88 pubblicazioni classificate nel seguente modo:

Concurrent Endometrial Cancer in Women with Atypical Endometrial Hyperplasia: What Is the Predictive Value of Patient Characteristics? †
CANCERS
Autore/i: Giannella, L.; Piva, F.; Delli Carpini, G.; Di Giuseppe, J.; Grelloni, C.; Giulietti, M.; Sopracordevole, F.; Giorda, G.; Del Fabro, A.; Clemente, N.; Gardella, B.; Bogani, G.; Brasile, O.; Martinello, R.; Caretto, M.; Ghelardi, A.; Albanesi, G.; Stevenazzi, G.; Venturini, P.; Papiccio, M.; Canni, M.; Barbero, M.; Fambrini, M.; Maggi, V.; Uccella, S.; Spinillo, A.; Raspagliesi, F.; Greco, P.; Simoncini, T.; Petraglia, F.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: The rate of concurrent endometrial cancer (EC) in atypical endometrial hyperplasia (AEH) can be as high as 40%. Some patient characteristics showed associations with this occurrence. However, their real predictive power with related validation has yet to be discovered. The present study aimed to assess the performance of various models based on patient characteristics in predicting EC in women with AEH. Methods: This is a retrospective multi-institutional study including women with AEH undergoing definitive surgery. The women were divided according to the final histology (EC vs. no-EC). The available cases were divided into a training and validation set. Using k-fold cross-validation, we built many predictive models, including regressions and artificial neural networks (ANN). Results: A total of 193/629 women (30.7%) showed EC at hysterectomy. A total of 26/193 (13.4%) women showed high-risk EC. Regression and ANN models showed a prediction performance with a mean area under the curve of 0.65 and 0.75 on the validation set, respectively. Among the best prediction models, the most recurrent patient characteristics were age, body mass index, Lynch syndrome, diabetes, and previous breast cancer. None of these independent variables showed associations with high-risk diseases in women with EC. Conclusions: Patient characteristics did not show satisfactory performance in predicting EC in AEH. Risk stratification in AEH based mainly on patient characteristics may be clinically unsuitable.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/326331

Raf kinase inhibitor protein expression in smooth muscle tumours of the uterus: a diagnostic marker for leiomyosarcoma?
REPRODUCTIVE BIOMEDICINE ONLINE
Autore/i: Greco, Stefania; Pinheiro, Joana; Cardoso-Carneiro, Diana; Giantomassi, Federica; Pellegrino, Pamela; Scaglione, Giulia; Delli Carpini, Giovanni; Ciavattini, Andrea; Zannoni, Gian Franco; Goteri, Gaia; Martinho, Olga; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Abstract: Research question: What is the expression pattern of Raf kinase inhibitory protein (RKIP) in different subtypes of leiomyoma (usual type, cellular, apoplectic or haemorrhagic leiomyoma, leiomyoma with bizarre nuclei and lipoleiomyoma) and leiomyosarcoma specimens, and what is its biological role in leiomyosarcoma cells? Design: Leiomyoma and leiomyosarcoma specimens underwent immunohistochemistry staining. Leiomyosarcoma SK-LMS-1 cell line was RKIP knocked down and RKIP overexpressed, and cell viability, wound healing migration and clonogenicity assays were carried out. Results: A higher immunohistochemical expression of RKIP was observed in bizarre leiomyomas, than in usual-type leiomyomas. Decreased expression was also found in cellular leiomyoma, with generally absent staining in leiomyosarcomas. Upon RKIP expression manipulation in SK-LMS-1 cell line, no major differences were observed in cell viability and migration capacity over time. RKIP knockout, however, resulted in a significant increase in the cell's ability to form colonies (P = 0.011). Conclusion: RKIP distinct expression pattern among leiomyoma histotype and leiomyosarcoma, and its effect on leiomyosarcoma cells on colony formation, encourages further studies of RKIP in uterine smooth muscle disorders.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/328914

Long-Term Follow-Up Outcomes in Women with In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix Undergoing Conservative Treatment—Cervical Adenocarcinoma Study Group Italian Society of Colposcopy and Cervico-Vaginal Pathology
CANCERS
Autore/i: Giannella, L.; Delli Carpini, G.; Di Giuseppe, J.; Grelloni, C.; Bogani, G.; Dri, M.; Sopracordevole, F.; Clemente, N.; Giorda, G.; De Vincenzo, R.; Evangelista, M. T.; Gardella, B.; Dominoni, M.; Monti, E.; Alessi, C.; Alessandrini, L.; Guerriero, A.; Pagan, A.; Caretto, M.; Ghelardi, A.; Amadori, A.; Origoni, M.; Barbero, M.; Raspagliesi, F.; Simoncini, T.; Vercellini, P.; Spinillo, A.; Scambia, G.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p = 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/328551

Atypical Endometrial Hyperplasia and Concurrent Cancer: A Comprehensive Overview on a Challenging Clinical Condition
CANCERS
Autore/i: Giannella, L.; Grelloni, C.; Bernardi, M.; Cicoli, C.; Lavezzo, F.; Sartini, G.; Natalini, L.; Bordini, M.; Petrini, M.; Petrucci, J.; Terenzi, T.; Delli Carpini, G.; Di Giuseppe, J.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: The present review regarding atypical endometrial hyperplasia (AEH) focused on the main debated factors regarding this challenging clinical condition: (i) predictive variables of occult endometrial cancer (EC); (ii) the rate of EC underestimation according to different endometrial sampling methods; and (iii) the appropriateness of lymph node status assessment. When cancer is detected, approximately 90% of cases include low-risk EC, although intermediate/high-risk cases have been found in 10–13% of women with cancer. Older age, diabetes, high BMI, and increased endometrial thickness are the most recurrent factors in women with EC. However, the predictive power of these independent variables measured on internal validation sets showed disappointing results. Relative to endometrial sampling methods, hysteroscopic endometrial resection (Hys-res) provided the lowest EC underestimation, ranging between 6 and 11%. Further studies, including larger sample sizes of women undergoing Hys-res, are needed to confirm these findings. These data are urgently needed, especially for female candidates for conservative treatment. Finally, the evaluation of lymph node status measured on 660 of over 20,000 women showed a lymph node positivity of 2.3%. Although there has been an increase in the use of this procedure in AEH in recent years, the present data cannot recommend this option in AEH based on a cost/risk/benefit ratio.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/328332

A survey on the current practice of indicating an elective cesarean after a previous myomectomy
ANNALS OF MEDICINE
Autore/i: Delli Carpini, G.; Verdecchia, V.; Giannella, L.; Di Giuseppe, J.; Gardella, B.; Greco, P.; Cicinelli, E.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: The objective of this study was to evaluate the attitude of obstetricians/gynecologists toward indicating an elective cesarean delivery in pregnant patients with a previous myomectomy. Materials and methods: Web-based multiple-choice questions survey evaluating the attitude to indicate a cesarean with a composite summated score (range 56-280) from a 56-item Likert scale: score 56-112: weak attitude, 113-168: moderate, 169-224: strong, and 225-280: very strong. The reliability of the score (internal consistency) was evaluated with Cronbach's alpha coefficient. The association between the score and participants' characteristics was determined with a bivariate analysis followed by linear regression analysis. The "global importance" of each risk factor was defined as the prevalence of the answers: "moderately important", "very important", and "extremely important" on the Likert scale. Factors with a "global importance" >75% were considered "crucial" in influencing the choice to indicate a cesarean. Results: One-hundred-twenty obstetricians/gynecologists responded (response rate 70.6%). The mean ± SD composite summated score was 137 ± 31; 30 (25.0%) participants presented a "weak attitude to cesarean", 68 (56.7%) a "moderate attitude", 22 (18.3%) a "strong attitude", and none a "very strong attitude". The Cronbach's alpha was 0.934 (high internal consistency). A self-reported number of myomectomies performed per year >50 was associated with a lower score (-25 points, 95% CI -50 to -1, p = 0.04). Eight criteria resulted "crucial" in indicating a cesarean: opening of the endometrial cavity, monopolar electrosurgery, time surgery-pregnancy <6 months, 2+ previous myomectomies, hematoma formation in the surgical wound, 3+ removed fibroids, and a FIGO4 or FIGO3 removed fibroid. Conclusions: Obstetricians/gynecologists are cautious to indicate a cesarean in pregnant patients with a previous myomectomy, except for cases at hypothetic high-risk for uterine rupture, mainly supported by weak evidence. Information to patients and among clinicians is crucial to avoid inappropriate cesarean indications.KEY MESSAGESObstetricians/gynecologists are cautious to indicate a cesarean in pregnant patients with a previous myomectomy.Information to patients and among clinicians is crucial to avoid inappropriate cesarean indications in pregnant patients with a previous myomectomy.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/315768

Homozygous C677T Methylenetetrahydrofolate Reductase (MTHFR) Polymorphism as a Risk Factor for Endometriosis: A Retrospective Case–Control Study
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Autore/i: Delli Carpini, G.; Giannella, L.; Di Giuseppe, J.; Montik, N.; Montanari, M.; Fichera, M.; Crescenzi, D.; Marzocchini, C.; Meccariello, M. L.; Di Biase, D.; Vignini, A.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: This study was conducted to evaluate the role of methylenetetrahydrofolate reductase (MTHFR) C677T homozygous polymorphism as a risk factor for endometriosis. A retrospective case–control study was conducted from January 2020 to December 2022 on all patients attending the gynecological outpatient clinic of our institution who had performed an MTHFR polymorphisms test. Patients with endometriosis were considered cases, while those without endometriosis were considered controls. The presence of an MTHFR C677T homozygous polymorphism was defined as exposure. Risk factors for endometriosis were considered confounders in a binomial logistic regression, with endometriosis diagnosis as the dependent variable. Among the 409 included patients, 106 (25.9%) cases and 303 (74.1%) controls were identified. A higher rate of MTHFR C677T homozygous polymorphism was found in patients with endometriosis (24.5% vs. 15.8%, p = 0.0453), with an adOR of 1.889 (95% CI 1.076–3.318, p = 0.0269) at the binomial logistic regression. A history of no previous pregnancy was associated with an endometriosis diagnosis (adOR 2.191, 95% CI 1.295–3.708, p = 0.0035). An MTHFR C677T homozygous polymorphism could be considered a risk factor for endometriosis. Epigenetic modifications may be the most important mechanism explaining the observed association through the processes of altered DNA methylation and reduced activity of antioxidant systems.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/324634

Microbiome Changes in Pregnancy Disorders
ANTIOXIDANTS
Autore/i: Giannella, L.; Grelloni, C.; Quintili, D.; Fiorelli, A.; Montironi, R.; Alia, S.; Delli Carpini, G.; Di Giuseppe, J.; Vignini, A.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: The human microbiota comprises all microorganisms, such as bacteria, fungi, and viruses, found within a specific environment that live on our bodies and inside us. The last few years have witnessed an explosion of information related to the role of microbiota changes in health and disease. Even though the gut microbiota is considered the most important in maintaining our health, other regions of the human body, such as the oral cavity, lungs, vagina, and skin, possess their own microbiota. Recent work suggests a correlation between the microbiota present during pregnancy and pregnancy complications. The aim of our literature review was to provide a broad overview of this growing and important topic. We focused on the most significant changes in the microbiota in the four more common obstetric diseases affecting women’s health. Thus, our attention will be focused on hypertensive disorders, gestational diabetes mellitus, preterm birth, and recurrent miscarriage. Pregnancy is a unique period in a woman’s life since the body undergoes different adaptations to provide an optimal environment for fetal growth. Such changes also involve all the microorganisms, which vary in composition and quantity during the three trimesters of gestation. In addition, special attention will be devoted to the potential and fundamental advances in developing clinical applications to prevent and treat those disorders by modulating the microbiota to develop personalized therapies for disease prevention and tailored treatments.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/315770

In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix and HPV-Type Impact: Pathologic Features, Treatment Options, and Follow-Up Outcomes—Cervical Adenocarcinoma Study Group (CAS-Group)
CANCERS
Autore/i: Giannella, L.; Delli Carpini, G.; Di Giuseppe, J.; Bogani, G.; Sopracordevole, F.; Clemente, N.; Giorda, G.; De Vincenzo, R. P.; Evangelista, M. T.; Gardella, B.; Dominoni, M.; Monti, E.; Alessi, C.; Alessandrini, L.; Pagan, A.; Caretto, M.; Ghelardi, A.; Amadori, A.; Origoni, M.; Barbero, M.; Raspagliesi, F.; Simoncini, T.; Vercellini, P.; Scambia, G.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: It is unknown whether human papillomavirus (HPV) status impacts the prognosis of early stage cervical glandular lesions. This study assessed the recurrence and survival rates of in situ/microinvasive adenocarcinomas (AC) according to HPV status during a 5-year follow-up. The data were retrospectively analyzed in women with available HPV testing before treatment. One hundred and forty-eight consecutive women were analyzed. The number of HPV-negative cases was 24 (16.2%). The survival rate was 100% in all participants. The recurrence rate was 7.4% (11 cases, including four invasive lesions (2.7%)). Cox proportional hazards regression showed no difference in recurrence rate between HPV-positive and HPV-negative cases (p = 0.148). HPV genotyping, available for 76 women and including 9/11 recurrences, showed a higher relapse rate for HPV-18 than HPV-45 and HPV-16 (28.5%, 16.6%, and 9.52%, p = 0.046). In addition, 60% and 75% of in situ and invasive recurrences, respectively, were HPV-18 related. The present study showed that most ACs were positive for high-risk HPV, and the recurrence rate was unaffected by HPV status. More extensive studies could help evaluate whether HPV genotyping may be considered for recurrence risk stratification in HPV-positive cases.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/318231

High levels of hypusinated eIF5A in leiomyoma and leiomyosarcoma pathologies: a possible novel therapeutic target
REPRODUCTIVE BIOMEDICINE ONLINE
Autore/i: Greco, Stefania; Zannotti, Alessandro; Pellegrino, Pamela; Giantomassi, Federica; Delli Carpini, Giovanni; D'Agostino, Mattia; Goteri, Gaia; Ciavattini, Andrea; Donati, Chiara; Bernacchioni, Caterina; Petraglia, Felice; La Teana, Anna; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Abstract: Research question: Is the hypusinated form of the eukaryotic translation initiation factor 5A (EIF5A) present in human myometrium, leiomyoma and leiomyosarcoma, and does it regulate cell proliferation and fibrosis? Design: The hypusination status of eIF5A in myometrial and leiomyoma patient-matched tissues was evaluated by immunohistochemistry and Western blotting as well as in leiomyosarcoma tissues by immunohistochemistry. Myometrial, leiomyoma and leiomyosarcoma cell lines were treated with N1-guanyl-1,7-diaminoheptane (GC-7), responsible for the inhibition of the first step of eIF5A hypunization, and the proliferation rate was determined by MTT assay; fibronectin expression was analysed by Western blotting. Finally, expression of fibronectin in leiomyosarcoma tissues was detected by immunohistochemistry. Results: The hypusinated form of eIF5A was present in all tissues examined, with an increasing trend of hypusinated eIF5A levels from normal myometrium to neoplastic benign leiomyoma up to neoplastic malignant leiomyosarcoma. The higher levels in leiomyoma compared with myometrium were confirmed by Western blotting (P = 0.0046). The inhibition of eIF5A hypusination, with GC-7 treatment at 100 nM, reduced the cell proliferation in myometrium (P = 0.0429), leiomyoma (P = 0.0030) and leiomyosarcoma (P = 0.0044) cell lines and reduced the expression of fibronectin in leiomyoma (P = 0.0077) and leiomyosarcoma (P = 0.0280) cells. The immunohistochemical staining of leiomyosarcoma tissue revealed that fibronectin was highly expressed in the malignant aggressive (central) part of the leiomyosarcoma lesion, where hypusinated eIF5A was also highly represented. Conclusions: These data support the hypothesis that eIF5A may be involved in the pathogenesis of myometrial benign and malignant pathologies.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/316029

Gestational Diabetes Mellitus and Small-for-Gestational-Age: An Insight into the Placental Molecular Biomarkers
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Autore/i: Giommi, Christian; Lombό, Marta; Montik, Nina; Paolucci, Michela; Notarstefano, Valentina; Delli Carpini, Giovanni; Ciavattini, Andrea; Ragusa, Antonio; Maradonna, Francesca; Giorgini, Elisabetta; Carnevali, Oliana
Classificazione: 1 Contributo su Rivista
Abstract: Gestational diabetes mellitus (GDM) and small-for-gestational-age (SGA) are two metabolic-related diseases that could affect women during pregnancy. Considering that the chorionic villi (CVs) are crucial structures for the feto-maternal exchange, the alterations in their conformation have been linked to an imbalanced metabolic environment of placenta. In this study, a multidisciplinary approach has been carried out to describe the changes occurring in the placental CVs of GDM and SGA patients. The results revealed higher levels of superoxide dismutase 1 (SOD-1) and catalase (CAT), especially in the GDM placentae, which could be correlated with the hyperglycemic environment characteristic of this pathology. Furthermore, spectroscopy and histologic analyses revealed that both pathologies modify the placental lipid composition altering its structure. However, SGA induces lipid peroxidation and reduces collagen deposition within the CVs. Since the endocannabinoid system (ECS) is involved in placentation and different metabolic activities, the cannabinoid receptor 1 (CB1) and transient receptor potential cation channel subfamily V member 1 (TRPV-1) were analyzed. No changes have been observed either at general or specific levels in the CVs comparing control and pathological samples, suggesting the non-involvement of the cannabinoid system in these two pathologies.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/313089

Inter-rater agreement of CDC criteria and ASEPSIS score in assessing surgical site infections after cesarean section: a prospective observational study
FRONTIERS IN SURGERY
Autore/i: Delli Carpini, Giovanni; Giannella, Luca; Di Giuseppe, Jacopo; Fioretti, Marco; Franconi, Ilaria; Gatti, Ludovica; Sabbatini, Keti; Montanari, Michele; Marconi, Chiara; Tafuri, Elisa; Tibaldi, Luisa; Fichera, Mariasole; Pizzagalli, Davide; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To assess and compare the inter-rater agreement of the CDC criteria and the ASEPSIS score in identifying surgical site infections after cesarean section. Methods: Prospective observational study including 110 patients subjected to a cesarean section at our institution. Surgical wounds were managed according to standard care and were photographed on the third, seventh, and thirtieth postoperative day or during any evaluation in case of complications. Three expert surgeons reviewed the prospectively gathered data and photographs and classified each wound using CDC criteria and the ASEPSIS score. The inter-rater agreements of CDC criteria and ASEPSIS score were determined with Krippendorff's Alpha with linear weights and compared with a confidence interval approach. Results: The weighted α coefficient for CDC criteria was 0.587 (95%CI, 0.411-0.763, p < 0.001, "moderate" agreement according to Altman's interpretation of weighted agreement coefficient), while the weighted α coefficient for the ASEPSIS score was 0.856 (95%CI, 0.733-0.980, p < 0.001, "very good" agreement). Conclusion: ASEPSIS score presents a "very good" inter-rater agreement for surgical site infections identification after cesarean, resulting in a more objective method than CDC criteria ("moderate" inter-rater agreement). ASEPSIS score could represent an objective tool for managing and monitoring surgical site infections after cesarean section, also by photographic evaluation.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/321672

The In Vitro Effects of Romina Strawberry Extract on 3D Uterine Leiomyosarcoma Cells
NUTRIENTS
Autore/i: Greco, Stefania; Pellegrino, Pamela; Giampieri, Francesca; Capocasa, Franco; Delli Carpini, Giovanni; Battino, Maurizio; Mezzetti, Bruno; Giannubilo, Stefano Raffaele; Ciavattini, Andrea; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/316811

Pathogenic Role of the Sphingosine 1-Phosphate (S1P) Pathway in Common Gynecologic Disorders (GDs): A Possible Novel Therapeutic Target
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Autore/i: DI PAOLO, Alice; Vignini, Arianna; Alia, Sonila; Membrino, Valentina; DELLI CARPINI, Giovanni; Giannella, Luca; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Sphingosine 1-phosphate (S1P) is a bioactive sphingolipid, noteworthy for its involvement both in the modulation of various biological processes and in the development of many diseases. S1P signaling can be either pro or anti-inflammatory, and the sphingosine kinase (SphK)-S1P-S1P receptor (S1PR) axis is a factor in accelerating the growth of several cells, including endometriotic cells and fibrosis. Gynecologic disorders, including endometriosis, adenomyosis, and uterine fibroids are characterized by inflammation and fibrosis. S1P signaling and metabolism have been shown to be dysregulated in those disorders and they are likely implicated in their pathogenesis and pathophysiology. Enzymes responsible for inactivating S1P are the most affected by the dysregulation of S1P balanced levels, thus causing accumulation of sphingolipids within these cells and tissues. The present review highlights the past and latest evidence on the role played by the S1P pathways in common gynecologic disorders (GDs). Furthermore, it discusses potential future approaches in the regulation of this signaling pathway that could represent an innovative and promising therapeutical target, also for ovarian cancer treatment.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309324

Monitoring the activities of Italian colposcopy clinics before and during the COVID-19 pandemic
JOURNAL OF GYNECOLOGIC ONCOLOGY
Autore/i: DELLI CARPINI, Giovanni; Giorgi Rossi, Paolo; Giannella, Luca; DI GIUSEPPE, Jacopo; Clemente, Nicolò; Sopracordevole, Francesco; Barbero, Maggiorino; Bogani, Giorgio; De Vincenzo, Rosa; Origoni, Massimo; Cantatore, Francesco; Gardella, Barbara; Dominoni, Mattia; Monti, Ermelinda; Antonio Liverani, Carlo; Viscardi, Anna; Pagan, Alessio; Amadori, Andrea; Alessi, Chiara; Andolfatto, Matteo; Cattani, Paolo; Pieralli, Annalisa; Stevenazzi, Guido; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: To evaluate the impact of healthcare reorganization during the severe acute respiratory syndrome coronavirus 2 pandemic on Italian colposcopy clinic activities, focusing on cervical excision procedures, follow-ups for conservative management of low-grade lesions, and follow-ups post cervical excision.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309325

Effect of the mode of delivery on the risk of endometriosis recurrence: a retrospective cohort study
FERTILITY AND STERILITY
Autore/i: Delli Carpini, Giovanni; Giannella, Luca; Di Giuseppe, Jacopo; Montanari, Michele; Fichera, Mariasole; Pizzagalli, Davide; Meccariello, Maria Liberata; Palazzo, Paola; Valenza, Carmine; Francucci, Alessio; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To evaluate the risk of endometriosis recurrence according to the mode of delivery (cesarean section vs. vaginal birth) in patients who had become pregnant with a live birth after surgery for endometriosis. Design: A retrospective cohort study. A Cox proportional-hazards regression was performed to evaluate the risk factors for endometriosis recurrence at 36 months of follow-up after the last pregnancy. Setting: Academic hospital. Patient(s): Patients who have had ≥1 pregnancy with a live birth following conservative surgery for ovarian endometriosis performed from January 2009 to December 2016 at our institution. Intervention(s): Patients who underwent ≥1 cesarean section after surgery for endometriosis. Main outcome measures: The recurrence rate of endometriosis after live-birth pregnancies obtained after the first surgery for endometriosis. Results: Patients with a history of ≥1 cesarean section after surgery for endometriosis have a higher risk of endometriosis recurrence than the patients who have had a vaginal birth, with an adjusted hazard ratio of 2.25 (95% confidence interval, 1.27-3.96). Conclusion: A cesarean section after surgery for endometriosis is associated with a twofold high risk of endometriosis recurrence with respect to vaginal birth. A different follow-up approach may be needed in those patients, and avoiding inappropriate indications for cesarean sections in pregnant patients with a history of surgery for endometriosis is necessary.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309703

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic
JOURNAL OF GYNECOLOGIC ONCOLOGY
Autore/i: Bogani, G.; Scambia, G.; Cimmino, C.; Fanfani, F.; Costantini, B.; Loverro, M.; Ferrandina, G.; Landoni, F.; Bazzurini, L.; Grassi, T.; Vitobello, D.; Siesto, G.; Perrone, A. M.; Zanagnolo, V.; De Iaco, P.; Multinu, F.; Ghezzi, F.; Casarin, J.; Berretta, R.; Capozzi, V. A.; Zupi, E.; Centini, G.; Pellegrino, A.; Corso, S.; Stevenazzi, G.; Montoli, S.; Boschi, A. C.; Comerci, G.; Greco, P.; Martinello, R.; Sopracordevole, F.; Giorda, G.; Simoncini, T.; Caretto, M.; Sartori, E.; Ferrari, F.; Cianci, A.; Sarpietro, G.; Matarazzo, M. G.; Zullo, F.; Bifulco, G.; Morelli, M.; Ferrero, A.; Biglia, N.; Barra, F.; Ferrero, S.; Maggiore, U. L. R.; Cianci, S.; Chiantera, V.; Ercoli, A.; Sozzi, G.; Martoccia, A.; Schettini, S.; Orlando, T.; Cannone, F. G.; Ettore, G.; Puppo, A.; Borghese, M.; Martinelli, C.; Muzii, L.; Di Donato, V.; Driul, L.; Restaino, S.; Bergamini, A.; Candotti, G.; Bocciolone, L.; Plotti, F.; Angioli, R.; Mantovani, G.; Ceccaroni, M.; Cassani, C.; Dominoni, M.; Giambanco, L.; Amodeo, S.; Leo, L.; Thomasset, R.; Raimondo, D.; Seracchioli, R.; Malzoni, M.; Gorlero, F.; Di Luca, M.; Busato, E.; Kilzie, S.; Dell'Acqua, A.; Scarfone, G.; Vercellini, P.; Petrillo, M.; Dessole, S.; Capobianco, G.; Ciavattini, A.; Delli Carpini, G.; Giannella, L.; Mereu, L.; Tateo, S.; Sorbi, F.; Fambrini, M.; Cicogna, S.; Romano, F.; Ricci, G.; Trojano, G.; Consonni, R.; Cantaluppi, S.; Lippolis, A.; Tinelli, R.; D'Ippolito, G.; Aguzzoli, L.; Mandato, V. D.; Palomba, S.; Calandra, D.; Rosati, M.; Gallo, C.; Surico, D.; Remorgida, V.; Ruscitto, F.; Beretta, P.; Panici, P. B.; Raspagliesi, F.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301813

Recurrence of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Systematic Review of the Literature
CANCERS
Autore/i: Di Giuseppe, J.; Grelloni, C.; Giuliani, L.; Delli Carpini, G.; Giannella, L.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: This study aimed to systematically review the existing literature on uterine smooth muscle tumor of uncertain malignant potential (STUMP) to provide information about characteristics and outcomes of patients and the risk factors for recurrence over a period of 60 years (1960–2021). Methods: According to PRISMA guidelines, we searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed (all fields) and Scopus (Title/Abstract/Keywords) databases (accessed on 1 January 2022). Relevant articles were obtained in full-text format and screened for additional references. The only filter used was the English language. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: Thirty-four studies, including 189 cases, were included. The median age was 43 years, and in 21.5% of cases there was a recurrence of the disease. Bivariate analysis showed a significant association between use of morcellation without bag and risk of recurrence (p = 0.001). Unprotected morcellation during demolitive or conservative surgery was independently associated with a higher risk of disease recurrence with a relative risk of 2.94 (p < 0.001). A significant progressive decrease in the recurrence rate was observed over time (r = −0.671, p = 0.008). The percentage of patients who underwent surgery followed by in-bag protected morcellation significantly increased after the publication of the U.S. Food and Drug Administration alert about the risk linked to this procedure (p = 0.01). Conclusions: Unprotected morcellation of the lesion is associated with the relapse of the disease. However, this clinical condition showed a drastic decrease over time. This could likely be due to the increased awareness by surgeons of the importance of customizing surgical treatment.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301816

HPV-Negative Adenocarcinomas of the Uterine Cervix: From Molecular Characterization to Clinical Implications
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Autore/i: Giannella, Luca; Di Giuseppe, Jacopo; Delli Carpini, Giovanni; Grelloni, Camilla; Fichera, Mariasole; Sartini, Gianmarco; Caimmi, Serena; Natalini, Leonardo; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Cervical cancer is the fourth most common cancer in women. It is the leading cause of female deaths in developing countries. Most of these cervical neoplasms are represented by squamous lesions. Cervical adenocarcinoma causes about a quarter of cervical cancers. In contrast to squamous lesions, cervical glandular disease is HPV-negative in about 15-20% of cases. HPV-negative cervical adenocarcinomas typically present in advanced stages at clinical evaluation, resulting in a poorer prognosis. The overall and disease-free survival of glandular lesions is lower than that of squamous lesions. Treatment options require definitive treatments, as fertility-sparing is not recommended. Moreover, the impact of HPV vaccination and primary HPV screening is likely to affect these lesions less; hence, the interest in this challenging topic for clinical practice. An updated review focusing on clinical and molecular characterization, prognostic factors, and therapeutic options may be helpful for properly managing such cervical lesions.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309321

Should attention be paid to the cone depth in the fully visible transformation zone? Retrospective analysis of 517 patients with cervical intraepithelial neoplasia grade 3
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Autore/i: Giannella, Luca; Delli Carpini, Giovanni; Di Giuseppe, Jacopo; Gardella, Barbara; Bogani, Giorgio; Monti, Ermelinda; Liverani, Carlo Antonio; Roncella, Elena; Raspagliesi, Francesco; Spinillo, Arsenio; Vercellini, Paolo; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Objective: The predictors of positive endocervical margin (EM) and a cone-depth cutoff value are not established in the fully visible transformation zone (TZ). The present study aimed to assess the independent variables associated with positive EM in women with high-grade cervical intraepithelial neoplasia (CIN) and fully visible TZ. Methods: The current investigation was a retrospective study including women with fully visible TZ and CIN 3 cone histology between 2014 and 2019. The sample was divided into women with positive versus those with negative EM. Univariate and multivariate analyses were performed. Finally, receiver operating characteristic curve analysis was also used. Results: A total of 123 of 517 women (23.8%) showed positive EM at conization. Multivariate analysis found a positive association with type 2 TZ (odds ratio [OR], 2.17 [95% confidence interval (CI), 1.19-3.94]) and lesion extension ≥2 cervical quadrants (OR, 35.57 [95% CI, 17.96-70.45]). Cone depth was inversely related to positive EM (OR, 0.71 [95% CI, 0.63-0.80]). In women with type 2 TZ and lesion extension ≥2 cervical quadrants, the cutoff value was achieved at 8-mm cone depth (area under the curve, 0.79 [95% CI, 0.67-0.90]). Conclusion: In women with high-grade CIN and fully visible TZ undergoing conization, the lesion extension and the TZ subtype (1 or 2) should be considered. A no less than 9-mm cone depth provided a fair predictive value in achieving free EM.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309702

A Possible Cause for the Differential Expression of a Subset of miRNAs in Mesenchymal Stem Cells Derived from Myometrium and Leiomyoma
GENES
Autore/i: Di Vincenzo, Mariangela; De Quattro, Concetta; Rossato, Marzia; Lazzarini, Raffaella; Delli Carpini, Giovanni; Ciavattini, Andrea; Orciani, Monia
Classificazione: 1 Contributo su Rivista
Abstract: The aetiology of leiomyoma is debated; however, dysregulated progenitor cells or miRNAs appear to be involved. Previous profiling analysis of miRNA in healthy myometrium- (M-MSCs) and leiomyoma- (L-MSCs) derived mesenchymal stem cells (MSCs) identified 15 miRNAs differentially expressed between M-MSCs and L-MSCs. Here, we try to elucidate whether these differentially regulated 15 miRNAs arise as a conversion of M-MSCs along the differentiation process or whether they may originate from divergent cell commitment. To trace the origin of the dysregulation, a comparison was made of the expression of miRNAs previously identified as differentially regulated in M-MSCs and L-MSCs with that detected in MSCs from amniotic fluid (considered as a substitute for embryonic cells). The results do not allow for a foregone conclusion: the miRNAs converging to the adherens junction pathway showed a gradual change along the differentiation process, and the miRNAs which coincided with the other three pathways (ECM-receptor interaction, TGFβ and cell cycle) showed a complex, not linear, regulation and, therefore, a trend along the hypothetical differentiation process was not deduced. However, the role of miRNAs appears to be predominant in the onset of leiomyoma and may follow two different mechanisms (early commitment; exacerbation); furthermore, miRNAs can support the observed (epigenetic) predisposition.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309705

Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi-institutional study
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Autore/i: Ciavattini, A.; Di Giuseppe, J.; Marconi, C.; Giannella, L.; Delli Carpini, G.; Paolucci, M.; Fichera, M.; De Vincenzo, R. P.; Scambia, G.; Evangelista, M. T.; Bogani, G.; Bertolina, F.; Raspagliesi, F.; Gardella, B.; Spinillo, A.; Dominoni, M.; Monti, E.; Liverani, C. A.; Vercellini, P.; Iorio, M.; Vitobello, D.; Portuesi, R.; Bresciani, G.; Origoni, M.; Cantatore, F.; Pellegri, A. M.; Moriconi, L.; Serri, M.; Chiari, A.; Sopracordevole, F.; Barbero, M.; Parazzini, F.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN). Methods: Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro-invasive neoplasia, sub-total hysterectomy, or trachelectomy were excluded. Results: A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415–0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow-up, a vaginal lesion was recorded in 5% of cases. Conclusion: A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301814

Histopathological findings in hysterectomy for cervical stenosis in postmenopausal women: A retrospective case series
MEDICINE
Autore/i: Sopracordevole, Francesco; Clemente, Nicolò; Papiccio, Maria; Del Fabro, Anna; Serri, Matteo; Fichera, Mariasole; Buttignol, Monica; Giorda, Giorgio; Delli Carpini, Giovanni; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To analyze the histopathological findings in postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis, evaluating the incidental findings of preinvasive or invasive uterine and cervical disease. Methods: Retrospective case series of postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis at Gynecological Oncology Unit of Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico Aviano-National Cancer Institute from January 2014 to January 2021. Results: During the study period, 36 women underwent hysterectomy for postsurgical cervical stenosis at our institution. Cervical stenosis occurred 10.2 ± 5.6 years from the onset of menopause. In particular, 26 (72.2%) patients underwent a single loop electrosurgical excision procedure or carbon dioxide (CO2)-laser conization before the onset of stenosis. The remaining 10 (27.8%) women had multiple surgical excision before the onset of stenosis. At the final histopathological analysis, 17 (47.2%) patients had a preinvasive or invasive gynecological disease. In particular, 9 cases of cervical disease (including 1 case of endocervical squamous cell carcinoma pT1a) and 6 cases of endometrial hyperplasia emerged. Also, 2 cases of tubo-ovarian diseases were found. Conclusions: Postsurgical cervical stenosis is a challenging clinical condition, especially in women treated for cervical intraepithelial neoplasia or microinvasive cervical cancer. As shown, cervical stenosis can prevent an adequate gynecological follow-up and a prompt diagnosis of malignancies. Therefore, postmenopausal women with cervical stenosis should be carefully counseled, and hysterectomy could be a reasonable option, especially in those cases in which a conservative approach is not feasible, failed, or is not accepted by the patient.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309706

Endometrial Cancer Individualised Scoring System (ECISS): A machine learning-based prediction model of endometrial cancer prognosis
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Autore/i: Shazly, Sherif A; Coronado, Pluvio J; Yılmaz, Ercan; Melekoglu, Rauf; Sahin, Hanifi; Giannella, Luca; Ciavattini, Andrea; Delli Carpini, Giovanni; Di Giuseppe, Jacopo; Yordanov, Angel; Karakadieva, Konstantina; Nedelcheva, Nevena Milenova; Vasileva-Slaveva, Mariela; Alcazar, Juan Luis; Chacon, Enrique; Manzour, Nabil; Vara, Julio; Karaman, Erbil; Karaaslan, Onur; Hacıoğlu, Latif; Korkmaz, Duygu; Onal, Cem; Knez, Jure; Ferrari, Federico; Hosni, Esraa M; Mahmoud, Mohamed E; Elassall, Gena M; Abdo, Mohamed S; Mohamed, Yasmin I; Abdelbadie, Amr S
Classificazione: 1 Contributo su Rivista
Abstract: Objective: Establishing a prognostic model for endometrial cancer (EC), that individualizes risk and management plan per patient and disease characteristics. Methods: this is multicentre retrospective study conducted in 9 European gynaecologic cancer centres. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pre-treatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). Results: Out of 1,150 women, 1,144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88% and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracy of model I, II and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. Conclusion: Endometrial Cancer Individualised Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/309707

Preeclampsia Correlates with an Increase in Cannabinoid Receptor 1 Levels Leading to Macromolecular Alterations in Chorionic Villi of Term Placenta
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Autore/i: Lombó, Marta; Giommi, Christian; Paolucci, Michela; Notarstefano, Valentina; Montik, Nina; Delli Carpini, Giovanni; Ciavattini, Andrea; Ragusa, Antonio; Maradonna, Francesca; Giorgini, Elisabetta; Carnevali, Oliana
Classificazione: 1 Contributo su Rivista
Abstract: Preeclampsia is a human pregnancy-specific disease characterized by abnormal placentation that usually presents with maternal hypertension and proteinuria. The main hallmark of preeclampsia, impaired trophoblast migration, and the subsequent disruption of uterine arteries remodeling lead to several molecular alterations in the placental compartments with those occurring in the chorionic villi being of the utmost importance. Given the essential role of the endocannabinoid system during preimplantation and trophoblast migration, we have combined the histological and hyperspectral imaging analyses to shed light on the involvement of two cannabinoid receptors in the macromolecular alterations related to preeclampsia. The results obtained by immunohistochemistry showed a significant increase in the protein levels of cannabinoid receptor 1 (CB1) in the preeclamptic chorionic villi. However, no changes were reported regarding transient receptor potential vanilloid 1 (TRPV-1) levels either in the bulk placental samples or chorionic villi when comparing control and preeclamptic patients. Histological analysis and Fourier-transform infrared spectroscopy (FTIRI) showed an increase in collagen deposition together with higher levels of lipid peroxidation and phosphorylated compounds in the pathological villi. Since CB1 enhancement has been described as promoting fibrosis and oxidative stress in several tissues, we proposed that the higher receptor abundance in preeclampsia could be triggering similar molecular effects in preeclamptic term placentas.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/308662

Uterine leiomyoma as useful model to unveil morphometric and macromolecular collagen state and impairment in fibrotic diseases: An ex-vivo human study
BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR BASIS OF DISEASE
Autore/i: Belloni, Alessia; Furlani, Michele; Greco, Stefania; Notarstefano, Valentina; Pro, Chiara; Randazzo, Basilio; Pellegrino, Pamela; Zannotti, Alessandro; Delli Carpini, Giovanni; Ciavattini, Andrea; Di Lillo, Francesca; Giorgini, Elisabetta; Giuliani, Alessandra; Cinti, Saverio; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Abstract: Collagen is one of the main components of the extracellular matrix (ECM), involved, among all, in the maintenance of the structural support of tissues. In fibrotic diseases, collagen is overexpressed, and its production determines the formation of a significantly stiffer ECM. The cross-linking of high-resolution analytical tools, able to investigate both the tridimensional organization and the secondary structure of collagen in fibrotic diseases, could be useful to identify defined markers correlating the status of this protein with specific pathological conditions. To this purpose, an innovative multidisciplinary approach based on Phase-Contrast MicroComputed Tomography, Transmission Electron Microscopy, and Fourier Transform Infrared Imaging Spectroscopy was exploited on leiomyoma samples and adjacent myometrium to characterize microstructural collagen features. Uterine leiomyoma is a common gynecological disorder affecting women in fertile age. It is characterized by a massive collagen production due to the repairing processes occurring at myometrium level, and, hence, it represents a valuable model to investigate collagen self-organization in a pathological condition. Moreover, to evaluate the sensitivity of this multidisciplinary approach, the effects of eicosapentaenoic (EPA) and docosahexaenoic (DHA) omega-3 fatty acids in collagen reduction were also investigated.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/304679

Huge vulvar varicosities in pregnancy: case report and systematic review
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
Autore/i: Giannella, Luca; Montanari, Michele; Delli Carpini, Giovanni; Di Giuseppe, Jacopo; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: The appearance of severe vulvovaginal varicosities (VVs) is challenging in pregnancy. The management of VVs may require a multidisciplinary approach, including radiologists, vascular surgeons, and obstetricians. We report a rare case of enormous VVs and pubic varicosities and summarize similar cases in the literature. A woman in her 20s with a full-term pregnancy visited our hospital for severe VVs and pubic varicosities. She had been in a spoke maternity unit where a cesarean section was scheduled. After a multidisciplinary evaluation, we offered her the chance to have a vaginal delivery (VD). The woman had an uneventful VD, and VVs disappeared after 40 days. A comprehensive literature search on this topic showed 11 cases of VVs during pregnancy (five VDs and six cesarean sections). The presence of VVs represented the indication for surgery in 70% of cases. Severe complications occurred in 20% of VDs vs. 50% of CSs. In pregnant women with VVs, the risk-benefit ratio suggests a chance of having VD.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/304020

Uterine fibroid vascularization: from morphological evidence to clinical implications
REPRODUCTIVE BIOMEDICINE ONLINE
Autore/i: Ciarmela, P.; Delli Carpini, G.; Greco, S.; Zannotti, A.; Montik, N.; Giannella, L.; Giuliani, L.; Grelloni, C.; Panfoli, F.; Paolucci, M.; Pierucci, G.; Ragno, F.; Pellegrino, P.; Petraglia, F.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Uterine fibroids are the most common cause of solid pelvic tumours, occurring in 20–30% of fertile women and presenting clinical complications that seriously affect women's health. They commonly cause severe symptoms, such as heavy, prolonged menstrual bleeding and anaemia. The study of microscopic and macroscopic vascular aspects of uterine fibroids is important for understanding the clinical manifestations of uterine fibroids, for predicting the effectiveness of alternative treatments to surgery, i.e. uterine artery embolization, for improving surgery outcomes and for carrying out a differential diagnosis with other benign conditions, e.g. adenomyosis, or malignancy, e.g. leiomyosarcoma, and to develop new therapeutic approaches. In this review, current knowledge of how the vascular network and angiogenesis are implied in the formation of uterine fibroids and in the pathogenesis of related symptoms is explored, and evidence on the role of ultrasound in evaluating fibroid vascularization is summarized. This review combines anatomical, morphological and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections. Uterine and fibroid vascularization need further investigation to gain a deeper understanding of the pathogenetic elements that lead to the formation of uterine fibroids and their clinical manifestations.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/294104

Trend of hpv 16/18 genotypes in cervical intraepithelial neoplasia grade 3: Data for 2007–2018
INFECTION AND DRUG RESISTANCE
Autore/i: Giannella, L.; Delli Carpini, G.; Di Giuseppe, J.; Bogani, G.; Gardella, B.; Monti, E.; Liverani, C. A.; Ghelardi, A.; Insinga, S.; Montanari, M.; Raspagliesi, F.; Spinillo, A.; Vercellini, P.; Roncella, E.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Aim: In the post-vaccination era, the starting age and time intervals of cervical screening could change (older age and longer screening intervals). This scenario may be achieved by significantly reducing human papillomavirus (HPV) 16/18 prevalence (genotypes included in the current vaccines). In this regard, assessing the trend over time of these HPV infections in high-grade cervical lesions can provide information on the objective. The present study aimed to evaluate the trend of HPV 16/18 over the years 2007–2018 in women with cervical intraepithelial neoplasia (CIN) grade 3. Methods: This is a retrospective multi-institutional study including HPV genotyped and unvaccinated women under 30 with CIN3. The sample was divided into the following periods: 2007–2010, 2011–2014, 2015–2018. HPV genotypes were grouped in genotypes 16/18, genotypes 31/33/35/52/58/67 (genetically related to HPV16), genotypes 39/45/59/68/ 70 (genetically related to HPV18), genotypes 31/33/45/52/58 (high-risk types included in the nonavalent vaccine), possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85), low-risk HPV (genotypes 6/11/40/42/43/44/54/55/61). The trend between periods and HPV genotypes was measured using the Cochran–Armitage test for trend. Results: The final analysis included 474 participants. HPV 16/18 prevalence decreased significantly over the years (77.8% vs 68.9% vs 66.0%, respectively, Ptrend=0.027). Possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85) showed a significant negative prevalence trend over time (4.9% vs 1.1% vs 1.3%, respectively, Ptrend=0.046). Finally, there was a significant positive trend over the years for high-risk HPV genotypes 31/33/45/52/58 in women under 25 (9.9% vs 17.0% vs 24.0%, respectively, Ptrend=0.048). Conclusion: The prevalence of CIN3 lesions related to HPV 16/18 genotypes decreased over time from 2007 to 2018. These data highlight a herd effect of the HPV vaccine. However, fifteen years after HPV vaccine introduction, we are still a long way from herd immunity. The increase in high-risk types 31/33/45/52/58 will need to be reassessed when the nonavalent vaccine impact will be more reliable.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301804

An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result
MEDICINE
Autore/i: Ciavattini, A.; Delli Carpini, G.; Giannella, L.; Del Fabro, A.; Banerji, V.; Hall, G.; Barbero, M.; Sopracordevole, F.
Classificazione: 1 Contributo su Rivista
Abstract: ABSTRACT: This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result.An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the "patient's journey" included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up.Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution.Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301811

Malignant transformation of postmenopausal endometriosis: A systematic review of the literature
CANCERS
Autore/i: Giannella, L.; Marconi, C.; Di Giuseppe, J.; Delli Carpini, G.; Fichera, M.; Grelloni, C.; Giuliani, L.; Montanari, M.; Insinga, S.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: This study aimed to systematically review the existing literature on malignant transformation of postmenopausal endometriosis to provide information about patient characteristics, hormonal replacement therapy (HRT) use, and outcomes over a period of 52 years (1969–2021). Methods: According to PRISMA guidelines, we searched for (endometriosis OR endometriotic) AND (cancer OR malignancy OR malignant transformation) AND (menopause OR menopausal OR postmenopause OR postmenopausal) in Pubmed (all fields) (accessed on 12 February 2021) and Scopus (Title/Abstract/Keywords) (accessed on 12 February 2021) databases. The only filter used was the English language. Relevant articles were obtained in full-text format and screened for additional references. Eligibility/inclusion criteria: studies including full case description of malignant transformation of endometriosis-related lesions in postmenopause. Results: 75 studies, including 90 cases, were retrieved. The mean age was 55.8 ± 8.5 years. Overall, about 65% of women had a positive personal history of endometriosis/adenomyosis, and 64% of women underwent previous hysterectomy ± bilateral salpingo-oophorectomy. Forty-nine of 74 women used HRT (66.2%). Among the women who used HRT, estrogen-only treatment was taken by approximately 75%. Duration of HRT was longer than five years in 63.3% of cases. About 70% of subjects had histology of endometrioid adenocarcinoma or clear cell carcinoma. Follow-up outcome, available for 61 women, showed a survival rate of 78.7%, recurrence of 9.8%, death of 11.5%. The duration of follow-up had a median of 12 months (interquartile range, 6.75–25 months). Interestingly, over the years of case publication there was a significant inverse correlation with previous history of endometriosis (r = −0.28, p = 0.007), HRT use (r = −0.31, p = 0.006), and previous definitive surgery (r = −0.42, p < 0.001). Conclusions: In the malignant transformation of postmenopausal endometriosis, there are some recurrent clinical conditions: previous endometriosis, major definitive surgery before menopause, and estrogen-only HRT for a relatively long time. However, these clinical conditions have shown a drastic decrease over time. This could likely be the consequence of different attitudes and management of gynecologists linked to up-to-date scientific evidence about the use of major surgery in gynecological pathologies. Malignant transformation of postmenopausal endometriosis is a clinical challenge to be explored further.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301808

Foetal ductus arteriosus constriction unrelated to non-steroidal anti-Inflammatory drugs: a case report and literature review
ANNALS OF MEDICINE
Autore/i: Battistoni, G.; Montironi, R.; Di Giuseppe, J.; Giannella, L.; Delli Carpini, G.; Baldinelli, A.; Pozzi, M.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Foetal ductus arteriosus (DA) constriction can be found in complex foetal heart malformations, but rarely as an isolated defect. Although many cases of DA constriction are usually related to Non-steroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake, other causes remain without an established aetiology and are referred to as idiopathic. Recently, a wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) showed a definitive effect upon the pathway of inflammation, causing DA constriction. We report a case of a premature DA constriction in a woman whose possible risk factor was identified in her maternal occupational exposure to solvents and a comprehensive literature review of 176 cases of NSAID-unrelated DA constriction. A 30-year-old Asian woman was referred to our institution at 33 gestational weeks and 0 days because of suspicion of premature DA constriction. The woman had no history of medication intake, including NSAIDs, alcohol, tobacco or polyphenol-rich-food consumption during pregnancy. A detailed foetal echocardiography revealed a normal cardiac anatomy with hypertrophic, hypokinetic and a dilated right ventricle due to right pressure overload, holosystolic tricuspid regurgitation, and, at the level of the DA, high systolic and diastolic velocities, indicating premature ductal restriction. The right outflow showed dilatation of the pulmonary artery with narrow DA. An urgent caesarean section was performed at 33 gestational weeks and 4 days due to worsening of DA PI and signs of right pressure overload, despite the interruption of exposure to solvents. We assume a relationship exists between premature DA constriction and a maternal occupational exposure to solvents. This hypothesis is reinforced by the presence of associated foetal malformations in in two of the patient’s children. Further research is needed to confirm the role of exposure to solvents and toxic chemicals in the pathogenesis of DA constriction, also with experimental animal models.KEY MESSAGES Many cases of DA constriction are usually related to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake. A wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) can cause foetal DA constriction. Further investigation are needed to confirm the role of maternal exposure to solvents in the pathogenesis of DA constriction.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301803

Factors influencing intraoperative blood loss and hemoglobin drop during laparoscopic myomectomy: a tailored approach is possible?
JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Autore/i: Delli Carpini, G.; Morini, S.; Tsiroglou, D.; Verdecchia, V.; Montanari, M.; Donati, V.; Giannella, L.; Burattini, L.; Giannubilo, S. R.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: A retrospective study was conducted on patients subjected to laparoscopic myomectomy at our institution from January 2017 to December 2018 to identify predictive factors of blood loss. Two multiple regression models were run to predict intraoperative blood loss and haemoglobin drop. Predictors of an increased intraoperative blood loss and haemoglobin drop were the presence of three-four fibroids at ultrasound (+47 ml, p =.01; +0.58 g/dl, p =.05) and increased operative time (r = 0.57, p =.01; r = 0.01, p <.01), while predictors of a reduced intraoperative blood loss and haemoglobin drop were epinephrine injection (–50 ml, p <.01; −0.42 g/dl, p <.01), FIGO7 (–87 ml, p <.01; −0.85, p =.01), and FIGO6 (–35 ml, p <.01; −0.44, p =.02) fibroids at the ultrasound. Preoperative ultrasound evaluation is crucial in identifying patients at higher risk for blood loss, which could benefit from optimising haemoglobin values. The injection of diluted epinephrine could be proposed in selected high-risk patients. In the clinical practice, a tailored approach based on fibroids’ ultrasonographic characteristics should be implemented to optimise preoperative Hb values and evaluate the use of diluted epinephrine in selected cases, reducing blood loss and the potential related complications.Impact statementWhat is already known on this subject? Laparoscopic myomectomy is the conservative surgical treatment of choice for symptomatic uterine fibroids. Still, it could represent a challenging procedure even for an experienced surgeon, with the risk of excessive blood loss, need of transfusions, prolonged operative time, and prolonged hospital stay. The knowledge of the predictive factors of blood loss is essential for patient preparation and surgical planning to reduce intraoperative and postoperative complications. What do the results of this study add? The results of the present study focus on the importance of presurgical evaluation to identify predictive factors of intraoperative blood loss and Hb drop such as the number of fibroids and the FIGO classification (at preoperative ultrasound), as well as intraoperative factors like operative time and the intramyometrial injection of diluted epinephrine. What are the implications of these findings for clinical practice and/or further research? A tailored approach based on the ultrasonographic characteristics of fibroids should be implemented to optimise preoperative haemoblobin levels.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301805

Grade of satisfaction and tolerability of a medical device based on p. Acnes in adults waiting for destructive treatments for genital warts
ITALIAN JOURNAL OF GYNAECOLOGY & OBSTETRICS
Autore/i: Ciavattini, A.; Di Giuseppe, J.; Giannella, L.; Tsiroglou, D.; Palomba, M.; Barbero, M.; Rabino, V.; Bocci, C.; Capodanno, M.; Sansone, M.; Barbieri Carones, M.; Agarossi, A.; Cattani, P.; Perolo, F.; Ribaldone, R.; Prestia, V.; Delli Carpini, G.
Classificazione: 1 Contributo su Rivista
Abstract: Vulvar and vaginal warts (genital warts – GW), also known as condylomata acuminata, are one of the clinical manifes-tations of human papillomavirus (HPV) infection. Oxidative stress may have an important role in the pathogenesis of GW. A preparate of bacterial lysate based on Propionibacterium acnes (P. acnes) showed a potent antioxidant activity in vitro, sug-gesting a potential role in the treatment of GW. The aim of the present study was to evaluate the grade of satisfaction of patients who were waiting for destructive treatment, prospective enrolled and treated for 60 days with a P. acnes lysate. The effect on the number, location of the lesions and the quadrants involved was also evaluated waiting destructive approach. Anamnestic data were collected and a vulvoscopy was per-formed with an accurate description of the lesions at the first visit and after 30-60-90 and 180 days of treatment. During the study period, 69 women, fulfilling the study inclusion/ exclusion criteria, constituted the study cohort. P. acnes preparation showed a high tolerability and a high grade of satisfac-tion. Moreover, all patients included decided to wait at least 60 days before being subjected to any destructive treatment, which was then necessary only in 31.8% of cases. The results obtained with this preliminary study enable to indicate this therapy as possible innovative option in the treatment of GW. A prospective blinded RCT will be necessary to evaluate the P. Acnes preparation efficacy in the treatment of condylomatosis.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/310133

The Impact of 9-Valent HPV Vaccination on Couple Infertility Prevention: A Comprehensive Review
FRONTIERS IN MEDICINE
Autore/i: Ciavattini, A.; Marconi, C.; Giannella, L.; Delli Carpini, G.; Sopracordevole, F.; Di Giuseppe, J.
Classificazione: 1 Contributo su Rivista
Abstract: A comprehensive literature review was performed to determine the relationship between HPV infection and infertility and the eventual role of the 9-valent vaccine for infertility prevention. The search was extended from January 1997 through July 2021. Data collected from selected articles focused on three main topics: statistical associations between HPV prevalence and assisted reproductive technology (ART) outcome, association between HPV and characteristics of semen, and associations between HPV and miscarriage. Articles that identified HPV genotypes were selected for this review to study the possible role of the 9-valent vaccine in infertility prevention. To date, there is no agreement on the implication HPV female infection has on the fertility and miscarriage rate. Although it can be stated that HPV prevalence among couples with infertility undergoing ART treatment is consistent, it does not seem to affect the performance of oocytes. Otherwise, HPV infection affects sperm parameters, in particular spermatozoa motility. When an association can be found, most cases of HR-HPV involved are those included in the 9-valent vaccine. The correlation between HPV male infection both with asthenozoospermia and increased risk of pregnancy loss could recommend the extension of anti-HPV vaccination to adolescent males along with cancer prevention. Despite the fact that the relation between 9-valent HPV genotypes involved in female infection and miscarriage/infertility is not clear, the impact of this virus on health reproduction is evident. Considering this, the importance of HPV vaccination in adolescent females is confirmed. A vaccine efficacy study could be useful to confirm the importance of primary prevention for couple reproductive health.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301809

Age-related distribution of uncommon HPV genotypes in cervical intraepithelial neoplasia grade 3
GYNECOLOGIC ONCOLOGY
Autore/i: Giannella, L.; Giorgi Rossi, P.; Delli Carpini, G.; Di Giuseppe, J.; Bogani, G.; Gardella, B.; Monti, E.; Liverani, C. A.; Ghelardi, A.; Insinga, S.; Raspagliesi, F.; Spinillo, A.; Vercellini, P.; Roncella, E.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Aim: Cervical cancer prevention guidelines include Human Papillomavirus (HPV) test, cytology, and HPV-16/18 typing for triage to determine the risk of cervical intraepithelial neoplasia (CIN) grade 3 as the best proxy of cervical cancer risk. In doing that, they do not consider how age can modify the type-specific risk of CIN3. The present study aimed to evaluate the age-related distribution of HPV genotypes affecting the risk-assessment in cervical cancer screening programs: non-screening-type-HPV and non-HPV-16/18 in unvaccinated women with CIN3. Methods: Retrospective multi-institutional study, including HPV genotyped women with CIN3 on cone histology treated between 2014 and 2019. The sample was divided into three categories of age: <30, 30–44, ≥45. HPV genotypes were grouped in non-screening-type-HPV (not-including genotypes 16/18/31/33/35/39/45/51/52/56/58/59/66/68) and non-HPV-16/18. Associations and trends between different age-groups and HPV genotypes were measured. Results: 1332 women were analyzed. Non-screening-type-HPV CIN3 were 73 (5.5%). Non-HPV-16/18 were found in 417 participants (31.3%). Women over 45 associated with non-screening-type HPV [odds ratio (OR) = 1.87, 95% confidence interval (CI) 1.07–3.25; p = 0.027]. Non-screening-type-HPV prevalence increased significantly with age (3.9% vs 5.1% vs 9.0%, p = 0.016). Women under 30 showed a lower rate of non-HPV-16/18 (OR = 0.65, 95% CI 0.47–0.89; p = 0.007). There was a positive trend with age of non-HPV-16/18 CIN3 (23.6% vs 32.1% vs 38.0%, p = 0.0004). Conclusion: The proportion of CIN3 lesions unrelated to genotypes detected by primary screening tests increased with age. This implies that age probably modifies the risk of CIN3 and possibly of cancer associated with HPV types. The risk-based recommendation should take into consideration age to define the management of HPV positive women.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301807

Macrophages and Immune Responses in Uterine Fibroids
CELLS
Autore/i: Zannotti, A.; Greco, S.; Pellegrino, P.; Giantomassi, F.; Delli Carpini, G.; Goteri, G.; Ciavattini, A.; Ciarmela, P.
Classificazione: 1 Contributo su Rivista
Abstract: Uterine fibroids represent the most common benign tumors of the uterus. They are considered a typical fibrotic disorder. In fact, the extracellular matrix (ECM) proteins-above all, collagen 1A1, fibronectin and versican-are upregulated in this pathology. The uterine fibroids etiology has not yet been clarified, and this represents an important matter about their resolution. A model has been proposed according to which the formation of an altered ECM could be the result of an excessive wound healing, in turn driven by a dysregulated inflammation process. A lot of molecules act in the complex inflammatory response. Macrophages have a great flexibility since they can assume different phenotypes leading to the tissue repair process. The dysregulation of macrophage proliferation, accumulation and infiltration could lead to an uncontrolled tissue repair and to the consequent pathological fibrosis. In addition, molecules such as monocyte chemoattractant protein-1 (MCP-1), granulocyte macrophage-colony-stimulating factor (GM-CSF), transforming growth factor-beta (TGF-β), activin A and tumor necrosis factor-alfa (TNF-α) were demonstrated to play an important role in the macrophage action within the uncontrolled tissue repair that contributes to the pathological fibrosis that represents a typical feature of the uterine fibroids.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/291079

Hop and artichoke extracts inhibit expression of extracellular matrix components in uterine leiomyoma cells
F&S SCIENCE
Autore/i: Islam, M. S.; Greco, S.; Delli Carpini, G.; Giannubilo, S. R.; Segars, J.; Ciavattini, A.; Ciarmela, P.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To screen 14 different plant extracts for their antifibrotic effect on human primary leiomyoma and healthy myometrial cells. Design: Preclinical study. Setting: University research laboratory. Patient(s): Human uterine leiomyoma and matched myometrial tissues were obtained from Caucasian premenopausal women with symptomatic uterine fibroids at the time of hysterectomy. Intervention(s): Primary human leiomyoma and myometrial cells were cultured in the absence or presence of the plant extracts. Main Outcome Measure(s): Quantification of the expression of extracellular matrix components, such as fibronectin 1 (FN1), collagen type I alpha 1 (COL1A1), and versican (VCAN), and the profibrotic growth factor activin A or inhibin beta A subunit (INHBA). Result(s): The cells were treated with the 14 extracts for 48 hours, and we measured FN1 messenger RNA (mRNA) expression. Of the 14 extracts, about (ABO) ABO-2 (hop) and ABO-9 (artichoke) significantly reduced FN1 expression in both the cell types. Next, we evaluated the effect of fractions of these 2 extracts on the mRNA expression of FN1 and other extracellular matrix components, such as COL1A1, VCAN, and INHBA, in leiomyoma and myometrial cells. We found that ABO-2 (hop) and ABO-9 (artichoke) as well as their fractions, ABO-AR-2016-015 (fraction of ABO-2) and ABO-AR-2014-168 (fraction of ABO-9), reduced the mRNA expression of FN1, COL1A1, VCAN, and INHBA in primary leiomyoma cells. In primary myometrial cells, the mRNA expression of FN1, COL1A1, VCAN, and INHBA was not greatly affected. Conclusion(s): These results suggest that the hop and artichoke extracts possess antifibrotic properties and support additional evaluation using in vivo models.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/294121

High-risk HPV positivity is a long-term risk factor for recurrence after cervical excision procedure in women living with HIV
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Autore/i: Agarossi, A.; Delli Carpini, G.; Sopracordevole, F.; Serri, M.; Giannella, L.; Gardella, B.; Maestri, M.; Del Fabro, A.; Sansone, M.; Fallani, M. G.; Pieralli, A.; Fasolo, M. M.; Mazzali, C.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: To evaluate the risk factors for recurrence of high-grade disease after cervical excision in women living with HIV (WLWH), with a specific interest in the role of high-risk (HR-) HPV positivity. Methods: Multicentric retrospective study conducted on WLWH who underwent cervical excision between January 1987 and June 2017 in six Italian institutions. The rate of high-grade recurrence was determined. Risk factors for recurrence and HR-HPV positivity were determined with the Log-rank test and Cox proportional hazards regression models. Results: A total of 271 WLWH were included in the final analysis. A high-grade recurrence was found in 58 (21.4%) patients. Age 41 years or more at inclusion and HR-HPV positivity during follow up were independently associated with a higher risk of disease recurrence with relative risks of 4.15 (95% confidence interval [CI] 2.01–8.58, P < 0.001) and 5.18 (95% CI 2.12–12.67, P < 0.01), respectively. Age 41 years or more (relative risk 1.75, 95% CI 1.01–3.04, P = 0.047) resulted as a risk factor for HR-HPV positivity during follow up. Conclusion: HR-HPV positivity is a risk factor for recurrence after cervical excision in WLWH. Women older than 41 years may benefit from a long-term yearly follow up. Future studies regarding HPV vaccination after treatment in WLWH may be useful, considering the protective role of the higher probability of HPV negativity in vaccinated women.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301812

Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature
JOURNAL OF ONCOLOGY
Autore/i: Liverani, C. A.; Di Giuseppe, J.; Giannella, L.; Delli Carpini, G.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Cervical cancer is relatively rare in high-income countries, where organized screening programs are in place, as well as opportunistic ones. As the human papillomavirus (HPV) vaccination rates increase, the prevalence of cervical precancers and cancers is going to decrease rapidly very soon, even if, in the most optimistic scenario, it is unlikely that optimal vaccination coverage will be achieved. Then, the optimal screening paradigm for cervical cancer prevention in the postvaccination era is still debated. Screening guidelines are being developed with the aim of reducing the number of tests a woman needs during her lifetime, in order to receive the maximum benefit from screening, while decreasing potential harms that may result with the use of a screening strategy (overdiagnosis, overtreatment, anxiety, and costs). With this purpose in mind, new management guidelines for cervical cancer screening abnormalities are recommendations based on risks, not on results. This review aims to summarize the process that led to the introduction of the HPV DNA test in screening programs and the different screening strategies. Moreover, it aims to introduce the new risk-based guidelines for the future, where full HPV genotyping can resize the risk on the basis of specific high-risk genotypes. In the same way, the data regarding HPV vaccination could be introduced as soon as women vaccinated with the nonavalent vaccine reach the screening age, with the recommendation of a prolonged screening interval.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/301818

Expert consensus from the Italian Society for Colposcopy and Cervico-Vaginal Pathology (SICPCV) for colposcopy and outpatient surgery of the lower genital tract during the COVID-19 pandemic
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Autore/i: Ciavattini, A.; Delli Carpini, G.; Giannella, L.; De Vincenzo, R.; Frega, A.; Cattani, P.; Boselli, F.; Sopracordevole, F.; Barbero, M.
Classificazione: 1 Contributo su Rivista
Abstract: In the context of the COVID-19 pandemic, patients need to be evaluated within 2–4 weeks in the following cases: cytology result of “squamous cell carcinoma,” “atypical glandular cells, favor neoplastic,” “endocervical adenocarcinoma in situ,” or “adenocarcinoma”; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/283599

HPV vaccination: The position paper of the Italian society of colposcopy and cervico-vaginal pathology (SICPCV)
VACCINES
Autore/i: Ciavattini, A.; Giannella, L.; De Vincenzo, R.; Di Giuseppe, J.; Papiccio, M.; Lukic, A.; Delli Carpini, G.; Perino, A.; Frega, A.; Sopracordevole, F.; Barbero, M.; Gultekin, M.
Classificazione: 1 Contributo su Rivista
Abstract: Human papillomavirus (HPV) related cervical cancer represents an issue of public health priority. The World Health Organization recommended the introduction of HPV vaccination in all national public programs. In Europe, vaccines against HPV have been available since 2006. In Italy, vaccination is recommended and has been freely offered to all young girls aged 11 years since 2008. Three prophylactic HPV vaccines are available against high-and low-risk genotypes. The quadrivalent vaccine contains protein antigens for HPV 6, 11, 16, and 18. The bivalent vaccine includes antigens for HPV 16 and 18. The nonavalent vaccine was introduced in 2014, and it targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Clinical trials demonstrated the effectiveness of the three vaccines in healthy young women. Likewise, all vaccines showed an excellent safety profile. The bivalent vaccine provides two doses in subjects aged between 9 and 14 years and three doses in subjects over 14 years of age. The quadrivalent vaccine provides two doses in individuals from 9 to 13 years and three doses in individuals aged 14 years and over. The nonavalent vaccine schedule provides two doses in individuals from 9 to 14 years of age and three doses in individuals aged 15 years and over at the time of the first administration. Preliminary results suggest that the HPV vaccine is effective in the prevention of cervical squamous intraepithelial lesions even after local treatment. Given these outcomes, in general, it is imperative to expand the vaccinated target population. Some interventions to improve the HPV vaccine’s uptake include patient reminders, physicians-focused interventions, school-based vaccinations programs, and social marketing strategies. The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV) is committed to supporting vaccination programs for children and adolescents with a catch-up program for young adults. The SICPCV also helps clinical and information initiatives in developing countries to decrease the incidence of cervico-vaginal and vulvar pathology.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/284562

European Federation for Colposcopy (EFC) and European Society of Gynaecological Oncology (ESGO) joint considerations about human papillomavirus (HPV) vaccination, screening programs, colposcopy, and surgery during and after the COVID-19 pandemic
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
Autore/i: Ciavattini, A.; Delli Carpini, G.; Giannella, L.; Arbyn, M.; Kyrgiou, M.; Joura, E. A.; Sehouli, J.; Carcopino, X.; Redman, C. W.; Nieminen, P.; Cruickshank, M.; Gultekin, M.
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/283600

Obstetric network reorganization during the COVID-19 pandemic: Suggestions from an Italian regional model
EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY
Autore/i: Giannubilo, S. R.; Giannella, L.; Delli Carpini, G.; Carnielli, V. P.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: The outbreak of the COVID-19 pandemic was characterized by its rapid spread. Italy was one of the first and most affected countries worldwide. Given that around 20 % of patients need sub-intensive or intensive care, the hospital system had to be reorganized. The obstetric network of our Region was quickly reorganized with a model that guarantees assistance to all pregnant women throughout the Region and identifies differenti- ated routes according to the level of infectious and obstetric risk.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281964

Initial validation of the diagnostic performance of Thymic-Thoracic Ratio as a marker of conotruncal abnormalities and for prediction of surgical prognosis in fetuses without 22q11.2 deletion
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
Autore/i: Battistoni, G. I.; Delli Carpini, G.; Colaneri, M.; Montironi, R.; Gelzoni, G.; Giannella, L.; Giannubilo, S. R.; Pozzi, M.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Aim: The present study aimed to perform an initial validation of the Thymic-Thoracic Ratio as a sonographic marker of conotruncal defects in non-syndromic fetuses and to assess the possible correlation between the grade of thymic hypoplasia and the severity of conotruncal defects. Methods: The study was conducted between January and June 2018 on singleton pregnant women who underwent fetal echocardiography at our institution. Fetuses with a diagnosis of conotruncal defects without 22q11.2 deletion composed the study group, while healthy appropriate for gestational age fetuses composed the control group. The Thymic-Thoracic Ratio was measured in all included fetuses and compared between the study and control group. A ROC curve analysis to evaluate the diagnostic performance of Thymic-Thoracic Ratio toward the diagnosis of conotruncal defects was performed, with determination of sensitivity, specificity, PPV, NPV, positive likelihood ratio, and negative likelihood ratio. The severity of conotruncal defects was defined with the Aristotle score in each newborn who underwent a surgical operation. The correlation between Thymic-Thoracic Ratio and Aristotle score was assessed. Results: During the study period, 23 fetuses with conotruncal defects without 22q11.2 deletion constituted the study group, and 67 healthy appropriate for gestational age fetuses were included in the control group. The T-T ratio of the study group was significantly lower than the control group (0.32 ± 0.08 vs. 0.41 ± 0.08, p <.001). The ROC curve analysis showed an AUC of 0.80 (95% CI, 0.71–0.89, p <.001) and a T-T ratio cutoff value of 0.35 for the identification of a CTD, with a sensibility of 73.9% (95% CI: 51.6–89.8%), a specificity of 79.1% (95% CI: 67.4–88.1%) a PPV of 54.8% (95% CI: 41.8–67.3%), a NPV of 89.8% (95% CI: 81.5–94.7), a positive likelihood ratio of 3.54 (95% CI 2.09–5.98), and a negative likelihood ratio of 0.33 (95% CI 0.16–0.66). A negative correlation between Aristotle score and T-T ratio was found, with a Kendall-Tau coefficient of −0.41, p =.04. Conclusion: T-T ratio measurement could be useful to identify fetuses at higher risk of conotruncal heart diseases, even without chromosomic deletion, with a cutoff of 0.35. Since a lower T-T ratio seems to be related to a worse surgical neonatal prognosis, it could be possible to provide effective counseling and refer patients to high-specialized centers for fetal echocardiography and cardiac surgery.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/284560

Clinical Characteristics and Long-Term Follow-up of Patients Treated for High-Grade Vaginal Intraepithelial Neoplasia: Results From a 20-Year Survey in Italy
JOURNAL OF LOWER GENITAL TRACT DISEASE
Autore/i: Sopracordevole, F.; Clemente, N.; Di Giuseppe, J.; Barbero, M.; Fallani, M. G.; Cattani, P.; Agarossi, A.; Del Fabro, A.; De Piero, G.; Pieralli, A.; Giannella, L.; Morini, S.; Parin, A.; Boselli, F.; Buttignol, M.; Nicodemo, M.; Delli Carpini, G.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVES: The aim of this survey was to evaluate the different surgical approaches for women with high-grade vaginal intraepithelial neoplasia (HG-VaIN) used in 8 hospitals in central and northern Italy in the last 20 years. In particular, the baseline characteristics of the patients and factors potentially leading to excisional treatment rather than ablation were considered. Moreover, the clinical outcome of patients treated for HG-VaIN (disease persistence or recurrence and progression toward invasive vaginal cancer) was analyzed. MATERIALS AND METHODS: The medical records of all women initially diagnosed with HG-VaIN and subsequently treated in 8 Italian hospitals from January 1996 to December 2016 were analyzed in a multicenter retrospective case series. RESULTS: Among the 226 women included, 116 (51.3%) underwent ablative procedures and 110 underwent excisional surgery (48.7%). An ablative procedure was preferred in cases where multiple lesions were found on colposcopic examinations. Physicians decided more frequently to perform excisional procedures in women with menopausal status, high-grade referral cervical cytology, previous hysterectomy for human papillomavirus-related disease, or VaIN 3 on colposcopic-guided biopsy. CONCLUSIONS: The surgical treatment of HG-VaIN should be tailored according to the clinical characteristics of each woman and each lesion. However, in potentially high-risk cases (VaIN 3, previous hysterectomy for human papillomavirus-related disease, and menopausal women) or in those cases in which an occult invasive disease cannot be ruled out, an excisional approach should be preferred.In any case, long-term follow-up is advisable in women treated for HG-VaIN.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/284559

What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status?
EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY
Autore/i: Giannella, L.; Di Giuseppe, J.; Prandi, S.; Delli Carpini, G.; Tsiroglou, D.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: Previous studies have shown associations between independent pre-conization variables (e.g. smoking, age, cytological grade, menopause) and positive or negative cone margins. However, it is not clear if these pre-surgical variables add predictive value to cone dimensions in the prediction of cone margin status. This study aimed to compare different models predicting positive ecto- or endocervical margins to assess whether pre-conization variables provide significant added value compared with cone dimensions alone. Study design: One hundred and sixty-one consecutive women with high-grade cervical intra-epithelial neoplasia on cone specimens were analysed retrospectively. The sample was divided into women with positive ecto- or endocervical cone margins and women with negative ecto- or endocervical cone margins. Pre-conization clinical features, cone volume and cone length were included among the study variables. Multivariate stepwise regression analysis was used to create different models predicting incomplete cervical excision. The added value of pre-conization predictors was measured with receiver operating characteristic (ROC) curve comparisons. Results: Fifty-seven (35.4 %) women had incomplete cervical excision. Multivariate analysis showed that a positive ectocervical margin was significantly associated with low-grade cervical cytology [odds ratio (OR) = 0.25, 95 % confidence interval (CI) 0.09–0.70] and cone length (OR = 0.69, 95 % CI 0.58–0.82, criterion <9 mm). The area under the curve (AUC) of the combined model for prediction of a positive ectocervical margin was 0.78 (95 % CI 0.70–0.84, p < 0.001). A positive endocervical margin was associated with cone length (OR=0.78, 95 % CI 0.65–0.93, criterion <9 mm) and age (OR=1.07, 95 % CI 1.02–1.11, criterion ≥45 years). The AUC of the combined model for prediction of positive endocervical margin was 0.75 (95 % CI 0.66–0.82, p < 0.001). Comparison of ROC curves showed that the addition of pre-conization variables to cone length did not yield significant predictive results for either ecto- or endocervical cone margins (p = 0.228 and 0.349, respectively). Conclusions: The addition of pre-conization clinical variables to cone dimensions did not improve the prediction of cone margin status significantly in the study cohort. Among cone dimensions, cone length was the best predictor of come margin status.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/282612

Atypical endometrial hyperplasia and unexpected cancers at final histology: A study on endometrial sampling methods and risk factors
DIAGNOSTICS
Autore/i: Giannella, L.; Delli Carpini, G.; Sopracordevole, F.; Papiccio, M.; Serri, M.; Giorda, G.; Tsiroglou, D.; Del Fabro, A.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient's characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193-177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002-1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/284689

From Clinical Research to Clinical Practice in Obstetrics and Gynecology
The First Outstanding 50 Years of “Università Politecnica delle Marche”
Autore/i: Giannubilo, Stefano Raffaele; Delli Carpini, Giovanni; Ciavattini, Andrea
Editore: Springer, Cham
Classificazione: 2 Contributo in Volume
Abstract: The book describes the significant multidisciplinary research findings at the Università Politecnica delle Marche and the expected future advances. It addresses some of the most dramatic challenges posed by today’s fast-growing, global society and the changes it has caused. It also discusses solutions to improve the wellbeing of human beings. The book covers the main research achievements in the various disciplines of the life sciences, and includes chapters that highlight mechanisms relevant to all aspects of human diseases, the molecular, cellular, and functional basis of therapy, and its translation into the management of people’s health needs. It also describes research on traditional and innovative foods to enhance quality, safety and functionality, and to develop bioactive/nutraceutical compounds. Further chapters address conservation and management of various environments, from the forests to the oceans, describing the studies on countermeasures against climate changes and terrestrial/aquatic pollutants, and on terrestrial/marine biodiversity, ecosystems and landscapes, erosion of genetic biodiversity, innovative aquaculture feed, sustainable crop production and management of forests. Lastly, the book reports the findings of research work on different classes of biomolecules, and on the molecular basis of antibiotic resistances and their diffusion.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281960

Atrophic endometrium in postmenopausal women referred to diagnostic hysteroscopy: A study to avoid unnecessary examinations
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
Autore/i: Giannella, L.; Delli Carpini, G.; Di Giuseppe, J.; Tsiroglou, D.; Papiccio, M.; Montanari, M.; Frega, A.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: Any diagnostic workup should be based on appropriateness criteria. Diagnostic hysteroscopy is a procedure widely used in endometrial pathology. Its high outpatient feasibility frequently leads to misuse. However, it can cause discomfort and, albeit rarely, complications. The present study aimed to provide an estimate of unnecessary examinations based on variables associated with atrophic endometrium in postmenopausal women referred to diagnostic hysteroscopy. PATIENTS AND METHODS: One-hundred and sixty-six postmenopausal women undergoing hysteroscopy were retrospectively analyzed. All included women had a final histological reference standard. The sample was divided into women with atrophic endometrium vs. women with endocavitary lesions (benign/pre-malignant/malignant). Univariate and multivariate analysis was performed to assess those patient characteristics associated with atrophic endometrium. Furthermore, based on the likelihood ratios, a post-test probability analysis was performed to provide an estimate of atrophy according to the presence of specific variables. RESULTS: Sixty-one postmenopausal women (36.7%) undergoing diagnostic hysteroscopy showed atrophic endometrium at final histology. Multivariate analysis showed that the independent variables associated with atrophy were the absence of abnormal uterine bleeding [Odds Ratio (OR)=6.43, Confidence Intervals (CI) 2.087 to 19.822], and endometrial thickness (criterion < 7 mm) (OR=0.417, CI 0.300 to 0.578). In women showing both variables associated with negative endometrial outcome, post-test probability analysis resulted in an atrophic endometrium rate of 89.13%, from a pre-test probability of 36.7%. CONCLUSIONS: About 90% of asymptomatic postmenopausal women with endometrial thickness <7 mm resulted in an atrophic endometrium at hysteroscopy. Every gynecologist should know and consider these data before referring such women to further examinations. In these cases, diagnostic hysteroscopy is not cost-effective leading to a high number of false positives.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/282649

Ultrasound features of a uterine perivascular epithelioid cell tumor (PEComa): Case report and literature review
DIAGNOSTICS
Autore/i: Giannella, L.; Delli Carpini, G.; Montik, N.; Verdecchia, V.; Puccio, F.; Di Giuseppe, J.; Tsiroglou, D.; Goteri, G.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors. One of the most frequent localizations of PEComas is the female genitourinary tract, and the uterus is the most involved site after the kidney. Correct preoperative diagnosis is rarely achieved due to the presence of nonspecific imaging features. We report a case of a uterine PEComa with particular reference to ultrasound's role in characterizing this rare occurrence. Case presentation: a 45-year-old White woman came to our observation for cyclic abdominopelvic pain and chronic constipation. The pre-surgical ultrasound examination showed a heterogeneous tumor that was 4 cm in size, localized on the right anterolateral uterine wall. The mass had well-delimited borders and a central hypoechoic portion. The use of color Doppler showed a rich, irregular vasculature in the center with low impedance. The preoperative diagnostic hypothesis was of a smooth muscle tumor of uncertain malignant potential. After careful counseling, a surgical approach was decided upon, including a total laparoscopic hysterectomy with bilateral salpingectomy. The histological and phenotypical features were consistent with a uterine PEComa. At the last follow-up, two years after surgery, the patient is alive and well. Conclusions: Uterine PEComa is a rare occurrence that should be included in the differential diagnosis of uterine wall tumors. It can appear as a small uterine mass with heterogeneous echogenicity and a rich vascular pattern during an ultrasound evaluation. This diagnostic suspicion may assist in better surgical planning.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/284690

Quercetin and indole-3-carbinol inhibit extracellular matrix expression in human primary uterine leiomyoma cells
REPRODUCTIVE BIOMEDICINE ONLINE
Autore/i: Greco, S.; Islam, M. S.; Zannotti, A.; Delli Carpini, G.; Giannubilo, S. R.; Ciavattini, A.; Petraglia, F.; Ciarmela, P.
Classificazione: 1 Contributo su Rivista
Abstract: Research question: What is the effect of quercetin and indole-3-carbinol (I3C) on extracellular matrix expression, cell migration and proliferation in human myometrial and uterine leiomyoma cells. Design: Myometrial and leiomyoma cells were treated with quercetin or I3C at different concentrations (10 µg/ml; 50 µg/ml; 100 µg/ml; and 250 µg/ml) for 48 h to measure mRNA and protein expressions of extracellular matrix (collagen 1A1, fibronectin and versican), as well as cell migration and the proliferation rate. Results: Quercetin decreased mRNA levels of collagen 1A1 in myometrial (P < 0.0001) and leiomyoma cells (P < 0.0001). Quercetin reduced mRNA and protein levels of fibronectin in myometrial cells (P < 0.05) and fibronectin protein in leiomyoma cells (P < 0.05). I3C reduced collagen 1A1 mRNA levels in myometrial (P < 0.05) and leiomyoma cells at higher dose (P < 0.05). The protein levels of fibronectin were also reduced in both myometrial and leiomyoma cells with highest dose of I3C (P < 0.05), although mRNA levels were not affected in leiomyoma cells. Neither quercetin nor I3C treatment altered versican mRNA levels in both cell types. A significant reduction of the migration of both myometrial and leiomyoma cells in response to quercetin was observed (P < 0.05) and I3C (P < 0.05 for myometrial and P < 0.01 for leiomyoma cells) treatment. Both quercetin and I3C significantly reduced myometrial cell proliferation (P < 0.05). Conclusions: The in-vitro anti-fibrotic, anti-migratory and anti-proliferative effects of quercetin and I3C form the scientific basis for developing new therapeutic, preventive agents, or both, for uterine leiomyomas.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/283309

Endometriosis-associated Clear Cell Carcinoma of the Abdominal Wall After Caesarean Section: A Case Report and Review of the Literature
IN VIVO
Autore/i: Giannella, L.; Serri, M.; Maccaroni, E.; DI Giuseppe, J.; Delli Carpini, G.; Berardi, R.; Sopracordevole, F.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: BACKGROUND/AIM: Clear cell carcinoma of the abdominal wall is a sporadic event. To date, about thirty cases have been reported in the literature. This article provides a case report and literature review of an infrequent occurrence with poor prognosis. CASE REPORT: A 45-year-old woman with pelvic pain and an abdominal mass came to our attention. Her medical history was notable for two previous cesarean sections. Physical examination revealed a smooth, multilocular mass measuring about 20 cm, arising from the previous surgical scar. Histology revealed clear-cell carcinoma resulting from the transformation of abdominal wall endometriosis. Given the disease extent, the patient underwent front-line chemotherapy. After several and multiple chemotherapy regimens, there was a disease progression that resulted in the death of the patient in 7 months. The literature review showed that a previous cesarean section was present in 91% of cases. Besides, approximately 26.5% of women died within 12 months of being diagnosed. The mean age of women was 45.88 years, while the average size of the lesion was 11 cm. CONCLUSION: Clear cell carcinoma is a rare but occurring event. Middle-aged women showing an abdominal wall mass in close relation with a surgical scar from a previous cesarean section must be promptly investigated. Treatment options usually include surgery and chemotherapy with poor results.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/283601

The association between childbirth, breastfeeding, and uterine fibroids: an observational study
SCIENTIFIC REPORTS
Autore/i: Delli Carpini, G.; Morini, S.; Papiccio, M.; Serri, M.; Damiani, V.; Grelloni, C.; Clemente, N.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: The aim of this study was to investigate the effect of childbirth and breastfeeding on uterine fibroids and to identify the factors associated with size variations. This was a monocenter observational study carried on women with a sonographic diagnosis of uterine fibroids from January 2007 to December 2016, with no indication for immediate treatment, and who became pregnant within one year from diagnosis. All patients were re-evaluated six months after delivery. Fibroid diameters were compared between pre-pregnancy period, first, second, third trimester and post-delivery. The rate of “regressed” (growth of diameter <−40%), “unchanged” (growth of diameter between −40% and +40%) or “increased” (growth of diameter >+40%) fibroids at the post-delivery evaluation with respect to the pre-pregnancy state was calculated. One-hundred fifty-seven women were included in the final analysis. At the post-delivery ultrasound, a significant reduction of the fibroid diameter with respect to all previous examinations was observed, and there was no evidence of 67 (37.2%) fibroids. Ongoing breastfeeding was positively associated with an “unchanged” or “regressed” fibroid diameter (adOR 3.23, 95%CI: 1.35–7.70, p < 0.01). Smaller pre-gravidic fibroids were more likely to return to pre-pregnancy dimensions or to regress, with a cut-off of 32 mm for lactating women and of 26 mm for non-lactating women. In conclusion, fibroids seem to return to pre-pregnancy dimensions or to regress in the post-partum period. This process may be sustained by uterine involution and hormonal variations, with an additional role of breastfeeding.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281061

Advanced 3D Imaging of Uterine Leiomyoma’s Morphology by Propagation-based Phase-Contrast Microtomography
SCIENTIFIC REPORTS
Autore/i: Giuliani, Alessandra; Greco, Stefania; Serena, Pacile; Zannotti, Alessandro; DELLI CARPINI, Giovanni; Giuliana, Tromba; Giannubilo, Stefano Raffaele; Ciavattini, Andrea; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Abstract: Uterine leiomyoma is the most common benign smooth muscle tumor in women pelvis, originating from the myometrium. It is caused by a disorder of fibrosis, with a large production and disruption of extracellular matrix (ECM). Medical treatments are still very limited and no preventative therapies have been developed. We supposed that synchrotron-based phase-contrast microtomography (PhC-microCT) may be an appropriate tool to assess the 3D morphology of uterine leiomyoma, without the use of any contrast agent. We used this technique to perform the imaging and the quantitative morphometric analysis of healthy myometrium and pathologic leiomyomas. The quantitative morphometric analysis of collagen bundles was coupled to the Roschger approach. This method, previously only used to evaluate mineralized bone density distribution, was applied here to study the fibrosis mass density distribution in healthy and pathologic biopsies from two patients. This protocol was shown to be powerful in studying uterine leiomyomas, detecting also small signs of the ECM alteration. This is of paramount importance not only for the follow-up of the present study, i.e. the investigation of different compounds and their possible therapeutic benefits, but also because it offers new methodologic possibilities for future studies of the ECM in soft tissues of different body districts.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/267665

Comparison of uterine fibroids' growth pattern during pregnancy according to fetal sex: an observational study
BIOLOGY OF SEX DIFFERENCES
Autore/i: Delli Carpini, G.; Verdecchia, V.; Papiccio, M.; Grelloni, C.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: To investigate the effect of fetal sex on fibroids' growth during pregnancy according to the hCG serum levels Methods: Observational study conducted from January 2007 to December 2016 on women with ultrasound identification of uterine fibroids who had a pregnancy within 1 year from diagnosis. The fibroids diameter was determined during the pre-pregnancy ultrasound, early first trimester (5-7 weeks), late first trimester (11-13 weeks), second trimester (19-21 weeks), and third trimester (31-33 weeks). The diameter growth was calculated in each interval between two ultrasounds. The hCG serum levels were determined both in early and late first trimester. The correlation between hCG levels and fibroid diameter was evaluated. Obstetric outcomes collected were gestational weeks at birth and the rate of cesarean section. Neonatal outcomes were birthweight and Apgar score at 1 min. Results: Eighty-seven of the included women had a male fetus, and 70 had a female fetus. A progressive increase of fibroid diameter was observed from pre-pregnancy to second trimester for both fetal sexes. In third trimester, the mean ± SD fibroid diameter of female fetuses showed a slowdown, while the mean ± SD fibroid diameter of male fetuses continued to grow. Women carrying a female fetus presented a higher fibroid diameter in early first trimester (33.5 ± 13.3 mm vs 27.4 ± 11.0 mm, p < 0.01), late first trimester (40.2 ± 13.9 mm vs 34.6 ± 11.7 mm, p < 0.01), and second trimester (40.5 ± 14.9 mm vs 34.7 ± 10.3 mm, p < 0.01). The hCG serum levels resulted higher in women with a female fetus: 61406 (50554-71760) mU/ml vs 46016 (37160-56744) mU/ml (p < 0.01). A positive correlation between hCG levels and fibroid diameter was found both for male and female fetuses (male r = 0.77, 95% CI 0.71-0.82, p < 0.01 and female r = 0.82, 95% CI 0.76-0.86, p < 0.01). Conclusion: Women with female fetus seem to have a higher growth of fibroids up to second trimester of pregnancy. This process may be mediated by the higher serum hCG levels found in women expecting a female fetus.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281064

Romina: A powerful strawberry with in vitro efficacy against uterine leiomyoma cells
JOURNAL OF CELLULAR PHYSIOLOGY
Autore/i: Giampieri, Francesca; Islam, Md Soriful; Greco, Stefania; Gasparrini, Massimiliano; Forbes Hernandez, Tamara Y.; Delli Carpini, Giovanni; Giannubilo, Stefano Raffaele; Ciavattini, Andrea; Mezzetti, Bruno; Mazzoni, Luca; Capocasa, Franco; Castellucci, Mario; Battino, Maurizio; Ciarmela, Pasquapina
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/264825

Long-term observational approach in women with histological diagnosis of cervical low-grade squamous intraepithelial lesion: An Italian multicentric retrospective cohort study
BMJ OPEN
Autore/i: Ciavattini, A.; Serri, M.; Di Giuseppe, J.; Liverani, C. A.; Gardella, B.; Papiccio, M.; Delli Carpini, G.; Morini, S.; Clemente, N.; Sopracordevole, F.
Classificazione: 1 Contributo su Rivista
Abstract: Objective To evaluate the risk of progression to high-grade squamous intraepithelial lesion (HSIL) (CIN2-3) or invasive cancer in women with histopathological diagnosis of low-grade squamous intraepithelial lesion (LSIL) (CIN1), managed in a long-term observational approach up to 5 years. Design Retrospective cohort study. Setting Four tertiary referral hospital. Participants 434 women with adequate colposcopy and complete colposcopic charts were included in the present analysis. Women with glandular lesions on the referral cytology or previous diagnosis of cervical dysplasia or invasive cervical cancer or with synchronous vaginal, or with HIV infection or immunodepression were excluded. Primary and secondary outcome measures The main study outcome was the rate of progression to histopathological HSIL (CIN2-3) or invasive cancer at any time during 5 years of follow-up. The possible risk factors were also evaluated. As secondary outcome, we analysed the possible risk factors at the 24-month evaluation for histopathological HSIL (CIN2-3) or invasive cancer progression between 2 and 5 years from initial diagnosis. Results A progression to histopathological HSIL (CIN2-3) was found in a total of 32 (7.4%) cases during 5 years of follow-up. A histopathological diagnosis of HSIL (CIN3) was found in four patients (0.9%) and no case of invasive cancer was detected. High-grade cytology at inclusion and the presence of a positive high-risk human papillomavirus (HR-HPV) DNA test at 2 years from inclusion maintained a significant correlation with the risk of histopathological progression to HSIL (CIN2-3). Conclusions The results of our study showed a low rate (7.4%) of histopathological progression to HSIL (CIN2-3) in women with LSIL (CIN1) diagnosis during long-term follow-up up to 5 years. In case of positive HR-HPV DNA test at the 2 years evaluation an excisional treatment could be the preferred choice to prevent progression to HSIL (CIN2-3) in the following years, preferring a continuation of follow-up in case of HR-HPV DNA negative result.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281122

Factors Related to Overtreatment in the See-and-Treat Approach: A Retrospective Multicentric Observational Study
JOURNAL OF LOWER GENITAL TRACT DISEASES
Autore/i: Ciavattini, A.; Morini, S.; Delli Carpini, G.; Del Fabro, A.; Serri, M.; Verdecchia, V.; Cigolot, F.; Cadel, M.; Clemente, N.; Sopracordevole, F.
Classificazione: 1 Contributo su Rivista
Abstract: Objective The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to "see-and-treat" approach, to identify subgroups of patients in which this approach could be more appropriate. Materials and Methods Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue. Results Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95-25.62, p <.001). Conclusions See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281123

From 2646 to 15: differentially regulated miRNAs between progenitors from normal myometrium and leiomyoma
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Autore/i: Lazzarini, Raffaella; Caffarini, Miriam; Carpini, Giovanni Delli; Ciavattini, Andrea; Di Primio, Roberto; Orciani, Monia
Classificazione: 1 Contributo su Rivista
Abstract: Uterine leiomyomas (fibroids) are smooth muscle neoplasms of the myometrial layer of the uterus and the most common benign tumors in women. Although their etiology is still unclear, progenitor cells (PCs) seem to be implicated.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/273421

Adenocarcinoma in situ of the uterine cervix: Clinical practice guidelines from the Italian society of colposcopy and cervical pathology (SICPCV)
EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY
Autore/i: Ciavattini, A.; Giannella, L.; Delli Carpini, G.; Tsiroglou, D.; Sopracordevole, F.; Chiossi, G.; Di Giuseppe, J.
Classificazione: 1 Contributo su Rivista
Abstract: Objective: to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice. Methods: the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I–VI) and letters (A–E). Results: Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1–1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20–25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B). Conclusion: the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281070

Complete spontaneous abortion with expulsion of an intact six-week embryo
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Autore/i: Delli Carpini, G; Ciavattini, A
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/268921

Age-Related Changes in the Fraction of Cervical Intraepithelial Neoplasia Grade 3 Related to HPV Genotypes Included in the Nonavalent Vaccine
JOURNAL OF ONCOLOGY
Autore/i: Giannella, Luca; Delli Carpini, Giovanni; Di Giuseppe, Jacopo; Prandi, Sonia; Tsiroglou, Dimitrios; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Objective. The prevalence of some human papillomavirus (HPV) genotypes has been shown to change with age. So, also the distribution of HPV genotypes included in the nonavalent vaccine may not be the same at all ages, and this could mean that vaccine protection against cervical cancer may be affected by age. The present study aimed to evaluate whether there are age-related changes in the fraction of high-grade cervical intraepithelial neoplasia (CIN) attributable to HPV genotypes included in the nonavalent vaccine. Methods. Two hundred four consecutive women undergoing conization with a histological diagnosis of CIN3 were retrospectively analyzed. All included women had a preconization HPV genotyping (HPV Sign (R) Genotyping Test). The women were divided into three groups according to age: <35, 35-44, and >= 45 years of age. Based on HPV genotypes detected in cervical lesions, the age-related changes in the expected vaccine protection were evaluated by the Cochran-Armitage test for trend. Results. The fraction of CIN3 attributable to HPV genotypes included in the nonavalent vaccine showed a significant negative trend with increasing age, with potential vaccine protection of 82% after the age of 45 (p=0.006). The rate of HPV-16 and HPV-33, included in the vaccine, showed a negative trend with age (p=0.047 and p=0.044, respectively). Among HPV genotypes not covered by the vaccine, the rate of non-high-risk HPVs (genotypes: 53-54-70-73-82-85-87) showed a significant positive trend with increasing age (p=0.018). Conclusions. Although the fraction of CIN3 attributable to genotypes included in the nonavalent HPV vaccine was high even after age 45, older women appeared to be more at risk of high-grade CIN related to HPV genotypes not included in the vaccine. Interestingly, older women showed a higher rate of precancerous cervical lesions associated with non-high-risk HPV. The present findings seem to raise the question about the management of cervical pathology at a later age in a future postvaccination era.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281124

Role of close endocervical margin in treatment failure after cervical excision for cervical intraepithelial neoplasia: A retrospective study
ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE
Autore/i: Sopracordevole, F.; Delli Carpini, G.; Del Fabro, A.; Serri, M.; Alessandrini, L.; Buttignol, M.; Canzonieri, V.; Cagnacci, A.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: Context.-A significant negative trend in length of cone excision has been observed in recent years, leading to a higher percentage of positive endocervical excision margin and close (,1 mm) negative endocervical margin cases. Objective.-To evaluate the rate of disease persistence and recurrence after cervical excision for cervical intraepithelial neoplasia in relation to a close (,1 mm), negative, or positive endocervical margin. Design.-We retrospectively analyzed a cohort of patients with cervical intraepithelial neoplasia having a carbon dioxide laser cervical excision performed by the same operator. We evaluated the rate of positive follow-up in relation to the status of endocervical margin. Results.-We found a higher percentage of positivity at follow-up and recurrence rate between 13 and 24 months in patients with positive margin than for patients with negative or close endocervical margin (P ¼ .005 and P ¼ .006, respectively), with no difference between negative and close margin (7.0% versus 8.3%, P ¼ .89, and 1.2% versus 0%, P ¼ .83, respectively). Conclusions.-Women with close and negative endocervical margin presented similar risk of positivity at long-term follow-up, disease persistence, and recurrence between 13 and 24 months, so the histopathologic report of a free endocervical margin less than 1 mm should not categorize the patient as being at increased risk of treatment failure. Therefore, the only information that the pathologist should report is the state of the margin (positive or negative), regardless of the negative endocervical margin length.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281126

Sensitivity and specificity values of high-risk HPV DNA, p16/ki-67 and HPV mRNA in young women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL)
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
Autore/i: Frega, A.; Pavone, M.; Sesti, F.; Leone, C.; Bianchi, P.; Cozza, G.; Colombrino, C.; Lukic, A.; Marziani, R.; Sanctis, L. D. E.; Delli Carpini, G.; Caserta, D.; Ciavattini, A.
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: The aim of the study was to evaluate the sensitivity and specificity values of high-risk HPV DNA test, p16/ki-67, and HPV mRNA in histologically high-grade cervical intraepithelial lesions (CIN2-CIN3) in women aged 21-24 years with diagnosis of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) at pap smear. PATIENTS AND METHODS: 342 patients between 21-24 years old, attending spontaneously our clinics, 118 with ASCUS and 224 with LSIL, were enrolled in the study. All patients underwent colposcopy and biopsies were performed in the areas with major changes. All patients were tested at the same time for p16/ki-67, high-risk HPV DNA and HPV mRNA. RESULTS: Nineteen out of 118 women with ASCUS showed a high-grade cervical intraepithelial lesion, 11 out of 118 (9.32%) CIN2, and 8 out of 118 (6.78%) CIN3. The sensitivity of high-risk HPV DNA was 99.9%, and the specificity 23.2%; p16/ki-67 pointed out a sensitivity of 90.9%, and a specificity of 81.8%; HPV mRNA showed a sensitivity of 81.8%, and specificity of 87.9% in CIN2 lesions. In CIN3 lesions, the sensitivity of high-risk HPV DNA was 99.9%, while the specificity was 19.1%; p16/ki-67 showed a sensitivity of 99.9%, and a specificity of 73.7%; HPV mRNA relived a sensitivity of 87.5%, and a specificity of 80.8%. In women with LSIL, a total of 42/224 (18.75%) of CIN2 were found at the histopathological examination, while 17/224 (7.59%) women presented a CIN3. No case of invasive cancer was identified. High-risk HPV DNA was positive in 190/224 (84.8%), p16/ki-67 in 119/224 (53.1%), and HPV mRNA in 104/224 (46.4%). In women with CIN2, the sensitivity of high-risk HPV DNA was of 92.8%, and the specificity 17.5%, the sensitivity of p16/ki-67 was 95.2%, and specificity 61.8%. HPV mRNA showed a sensitivity of 88.8% and a specificity of 87.8%. In women with CIN3, the sensitivity of high-risk HPV DNA was 88.2%, and the specificity 29.7%; p16/ki-67 pointed out a sensitivity of 94.1%, and a specificity of 49%; HPV mRNA showed a sensitivity of 88.2% and a specificity of 80.6. CONCLUSIONS: Taking into account the high rate of spontaneous regression of high-grade lesions in young women, these tests, in particular, the HPV mRNA test, used as a triage test for ASCUS or LSIL, can modify follow-up triage strategy. In fact, this biomarker, due to its high specificity, could lead to a cytology repetition instead of an immediate colposcopy, avoiding over diagnosis and potential overtreatment in this category of women.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281128

Conservative treatment of ectopic cervical pregnancy with uterine artery embolization and cervical curettage: A case report
CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY
Autore/i: Ciavattini, A.; Clemente, N.; Morini, S.; Fichetti, M.; Delli Carpini, G.; Candelari, R.
Classificazione: 1 Contributo su Rivista
Abstract: Cervical pregnancy is a rare form of non-tubal ectopic pregnancy. Although uncommon, this condition can determine serious complications with massive hemorrhages and a high rate of fatality. The choice of the appropriate management depends on several factors, such as severity of vaginal bleeding, gestational age, serum β-hCG level, and on embryonic cardiac activity. However, no specific guidelines have been developed, and the "gold standard" treatment has yet to be defined. The authors report a case of cervical pregnancy successfully managed through a combined approach of percutaneous bilateral uterine artery embolization immediately followed by cervical curettage.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/282645

Mesenchymal Stem Cells from Cervix and Age: New Insights into CIN Regression Rate
OXIDATIVE MEDICINE AND CELLULAR LONGEVITY
Autore/i: Orciani, Monia; Caffarini, Miriam; Lazzarini, Raffaella; Delli Carpini, Giovanni; Tsiroglou, Dimitrios; Di Primio, Roberto; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/262470

Effect of age and cone dimensions on cervical regeneration: An Italian multicentric prospective observational study
BMJ OPEN
Autore/i: Ciavattini, Andrea; Delli Carpini, Giovanni; Moriconi, Lorenzo; Clemente, Nicolò; Montik, Nina; De Vincenzo, Rosa; Del Fabro, Anna; Buttignol, Monica; Ricci, Caterina; Moro, Francesca; Sopracordevole, Francesco
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/258554

Data on post-partum evaluation of women with abnormal cervical cytology in pregnancy
DATA IN BRIEF
Autore/i: Ciavattini, A.; Serri, M.; Di Giuseppe, J.; Liverani, C. A.; Fallani, M. G.; Tsiroglou, D.; Papiccio, M.; Delli Carpini, G.; Pieralli, A.; Clemente, N.; Sopracordevole, F.
Classificazione: 1 Contributo su Rivista
Abstract: During pregnancy, the only diagnosis that may alter management is invasive cancer. Thus, the primary aim of the cytological screening and subsequent colposcopy performed during pregnancy should be the exclusion of invasive cancer, “Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors,” (American College of Obstetricians and Gynecologists, 2013) [1]. However, the impact of the delivery on the regression of the cervical lesions is still debated. This data article concerns the post-partum evaluation of colposcopic patterns, cytological and histopathology findings in women diagnosed with abnormal cervical cytology in pregnancy, included in the paper entitled “Reliability of colposcopy during pregnancy” (Ciavattini et al., 2018). Data about the rates of persistence, progression and regression of CIN after delivery are reported.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/281130

Reliability of colposcopy during pregnancy
EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY
Autore/i: Ciavattini, A.; Serri, M.; Di Giuseppe, J.; Liverani, C. A.; Fallani, M. G.; Tsiroglou, D.; Papiccio, M.; Delli Carpini, G.; Pieralli, A.; Clemente, N.; Sopracordevole, F.
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/268919

Vaginal natural oxygenation device (VNOD) for concomitant administration of hyaluronic acid and topical hyperbaric oxygen to treat vulvo-vaginal atrophy: a pilot study
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
Autore/i: Condemi, L; Di Guseppe, J; Delli Carpini, G; Garoia, F; Frega, A; Ciavattini, A
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: This is a pilot study to evaluate the effectiveness of concomitant administration of hyaluronic acid and topical hyperbaric oxygen therapy (THOT) by a specifically designed medical device (vaginal natural oxygenation device, VNOD) in improving the symptomatology of postmenopausal patients with vulvo-vaginal atrophy (VVA).PATIENTS AND METHODS: Women with diagnosis of severe VVA from September 2017 to May 2018 were included. Five biweekly administration of THOT and concomitant of hyaluronic acid were performed with a specifically designed medical device. In each occasion, the intensity of patient's symptoms (well-being such as absence of dyspareunia, vaginal dryness, vulvar and/or vaginal itching; vaginal burning; presence of fluid) was determined with a graduated scale from 1 to 6 and the vaginal elasticity and the vaginal wall epithelium appearance were also determined with a graduated scale from 1 to 5. The change in all parameters from baseline to end of therapy was evaluated.RESULTS: Twenty-five patients were considered for the final analysis. A significant improvement in well-being (0.3 vs. 5.1, p < 0.001). vaginal burning (0.2 vs. 5.1, p < 0.001), presence of fluid (0.6 vs. 4.9, p < 0.001), vaginal epithelium appearance (1.8 vs. 4.7, p < 0.001), and vaginal elasticity (1.1 vs. 3.8, p < 0.001) was observed between the first and the last therapy session. All the patients reported a recovery of their sexuality at the end of the five treatment sessions.CONCLUSIONS: In this pilot study, the use of VNOD seems to be a valid treatment of VVA, resulting in a completely natural type of therapy well accepted by patients with immediate therapeutic effects and without side effects: these findings must be confirmed in a well-designed randomized controlled trial.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/283598

Chronic Inflammation May Enhance Leiomyoma Development by the Involvement of Progenitor Cells
STEM CELLS INTERNATIONAL
Autore/i: Orciani, Monia; Caffarini, Miriam; Biagini, Alessandra; Lucarini, Guendalina; Delli Carpini, Giovanni; Berretta, Antonella; Di Primio, Roberto; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Although the etiology of leiomyoma is unclear, a progenitor/undifferentiated cell population has been described whose dysregulation may be involved in the onset of uterine conditions. Moreover, inflammation is involved in the development of several tumors. The aim of this work was to understand if progenitor cells sustain a chronic inflammatory microenvironment that enhances leiomyoma development. Cells from 12 human leiomyoma and 12 normal myometrium samples of the same patients were in vitro isolated and exhaustively characterized (morphology, proliferation, cytofluorometry, differentiation, RT-PCR, immunofluorescence, immunohistochemistry, and Western blotting assays). Selected cytokines (ELISA) and inflammation-related genes (RT-PCR) were analyzed to identify healthy myometrium progenitor cells (MPCs) and leiomyoma progenitor cells (LPCs). Results show that (i) MPCs and LPCs share stemness features, such as immunophenotype and multidifferentiation assay, (ii) LPCs have a significantly shorter doubling time and a significantly higher expression of stemness genes (p < 0.05), and (iii) LPCs secreted significantly higher levels (p < 0.05) of cytokines related to chronic inflammation and significantly lower amounts (p < 0.05) of cytokines related to acute inflammation. Despite the limited sample size, comparisons between leiomyoma and normal myometrium tissue from each patient allowed normalization of patient-specific differences. The evidenced cytokine expression pattern related to chronic inflammation in LPCs may play a role in the increased risk of adverse obstetric outcomes (infertility, spontaneous miscarriage, and preterm birth) in women affected by leiomyomas. These women should be recognized as "high risk" and subjected to specialized management both before and during pregnancy.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259561

Unfolded protein response, a link between endometrioid ovarian carcinoma and endometriosis: A pilot study
ONCOLOGY LETTERS
Autore/i: Ciavattini, A.; Delli Carpini, G.; Serri, M.; Tozzi, A.; Leoni, F.; Di Loreto, E.; Saccucci, F.
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/282616

Preperitoneal Fat Thicknesses, Lipid Profile, and Oxidative Status in Women With Uterine Fibroids
REPRODUCTIVE SCIENCES
Autore/i: Vignini, Arianna; Sabbatinelli, Jacopo; Clemente, Nicolo'; DELLI CARPINI, Giovanni; Tassetti, Marta; Zagaglia, Giulia; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Purpose: There is growing evidence supporting a possible role for metabolic syndrome and its determinants, such as dyslipidemia, in uterine fibroid (UF) pathogenesis. The present study aims to investigate the association between UFs and visceral and subcutaneous fat thickness (SFT), lipid profile, and oxidative and antioxidative status. Methods: In this cross-sectional study, 35 patients diagnosed with UFs and 15 women without UFs were enrolled. Clinical history and anthropometric parameters were collected for every woman. Characteristics of UFs, preperitoneal fat thickness (PFT), and SFT were assessed ultrasonically. Lipid profile, glucose, thiobarbituric acid reactive substances (TBARs), and superoxide dismutase (SOD) activity were evaluated on plasma from participants. Results: Women with UFs showed a significantly increased PFT (11.63 ± 3.39 vs 7.01 ± 3.10 mm; P < .001), lower levels of high-density lipoprotein cholesterol (HDL-C; 45.4 ± 8.3 vs 57.2 ± 13.4 mg/dL; P = .017), higher levels of low-density lipoprotein cholesterol (LDL-C; 92.3 ± 21.5 vs 72.0 ± 14.6 mg/dL; P = .007), and oxidized LDL (65.2 ± 20.7 vs 43.0 ± 11.3 U/L; P = .002). In patients, TBARs concentration was significantly higher (9.41 ± 6.49 vs 2.92 ± 1.65 nmol malondialdehyde/100 μg prot; P < .001), whereas SOD activity was lower (1.09 ± 0.19 vs 1.37 ± 0.41 U/μL; P = .005). Preperitoneal fat thickness was positively associated with body mass index, oxidized LDL, and TBARs. At multivariate analysis, PFT and HDL-C maintained a significant correlation with the diagnosis of UFs. Conclusion: Chronic inflammation triggered and sustained by visceral fat could play a determinant role in cell differentiation and proliferation processes, necessary for the development of UFs. Alterations in cholesterol fractions may be explained as a consequence of the increased visceral fat deposits and can reflect an increased risk of subclinical atherosclerosis in patients with UF.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/246089

Follow up in women with biopsy diagnosis of cervical low-grade squamous intraepithelial lesion (LSIL): how long should it be?
ARCHIVES OF GYNECOLOGY AND OBSTETRICS
Autore/i: Ciavattini, Andrea; Clemente, Nicolò; Tsiroglou, Dimitrios; Sopracordevole, Francesco; Serri, Matteo; DELLI CARPINI, Giovanni; Papiccio, Maria; Cattani, Paolo
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/249874

The association between ultrasound-estimated visceral fat deposition and uterine fibroids: an observational study
GYNECOLOGICAL ENDOCRINOLOGY
Autore/i: Ciavattini, Andrea; DELLI CARPINI, Giovanni; Moriconi, Lorenzo; Clemente, Nicolò; Orici, Francesca; Boschi, Anna Chiara; Montik, Nina; Mazzanti, Laura
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/249873

Cervical Excision Procedure: A Trend of Decreasing Length of Excision Observed in a Multicenter Survey
JOURNAL OF LOWER GENITAL TRACT DISEASES
Autore/i: Ciavattini, Andrea; Clemente, Nicolò; Liverani, Carlo Antonio; Cattani, Paolo; Giannella, Luca; Delli Carpini, Giovanni; Morini, Stefano; Buttignol, Monica; Sopracordevole, Francesco
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/258558

Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for “large” uterine fibroids: comparison of clinical efficacy
ARCHIVES OF GYNECOLOGY AND OBSTETRICS
Autore/i: Ciavattini, Andrea; Clemente, Nicolò; Delli Carpini, Giovanni; Saccardi, Carlo; Borgato, Shara; Litta, Pietro
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/258556

Trend of decreasing length of cervical cone excision during the last 20 years
EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
Autore/i: Sopracordevole, F; Clemente, N; Delli Carpini, G; Giorda, G; Del Fabro, A; Moriconi, L; De Piero, G; Alessandrini, L; Canzonieri, V; Buttignol, M; Nicodemo, M; Ciavattini, A
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/258555

Thickness of preperitoneal fat as a predictor of malignancy in overweight and obese women with endometrial polyps
ONCOLOGY LETTERS
Autore/i: Ciavattini, Andrea; Di Giuseppe, Jacopo; Clemente, Nicolò; Moriconi, Lorenzo; Delli Carpini, Giovanni; Montik, Nina; Mazzanti, Laura
Classificazione: 1 Contributo su Rivista
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/235740

Hypovitaminosis D and "small burden" uterine fibroids: Opportunity for a vitamin D supplementation
MEDICINE
Autore/i: Ciavattini, Andrea; DELLI CARPINI, Giovanni; Serri, Matteo; Vignini, Arianna; Sabbatinelli, Jacopo; Tozzi, Alessandra; Aggiusti, Alice; Clemente, Nicolo'
Classificazione: 1 Contributo su Rivista
Abstract: The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and "small burden" uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with "small burden" uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the "study group" (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the "control group" (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = -0.18, P = 0.01) and the total volume of fibroids (r = -0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = -0.10, P = 0.16). In women of the "study group," a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the "progression to extensive disease" was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with "small burden" fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/244870

Effectiveness of emergency cerclage in cervical insufficiency
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
Autore/i: Ciavattini, Andrea; DELLI CARPINI, Giovanni; Boscarato, Virginia; Febi, Tamara; DI GIUSEPPE, Jacopo; Landi, Beatrice
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: To assess the effectiveness of emergency cerclage versus conservative management in improving obstetric and neonatal outcomes in women with clinically evident cervical insufficiency. METHODS: Retrospective cohort study conducted on all women with a single viable pregnancy diagnosed with cervical insufficiency between the 14th and 24th gestational week without pPROM, clinical chorioamnionitis, vaginal bleeding, treatment-resistant uterine contractions or life-incompatible fetal anomalies, from January 2009 to December 2014. Obstetric and neonatal outcomes were compared between women who underwent cerclage and those who refused, preferring a conservative therapy. RESULTS: Eighteen women underwent emergency cerclage and 19 were managed with a conservative therapy. Mean gestational age at delivery, time from diagnosis to delivery and rate of term birth were significantly higher in the first cohort. Those variables show a linear inverse correlation with the degree of cervical dilatation, with better outcomes in patients who underwent cerclage with a dilatation lower than 5.0 cm. No difference in mode of delivery were found. CONCLUSION: Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/239979

Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2-3) is a predictor of pregnancy outcome
EUROPEAN JOURNAL OF CANCER PREVENTION
Autore/i: Liverani, Carlo A.; DI GIUSEPPE, Jacopo; Clemente, Nicolo'; DELLI CARPINI, Giovanni; Monti, Ermelinda; Fanetti, Fabiana; Bolis, Giorgio; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: The objective of this study was to analyze the impact of cone characteristics (depth, transverse diameter, and volume) on subsequent pregnancies after the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2-3). Pregnancy outcomes (preterm birth, gestational age at birth, mode of delivery, and birth weight) of 501 women with singleton gestations and no previous preterm birth or history of late miscarriage, who had previously undergone a single LEEP for CIN 2-3, were retrospectively analyzed with respect to length, transverse diameter, and volume of the excision specimen. The overall incidence of preterm birth was 2.4%. The rate of preterm birth in women with length greater than 20 mm or volume greater than 2.5 cm was significantly higher than that in women with length between 15 and 19 mm (15.6 vs. 3.9%, P=0.02) or women with volume between 2.0 and 2.4 cm (5.8 vs. 1.6%, P=0.04). A linear inverse correlation (r=-0.3, P<0.001) between gestational age at birth and length, but not volume (r=0.0, P=0.9) or transverse diameter (r=0.2, P<0.0001), emerged. The mode of delivery was not affected by cone characteristics. Length, but not transverse diameter and volume, of the excised specimen seems to be related to a lower gestational age at birth. When excisions are performed under strict colposcopic guidance, with a correct modulation of cone length, the risk for preterm birth and cesarean delivery in subsequent pregnancies is not increased.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240092

Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: An observational study
FERTILITY AND STERILITY
Autore/i: Ciavattini, Andrea; DELLI CARPINI, Giovanni; Clemente, Nicolo'; Moriconi, Lorenzo; Gentili, Chiara; DI GIUSEPPE, Jacopo
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: To analyze the growth trend of small uterine fibroids during early pregnancy, evaluating the potential factors involved, with particular interest in hCG levels. DESIGN: Observational study. SETTING: Tertiary care university hospital. PATIENT(S): Women who had an ultrasound diagnosis of small myomas (diameter, ≥10 mm and ≤50 mm) from January 2007 to December 2013, and who subsequently became pregnant within 1 year. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Three additional ultrasound examinations were performed during early pregnancy (7-8, 10-13, and 20-22 complete gestational weeks, respectively) and the modifications in diameter and volume of each uterine fibroid were recorded. A serial evaluation of hCG serum levels from 5-12 weeks was performed. RESULT(S): From the 109 women who fulfilled the study inclusion/exclusion criteria, a significant increase emerged, both for volume and diameter of the detected fibroids. Specifically, a median growth rate (GR) of 122% was observed during the interval of the first to the second ultrasound, whereas a median GR of 108% was detected during the interval between the second and the third ultrasound, and a median GR of 25% between the third and the fourth ultrasound. A significant positive correlation between hCG levels and diameter (R = 0.69) of myomas between 5 and 12 weeks emerged. CONCLUSION(S): A remarkable nonlinear growth of small fibroids during initial pregnancy was observed, with a faster rate in the first trimester and a slowdown by midpregnancy. Those changes seem to be related to the similar increase of hCG levels until 12 weeks.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/235742

Ovarian endometriosis and vitamin D serum levels
GYNECOLOGICAL ENDOCRINOLOGY
Autore/i: Ciavattini, Andrea; Serri, Matteo; DELLI CARPINI, Giovanni; Morini, Stefano; Clemente, Nicolo'
Classificazione: 1 Contributo su Rivista
Abstract: AIM:The aim of this study was to assess the vitamin D serum level in women with ovarian endometriosis; specifically, a possible correlation between the dimensions of ovarian endometriomas and vitamin D serum levels was evaluated. MATERIALS AND METHODS: This was an observational study of childbearing-age women diagnosed with singleton ovarian endometrioma from January 2015 to December 2015. Women diagnosed with multiple ovarian endometriomas or extraovarian endometriosis were excluded. RESULTS: Forty-nine women constituted the initial study cohort. In these women, the mean (±SD) 25-OH-D3 serum level was 22.0 (±8.9) ng/ml, and 42 of them (85.7%) were diagnosed with hypovitaminosis D. In the "hypovitaminosis D women", the mean (± SD) diameter of ovarian endometriomas was 40.2 ± 22.6 mm, while in the "normal vitamin D serum level women" it was 26.7 ± 12.1 mm (p = 0.1). However, a significant linear correlation between 25-OH-D3 serum level and the diameter of ovarian endometriomas was found (r = -0.3, p = 0.03). CONCLUSION: We found a relatively high rate of women with ovarian endometriosis and hypovitaminosis D. Interestingly, a significant linear correlation between 25-OH-D3 serum levels and the diameter of ovarian endometrioma emerged.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240101

Loop electrosurgical excision procedure and risk of miscarriage
FERTILITY AND STERILITY
Autore/i: Ciavattini, Andrea; Clemente, Nicolo'; DELLI CARPINI, Giovanni; Gentili, Chiara; DI GIUSEPPE, Jacopo; Barbadoro, Pamela; Prospero, Emilia; Liverani, Carlo Antonio
Classificazione: 1 Contributo su Rivista
Abstract: To evaluate the risk of miscarriage in the subsequent pregnancy after a loop electrosurgical excision procedure (LEEP), also considering time elapsed from LEEP to pregnancy.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/225483

Number and size of uterine fibroids and obstetric outcomes.
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
Autore/i: Ciavattini, Andrea; Clemente, Nicolo'; DELLI CARPINI, Giovanni; DI GIUSEPPE, Jacopo; Giannubilo, Stefano Raffaele; Tranquilli, Andrea Luigi
Classificazione: 1 Contributo su Rivista
Abstract: Objective: Estimating the impact of sonographically identified multiple or large (≥5 cm in diameter) fibroids on obstetric outcomes. Methods: Retrospective cohort study of 219 women with uterine fibroids (identified on a routine second-trimester ultrasound survey over a 3-year period, 2010-2012) and their age-matched controls. Inclusion criteria were singleton pregnancy, delivery at >24 weeks of gestation and no pathological conditions (chronic hypertension, gestational diabetes or pre-existing diabetes mellitus, uterine anomalies or fetal malformations). Results: Compared to women with no fibroids, women with multiple fibroids (n = 34) had a significantly higher rate of preterm birth (29.4% versus 5%, p < 0.001), cesarean section (73.5% versus 37%, p < 0.001) and breech presentation (11.8% versus 2.7%, p = 0.04). Women with large fibroids (n = 48) had a higher rate of preterm birth (16.7% versus 5%, p = 0.01) and pPROM (10.4% versus 0.5%, p < 0.001). By multivariate analysis, only multiple fibroids and previous preterm birth showed an independent significant association with preterm birth (OR = 7.37, 95% CI 2.50-21.68 and OR = 13.01, 95% CI 3.56-47.52, respectively). Conclusions: Women with uterine fibroids are at an increased risk of obstetric complications. In particular, multiple rather than large fibroids are associated with a significantly increased risk of preterm birth and cesarean delivery while large fibroids are associated with a higher risk of pPROM. No correlation with IUGR, placenta previa or placental abruption was found.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/205931

Risk of recurrent menorrhagia after hydrothermoablation: role of GnRH analogues neoadjuvant treatment in long-term successful rate
CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY
Autore/i: Litta, P.; Saccardi, C.; Tommasi, L.; DI GIUSEPPE, Jacopo; DELLI CARPINI, Giovanni; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: OBJECTIVE: To evaluate the long-term effectiveness of presurgical therapy with GnRH analogues in patients who underwenthydrothermal endometrial ablation (HTA) for menorrhagia and assess the relationship between sonographically measured myometrium thickness and pelvic pain. MATERIALS AND METHODS: A prospective randomized control study comparing 15 women (Group A) with presurgical subcutaneous triptorelin depot injection before HTA with controls (Group B, n = 15). Inclusion criteria were: recurrent menorrhagia, uterus length < 12 cm, no previous hormonal therapy for at least six month, and family plan completed. Student's t test was applied, as appropriate, to compare continuous variables. Proportion were compared with chi-squared. RESULTS: After 12 months of follow-up, Group A showed a significantly lower (0% vs 20%; p = 0.03) failure rate after hydrothermoablation than the Group B and a generally higher successful rate at 24 and 48 months. The discomfort, evaluated with VAS, showed a mean value of 47.6 +/- 15.9 +/- SD); 96.7% of women reported a mild-moderate postoperative pain. No perioperative and late complications were recorded. CONCLUSIONS: Presurgical treatment with GnRH analogues seems to improve long-term efficacy of HTA. Perioperative pelvic pain seems to not be affected by myometrium thickness.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/209114

Predictors of malignancy in endometrial polyps: a multi-institutional cohort study
EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY
Autore/i: Litta, P.; DI GIUSEPPE, Jacopo; Moriconi, Lorenzo; DELLI CARPINI, Giovanni; Piermartiri, MARIA GIOVANNA; Ciavattini, Andrea
Classificazione: 1 Contributo su Rivista
Abstract: Abstract PURPOSE OF INVESTIGATION: The risk of endometrial cancer in women with endometrial polyps (EPs) has been reported to vary between 0.3% and 4.8%. There is a lack of data about the management of asymptomatic women with incidental diagnosis of EPs. In the present study the authors correlated demographic and clinical characteristics with histopathological features of the EPs hysteroscopically removed. MATERIALS AND METHODS: An observational multi-institutional cohort study was conducted from February 2010 to December 2012 to identify all the premenopausal and postmenopausal women consecutively undergoing hysteroscopic polypectomy. The data of women were reviewed and clinical features were related to histopathologic results. RESULTS: The patients recruited were 813. The mean age was 52.5 years (range 22-87). The results showed a correlation between older age, high body mass index (BMI) and obesity, postmenopausal state, abnormal uterine bleeding (AUB), hypertension, and risk of malignant EPs. On multivariable analysis, the correlation remained only for age (OR 1.08, 95% CI 1.03 - 1.14) and AUB (OR 3.53, 95% CI 1.87 - 6.65). CONCLUSION: Older patients in postmenopausal status with AUB, a high BMI, and hypertension are at higher risk for premalignant and malignant polyps. In these patients a surgical approach should be used, consisting in hysteroscopical removing of the polyp.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/209113