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Loverro MT, Di Naro E, Nicolardi V, Resta L, Mastrolia SA, Schettini F, Capozza M, Loverro M, Loverro G, Laforgia N. Pregnancy Complications, Correlation With Placental Pathology and Neonatal Outcomes. Front Clin Diabetes Healthc 2022; 2:807192. [PMID: 36994339 PMCID: PMC10012052 DOI: 10.3389/fcdhc.2021.807192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
PurposeWe aimed to clarify and contribute to a better comprehension of associations and correlations between placental histological findings, pregnancy evolution, and neonatal outcomes.Study DesignThis is a longitudinal and prospective observational study, performed between May 2015 and May 2019, on 506 pregnant women. Clinical data related to pregnancy outcome, neonatal health status, and placental histology were primarily collected. Twin pregnancies or malformed newborns were excluded and therefore the study was conducted on 439 cases. These cases have been then subdivided into the following study groups: (a) 282 placentas from pathological pregnancies; and, (b) a control group of 157 pregnancies over 33 weeks of gestational age, defined as physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies, most of which had undergone elective cesarean section for maternal or fetal indication.ResultsA normal placenta was present in 57.5% of normal pregnancies and in 42.5% of pathological pregnancies. In contrast, placental pathology was present in 26.2% of normal pregnancies and 73.8% of pathological pregnancies. Comparison of the neonatal health status with the pregnancy outcome showed that, among the 191 newborns classified as normal, 98 (51.3%) were born from a normal pregnancy, while 93 (48.7%) were born from mothers with a pathological pregnancy. Among the 248 pathological infants, 59 (23.8%) were born from a mother with a normal pregnancy, while 189 (76.2%) were born from pregnancies defined as pathological.ConclusionPlacental histology must be better understood in the context of natural history of disease. Retrospective awareness of placental damage is useful in prevention in successive pregnancy, but their early identification in the evolving pregnancy could help in association with biological markers or more sophisticated instruments for early diagnosis.
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Affiliation(s)
- Maria Teresa Loverro
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Edoardo Di Naro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Vittorio Nicolardi
- Department of Economics and Finance University of Bari “Aldo Moro”, Bari, Italy
| | - Leonardo Resta
- Department Emergency and Organ Transplantation, Institute of Pathology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Ospedale dei Bambini “Vittore Buzzi”, University of Milan, Milan, Italy
- *Correspondence: Salvatore Andrea Mastrolia,
| | - Federico Schettini
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Matteo Loverro
- Department of Women and Child Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giuseppe Loverro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
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2
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Loverro G, Damiani GR, Malvasi A, Loverro M, Schonauer LM, Muzzupapa G, Dinaro E. Myomectomy during pregnancy: an obstetric overview and two case-series. Minerva Obstet Gynecol 2021; 73:646-653. [PMID: 33988017 DOI: 10.23736/s2724-606x.21.04676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Uterine fibroids (UFs) are the most common benign disease affecting female reproductive system, occur in 20-40 % of women, and in 10 % of pregnancies. The aim of the investigation was to summarize evidences about the management and treatment of UFs and related complications in pregnancy. MATERIALS AND METHODS A literature review was performed using scientific databases, including all case report and case series, using a combination of key words relating to the problem exposed. Data about gestational age at diagnosis, maximum fibroids diameter, type of surgery and gestational age at surgery, delivery and perinatal outcome were collected. Two clinical cases were also included. RESULTS Sixty-six articles were selected and 199 patients were included. In 76 % of patients the gestational age at myomectomy was lower than 20 weeks, in 85 % laparotomic surgery was chosen, in 41 % of cases the maximum fibroid diameter was between 7-20 cm, in 41 % of pregnancies the route of delivery was cesarean section. The eight percent of cases was complicated by miscarriage or fetal demise or neonatal death. CONCLUSIONS Myomectomy is a feasible procedure in those pregnancies complicated by symptomatic fibroids, though surgery in pregnancy is associated with an increased risk of obstetric complications.
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Affiliation(s)
- Giuseppe Loverro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca R Damiani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, Bari, Italy -
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Matteo Loverro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Luca M Schonauer
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Giuseppe Muzzupapa
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Edoardo Dinaro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Schönauer LM, Dellino M, Loverro M, Carriero C, Capursi T, Leoni C, Loverro G, Di Naro E. Hormone therapy in female-to-male transgender patients: searching for a lifelong balance. Hormones (Athens) 2021; 20:151-159. [PMID: 33026609 DOI: 10.1007/s42000-020-00238-2] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reassignment of a female-to-male (FtM) person requires gender-affirming, androgenic hormonal treatment that is planned to induce appropriate structural changes. This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). The purpose of this study is to evaluate the effects of hormone therapy with testosterone in FtM subjects during a 24-month follow-up in order to highlight the occasional need for early decompensation and to make adequate hormone therapy modulations. METHODS Fifteen out of 23 FtM persons had been previously treated with SRS, while eight were still awaiting surgery. During hormone therapy, both groups were followed for 24 months, with evaluation of desired changes, adverse effects, and functional or metabolic indicators. RESULTS In the group of operated FtM subjects (15/23), a significant increase of total testosterone (total T) and free testosterone (free T) was found after 24 months. Luteinizing hormone (LH) maintained a low level, decreasing after ovariectomy, while FSH increased. Voice deepening, facial and body hair variation, male-pattern balding, and body mass index (BMI) increase are all physical changes due to androgenization. In both groups of patients who have been closely monitored, the side effects and thromboembolic, metabolic, and cardiovascular risks of androgen therapy, even in the long term, appear to be irrelevant. CONCLUSION Total T, free T, and LH dosages are shown to be reliable markers of correct androgenization. Strict monitoring of lipid profile, evaluation of BMI and hematocrit, avoidance of self-initiated therapeutic modifications, adherence to a healthy lifestyle, and avoidance of excessive daily calorie intake can limit risks linked to long-term testosterone administration. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Luca Maria Schönauer
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Bari, Italy
| | - Miriam Dellino
- Interdisciplinary Department of Medicine, Gynecology and Ostetrics Clinic, University of Bary, Bari, Italy.
| | - Matteo Loverro
- Department of Obstetrics and Gynaecology, ASTT Lecco, Ospedale Leopoldo Mandic, Merate, Italy
| | - Carmine Carriero
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Bari, Italy
| | - Teresa Capursi
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Bari, Italy
| | - Claudia Leoni
- Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, CNR, Bari, Italy
| | - Giuseppe Loverro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Bari, Italy
| | - Edoardo Di Naro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Bari, Italy
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Cormio G, Colamaria A, Loverro G, Pierangeli E, Di Vagno G, De Tommasi A, Selvaggi L. Surgical Resection of a Cerebral Metastasis from Cervical Cancer: Case Report and Review of the Literature. Tumori 2018; 85:65-7. [PMID: 10228501 DOI: 10.1177/030089169908500114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Central nervous system metastasis from cervical carcinoma is uncommon. Case report We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2×3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. Conclusion Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.
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Affiliation(s)
- G Cormio
- Department of Obstetrics and Gynecology, University of Bari, Italy
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Abstract
Both obesity and overweight are increasing worldwide and have detrimental influences on several human body functions including the reproductive health. In particular, obese women undergo perturbations of the 'hypothalamic pituitary ovarian axis', and frequently suffer of menstrual dysfunction leading to anovulation and infertility. Besides the hormone disorders and subfertility that are common in the polycystic ovary syndrome (PCOS), in obesity the adipocytes act as endocrine organ. The adipose tissue indeed, releases a number of bioactive molecules, namely adipokines, that variably interact with multiple molecular pathways of insulin resistance, inflammation, hypertension, cardiovascular risk, coagulation, and oocyte differentiation and maturation. Moreover, endometrial implantation and other reproductive functions are affected in obese women with complications including delayed conceptions, increased miscarriage rate, reduced outcomes in assisted conception treatments.On the contrary, weight loss programs through lifestyle modification in obese women, have been proven to restore menstrual cyclicity and ovulation and improve the likelihood of conception.
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Affiliation(s)
- Erica Silvestris
- 0000 0001 0120 3326grid.7644.1Interdisciplinary Department of Medicine, Section of Obstetrics and Gynecology, University of Bari Aldo Moro, P.za G.Cesare, 11-70124 Bari, Italy
| | - Giovanni de Pergola
- 0000 0001 0120 3326grid.7644.1Departmentof Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G.Cesare, 11-70124 Bari, Italy
| | - Raffaele Rosania
- 0000 0001 0120 3326grid.7644.1Interdisciplinary Department of Medicine, Section of Obstetrics and Gynecology, University of Bari Aldo Moro, P.za G.Cesare, 11-70124 Bari, Italy
| | - Giuseppe Loverro
- 0000 0001 0120 3326grid.7644.1Interdisciplinary Department of Medicine, Section of Obstetrics and Gynecology, University of Bari Aldo Moro, P.za G.Cesare, 11-70124 Bari, Italy
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Silvestris E, Cafforio P, D’Oronzo S, Felici C, Silvestris F, Loverro G. In vitro differentiation of human oocyte-like cells from oogonial stem cells: single-cell isolation and molecular characterization. Hum Reprod 2018; 33:464-473. [DOI: 10.1093/humrep/dex377] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/18/2017] [Indexed: 01/26/2023] Open
Affiliation(s)
- Erica Silvestris
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
- Department of Emergency and Organ Transplantation, Section of Obstetrics and Gynecology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
| | - Paola Cafforio
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
| | - Stella D’Oronzo
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
| | - Claudia Felici
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
| | - Franco Silvestris
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
| | - Giuseppe Loverro
- Department of Emergency and Organ Transplantation, Section of Obstetrics and Gynecology, University of Bari Aldo Moro, P.za G. Cesare, 11-70124 Bari, Italy
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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Mastrolia SA, Mazor M, Holcberg G, Leron E, Beharier O, Loverro G, Erez O. The physiologic anticoagulant and anti-inflammatory role of heparins and their utility in the prevention of pregnancy complications. Thromb Haemost 2017; 113:1236-46. [DOI: 10.1160/th14-10-0848] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/14/2015] [Indexed: 01/13/2023]
Abstract
SummaryAccumulating evidence supports the concept of increased thrombin generation, placental vascular lesions, and inflammation as crucial points in the development of the great obstetrical syndromes [preeclampsia, intrauterine growth restriction (IUGR), preterm labor (PTL), preterm prelabor rupture of membranes (PROM), fetal demise and recurrent abortions]. In light of this, the role of heparins for primary or secondary prevention of these syndromes is becoming more and more apparent, mainly due to the antithrombotic and anti-inflammatory effects of heparins. There is agreement regarding the use of heparin in the prevention of gestational complications in patients with antiphospholipid syndrome, while its use for other obstetrical complications is under debate. In the present review we will describe the physiologic role of heparins on coagulation and inflammation and we will discuss current evidence regarding the use of heparins for the prevention/ treatment of obstetrical syndromes.
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Ciccone MM, Loverro G, Scicchitano P, Loverro M, Ricci G, Scaramuzzi F, Gesualdo M, Zito A, Campagna M, Moncelli M, Nicolardi V, Manca F, Boninfante B, Carbonara S, Cortese F, Todarello O, Bettocchi C. Surgical and pharmacological reassignment: influence on transsexual cardiovascular risk profile. Intern Med J 2017; 47:1255-1262. [PMID: 28857448 DOI: 10.1111/imj.13597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Marco M. Ciccone
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology; University of Bari; Bari Italy
| | - Pietro Scicchitano
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Matteo Loverro
- Department of Obstetrics and Gynecology; University of Bari; Bari Italy
| | - Gabriella Ricci
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | | | - Michele Gesualdo
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Annapaola Zito
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Marcello Campagna
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit; University of Bari; Bari Italy
| | - Michele Moncelli
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Vittorio Nicolardi
- Department of Economics and Mathematical Methods; University of Bari; Italy
| | - Fabio Manca
- Department of Science of Educational Psychology, and Communication; University of Bari; Bari Italy
| | - Barbara Boninfante
- P.J.D. of Statistical Part-time Lecturer of Medical Statistics; University of Bari; Bari Italy
| | - Santa Carbonara
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - Francesca Cortese
- Department of Cardiovascular Disease Section, Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | | | - Carlo Bettocchi
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit; University of Bari; Bari Italy
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Ciccone M, Carbonara R, Giardinelli F, Zito A, Ricci G, Dentamaro I, Bulzis G, Catalano M, Panettieri I, Loverro G, Vulpis V. P2632Gestational hypertension: endothelial dysfunction as a marker of pre-eclampsia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Indrio F, Martini S, Francavilla R, Corvaglia L, Cristofori F, Mastrolia SA, Neu J, Rautava S, Russo Spena G, Raimondi F, Loverro G. Epigenetic Matters: The Link between Early Nutrition, Microbiome, and Long-term Health Development. Front Pediatr 2017; 5:178. [PMID: 28879172 PMCID: PMC5572264 DOI: 10.3389/fped.2017.00178] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022] Open
Abstract
Epigenetic modifications are among the most important mechanisms by which environmental factors can influence early cellular differentiation and create new phenotypic traits during pregnancy and within the neonatal period without altering the deoxyribonucleic acid sequence. A number of antenatal and postnatal factors, such as maternal and neonatal nutrition, pollutant exposure, and the composition of microbiota, contribute to the establishment of epigenetic changes that can not only modulate the individual adaptation to the environment but also have an influence on lifelong health and disease by modifying inflammatory molecular pathways and the immune response. Postnatal intestinal colonization, in turn determined by maternal flora, mode of delivery, early skin-to-skin contact and neonatal diet, leads to specific epigenetic signatures that can affect the barrier properties of gut mucosa and their protective role against later insults, thus potentially predisposing to the development of late-onset inflammatory diseases. The aim of this review is to outline the epigenetic mechanisms of programming and development acting within early-life stages and to examine in detail the role of maternal and neonatal nutrition, microbiota composition, and other environmental factors in determining epigenetic changes and their short- and long-term effects.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, Aldo Moro University, Bari, Italy
| | - Silvia Martini
- Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luigi Corvaglia
- Neonatology and Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Salvatore Andrea Mastrolia
- Department of Biomedical Science and Human Oncology, Section of Obstetrics and Gynecology, Aldo Moro University, Bari, Italy
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Samuli Rautava
- Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland
| | - Giovanna Russo Spena
- Division of Neonatology, Department of Translational Medical Sciences, University "Federico II" di Napoli, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University "Federico II" di Napoli, Naples, Italy
| | - Giuseppe Loverro
- Department of Biomedical Science and Human Oncology, Section of Obstetrics and Gynecology, Aldo Moro University, Bari, Italy
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12
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Mastrolia SA, Baumfeld Y, Hershkovitz R, Loverro G, Di Naro E, Yohai D, Schwarzman P, Weintraub AY. Bicornuate uterus is an independent risk factor for cervical os insufficiency: A retrospective population based cohort study. J Matern Fetal Neonatal Med 2016; 30:2705-2710. [DOI: 10.1080/14767058.2016.1261396] [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] [Indexed: 10/20/2022]
Affiliation(s)
- Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - David Yohai
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Silvestris E, Cafforio P, D'Oronzo S, Felici C, Loverro G, Silvestris F. Post-menopausal ovary cancer is enriched of Ddx4+ primordial oogones as putative cancer stem cells. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw338.05] [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: 11/12/2022] Open
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Tartagni M, Cicinelli MV, Tartagni MV, Alrasheed H, Matteo M, Baldini D, De Salvia M, Loverro G, Montagnani M. Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis D. J Pediatr Adolesc Gynecol 2016; 29:357-61. [PMID: 26724745 DOI: 10.1016/j.jpag.2015.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Received: 05/05/2015] [Revised: 11/24/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Premenstrual syndrome (PMS) might become severe enough to interfere with normal interpersonal relationships. This study was planned to assess whether administration of vitamin D (200,000 IU at first, followed by 25,000 IU every 2 weeks) for a 4-month period might lessen the appearance and the intensity of mood disorders associated with PMS in young girls with severe hypovitaminosis D. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: One hundred fifty-eight young girls (15-21 years old) with PMS-related severe symptoms of the emotional and cognitive domains and low serum 25-hydroxycholecalciferol (25-OH-D) levels (≤10 ng/mL) were randomly assigned to two treatment groups and treated for 4 months with vitamin D (group 1; n = 80) or placebo (group 2; n = 78). Clinical and hormonal effects were compared between the two groups. RESULTS In patients from group 1, levels of vitamin D reached the normal range (35-60 ng/mL) after the first month and remained stable throughout the whole study. At the end of treatment, anxiety score decreased from 51 to 20 (P < .001 vs baseline); irritability score declined from 130 to 70 (P < .001 vs baseline). Crying easily and sadness decreased by a score of 41 and 51 to a score of 30 and 31, respectively (P < .001). For disturbed relationships, the score decreased from 150 to 70 (P < .001). Conversely, no appreciable changes were noted in symptom intensity from patients of group 2. The frequency of adverse events (nausea and constipation) was not different between participants of group 1 and group 2. CONCLUSION On the basis of the present findings, vitamin D therapy can be proposed as a safe, effective, and convenient method for improving the quality of life in young women with severe hypovitaminosis D and concomitant mood disorders associated with PMS.
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Affiliation(s)
- Massimo Tartagni
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Vittoria Cicinelli
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | | | - Hala Alrasheed
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy
| | - Maria Matteo
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Baldini
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy
| | - Maria De Salvia
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
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Mastrolia SA, Novack L, Thachil J, Rabinovich A, Pikovsky O, Klaitman V, Loverro G, Erez O. LMWH in the prevention of preeclampsia and fetal growth restriction in women without thrombophilia. A systematic review and meta-analysis. Thromb Haemost 2016; 116:868-878. [PMID: 27440387 DOI: 10.1160/th16-02-0169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Abstract
Placental mediated pregnancy complications such as preeclampsia and fetal growth restriction (FGR) are common, serious, and associated with increased morbidity and mortality. We conducted a systematic review and meta-analysis to determine the effect of treatment with low-molecular-weight heparins (LMWHs) for secondary prevention of these complications in non thrombophilic women. We searched the electronic databases PubMed, Scopus, and Cochrane Library for randomised controlled trials addressing this question. Five studies including 403 patients met the inclusion criteria, 68 developed preeclampsia and 118 FGR. The studies were very heterogeneous in terms of inclusion criteria, LMWH preparation, and dosage. Meta-analyses were performed using random-effect models. The overall use of LMWHs was associated with a risk reduction for preeclampsia (Relative risk (RR) 0.366; 95 % confidence interval (CI), 0.219-0.614) and FGR (RR 0.409; 95 % CI, 0.195-0.932) vs. no treatment. From the data available for analysis it appears that the use of Dalteparin is associated with a risk reduction for preeclampsia (p=0.002) and FGR (p<0.001); while Enoxaparin is associated with risk reduction for preeclampsia (p=0.013) but not for FGR (p=0.3). In spite of the small number of studies addressing the research question, and the high variability among them, our meta-analysis found a modest beneficial effect of LMWH for secondary prevention of preeclampsia and FGR. Further studies are needed to address these questions before a definite conclusion can be reached.
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Affiliation(s)
| | | | | | | | | | | | | | - Offer Erez
- Prof. Offer Erez, MD, Acting Director Maternity Department D and Obstetrical Day care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, P. O.Box 151, 84101, Beer Sheva, Israel, Tel.: +972 8 6400061, E-mail
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Mastrolia SA, Erez O, Loverro G, Di Naro E, Weintraub AY, Tirosh D, Baron J, Hershkovitz R. Ultrasonographic approach to diagnosis of fetal inflammatory response syndrome: a tool for at-risk fetuses? Am J Obstet Gynecol 2016; 215:9-20. [PMID: 26821337 DOI: 10.1016/j.ajog.2016.01.164] [Citation(s) in RCA: 8] [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: 11/02/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 12/11/2022]
Abstract
Preterm parturition is a syndrome that may result from many underlying mechanisms. Infection and inflammation are the prominent ones. Intrauterine infection and inflammation have an effect akin to sepsis, and that is similar to systemic inflammatory response in adults. Indeed, there is evidence to support the association of a fetal inflammatory response syndrome (FIRS) to systemic infection and inflammation. The utilization of invasive procedures for the prenatal diagnosis of FIRS is associated with a risk for complications resulting from the invasive method. The progress in the imaging quality of obstetrical ultrasound and the development of novel methods for functional anatomical assessment of the fetal organs may help to identify, noninvasively, fetuses at risk for FIRS in patients presenting with preterm labor. We review the studies describing advanced sonographic modalities and the imaging findings in the heart, thymus, kidney, adrenal glands, and spleen of these fetuses.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro," Bari, Italy; US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Offer Erez
- Maternity Department D and Obstetrical Day Care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro," Bari, Italy
| | - Edoardo Di Naro
- US Unit, Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro," Bari, Italy
| | - Adi Yehuda Weintraub
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Tirosh
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Baron
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reli Hershkovitz
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Pellegrino A, Damiani GR, Mangioni C, Strippoli D, Loverro G, Cappello A, Turoli Scd D, Corso S, Tartagni M, Pezzotta MG. Outcomes of Bleomycin-based electrochemotherapy in patients with repeated loco-regional recurrences of vulvar cancer. Acta Oncol 2016; 55:619-24. [PMID: 26882959 DOI: 10.3109/0284186x.2015.1117134] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective To evaluate the safety, local tumor efficacy and relief of symptoms of electrochemotherapy (ECT) treatment in patients affected by recurrence of vulvar cancer (VC), unsuitable for standard treatments. Methods Ten patients were recruited with histological diagnosis of recurrence of VC. Intravenous bleomycin was injected, after an accurate mapping of all lesions and ECT was performed. Response to therapy was evaluated and quality of life (QoL) was evaluated via questionnaires. Results Diagnosis stage of primary tumors, according to the FIGO system, was: four patients respectively at stage IB (40%), and at stage II (40%), one patient at stage IIIA (10%), one patient with Paget cancer (10%). Mean age was 76 years (SD ± 7) at time of enrollment. Eight patients (80%) were previously submitted to surgery and/or radio-chemotherapy. Mean treatment time was 20 (range 10-20) min. After a median follow-up of 12 (3-22) months, six patients (60%) were alive. Conclusions Objective responses (ORs) with local control of the tumor were obtained in 80%. After a mean follow-up of 12 (3-22) months six patients (60%) were alive. The favorable outcome of this study, indicates that ECT is a reliable treatment option that may improve their functioning, thus enhancing the care provided in the palliative setting.
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Affiliation(s)
- Antonio Pellegrino
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Gianluca Raffaello Damiani
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Di Lodi, Milan, Italy
- Department of dermatology, Alessandro Manzoni Hospital, Lecco, Italy
- Alessandro Manzoni Hospital, Lecco, Italy
| | - Costantino Mangioni
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Davide Strippoli
- Department of dermatology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, University of Bari, Italy
| | - Antonio Cappello
- Department of Radiology, Alessandro Manzoni Hospital, Lecco, Italy
| | | | - Silvia Corso
- Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Massimo Tartagni
- Department of Obstetrics and Gynecology, University of Bari, Italy
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Mastrolia SA, Baumfeld Y, Loverro G, Yohai D, Hershkovitz R, Weintraub AY. Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study. J Matern Fetal Neonatal Med 2016; 29:3467-71. [PMID: 26653989 DOI: 10.3109/14767058.2015.1131264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/13/2022]
Abstract
INTRODUCTION The aim of our study was to compare maternal and neonatal outcomes in women with placenta previa complicated with severe bleeding leading to hospitalization until delivery versus those without severe bleeding episodes. METHODS This is a population-based retrospective cohort study including all pregnant women with placenta previa who delivered at our medical center in the study period, divided into the following groups: 1) women with severe bleeding leading to hospitalization resulting with delivery (n = 32); 2) patients with placenta previa without severe bleeding episodes (n = 1217). RESULTS Out of all women with placenta previa who delivered at our medical center, 2.6% (32/1249) had an episode of severe bleeding leading to hospitalization and resulting with delivery. The rate of anemia was lower (43.8% versus 63.7%, p = 0.02) while the need for blood transfusion higher (37.5% versus 21.1%, p = 0.03) in the study group. The rate of cesarean sections was significantly different between the groups, and a logistic regression model was constructed in order to find independent risk factors for cesarean section in our patients. CONCLUSION To the best of our knowledge, this is the first study to evaluate the impact of severe bleeding on the outcome of pregnancies complicated with placenta previa. Our study demonstrates that, in women with placenta previa, severe bleeding does not lead to increased adverse maternal or neonatal outcomes.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and.,b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - Yael Baumfeld
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Giuseppe Loverro
- b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - David Yohai
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Reli Hershkovitz
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Adi Yehuda Weintraub
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
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19
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Carriero C, Dellino M, Campanelli FD, Licchelli M, Loverro G. Psychosexual Assessment of Transgender Individuals during the Sex Reassignment Process: Sexual Desire, Activity, and Satisfaction. Health (London) 2016. [DOI: 10.4236/health.2016.811111] [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: 11/20/2022]
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20
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Tartagni M, Matteo M, Baldini D, Tartagni MV, Alrasheed H, De Salvia MA, Loverro G, Montagnani M. Males with low serum levels of vitamin D have lower pregnancy rates when ovulation induction and timed intercourse are used as a treatment for infertile couples: results from a pilot study. Reprod Biol Endocrinol 2015; 13:127. [PMID: 26589555 PMCID: PMC4654914 DOI: 10.1186/s12958-015-0126-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Vitamin D (Vit D) is important for the regulation of reproductive physiology. In humans, maternal Vit D deficiency has been implicated in several reproductive- and pregnancy-related disorders. Very few data are available regarding the Vit D status in male partners of couples attempting pregnancy. This observational study (IRB Prot. N. 078/13) aimed to evaluate whether low Vit D serum levels in males might decrease the rate of successful conception in couples attempting pregnancy. METHODS Male and female partners of infertile couples (n = 102) were classified into 2 GROUPS according to normal (≥30 ng/ml) or low (below 30 ng/ml) serum Vit D levels in male partners. Semen analysis was performed in each male participant based on the WHO reference criteria. The female partners of both groups were subjected to 3 consecutive cycles of gonadotropin-induced mono-ovulation. The main outcome measures included the clinical pregnancy rate, delivery per patient and per cycle, and miscarriage rate between the 2 groups evaluated at the end of the three-month period of the study. RESULTS In male partners of both groups, standard semen analysis did not highlight substantial differences in sperm concentration, sperm progressive motility, or typical form. The pregnancy rates per patient and per cycle and delivery rates per patient and per cycle were all significantly higher (p< 0.05) in couples with normal Vit D levels. CONCLUSIONS These results suggest the existence of a relationship between male Vit D serum levels and semen ability to begin a pregnancy during cycles of timed vaginal intercourse.
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Affiliation(s)
- Massimo Tartagni
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria Matteo
- University Department of Gynecology and Obstetrics - Ospedali Riuniti di Foggia, Viale Pinto, 71100, Foggia, Italy.
| | - Domenico Baldini
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Mario V Tartagni
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Hala Alrasheed
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Maria A De Salvia
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
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Damiani GR, Riva D, Pellegrino A, Gaetani M, Tafuri S, Turoli D, Croce P, Loverro G. Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments. J OBSTET GYNAECOL 2015; 36:410-5. [PMID: 26492359 DOI: 10.3109/01443615.2015.1086990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
117 women with severe pelvic organ prolapse (POP; stage > 2) were enrolled to elucidate a 24-month outcome of POP surgery, using conventional or mesh repair with 3 techniques. 59 patients underwent conventional repair and 58 underwent mesh repair. Two types of mesh were used: a trocar-guided transobturator polypropylene (Avaulta, Bard Inc.) and a porcine dermis mesh (Pelvisoft, Bard Inc.). Women with recurrences, who underwent previous unsuccessful conventional repair, were randomised. Primary outcome was the evaluation of anatomic failures (prolapse stage > 1) in treated and untreated compartments. Anatomic failure was observed in 11 of 58 patients (19%; CI 8.9-29) in the mesh group and in 16 of 59 patients (27.1%; p value = 0.3) in the conventional group. 9 of 11 failures in the mesh group (15.5%; CI 6.2-24.8) were observed in the untreated compartment (de novo recurrences), 14.3% in Pelvisoft and 16.7% in Avaulta arm, while only 1 recurrence in the untreated compartment (1.7%) was observed in the conventional group (odds ratio 10.6, p = 0.03).
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Affiliation(s)
- G R Damiani
- a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy.,b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy.,c Department of Obstetrics and Gynecology , Azienda Ospedaliera di Lodi , Italy.,d Ospedale Manzoni Lecco , via dell' eremo 9/11 Lecco, Lecco , Italy
| | - D Riva
- e Department of Obstetrics and Gynecology , Cantu'-Sant Anna Hospital , Como , Italy
| | - A Pellegrino
- a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy
| | - M Gaetani
- b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy
| | - S Tafuri
- f Department of Biomedical Sciences , Hygiene Section, University of Bari Aldo Moro , Policlinico, Bari , Italy
| | - D Turoli
- a Department of Obstetrics and Gynecology , Manzoni Hospital , Lecco , Italy
| | - P Croce
- g Department of Obstetrics and Gynecology , Azienda Ospedaliera di Lodi , Italy
| | - G Loverro
- b Department of Obstetrics and Gynecology , University of Bari Aldo Moro , Policlinico, Bari , Italy
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Silvestris E, D'Oronzo S, Cafforio P, D'Amato G, Loverro G. Perspective in infertility: the ovarian stem cells. J Ovarian Res 2015; 8:55. [PMID: 26250560 PMCID: PMC4528806 DOI: 10.1186/s13048-015-0184-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
Infertility is a medical and social condition that affects millions of women worldwide and is today considered so far as a new disease. A considerable progress has been recently pursued in the field of the reproductive medicine and the infertility treatment may account for novel and modern procedures such as in vitro oocyte fertilization, egg donation, pregnancy surrogacy and preimplantation diagnosis. However, great interest has lately been reserved to the ovarian stem cells (OSCs) whose existence in woman ovaries has been proven. OSCs are thus suitable for developmental studies in infertility and in other clinical applications as endocrine derangements due to premature ovarian failure, or for infertility treatment after cancer chemotherapies, as well as in restoring the hormonal balance in postmenopausal age.
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Affiliation(s)
- Erica Silvestris
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari 'Aldo Moro', P.za Giulio Cesare, 11, Bari, 70124, Italy.
| | - Stella D'Oronzo
- Department of Biomedical Sciences and Human Oncology, Division of Molecular Oncology, University of Bari 'Aldo Moro', Conversano, Bari, Italy.
| | - Paola Cafforio
- Department of Biomedical Sciences and Human Oncology, Division of Molecular Oncology, University of Bari 'Aldo Moro', Conversano, Bari, Italy.
| | - Giuseppe D'Amato
- Department of Biomedical Sciences and Human Oncology, ASL Bari, PT Jaia, Reproduction and IVF Unit, University of Bari 'Aldo Moro', Conversano, Bari, Italy.
| | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari 'Aldo Moro', P.za Giulio Cesare, 11, Bari, 70124, Italy.
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Damiani GR, Pellegrino A, Gaetani M, Loverro G, Loverro MT. Acute spinal cord compression in the third trimester of pregnancy. Minerva Ginecol 2015; 67:386-387. [PMID: 25300767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- G R Damiani
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy -
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Loverro G, Di Naro E, Caringella AM, De Robertis AL, Loconsole D, Chironna M. Prevalence of human papillomavirus infection in a clinic sample of transsexuals in Italy. Sex Transm Infect 2015. [PMID: 26203116 DOI: 10.1136/sextrans-2014-051987] [Citation(s) in RCA: 24] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Detectable human papillomavirus (HPV) DNA is the most common sexually transmitted infection. Reports on the prevalence of detectable HPV DNA among transsexuals (not sex workers) are scarce. The objective of the study was to determine the prevalence of detectable HPV DNA in a clinic sample of transsexuals and to assess the relationship between detectable HPV DNA and cytological outcomes. METHODS Clinical samples (oral, anal, vaginal, cervicovaginal and penile scraped cells) from 35 transsexuals (surgically treated and surgically untreated) who attended the outpatient Clinic of Gender Identity Dysphoria of the Department of Obstetrics and Gynecology of Policlinico Hospital (Bari, Italy) were collected for cytological analysis and HPV DNA detection and typing. All enrolled subjects answered an anonymous structured questionnaire about their sexual habits. Serological status for other sexually transmitted diseases (hepatitis B virus (HBV), hepatitis C virus (HCV), HIV and syphilis) was also evaluated. RESULTS HPV DNA was detected in 14 of 35 patients (40.0%). The prevalence of detectable HPV DNA was 38.2% (13/34) in tested anal samples, 9.1% (2/22) in vaginal samples and 8.3% (1/12) in penile samples. Oncogenic HPV genotypes have been detected in 93% of HPV-positive transsexuals. More than one-third (35.7%) of HPV-positive transsexuals were infected with at least one of the four vaccine-preventable genotypes, 6, 11, 16 and 18. CONCLUSIONS The high rate of detectable HPV DNA by oncogenic types suggests that periodic cytological screening and clinical evaluation may be necessary since transsexuals are at high risk of anogenital cancer. Also promoting HPV vaccination in younger subjects may be advisable.
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Affiliation(s)
- Giuseppe Loverro
- Section of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
| | - Edoardo Di Naro
- Section of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
| | - Anna Maria Caringella
- Section of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
| | - Anna Lisa De Robertis
- Section of Hygiene, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
| | - Daniela Loconsole
- Section of Hygiene, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
| | - Maria Chironna
- Section of Hygiene, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro-Policlinico, Bari, Italy
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Mastrolia SA, Weintraub AY, Sciaky-Tamir Y, Tirosh D, Loverro G, Hershkovitz R. Placental calcifications: a clue for the identification of high-risk fetuses in the low-risk pregnant population? J Matern Fetal Neonatal Med 2015; 29:921-7. [DOI: 10.3109/14767058.2015.1023709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ciavarella S, Caselli A, Tamma AV, Savonarola A, Loverro G, Paganelli R, Tucci M, Silvestris F. A peculiar molecular profile of umbilical cord-mesenchymal stromal cells drives their inhibitory effects on multiple myeloma cell growth and tumor progression. Stem Cells Dev 2015; 24:1457-70. [PMID: 25758779 DOI: 10.1089/scd.2014.0254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are under intensive investigation in preclinical models of cytotherapies against cancer, including multiple myeloma (MM). However, the therapeutic use of stromal progenitors holds critical safety concerns due to their potential MM-supporting activity in vivo. Here, we explored whether MSCs from sources other than BM, such as adipose tissue (AD-MSCs) and umbilical cord (UC-MSCs), affect MM cell growth in comparison to either normal (nBM-MSCs) or myelomatous marrow MSCs (MM-BM-MSCs). Results from both proliferation and clonogenic assays indicated that, in contrast to nBM- and MM-BM-MSCs, both AD and particularly UC-MSCs significantly inhibit MM cell clonogenicity and growth in vitro. Furthermore, when co-injected with UC-MSCs into mice, RPMI-8226 MM cells formed smaller subcutaneous tumor masses, while peritumoral injections of the same MSC subtype significantly delayed the tumor burden growing in subcutaneous plasmocytoma-bearing mice. Finally, both microarrays and ELISA revealed different expression of several genes and soluble factors in UC-MSCs as compared with other MSCs. Our data suggest that UC-MSCs have a distinct molecular profile that correlates with their intrinsic anti-MM activity and emphasize the UCs as ideal sources of MSCs for future cell-based therapies against MM.
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Affiliation(s)
- Sabino Ciavarella
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Anna Caselli
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Antonella Valentina Tamma
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Annalisa Savonarola
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Giuseppe Loverro
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Roberto Paganelli
- 2Department of Medicine and Sciences of Aging, Ce.S.I. Center for Aging Studies, Stem TECH Group, University "G. D'Annunzio," Chieti Scalo, Italy
| | - Marco Tucci
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Franco Silvestris
- 1Section of Medical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
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Tartagni M, Cicinelli MV, Baldini D, Tartagni MV, Alrasheed H, DeSalvia MA, Loverro G, Montagnani M. Dehydroepiandrosterone decreases the age-related decline of the in vitro fertilization outcome in women younger than 40 years old. Reprod Biol Endocrinol 2015; 13:18. [PMID: 25884390 PMCID: PMC4355976 DOI: 10.1186/s12958-015-0014-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With infertility populations rapidly aging, treatments improving pregnancy chances assume increasing clinical importance. Dehydroepiandrosterone (DHEA) has been reported to improve pregnancy rates and lower miscarriage rates in women with diminished ovarian function. This study was planned to evaluate whether pretreatment with DHEA may improve in vitro fertilization (IVF) parameters and pregnancy outcomes in infertile women with advanced reproductive age and normal ovarian reserve. METHODS In this double-blind, randomized, placebo-controlled study, 109 infertile patients aging 36-40 years old were selected to undergo the long protocol IVF. Eight weeks before starting the IVF cycle and during treatment, patients in Group 1 received 75 mg of DHEA once a day; patients in control group (Group 2) received placebo. The primary endpoint of the study was number of clinical pregnancy, live birth and miscarriage rates; secondary endpoint was modification of standard IVF parameters, including stimulation duration (days of rhFSH administration), E2 on HCG-day, endometrial thickness, number of retrieved oocytes, metaphase II oocytes, number of transferred embryos and score of leading embryos transferred. RESULTS Patients in the DHEA group had a significantly higher live birth rate compared with controls (P<0.05). Conversely, miscarriage rate was higher for patients in the control group (P<0.05). CONCLUSIONS DHEA supplementation may significantly improve IVF outcomes in infertile women with advanced reproductive age and normal ovarian reserve.
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Affiliation(s)
- Massimo Tartagni
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria V Cicinelli
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Domenico Baldini
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Mario V Tartagni
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Hala Alrasheed
- Centro di Fecondazione Medicalmente Assistita MoMò Fertilife, Bisceglie, Italy.
| | - Maria A DeSalvia
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
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Tartagni M, De Pergola G, Damiani GR, Pellegrino A, Baldini D, Tartagni MV, Alrasheed H, De Salvia MA, Loverro G. Potential benefit of dehydroepiandrosterone supplementation for infertile but not poor responder patients in a IVF program. Minerva Ginecol 2015; 67:7-12. [PMID: 24867068] [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: 06/03/2023]
Abstract
AIM The aim of this paper was to evaluate the hypothesis that pretreatment with dehydroepiandrosterone (DEHA) may improve the result on in vitro fertilization (IVF) and the pregnancy outcome among infertile women with normal ovarian reserve. METHODS Double-blind, randomized, placebo-controlled study; 52 infertile patients received the long protocol IVF. Patients in Group 1, received 75 mg of DHEA once a day, 8 weeks before starting the IVF cycle and during treatment; control group (Group 2) received placebo. The primary endpoint was pregnancy, live birth and miscarriage rates, secondary endpoint was standard IVF parameters such us stimulation duration (hCG day), E2 on HCG-day, endometrial thickness, number of retrieved oocytes, metaphase II oocytes, embryos transferred and score of leading embryos transferred. RESULTS Patients in the DHEA group had a significantly higher live birth rate compared with controls (P<0.05). Miscarriage rate was higher in control group (P<0.05). CONCLUSION DHEA supplementation could have a beneficial effect on IVF outcome in infertile women with normal ovarian reserve.
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Affiliation(s)
- M Tartagni
- Dimo gynecology and Pharmacology Section University of Bari, Policlinico, Bari, Italy -
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29
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Mastrolia SA, Weintraub AY, Baron J, Sciaky-Tamir Y, Koifman A, Loverro G, Hershkovitz R. Antenatal diagnosis of idiopathic arterial calcification: a systematic review with a report of two cases. Arch Gynecol Obstet 2014; 291:977-86. [DOI: 10.1007/s00404-014-3567-z] [Citation(s) in RCA: 6] [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] [Received: 10/06/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
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Mastrolia SA, Mazor M, Loverro G, Klaitman V, Erez O. Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromes. PeerJ 2014; 2:e653. [PMID: 25426334 PMCID: PMC4243334 DOI: 10.7717/peerj.653] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/14/2014] [Indexed: 12/12/2022] Open
Abstract
Obstetrical complications including preeclampsia, fetal growth restriction, preterm labor, preterm prelabor rupture of membranes and fetal demise are all the clinical endpoint of several underlying mechanisms (i.e., infection, inflammation, thrombosis, endocrine disorder, immunologic rejection, genetic, and environmental), therefore, they may be regarded as syndromes. Placental vascular pathology and increased thrombin generation were reported in all of these obstetrical syndromes. Moreover, elevated concentrations of thrombin-anti thrombin III complexes and changes in the coagulation as well as anticoagulation factors can be detected in the maternal circulation prior to the clinical development of the disease in some of these syndromes. In this review, we will assess the changes in the hemostatic system during normal and complicated pregnancy in maternal blood, maternal–fetal interface and amniotic fluid, and describe the contribution of thrombosis and vascular pathology to the development of the great obstetrical syndromes.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Azienda Ospedaliera-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy ; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - Vered Klaitman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev , Beer Sheva , Israel
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Damiani GR, Landi S, Pellegrino A, Loverro G, Farina A, Cormio G. Caesarean scar pregnancy complicated by placenta percreta followed by suppurative appendicitis after conservative management with methotrexate. J OBSTET GYNAECOL 2014; 34:545-6. [PMID: 25072924 DOI: 10.3109/01443615.2014.920784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G R Damiani
- Department of Obstetrics and Gynecology, University of Bari , Policlinico of Bari
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Loverro G, Di Naro E, Mastrolia SA, Caringella AM, Vicino M. Presacral Retroperitoneal Teratoma in a 24-Year-Old Woman. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe Loverro
- Second Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Edoardo Di Naro
- Second Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | | | | | - Mario Vicino
- Second Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Tartagni MV, Alrasheed H, Damiani GR, Montagnani M, De Salvia MA, De Pergola G, Tartagni M, Loverro G. Intermittent low-dose finasteride administration is effective for treatment of hirsutism in adolescent girls: a pilot study. J Pediatr Adolesc Gynecol 2014; 27:161-5. [PMID: 24559619 DOI: 10.1016/j.jpag.2013.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Received: 07/09/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Hirsutism has negative impact on adolescent psychosocial development for both cosmetic and endocrine reasons. This study evaluated the effectiveness of a new intermittent, low-dose finasteride regimen consisting of 2.5 mg of drug given every 3 days (1 day of treatment, 2 days of drug withdrawal) for 6 months in girls with hirsutism by polycystic ovarian syndrome (PCOS) or idiopathic hirsutism (IH). DESIGN AND PARTICIPANTS Twenty-eight girls (15-19 y old) with hirsutism were randomly assigned to 2 treatment groups and treated for 6 months. Fourteen patients (7 with IH, 7 with PCOS) received finasteride; fourteen patients (7 with IH, 7 with PCOS) received placebo. Hirsutism score (HS), clinical, and hormonal effects were compared between the 2 groups. RESULTS In patients treated with finasteride, the HS value at 6 months was 52.9% lower than that observed at baseline in girls with IH, and 52.8% lower in girls with PCOS (P < .0001 for both). Similarly, the 3α-17 β-androstenediol glucuronide serum levels were decreased by 34.8% in patients with IH, and by 47.5% in patients with PCOS (P < .0001, respectively). Finasteride treatment was well tolerated and did not alter values of BMI, serum levels of sexual hormones, metabolic parameters related to liver and kidney function as well as glycemic and lipidic asset. CONCLUSIONS A low-dose of finasteride, given every 3 days, reduces the HS in young patients affected by PCOS or IH. Compared with conventional continuous finasteride administration, the intermittent low-dose regimen has similar efficacy with the advantage to be safer and less expensive.
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Affiliation(s)
| | - Hala Alrasheed
- Faculty of Medicine, University of Kosice, Kosice, Slovakia
| | - Gianluca R Damiani
- Department of Obstetrics and Gynecology, Hospital of Sondrio, Sondrio, Italy
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria A De Salvia
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni De Pergola
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Massimo Tartagni
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Pellegrino A, Damiani GR, Landi S, Tartagni M, Tafuri S, Caringella A, Sportelli C, Gaetani M, Loverro G. Pivotal points in interstitial pregnancy: New insights in conservative medical treatment of non-ruptured interstitial pregnancy. J OBSTET GYNAECOL 2013; 34:93-5. [DOI: 10.3109/01443615.2013.789834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Pellegrino
- Department of Obstetrics and Gynecology, Malzoni Hospital , Lecco
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Damiani GR, Landi S, Tartagni M, Bettocchi S, Loverro G, Pellegrino A. Cornual pregnancy after surgical treatment of an incarcerated fallopian tube: a case report. J Reprod Med 2013; 58:550-552. [PMID: 24568053] [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: 06/03/2023]
Abstract
BACKGROUND Incarceration of the fallopian tube is a rare condition. Symptoms are often misleading, making proper diagnosis difficult because of nonspecific clinical presentations. We report a case of cornual pregnancy occurring 7 months after the treatment of an incarcerated fallopian tube. We believe that the abnormal cornual implantation of the gestational sac was due to myometrial reconstruction of the uterine wall. CASE A primigravid woman treated for the incarceration of a fallopian tube was subsequently found to have a cornual pregnancy in a septate uterus. The cornual pregnancy was successfully aborted after laparoscopic myometrial reconstruction, and a metroplasty allowed a subsequent pregnancy. CONCLUSION This hazardous type of ectopic pregnancy can be managed with systemic administration of methotrexate. If the cornual pregnancy is correctly identified at an early stage, this medical management can be attempted and offers the potential advantage of avoiding surgery and increasing the likelihood of preserving fertility.
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Affiliation(s)
| | - Stefano Landi
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy
| | - Massimo Tartagni
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy
| | - Stefano Bettocchi
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Bari, Italy
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Damiani GR, Landi S, D'Addario V, Spellecchia D, Loverro G, Pellegrino A. Pivotal points to prevent iatrogenic infections triggered by hysteroscopy. Aust N Z J Obstet Gynaecol 2013; 53:99-100. [PMID: 23406001 DOI: 10.1111/ajo.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tartagni M, Cicinelli E, Schonauer MM, Causio F, Petruzzelli F, Loverro G. Males With Subnormal Hypo-Osmotic Swelling Test Scores Have Lower Pregnancy Rates Than Those With Normal Scores When Ovulation Induction and Timed Intercourse Is Used as a Treatment for Mild Problems With Sperm Count, Motility, or Morphology. ACTA ACUST UNITED AC 2013; 25:781-3. [PMID: 15292111 DOI: 10.1002/j.1939-4640.2004.tb02856.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/07/2022]
Abstract
This study was designed to evaluate the effectiveness and clinical usefulness of the hypo-osmotic swelling (HOS) test in predicting successful conception in couples in which men with mild male-factor infertility criteria were undergoing a timed vaginal inter-course protocol. One hundred couples, in which mild male infertility was the only abnormality, were included in the study. Semen was analyzed according to standard World Health Organization (WHO) criteria and subjected to the HOS test. Patients were divided into 2 groups: group 1 (n=39) with normal HOS test and group 2 (n=61) with abnormal HOS test. All women underwent three consecutive cycles of follicular growth ultrasound monitoring and timed intercourse. Ten couples were exclude from the study. Ten clinical pregnancies were achieved in group 1 with a pregnancy rate per patient and per cycle of 28.5% and 9.5%, respectively. In group 2, 6 pregnancies were achieved, with a pregnancy rate per patient and per cycle of 10.9% and 3.6%, respectively. Both pregnancy rates per patients and per cycle was significantly higher (P <.05) in group 1 than in group 2. The HOS test may be considered an easy and reliable test in identifying among subfertile men those who have a greater possibility of causing pregnancy.
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Affiliation(s)
- Massimo Tartagni
- Clinica Ostetrica e Ginecologica III, Università di Bari, Policlinico di Bari, Piazza Giulio Cesare, 70124 Bari, Italy.
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Ribatti D, Loverro G, Vacca A, Greco P, Vimercati A, Roncali L, Selvaggi L. Correlative study of angiogenesis in endometrial cancer assessed by the color Doppler ultrasound and by the chick embryo chorioallantoic membrane. Int J Oncol 2012; 11:1191-5. [PMID: 21528321 DOI: 10.3892/ijo.11.6.1191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Angiogenesis is required for both tumor growth and progression and the degree of vascularization seems to correlate with prognosis in several human tumors including uterine malignant neoplasms. In this study we have investigated if three Doppler parameters, such as peak systolic velocity (PSV), resistance index (RI) and pulsatily index (PI), measured in patients with endometrial cancer, were correlated to the angiogenic response induced by grafting of bioptic specimens obtained from the same patients onto the chick embryo chorioallantoic membrane (CAM), a useful in vivo model for such an investigation. Results showed that only PSV was directly correlated to the degree of angiogenesis measured by means of the CAM assay. Moreover, these two parameters were also directly correlated to the malignancy grade of the disease.
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Affiliation(s)
- D Ribatti
- UNIV BARI,SCH MED,INST HUMAN ANAT HISTOL & EMBRYOL,I-70124 BARI,ITALY. UNIV BARI,SCH MED,INST OBSTET & GYNECOL,I-70124 BARI,ITALY. UNIV BARI,SCH MED,DEPT BIOMED SCI & HUMAN ONCOL,I-70124 BARI,ITALY
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Damiani GR, Loverro G, Tagliabue R, Riva D, Gaetani M, Maggi R. Recurrence of Paget's disease: total vaginal occlusion and partial occlusion of urethra. Acta Obstet Gynecol Scand 2012; 91:1125-6. [PMID: 22525049 DOI: 10.1111/j.1600-0412.2012.01424.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Damiani GR, Seghezzi U, Gaetani M, Riva D, Tartagni M, Loverro G. Intrauterine bone fragments and endometrial plaque of osseous metaplasia. Acta Obstet Gynecol Scand 2012; 91:1001. [PMID: 22375815 DOI: 10.1111/j.1600-0412.2012.01388.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caringella AM, Di Naro E, Loverro G. [Clinical function of estrogen receptors in endometrial cancer]. Minerva Ginecol 2011; 63:495-504. [PMID: 22036754] [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: 05/31/2023]
Abstract
Approximately 70-80% of endometrial carcinomas, type I carcinomas, are associated with endometrial hyperplasia, hyperestrogenism, and expression of estrogen receptor (ER). The aim of this review was to clarify the role of ER in endometrial diseases carcinoma. The estrogens exert their effect via two estrogen receptor: α and β. The ERs modulate transcriptional process by binding directly to the estrogen response elements (ERE) located in the target gene, or in non classical mode through protein-protein tethering with other transcription factors. There are also orphan receptors (their natural ligands have not been identified). Among this group, estrogen receptor-related receptors (ERRs) were identified by their sequences similar to those of ERs. Since the ERRs have shown a high similarity in DNA binding domain with ERs can interfere with estrogen signalling strengthening the hypothesis of an estrogen-ER-ERR crosstalk. Recently, the ERs and estrogen enzymes emerge as pharmacological targets in different disorders, as well as ERRs, and they may represent the reliable biomarkers in endometrial disease.
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Affiliation(s)
- A M Caringella
- Dipartimento di Ginecologia, Ostetricia e Neonatologia Università degli Studi di Bari, Bari, Italia.
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Cavallini A, Resta L, Caringella AM, Dinaro E, Lippolis C, Loverro G. Involvement of estrogen receptor-related receptors in human ovarian endometriosis. Fertil Steril 2011; 96:102-6. [PMID: 21561608 DOI: 10.1016/j.fertnstert.2011.04.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/26/2011] [Accepted: 04/08/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether decreased estrogen receptor alpha (ER-α) expression in endometriotic lesions could be balanced by an increased expression of estrogen receptor-related receptors (ERRs). To evaluate whether ERR-α expression is influenced by hormonal change in fertile and menopausal women. DESIGN Prospective controlled study. SETTING University Hospital, Department of Gynecology. PATIENT(S) Twenty-five women: 20 women of reproductive age with (n = 10) and without (control; n = 10) endometriosis and 5 menopausal women. INTERVENTION(S) Real-time polymerase chain reaction (qPCR). Immunohistochemistry. MAIN OUTCOME MEASURE(S) The ER and ERR expression levels were studied by reverse transcriptase-qPCR, ELISA, and immunohistochemistry using endometriotic and normal endometrial tissues. The ERR-α protein distribution was performed by immunohistochemistry in fertile and menopausal women. RESULT(S) Increased levels of ER-β were associated with ER-α, ERR-α, and ERR-γ reductions in ectopic tissue but not in eutopic and normal endometria. Similar levels of ERR-β were found in women with and without endometriosis. The ERR-α expression was similar in proliferative and secretory endometrial samples, whereas a down-regulation of this receptor was found in atrophic tissue. CONCLUSION(S) Our data confirm the up-regulation of ER-β as the principal receptor involved in the progression of human endometriosis. In addition, we found that ERR-α seems to be unresponsive to hormonal changes during the menstrual cycle.
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Affiliation(s)
- Aldo Cavallini
- Laboratory of Biochemistry, National Institute for Digestive Diseases, I.R.C.C.S. Saverio de Bellis, Castellana Grotte, Bari, Italy.
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Damiani GR, Tartagni M, Crescini C, Persiani P, Loverro G, Von Wunster S. Intussusception and Incarceration of a Fallopian Tube: Report of 2 Atypical Cases, with Differential Considerations, Clinical Evaluation, and Current Management Strategies. J Minim Invasive Gynecol 2011; 18:246-9. [PMID: 21354072 DOI: 10.1016/j.jmig.2010.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/17/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
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Loverro G, De Pergola G, Di Naro E, Tartagni M, Lavopa C, Caringella AM. Predictive value of ovarian stroma measurement for cardiovascular risk in polycyctic ovary syndrome: a case control study. J Ovarian Res 2010; 3:25. [PMID: 21062435 PMCID: PMC2999603 DOI: 10.1186/1757-2215-3-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres (echogenicity and volume) with hyperandrogenism, and both cardiovascular and metabolic risk factors in PCOS. METHODS Twenty four young PCOS patients and twelve age-matched control women were enrolled. Diagnosis of PCOS was based on the Rotterdam criteria. Ultrasound ovarian study included ovarian volume, stromal volume, stromal area and stromal area/total ovarian area ratio (S/A). Concerning hormones, insulin, LH, FSH, estradiol, androstenedione, testosterone, DHEAS, 17-hydroxy-progesterone, and SHBG were measured during the early follicular phase (days 2-5). Cardiovascular risk factors were represented by fasting plasma levels of glucose, lipids (total and HDL-cholesterol), plasminogen activator inhibitor 1 (PAI-1), von-Willebrand factor (vWF), and adiponectin. Carotid intima-media thickness (C-IMT) was measured as a parameter of cardiovascular risk. RESULTS A positive correlation between the S/A ratio and plasma levels of testosterone (p < 0.05) and androstenedione (p < 0.05) was found. The stromal volume, stromal area and S/A ratio were also significantly and positively correlated with PAI-1, and vWF levels, and with IMT in PCOS women (P < 0.05). CONCLUSIONS This study shows that the ultrasound measurement of ovarian stroma is a predicting factor of hyperandrogenism degree, prothrombotic factors and cardiovascular risk in patients with PCOS.
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Affiliation(s)
- Giuseppe Loverro
- Clinic of Obstetrics and Gynecology III, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Giovanni De Pergola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease. Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Edoardo Di Naro
- Clinic of Obstetrics and Gynecology III, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Massimo Tartagni
- Clinic of Obstetrics and Gynecology III, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Cristina Lavopa
- Clinic of Obstetrics and Gynecology III, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Anna Maria Caringella
- Clinic of Obstetrics and Gynecology III, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy
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Tartagni M, Cicinelli E, De Pergola G, Lavopa C, Di Naro E, De Salvia MA, Loverro G. Effect of finasteride on ovulation induction in nonresponder (hyperandrogenic) polycystic ovary syndrome (PCOS) women. Fertil Steril 2010; 94:247-9. [DOI: 10.1016/j.fertnstert.2009.01.150] [Citation(s) in RCA: 6] [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: 04/21/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/24/2022]
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Matrone A, Grossi V, Chiacchiera F, Fina E, Cappellari M, Caringella AM, Di Naro E, Loverro G, Simone C. p38alpha is required for ovarian cancer cell metabolism and survival. Int J Gynecol Cancer 2010; 20:203-11. [PMID: 20169663 DOI: 10.1111/igc.0b013e3181c8ca12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Ovarian cancer is highly sensitive to chemotherapy but also shows a high rate of recurrence and drug resistance. These negative outcomes mostly depend on altered apoptotic pathways, making the design of new therapeutic strategies based on the induction of other types of cell death highly desirable. Several lines of research are now addressing cancer-specific features to specifically target tumor cells, thus reducing adverse effects. In this light, a great deal of attention has been devoted to the metabolic reprogramming occurring in cancer cells, which display increased levels of glycolysis compared with their normal counterparts. We recently showed that inhibition of p38alpha impairs key metabolic functions of colorectal cancer cells, inducing growth arrest, autophagy, and cell death both in vivo and in vitro. These effects are mediated by a switch from hypoxia-inducible factor 1alpha (HIF1alpha) to forkhead transcription factor O (FoxO)-dependent transcription. METHODS We first characterized p38 expression in OVCAR-3, A2780, and SKOV-3 ovarian cancer cell lines. Then, we treated these cells with the p38alpha/p38beta-specific inhibitor SB202190 and performed a morphological, proliferation, and survival analyses. Finally, we studied HIF1alpha and FoxO3A expressions and signaling pathways to evaluate their role in SB202190-induced effects. RESULTS p38alpha blockade induces the formation of intracellular autophagic vacuoles and reduces growth and viability of ovarian cancer cells. As in colorectal cancer, the underlying molecular mechanism seems to rely on a shift from HIF1alpha- to FoxO3A-dependent transcription, which is promoted by the activation of the adenosine monophosphate-activated protein kinase pathway. CONCLUSIONS These data corroborate the hypothesis that pharmacological modulation of genes involved in cancer-specific homeostasis, such as p38alpha, might be exploited to design new therapeutic approaches to cancer treatment.
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Affiliation(s)
- Antonio Matrone
- Department of Translational Pharmacology, Laboratory of Signal-Dependent Transcription, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
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Ciavarella S, Dammacco F, De Matteo M, Loverro G, Silvestris F. Umbilical cord mesenchymal stem cells: role of regulatory genes in their differentiation to osteoblasts. Stem Cells Dev 2009; 18:1211-20. [PMID: 19125623 DOI: 10.1089/scd.2008.0340] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Umbilical cord (UC) mesenchymal stem cells (MSCs) are being currently investigated as an alternative to bone marrow (BM) MSCs for bone repair and regeneration. Here, we describe the gene regulation of their differentiation to osteogenic, adipogenic, and chondrogenic precursors and demonstrate their tendency to differentiate toward the osteoblast lineage. Fibroblast-like cells from the Warthon's Jelly were cultured with dedicated media to obtain osteogenic-, adipogenic-, and chondrogenic-differentiated cells. After induction, a typical fibroblast-like shape with condensed fibers of F-actin was early noted in osteogenic-induced UC-MSCs, whereas those differentiating to adipocytes were flat with minor cytoskeleton relevance. Real-time PCR measured the transcription of master genes of the three lineages, thus revealing a remarkable up-regulation of Runx2 in osteogenic-induced cells with respect to both PPARg and SOX9 for adipogenic- and chondrogenic-differentiating UC-MSCs. However, TAZ, a coactivator of the nuclear transcription of Runx2 previously detected in BM-MSCs, was expressed in osteogenic- and, at lower magnitude, in adipogenic-induced cells, in keeping with its role in the reciprocal control of the differentiation between osteogenic- and adipogenic-induced cells. Its differential role in these cells was confirmed by its accumulation as protein product in the nuclei to activate Runx2 in osteogenic-differentiating UC-MSCs. These data emphasize the predominant expression by UC-MSCs of genes engaged in the osteogenic differentiation and their tendency to differentiate into osteoblasts, being similar in this respect to BM-MSCs. They may, thus, constitute a promising option for bone remodeling in regenerative medicine.
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Affiliation(s)
- Sabino Ciavarella
- Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy
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Ciccone MM, Favale S, Bhuva A, Scicchitano P, Caragnano V, Lavopa C, De Pergola G, Loverro G. Anteroposterior diameter of the infrarenal abdominal aorta is higher in women with polycystic ovary syndrome. Vasc Health Risk Manag 2009; 5:561-6. [PMID: 19590590 PMCID: PMC2704897 DOI: 10.2147/vhrm.s5639] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Indexed: 11/23/2022] Open
Abstract
Background: Women affected by polycystic ovary syndrome (PCOS) are known to be at higher risk of cardiovascular disease. The aim of this study was to identify the artery that first is affected by early pre-atherosclerotic changes in PCOS. Methods: Twenty-nine women with PCOS aged 17 to 27 years and 26 healthy nonhyperandrogenic volunteers with regular menses (control women) aged 16 to 28 years were enrolled. All PCOS patients were overweight or obese (body mass index [BMI] ≥ 25). Diagnosis of PCOS was performed in line with the 2003 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Accordingly, PCOS was defined when at least two of the following three features were present after exclusion of other etiologies: 1) oligomenorrhea and or anovulation; 2) hyperandrogenism and/or hyperandrogenemia; and 3) polycystic ovaries visible at ultrasound. Androgen excess or related disorders were excluded. The intima-media thickness (IMT) of common carotid arteries and common femoral arteries and the anteroposterior diameter of the infrarenal abdominal aorta were measured by ultrasound. Lutenizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, total testosterone, androstenedione, and sex hormone-binding globulin (SHBG) serum levels were measured between the 3rd and the 6th day of spontaneous or progestin-induced menstrual cycle. Our study was performed in the absence of any medical treatment. Results: Women with PCOS showed a higher LH to FSH ratio (p < 0.01), increased fasting insulin (p < 0.001), total testosterone (p < 0.001), and androstenedione (p < 0.001) levels, and lower SHBG concentrations (p < 0.001) compared to control women. BMI and waist-to-hip ratio were also higher in women with PCOS (p < 0.000 and p < 0.001, respectively). Women with PCOS also showed increased total cholesterol (p < 0.001), triglyceride (p < 0.001), and apolipoprotein B (p < 0.001) levels. Vascular data showed women with PCOS had a higher anteroposterior diameter than control women (p < 0.005). However, when analysis of covariance was performed and BMI was entered into the model as a covariate, anteroposterior diameter did not maintain a significant association with PCOS. Conclusion: This study shows that anteroposterior diameter of the infrarenal abdominal aorta, but not IMT of common carotid arteries or common femoral arteries, is higher in women with PCOS than in women without this disease. This represents the earliest atherosclerotic change in women with PCOS. However, this alteration seems to be due to body weight secondary to PCOS and not due to PCOS per se.
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Affiliation(s)
- Marco Matteo Ciccone
- Institute of Cardiovascular Diseases, Azienda Ospedaliera Policlinico, Piazza Giulio Cesare 11, 70124-I, Italy.
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Cromi A, Ghezzi F, Di Naro E, Siesto G, Loverro G, Bolis P. Blunt expansion of the low transverse uterine incision at cesarean delivery: a randomized comparison of 2 techniques. Am J Obstet Gynecol 2008; 199:292.e1-6. [PMID: 18771988 DOI: 10.1016/j.ajog.2008.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 06/01/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare 2 methods of expansion of the uterine incision at the time of cesarean delivery. STUDY DESIGN Women who underwent a low-segment transverse cesarean delivery were assigned randomly to have the blunt expansion of the uterine incision by the physician separating the fingers either in a transversal direction or in a cephalad-caudad direction. The primary outcome measure was the incidence of unintended extensions. RESULTS The transversal (n = 406) and cephalad-caudad (n = 405) expansion groups were similar with regard to patient characteristics, indication to surgery, type of anesthesia, and proportion of emergency procedures. No difference in the need for transfusions (0.7% vs 0.7%; P = 1.0) or estimated blood loss (440 +/- 341 vs 398 +/- 242 mL; P = .09) was noted. The incidence of unintended extension (7.4% vs 3.7%; P = .03) and blood loss of >1500 mL (2.0% vs 0.2%; P = .04) was significantly higher in the transversal expansion group, compared with the cephalad-caudad group. Transversal expansion was an independent contributor to unintended extension and blood loss of >1500 mL. CONCLUSION Because it is associated with less risk of unintended extension and excessive blood loss, expansion of the uterine incision with a cephalad-caudad traction should be preferred to transversal expansion when a cesarean delivery is performed.
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