Clinical and ultrasonographic characteristics of pregnancy-related enhanced myometrial vascularity: prospective cohort study.

OBJECTIVES: To assess the ultrasonographic, epidemiological, clinical and evolutive characteristics of enhanced myometrial vascularity (EMV) following a first-trimester termination of pregnancy (TOP) or management of non-viable pregnancy. METHODS: This prospective study included women who underwent follow-up ultrasound examination 5-6 weeks after a first-trimester TOP or after management of a first-trimester non-viable pregnancy at the University Hospital Polyclinic San Martino of Genoa between March 2021 and March 2022. EMV was characterized using two- and three-dimensional ultrasound and Virtual Organ Computer-aided Analysis. Ultrasonographic diagnosis of EMV was made when an unusual, tortuous myometrial vessel structure, with high-velocity blood flow, protruding towards the endometrium was observed, while an abnormal junctional zone, absent endometrial midline and heterogeneous endometrium supported the diagnosis. Patients with EMV underwent expectant management with planned ultrasonographic follow-up every 2 weeks until resolution. RESULTS: During the study period, 305 women underwent TOP, of whom 132 attended the initial follow-up 5-6 weeks later, at which 52 were diagnosed with EMV. Ninety-six women were managed for a non-viable pregnancy, of whom 32 presented for follow-up, at which six had a diagnosis of EMV. Thus, overall, 164 of 401 women were included in the study and EMV was identified in 58 (35%) of these. The prevalence of EMV 5-6 weeks after a TOP was therefore between 52/305 (17%) and 52/132 (39%), and that after management of a non-viable pregnancy was between 6/96 (6%) and 6/32 (19%). Bleeding/pelvic pain was present in half (29/58) of the women with EMV, and serum human chorionic gonadotropin was detectable in 29% (17/58) at the first follow-up examination. At ultrasound assessment, all cases with EMV presented abundant tortuous myometrial vessels with high-velocity flow projecting from the myometrium towards the endometrium, along with non-uniform heterogeneous endometrium in 97% of cases, which often (67% of these) contained cystic areas, absence of the endometrial midline in 98% of cases and an abnormal junctional zone in 97% of cases (64% interrupted, 33% irregular). Most (67%) women with EMV were parous and 90% of them had undergone TOP rather than management for a non-viable pregnancy. Medical management of the TOP or non-viable pregnancy was more frequent in women with than those without EMV (93% vs 77%, P = 0.023). Multiple regression analysis showed the risk of EMV to be increased following TOP vs non-viable pregnancy (odds ratio (OR), 3.67 (95% CI, 1.16-11.56), P = 0.026) and in parous compared with nulliparous women (OR, 2.95 (95% CI, 1.45-6.01), P = 0.002). All women with EMV underwent expectant management. Eleven women did not return for subsequent follow-up examinations and did not present to our outpatient or emergency facilities, so were lost to further follow-up. Spontaneous resolution of the lesion was observed within 7-16 weeks after the procedure in 96% (45/47) of the remaining cases. Two women chose to undergo surgery for pelvic discomfort, and histology showed the presence of neovessels mixed with retained chorionic villi. CONCLUSION: EMV is a transient and common finding 5-6 weeks following first-trimester TOP or management of non-viable pregnancy. TOP and being parous are risk factors for EMV. Expectant management of EMV is appropriate, because, in almost all cases, this resolves spontaneously, without complications, within 2-4 months. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Does a decannulation protocol exist in COVID-19 patients? The importance of working in a multiprofessional team.

As a Covid Hub in Emilia Romagna, we have experienced an increasing number of tracheostomized patients, prompting us to develop a standardized decannulation protocol for COVID-19 ARDS patients. Currently, there are no guidelines or protocols for decannulation in this population, and few studies have investigated the early outcomes of tracheostomy in COVID-19 patients, with no detailed analysis of the decannulation process. We recognized the importance of mutual reliance among our team members and the significant achievements we made compared to previous decannulation methods. Through the optimization of the decannulation process, we identified a clear, safe, and repeatable method based on clinical best practice and literature evidence. We decided to implement an existing standardized decannulation protocol, which was originally designed for severe brain-damaged patients, due to the growing number of COVID-19 patients with tracheostomy. This protocol was designed for daily practice and aimed to provide a uniform approach to using devices like fenestrated cannulas, speaking valves, and capping. The results of our implementation include:expanding the applicability of the protocol beyond severe brain-damaged patients to different populations and settings (in this case, patients subjected to a long period of sedation and invasive ventilation)early activation of speech therapy to facilitate weaning from the cannula and recovery of physiological swallowing and phonationearly activation of otolaryngologist evaluation to identify organic problems related to prolonged intubation, tracheostomy, and ventilation and address proper speech therapy treatmentactivation of more fluid and effective management paths for decannulation with a multiprofessional team.

Relation between adenomyosis and elastographic characteristics of the cervix.

STUDY QUESTION: Is there a possible etiologic link between cervical stiffness and adenomyosis? SUMMARY ANSWER: Women with adenomyosis have a stiffer internal cervical os than those without adenomyosis. WHAT IS KNOWN ALREADY: An increased myometrial contractility during menses, leading to breaches in the endometrial basal lamina and subsequent infiltration of endometrial cells into the myometrium, has been proposed as a possible pathogenic mechanism for adenomyosis. Intense menstrual pain has already been shown to be associated with an increased stiffness, at elastography, of the internal cervical os. STUDY DESIGN, SIZE, DURATION: A cross-sectional study on 275 women was performed between 1 February and 31 July 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Among the participants, 103 were and 172 women were not affected by adenomyosis as evaluated by ultrasonography. General and clinical characteristics of the patients were collected. Strain elastography was used to document tissue stiffness at different regions of interest of the cervix, i.e. the internal cervical os, the middle cervical canal, the anterior and the posterior cervical compartment. Tissue stiffness was expressed as a colour score from 0.1 = blue/violet (high stiffness) to 3.0 = red (low stiffness). Simple and multiple logistic regression analyses were used to evaluate the relation between the presence of adenomyosis, as the dependent variable, and independent factors. MAIN RESULTS AND THE ROLE OF CHANCE: Women with adenomyosis had a higher prevalence (P = 0.0001) and intensity (P = 0.0001) of pain during menses, between menses and at intercourse compared to control. The internal cervical os colour score was lower (higher stiffness) in women with adenomyosis (0.55 ± 0.29 versus 0.67 ± 0.26; P = 0.001) and the middle cervical canal/internal cervical os colour score ratio was greater (3.32 ± 4.36 versus 2.59 ± 4.99; P = 0.008), compared to controls. Upon logistic regression modelling (R2 = 0.077), the internal cervical os stiffness was an independent factor related to adenomyosis (odds ratio (OR) 0.220, 95% CI 0.077, 0.627; P = 0.005) along with age (P = 0.005) and the use of gonadal steroid therapies (P = 0.002). We obtained the same results using a different logistic regression model (R2 = 0.069), by substituting the internal cervical os stiffness with the ratio of the middle cervical canal/internal cervical os stiffness (OR 1.157, 95% CI 1.024, 1.309; P = 0.019). LIMITATIONS, REASONS FOR CAUTION: Women did not undergo surgery therefore we have no histological confirmation of the adenomyosis diagnosis. Strain elastography is a semiquantitative analysis and can be conditioned by the force applied by the operator during the analysis. The data were obtained mainly in White women in a single centre. WIDER IMPLICATIONS OF THE FINDINGS: To the best of our knowledge, this is the first study indicating that women with adenomyosis have an increased stiffness of the internal cervical os. The results indicate that a stiff internal cervical os, as determined by elastography, is a possible contributor to the development of adenomyosis. These findings may have clinical significance and should prompt further investigation. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: N/A.

Symptomatic enhanced myometrial vascularity after medically managed early miscarriage or abortion. A case series.

This case series evaluates clinical outcomes and sonographic features of symptomatic enhanced myometrial vascularity developed after either first trimester medical abortion or miscarriage management. All cases were followed until spontaneous resolution. Ultrasonography alongside persistent low serum ß-HCG supports enhanced myometrial vascularity diagnosis and expectant management is a feasible approach.

Energy levels in CaWO4:Tb(3+) at high pressure.

The luminescence properties of Tb(3+) in CaWO4 crystals are investigated under a hydrostatic pressure of up to 200 kbar, i.e. across scheelite-to-fergusonite phase transition. It is shown that the typical blue ((5)D3) and green ((5)D4) emissions in this material are progressively quenched at room temperature as pressure is increased. This quenching is caused by a downshift of the charge transfer (or impurity trapped exciton) state that is formed between Tb(3+) and nearby W(6+) cations in conjunction with a pressure-induced increase of the lattice relaxation experienced by this excited state. An empirical model is introduced to calculate the evolution of the (Tb(3+)-W(6+)) charge transfer energy with pressure. Combined with the pressure dependence of the energy bandgap in CaWO4, the model allows locating the 4f levels of Tb(3+) relative to the fundamental host lattice for any pressure in the range 0-200 kbar.

Effects of pumping wavelength and pump density on the random laser performance of stoichiometric Nd crystal powders.

Laser slope and threshold properties have been investigated in Nd stoichiometric crystal powders as a function of pump wavelength and pump beam size. Above a given pumped area, the laser slope and the threshold pump energy per unit area are invariant and the known theoretical expressions are well fulfilled. Likewise, the size of the stimulated emission zone as a function of the pump beam area has been measured, also showing a different behavior above or below a given pumped area value which coincides with the one mentioned above. In conclusion, two different operating regimes with different performances are clearly observed as a function of the pump beam area.

High pressure luminescence spectra of CaMoO4:Ln3+ (Ln = Pr, Tb).

Photoluminescence spectra and luminescence kinetics of pure CaMoO(4) and CaMoO(4) doped with Ln(3+) (Ln = Pr or Tb) are presented. The spectra were obtained at high hydrostatic pressure up to 240 kbar applied in a diamond anvil cell. At ambient pressure undoped and doped samples exhibit a broad band emission extending between 380 and 700 nm with a maximum at 520 nm attributed to the MoO(4)(2-) luminescence. CaMoO(4) doped with Pr(3+) or Tb(3+) additionally yields narrow emission lines related to f-f transitions. The undoped CaMoO(4) crystal was characterized by a strong MoO(4)(2-) emission up to 240 kbar. In the cases of CaMoO(4):Pr(3+) and CaMoO(4):Tb(3+), high hydrostatic pressure caused quenching of Pr(3+) and Tb(3+) emission, and this effect was accompanied by a strong shortening of the luminescence lifetime. In doped samples, CaMoO(4):Pr(3+) and CaMoO(4):Tb(3+), quenching of the emission band attributed to MoO(4)(2-) was also observed, and at pressure above 130 kbar this luminescence was totally quenched. The effects mentioned above were related to the influence of the praseodymium (terbium) trapped exciton PTE (ITE-impurity trapped exciton) on the efficiency of the Pr(3+) (Tb(3+)) and MoO(4)(2-) emissions.

Photon conversion in Bi(3+)/Pr(3+)-codoped CaTiO(3).

The luminescence properties of CaTiO(3) both singly and doubly doped with Bi(3+) and Pr(3+) have been measured in different experimental conditions in order to investigate the de-excitation processes active in these materials and in particular to understand the mechanism responsible for the significant increment of the red emission observed in the codoped system upon near-ultraviolet (NUV) excitation. The steady state spectra and the decay profiles have been analyzed in the light of the possible interactions between active ions and host lattice. The general model applied to the analysis of the temporal profiles of the emission allows us to assess which are the main mechanisms involved in the Bi(3+)  â†’  Pr(3+) sensitization process.

High pressure luminescence spectra of CaMoO4:Pr3+.

Steady state and time resolved luminescence measurements of CaMoO(4) doped with Pr(3+) as a function of hydrostatic pressure in the 1-175 kbar range are presented. It has been observed that with increasing pressure the spectral features shift towards lower energies, the decay times of both (3)P(0) and (1)D(2) emitting levels become shorter and the intensity of the (3)P(0) emission decreases to complete quenching at about 110 kbar, whereas that of the (1)D(2) emission increases in the 0-100 kbar range and then rapidly decreases when the pressure exceeds 127 kbar. A variation of the structure of the spectral manifolds indicates that a pressure induced phase transition of the host lattice occurs in the 80-100 kbar range. The quenching of the luminescence and the shortening of the decay times have been accounted for by means of a model that takes into account the role played by a praseodymium trapped exciton in the excited state dynamics of the investigated material.

Luminescence properties of K1/2Bi1/2TiO3:Pr3+ and Na1/2Bi1/2TiO3:Pr3+.

The luminescence properties of K(1/2)Bi(1/2)TiO(3):Pr(3+) and Na(1/2)Bi(1/2)TiO(3):Pr(3+) powders are investigated in the temperature range 10-600 K. The experimental data are interpreted on the basis of metal-to-metal charge transfer processes and by considering Bi(3+)-to-Pr(3+) sensitization effects.

Arthroscopic assisted bone grafting for early stages of Kienböck's disease.

Kienböck's disease is known for its difficulty in being diagnosed and treated at early stages; option treatments are few and most of them quite aggressive. The author describes his experience with arthroscopic assisted lunate bone grafting. Three patients with diagnosis of stage I avascular necrosis of the lunate (average age: 45 years), were treated. Before surgical procedure, the patients underwent to a conservative treatment. After harvesting the bone graft from the volar surface of the radius, arthroscopic bone grafting was performed. At an average follow-up of 13.5 months (9-15), all the patients show a normal density of the lunate and no arthritic changes in radiographs. The MRI confirmed the lunate vascularity. The number of patients is definitely small, due also to the rarity of the disease and the difficulty in diagnosis, but, despite the very high learning curve, could be the proper first choice of treatment.

Optical transition probabilities in Er3+- and Tm3+-doped LiLa9(SiO4)6O2 crystals.

In this work, Er(3+) and Tm(3+)-doped LiLa(9)(SiO(4))(6)O(2) crystals have been grown from an Li(2)MoO(4) flux in the 1360-940 °C temperature range. Optical absorption spectra have been measured to obtain the experimental oscillator strengths of the transitions from the ground state to the excited levels. Judd-Ofelt calculations have been performed to estimate the Ω(2), Ω(4) and Ω(6) intensity parameters. The dynamics of selected Er(3+) and Tm(3+) manifolds have been investigated under selective pulsed excitation in order to determine the energy gap law by comparing the observed decay rates with the Judd-Ofelt predictions.

High pressure evolution of YVO(4):Pr(3+) luminescence.

Photoluminescence and time-resolved photoluminescence spectra of YVO(4) doped with Pr(3+) obtained at high hydrostatic pressure up to 76 kbar applied in a diamond anvil cell are presented. At pressures lower than 60 kbar the steady state emission spectra consist of sharp lines related to the [Formula: see text] transition in Pr(3+). At pressures above 68 kbar the Pr(3+) emission intensity decreases and the corresponding bands are replaced by a broad band peaking at 19 500 cm(-1) attributed to perturbed VO(4)(3-) host luminescence. The quenching of the [Formula: see text] emission has been attributed to nonradiative transition to the charge transfer exciton trapped at Pr(3+) ion. The recovering of the VO(4)(3-) host luminescence at high pressure has been attributed to energy transfer from a Pr(3+) trapped exciton (PTE) to the host YVO(4). The kinetics of such a process is analyzed using the model of PTE considered as a Pr(4+) + electron bound by the Coulomb potential at the delocalized Rydberg states.

Energy levels and emission parameters of the Dy(3+) ion doped into the YPO(4) host lattice.

Single crystals of Dy(3+)-doped YPO(4) have been grown from Pb(2)P(2)O(7) flux and investigated by optical spectroscopy techniques. The energy level scheme of the active ion has been deduced from the low temperature spectra and reproduced by means of a crystal-field calculation. The room temperature absorption spectra have been analysed in the framework of the Judd-Ofelt approach, and the results of this analysis have been applied in a discussion concerning the spectral composition of the visible luminescence.

A comparison of endoscopic and open trigger finger release.

The main complaint of the patients after an open trigger finger release is a discomfort at the incision site. In this prospective study, we compared the two consecutive groups of patients with trigger fingers. One was treated by an open approach and the other by the endoscopic release of the A1 pulley. Pre- and post-operative evaluation at seven, 30 and 90 days showed a faster recovery from the discomfort with a faster return to daily and working activities, after the endoscopic procedure.

Effects of neodymium incorporation on the structural and luminescence properties of the YAl(3)(BO(3))(4)-NdAl(3)(BO(3))(4) system.

The luminescence of Nd(3+) ions in Nd(x)Y(1-x)Al(3)(BO(3))(4) (Nd:YAB) single crystals has been investigated as a function of the neodymium concentration in order to evidence the relation between the structural and spectroscopic properties in this nonlinear laser system. The analysis of the experimental data allowed us to individuate four different composition ranges. For moderate concentrations (x<0.2) the lattice parameters are nearly constant, and the emission spectra arise from Nd(3+) ions in unperturbed crystal sites. For concentrations in the 0.20.9 the final formation of the NdAl(3)(BO(3))(4) (NAB) monoclinic phase is complete, and a new local ordering around Nd(3+) is very evident in the spectral features.

[Actinomycosis infection presenting as malignant pelvic frostbite]. / Infezione da actionomicosi presentatasi con un quadro di congelamento pelvico maligno.

Actinomycosis is a chronic inflammatory disease rarely observed in the pelvic form but rather frequently in the cervicofacial tract. The pelviabdominal form is difficult to diagnose because of its various clinical presentations that can lead to misdiagnosis by imitating a neoblastic disease, a bowel inflammatory disease, an acute diverticulitis or gynecological disorders. The case is reported of a 43 year old woman with prolonged use of an intrauterine contraceptive device and with severe phlogosis secondary to extensive pelvic actinomycosis involving both ovaries, the urinary duct and the rectosigmoid, misdiagnosed as pelvic frostbite presentation of a malignant neoplasm. A bilateral hysterosalpingo-oophorectomy surgery was performed and a urethral stent was placed before the operation. Rarely, has the pelvis been so heavily involved by a chronic actinomycosis infection.

Triazinic herbicide determination by gas chromatography-mass spectrometry in breast milk.

A solid-phase extraction procedure using a graphitized carbon black cartridge for extraction and cleaning of a series of five triazines (atrazine, deethylatrazine, deisopropylatrazine, ametryne and prometryne) from breast milk samples was developed. Using a chemometric methodology, the optimisation of both the analysis time and the triazinic herbicide separation by gas chromatography-mass spectrometry (GC-MS) was then carried out with only 18 experiments. Detection and quantification limits for 1ml breast milk sample were, respectively, 0.3 and 1 ppb for each studied compound. The variation coefficients were less than 5% over the concentration range from 1 to 100 ppb. The accuracy was between 98.63 and 104.62% for each triazinic herbicide. The recovery was between 58.64 and 63.22% for the concentration range from 1 to 100 ppb for each triazinic herbicide. The assay was successfully applied to the analysis of several breast milk samples.