Affiliation(s)
- R Rordorf
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - L Frigerio
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - E Chieffo
- Maggiore Hospital of Crema, Cardiology, Crema, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - G Sirico
- Sant'Ambrogio Clinical Institute, Cardiology, Milan, Italy
| | - A Scopinaro
- Ospedale SS. Antonio e Biagio e Cesare Arrigo, Cardiology, Alessandria, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Cardiology, Mercogliano, Italy
| | - L Fedele
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
| | - G Augello
- Istituto Clinico Città Studi, Cardiology, Milan, Italy
| | - N Marrazzo
- Fatebenefratelli Hospital of Benevento, Cardiology, Benevento, Italy
| | - F Turreni
- Ospedale S. Pertini, Cardiology, Rome, Italy
| | - M Tritto
- Clinical Institute Humanitas of Castellanza, Cardiology, Castellanza, Italy
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14
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonin C, Busacca M, Candiani M, Centini G, D’Alterio MN, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Raimondo D, Remorgida V, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Venturella R, Vercellini P, Viganó P, Vignali M, Zullo F, Zupi E. When more is not better: 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod Open 2019; 2019:hoz009. [PMID: 31206037 PMCID: PMC6560357 DOI: 10.1093/hropen/hoz009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.
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Candiani M, Vanni VS, Papaleo E, Delprato D, Tandoi I, Gervasio V, Parma M, Corti L, Girardelli S, Fedele L. Oocyte Retrieval during Laparoscopic Vaginoplasty to Reduce Invasiveness in the Treatment of Mayer-Rokitansky-Küster-Hauser Syndrome. J Minim Invasive Gynecol 2019; 27:74-79. [PMID: 31129299 DOI: 10.1016/j.jmig.2019.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To evaluate the treatment of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a combination of oocyte retrieval and surgical vaginoplasty in a single laparoscopic procedure. DESIGN A case series. SETTING The study was conducted at 2 tertiary referral facilities for MRKH syndrome in Milan, Italy, between July 2017 and September 2018. PATIENTS Eleven patients presented with MRKH and required surgical vaginoplasty while expressing a desire for future fertility. INTERVENTIONS Two experienced surgeons and an expert in assisted reproductive technology performed concomitant vaginoplasty according to the modified technique of Davydov and laparoscopic oocyte retrieval for gamete cryopreservation. MEASUREMENTS AND MAIN RESULTS Before the procedure, patients underwent extensive counseling and gave written consent. At the start of surgery, 10.4 ± 4.4 (mean ± standard deviation [SD]) oocytes were retrieved laparoscopically, and 8.8 ± 3.1 (SD) mean mature oocytes were cryopreserved. After oocyte retrieval, the steps of the modified Davydov technique were followed. The total operative time was 116 ± 16 minutes (mean ± SD), and no intraoperative/postoperative complications were observed. CONCLUSION This is the first report of combined oocyte retrieval and vaginoplasty for patients with MRKH syndrome. The approach was found to be feasible in patients with a desire for future fertility. It is our belief that physicians treating patients with MRKH should refer patients to centers with expertise in both vaginoplasty and assisted reproductive technology.
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Affiliation(s)
- Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria S Vanni
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Enrico Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti).
| | - Diana Delprato
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Iacopo Tandoi
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria Gervasio
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Marta Parma
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Laura Corti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Serena Girardelli
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Luigi Fedele
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr. Fedele)
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16
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Busnelli A, Dallagiovanna C, Reschini M, Paffoni A, Fedele L, Somigliana E. Risk factors for monozygotic twinning after in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2019; 111:302-317. [PMID: 30691632 DOI: 10.1016/j.fertnstert.2018.10.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To establish the risk factors for monozygotic twin (MZT) and monochorionic twin (MCT) pregnancies after in vitro fertilization (IVF). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Women who achieved MZT and non-MZT pregnancies through IVF. INTERVENTION(S) Systematic search of Medline from January 1995 to October 2018 with cross-checking of references from relevant articles in English. MAIN OUTCOME MEASURE(S) Possible risk factors for MZT or MCT pregnancies after IVF, comprising extended embryo culture, insemination method (conventional IVF and intracytoplasmic sperm injection [ICSI]), embryo biopsy for preimplantation genetic testing for aneuploidies or for monogenic/single-gene defects (PGT-A or PGT-M) programs, assisted hatching (AH), oocytes donation, female age, and embryo cryopreservation. RESULT(S) A total of 40 studies were included. Blastocyst transfer compared with cleavage-stage embryo transfer, and female age <35 years were associated with a statistically significant increase in the MZT and MCT pregnancy rate after IVF: (23 studies, OR 2.16, 95% CI, 1.74-2.68, I2=78%; 4 studies, OR 1.29; 95% CI, 1.03-1.62, I2=62%; and 3 studies, OR 1.90, 95% CI, 1.21-2.98, I2=59%; 2 studies, OR 2.34; 95% CI, 1.69-3.23, I2=0, respectively). Conventional IVF compared with ICSI and assisted hatching were associated with a statistically significantly increased risk of MZT pregnancy (9 studies, OR 1.19, 95% CI, 1.04-1.35, I2=0; 16 studies, OR 1.17, 95% CI, 1.09-1.27, I2=29%, respectively). Embryo biopsy for PGT-A or PGT-M, embryo cryopreservation, and oocytes donation were not associated with MZT pregnancies after IVF. CONCLUSION(S) Blastocyst transfer is associated with an increased risk of both MZT and MCT pregnancies after IVF. Further evidence is needed to clarify the impact of female age, insemination method and AH on the investigated outcomes.
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Affiliation(s)
- Andrea Busnelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Chiara Dallagiovanna
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Reschini
- Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Paffoni
- ART Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Luigi Fedele
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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17
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonanni V, Bonin C, Buggio L, Candiani M, Centini G, D'Alterio MN, De Stefano F, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Geraci E, Lavarini E, Lazzeri L, Luisi S, Maiorana A, Makieva S, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Pagliardini L, Perandini A, Perelli F, Pino I, Porpora MG, Remorgida V, Scagnelli G, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Ticino A, Venturella R, Viganò P, Vignali M, Zullo F, Zupi E. Endometriosis: seeking optimal management in women approaching menopause. Climacteric 2019; 22:329-338. [PMID: 30628469 DOI: 10.1080/13697137.2018.1549213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.
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Affiliation(s)
- L Alio
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Angioni
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - S Arena
- c Department of Obstetrics and Gynecology , Azienda Ospedaliera Perugia , Perugia , Italy
| | - L Bartiromo
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - V Bergamini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - N Berlanda
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - V Bonanni
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - C Bonin
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Buggio
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M Candiani
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - G Centini
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - M N D'Alterio
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - F De Stefano
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Di Cello
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - C Exacoustos
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - L Fedele
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M P Frattaruolo
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - E Geraci
- l Department of Obstetrics and Gynecology , Asola Hospital , Mantova , Italy
| | - E Lavarini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Lazzeri
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - S Luisi
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - A Maiorana
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Makieva
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - F Maneschi
- n Department of Obstetrics and Gynecology , San Giovanni Addolorata Hospital , Roma , Italy
| | - F Martire
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - C Massarotti
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - A Mattei
- q Department of Minimally Invasive Gynaecological Surgery , Centre Tuscany USL , Florence , Italy
| | - L Muzii
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - J Ottolina
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Pagliardini
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Perandini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - F Perelli
- r Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynaecology , University of Florence , Florence , Italy
| | - I Pino
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - M G Porpora
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - V Remorgida
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - G Scagnelli
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - R Seracchioli
- t Gynecology and Physiopathology of Human Reproductive Unit , University of Bologna, S. Orsola-Malpighi Hospital of Bologna , Bologna , Italy
| | - E Solima
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - E Somigliana
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - G Sorrenti
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - A Ticino
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - R Venturella
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - P Viganò
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M Vignali
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - F Zullo
- u Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy
| | - E Zupi
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
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18
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Cossellu G, Fedele L, Badaoui B, Angiero F, Farronato G, Monti E, Liverani CA, Gorni C, Botti S. Prevalence and concordance of oral and genital HPV in women positive for cervical HPV infection and in their sexual stable partners: An Italian screening study. PLoS One 2018; 13:e0205574. [PMID: 30335788 PMCID: PMC6193646 DOI: 10.1371/journal.pone.0205574] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/27/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed to evaluate the prevalence and type of oral HPV-infection in women with a cervical HPV-lesion and in the oral and genital mucosa of their male partners. METHODS The study group comprised 44 sexually-active women, 20-45 years with abnormal PAP smear, not more than 6 months prior to referral together with the male partners cohabiting in stable partnerships. A detailed questionnaire was administered concerning the HPV-related risk factors. Oral swabs, oral rinses, cervical swabs and urine samples were collected. HPV DNA was detected using two different polymerase chain reactions (PCRs): MY09-11 and FAP59-64. Positive samples were genotyped by Sanger sequencing and the INNO-LiPA HPV Genotyping Extra II probe assay. The association with risk factors was assessed by fitting a generalized model, using the General Linear Model function in the R-software; correlations were calculated between all data. RESULTS HPV was detected in 84% of Cervical Samples, in 24.3% of oral samples and in one urine sample. Only 27% of the HPV-positive results were identical with both PCR DNA assays. 8 male had oral HPV-positive samples different from women cervical samples. In one couple the urine-male sample had the same HPV present in the female-cervical sample. A significant association resulted between women/oral sex practices and men/n. of partners. CONCLUSIONS This study reports that women (20.4%) with a diagnosis of cervical-HPV and their male partners (30,7%) are at high risk for subclinical oral HPV infection.
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Affiliation(s)
- Gianguido Cossellu
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Luigi Fedele
- Dipartimento Donna - Bambino - Neonato, Centro di riferimento per la prevenzione, la diagnosi e la cura della patologia genitale HPV correlate, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Bouabid Badaoui
- Laboratory of Biodiversity, Ecology and Genome; Mohamed V University, Rabat, Maroc
| | - Francesca Angiero
- Department of Medical Sciences and Diagnostic Integrated, S. Martino Hospital, University of Genoa, Italy
| | - Giampietro Farronato
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ermelinda Monti
- Dipartimento Donna - Bambino - Neonato, Centro di riferimento per la prevenzione, la diagnosi e la cura della patologia genitale HPV correlate, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Antonio Liverani
- Dipartimento Donna - Bambino - Neonato, Centro di riferimento per la prevenzione, la diagnosi e la cura della patologia genitale HPV correlate, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Gorni
- Parco Tecnologico Padano - CERSA, Integrative Biology Group, Lodi, Italy
| | - Sara Botti
- Parco Tecnologico Padano - CERSA, Integrative Biology Group, Lodi, Italy
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19
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Busnelli A, Lattuada D, Ferrari S, Reschini M, Colciaghi B, Somigliana E, Fedele L, Ferrazzi E. Mitochondrial DNA Copy Number in Peripheral Blood in the First Trimester of Pregnancy and Different Preeclampsia Clinical Phenotypes Development: A Pilot Study. Reprod Sci 2018; 26:1054-1061. [PMID: 30296910 DOI: 10.1177/1933719118804410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Inflammation and oxidative stress are intrinsically linked to early poor placentation, typical of pregnancies complicated by preeclampsia associated with intrauterine growth restriction (PE-IUGR). Low mitochondrial DNA copy number (mtDNAcn) in peripheral blood constitutes a good peripheral surrogate marker of inflammation and oxidative stress. On these basis, we explored a possible correlation between mtDNAcn in peripheral blood in the first trimester of pregnancy and the PE-IUGR onset. To shed light on this issue, we setup a nested case-control study from a prospective cohort of pregnant women undergoing first-trimester aneuploidies screening. Two groups of patients affected by PE classified according to the clinical phenotype were identified: (1) patients who developed PE-IUGR and (2) patients who developed PE associated with appropriate for gestational age intrauterine fetal growth (PE-AGAf). Controls were women with a physiologic pregnancy matched to cases on the basis of age (±6 months, ratio 2:1). Mitochondrial DNA copy number was quantified using real-time polymerase chain reaction and normalized to nuclear DNA. The median (interquartile range) mtDNAcn in peripheral blood in patients with PE-IUGR (n = 12) and in patients with PE-AGAf (n = 16) was 70 (44-97) and 108 (95-145), respectively (P = .004). Both these values were significantly lower than that detected in the control group (161[133-183], P < .001). The area under the receiver-operator curve for PE-IUGR and PE-AGAf were 0.94 (95% confidence interval [CI]: 0.88-1.00, P < .001) and 0.81 (95%CI: 0.70-0.91, P < .001), respectively. In conclusion, MtDNAcn in peripheral blood resulted significantly lower both in patients affected by PE-IUGR and in those affected by PE-AGAf when compared to controls. The accuracy of this biomarker resulted particularly good in predicting PE-IUGR.
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Affiliation(s)
- Andrea Busnelli
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Debora Lattuada
- 2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Ferrari
- 2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Reschini
- 2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Colciaghi
- 2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Fedele
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- 1 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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20
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Busnelli A, Lattuada D, Rossetti R, Paffoni A, Persani L, Fedele L, Somigliana E. Mitochondrial DNA copy number in peripheral blood: a potential non-invasive biomarker for female subfertility. J Assist Reprod Genet 2018; 35:1987-1994. [PMID: 30120634 DOI: 10.1007/s10815-018-1291-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Low mitochondrial DNA (mtDNA) content in oocytes and in cumulus cells is an indicator of poor oocyte quality. Moreover, initial evidence showed a correlation between mtDNA content in cumulus cells and mtDNA copy number in peripheral blood cells. On these bases, we deemed of interest investigating the correlation between mtDNA copy number in peripheral blood and natural fecundity. METHODS This is a nested case-control study drawn from a prospective cohort of pregnant women referred for routine first trimester screening for aneuploidies (from 11 + 0 to 12 + 6 weeks of gestation) between January 2012 and March 2013 at the "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico" of Milan, Italy. Cases were subfertile women who attempted to become pregnant for 12-24 months. Controls were the two subsequently age-matched women who became pregnant in less than 1 year. MtDNA was quantified using real-time PCR and normalized to nuclear DNA. RESULTS One hundred and four subfertile women and 208 controls were selected. The median (IQR) mtDNA copy number was 95 (73-124) and 145 (106-198), respectively (p < 0.001). The area under the ROC curve was 0.73 (95% CI 0.67-0.79) (p < 0.001). The Youden index was 105 mtDNA copy number. The crude OR for subfertility in women with mtDNA copy number below this threshold was 5.72 (95% CI 3.43-9.55). The accuracy of mtDNA copy number assessment in peripheral blood progressively decreased with increasing female age. CONCLUSIONS Low mtDNA copy number in peripheral blood is associated with an increased risk of subfertility and may represent a biomarker of natural fecundity.
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Affiliation(s)
- Andrea Busnelli
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Debora Lattuada
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Rossetti
- Division of Endocrine and Metabolic Diseases, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessio Paffoni
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Endocrine and Metabolic Diseases, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luigi Fedele
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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21
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Barbara G, Collini F, Cattaneo C, Marasciuolo L, Chiappa L, Fedele L, Kustermann A. Sexual violence and unwanted pregnancies in migrant women. Lancet Glob Health 2018; 5:e396-e397. [PMID: 28288742 DOI: 10.1016/s2214-109x(17)30075-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Giussy Barbara
- Department of Obstetrics and Gynecology, Milan 20122, Italy; Service for Sexual and Domestic Violence, Milan 20122, Italy.
| | - Federica Collini
- Department of Obstetrics and Gynecology, Milan 20122, Italy; Service for Sexual and Domestic Violence, Milan 20122, Italy; Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Cristina Cattaneo
- Department of Obstetrics and Gynecology, Milan 20122, Italy; Service for Sexual and Domestic Violence, Milan 20122, Italy; Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Laura Marasciuolo
- Department of Obstetrics and Gynecology, Milan 20122, Italy; Service for Sexual and Domestic Violence, Milan 20122, Italy; Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Laura Chiappa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Luigi Fedele
- Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology, Milan 20122, Italy; Service for Sexual and Domestic Violence, Milan 20122, Italy
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22
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Fedele L, Marchini M, Baglioni A, Arcaini L, Zamberletti D, Carinelli SG. Dental Elements in Mature Teratomas of the Ovary: Scanning Electron Microscope Ultrastructure. Tumori 2018; 75:76-8. [PMID: 2711481 DOI: 10.1177/030089168907500120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seventy-two teeth from 10 ovarian mature teratomas and 12 unerupted and erupted teeth from subjects aged 8 to 21 years were examined at the scanning electron microscope to evaluate the morphologic and histogenetic differences. The ultrastructure of the teratomatous teeth was similar to that of the corresponding orthotopic tissues. Despite this similarity the morphology of the teratomatous teeth was much less well defined, attesting to the inductive effect of the contiguous tissues that are normally present in the oral cavity.
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Affiliation(s)
- L Fedele
- 1st Department Obstetrics and Gynecology, University of Milan, Italy
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23
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Restaino OF, Borzacchiello MG, Scognamiglio I, Fedele L, Alfano A, Porzio E, Manco G, De Rosa M, Schiraldi C. High yield production and purification of two recombinant thermostable phosphotriesterase-like lactonases from Sulfolobus acidocaldarius and Sulfolobus solfataricus useful as bioremediation tools and bioscavengers. BMC Biotechnol 2018; 18:18. [PMID: 29558934 PMCID: PMC5861644 DOI: 10.1186/s12896-018-0427-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/09/2018] [Indexed: 02/01/2023] Open
Abstract
Background Thermostable phosphotriesterase-like lactonases (PLLs) are able to degrade organophosphates and could be potentially employed as bioremediation tools and bioscavengers. But nowadays their manufacturing in high yields is still an issue that limits their industrial applications. In this work we aimed to set up a high yield production and purification biotechnological process of two recombinant PLLs expressed in E. coli, the wild type SacPox from Sulfolobus acidocaldarius and a triple mutated SsoPox C258L/I261F/W263A, originally from Sulfolobus solfataricus. To follow this aim new induction approaches were investigated to boost the enzyme production, high cell density fermentation strategies were set-up to reach higher and higher enzyme yields up to 22-L scale, a downstream train was studied to meet the requirements of an efficient industrial purification process. Results Physiological studies in shake flasks demonstrated that the use of galactose as inducer increased the enzyme concentrations up to 4.5 folds, compared to the production obtained by induction with IPTG. Optimising high cell density fed-batch strategies the production and the productivity of both enzymes were further enhanced of 26 folds, up to 2300 U·L− 1 and 47.1 U·L− 1·h− 1 for SacPox and to 8700 U·L− 1 and 180.6 U·L− 1·h− 1 for SsoPox C258L/I261F/W263A, and the fermentation processes resulted scalable from 2.5 to 22.0 L. After being produced and extracted from the cells, the enzymes were first purified by a thermo-precipitation step, whose conditions were optimised by response surface methodology. A following ultra-filtration process on 100 and 5 KDa cut-off membranes drove to a final pureness and a total recovery of both enzymes of 70.0 ± 2.0%, suitable for industrial applications. Conclusions In this paper, for the first time, a high yield biotechnological manufacturing process of the recombinant enzymes SacPox and SsoPox C258L/I261F/W263A was set-up. The enzyme production was boosted by combining a new galactose induction approach with high cell density fed-batch fermentation strategies. An efficient enzyme purification protocol was designed coupling a thermo-precipitation step with a following membrane-based ultra-filtration process. Electronic supplementary material The online version of this article (10.1186/s12896-018-0427-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Odile Francesca Restaino
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy.
| | - Maria Giovanna Borzacchiello
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
| | - Ilaria Scognamiglio
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
| | - Luigi Fedele
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
| | - Alberto Alfano
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
| | - Elena Porzio
- Institute of Protein Biochemistry, National Research Council of Italy, Naples, Italy
| | - Giuseppe Manco
- Institute of Protein Biochemistry, National Research Council of Italy, Naples, Italy
| | - Mario De Rosa
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
| | - Chiara Schiraldi
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, University of Campania "Luigi Vanvitelli"-ex Second University of Naples, Naples, Italy
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Brunini F, Zaina B, Gianfreda D, Ossola W, Giani M, Fedele L, Messa P, Moroni G. Alport syndrome and pregnancy: a case series and literature review. Arch Gynecol Obstet 2018; 297:1421-1431. [PMID: 29492669 DOI: 10.1007/s00404-018-4720-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/12/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess pregnancy outcome in women with Alport syndrome and the impact of pregnancy on the disease progression. METHODS We describe one of the largest series of pregnancies in Alport syndrome. Seven pregnancies of six women were monitored by a multidisciplinary team of nephrologists and gynecologists. After delivery, patients were followed for at least 3 years. We compare our results with those in the literature. RESULTS Pregnancy course was uneventful in the patient with isolated microscopic hematuria. In the other cases, all presenting mild proteinuria at conception, some complications occurred. Proteinuria worsened during the last trimester, reaching nephrotic ranges in five out of six pregnancies and was associated with fluid overload leading to hospitalizations and early delivery. The majority of the newborns had a low birth weight. The two patients with arterial hypertension at conception and twin pregnancy developed pre-eclampsia and renal function deterioration persisted after delivery. The one with pre-pregnancy renal dysfunction reached end-stage renal disease. In the other patients, in which renal function and blood pressure were and remained normal, proteinuria improved after delivery and no signs of disease progression were recorded at last observation. CONCLUSIONS Our observations suggest that Alport syndrome should be considered a potential risk factor for pregnancy in proteinuric patients due to the development of pre-eclampsia, renal function deterioration, and/or full-blown nephrotic syndrome that results in anasarca, slowing of fetal growth and pre-term delivery. Thus, all women with Alport syndrome should receive pre-conceptional counseling and be kept in close follow-up during pregnancy.
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Affiliation(s)
- Francesca Brunini
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Barbara Zaina
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Gianfreda
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Wally Ossola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marisa Giani
- Pediatric Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Moroni
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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25
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Persico N, D'Ambrosi F, Fabietti I, Boito S, Aiello E, Bulfoni A, Ciralli F, Kustermann A, Mosca F, Fedele L. Fetal Doppler changes 1 week after endoscopic equatorial laser for twin-to-twin transfusion syndrome: A longitudinal study. Prenat Diagn 2018; 38:344-348. [PMID: 29436718 DOI: 10.1002/pd.5234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/27/2017] [Accepted: 02/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate sequential Doppler changes in donors and recipients before and 1 week after endoscopic laser for twin-to-twin transfusion syndrome (TTTS) and to examine factors that may be associated with such changes. METHODS In TTTS pregnancies undergoing laser treatment, we examined fetal Doppler changes before and 1 week postintervention. Intrauterine death rates and preoperative factors were analyzed in relation to Doppler changes. RESULTS Among 129 (85.4%) donors surviving at 1 week after laser, there was normalization of umbilical artery flow in 26 (72.2%) of 36 cases with preoperative abnormal Dopplers. In the remaining 10 (27.8%) fetuses, abnormal findings persisted. The rate of later intrauterine death was significantly higher in the latter group (6 of 10, 60.0%) compared with fetuses in which Doppler findings normalized (4 of 26, 15.4%; P < .05), with no difference in the rate of severe donor growth restriction between the 2 groups (80.0% vs 65.4%, respectively; P = .688). CONCLUSIONS In about 70% of TTTS donors with preoperative abnormal umbilical artery Doppler, there was normalization 1 week after endoscopic laser. The incidence of fetal growth restriction was not significantly different in donors with persistence of Doppler abnormalities compared with those with normalized findings.
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Affiliation(s)
- Nicola Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Francesco D'Ambrosi
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Isabella Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Boito
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Aiello
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Fabrizio Ciralli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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Berlanda N, Bianchi S, Caroggio CF, Ciappina N, Bulfoni A, Fedele L. Laparoscopic tubal salvage in an adolescent girl with bilateral isolated tubal torsion. CLIN EXP OBSTET GYN 2018. [DOI: 10.12891/ceog4247.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Cabaleiro D, Colla L, Barison S, Lugo L, Fedele L, Bobbo S. Heat Transfer Capability of (Ethylene Glycol + Water)-Based Nanofluids Containing Graphene Nanoplatelets: Design and Thermophysical Profile. Nanoscale Res Lett 2017; 12:53. [PMID: 28102524 PMCID: PMC5247394 DOI: 10.1186/s11671-016-1806-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/17/2016] [Indexed: 05/04/2023]
Abstract
This research aims at studying the stability and thermophysical properties of nanofluids designed as dispersions of sulfonic acid-functionalized graphene nanoplatelets in an (ethylene glycol + water) mixture at (10:90)% mass ratio. Nanofluid preparation conditions were defined through a stability analysis based on zeta potential and dynamic light scattering (DLS) measurements. Thermal conductivity, dynamic viscosity, and density were experimentally measured in the temperature range from 283.15 to 343.15 K and nanoparticle mass concentrations of up to 0.50% by using a transient plate source, a rotational rheometer, and a vibrating-tube technique, respectively. Thermal conductivity enhancements reach up to 5% without a clear effect of temperature while rheological tests evidence a Newtonian behavior of the studied nanofluids. Different equations such as the Nan, Vogel-Fulcher-Tamman (VFT), or Maron-Pierce (MP) models were utilized to describe the temperature or nanoparticle concentration dependences of thermal conductivity and viscosity. Finally, different figures of merit based on the experimental values of thermophysical properties were also used to compare the heat transfer capability and pumping power between nanofluids and base fluid.
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Affiliation(s)
- D Cabaleiro
- Departamento de Física Aplicada, Facultade de Ciencias, Universidade de Vigo, E-36310, Vigo, Spain.
| | - L Colla
- Istituto per le Tecnologie della Costruzione, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - S Barison
- Istituto di Chimica della Materia Condensata e di Tecnologie per l'Energia, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - L Lugo
- Departamento de Física Aplicada, Facultade de Ciencias, Universidade de Vigo, E-36310, Vigo, Spain
| | - L Fedele
- Istituto per le Tecnologie della Costruzione, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - S Bobbo
- Istituto per le Tecnologie della Costruzione, Consiglio Nazionale delle Ricerche, Padova, Italy
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Crovetto F, Fumagalli M, De Carli A, Baffero GM, Nozza S, Dessimone F, Vergani P, Fedele L, Mosca F, Acaia B. Obstetric risk factors for poor neonatal adaptation at birth. J Matern Fetal Neonatal Med 2017. [PMID: 28629245 DOI: 10.1080/14767058.2017.1344635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth. MATERIAL AND METHODS Nested case-control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12 mmol/L, Apgar score at 1' ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression. RESULTS One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p ≤ .001, odds ratio (OR) 3.9 [95%CI: 2.3-6.8]), nulliparity (p ≤ .001, OR 3.3 [95%CI: 1.8-6]), complications during pregnancy (p = .032, OR 2.2 [95%CI: 1.1-4.4]), gestational age at delivery <37 weeks (p = .008, OR 5.2 [95%CI: 1.5-17.8]) and cardiotocography category II or III (p ≤ .001, OR 36.3 [95%CI: 16.5-80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87-0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively. CONCLUSIONS Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.
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Affiliation(s)
- Francesca Crovetto
- a Department of Obstetrics and Gynecology "L. Mangiagalli" , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy.,b Università degli Studi di Milano , Milan , Italy
| | - Monica Fumagalli
- c Department of Neonatology , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
| | - Agnese De Carli
- b Università degli Studi di Milano , Milan , Italy.,c Department of Neonatology , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
| | - Giulia Maria Baffero
- a Department of Obstetrics and Gynecology "L. Mangiagalli" , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy.,b Università degli Studi di Milano , Milan , Italy
| | - Silvia Nozza
- a Department of Obstetrics and Gynecology "L. Mangiagalli" , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy.,b Università degli Studi di Milano , Milan , Italy
| | - Francesca Dessimone
- b Università degli Studi di Milano , Milan , Italy.,c Department of Neonatology , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
| | - Patrizia Vergani
- d Department of Obstetrics and Gynecology , Università degli Studi di Milano-Bicocca, Fondazione MBBM , Monza , Italy
| | - Luigi Fedele
- a Department of Obstetrics and Gynecology "L. Mangiagalli" , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy.,b Università degli Studi di Milano , Milan , Italy
| | - Fabio Mosca
- b Università degli Studi di Milano , Milan , Italy.,c Department of Neonatology , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
| | - Barbara Acaia
- a Department of Obstetrics and Gynecology "L. Mangiagalli" , Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
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Persico N, Berrettini A, Fabietti I, Dallagiovanna C, Minoli D, Mosca F, Fedele L, Manzoni G. New minimally invasive technique for cystoscopic laser treatment of fetal ureterocele. Ultrasound Obstet Gynecol 2017; 50:124-127. [PMID: 27607564 DOI: 10.1002/uog.17296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/08/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end-stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5-mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3-mm uterine entry was used. In the second case, a new approach was adopted using an 'all-seeing needle' 1.6-mm endoscope. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - I Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Dallagiovanna
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Minoli
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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D'Ambrosi F, Crovetto F, Colosi E, Fabietti I, Carbone F, Tassis B, Motta S, Bulfoni A, Fedele L, Rossi G, Persico N. Maternal Subcutaneous and Visceral Adipose Ultrasound Thickness in Women with Gestational Diabetes Mellitus at 24-28 Weeks' Gestation. Fetal Diagn Ther 2017. [PMID: 28624818 DOI: 10.1159/000475988] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the sonographic measurement of maternal subcutaneous and visceral adipose thickness between pregnant women with gestational diabetes mellitus (GDM) and patients with nondiabetic pregnancies. METHODS Adipose thickness was measured by transabdominal ultrasound in pregnant women attending our antenatal clinics at 24-28 weeks' gestation. All patients underwent a 75-g oral glucose challenge as a diagnostic test for GDM. RESULTS The study population comprised 56 women with a positive glucose challenge test and 112 nondiabetic pregnancies. Measurements of subcutaneous and visceral adipose tissues were converted into multiples of the median (MoM), adjusted for gestational age. The mean subcutaneous thickness MoM in patients with GDM was significantly higher compared to nondiabetic pregnancies (1.31 vs. 1.07; p = 0.011). Similarly, the mean visceral thickness MoM was higher in women with a positive oral glucose tolerance test compared to controls (1.61 vs. 1.06; p < 0.001). Multivariate logistic regression analysis demonstrated that visceral adipose thickness, but not subcutaneous thickness, was significantly and independently associated with GDM (odds ratio 34.047, 95% confidence interval 9.489-122.166). CONCLUSIONS Sonographic thickness of maternal visceral adipose tissue at 24-28 weeks' gestation was higher in women with GDM compared to nondiabetic pregnancies, independently from other known risk factors associated with GDM.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Obstetrics and Gynecology "L. Mangiagalli," Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
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Restaino OF, Borzacchiello MG, Scognamiglio I, Porzio E, Manco G, Fedele L, Donatiello C, De Rosa M, Schiraldi C. Boosted large-scale production and purification of a thermostable archaeal phosphotriesterase-like lactonase for organophosphate decontamination. J Ind Microbiol Biotechnol 2017; 44:363-375. [PMID: 28074318 DOI: 10.1007/s10295-016-1892-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Thermostable phosphotriesterase-like lactonases (PLLs) from extremophile archaea, like SsoPox from Sulfolobus solfataricus, are attractive biotechnological tools with industrial applications as organophosphate decontaminants, but their manufacturing still remains an unresolved issue because of the high costs and the low production yields. In this paper, for the first time, an efficient biotechnological process for the production and purification of a recombinant, engineered PLL, SsoPox W263F, expressed in E. coli, has been set up by studying new induction strategies, by designing high cell density cultivations and a new membrane-based downstream process. In fed batches, the enzyme production was boosted of 69-fold up to 4660.0 U L-1 using galactose as inducer in the replacement of IPTG; the process was scalable from 2.5 up to 150 L. By coupling a single thermo-precipitation step and an ultrafiltration process, a total enzyme recovery of 77% with a purity grade of almost 80% was reached.
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Affiliation(s)
- Odile Francesca Restaino
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy.
| | - Maria Giovanna Borzacchiello
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy
| | - Ilaria Scognamiglio
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy
| | - Elena Porzio
- Institute of Protein Biochemistry, National Research Council of Italy, Naples, Italy
| | - Giuseppe Manco
- Institute of Protein Biochemistry, National Research Council of Italy, Naples, Italy
| | - Luigi Fedele
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy
| | - Cinzia Donatiello
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy
| | - Mario De Rosa
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy
| | - Chiara Schiraldi
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples, Naples, Italy.
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Molloy JK, Jarjayes O, Philouze C, Fedele L, Imbert D, Thomas F. A redox active switch for lanthanide luminescence in phenolate complexes. Chem Commun (Camb) 2017; 53:605-608. [DOI: 10.1039/c6cc07942c] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The reversible oxidation of coordinated phenolates into phenoxyl radicals results in a dramatic quenching (>95%) of the luminescence of the f metal ion.
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Affiliation(s)
- J. K. Molloy
- Département de Chimie Moléculaire
- Chimie Inorganique Redox (CIRE)
- UMR CNRS 5250
- Université Grenoble-Alpes
- 38041 Grenoble Cedex 9
| | - O. Jarjayes
- Département de Chimie Moléculaire
- Chimie Inorganique Redox (CIRE)
- UMR CNRS 5250
- Université Grenoble-Alpes
- 38041 Grenoble Cedex 9
| | - C. Philouze
- Département de Chimie Moléculaire
- Chimie Inorganique Redox (CIRE)
- UMR CNRS 5250
- Université Grenoble-Alpes
- 38041 Grenoble Cedex 9
| | - L. Fedele
- Laboratoire de Reconnaissance Ionique et Chimie de Coordination SCIB
- UMR-E3 CEA-UJF
- INAC, CEA-Grenoble
- 38054 Grenoble Cedex 09
- France
| | - D. Imbert
- Laboratoire de Reconnaissance Ionique et Chimie de Coordination SCIB
- UMR-E3 CEA-UJF
- INAC, CEA-Grenoble
- 38054 Grenoble Cedex 09
- France
| | - F. Thomas
- Département de Chimie Moléculaire
- Chimie Inorganique Redox (CIRE)
- UMR CNRS 5250
- Université Grenoble-Alpes
- 38041 Grenoble Cedex 9
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Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Clin Genet 2016; 91:233-246. [PMID: 27716927 DOI: 10.1111/cge.12883] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/16/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian agenesis, is the second most common cause of primary amenorrhea. It is characterized by congenital absence of the uterus, cervix, and the upper part of the vagina in otherwise phenotypically normal 46,XX females. MRKH syndrome has an incidence of about 1 in 4,500-5,000 newborn females and it is generally divided into two subtypes: MRKH type 1, in which only the upper vagina, cervix and the uterus are affected, and MRKH type 2, which is associated with additional malformations generally affecting the renal and skeletal systems, and also includes MURCS (MÜllerian Renal Cervical Somite) characterized by cervico-thoracic defects. MRKH syndrome is mainly sporadic; however, familial cases have been described indicating that, at least in a subset of patients, MRKH may be an inherited disorder. The syndrome appears to demonstrate an autosomal dominant inheritance pattern, with incomplete penetrance and variable expressivity. The etiology of MRKH syndrome is still largely unknown, probably because of its intrinsic heterogeneity. Several candidate causative genes have been investigated, but to date only WNT4 has been associated with MRKH with hyperandrogenism. This review summarizes and discusses the clinical features and details progress to date in understanding the genetics of MRKH syndrome.
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Affiliation(s)
- L Fontana
- Department of Pathophysiology & Transplantation, Università degli Studi di Milano, Milano, Italy
| | - B Gentilin
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - C Gervasini
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - M Miozzo
- Department of Pathophysiology & Transplantation, Università degli Studi di Milano, Milano, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Busnelli A, Paffoni A, Fedele L, Somigliana E. The impact of thyroid autoimmunity on IVF/ICSI outcome: a systematic review and meta-analysis. Hum Reprod Update 2016; 22:793-794. [DOI: 10.1093/humupd/dmw034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Indexed: 11/14/2022] Open
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Busnelli A, Paffoni A, Fedele L, Somigliana E. Reply: The impact of thyroid autoimmunity on IVF/ICSI outcome: re-evaluation of the findings. Hum Reprod Update 2016; 22:792. [DOI: 10.1093/humupd/dmw032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Facchin F, Barbara G, Saita E, Mosconi P, Roberto A, Fedele L, Vercellini P. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol 2016; 36:135-41. [PMID: 26328618 DOI: 10.3109/0167482x.2015.1074173] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION No prior study of endometriosis has investigated the psychological impact of having asymptomatic endometriosis versus endometriosis with pelvic pain in a systematic way. This study aimed at examining the impact of endometriosis on quality of life, anxiety and depression by comparing asymptomatic endometriosis, endometriosis with pelvic pain, and healthy, pain-free controls. The psychological impact of different types of endometriosis pain was also tested. METHODS One hundred and ten patients with surgically diagnosed endometriosis (78 with pelvic pain and 32 without pain symptoms) and 61 healthy controls completed two psychometric tests assessing quality of life, anxiety and depression. Endometriosis participants indicated on a numerical rating scale the intensity of four types of pain (dysmenorrhea, dyspareunia, non-menstrual pelvic pain and dyschezia). RESULTS Endometriosis patients with pelvic pain had poorer quality of life and mental health as compared with those with asymptomatic endometriosis and the healthy controls. No significant differences were found between asymptomatic endometriosis and the control group. Dysmenorrhea had significant effects only on physical quality of life; non-menstrual pelvic pain affected all the variables; no significant effects were found for dyspareunia and dyschezia. CONCLUSIONS Pain significantly affects women's experience of endometriosis. The medical treatment of endometriosis with pain may not be sufficient and psychological intervention is recommended.
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Affiliation(s)
- Federica Facchin
- a Department of Psychology , Catholic University of Milan , Milan , Italy
| | - Giussy Barbara
- b Department of Obstetrics and Gynecology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milano , Italy , and
| | - Emanuela Saita
- a Department of Psychology , Catholic University of Milan , Milan , Italy
| | - Paola Mosconi
- c Department of Public Health , IRCCS - Istituto Mario Negri , Milano , Italy
| | - Anna Roberto
- c Department of Public Health , IRCCS - Istituto Mario Negri , Milano , Italy
| | - Luigi Fedele
- b Department of Obstetrics and Gynecology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milano , Italy , and
| | - Paolo Vercellini
- b Department of Obstetrics and Gynecology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milano , Italy , and
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Persico N, Fabietti I, Ciralli F, Gentilino V, D'Ambrosi F, Boito S, Ossola MW, Colnaghi M, Condò V, Macchini F, Leva E, Mosca F, Fedele L. Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience. Fetal Diagn Ther 2016; 41:215-219. [PMID: 27486655 DOI: 10.1159/000448096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO). METHODS Between 2012 and 2014, FETO was performed at our center in 21 cases of CDH considered to be severe based on sonographic measurement of observed/expected lung-to-head ratio (O/E LHR) and side of the defect. We reported pre- and postoperative ultrasound findings, procedure-related complications, pregnancy outcome and survival at 1-3 years of age. RESULTS The median gestational age (GA) at balloon insertion was 28.1 weeks (range 26.0-31.1) and the median GA at delivery 34.7 weeks (range 31.6-39.0); delivery before 32 and 34 weeks occurred in 2 (9.5%) and 7 (33.3%) cases, respectively. Postnatal survival at 1-3 years of age in the 17 cases with isolated unilateral CDH was 47.1%. The percentage difference between pre-balloon removal O/E LHR and pre-FETO O/E LHR was significantly higher in survivors compared to neonates who died (40.8 vs. 21.2%, respectively; p < 0.05). CONCLUSIONS In this study, FETO was associated with an infant survival of 47% in cases with isolated unilateral severe CDH. The post-FETO increase in O/E LHR was higher in fetuses that survived compared to those who died.
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Affiliation(s)
- Nicola Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Cossellu G, Persico N, D'Ambrosi F, Carbone F, Fabietti I, Boito S, Farronato G, Fedele L, Nicolaides KH. Sphenofrontal distance on three-dimensional ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks' gestation. Ultrasound Obstet Gynecol 2016; 48:177-180. [PMID: 26924522 DOI: 10.1002/uog.15897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the distance between the sphenoid and frontal bones on three-dimensional (3D) ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks' gestation. METHODS We acquired 3D volumes of the fetal profile from 80 normal and 30 trisomy-21 fetuses at 16-24 weeks' gestation. We used the multiplanar mode to obtain the mid-sagittal plane and measured the sphenofrontal distance as the shortest distance between the most anterior edge of the sphenoid bone and the lowest edge of the frontal bone. RESULTS In normal fetuses, the sphenofrontal distance increased linearly with gestational age, from 15.1 mm at 16 weeks to 18.2 mm at 24 weeks. In fetuses with trisomy 21, the mean sphenofrontal distance delta value was significantly smaller than in normal cases (-3.447 mm (95% CI, -5.684 to -1.211 mm); P < 0.01). The sphenofrontal distance was below the 5(th) and 1(st) percentiles of the normal range in 29 (96.7%) and 27 (90.0%) trisomy-21 fetuses, respectively. CONCLUSIONS The sphenofrontal distance is shorter at 16-24 weeks' gestation in fetuses with trisomy 21 than in normal fetuses. A reduction in the growth of the anterior cranial base contributes to the mid-facial hypoplasia observed in fetuses with trisomy 21. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G Cossellu
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F D'Ambrosi
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Carbone
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - I Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - S Boito
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Farronato
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Buschmann M, Colla L, Fedele L. Modelling mixed convection in laminar pipe flow. Int J CMEM 2016. [DOI: 10.2495/cmem-v4-n3-311-320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Restaino OF, Borzacchiello MG, Ilaria S, Fedele L, Schiraldi C. Biotechnological process design for the production and purification of three recombinant thermophilic phosphotriesterases. N Biotechnol 2016. [DOI: 10.1016/j.nbt.2016.06.776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boito S, Crovetto F, Ischia B, Crippa BL, Fabietti I, Bedeschi MF, Lalatta F, Colombo L, Mosca F, Fedele L, Persico N. Prenatal ultrasound factors and genetic disorders in pregnancies complicated by polyhydramnios. Prenat Diagn 2016; 36:726-30. [DOI: 10.1002/pd.4851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/17/2016] [Accepted: 05/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Simona Boito
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Francesca Crovetto
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
- Università degli Studi di Milano; Milan Italy
| | - Benedetta Ischia
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
- Università degli Studi di Milano; Milan Italy
| | - Beatrice Letizia Crippa
- Università degli Studi di Milano; Milan Italy
- Department of Neonatology; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Isabella Fabietti
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Maria Francesca Bedeschi
- Department of Clinical Genetics; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Faustina Lalatta
- Department of Clinical Genetics; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Lorenzo Colombo
- Department of Neonatology; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Fabio Mosca
- Università degli Studi di Milano; Milan Italy
- Department of Neonatology; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
- Università degli Studi di Milano; Milan Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’; Fondazione IRCCS ‘Ca' Granda’ - Ospedale Maggiore Policlinico; Milan Italy
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Busnelli A, Paffoni A, Fedele L, Somigliana E. The impact of thyroid autoimmunity on IVF/ICSI outcome: a systematic review and meta-analysis. Hum Reprod Update 2016; 22:775-790. [PMID: 27323769 DOI: 10.1093/humupd/dmw019] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 05/11/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Thyroid autoimmunity (TAI) is the most frequent autoimmune condition and the first cause of thyroid dysfunction among women of reproductive age. Notably, it has been associated with adverse obstetric outcomes during all trimesters of pregnancy. Furthermore, since most studies show an increased prevalence of TAI among women attending infertility clinics, a detrimental impact of this condition on natural fertility and on the rate of success of assisted reproductive techniques has been suggested. However, to date, the results have been inconsistent. OBJECTIVE AND RATIONALE The objective of this study was to define the relation between TAI per se and the outcome of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles. SEARCH METHODS A systematic literature review and meta-analysis were conducted. A Medline search was performed to identify all the comparative studies published from January 1990 to November 2015 in the English language literature on IVF/ICSI outcome in women with and without TAI, using combinations of the medical subject heading terms 'thyroid autoimmunity', 'thyroid autoantibodies', 'IVF', 'ICSI', 'pregnancy', 'miscarriage' and 'delivery'. The primary outcome was live birth rate (LBR). Our secondary outcomes were number of oocytes retrieved (NOR), fertilisation rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and miscarriage rate (MR). We also extracted data on mean age and basal serum concentrations of thyroid stimulating hormone (TSH) and performed a meta-regression analysis to assess the effect of these two covariates on CPR and MR. OUTCOMES We selected 12 studies for the meta-analysis. Six of the included studies were prospective cohort studies, and six were retrospective cohort studies. Compared with women with negative TAI, women with positive TAI had a lower LBR (odds ratio (OR) 0.73; 95% confidence interval (CI) [0.54-0.99]; P = 0.04; 9 studies; 4396 women; I2 = 41%), a higher MR (OR 1.44; 95% CI [1.06-1.95]; P = 0.02; 12 studies; 4876 women; I2 = 35%), a similar CPR (OR 0.90; 95% CI [0.77-1.06]; P = 0.22; 12 studies; 4876 women; I2 = 7%), a similar number of oocytes (standardized mean difference [SMD] 0.10; 95% CI [-0.09 to 0.29]; P = 0.28; 5 studies; 1506 women; I2 = 47%), a similar FR (OR 1.11; 95% CI [0.97-1.27]; P = 0.13; 3 studies; 1082 women; I2 = 0%) and a similar IR (OR 0.98; 95% CI [0.73-1.32]; P = 0.91; 2 studies; 918 women; I2 = 0%). Both mean age (SMD 0.96; 95% CI [0.66-1.27]; P < 0.00001; 9 studies; 3256 women; I2 = 85%) and serum TSH (SMD 0.24; 95% CI [0.15-0.34]; P < 0.00001; 6 studies; 2098 women; I2 = 59%) were higher in women with TAI. However, neither of these two covariates were significantly associated with CPR or MR. WIDER IMPLICATIONS TAI does not impact on IVF/ICSI outcome in terms of NOR and likelihood of fertilisation, implantation and clinical pregnancy. On the contrary, the presence of thyroid autoantibodies may have a detrimental effect on the course of a pregnancy, determining an increased risk of miscarriage and a decreased chance of live birth. However, given the possible modifying effects of age and serum TSH, further evidence is warranted prior to drawing inferences on causality.
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Affiliation(s)
- Andrea Busnelli
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy .,Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alessio Paffoni
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Luigi Fedele
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy.,Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Edgardo Somigliana
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
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Borsoi G, Lubelli B, van Hees R, Veiga R, Silva AS, Colla L, Fedele L, Tomasin P. Effect of solvent on nanolime transport within limestone: How to improve in-depth deposition. Colloids Surf A Physicochem Eng Asp 2016. [DOI: 10.1016/j.colsurfa.2016.03.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N, Busacca M, Candiani M, Centini G, Di Cello A, Exacoustos C, Fedele L, Fuggetta E, Gabbi L, Geraci E, Imperiale L, Lavarini E, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Mannini L, Mattei A, Muzii L, Pagliardini L, Perandini A, Perelli F, Pinzauti S, Porpora MG, Remorgida V, Leone Roberti Maggiore U, Seracchioli R, Solima E, Somigliana E, Tosti C, Venturella R, Vercellini P, Viganò P, Vignali M, Zannoni L, Zullo F, Zupi E. Adenomyosis: What the Patient Needs. J Minim Invasive Gynecol 2016; 23:476-88. [DOI: 10.1016/j.jmig.2015.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/19/2023]
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Persico N, Fabietti I, D’Ambrosi F, Riccardi M, Boito S, Fedele L. Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2016; 214:533.e1-533.e7. [PMID: 26517964 DOI: 10.1016/j.ajog.2015.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome. A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least 1 twin compared with the group that was treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of twin-to-twin transfusion syndrome and the development of twin anemia-polycythemia sequence in the equatorial group. OBJECTIVE The purpose of this study was to report on neonatal survival in twin-to-twin transfusion syndrome pregnancies that were treated with endoscopic laser therapy with the use of the equatorial technique and to examine the relationship between preoperative factors and twin loss. STUDY DESIGN Endoscopic equatorial laser therapy was carried out as the primary treatment for twin-to-twin transfusion syndrome in all consecutive monochorionic diamniotic twin pregnancies that were referred at a single fetal surgery Center over a 4-year period. All visible placental anastomoses were coagulated; additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, periprocedural complications, pregnancy outcome, and postnatal survival at hospital discharge were recorded and analyzed. RESULTS A total of 106 pregnancies were treated during the study period. Median gestational age at laser therapy was 19.7 weeks (range, 15.1-27.6 weeks). There was postoperative recurrence of twin-to-twin transfusion syndrome or the development of twin anemia-polycythemia sequence in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least 1 twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared with the recipient co-twin (64.2% vs 75.5%, respectively; P < .05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared with recipient fetuses (23.6% vs 10.4%, respectively; P < .05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; P < .05). There were no significant differences between the 2 groups in the survival of at least 1 twin and in the recipient survival. CONCLUSIONS Endoscopic equatorial laser therapy was associated with a survival of both and at least 1 twin of approximately 55% and 83%, respectively, with a low rate of recurrent twin-to-twin transfusion syndrome and twin anemia-polycythemia sequence. In addition, the preoperative finding of abnormal donor umbilical artery Doppler on ultrasound identified a subgroup of twin-to-twin transfusion syndrome pregnancies with a lower dual survival rate caused by increased intrauterine deaths of donor twins.
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Persico N, Boito S, Ischia B, Cordisco A, De Robertis V, Fabietti I, Periti E, Volpe P, Fedele L, Rembouskos G. Cell-free DNA testing in the maternal blood in high-risk pregnancies after first-trimester combined screening. Prenat Diagn 2016; 36:232-6. [DOI: 10.1002/pd.4773] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nicola Persico
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Simona Boito
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Benedetta Ischia
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | | | - Isabella Fabietti
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Enrico Periti
- Fetal Medicine Unit; Palagi Hospital; Florence Italy
| | - Paolo Volpe
- Fetal Medicine Unit; Di Venere and Sarcone Hospitals; Bari Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
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Vercellini P, Cribiù FM, Bosari S, Scarfone G, Bolis G, Aimi G, Fedele L. Prevalence of unexpected leiomyosarcoma at myomectomy: a descriptive study. Am J Obstet Gynecol 2016; 214:292-294. [PMID: 26450408 DOI: 10.1016/j.ajog.2015.09.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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Somigliana E, Paffoni A, Lattuada D, Colciaghi B, Filippi F, La Vecchia I, Tirelli A, Baffero GM, Persico N, Viganò P, Bolis G, Fedele L. Serum Levels of 25-Hydroxyvitamin D and Time to Natural Pregnancy. Gynecol Obstet Invest 2016; 81:468-71. [PMID: 26784950 DOI: 10.1159/000443397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to evaluate whether natural fertility is related to serum 25-hydroxyvitamin D (25-OH-vitamin D) levels. METHODS A nested case-control study was designed from a prospective cohort of pregnant women undergoing first trimester screening for aneuploidies. Cases included women seeking pregnancy for 12-24 months. Controls were the subsequent age-matched women conceiving in less than 1 year. We excluded women aged ≥40 or <18 years, those assuming supplementary products that included vitamin D before or during pregnancy, those with irregular menstrual cycles or known causes of subfertility, those conceiving through assisted reproductive techniques or requiring ovarian stimulation and those who were overweight or obese. A quantitative detection of serum 25-OH-vitamin D and patients' interview were performed. RESULTS Seventy-three cases and 73 matched controls were selected. The mean ± SD serum 25-OH-vitamin D was 21.2 ± 6.8 and 19.7 ± 7.3 ng/ml, respectively (p = 0.16). The number (%) of women with serum levels <20 ng/ml (vitamin D insufficiency) was 34 (47%) and 37 (51%), respectively (p = 0.73). The adjusted OR of longer time to pregnancy in women with vitamin D insufficiency was 0.84 (95% CI 0.42-1.66). CONCLUSIONS Our study does not support a crucial role of 25-OH-vitamin D in natural fertility.
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Affiliation(s)
- Edgardo Somigliana
- Obstet-Gynecol Department, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Busnelli A, Somigliana E, Ferrari S, Filippi F, Vannucchi G, Fugazzola L, Fedele L. THE LONG-TERM IMPACT OF CONTROLLED OVARIAN HYPERSTIMULATION ON THYROID FUNCTION. Endocr Pract 2015; 22:389-95. [PMID: 26574787 DOI: 10.4158/ep15933.or] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evidence on the long-term impact of controlled ovarian hyperstimulation (COH) on thyroid function is scarce. To investigate this, we report on serum thyroid-stimulating hormone (TSH) modifications in euthyroid and hypothyroid women during COH and 3 months after the end of the stimulation cycle. METHODS Women who underwent in vitro fertilization (IVF) and who did not become pregnant were eligible. Cases were women with treated hypothyroidism and basal serum TSH <2.5 mIU/L. Controls were euthyroid women matched to cases by age and basal serum TSH. Women could be included if serum TSH was available at 4 time points: prior to initiating COH (time 1); at the time of human chorionic gonadotropin (hCG) administration (time 2); 16 days after hCG administration (time 3); and 3 months after the end of the IVF cycle (time 4). RESULTS Thirty-seven case-control pairs were included. Serum TSH at times 1, 2, 3, and 4 was 1.7 ± 0.6, 3.1 ± 1.4, 3.1 ± 1.3, and 2.7 ± 1.7 mIU/L, and 1.7 ± 0.6, 2.9 ± 1.0, 2.7 ± 1.0, and 1.9 ± 0.7 mIU/L among cases and controls, respectively. A statistically significant difference emerged at time 4 (P<.001). In both groups, serum TSH was higher at time 4 compared to time 1. Serum TSH exceeded the recommended threshold of 2.5 mIU/L at time 4 in 51% of cases (95% confidence interval [CI], 35 to 68%) and in 16% of controls (95% CI, 4 to 28%) (P = .003). CONCLUSION COH seems to have a long-term impact on TSH levels. The magnitude of this effect is particularly pronounced in hypothyroid women.
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Busnelli A, Vannucchi G, Paffoni A, Faulisi S, Fugazzola L, Fedele L, Somigliana E. Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF. Eur J Endocrinol 2015; 173:417-24. [PMID: 26139211 DOI: 10.1530/eje-15-0151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/02/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE About one out of two women with primary hypothyroidism has to increase the dosage of exogenous levothyroxine (L-T4) during pregnancy. Considering the detrimental impact of IVF on thyroid function, it has been claimed but not demonstrated that L-T4 dose adjustment may be more significant in hypothyroid women who become pregnant after IVF. DESIGN Retrospective cohort study. METHODS Hypothyroid-treated women who achieved a live birth through IVF were reviewed. Women could be included if thyroid function was well compensated with L-T4 before the IVF cycle (i.e., serum TSH <2.5 mIU/l and serum free T4 within the normal range). Serum TSH and dose adjustment were evaluated at five time points during pregnancy. The trimester ranges for serum TSH considered as reference to adjust L-T4 therapy were 0.1-2.5 mIU/l for the first trimester, 0.2-3.0 mIU/l for the second trimester, and 0.3-3.0 mIU/l for the third trimester. RESULTS Thirty-eight women were selected. During the whole pregnancy 32 women (84%; 95% CI: 72-96%) required an increase in the dose of L-T4. In most cases (n=28), this occured within the first 5-7 weeks of gestation (74%, 95% CI: 58-85%). At 5-7 weeks of gestation, the median (interquartile range) increase of L-T4 dose for the whole cohort was 26% (0-50%). At 30-32 weeks, it was 33% (14-68%). In order to identify predictive factors of dose adjustment, we compared women who did (n=28) and did not (n=10) adjust L-T4 dosage at 5-7 weeks' gestation. Significant differences emerged for thyroid autoimmunity prevalence and for the distribution of hypothyroidism aetiology. CONCLUSIONS The vast majority of hypothyroid-treated women who achieve pregnancy through IVF need an increase in the L-T4 dose during gestation. This requirement tends to occur very early during gestation.
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Affiliation(s)
- Andrea Busnelli
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Guia Vannucchi
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Alessio Paffoni
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Sonia Faulisi
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Laura Fugazzola
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Luigi Fedele
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
| | - Edgardo Somigliana
- Infertility UnitFondazione Ca' Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, ItalyUniversità degli StudiMilan, Italy
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