Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review

Purpose: Chronic endometritis (CE) is a frequent hysteroscopic and histological finding which affects embryo transfer implantation during IVF-ICSI cycles. In particular, CE impairs proper decidualization and, subsequently, implantation. Although this correlation has been clearly clarified, a pathophysiological explanation assembling all the studies performed has not been elucidated yet. For this reason, we have structured a systematic review considering all the original articles that evaluated a pathological element involved in CE and implantation impairment. Methods: The authors searched electronic databases and, after screening, collected 15 original articles. These were fully scanned and used to create a summary pathway. Results: CE is primarily caused by infections, which lead to a specific cytokine and leukocyte pattern in order to prepare the uterus to fight the noxa. In particular, the immunosuppression requested for a proper semi-allogenic embryo transfer implantation is converted into an immunoreaction, which hampers correct embryo implantation. Moreover, endometrial vascularization is affected and both irregular vessel density and luminal thickening and thrombosis reduce what we have first identified as endometrial flow reserve. Finally, incorrect uterine wave propagation could affect embryo contact with decidua. Conclusion: This is the first summary of evidence on CE pathophysiology and its relationship with infertility. Understanding the CE pathophysiology could improve our knowledge in embryo transfer success

Metaplasia ossea diagnosticata su leiomioma uterino

Riportiamo un caso di metaplasia ossea in un leiomioma uterino scoperto casualmente in una donna di 53 anni operata di isterectomia totale per una neoformazione annessial

Peri-Conceptional Intake of Folic Acid Supplement to Date: A Medical-Legal Issue

Folic Acid (FA) supplementation during pregnancy represents a so widespread and established recommendation all over the world, to be taken for granted sometimes. As a matter of fact, this vitamin supplement is worldwide recommended mostly during peri-conceptional period for its proved preventive effect on Neural Tubal Defects (NTDs), like spina bifida. However, The biological and clinical potential of FA is reassessing and this represents a hot topic in scientific community, mostly in consideration of the possible medical-legal implications. An overview is mandatory in order to keep in mind FA-related possibl

Alterazioni endocrine e metaboliche della donna diabetica in menopausa.

Hormonal and metabolic disorders in menopause play a key role in hyperinsulinemia, insulin resistance and visceral obesity, contributing to dyslipidemia, oxidative stress, inflammation, clotting and atherosclerosis. These conditions all constitute risk factors for cardiovascular disease. In menopausal women estrogen deficiency and the relative hyperandrogenism promote metabolic dysfunction, predisposing to obesity, metabolic syndrome and type 2 diabetes. This review focuses on the role of estradiol (E2) and its receptors (ERs) in the control of energy homeostasis and glucose metabolism. E2 in the hypothalamic nuclei separately controls food intake, energy expenditure and fat distribution. In skeletal muscle, liver, adipose tissue and immune cells, E2 is involved in insulin sensitivity and prevents obesity and inflammation. E2 regulates insulin secretion in pancreatic β-cells. In menopausal women with pre-existing Type 1 and Type 2 diabetes mellitus, climacteric symptoms, metabolic disorders and diabetic complicationsare more severe. Hormone therapy (HRT) is not recommended for the prevention of metabolic disorders in menopausal women, but can be considered part of a tailored global strategy to improve the perception of menopausal symptoms and prevent diabetes complications. For the future, new selective estrogen receptor modulators - SERMs - are undergoing testing; they act only on ERs involved in energy balance and glucose homeostasis which activate cellular pathways, with beneficial metabolic effects by blocking ERs in the breast and uterus. New synthesis peptides (GLP-1 + E2) can transport E2 directly to pancreatic β-cells

Ultrasonic assessment of cesarean section scar to vesicovaginal fold distance: an instrument to estimate pre-labor uterine rupture risk

Background: The number of Cesarean sections (CS) is growing worldwide, intensifying the risk of complications in subsequent pregnancies and leading to increased maternal and fetal morbidity and mortality. In particular, the literature shows a higher risk of uterine rupture (UR) in subsequent pregnancy with trial of labor after cesarean section (TOLAC) Furthermore, there are few data about pre-labor UR in scarred uteri. Objective: Since the key factor for management is timing, the aim of this study was to evaluate the accuracy of prenatal ultrasound (US) of scars in the early determining of pre-labor UR risk in women with a previous CS during their subsequent pregnancy Methods: From April 2014 to November 2018 a retrospective analysis was performed in order to evaluate the scar to vesicovaginal fold (VVF) distance in three patients with pre-labor UR and in 60 cases of the control group. Results: The periconceptional CS scar-VVF distance in the three UR cases resulted significantly increased compared to the controls (23.7 ± 3.5 mm vs 2.3 ± 2.7 mm, p < 005); moreover, a time interval of less than 18 months and a previous pre-labor preterm CS were found as known risk factors. Conclusion: In this study, a higher uterine incision due to placenta previa or isthmic myoma seems to be correlated with a major risk of UR. Therefore, periconceptional US examination of CS-VVF distance, (which represents the level of the previous CS), seems to be a useful predictive factor of pre-labor UR in subsequent pregnancies

Liquid biopsy in cervical cancer: Hopes and pitfalls

Cervical cancer (CC) is the fourth most common cancer in women worldwide, with about 90% of cancer-related deaths occurring in developing countries. The geographical influence on disease evolution reflects differences in the prevalence of human papilloma virus (HPV) infection, which is the main cause of CC, as well as in the access and quality of services for CC prevention and diagnosis. At present, the most diffused screening and diagnostic tools for CC are Papanicolaou test and the more sensitive HPV-DNA test, even if both methods require gynecological practices whose acceptance relies on the woman’s cultural and religious background. An alternative (or complimen-tary) tool for CC screening, diagnosis, and follow-up might be represented by liquid biopsy. Here, we summarize the main methodologies developed in this context, including circulating tumor cell detection and isolation, cell tumor DNA sequencing, coding and non-coding RNA detection, and exosomal miRNA identification. Moreover, the pros and cons of each method are discussed, and their potential applications in diagnosis and prognosis of CC, as well as their role in treatment mon-itoring, are explored. In conclusion, it is evident that despite many advances obtained in this field, further effort is needed to validate and standardize the proposed methodologies before any clinical use

Regarding “Histopathology and Clinical Outcomes of 151 Women with Postmenopausal Bleeding Treated with Resectoscopic Surgery”

No abstract availabl