Severe Ovarian Hyperstimulation Syndrome in a Woman With Breast Cancer Under Letrozole Triggered With GnRH Agonist: A Case Report and Review of the Literature

We report a rare case of ovarian hyperstimulation syndrome (OHSS) in a 28-year-old woman with breast cancer and with a history of polycystic ovary syndrome (PCOS) despite treatment with letrozole and gonadotropin-releasing hormone agonist (GnRH-a) triggering in a GnRH antagonist (GnRH-ant) protocol without the administration of any human chorionic gonadotropin (hCG) for luteal-phase support. The patient, who underwent controlled ovarian syndrome (COS)-oocyte cryopreservation before chemotherapy, required hospitalization. Complete recovery was achieved after treatment with volume expanders, human albumin, and cabergoline. Based on our case and literature review, it is possible to establish that estradiol (E2) modulation with letrozole and GnRH-a triggering does not eliminate the risk of OHSS. Furthermore, it is advisable to postpone GnRH-a depot to minimize the risk of OHSS after the suspension of letrozole, following menstruation or at least 7–8 days after triggering. It would be desirable to identify high-risk patients, also on a genetic basis, in order to avoid delays in oncologic treatments that could strongly impact life expectancy

Optimizing the “Time to pregnancy” in women with multiple sclerosis: the OPTIMUS Delphi survey

BackgroundThe debate on how to manage women affected by multiple sclerosis (MS) during reproductive age is still open, as is the issue of fertility in such patients. Main issue regard the identification of the optimal window for pregnancy and how to deal with medical therapy before and during conception. The aim of this Delphi consensus was to collect the opinions of a multidisciplinary group, involving reproductive medicine specialists and neurologists with experience in the management of multiple sclerosis women with reproductive desire.MethodsFour experts plus scientific coordinators developed a questionnaire distributed online to 10 neurologists and later discussed the responses and amended a list of statements. The statements were then distributed via an online survey to 23 neurologists (comprising the first 10), who voted on their level of agreement/disagreement with each statement. Consensus was achieved if agreement or disagreement with a statement exceeded 66%.ResultsTwenty-one statements reached consensus after two rounds of voting, leading to the following main recommendations: (1) Fertility evaluation should be suggested to wMS, in case of the need to shorten time to pregnancy and before treatment switch in women on DMTs contraindicated in pregnancy, particularly in case of highly active disease and age > 35 years. (2) ART should not be discouraged in wMS, but the use of DMTs until pregnancy confirmation should be suggested; ART may be considered in order to reduce time to pregnancy in MS women with a reduced ovarian reserve and/or age > 35 years, but in case of an expected poor ART prognosis and the need for more than one ART cycle, a switch to a high-efficacy DMD before ART should be offered. (3) Oocyte cryopreservation may be considered in women with reduced ovarian reserve, with unpredictable time to complete diagnostic workup and achieve disease control; a risk/cost–benefit analysis must be performed in women >35 years, considering the diminished ovarian reserve.ConclusionThis consensus will help MS neurologists to support family planning in wMS, respecting MS therapeutic needs while also taking into account the safety and impact of advancing age on fertility

Valorising faba bean residual biomass : Effect of farming system and planting time on the potential for biofuel production

Research was carried out in southern Italy with the aim to assess the quality of faba bean residual biomass and its potential for biorefinery application. Faba bean is a sustainable crop, due to its ability to fix atmospheric nitrogen, and a large amount of biomass remains after harvest which can be valorised for energy production. Greenhouse and early planting are known to affect pod yield and, in this respect, even the residual biomass quality needs to be assessed. For this purpose, the effects of five planting times (i.e. the dates of transplants ranging from 27 September to 22 November at two-week interval, earlier and later than the common planting date of 25 October in Naples province) on pods yield, residual biomass, and saccharification potential were evaluated in faba bean grown in open field and in greenhouse. The third planting time resulted in the highest fruit and residual biomass yield under greenhouse, whereas the fourth was the best in open field. Harvest index was best affected by the third and fourth planting times in open field. Greenhouse grown biomass showed higher values of lignin, hemicellulose and pectin, compared to open field, whereas the opposite trend was recorded with cellulose. Lignin content showed a gradual decrease from the first to the last planting time (17.7%–13.7% biomass fraction respectively), as well as pectin (from 14.1 to 11.5% biomass fraction); conversely, cellulose increased from the first to the last planting time (from 41.1 to 48.7% biomass fraction). Glucose was the most represented monosaccharide (46.7 mol%), followed by xylose (27.4 mol%) and galactose (9.9 mol%). Overall, the potential of faba bean residual biomass for energy production was best affected by open field growing, the latest planting time and alkali pre-treatment, the latter giving the highest value of saccharification (60.7 g kg−1 h−1 compared to 27.6 relevant to hot water pre-treatment)

Forest condition and chemical characteristics of atmospheric depositions: research and monitoring network in Lombardy

Since 1987, the Regional Forestry Board of Lombardy and the Water Research Institute of the National Research Council have been carrying out surveys of forest conditions and the response of the ecosystem to environmental factors. The study approach is based on a large number of permanent plots for extensive monitoring (Level 1). At this level, crown condition is assessed annually, and soil condition and the nutritional status of forests surveyed. Some of the permanent plots were selected for intensive monitoring (Level 2), focussing mainly on the impact of atmospheric pollution on forest ecosystems. Level 2 monitoring also includes increment analyses, ground vegetation assessment, atmospheric deposition, soil solution analyses and climatic observations. This paper summarises the main results of a pluriannual research, which provides a general picture of the state of forest health in the region and focuses on more detailed investigations, described as case studies. Modified wet and dry samplers which use a water surface to collect dry deposition were used in a pluriannual field campaign at five sites in alpine and prealpine areas, to measure the total atmospheric depositions and to evaluate the nitrogen and sulphate exceedances of critical loads. Throughfall and bulk precipitation chemistry were studied for five years (June 1994-May 1999) at two high elevation forest sites (Val Gerola and Val Masino) which were known to differ in terms of tree health, as assessed by live crown condition. Results indicated a higher contribution from the dry deposition of N-NO3 -, N-NH4 + and H+ and considerable canopy leaching of Ca2+, K+ and weak organic acids at Val Gerola, where the symptoms of damage were more evident. In the area of Val Masino (SO), included since 1997 in the national CONECOFOR network, investigations focused on the effectiveness of the biological compartment in modifying fluxes of atmospheric elements, and on the role of nitrogen both as an acidifying element and as a nutrient. To estimate the input-output budget of the catchment, monitoring was extended to stream water and soil solution

Cryptogenic stroke and atrial fibrillation in a real-world population: the role of insertable cardiac monitors

Abstract The incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been studied in carefully controlled clinical trials, but real-world data are limited. We investigated the incidence of AF in clinical practice among CS patients with an insertable cardiac monitor (ICM) placed for AF detection. Patients with CS admitted to our Stroke Unit were included in the study; they received an ICM and were monitored for up to 3 years for AF detection. All detected AF episodes of at least 120 sec were considered. From March 2016 to March 2019, 58 patients (mean age 68.1 ± 9.3 years, 67% male) received an ICM to detect AF after a CS. No patients were lost to follow-up. AF was detected in 24 patients (41%, AF group mean age 70.8 ± 9.4 years, 62% male) after a mean time of 6 months from ICM (ranging from 2 days to 2 years) and 8 months after CS (ranging from 1 month to 2 years). In these AF patients, anticoagulant treatment was prescribed and nobody had a further stroke. In conclusion, AF episodes were detected via continuous monitoring with ICMs in 41% of implanted CS patients. AF in CS patients is asymptomatic and difficult to diagnose by strategies based on intermittent short-term recordings. Therefore, we suggest that ICMs should be part of daily practice in the evaluation of CS patients

Features and follow-up of patients affected by noninflammatory myocarditis after coronavirus disease 2019 vaccination

Although acute myocarditis has not been described as an adverse event in landmark trials of coronavirus disease 2019 (COVID-19) vaccines, it has been frequently reported as a rare complication in the real world.1–6 The prognosis of this self-limiting condition is generally good, but little is known about the long-term outcomes.2 This work aims to report a single-center experience giving new insights into this topic