Infectious complications of extra-peritoneal pelvic packing in emergency room.

PURPOSE: The Extra-Peritoneal Pelvic Packing (EPP) is a procedure used in emergency conditions to control pelvic hemorrhage. This procedure can be performed in Emergency Room (ER) if the patient is too unstable to be transported into the operating room (OR), with a possible increased risk of infections linked to a less sterile environment. METHODS: All patients who underwent EPP from 2009 to 2018 were selected from the trauma registry. The patients were divided into two groups according to where EPP was performed (ER or OR). A Propensity Score Matching was realized. EPP was removed in all patients in the OR after obtaining hemodynamic stabilization within 24-48 h and surgical pads were sent to the laboratory for microbiological analysis. RESULTS: Eighty-four patients underwent EPP during the period of the study. After PSM, 26 couples of patients were selected. No differences were observed between the two groups in the development of pelvic infection. Patients managed in OR showed a higher rate of associated abdominal injuries (p = 0.027) and an increasing need for external fixation (p = 0,005) as well as an increased proportion of laparotomies (p = 0.023), orthopedic interventions (p = 0.005) and a higher systolic blood pressure on admission (p = 0.003). CONCLUSIONS: The EPP is a safe procedure, even when performed out of OR. The EPP in ER allows an earlier control of bleeding in patients in extremis. To minimize the risk of infection, EPP should be removed early, as soon as hemodynamics have been stabilized.

Reasons for non-participation in public oncological screening programs in the Italian region Friuli Venezia Giulia.

OBJECTIVES: In the Italian region Friuli Venezia Giulia, public screening is offered for cervical cancer, breast cancer, and colorectal cancer. Participation of the target population is lower than 70%. Our aim was to investigate reasons for non-participation. STUDY DESIGN: This is a qualitative survey. METHODS: A telephone survey was conducted in 2018 on a random sample of persons not adhering in 2017. Only one question about the reason for non-participation was asked. The answers were transcribed verbatim with no personal identifiers and no additional information. The transcribed anonymous answers were then read and classified into mutually exclusive macrocategories and subcategories. RESULTS: A total of 4456 non-adhering persons were surveyed. Personal practical issues were the most common type of barrier reported in all three screening programs, followed by personal beliefs. Program-related issues were more common in cervical cancer screening than in the others. Almost half of the women not participating in the public breast cancer screening and 40% of those not adhering to the public cervical cancer screening had mammography or Pap test out of the public program. CONCLUSIONS: In this region, practitioners should work to overcome practical barriers and discuss personal beliefs. Surveys of non-participants in other geographic areas would be important to adequately inform local policymaking.

The Fertility Quality of Life Questionnaire (FertiQoL) Relational subscale: psychometric properties and discriminant validity across gender.

STUDY QUESTION: Is the Fertility Quality of Life Questionnaire (FertiQoL)-Relational Scale a valid measure to assess the relational domain regarding quality of life in women and men undergoing infertility treatment? SUMMARY ANSWER: The FertiQoL-Relational scale (FertiQoL-REL) showed good psychometric properties and captured core aspects of couple relationships. WHAT IS KNOWN ALREADY: FertiQoL has become a gold standard for the assessment of infertility-related quality of life in patients undergoing assisted reproduction treatment (ART). Despite its growing importance, no previous studies have examined the convergent validity of the FertiQoL-REL and its discriminant validity across gender. STUDY DESIGN, SIZE, DURATION: Baseline cross-sectional data as part of a longitudinal study of infertile couples undergoing an ART between February 2013 and January 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: Five hundred and eighty-nine patients (301 females and 288 males), prior to starting an ART in a private clinic, filled in the Fertility Quality of Life Questionnaire (FertiQoL) and several measures of the marital relationship (Dyadic Adjustment Scale, Marital Commitment Inventory and ENRICH Marital Satisfaction Scale) and infertility-related distress (Fertility Problem Inventory). MAIN RESULTS AND THE ROLE OF CHANCE: Confirmatory factor analysis showed that the FertiQoL four-factor solution provided a good fit for the observed data. Reliability of the FertiQoL-REL was higher for women than men. Significant correlations between the FertiQoL-REL scores and all the other measures of marital relationship were found for both women and men. FertiQoL-REL scores did not differ significantly in women and men. The FertiQoL-REL was able to differentiate subjects as regards the Dyadic Adjustment Scale and ENRICH Marital Satisfaction Scale threshold. LIMITATIONS, REASONS FOR CAUTION: Findings are limited because the data were obtained from only one Italian private clinic. WIDER IMPLICATIONS OF THE FINDINGS: FertiQoL-REL threshold scores are useful for identifying those patients undergoing ART who are more likely to report poor or good relationship quality. Clinicians should tailor their counselling strategies to the positive qualities in a couple's relationship, so as to reinforce the overall quality of life, especially among women, and to support patients in tackling the psychological burden, so that they can either continue treatment or choose discontinuation. STUDY FUNDING/COMPETING INTERESTS: This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study. TRIAL REGISTRATION NUMBER: Not necessary.

Is there a uniform basal endometrial gene expression profile during the implantation window in women who became pregnant in a subsequent ICSI cycle?

BACKGROUND: To understand which genes are really involved in the implantation process, we planned to study the gene basal expression profile during the window of implantation (WOI) of patients who became pregnant in a subsequent ICSI cycle. METHODS: Women attending their first ICSI cycle at ANDROS Day Surgery for severe male factor infertility were included in the study. An endometrial biopsy was performed during the WOI, in one of the last two cycles before the ICSI cycle. Forty-seven selected gene profiles were analyzed using Low Density Array technology. Only biopsies from women who subsequently became pregnant were evaluated, to exclude any bias regarding embryo viability and embryo transfer difficulties. RESULTS: Fifteen patients were included in the analysis as they became pregnant after ICSI procedure. Four of 47 selected genes were excluded from the analysis. Of the 43 genes analyzed, only 6 genes (VEGFA, PLA2G2A, ALPL, LIF, NNMT and STC1) showed a statistically uniform expression among patients who subsequently became pregnant. For all the other genes analyzed there were considerable differences in their expression levels amongst women who subsequently became pregnant. CONCLUSIONS: Our data suggest that very few genes, which change their expression level during the WOI, show a quantitative homogeneous expression in endometrially-receptive patients. In conclusion, in this study only six genes showed a homogeneous expression, and are probably involved in embryo implantation mechanisms.

GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial.

BACKGROUND: Our prospective randomized controlled trial was designed to assess whether the use of GnRH antagonists can improve the success rate of controlled ovarian stimulation (COS)/intrauterine insemination (IUI) treatments, via inhibition of the premature LH rise. METHODS: A total of 104 patients were randomly divided, using a randomization list, into two groups: in group A (n = 52), recombinant FSH (rFSH) was given with GnRH antagonist Cetrorelix, and in group B (n = 52), the patients received rFSH alone in a manner similar to that of group A. The primary outcome measure was clinical pregnancy rate per couple. RESULTS: The pregnancy rate per patient was 53.8% in group A and 30.8% in group B (P = 0.017). The rate of premature LH surge was 7% in group A and 35% in group B (P < 0.0001). A premature luteinization was observed in two cycles of 144 in group A (1.4%) and in 16 cycles of 154 in group B (10.4%) (P = 0.001). The mean values of LH and progesterone were significantly lower in patients receiving GnRH antagonist than in those who did not (3.3 +/- 3.3 mIU/ml in group A versus 9.9 +/- 7.9 mIU/ml in group B, P < 0.0001, for LH; 1.3 +/- 1.1 ng/ml versus 2.1 +/- 1.9 ng/ml for group A and B, respectively, P < 0.0001, for progesterone). CONCLUSION: The use of GnRH antagonist in COS/IUI cycles improves pregnancy rate, preventing the premature LH rise and luteinization.

Monozygotic bichorionic twinning after transfer of a single frozen/thawed embryo that has undergone quarter laser-assisted zona thinning: a case report.

PURPOSE: To present the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo has undergone assisted zona hatching (AZH), using a non contact laser. METHODS: A 33-year-old woman who underwent single frozen embryo replacement (FER). Before transfer, the patient was treated with GnRH agonist and with substitutive therapy (estrogens and progesterone). CONCLUSIONS: We are absolutely certain that we are reporting a monozygotic bichorionic pregnancy: a single frozen/thawed embryo was transferred and no concomitant spontaneous conception was possible. Moreover, molecular biology assessment for polymorphisms confirmed clinical findings. The possibility of the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo should be borne in mind and its incidence will have to be studied further.

HLA-B8,DR3 phenotype and the antibody response against Epstein-Barr virus.

Antibodies against the viral capsid antigen (VCA) and nuclear antigens (EBNAs) of the Epstein-Barr virus (EBV) were determined in a sample of Sicilian population. A significant correlation was observed between HLA-B8,DR3 phenotype and reduced titres of antibodies to EBNAs, whereas HLA-B8,DR3 positive individuals displayed levels of antibodies to VCA comparable to those of HLA-B8,DR3 negative ones. These results further strengthen the suggestion that HLA-B8,DR3 positive subjects are low responders and that the depth of immune response depends on the fashion of antigenic challenge.

Is it possible to use the hypoosmotic swelling test as criteria for "freezeability" of human semen in an AID program?

The aim of this study was to determine the possibility of the introduction of another parameter--the hypoosmotic swelling test--in the evaluation of the freezing potentially of anonymous donor's semen sample to be utilized in an AID program. 154 donor semen samples were frozen using classic seminal parameters: HOS tests were performed but not utilized as criteria for freezeability. All specimens were thawed and another HOS test was performed. All specimens were divided into two groups on the basis of the pre freezing HOS test value--HOS tests positive (> or = 55%) and HOS test negative (< 55%)--to verify if it's possible to correlate this value to the recovery of a good motility after thawing. A further division was performed: HOS tests highly positive (> or = 70%), HOS positive (60-55%) and HOS tests negative (< 55%) but the authors did not find any statistical difference. As concerns the clinical evaluation, were considered the last 15 pregnancies achieved with 11 samples out of 22 utilized. There was not any statistical difference. The data could seem to confirm the hypothesis that it is not possible to utilize the HOS test as a predictive value of "freezeability" of human semen sample.

Treatment of prepubertal periodontitis. A case report and discussion.

This paper reports the treatment of prepubertal periodontitis in a 3-year-old girl with Papillon-Lefèvre Syndrome. Initially, the patient was found to have a myeloperoxidase deficiency and microbiological tests have identified Bacteroides and Fusobacterium, in 60% and 25%, respectively of the total number of microbial flora cultivated. The initial treatment was extraction of all the primary teeth with grade 3 mobility, scaling, root planing and daily subgingival irrigation with a 0.2% solution of chlorhexidine. Several months before the eruption of the first permanent molars, the rest of the primary teeth were extracted. The patient was treated with daily subgingival irrigation of chlorhexidine and weekly professional oral hygiene. At the age 6 1/2 years, the permanent teeth have normal gingiva and crevice depths; microbiological investigation reveals a prevalence of the coccoid forms, and radiographs show no evidence of periodontal pathology.

[Clinical and pathogenetic observations on children with chronic mononucleosis]. / Rilievi clinico-patogenetici su bambini con mononucleosi cronica.

Epstein-Barr virus is seldom the causative agent of a prolonged atypical illness, known as chronic mononucleosis syndrome, characterized by a persistent pattern of clinical manifestations and by a defective immune response to specific viral antigens. This paper refers about 6 children for whom clinical and serological findings suggest the chronic Epstein-Barr virus infection. The authors believe that this chronic state might be explained by the unusual antibody pattern to EBV virus, with the persistent presence of anti-EA and the absence of anti-EBNA titers, expression of a reduced EBV-specific cytotoxic T cell activity.

Immune status towards Epstein-Barr virus in a group of Sicilian children.

The prevalence of antibodies to Epstein-Barr virus-determined antigens was studied in 17 children with acute infectious mononucleosis (IM) and in 263 children hospitalized for diseases unrelated to EBV infection. Antibodies against Epstein-Barr viral capsid antigens (VCA) were observed in 173 patients of the control group (66%), but 58 of them (33,5%) had not yet developed antibodies against Epstein-Barr virus-associated nuclear antigen (EBNA). IgM-specific antibodies were not found in any of the children of the control group but were present in all of the 17 patients with IM. The rates of positivity for IgA anti-VCA and IgG anti-early antigen (EA) were similar in all age groups. Anti-viral capsid antigen IgG seropositivity increased to 83% by the age of six years, the mean geometric titre being highest between the ages of 2 and 4 years. Our results suggest that in Sicilian children the primary infection occurs prevalently early in life, in parallel with the occurrence of IM.

Serological and immunohistological assessment of Epstein-Barr virus infection in Sicilian patients with suspected nasopharyngeal carcinoma.

An evaluation of antibodies to Epstein-Barr virus (EBV) was carried out on 18 patients with suspected nasopharyngeal carcinoma (NPC). With one exception, 9 patients, with histologically confirmed NPC, had high levels of IgG and IgA antibodies to EBV-related antigens, VCA and EA. Out of 4 patients, without histologically confirmed NPC and an antibody pattern compatible with the disease, one developed NPC 22 months later. These data confirm the usefulness of serological markers as a diagnostic aid in NPC and indicate that the occurrence of this malignancy might be higher in Sicily than in low-risk zones.

Resistance of HSV-1 growth to aphidicolin in two aphidicolin resistant cell lines.

The growth of herpes simplex virus type 1 (HSV-1) was examined in two cell lines resistant to aphidicolin by inhibition of infectious progeny production in the presence of the drug. The results reported show that the virus yield, which was severely inhibited by the drug in sensitive cells, was only slightly inhibited in the resistant cell lines. This suggests that the metabolic alteration known to confer resistance to the cell line (that is the altered deoxyribonucleoside triphosphate pool) may also allow viral growth to proceed in the presence of aphidicolin, and that therefore HSV replication at least partially depends upon the host replicative apparatus.

Reciprocal translocations in couples with spontaneous abortions.

A sample of 87 couples addressed to cyto-genetic analysis after the occurrence of one or more spontaneous abortions was studied. Reciprocal translocations were found in three couples. In reviewing the literature, the data were broken down and reassembled in order to estimate the translocation frequency in homogeneous samples. The conclusions of this re-examination is that for those couples with a history of frequent spontaneous abortions, a cytogenetic investigation is advisable, even if there have been no cases of still-borns or malformed children.