Rola nacięcia krocza w profilaktyce uszkodzeń podczas porodów pochwowych – wyniki z dwóch ośrodków europejskich

Objectives: There is an ongoing debate regarding the routine versus restrictive use of episiotomy. The study aim was to investigate if episiotomy during vaginal deliveries can reduce both, the number and severity of genital lacerations. Material and methods: The study included all women who gave vaginal birth at AOU. “G. Martino” Messina (n=382) and the Clinic for Ob/Gyn Clinical Center of Serbia, Belgrade (n=4221) during 2011. Lacerations during birth were recorded and divided according to location and severity. Women with lacerations were subdivided into two groups: with or without medio-lateral episiotomy. We assessed potential risk factors for laceration: maternal age, parity, use of labor stimulants and epidural analgesia, participation in antenatal classes, fetal presentation, neonatal birth weight, and duration of the second stage of labor. Results: Older women had higher grade perineum or combined lacerations. Children with higher birth weight in occipito-posterior presentation caused higher grade lacerations. Performance of episiotomy was connected with fewer perineum and labial lacerations. There were no differences in laceration grade between patients with and without episiotomy. Assessed parameters proved to be good discriminating factors between lacerations sites. According to logistic regression, laceration site was the most important risk factor for laceration grade. Combined lacerations had the highest grade. Conclusions: Episiotomy can significantly reduce the number of genital lacerations, but it does not influence laceration grade. Advanced maternal age, higher parity, occipito-posterior presentation and fetal macrosomia can cause lacerations during vaginal birth. Therefore, we suggest analysis of maternal and fetal factors to prevent widespread genital lacerations.Cel: Trwa debata w prawie właściwego stosowania nacięcia krocza: regularne kontra ograniczone. Celem badania była ocena czy nacięcie krocza podczas porodu pochwowego może zredukować zarówno liczbę jak i ciężkość uszkodzeń krocza. Materiał i metoda: Do badania włączono wszystkie kobiety, które w 2011 roku urodziły drogą pochwową w ośrodku w AOU „G.Martino” Messina (n=382) i w Klinice Położniczo-Ginekologicznej w Serbii, w Belgradzie (n=4221). Uszkodzenia krocza podczas porodu zostały podzielone względem lokalizacji i ciężkości. Kobiety z uszkodzeniami podzielono na dwie podgrupy: z nacięciem i bez nacięcia pośrodkowo-bocznego krocza. Oceniono możliwe czynniki ryzyka uszkodzeń krocza: wiek matki, rodność, użycie stymulacji porodu, znieczulenie zewnątrzoponowe, uczestnictwo w szkole rodzenia, położenie płodu, masa urodzeniowa noworodka, czas trwania drugiej fazy porodu. Wyniki: Starsze kobiety miały wyższy stopień uszkodzenia krocza i bardziej złożone pęknięcia. Urodzenie dziecka z większą masą urodzeniową w ułożeniu potylicowym-tylnym powodowało wyższy stopień pęknięć krocza. Nacięcie krocza wiązało się z mniejszą ilością pęknięć krocza i warg sromowych. Nie zanotowano różnic w stopniu uszkodzenia krocza pomiędzy pacjentkami z i bez nacięcia krocza. Oceniane czynniki są przydatne w różnicowaniu miejsca uszkodzenia. Na podstawie regresji logistycznej, miejsce pęknięcia było najważniejszym czynnikiem ryzyka stopnia uszkodzenia krocza. Złożone uszkodzenia miały najwyższy stopień. Wnioski: Nacięcie krocza istotnie zmniejszało liczbę uszkodzeń krocza, lecz nie wpływało na ich stopień. Zaawansowany wiek matki, wyższa rodność, ułożenie potylicowe-tylne i makrosomia płodu mogą powodować pęknięcia krocza w trakcie porodu. Sugerujemy analizę matczynych i płodowych czynników ryzyka celem zapobiegania szerokim uszkodzeniom krocza w trakcie porodu

Interplay between Misplaced Müllerian-Derived Stem Cells and Peritoneal Immune Dysregulation in the Pathogenesis of Endometriosis

In the genetic regulation of Müllerian structures development, a key role is played by Hoxa and Wnt clusters, because they lead the transcription of different genes according to the different phases of the organogenesis, addressing correctly cell-to-cell interactions, allowing, finally, the physiologic morphogenesis. Accumulating evidence is suggesting that dysregulation of Wnt and/or Hox genes may affect cell migration during organogenesis and differentiation of Müllerian structures of the female reproductive tract, with possible dislocation and dissemination of primordial endometrial stem cells in ectopic regions, which have high plasticity to differentiation. We hypothesize that during postpubertal age, under the influence of different stimuli, these misplaced and quiescent ectopic endometrial cells could acquire new phenotype, biological functions, and immunogenicity. So, these kinds of cells may differentiate, specializing in epithelium, glands, and stroma to form a functional ectopic endometrial tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease

Il robot nella chirurgia ginecologica endoscopica

Nell’ultimo decennio la chirurgia robotica ha rivoluzionato il concetto di chirurgia mini-invasiva, rappresentandone oggi la forma più sofisticata. La robotica ha superato le difficoltà e le limitazioni della chirurgia laparoscopica, permettendo di estendere i benefici della mini-invasività anche ad interventi più complessi. L’introduzione del sistema robotico da Vinci ha consentito un’innovativa tecnica chirurgica che rappresenta un valido ausilio anche per la patologia ginecologica. Per tale motivo, dal 2008 abbiamo dato vita ad una collaborazione clinico-operativa e di ricerca scientifica tra la Medical University di Pleven (Bulgaria), settore Chirurgia Ginecologica ed Oncologica, dove è operativo tale dispositivo, e l’unità Operativa Complessa di Ostetricia e Ginecologia dell’Università degli Studi di Messina. Nel nostro studio abbiamo analizzato 15 donne sottoposte ad isterectomia o miomectomia con tecnica laparoscopica assistita con il robot da Vinci con l’obiettivo di valutare l’effettiva applicabilità, i vantaggi e la sicurezza offerti da questa tecnica, che risulta essere vantaggiosa in quanto permette un più accurato gesto chirurgico, ridotte complicanze intra- e post-operatorie ed una minore durata dei tempi di degenza. Il maggior limite della chirurgia robotica rimane, comunque, l’elevato costo; a tal proposito una soluzione auspicabile potrebbe essere la condivisione dei robot in un’ottica multidisciplinare. In letteratura non esistono ancora studi che forniscono informazioni sufficienti sulla reale efficacia clinica di tale tecnica

A new inactive conformation of SARS-CoV-2 main protease

The SARS-CoV-2 main protease (Mpro) has a pivotal role in mediating viral genome replication and transcription of the coronavirus, making it a promising target for drugs against the COVID-19 pandemic. Here, a crystal structure is presented in which Mproadopts an inactive state that has never been observed before, called new-inactive. It is shown that the oxyanion loop, which is involved in substrate recognition and enzymatic activity, adopts a new catalytically incompetent conformation and that many of the key interactions of the active conformation of the enzyme around the active site are lost. Solvation/ desolvation energetic contributions play an important role in the transition from the inactive to the active state, with Phe140 moving from an exposed to a buried environment and Asn142 moving from a buried environment to an exposed environment. In new-inactive Mproa new cavity is present near the S2' subsite, and the N-terminal and C-terminal tails, as well as the dimeric interface, are perturbed, with partial destabilization of the dimeric assembly. This novel conformation is relevant both for comprehension of the mechanism of action of Mprowithin the catalytic cycle and for the successful structure-based drug design of antiviral drug

Fertility outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy A 12-years retrospective cohort study

To compare the subsequent reproductive outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy (EP)

Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options

Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes