Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically-based prevalence and clinical characteristics.

OBJECTIVE: To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH). METHODS: A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight. RESULTS: The histologically-based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34-8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38-24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08-10.31, P = 0.036), urgent/emergency C-section (OR: 24.15, 95% CI: 2.60-223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48-16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05-12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32-11.02, P = 0.013). CONCLUSION: In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.

Gambling and virtual reality: unraveling the illusion of near-misses effect.

Introduction: Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context. Methods: This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform. Results: The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses. Discussion: Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.

Exploring Social Bonds and Well-Being in Young Adults during and beyond the COVID-19 Pandemic.

BACKGROUND: Young adults, aged between 17 and 25 years, experienced a strong impact on both their mental health and well-being due to COVID-19. Indeed, they were simultaneously faced with the normative tasks of their age and stressors associated with the long-lasting COVID-19 pandemic. This study offers further insights into the perceptions of the well-being (stress, anxiety, and depression) and social bonds in young Italian adults during and after the COVID-19 pandemic. METHODS: The first survey was conducted between December and February 2021 (i.e., during the second wave in Italy) and included a total sample of 347 participants. The second survey took place between April and May 2022 (i.e., at the end of the health emergency in Italy) and consisted of a total sample of 313 participants. RESULTS: T-tests, correlations, and linear regressions were performed. Overall, our findings showed an increased mood disturbance was positively correlated with having contracted COVID-19 and negatively associated with social connectedness. Furthermore, social assurance was found to negatively predict mood disorders during COVID-19. CONCLUSION: While numerous studies have focused on mental health, there has been limited exploration of protective factors, which could represent a different perspective that emphasizes individuals' resources rather than their vulnerabilities.

A Medical-Legal and Psychological Systematic Review on Vitriolage Related to Gender-Based Violence.

Attacks perpetrated using acid are a particular form of interpersonal violence, possibly one of the most heinous manifestations of Intimate Partner Violence (IPV). Acid attacks are mainly motivated by extramarital cheating, marital conflicts, women's rejection of marriage proposals, and sexual advances. As these attacks are not well understood from a psychological perspective, we conducted a systematic review, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, of 284 articles identified, 13 were eligible for inclusion. Three main focuses were identified: "Risk and vulnerability factors," "Consequences and implications," and "Interventions and treatments." Acid attacks seem to be more frequent in countries where social and economic development leads to greater tensions over traditional gender roles like Bangladesh, Pakistan, and India. Identified risk factors were young age, low socioeconomic status, low educational attainment, ethnicity, unemployment status of the victim, alcohol, and drug use of the perpetrator. Among the main psychosocial consequences of acid attacks, isolation and social exclusion emerged. Additionally, the paper will discuss the role of mental health consequences and specific treatments from psychological, clinical, and medical-legal points of view.

Did They Deserve It? Adolescents' Perception of Online Harassment in a Real-Case Scenario.

Online harassment, particularly cyberbullying and the non-consensual sharing of intimate images, is a widespread phenomenon among adolescents and young adults. Descriptive research was carried out to investigate any differences among Italian school classes in the perception of cybercrime through a real-case scenario. Following the Italian school system, the final sample of 1777 adolescents (Mage = 15.37, SD = 1.65; Male = 52%) was divided into three groups based on the school class attended: middle school (N = 562; Mage = 13.37, SD = 0.48); high school biennium (N = 728; Mage = 15.55, SD = 0.50), and triennium (N = 487, Mage = 17.40, SD = 0.71). Participants completed a self-report questionnaire investigating the use of the Internet and the perception of a real case scenario involving the non-consensual sharing of intimate images and cyberbullying received by the National Centre for Combating Child Pornography Online (NCPO). Results showed differences among the three groups' perceptions of the event's features, motivations underlying the offense, victim-blaming and harassment justification (e.g., cyberbullying, in particular non-consensual sharing of intimate images, is recognized as a crime as age increases). The findings provide significant insights for future research and age-specific factors to consider when developing prevention programs for online risks.

The Fear of COVID-19: Gender Differences among Italian Health Volunteers.

BACKGROUND: During the COVID-19 pandemic, the fear of being infected was a major concern, resulting in both physical and psychological effects. Despite several studies on fear of COVID-19 in the general population, the effects on healthy volunteers who face COVID-19 on the frontlines have not yet been investigated. METHODS: An online survey on specific psychological variables related to COVID-19 was administered to 720 healthy volunteers, and gender differences were investigated. RESULTS: The primary finding was that females showed higher scores in all dimensions assessed. A multiple linear regression conducted on both genders exhibited a similar pattern of predictors, highlighting the pivotal role of negative affect in the male group. CONCLUSIONS: The findings suggest that COVID-19 had significant effects on healthy volunteers, especially in the female group. Although the previous literature did not report the crucial role played by the negative affect in the male sample, these results highlight the need to deepen how both genders use different emotional strategies to cope with stressful situations. This study may be useful in the development of specific psychological support and ad hoc training for healthy volunteers.

Can Emotion Regulation Affect Aggressive Responses? A Study on the Ukrainian-Russian Conflict in a Non-Directly Exposed Sample.

On 24 February, Russian President Vladimir Putin gave the order to invade neighbouring Ukraine; a typical trend during the war is considering events in a one-sided way, emphasising the exclusive contribution of one opponent over the other for the outbreak of war. War may trigger the experience of emotions, such as anger, shame, and disgust. The present study reproduces previous studies on the influence of emotional regulation in support of aggressive reactions (AR) in the Israeli-Palestinian conflict. A questionnaire referring to the Russian-Ukrainian conflict has been implemented and spread in the Italian territory. A multiple moderated mediation model was proposed to evaluate the effect of emotional cognitive reappraisal on the propensity for AR, including conflict-related emotions (anger, shame, disgust) as mediators and political alignment and the appraisal of one's own emotions subscale of the brief emotional intelligence scale as moderators. The results show that cognitive reappraisal of emotions has a negative effect on AR; moreover, recognising and regulating emotions decreases anger, while taking sides with Ukraine or not siding seems to have an effect on AR depending on the emotion felt (anger or shame). The results are discussed according to the current literature on the topic, highlighting the practical implications and limits of the research.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY EVALUATION OF PERIPAPILLARY MICROVASCULAR CHANGES AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

PURPOSE: To evaluate the radial peripapillary capillary plexus (RPCP) vessel density (VD) and the retinal nerve fiber layer (RNFL) thickness in eyes successfully treated with pars plana vitrectomy for primary rhegmatogenous retinal detachment. METHODS: In this cross-sectional multicenter clinical study, eyes with a minimum 12-month follow-up were reexamined. The RPCP VD and RNFL thickness in the rhegmatogenous retinal detachment subfields of the affected eye (study group) were compared with the corresponding areas of the healthy fellow eyes (control group). RESULTS: Fifty-three eyes were included in the study. A significantly lower RPCP VD and RNFL thickness were observed in those subfields affected by rhegmatogenous retinal detachment compared with those of the control group (P < 0.001). No statistically significant differences were observed between undetached subfields in the study group and their corresponding images in the control group. In the study group, a significant correlation was found between RPCP VD and RNFL thickness in subfields with detached retina (r = 0.393, P < 0.001) and undetached retina (r = 0.321, P < 0.001). CONCLUSION: Radial peripapillary capillary plexus VD changes were found in the subfields of detached retina successfully treated with pars plana vitrectomy and they correlated with RNFL thinning. These data suggest a coexistence of neuronal and microvascular damage in patients affected by rhegmatogenous retinal detachment.

Fostering the Aesthetic Pleasure: The Effect of Verbal Description on Aesthetic Appreciation of Ambiguous and Unambiguous Artworks.

BACKGROUND: Aesthetic experience begins through an intentional shift from automatic visual perceptual processing to an aesthetic state of mind that is evidently directed towards sensory experience. In the present study, we investigated whether portrait descriptions affect the aesthetic pleasure of both ambiguous (i.e., Arcimboldo's portraits) and unambiguous portraits (i.e., Renaissance portraits). METHOD: A total sample of 86 participants were recruited and completed both a baseline and a retest session. In the retest session, we implemented a sample audio description for each portrait. The portraits were described by three types of treatment, namely global, local, and historical descriptions. RESULTS: During the retest session, aesthetic pleasure was higher than the baseline. Both the local and the historical treatments improved the aesthetic appreciation of ambiguous portraits; instead, the global and the historical treatment improved aesthetic appreciation of Renaissance portraits during the retest session. Additionally, we found that the response times were slower in the retest session. CONCLUSION: taken together, these findings suggest that aesthetic preference was affected by the description of an artwork, likely due to a better knowledge of the painting, which prompts a more accurate (and slower) reading of the artwork.

Mobile Phone Use "on the Road": A Self-Report Study on Young Drivers.

BACKGROUND: Extensive research showed that multitasking negatively affects driving performance. Multitasking activities can range from talking and texting to listening to music; particularly among young drivers, multitasking behavior is caused mainly from mobile phone use while driving which is one of the main causes of road accidents. OBJECTIVE: The main purpose of this study was to investigate whether some variables (e.g., Sensation-Seeking, preferences of Multitasking) could affect mobile phone use while driving in young drivers and whether any gender differences were present among the examined variables. SETTING AND PARTICIPANTS: The sample consists of 424 Italian students (56% males) with an age range of 18-21 years. A self-report questionnaire was specifically developed to assess variables such as: Attitude toward Multitasking, Perceived Self-efficacy in Multitasking, Accident Risk Perception, General Multitasking Habits, and Sensation Seeking. RESULTS: Through SEM modeling, we found the attitude to multitasking while driving to be largely explained by the considered variables. Using multigroup analysis (MGSEM), the model we developed appears to be suitable for explaining the behaviors of both male and female young drivers. Furthermore, data comparison showed that females were more likely to risk perception toward multitasking, and risk perception when using a mobile phone while driving, while males obtained higher mean scores in Sensation Seeking, Perceived Self-Efficacy in Multitasking, and in Multitasking caused by mobile phone use while driving. CONCLUSION: Our research showed how some variables may influence the inclination of some subjects to engage in multitasking while driving. Furthermore, we discussed the importance of considering these variables in the implementation of effective road safety education projects on driving multitasking.

"Stay at Home" in Italy during the COVID-19 Outbreak: A Longitudinal Study on Individual Well-Being among Different Age Groups.

The restrictions imposed by the Italian government because of the coronavirus outbreak have been shown to be demanding on the Italian population. Data were collected at four different time points from 29 March 2020 to 3 May 2020 and during the final follow-up survey on 12 October 2020. In the present study, we provided longitudinal evidence on the relationship between the lockdown and mental health dimensions, such as emotional state, perceived stress, and time perspective, for three age groups. The results allowed us to observe their psychological status from different perspectives at five different time points. Notably, a negative effect of the lockdown individual well-beings emerged as a trend, and differences in individual adaptation strategies to a prolonged stressful situation were observed at the follow-up. Indeed, pairwise comparisons between age groups showed that the young adult group (18-23 years old) seemed to be the most psychologically affected by the lockdown. The findings are discussed according to the most recent literature on the topic. To the best of our knowledge, this is one of the first longitudinal studies carried out in Italy concerning the general psychological effects of the coronavirus lockdown.

Intimate Partner Violence during the COVID-19 Pandemic: A Review of the Phenomenon from Victims' and Help Professionals' Perspectives.

Social isolation is considered one of the main risk factors leading to intimate partner violence episodes; this evidence also emerged during the application of stay-at-home policies to contain the COVID-19 pandemic. For this reason, we aimed to collect data on intimate partner violence over the last year, comparing data reported by victims with data collected by help professionals. In accordance with PRISMA guidelines, through keywords related to abuse, pandemic and containment measures, 3174 articles were identified for screening. After full-text reading and risk of bias analysis, 19 studies were included, and a thematic synthesis was conducted according to two categories: "studies with victims" and "studies with help professionals". The results of the present review showed that there were significant differences between the data provided by victims and the data collected by health care facilities and police departments; additionally, differences among different forms and severity of victimization emerged. The results have been discussed according to the literature; in particular, we reflected on how containment measures have apparently made it more difficult for victims to report, thus making the existence of the dark figure of crime even more salient.

Forced Cohabitation during Coronavirus Lockdown in Italy: A Study on Coping, Stress and Emotions among Different Family Patterns.

BACKGROUND: At the beginning of 2020, a pandemic caused by a new strain of coronavirus occurred. On March 9th, the Italian population was forced to lockdown to prevent the spread of this new virus. This event forced families and cohabitants to spend their entire days and weeks in the same physical space, interacting with partners and children with a very different degree of intimacy than in the earlier situation. The present study investigated the effects of being forced to live together on different family patterns, on various dimensions such as stress, coping strategies, time perception and quality evaluation of cohabitation. METHOD: A total sample consisting of 1750 individuals was recruited through a random sample of probability across the Italian country. Due to the lockdown condition, an online questionnaire was set up; several validated scales were chosen, and some open-ended items were included for the thoughts of the participants. RESULTS: The results showed statistically significant differences between the three family patterns examined. CONCLUSION: During the forced period of living together, a positive effect could be inferred as given by the presence of children and the collaborative coping strategies that have been adopted; the results have been discussed according to the literature on the topic.

Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment.

The treatment for rhegmatogenous retinal detachment (RRD) is surgery, including pars plana vitrectomy (PPV) and scleral buckling (SB). Despite surgical advances, degeneration of the photoreceptors and post-operative complications, such as proliferative vitreoretinopathy (PVR), often occurs as the result of inflammation, preventing complete visual recovery or causing RRD recurrence. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs and the surgery itself induces an inflammatory response. This comprehensive review focuses on the use of different formulations of corticosteroids (CCS), as an adjunctive treatment to surgery, either PPV or SB, for RRD repair. The purpose was to review the efficacy and safety of CCS in improving functional and anatomical outcomes and in preventing postoperative complications. This review is organized according to the timing of CCS administration: preoperative, intraoperative, and postoperative. The evidence reviewed supported the role of the pre-operative use of CCS in the treatment of combined RRD and choroidal detachment (CD), reducing CD height. No solid consensus exists on intraoperative and postoperative use of CCS to treat and prevent postoperative complications. However, a large randomized clinical trial including more than 200 eyes suggested that oral prednisone after surgery decreases the rate of postoperative grade B PVR.

Vascular changes after vitrectomy for rhegmatogenous retinal detachment: optical coherence tomography angiography study.

PURPOSE: To analyse the postoperative foveal avascular zone (FAZ) area, superficial vessel density (SVD) and deep vessel density (DVD) and their correlation with functional (best-corrected visual acuity, BCVA) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair. METHOD: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas tamponade and a minimum 12 months follow-up, were re-examined. Foveal avascular zone (FAZ) area, SVD, DVD and FMT were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye. RESULTS: Fifty-six patients with macula-on and 37 with macula-off RRD were included in the study. In both groups, no difference in FMT and FAZ area was found compared to fellow eyes. In macula-on RRD eyes, a lower parafoveal DVD (p = 0.001) was detected; FAZ area was related to FMT (p = 0.025), and the postoperative BCVA was correlated with parafoveal DVD (p = 0.010) and FAZ area (p = 0.003). In macula-off RRD eyes, lower parafoveal SDV (p = 0.012), and foveal and parafoveal DVD (p = 0.012 and p < 0.001, respectively) were observed. BCVA was related to FAZ area (p = 0.012), foveal SVD (p = 0.005) and parafoveal DVD (p = 0.010). CONCLUSION: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to FAZ area and vessel density.

Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers.

PURPOSE: To analyse the effects of intravitreal dexamethasone implant (DEX) in patients with diabetic macular oedema (DME) unresponsive to ranibizumab treatment, in relation to the inflammatory optical coherence tomography (OCT) retinal features, subfoveal neuroretinal detachment (SND) and hyperreflective retinal spots (HRS). METHODS: Patients with DME poorly responsive to three injections of ranibizumab were treated with DEX. Best-corrected visual acuity (BCVA) and central macula thickness (CMT, measured by Spectralis SD-OCT) were assessed at baseline and at 1, 3, and 6 months. RESULTS: Overall, 44 eyes were included in the study. In the whole group, mean BCVA (baseline 51.5 ± 8.3 letters) increased significantly at 1 month (to 56.9 ± 8.8 letters; Tukey HSD p = 0.017) and was 55.5 ± 8.8 letters at 3 months (Tukey HSD p = 0.128). Central macula thickness (CMT) reduced significantly at 1 and 3 months (417 ± 149 µm and 469 ± 128 µm, respectively, both Tukey HSD p < 0.001 versus baseline). Subgroup analysis showed a significant BCVA increase at 1 month in eyes with SND + HRS (from 51.2 ± 9.2 to 58.2 ± 9.0, p = 0.029), and a trend to BCVA increase in eyes with HRS (from 52.3 ± 6.4 to 56.8 ± 7.9, p = 0.080), with a significant CMT decrease in both groups (p < 0.001). No changes of either parameter were found in eyes without SND and HRS. CONCLUSION: Spectral domain OCT is useful in identifying some inflammatory features in DME. Among DME eyes 'poorly responsive' to ranibizumab, those with SND and HRS responded better to DEX implants than those without these features.

Isolated Ovarian Endometrioma: A History Between Myth and Reality.

STUDY OBJECTIVE: To assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extraovarian lesions including adhesions, deep infiltrating endometriosis (DIE), and adenomyosis. DESIGN: Retrospective observational study (Canadian Task Force classification II-2). SETTING: Two university hospitals. PATIENTS: Two hundred fifty-five symptomatic women with at least 1 ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation. INTERVENTIONS: Patients underwent TVS followed by either medical or surgical treatment. MEASUREMENTS AND MAIN RESULTS: Two hundred fifty-five women, aged 20 to 40 years, underwent TVS and were found to have at least 1 endometrioma with a diameter > 20 mm. Associated sonographic signs of pelvic endometriosis (adhesions, DIE, and adenomyosis) were recorded, and a subgroup of patients (n = 50) underwent laparoscopic surgery within 3 months of TVS. Mean endometrioma diameter was 40.0 ± 18.1 mm, and bilateral endometriomas were observed in 65 patients (25.5%). TVS showed posterior rectal DIE in 55 patients (21.5%) and a thickening of at least 1 uterosacral ligament in 93 patients (36.4%). One hundred eighty-six patients (73%) had adhesions, and 134 patients (53%) showed signs of myometrial adenomyosis on TVS. Thirty-eight patients (15%) exhibited only a single isolated endometrioma with a mobile ovary and no other signs of pelvic endometriosis/adenomyosis at TVS. CONCLUSION: Ovarian endometriomas are indicators for pelvic endometriosis and are rarely isolated. Particularly, left endometriomas were found to be associated with rectal DIE and left uterosacral ligament localization and bilateral endometriomas correlated with adhesions and pouch of Douglas obliteration, whereas no correlation was found between endometrioma size and DIE. Determining appropriate management, whether clinical or surgical, is critical for ovarian endometriomas and concomitant adhesions, endometriosis, and adenomyosis in patients desiring future fertility.

Widening use of dexamethasone implant for the treatment of macular edema.

Sustained-release intravitreal 0.7 mg dexamethasone (DEX) implant is approved in Europe for the treatment of macular edema related to diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, and non-infectious uveitis. The implant is formulated in a biodegradable copolymer to release the active ingredient within the vitreous chamber for up to 6 months after an intravitreal injection, allowing a prolonged interval of efficacy between injections with a good safety profile. Various other ocular pathologies with inflammatory etiopathogeneses associated with macular edema have been treated by DEX implant, including neovascular age-related macular degeneration, Irvine-Gass syndrome, vasoproliferative retinal tumors, retinal telangiectasia, Coats' disease, radiation maculopathy, retinitis pigmentosa, and macular edema secondary to scleral buckling and pars plana vitrectomy. We undertook a review to provide a comprehensive collection of all of the diseases that benefit from the use of the sustained-release DEX implant, alone or in combination with concomitant therapies. A MEDLINE search revealed lack of randomized controlled trials related to these indications. Therefore we included and analyzed all available studies (retrospective and prospective, comparative and non-comparative, randomized and nonrandomized, single center and multicenter, and case report). There are reports in the literature of the use of DEX implant across a range of macular edema-related pathologies, with their clinical experience supporting the use of DEX implant on a case-by-case basis with the aim of improving patient outcomes in many macular pathologies. As many of the reported macular pathologies are difficult to treat, a new treatment option that has a beneficial influence on the clinical course of the disease may be useful in clinical practice.

Three-Dimensional Hysterosalpingo Contrast Sonography with Gel Foam: Methodology and Feasibility to Obtain 3-Dimensional Volumes of Tubal Shape.

OBJECTIVES: To investigate the feasibility of hysterosalpingo foam sonography (HyFoSy) with automated 3-dimensional (3D) software in the evaluation of tubal patency and visualization of the tubal course by obtaining a 3D volume acquisition of tubes. DESIGN: Prospective observational study (Canadian Task Force classification III). SETTING: University hospital. PATIENTS: A total of 132 infertile females evaluated between October 2013 and February 2015. INTERVENTIONS: All patients underwent HyFoSy with the new automated 3D coded contrast imaging (CCI) followed by 2-dimensional (2D) real-time HyFoSy. To evaluate the feasibility of 3D visualization of the tubal course, consecutive volume acquisitions were performed during gel foam contrast agent injection. Conventional 2D real-time hysterosalpingo contrast sonography (HyCoSy) by detection of gel foam moving through the tubes and around the ovaries was finally performed and considered to indicate the final results of tubal status. MEASUREMENTS AND MAIN RESULTS: All the patients underwent 3D CCI HyFoSy, followed by 2D real-time HyFoSy. After both procedures, we observed 108 patients (81.8%) with bilateral tubal patency, 22 patients (16.6%) with unilateral tubal patency, and 2 patients (1.5%) with bilateral tubal occlusion. The concordance rate for tubal status between the first and second 3D volume acquisitions and the final 2D real-time evaluation was 84.8% and 97.0%, respectively. CONCLUSIONS: Transvaginal ultrasound HyFoSy with 3D volume reconstruction of the uterus and tubes is an accurate and safe technique that allows complete visualization of tubal shape and patency with high patient compliance.

Neuroendocrine and stress-related aspects of endometriosis.

Endometriosis is a model of a benign gynecologic disease associated with two major symptoms: pain and infertility. When becomes chronic, severe psychological and neuroendocrine changes may occur. The high levels of perceived stress caused by symptoms cause a neuroendocrine disequilibrium thus contributing to the progression of the disease. Elevated stress levels alter hormonal secretions, mood and behavior, sexual disorders and appetite custom. Inflammatory comorbidities may be associated with elevated stress in endometriotic patients (inflammatory bowel disease, fibromyalgia, chronic fatigue) and even autoimmune diseases (thyroid disease, systemic lupus erythematosus, multiple sclerosis). Neurogenic mechanisms are described in endometriotic lesions and they affect peripheral and central nervous system of these patients increasing pain sensitivity and stress reactivity. In conclusion, endometriosis is a disease which affects reproductive and neuroendocrine functions with a great impact on women's health and quality of life.