The impact of mpMRI-targeted vs systematic biopsy on the risk of prostate cancer downgrading at final pathology

PURPOSE

Although targeted biopsies (TBx) are associated with improved disease assessment, concerns have been raised regarding the risk of prostate cancer (PCa) overgrading due to more accurate biopsy core deployment in the index lesion.

METHODS

We identified 1672 patients treated with radical prostatectomy (RP) with a positive mpMRI and ISUP ≥ 2 PCa detected via systematic biopsy (SBx) plus TBx. We compared downgrading rates at RP (ISUP 4-5, 3, and 2 at biopsy, to a lower ISUP) for PCa detected via SBx only (group 1), via TBx only (group 2), and eventually for PCa detected with the same ISUP 2-5 at both SBx and TBx (group 3), using multivariable logistic regression models (MVA).

RESULTS

Overall, 12 vs 14 vs 6% (n = 176 vs 227 vs 96) downgrading rates were recorded in group 1 vs group 2 vs group 3, respectively (p < 0.001). At MVA, group 2 was more likely to be downgraded (OR 1.26, p = 0.04), as compared to group 1. Conversely, group 3 was less likely to be downgraded at RP (OR 0.42, p < 0.001).

CONCLUSIONS

Downgrading rates are highest when PCa is present in TBx only and, especially when the highest grade PCa is diagnosed by TBx cores only. Conversely, downgrading rates are lowest when PCa is identified with the same ISUP through both SBx and TBx. The presence of clinically significant disease at SBx + TBx may indicate a more reliable assessment of the disease at the time of biopsy potentially reducing the risk of downgrading at final pathology.

ENFSI 2022 multidisciplinary collaborative exercise: organisation and outcomes

The use of collaborative exercises (CE) and proficiency tests (PT) as part of the governance programme for any forensic science laboratory has become commonplace and recommended by several international organisations. Traditionally these have been discipline-specific exercises testing a laboratory's ability in a single area of forensic science. However, the "real" world is normally more complex and, in many instances, forensic material must be examined for a number of different evidence types. This article summarises the concepts, planning, design, preparation, implementation, co-ordination and evaluation of the 2022 Multidisciplinary Collaborative Exercise (2022-MdCE) covering a range of forensic disciplines, specifically DNA, fingerprint, documents and handwriting. The exercise consisted of a questioned letter with typescript text and a signature. In addition, the letter contained a visible bloody fingermark in the area of the signature, a visible staining in the lower left-hand corner, a latent fingermark and an indented impression. The analysis of the results showed that, in the investigation of the bloody fingermark, the priority was given to the DNA examination. Some critical issues emerged in relation to the biological (DNA)/ink sampling strategies when applied before fingermark visualisation. Another outcome of the exercise has been to demonstrate the importance of indented impressions, which have been underestimated by a significant number of participants. As setters, more in-depth studies are needed to produce consistent samples. This concerns all the disciplined involved but especially DNA and fingermarks. Based on this exercise, it is believed that this approach to testing of forensic disciplines allows the analysis of good practice within the various scientific areas, as well as scrutinising the process and sequence of events for examining the material within a forensic laboratory in the best conservative way for all kind of evidences.

ZeroExpander® effectiveness assessment in PEEK or PA12 in a group of paediatric patients with transverse maxillary deficiency

AIM

The aim of this article is to compare the performance of ZeroExpander® realised using PEEK or PA12 for the expansion of the maxilla in paediatric patients, exploring a new concept for approaching maxillary expansion with a metal-free fixed automatic appliance, based on pre-programmed set-up and anchored on deciduous teeth.

MATERIALS

It is a retrospective comparative study with a sample of 40 children in early or mixed deciduous dentition and transversal maxillary deficit, 20 treated with ZeroExpander® in PEEK and 20 treated with ZeroExpander® in PA12 with a mean age of 7.3 years old. The intraoral scans at T0 and at the end of the expansion were all performed by the same operator to obtain digital models on which were performed measurements by two other different operators. A descriptive analysis was conducted using frequencies and percentages for nominal variables and means and standard deviations for continuous variables.

CONCLUSION

In cases of allergy or hypersensitivity to metals or to specific chronic or acute pathological conditions, which may require periodic magnetic resonance imaging (MRI), it may not be possible to use traditional and metal fixed expansion devices. Moreover the concept of autonomous driving in paediatric orthodontics is not only possible, but it is and will be more real and very useful in the future. The "ortho-paediatric dentistry concept" will increase the range of benefits for children and their families which, in addition to care and thanks to technology, demand well-being, safety, comfort and quality of life beyond clinics.

Laryngeal office-based procedures: A safe approach

PURPOSE

Laryngeal surgeries using a flexible nasopharyngoscope equipped with an operative channel has gained popularity, with gradual increase in the variety of interventional office-based procedures, under local anesthesia. The purpose of this study is to analyze the tolerance of such procedures.

MATERIALS AND METHODS

Retrospective cohort study. 337 cases were performed during 2 years. We collected the following data: type of pathology, type of procedure and modalities of anesthesia, adverse events.

RESULTS

19 % of the visits were for the purpose of Biopsy, 65 % for an injection, and Trublue Laser was utilized in 12 % of the procedures. Regarding the pathologies, 27 % were vocal fold paralysis, 18 % leukoplakia or another suspicious lesion, 15 % recurrent respiratory papillomatosis, 13 % neuromuscular disorder, 9 % vocal fold scarring, 7 % vocal cord atrophy and 6 % had an inflammatory presentation. Side effects were documented in 26 visits (7.7 %) and were minor in almost all the encounters: they included strong reflexive cough, deep throat pain, discomfort, gag reflex, anxiety, vagal discomfort, malaise, hypersalivation, nose pain, labile hypertension. More severe side effects were very rare and included septal wound and epistaxis, erythematous rash, dyspnea, and transient dysarthria. 13 procedures were either aborted, or canceled at initial steps, due to inability of the patient to tolerate the procedure and were rescheduled for general anesthesia. 97 % of the cases were released home after 1 h of surveillance.

CONCLUSION

Office-based flexible interventional laryngoscopy under local anesthesia is a safe and well-tolerated procedure, with abundance of various interventions feasible on ambulatory, office-based setup.

Pre-cervical ripening and hygroscopic cervical dilators in pre-labor induction

INTRODUCTION

Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool to prepare the cervix when the BISHOP-score is low. About one-third of IOL cases require cervical ripening, which is the physical softening, thinning, and dilation of the cervix in preparation for labor and birth. We report a single center experience regarding the use of hygroscopic dilators in the pre-labor phase to obtain cervical ripening before labor induction.

MATERIALS & METHODS

We conducted a retrospective observational study comparing patient records from the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital in Prato, Tuscany. The inclusion criteria for participants were women who had undergone pre-labor induction because of a BISHOP-score < 3. The gestational age of all the pregnant women was at term (> 37 weeks).

RESULTS

From January 2022 to April 2022, a total of 581 women delivered at term of gestational age at the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital. Cervical ripening was necessary for 82 women with a Bishop score < 3 and hygroscopic cervical dilators were used in 35/82 (42.7%) patients. All patients showed a change in Bishop-score upon removal of the dilators. All 35 patients (100%) reported an increase in terms of consistency and dilation of the cervix but not in terms of length. None of the patients reported discomfort during the 24 h that they kept the hygroscopic dilators in place. No patients reported uterine tachysystole on cardiotocographic tracing, vaginal bleeding, rupture of membranes or cervical tears.

CONCLUSIONS

Our results are in line with those in the literature, demonstrating the validity of hygroscopic dilators in cervical maturation of pregnancies at term and their efficacy was again highlighted in terms of both maternal and fetal safety and patient satisfaction.

Case report: vertical transmission of Plesiomonas shigelloides. Is it time to strengthen information on safety concerns for raw seafood dietary exposure in pregnancy?

The consumption of raw seafood, generally considered to be a healthy food, has greatly increased worldwide. Pathogens of fish can cause foodborne illnesses in humans, especially following the consumption of raw seafood from contaminated water.Foodborne illness in pregnant women is seldom the cause of neonatal infection, but, as in the reported cases, it has been associated with a high degree of morbidity and mortality.We present the case of a newborn with septicemia and meningitis caused by Plesiomonas shigelloides acquired via the transplacental route. There was a maternal history of ingestion of raw seafood 1 week prior to delivery. A few similar cases are described in the existing literature, which reports 7 neonatal deaths.Therefore, the primary objective of this paper is to highlight the fact that the popularity of raw seafood such as sushi, sashimi, and oysters, requires an improvement in dietary advice regarding unsafe choices in pregnancy in order to avoid preventable foodborne diseases, sometimes fatal for the newborn.

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19

BACKGROUND

High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19.

METHODS

This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study.

MAIN FINDINGS

Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing.

CONCLUSIONS

The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.

Socio-hydrogeological survey and assessment of organic pollutants to highlight and trace back pollution fluxes threatening a coastal groundwater-dependent ecosystem

Despite being a vector of pollution towards connected ecosystems, groundwater is often underestimated or not taken into account in management frameworks. To fill this gap, we propose to add socio-economic data to hydrogeological investigations to identify past and present pollution sources linked to human activities at watershed scale in order to forecast threats towards groundwater-dependent ecosystems (GDEs). The aim of this paper is to demonstrate, by a cross-disciplinary approach, the added value of socio-hydrogeological investigations to tackle anthropogenic pollution fluxes towards a GDE and to contribute to more sustainable management of groundwater resources. A survey combining chemical compounds analysis, data compilation, land use analysis and field investigations with a questionnaire was carried out on the Biguglia lagoon plain (France). Results show a pollution with a two-fold source, both agricultural and domestic, in all water bodies of the plain. The pesticide analysis reveals the presence of 10 molecules, including domestic compounds, with concentrations exceeding European groundwater quality standards for individual pesticides, as well as pesticides already banned for twenty years. On the basis of both the field survey and the questionnaire, agricultural pollution has been identified as very local highlighting the storage capacity of the aquifer, whereas domestic pollution is diffuse over the plain and attributed to sewage network effluents and septic tanks. Domestic compounds present shorter residence time within the aquifer highlighting continuous inputs, related to consumption habits of the population. Under the Water Framework Directive (WFD), member states are required to preserve the good ecological status, quality and quantity of water bodies. However, for GDEs it is difficult to achieve the 'good status' required without considering the groundwater's pollutant storage capacity and pollution legacy. To help resolve this issue, socio-hydrogeology has proved to be an efficient tool as well as for implementing effective protection measures for Mediterranean GDEs.

How to Manage Endometriosis in Adolescence: The Endometriosis Treatment Italian Club Approach

The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice.

The role of groundwater in CO2 production and carbon storage in Mediterranean peatlands: An isotope geochemistry approach

Peatlands are permanent wetlands recognized for ecosystem services such as biodiversity conservation and carbon storage capacity. Little information is available about their response to global change, the reason why most Earth system climate models consider a linear increase in the release of greenhouse gases (GHG), such as CO₂, with increasing temperatures. Nevertheless, numerous studies suggest that an increase in the temperature may not imply a decrease in photosynthesis and carbon storage rates if water availability is sufficient, the latter being under the control of local hydrology mechanisms. Mediterranean peatlands well illustrate this fact. Since they are groundwater-dependent, they are hydrologically resilient to the strong seasonality of hydroclimatic conditions, especially during the summer drought. In the present study, we demonstrate that, even if such peatlands release CO₂ into the atmosphere, they can maintain a carbon storage capacity. To this end, a geochemical study disentangles the origin and fate of carbon within a Mediterranean peatland at the watershed scale. Field parameters, major ions, dissolved organic and inorganic carbon content and associated δ¹³C values allow for characterizing the seasonality of hydrochemical mechanisms and carbon input from an alluvial aquifer (where rain, river, shallow, and deep groundwater flows are mixing) to the peatland. The inorganic and organic content of peat soil and δ¹³C values of total organic matter and CO₂ complete the dataset, making it possible to provide arguments in favour of lower organic matter oxidation compared to primary production. Overall, this study highlights the groundwater role in the fluxes of CO₂ at the peatland-atmosphere interface, and more broadly the need to understand the interactions between the water and carbon cycles to build better models of the future evolution of the global climate.

"Better late than never but never late is better", especially in young women. A multicenter Italian study on diagnostic delay for symptomatic endometriosis

PURPOSE

The aim of the study was to assess the length of diagnostic delay of symptomatic endometriosis in Italy and analyse the presence of correlations between the socio-demographic status of patients and the clinical characteristics/type of diagnosis.

MATERIALS AND METHODS

This multicenter cross-sectional questionnaire-based study was conducted in 10 tertiary Italian referral centres for diagnosis and treatment endometriosis. A total of 689 respondents with histologically proven endometriosis and onset of the disease with pain symptoms completed an on-line self-reported questionnaire written in their own language (World Endometriosis Research Foundation-Endometriosis Phenome and Biobanking Harmonisation Project-Endometriosis Patient Questionnaire-Minimum) evaluating endometriosis related symptoms, family history of endometriosis and chronic pelvic pain, demographic data, as well as medical, reproductive, and obstetric history.

RESULTS

The mean diagnostic delay found was of 11.4 years. The mean time (14.8 years) from symptoms onset to diagnosis was significantly longer among patients aged 9-19 vs patients aged 20-30 (mean 6.9 years, p < 0.001) and patients aged 31-45 (mean 2.9, p < 0.001). No significant association were found between a delayed diagnosis and any of the clinically relevant factors such as the number or severity of the reported symptoms, familiarity, hormonal therapy intake or methodology of diagnosis.

CONCLUSIONS

The mean diagnostic delay of endometriosis in Italy is about 11 years. The delay can be up to 4 years longer in patients with pain symptoms onset under 20 years. Educating clinicians and patients on pathologic nature of endometriosis related pelvic pain is advisable to reduce waiting time to diagnosis, especially for young women.

Prevalence of sealant in an Italian paediatric population: an epidemiological study

AIM

The use of sealants is an effective measure for the prevention of pit and fissure caries in children and it has been well documented by several studies In order to plan and establish a preventive national programme, it is important to know the epidemiological pattern in an Italian paediatric population, correlated to the risk of caries, DMFT and other sociodemographic factors.

METHODS

This study was conducted on 2,442 children aged between 6 and 12 years attending the paediatric dentistry department of the University of L'Aquila, Italy. In addition to the oral examination, a questionnaire was administered on bad habits and the family perception of sealing. For descriptive analysis, the sample was stratified into two groups based on the presence/absence of at least one tooth with sealant. The differences between discrete and nominal variables, reported as absolute and percentage frequencies, were assessed by applying the χ2 test or the Fisher's exact test, as appropriate. Continuous variables were expressed in terms of mean values and their standard deviation(±DS) and the differences between the two groups under consideration were analysed through Student's t-test. The tests used are two-way and a significance level of 5% was applied. The statistical analysis was carried out using the statistical package STATA/IC 15.0 (StataCorp LLC, Texas, USA).

CONCLUSION

The application of sealants to healthy occlusal surfaces is the best aid in preventing the development of caries in these areas, and this is especially important in childhood and adolescence, when the incidence of this pathology is particularly high.

Contrast Agents during Pregnancy: Pros and Cons When Really Needed

Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

Knowledge of, and attitudes towards, adult vaccination among General Practitioners in Piedmont, Italy: results from a cross-sectional study

BACKGROUND

"Life-course immunization" is increasingly recognized as important. In Italy, adults are recommended to receive influenza; pneumococcal; tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap); and herpes zoster (HZ) vaccines at various ages.

STUDY DESIGN

Cross-sectional study.

METHODS

To study the knowledge and attitudes of Italian general practitioners (GPs) towards adult vaccination, we surveyed 335 GPs in Piedmont from December 2019 through March 2020; and compared the results by GPs' age (≤50 vs >50 years).

RESULTS

The most common vaccination information source was the regional/local educational courses (72.8%), with older vs younger GPs more likely to attend (79.4% vs 64.4%; p=0.002). Approximately half felt that they needed further information on vaccine co-administration (55.5%), duration of protection (49.6%), and safety/tolerability (48.7%), with older vs younger GPs being more interested in safety/tolerability. Overall, most respondents (86.0%) felt that information for the patient would most engage them, and 68.1% planned to co-administer vaccines. Respondents felt most comfortable proposing influenza, but were also comfortable about pneumococcal/Tdap/HZ vaccination. However, younger vs older GPs were more comfortable about proposing Tdap and HZ. The most common ways to inform patients about influenza or pneumococcal/Tdap/HZ vaccination eligibility were personally during a visit (42.7% or 54.3%, respectively) or via an information poster (30.7% or 17.9%).

CONCLUSIONS

The surveyed GPs had favorable attitudes towards adult vaccination and were interested in ongoing education.

BJS-01 SARCOPENIA AND VISCERAL FAT IN PATIENTS WITH INCISIONAL HERNIA AFTER URGENT LAPAROTOMY

Aim

Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy.

Material & methods

Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-months follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups.

Results

From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged &gt;18 years-old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant.

Conclusions

When surgery is performed in urgent settings it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease. In these patients a prophylactic mesh placement could be evaluated.

Not just a matter of weight: A case report of ECMO treatment in a severely obese patient

The ELSO Guidelines list a BMI ≥ 40 kg/m² among the relative contraindications to give ECMO treatment in SARS – COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m², admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.

A monocentric retrospective analysis about the effects of COVID-19 pandemic on emergency general surgery consultations

OBJECTIVE

The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates.

PATIENTS AND METHODS

We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded.

RESULTS

In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery.

CONCLUSIONS

We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.

High-Content Screening Pipeline for Natural Products Targeting Oncogenic Signaling in Melanoma

The incidence of melanoma, the most fatal dermatological cancer, has dramatically increased over the last few decades. Modern targeted therapy with kinase inhibitors induces potent clinical responses, but drug resistance quickly develops. Combination therapy improves treatment outcomes. Therefore, novel inhibitors targeting aberrant proliferative signaling in melanoma via the MAPK/ERK and PI3K/AKT pathways are urgently needed. Biosensors were combined that report on ERK/AKT activity with image-based high-content screening and HPLC-based activity profiling. An in-house library of 2576 plant extracts was screened on two melanoma cell lines with different oncogenic mutations leading to pathological ERK/AKT activity. Out of 140 plant extract hits, 44 were selected for HPLC activity profiling. Active thymol derivatives and piperamides from Arnica montana and Piper nigrum were identified that inhibited pathological ERK and/or AKT activity. The pipeline used enabled an efficient identification of natural products targeting oncogenic signaling in melanoma.

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Endometrial cancer is the most frequent gynecological malignancy, and, although epidemiologically it mainly affects advanced age women, it can also affect young patients who want children and who have not yet completed their procreative project. Fertility sparing treatments are the subject of many studies and research in continuous evolution, and represent a light of hope for young cancer patients who find themselves having to face an oncological path before fulfilling their desire for motherhood. The advances in molecular biology and the more precise clinical and prognostic classification of endometrial cancer based on the 2013 The Cancer Genome Atlas classification allow for the selection of patients who can be submitted to fertility sparing treatments with increasing oncological safety. It would also be possible to predict the response to hormonal treatment by investigating the state of the genes of the mismatch repair.

The early prediction of mortality in acute cholecystitis: Temperature, Neutrophils and Multiple organ failure (TNM) score

OBJECTIVE

Acute Cholecystitis (AC) accounts for a significant proportion of patients presenting to the Emergency Department with abdominal pain. We suggest grading the severity of AC with a simple system: TNM, an acronym borrowed by cancer staging where T indicated Temperature, N neutrophils and M Multiple organ failure. This retrospective-prospective observational study evaluates the predictive value of TNM score on mortality of patients with AC.

PATIENTS AND METHODS

TNM was developed in a training cohort of 178 patients with AC who underwent cholecystectomy from February 2005 to December 2012 (retrospectives data). To verify the prognostic value of TNM score, we prospectively recruited 172 patients who were consecutively included and treated from January 2013 to July 2020 as the validation cohort. After defining the categories T, N and M, patients were grouped in stages. The variables analyzed were age, sex, American Society of Anesthesiologists (ASA) score, blood transfusion, temperature, neutrophils count, preoperative organ failure, immune-compromised status, stage.

RESULTS

In the training cohort TNM staging was: none patient at stage 0; 6 patients at stage I; 71 patients at stage II; 71 patients at stage III; 30 patients at stage IV. Death occurred in 51 patients. ASA score, neutrophils count, preoperative organ failure, stage III-IV emerged as statistically significant different prognostic factors. ASA score (III-IV) and stage (III-IV) were significant independent predictors of post-operative mortality in multivariate analysis. Comparable results were observed in the validation cohort.

CONCLUSIONS

TNM classification is very easy to use; it helps to define the mortality risk and it is useful to objectively compare patients with AC.

Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study

Purpose

To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy.

Methods

Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis.

Results

Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09).

Conclusion

Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery.

Trial registration

Clinical trial registration number: NCT03354793.

P–089 Paternal age affects the performance of EAU guidelines for genetic testing in infertile men: implications for candidate selection

Study question

We aimed at challenge EAU Guidelines for genetic testing performance in infertile men according to normal vs. advanced paternal age (APA).

Summary answer

EAU Guidelines perform better in karyotype analysis (KA) and Y-chromosome microdeletions (YCM) investigation in men above 35 years of age.

What is known already

EAU Guidelines for genetic testing in infertile men recommend specific threshold for candidate selection for both KA (&lt;10 million spermatozoa/ml) and YCM (&lt;5 million spermatozoa/ml). However, paternal age is not taken into account for candidate selection in this setting.

Study design, size, duration

Data from 2188 infertile men (according to WHO definition) consecutively evaluated at a single academic centre were analysed.

Participants/materials, setting, methods

Demographic, clinical and laboratory data were analysed. Semen analyses were based on 2010 WHO criteria. Advanced age was defined as above 35. All men underwent KA and YCM testing. EAU Guidelines were validated in our cohort and according to APA. Specificity, sensitivity, and AUC were estimated for all scenarios. A Wald-type test compared AUC according to APA for KA and YCM. Decision curve analysis (DCA) estimated the benefit of using EAU Guidelines according to APA.

Main results and the role of chance

Median (IQR) paternal age was 37 (34–41) years. Advanced paternal age was found in 1306 (60%) of included men. Prevalence of KA and YCM was 4% (48 men) and 1% (13 men), respectively. EAU Guidelines sensitivity, specificity and AUC in the overall population were 85%, 47% and 66% for KA, whereas they were 100%, 57% and 80% for YCM. When stratifying according to APA, EAU Guidelines performed better in men over 35 both in terms of KA and YCM detection. Specifically, AUC for KA detection in men with APA was 70% vs. 63% in younger men (p = 0.04). AUC for YCM detection in men with APA was 82% vs. 79% in younger men (p = 0.03). DCA confirmed higher net benefit in using EAU Guidelines in old vs. young men for the detection of both KA and YCM.

Limitations, reasons for caution

It is a retrospective analysis at a single, tertiary-referral academic centre, thus raising the possibility of selection biases.

Wider implications of the findings: EAU Guidelines for genetic testing in infertile men perform differentially according to APA. KA and YCM are better detected in older men, likely due to a wider pool of confounding etiological factors in young men. These results suggest the implementation of more accurate predictive models in younger men.

Trial registration number

Not applicable