Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary?

Granulosa cell tumors (GCTs) are the most common estrogen-secreting ovarian tumors; perhaps due to the persistent hyperestrogenism, a wide spectrum of associated endometrial pathologies ranging from endometrial hyperplasia to carcinoma has been documented in patients with GCTs. The aim of this study is to evaluate the incidence of endometrial pathologies in a large series of GCT patients treated in MITO centers

Activity of chemotherapy in mucinous ovarian cancer with a recurrence free interval of more than 6 months: results from the SOCRATES retrospective study

<p>Abstract</p> <p>Background</p> <p>Mucinous ovarian carcinoma have a poorer prognosis compared with other histological subtypes. The aim of this study was to evaluate, retrospectively, the activity of chemotherapy in patients with platinum sensitive recurrent mucinous ovarian cancer.</p> <p>Methods</p> <p>The SOCRATES study retrospectively assessed the pattern of care of a cohort of patients with recurrent platinum-sensitive ovarian cancer observed in the years 2000–2002 in 37 Italian centres. Data were collected between April and September 2005. Patients with recurrent ovarian cancer with > 6 months of platinum free interval were considered eligible.</p> <p>Results</p> <p>Twenty patients with mucinous histotype and 388 patients with other histotypes were analyzed. At baseline, mucinous tumours differed from the others for an higher number of patients with lower tumor grading (p = 0.0056) and less advanced FIGO stage (p = 0.025). At time of recurrence, a statistically significant difference was found in performance status (worse in mucinous, p = 0.024). About 20% of patients underwent secondary cytoreduction in both groups, but a lower number of patients were optimally debulked in the mucinous group (p = 0.03). Patients with mucinous cancer received more frequently single agent platinum than platinum based-combination therapy or other non-platinum schedules as second line therapy (p = 0.026), with a response rate lower than in non-mucinous group (36.4% vs 62.6%, respectively, p = 0.04). Median time to progression and overall survival were worse for mucinous ovarian cancer. Finally, mucinous cancer received a lower number of chemotherapy lines (p = 0.0023).</p> <p>Conclusion</p> <p>This analysis shows that platinum sensitive mucinous ovarian cancer has a poor response to chemotherapy. Studies dedicated to this histological subgroup are needed.</p

Characterization of port noise through a measurement campaign

A measurement campaign has been developed for the purpose to identify a survey methodology to be applied to port noise. Until now a specific approach for harbour noise is still missing and this complicates the task of analysing and assessing the acoustic impact of ports on exposed population. The performed study confirmed the need to upgrade the current way. Sources overlapping, directivity ignorance, seasonality and day alternation, sources mix are as many as issues that requires new, more effective, techniques to characterize port noise. With regard to the measures, contemporary close and remote measures are to be made; specific measures designed to characterize the sources are needed (including intensimetric measurements and acoustic cameras); protracted and detailed measurement campaigns are needed. Concerning the port noise modelling, two different approaches are possible. Either every single source and the geometry of the port area are characterized, and then modelled by ray tracing according to the usual method. Or measures are taken on the harbour perimeter, assigning then attempt values to the sound power level of the sources with a "try and correct" technique, until the correct values are determined and the acoustic field is accurately described

Infusion of 2.5 meq/min of lactic acid minimally increases CO2 production compared to an isocaloric glucose infusion in healthy anesthetized, mechanically ventilated pigs

Introduction: Blood acidification by lactic acid infusion converts bicarbonate to CO2. This effect can be exploited to increase the transmembrane PCO2 gradient of an extracorporeal membrane lung, resulting in a significant increase of extracorporeal CO2 removal. Lactic acid, however, is an energetic substrate and its metabolism might increase total body CO2 production (VCO2), limiting the potential beneficial effects of this technique. The aim of our study was to compare VCO; during isocaloric infusion of lactic acid or glucose.Methods: Six pigs (45 \uc2\ub1 5 kg) were sedated and mechanically ventilated. Estimated caloric needs were 2,300-2,400 Kcal/die (95 to 100 Kcal/h). A sequence of two steps lasting four hours each was performed: 1) Glucose, 97 kcal/h were administered as 50% glucose solution, and 2) Lactic Acid, approximately 48.5 kcal/h were administered as lactic acid and approximately 48.5 kcal/h as 50% glucose solution. This sequence was repeated three times with two-hour intervals. Every hour VCO;, arterial blood gases and lactate were measured. Blood glucose level was kept constant by titrating an insulin infusion, ventilation was adjusted to maintain arterial PCO2 at 50 mmHg, a normal value for our animal model.Results: During Lactic Acid steps VCO2 increased less than 5% compared to the Glucose steps (282 vs. 269 ml/min, P &lt;0.05); blood glucose did not differ between the two groups (respectively 101 \uc2\ub1 12 vs. 103 \uc2\ub1 8 mg/dl). Arterial lactate was always lower than 3 mmol/L. Arterial pH was lower during Lactic Acid steps (7.422 vs. 7.445, P &lt;0.05).Conclusions: Replacing 50% of the caloric input with lactic acid increased total CO2 production by less than 5% compared to an equal caloric load provided entirely by a 50% glucose solution. \uc2\ua9 2013 Zanella et al.; licensee BioMed Central Ltd

Extracorporeal carbon dioxide removal through ventilation of acidified dialysate: An experimental study

Background: Extracorporeal (EC) carbon dioxide (CO2) removal (ECCO2R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO2R. We evaluated an innovative ECCO2R technique based on ventilation of acidified dialysate. Methods: Four swine were sedated, mechanically ventilated, and connected to a venovenous dialysis circuit (blood flow, 250 ml/min). The dialysate was recirculated in a closed loop circuit including a ML (gas flow, 10 liters/min) and then returned to the dialyzer. In each animal, 4 different dialysis flows (DF) of 200, 400, 600, and 800 ml/min were evaluated with and without lactic acid infusion (2.5 mEq/min); the sequence was completed 3 times. At the end of each step, we measured the volume of CO2R by the ML (Vco2ML) and collected blood and dialysate samples for gas analyses. Results: Acid infusion substantially increased Vco2ML, from 33 \uc2\ub1 6 ml/min to 86 \uc2\ub1 7 ml/min. Different DFs had little effect on Vco2ML, which was only slightly reduced at DF 200 ml/min. The partial pressure of CO2of blood passing through the dialysis filter changed from 60.9 \uc2\ub1 3.6 to 37.1 \uc2\ub1 4.8 mm Hg without acidification and to 32.5 \uc2\ub1 5.3 mm Hg with acidification, corresponding to a pH increase of 0.18 \uc2\ub1 0.03 and 0.03 \uc2\ub1 0.04 units, respectively. Conclusions: Ventilation of acidified dialysate efficiently increased ECCO2R of an amount corresponding to 35% to 45% of the total CO2production of an adult man from a blood flow as low as 250 ml/min. \uc2\ua9 2014 International Society for Heart and Lung Transplantation. All rights reserved

Plant and arthropod colonisation of a glacier foreland in a peripheral mountain range

<div><p>Primary successions along glacier forelands are perfect examples of the changing climate upon high mountain ecosystems. Peripheral mountain ranges deserve particular attention, given they are characterised by high numbers of species and endemism and are considered to be particularly susceptible to climate change. We analysed thermal regime, soil parameters and plant/arthropod primary succession along a glacier foreland located in such a context, comparing it with those previously studied in the inner Alps. The overall patterns of the investigated primary succession agree with those of the inner Alps at the same elevation, but stands out for a delayed plant and arthropod colonisation which promotes the long-lasting persistence of pioneer cold-adapted species. In light of the results obtained, and considering the glaciological features of peripheral mountain ranges (glaciers persistence at low elevation), this paper asserts the hypothesis that glacial landforms of these areas may act as warm-stage refugia for pioneer cold-adapted species.</p></div

Management of endometrial cancer in Italy: a national survey endorsed by the Italian Society of Gynecologic Oncology

Endometrial carcinoma (EC) is a frequent cancer in developed countries, but with evidence for discrepant clinical management. Under the auspices of the Italian Society of Gynecologic Oncology (SIOG), we conducted a survey among Italian centers with ≥20 surgeries for gynecological cancer per year, trying to depict a reliable picture of EC management in our country

Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes

Background: Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. Purpose: This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5–70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5–27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0–52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0–46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3–100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7–79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0–82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. Conclusion: Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes

Not Only Diagnostic Yield: Whole-Exome Sequencing in Infantile Cardiomyopathies Impacts on Clinical and Family Management

Whole-exome sequencing (WES) is a powerful and comprehensive tool for the genetic diagnosis of rare diseases, but few reports describe its timely application and clinical impact on infantile cardiomyopathies (CM). We conducted a retrospective analysis of patients with infantile CMs who had trio (proband and parents)-WES to determine whether results contributed to clinical management in urgent and non-urgent settings. Twenty-nine out of 42 enrolled patients (69.0%) received a definitive molecular diagnosis. The mean time-to-diagnosis was 9.7 days in urgent settings, and 17 out of 24 patients (70.8%) obtained an etiological classification. In non-urgent settings, the mean time-to-diagnosis was 225 days, and 12 out of 18 patients (66.7%) had a molecular diagnosis. In 37 out of 42 patients (88.1%), the genetic findings contributed to clinical management, including heart transplantation, palliative care, or medical treatment, independent of the patient’s critical condition. All 29 patients and families with a definitive diagnosis received specific counseling about recurrence risk, and in seven (24.1%) cases, the result facilitated diagnosis in parents or siblings. In conclusion, genetic diagnosis significantly contributes to patients’ clinical and family management, and trio-WES should be performed promptly to be an essential part of care in infantile cardiomyopathy, maximizing its clinical utility