Publications by authors named "Jacopo Lenzi"

95 Publications

Sleep disorders reveal distress among children and adolescents during the Covid-19 first wave: results of a large web-based Italian survey.

Ital J Pediatr 2021 Jun 4;47(1):130. Epub 2021 Jun 4.

Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.

Background: Measures to contain the Covid-19 pandemic led to significant lifestyle changes for children and adolescents mainly related to the closure of schools and recreational activities, reduced social interaction, and increased family concerns.

Methods: A cross-sectional online survey of 78 questions investigating social determinants of health, mood changes, symptoms of anxiety, increase in sleep disorders and unusual repetitive movements was offered to parents living in Italy with children ≤18 years; including families of children with disabilities, autism spectrum disorders, chronic diseases, and specific learning disabilities. The survey was conducted on the Qualtrics platform 6 months after the beginning of the pandemic and distributed in hospitals and paediatricians' waiting rooms as well as through social networks. The primary outcomes were the increase in sleep disorders among children and adolescents. Possible risk factors were investigated through multivariable regression.

Results: Six thousand two hundred ten volunteer parents responded to the questions concerning mood changes, sleep disorders and unusual repetitive movements, and were included in the present study. The majority were female (91.8%) and Italian (97.0%). 72.7% answered that their children had become more nervous, worried, or sad (80.2% in children with learning disabilities); 77.6% reported feelings of loneliness and 69.3% more difficulties in children falling asleep, 30.2% in staying asleep, and 18.7% an increase in nightmares and/or sleep terrors. Statistical analysis identified socioeconomic status, parent's job loss, food insecurity, family attitude toward the pandemic, and children's mood swing, feelings of loneliness, or missing outdoor activities, as major risk factors for sleep disorders.

Conclusion: The first Covid-19 lockdown impacted children's and adolescents' health through an increase in sleep disorders. In the following phases of the pandemic, this evidence may be useful to investigate and treat these disorders as well as make decisions about containment health policies concerning this age group.
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http://dx.doi.org/10.1186/s13052-021-01083-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176278PMC
June 2021

Prenatal Screening for Developmental Displacement of the Hip: The BUDDHA (Pre-Birth Ultrasound for Developmental Displacement of the Hip Assessment) Study.

Diagnostics (Basel) 2021 May 12;11(5). Epub 2021 May 12.

Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, IRCCS Sant'Orsola-Malpighi, University of Bologna, 40138 Bologna, Italy.

Background: developmental dysplasia of the hip has an incidence of 3-5 out of 1000 children. Currently, only postnatal screening is available.

Objective: to test the feasibility of a method based on Graf technique application at antenatal ultrasound in assessing the normal development of the hip in unselected term fetuses.

Methods: a prospective cohort study in a single university tertiary hospital from January 2017 to January 2020. Single uncomplicated term pregnancies (37-40 weeks) attending our center for routine ultrasound were consecutively recruited for the purpose of the study. A 3D volume acquisition was launched on the coxofemoral joint of the fetus by a single expert operator, and offline analysis was then performed in the multiplanar mode by two operators (blinded to each other analysis) in order to measure the alpha and beta angles according to our modified Graf technique. Intra- and inter-observer variations were calculated. Reference charts for normal values of both angles were produced. Postnatal ultrasound was then performed to measure the Graf angles in newborns, confirming a normal development of the hip.

Results: in the study period, 433 uncomplicated term pregnancies underwent 3D ultrasound for the assessment of the fetal hip. One case was subsequently excluded because of confirmed postnatal diagnosis of developmental dysplasia of the hip. The measurement of our modified Graf angles was feasible at prenatal ultrasound with a good reproducibility. The inter-rater and intra-rater reliability of both angles was substantial. Reference charts for normal values of both angles were produced.

Conclusions: the evaluation of the coxofemoral joint in fetuses at term of gestation has never been attempted before. The Graf technique application, currently employed at postnatal ultrasound, may also be adapted to prenatal ultrasound with a substantial reproducibility. However, there was no evidence of a linear relationship between prenatal and postnatal alpha angles and beta angles. Further research is needed to establish if developmental dysplasia of the hip could be diagnosed antenatally.
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http://dx.doi.org/10.3390/diagnostics11050868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150805PMC
May 2021

The unbearable burden of endometriosis: Results from a large cohort about anxiety reduction during the first outpatient evaluation.

J Psychosom Res 2021 May 18;147:110512. Epub 2021 May 18.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Via Massarenti, 13, IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Objective: To evaluate the impact of the first outpatient evaluation on anxiety levels in women with suspected endometriosis. Secondarily, we investigated which individual characteristics exerted the greatest influence on distress levels.

Methods: Women referred to our academic center between January 2019 and March 2020 on the suspicion of endometriosis were enrolled in this prospective, observational study. Before the visit, participants answered questionnaires such as the Generalized Anxiety Disorder-7 (GAD) and the Spielberg State Trait Anxiety Inventory (STAI) Y6. After the visit, the STAI-Y6 was resubmitted to each woman, along with the Patient Global Impression of Improvement (PGII) questionnaire. Women's and physicians' satisfaction with the visit were also evaluated using a 5-point scale.

Results: One hundred and four women were enrolled. Anxiety levels decreased after the evaluation (STAI-Y6 60.0 ± 15.0 vs 40.8 ± 14.2, P < .001). Higher reductions were noted in patients who had higher baseline anxiety levels (est. change -24.3; 95% CI -29.2, -19.5; P < .001), had previously sought information online (est. change -15.9; 95% CI -21.4, -10.5; P < .001), and when endometriosis was not confirmed, but not in those waitlisted for surgery (est. change 1.7; 95% CI -5.9, 9.2; P 0.659). Most patients' mood improved after the examination (67%) and were satisfied with the visit (98%).

Conclusions: Anxiety levels are reduced after medical examination in women with higher baseline distress and who sought information online. To create a trustful relationship with women, providing them with tailored counselling, seems essential to improve their psychological wellbeing.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110512DOI Listing
May 2021

Small-scale spatial distribution of COVID-19-related excess mortality.

MethodsX 2021 3;8:101257. Epub 2021 Feb 3.

Unit of Biostatistics and Hygiene, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.

Mortality due to massive events like the COVID-19 pandemic is underestimated because of several reasons, among which the impossibility to track all positive cases and the inadequacy of coding systems are presumably the most relevant. Therefore, the most affordable method to estimate COVID-19-related mortality is excess mortality (EM). Very often, though, EM is calculated on large spatial units that may entail different EM patterns and without stratifying deaths by age or sex, while, especially in the case of epidemics, it is important to identify the areas that suffered a higher death toll or that were spared. We developed the Stata COVID19_EM.ado procedure that estimates EM within municipalities in six subgroups defined by sex and age class using official data provided by ISTAT (Italian National Statistics Bureau) on deaths occurred from 2015 to 2020. Using simple linear regression models, we estimated the mortality trend in each age-and-sex subgroup and obtained the expected deaths of 2020 by extrapolating the linear trend. The results are then displayed using choropleth maps. Subsequently, local autocorrelation maps, which allow to appreciate the presence of local clusters of high or low EM, may be obtained using an R procedure that we developed.•We focused on estimating excess mortality in small-scale spatial units (municipalities) and in population strata defined by age and sex.•This method gives a deeper insight on excess mortality than summary figures at regional or national level, enabling to identify the local areas that suffered the most and the high-risk population subgroups within them.•This type of analysis could be replicated on different time frames, which might correspond to successive epidemic waves, as well as to periods in which containment measures were enforced and for different age classes; moreover, it could be applied in every instance of mortality crisis within a region or a country.
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http://dx.doi.org/10.1016/j.mex.2021.101257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105045PMC
February 2021

Prenatal sonography of the foramen ovale predicts urgent balloon atrial septostomy in neonates with complete transposition of the great arteries.

Am J Obstet Gynecol MFM 2021 May 6:100379. Epub 2021 May 6.

Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.

Background: Hypoxia caused by inadequate intracardiac mixing due to a restrictive foramen ovale (FO) is a potentially life-threatening complication in neonates with transposition of the great arteries (dTGA). An urgent balloon atrial septostomy (BAS) is a procedure of choice in such cases, but dependent on the availability of a 24-hour interventional cardiology facility. The prenatal identification of predictors for an urgent BAS at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage.

Objective: to predict with prenatal echocardiography the need of urgent BAS in neonates with dTGA.

Study Design: this was a retrospective cohort study of patients with a prenatal diagnosis of TGA that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained less than three weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of FO, septum primum excursion (FO flap angle at the maximal excursion), diameters of the atria, size of the ductus arteriosus. BAS was defined as urgent if performed within 12 hours from birth in neonates with restrictive foramen ovale. Neonatal follow-up was obtained through medical records analysis.

Results: From November 2007 to April 2019, 160 fetuses with complete TGA were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent BAS, 11 elective BAS and 22 no BAS. The size of the FO was the best predictor of a urgent BAS. A measurement > 6.5 mm had a sensitivity of 100% and a false positive rate of 45%.

Conclusion: Fetal echocardiography predicts the need of a urgent BAS in fetuses with dTGA although with a limited precision. In our experience a measurement of the FO within three weeks of delivery had the greatest accuracy.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100379DOI Listing
May 2021

Endometriosis, the hidden enemy: multivariable fractional polynomial approach for evaluation of preoperative risk factors in the absence of ureteral dilation.

Fertil Steril 2021 May 4. Epub 2021 May 4.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Objective: To determine whether it is possible to predict the risk of ureteral endometriosis (UE) using a mathematical model based on preoperative findings.

Design: Prospective observational study conducted between January 2017 and April 2020.

Setting: Tertiary-level academic referral center.

Patient(s): Three hundred consecutive women of reproductive age with a diagnosis of posterior deep infiltrating endometriosis (DIE) scheduled for laparoscopic surgery.

Intervention(s): Before surgery, anamnestic data and the severity of endometriosis-related symptoms were evaluated, and all patients underwent a complete gynecological examination. Transvaginal and transabdominal ultrasound were performed to map the endometriotic lesion. Ureteral involvement was surgically and histologically confirmed.

Main Outcome Measure(s): To select important risk factors for UE and determine a suitable functional form for continuous predictors, we used the multivariable fractional polynomial.

Results: UE was surgically found in 145 women (48.3%). Based on our multivariable polynomial mathematical model, UE was significantly associated with adenomyosis, parametrial involvement, and previous surgery for endometriosis. A posterior DIE nodule with a transverse diameter >1.8 cm was associated with a higher probability of ureteral involvement.

Conclusions: Posterior DIE nodule with a transverse diameter >1.8 cm, adenomyosis, parametrial involvement, and previous surgery for endometriosis appear to be good predictors of UE.
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http://dx.doi.org/10.1016/j.fertnstert.2021.03.027DOI Listing
May 2021

Long-Term Medical Therapy after Laparoscopic Excision of Ovarian Endometriomas: Can We Reduce and Predict the Risk of Recurrence?

Gynecol Obstet Invest 2021 13;86(1-2):170-176. Epub 2021 Apr 13.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Objectives: Up to 32% of women experience anatomic recurrence after conservative surgery for endometriomas, while pain recurs in 10-40% of cases. Long-term postoperative hormonal therapy is recommended to prevent disease recurrence. We evaluated the efficacy of long-term therapy with estroprogestins (EPs) or progestins (Ps) in preventing endometrioma recurrence, as identifiable cysts and subjective symptoms, after laparoscopic excision.

Design: This retrospective cohort study included 375 women submitted to laparoscopic endometrioma excision. Women were followed up at 6 and 12 months and then yearly after surgery. Based on postoperative medical therapy, women were divided into 4 groups: nonusers, cyclic EP users, continuous EP users, and progestogen users. Materials, Setting, Methods: Anamnestic and anthropometric characteristics were collected as well as clinical and surgical data. Gynecological examination, and transvaginal and transabdominal ultrasound scans were performed. Pain (numerical rating score >5) and endometrioma recurrence at ultrasound (ovarian cyst with typical sonographic features ≥10 mm in mean diameter) were recorded at each examination. The reoperation rate in women with recurrence was investigated.

Results: The median follow-up was 3.7 years with a maximum of 16.7 years. Most patients used EPs (119 cyclic and 61 continuous users), 95 used P, and 100 were nonusers. In 135 women (36%), endometriotic cyst recurrence was diagnosed, with a mean diameter of 18.7 ± 10.8 mm (range 10-55 mm). The median recurrent cyst-free time was 7.9 years (95% CI 5.8-10.8). Dysmenorrhea was the first symptom to reappear, affecting 162 patients (43.2%). Upon multivariable regression analysis, continuous users had a lower risk of relapse (OR 0.56, 95% CI 0.32-0.99), in terms of both cysts and symptom recurrence, than patients who received no medications. The reoperation rate was 16.2%.

Limitations: The main limitation of this study is its retrospective design. Also, women switching therapies throughout the follow-up period were sorted into one of the study groups based on the longest treatment taken, without considering the discontinuation rates.

Conclusions: Long-term EPs, administered in a continuous regimen and starting immediately after conservative surgery for endometriomas, seem to reduce the disease recurrence risk.
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http://dx.doi.org/10.1159/000514310DOI Listing
April 2021

Fetal speckle-tracking echocardiography: a comparison between two-dimensional and electronic spatio-temporal image correlation (e-STIC) technique.

J Matern Fetal Neonatal Med 2021 Apr 6:1-7. Epub 2021 Apr 6.

Department of Medical and Surgical Sciences, Obstetric Unit, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.

Background: Speckle tracking technology has been applied to assess ventricular deformation throughout the cardiac cycle. An electronic four dimensional probe that allows rapid acquisition of electronic spatio-temporal image correlation volumes (eSTIC) has been recently introduced.

Objectives: The aim of our study was to investigate whether e-STIC acquisition improves deformation analyses reproducibility.

Study Design: We recruited fetuses between 20 and 40 weeks of gestation. We obtained a 2D video clip and an e-STIC volume of a four-chamber view. We focused on left ventricular global strain (LV-GS) and left ventricular ejection fraction (LV-FE). Intraobserver, interobserver and intermethod agreement were assessed by means of intraclass correlation coefficient (ICC) and illustrated by Bland-Altman plots. Systematic differences between measurements were assessed using a paired t-test.

Results: The mean difference between LV-GS values obtained with e-STIC and 2D analysis was -0.10 (95% CI -2.28, 2.08). No systematic differences were found between the two techniques for LV-GS values (-value = .927). The mean difference between LV-FE values obtained with e-STIC and 2D analysis was 7.55 (95% CI 4.16, 10.95; -value <.001). The inter-rater reliability of LV-GS was moderate-to-substantial for both e-STIC and 2D. The inter-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis. The intra-rater reliability of LV-GS obtained with e-STIC was superior to that obtained with 2D analysis (ICC 0.857; 95% IC 0.761-0.917). The intra-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis (ICC 0.647; IC 0.51-0.783).

Conclusions: e-STIC seems to be a better technique than 2D analysis for intra-rater reliability of LV-GS. 4D acquisition might improve intrinsic limitations of speckle tracking echocardiography.
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http://dx.doi.org/10.1080/14767058.2021.1906855DOI Listing
April 2021

Sylvian fossa sonographic measurements in 18 to 23 weeks fetuses with and without cerebral malformations.

Am J Obstet Gynecol MFM 2021 Mar 21;3(4):100357. Epub 2021 Mar 21.

Obstetric Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital (Drs Montaguti, Rizzo, Livi, and Salsi and Pilu).

Background: Abnormal sulcation of the brain is frequently associated with severe malformations, but the prenatal diagnosis is challenging, especially in early pregnancy.

Objective: Our study aimed to investigate the value of Sylvian fossa sonographic biometry in the diagnosis of cerebral malformation in the second trimester of gestation.

Study Design: We prospectively established the normal values of the Sylvian fossa depth in a cohort of nonconsecutive patients, with singleton pregnancies and normal fetuses between 18+0 and 23+0 weeks' gestation. For each patient, a coronal view of the fetal brain, with a clear visualization of the anterior complex and the Sylvian fissure, was acquired by 1 sonologist, who also measured the depth of the fossa. Reproducibility for each parameter was assessed by a second sonologist using stored images. We also retrospectively acquired the same measurements in second trimester fetuses with central nervous system anomalies.

Results: In 103 fetuses with a normal sonogram, the mean depth of the Sylvian fossa was 3.9±0.8 mm Interobserver reproducibility analysis demonstrated good results. Notably, 11 of 31 fetuses with cerebral malformations had a Sylvian fossa depth of <-2 z-scores, and these were found to have malformations of cortical development, lissencephaly in particular, or microcephaly.

Conclusion: Sonographic measurement of the Sylvian fossa during second trimester is feasible and reproducible. A shallow Sylvian fossa is associated with malformations of cortical development, microcephaly, or both.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100357DOI Listing
March 2021

High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America.

Acta Paediatr 2021 06 26;110(6):1902-1910. Epub 2021 Mar 26.

Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.

Aim: This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID-19 or Multisystem Inflammatory Syndrome (MIS-C).

Methods: Children <18 years-old assessed in five Latin Americas countries with a diagnosis of COVID-19 or MIS-C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed.

Results: A total of 990 children were included: 921 (93%) with COVID-19, 69 (7.0%) with MIS-C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X-rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals.

Conclusion: Our study showed a high rate of antibiotic prescriptions in children with COVID-19, in particular in those with severe disease or MIS-C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children.
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http://dx.doi.org/10.1111/apa.15847DOI Listing
June 2021

and /β-Catenin Molecular Status Affects the Clinicopathologic Features and Prognosis of Endometrial Carcinoma: Implications for an Improved Surrogate Molecular Classification.

Cancers (Basel) 2021 Feb 25;13(5). Epub 2021 Feb 25.

Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.

The collaborative Cancer Genome Atlas (TCGA) project identified four distinct prognostic groups of endometrial carcinoma (EC) based on molecular alterations: (i) the ultramutated subtype that encompasses mutated () cases; (ii) the hypermutated subtype, characterized by MisMatch Repair deficiency (MMRd); (iii) the copy-number high subtype, with p53 abnormal/mutated features (p53abn); (iv) the copy-number low subtype, known as No Specific Molecular Profile (NSMP). Although the prognostic value of TCGA molecular classification, NSMP carcinomas present a wide variability in molecular alterations and biological aggressiveness. This study aims to investigate the impact of and /β-catenin alterations by targeted Next-generation sequencing (NGS) and immunohistochemistry (IHC) in a consecutive series of 125 molecularly classified ECs. NGS and IHC were used to assign surrogate TCGA groups and to identify molecular alterations of multiple target genes including , , , , . Associations with clinicopathologic parameters, molecular subtypes, and outcomes identified NSMP category as the most heterogeneous group in terms of clinicopathologic features and outcome. Integration of surrogate TCGA molecular classification with and β-catenin analysis showed NSMP cases with mutation characterized by the worst outcome with early recurrence, while NSMP tumors with wild-type and β-catenin alteration had indolent clinicopathologic features and no recurrence. This study indicates how the identification of and β-catenin alterations in EC represents a simple and effective way to characterize NSMP tumor aggressiveness and metastatic potential.
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http://dx.doi.org/10.3390/cancers13050950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956405PMC
February 2021

Maternal perception of the risk of vertically transmitted infections: the impact of expert counseling.

Am J Obstet Gynecol MFM 2021 Feb 27;3(4):100341. Epub 2021 Feb 27.

Obstetric Unit, Department of Medical and Surgical Sciences (Drs Cataneo, Livi, and Simonazzi),. Electronic address:

Background: Insufficient and imprecise information during pregnancy can lead to an overestimation of maternal and fetal risk associated to various exposures during gestation.

Objective: This study aimed to assess whether expert obstetrical counseling in cases of maternal infections at risk of vertical transmission could impact maternal perception of risk and the tendency to terminate pregnancy.

Study Design: This is a monocentric prospective observational study of 185 consecutive pregnant women with confirmed diagnosis of infectious diseases at risk of vertical transmission during the first or second trimester of pregnancy. Patients were divided into 2 different groups, according to the type infectious disease: infections at high risk of fetal damages and infections at low risk. Every woman included in the study underwent medical counseling with a physician with experience of vertically transmitted infections. Moreover, each woman involved in the study was offered a detailed second trimester ultrasound scan. Maternal concern for their pregnancy and the disposition to interrupt the pregnancy were investigated by 2 questionnaires submitted to patients before and after medical expert counseling; a third questionnaire was completed only by those women who decided to undergo second trimester ultrasound scan at our hospital.

Results: Of the 185 consecutive patients meeting the inclusion criteria, 171 (92.4%) filled out the visual analog scale for concern about the baby's health both before and after medical consultation. After medical consultation, there was a significant decrease in mean visual analog scale for concern: from 67.1±26.0 to 41.3±28.8 (change score, -25.8; 95% confidence interval, -29.9 to -21.7). Higher baseline levels of concern had more room for reduction, and infections at high fetal risk of damage were associated with lower decrease in concern. However, risk perception decreased in both low-risk and high-risk pregnancies. Notably, 82 patients (53.2%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 28.3±24.4 and significantly lower than the mean score registered after consultation (change score, -16.6; 95% confidence interval, -22.9 to -10.3). A total of 162 women (87.6%) declared their tendency to interrupt pregnancy both before and after the consultation. There was a significant decrease in mean tendency from 42.1±32.6 to 22.7±27.1 (change score, -19.4; 95% confidence interval, -23.6 to -15.2). Regression analysis revealed that both low- and high-risk patients significantly reduced their tendency. A total of 73 patients (45.1%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 9.9±20.6 and significantly lower than the mean score registered after consultation (change score, -13.4; 95% confidence interval, -19.1 to -7.7).

Conclusion: Our results confirm the importance of a comprehensive and sufficient expert medical counseling that, on one hand, can reduce maternal risk perception, improving quality of life for mothers, and, on the other hand, can lead to feasible results, reducing a woman's disposition to termination of pregnancy.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100341DOI Listing
February 2021

Validation of oral brushing as a non-invasive technique for the identification of feline oral squamous cell carcinoma by DNA methylation and TP53 mutation analysis.

Vet Comp Oncol 2021 Feb 23. Epub 2021 Feb 23.

Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Feline oral squamous cell carcinoma (FOSCC) is a frequent and progressively invasive tumour. Early lesions are difficult to recognize based on the sole clinical examination and may be misinterpreted as non-neoplastic. Mutations of TP53 and epigenetic alterations of specific genes are present in FOSCC and may be early detected. Aim of this prospective study was to investigate the DNA methylation pattern of a 17-gene panel and TP53 mutational status of FOSCC cytological samples obtained by oral brushing. Results were compared with a control group, in order to validate this non-invasive procedure for the screening of FOSCC. In FOSCC, the same analyses were carried out on the corresponding histological sample, if available. Thirty-five FOSCC and 60 controls were included. Mutations of TP53 were detected in 17 FOSCC brushings (48%) and in none of the controls (P < .001). Six genes (ZAP70, FLI1, MiR124-1, KIF1A, MAGEC2 and MiR363) were differentially methylated in FOSCC and were included in a methylation score. An algorithm based on TP53 mutational status and methylation score allowed to differentiate FOSCC from controls with a 69% sensitivity and a 97% specificity (accuracy, 86%). In 19 FOSCC histological samples, TP53 mutational status was fully concordant with brushings and a positive methylation score was observed in all cases. These results are promising for the identification of FOSCC by oral brushing, although some factors may limit the accuracy of this technique and further studies are required to assess its reproducibility in clinical practice.
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http://dx.doi.org/10.1111/vco.12688DOI Listing
February 2021

SARS-CoV-2/COVID-19 Testing: The Tower of Babel.

Acta Biomed 2020 11 9;91(4):e2020144. Epub 2020 Nov 9.

Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.

Background And Aim: Testing represents one of the main pillars of public health response to SARS-CoV-2/COVID-19 pandemic. This paper shows how accuracy and utility of testing programs depend not just on the type of tests, but on the context as well.

Methods: We describe the testing methods that have been developed and the possible testing strategies; then, we focus on two possible methods of population-wide testing, i.e., pooled testing and testing with rapid antigen tests. We show the accuracy of split-pooling method and how, in different pre-test probability scenarios, the positive and negative predictive values vary using rapid antigen tests.

Results: Split-pooling, followed by retesting of negative results, shows a higher sensitivity than individual testing and requires fewer tests. In case of low pre-test probability, a negative result with antigen test could allow to rule out the infection, while, in case of a positive result, a confirmatory molecular test would be necessary.

Conclusions: Test performance alone is not enough to properly choose which test to use; goals and context of the testing program are essential. We advocate the use of pooled strategies when planning population-wide screening, and the weekly use of rapid tests for close periodic monitoring in low-prevalence populations.
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http://dx.doi.org/10.23750/abm.v91i4.10911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927496PMC
November 2020

Patterns of COVID-19 related excess mortality in the municipalities of Northern Italy during the first wave of the pandemic.

Health Place 2021 Jan 11;67:102508. Epub 2021 Jan 11.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.

The impact of Coronavirus Disease 2019 (COVID-19) on mortality in Italy has been described at the regional level, while less is known about mortality in municipalities, although the spatial distribution of COVID-19 in its first wave has been uneven. We aimed to describe the excess mortality due to COVID-19 from February 23rd to April 30th, 2020 in the three most affected Italian regions, in age and gender subgroups within each municipality. Excess mortality varied widely among municipalities even within the same region; it was higher among the elderly and higher in males except in the ≥75 age group. Thus, nearby municipalities may show a different mortality burden despite being under common regional health policies, possibly as a result of local reinforcements of regional policies. Identifying the municipalities where mortality was higher and the pathways used by the virus to spread may help to concentrate efforts in understanding the reasons why this happened and to identify the frailest areas in light of recurrences of the epidemic.
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http://dx.doi.org/10.1016/j.healthplace.2021.102508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834600PMC
January 2021

Timing of induction for term prelabor rupture of membranes and intravenous antibiotics.

Am J Obstet Gynecol MFM 2021 01 6;3(1):100245. Epub 2020 Oct 6.

Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.

Background: Induction of labor usually within 24 hours is recommended for term prelabor rupture of membranes. It is still unclear when within the 24 hours induction of labor for term prelabor rupture of membranes should be initiated. Antibiotic prophylaxis for group B Streptococcus is usually recommended for prolonged prelabor rupture of membranes.

Objective: The aim of our study was to evaluate whether induction of labor at ≤6 hours from prelabor rupture of membranes with intravenous oxytocin in singleton pregnancies at ≥37 weeks' gestation without regular uterine contractions reduces the administration of intravenous antibiotic agents.

Study Design: This was a retrospective cohort study including all women with prelabor rupture of membranes at ≥37 weeks' gestation and without regular uterine contractions in which labor was induced using intravenous oxytocin. Women were divided into 2 groups according to the timing of induction (≤6 hours vs >6 hours after prelabor rupture of membranes).

Results: A total of 166 women with term prelabor rupture of membranes were included, 53 of whom (31.9%) were induced within 6 hours of prelabor rupture of membranes and 113 (68.1%) were induced after 6 hours. There were no differences in demographic characteristics and risk factors for term prelabor rupture of membranes between the 2 groups. Women who underwent induction of labor at ≤6 hours were significantly less exposed to intravenous antibiotic prophylaxis compared with women induced at >6 hours (36% vs 80.5%, respectively; odds ratio, 0.14; 95% confidence interval, 0.07-0.28). Furthermore, for women induced within 6 hours after prelabor rupture of membranes, the chances of delivering at <12 or <24 hours were increased, nonreassuring cardiotocogram significantly less common, and hospital stay significantly shorter. No differences were found in regard to neonatal outcomes.

Conclusion: Induction of labor at ≤6 hours with intravenous oxytocin after term prelabor rupture of membranes is significantly associated with lesser use of antibiotic agents, shorter latency to delivery, lower incidence of nonreassuring cardiotocogram, and shorter hospital stay than induction of labor at >6 hours after prelabor rupture of membranes.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100245DOI Listing
January 2021

Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis.

Nutrients 2021 Jan 9;13(1). Epub 2021 Jan 9.

Neonatal Intensive Care Unit, AOU Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants.

Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed.

Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00-0.21). The subgroup analysis showed that Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01-0.49 vs. OR 0.32; 95% CrIs 0.10-0.36).

Conclusions: Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.
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http://dx.doi.org/10.3390/nu13010192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827781PMC
January 2021

Parents' Perception of Food Insecurity and of Its Effects on Their Children in Italy Six Months after the COVID-19 Pandemic Outbreak.

Nutrients 2020 Dec 31;13(1). Epub 2020 Dec 31.

Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, 40138 Bologna, Italy.

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic and subsequent containment measures are causing an increase in food insecurity (FI) worldwide, with direct consequences on children's nutrition. We aimed to investigate the effects of the lockdown imposed in Italy on FI and changes in eating habits and body weight in the pediatric population 6 months after the beginning of the pandemic through a cross-sectional online survey proposed to parents of children <18 and living in Italy. Among 5811 respondents, most of whom were Italian, living in Northern Italy, and with a wealthy household economy, 8.3% reported that their families were at risk of FI before the appearance of SARS-CoV-2 and, alarmingly, this percentage increased to 16.2% after the pandemic began, with households from Southern Italy being more at risk. Moreover, 27.3% of the parents reported that their children were eating more; an increase in "junk food" consumption was also found; 31.8% of the respondents declared an increase in children's weight; weight loss prevailed among adolescents. Since the SARS-CoV-2 pandemic is again requiring restrictions, our findings might serve as a warning to politicians to promote healthy lifestyles and provide assistance to the groups in need.
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http://dx.doi.org/10.3390/nu13010121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824075PMC
December 2020

Sonographic diagnosis of fetal head deflexion and the risk of cesarean delivery.

Am J Obstet Gynecol MFM 2020 11 18;2(4):100217. Epub 2020 Aug 18.

Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.

Background: Malpositions and deflexed cephalic malpresentations are well recognized causes of dysfunctional labor, may result in fetal and maternal complications, and are diagnosed more precisely with an ultrasound examination than with a digital examination.

Objective: This study aimed to assess the incidence of malpositions and deflexed cephalic malpresentations at the beginning of the second stage of labor and to evaluate the role of the sonographic diagnosis of deflexion in the prediction of the mode of delivery.

Study Design: Women in labor with a singleton pregnancy at term with fetuses in a cephalic presentation at 10 cm of cervical dilatation were prospectively examined. A transabdominal ultrasound was performed to assess the fetal head position by demonstrating the fetal occiput or the eyes. Deflexion was assessed by the measurement of the occiput-spine angle when the occiput was anterior or transverse and by qualitative assessment of the relationship between chin and thorax when the occiput was posterior. Transperineal ultrasound was performed in occiput posterior fetuses to discriminate between sinciput, brow, and face presentation. Maternal, labor, and neonatal parameters including maternal age, induction of labor, use of epidural, birthweight, arterial pH, and neonatal intensive care unit admission were recorded. Patients were divided into 2 groups according to the sonographic diagnosis of head deflexion. Adjusted odds ratios were calculated using multivariate logistic regression to determine the association between cesarean delivery and the 2 groups. In addition, labor and neonatal characteristics were compared between occiput anterior and occiput posterior-occiput transverse fetuses.

Results: Of the 200 women at the beginning of the second stage, the fetus was in occiput anterior position in 156 (78%), transverse in 11 (5.5%), and posterior in 33 (16.5%) cases. Deflexion was diagnosed in 33 of 156 (21.2%) occiput anterior fetuses and 19 of 44 (43.2%) occiput posterior and occiput transverse fetuses. Cesarean deliveries were significantly associated with fetal head deflexion both in occiput anterior (P=.001) and occiput posterior (P<.001) fetuses. Sonographic diagnosis of fetal head deflexion was an independent risk factor for cesarean delivery both in occiput anterior (adjusted odds ratio, 5.37; 95% confidence interval, 1.819-15.869) and occiput posterior (adjusted odds ratio, 13.9; 95% confidence interval, 1.958-98.671) cases, and it was an independent risk factor for cesarean delivery regardless of the occiput position (adjusted odds ratio, 5.83; 95% confidence interval, 2.47-13.73).

Conclusion: The sonographic diagnosis of fetal head deflexion at the beginning of the second stage increases the risk of cesarean delivery.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100217DOI Listing
November 2020

Excess Cardiovascular Mortality in Latvia: A Novel Approach Based on Patient-Level Data to Estimate the Separate Contributions of Primary Prevention, Accessibility and Quality of Hospital Care.

Int J Health Policy Manag 2020 Nov 23. Epub 2020 Nov 23.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.

Background: Because quantifying the relative contributions of prevention and medical care to the decline in cardiovascular mortality is controversial, at present mortality indicators use a fifty-fifty allocation to fraction avoidable cardiovascular deaths as being partly preventable and partly amenable. The aim of this study was to develop a dynamic approach to estimate the contributions of preventable versus amenable mortality, and to estimate the proportion of amenable mortality due to non-utilisation of care versus suboptimal quality of care.

Methods: We calculated the contribution of primary prevention, healthcare utilisation and healthcare quality in Latvia by using Emilia-Romagna (ER) (Italy) as the best performer reference standard. In particular, we considered preventable mortality as the number of cardiovascular deaths that could be avoided if Latvia had the same incidence as ER, and then apportioned non-preventable mortality into the two components of non-utilisation versus suboptimal quality of hospital care based on the presence of hospital admissions in the days before death. This calculation was possible thanks to the availability of the unique patient identifier in the administrative databases of Latvia and ER.

Results: 41.5 people per 100 000 population died in Latvia in 2016 from cardiovascular causes amenable to healthcare; about half of these (21.4 per 100 000) had had no contact with acute care settings, while the other half (20.1 per 100 000) had accessed the hospital but received suboptimal-quality healthcare. Another estimated 26.8 deaths per 100 000 population were due to lack of primary prevention. Deaths attributable to suboptimal quality or non-utilisation of hospital care constituted 60.7% of all avoidable cardiovascular mortality.

Conclusion: If research is undertaken to understand the reasons for differences between territories and their possible relevance to lower performing countries, the dynamic assessment of country-specific contributions to avoidable mortality has considerable potential to stimulate cross-national learning and continuous improvement in population health outcomes.
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http://dx.doi.org/10.34172/ijhpm.2020.229DOI Listing
November 2020

The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective.

Front Public Health 2020 12;8:599170. Epub 2020 Nov 12.

Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
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http://dx.doi.org/10.3389/fpubh.2020.599170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689262PMC
May 2021

Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database.

Aging (Albany NY) 2020 Oct 5;12(19):19711-19739. Epub 2020 Oct 5.

Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

The aim of this study was to assess the risk of hospitalization associated with the concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs) among all individuals aged ≥65 residing in Bologna's area, Italy. We used incidence density sampling, and the effect of current (last month) and past (≥30 days before) exposure to DDI was investigated through conditional multivariable logistic regression analysis. Two DDIs were associated with increased hospitalization due to DDI related conditions: ACE-inhibitors/ diuretics plus glucocorticoids (current DDI: OR 2.36, 95% CI 1.94-2.87; past DDI: OR 1.36, 95% CI 1.12-1.65) and antidiabetic therapy plus current use of fluoroquinolones (OR 4.43, 95% CI 1.61-11.2). Non-Steroidal Anti-inflammatory Drugs (NSAIDs) increased the risk of re-bleeding in patients taking Selective Serotonin Reuptake Inhibitors (OR 5.56, 95% CI 1.24-24.9), while no significant effect was found in those without a history of bleeding episodes. Concomitant prescription of NSAIDs and ACE-inhibitors/diuretics in patients with a history of high-risk conditions was infrequent. Within the pattern of drug prescriptions in the older population of Bologna's area, we distinguished DDIs with actual clinical consequences from others that might be considered generally safe. Observed prescribing habits of clinicians reflect awareness of potential interactions in patients at risk.
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http://dx.doi.org/10.18632/aging.104018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732312PMC
October 2020

Pre-Operative Evaluation of DNA Methylation Profile in Oral Squamous Cell Carcinoma Can Predict Tumor Aggressive Potential.

Int J Mol Sci 2020 Sep 14;21(18). Epub 2020 Sep 14.

Section of Oral Science, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40159 Bologna, Italy.

Background: Prognosis of oral squamous cell carcinoma (OSCC) is difficult to exactly assess on pre-operative biopsies. Since OSCC DNA methylation profile has proved to be a useful pre-operative diagnostic tool, the aim of the present study was to evaluate the prognostic impact of DNA methylation profile to discriminate OSCC with high and low aggressive potential.

Methods: 36 OSCC cases underwent neoplastic cells collection by gentle brushing of the lesion, before performing a pre-operative biopsy. The CpG islands methylation status of 13 gene (, , , , , , , , , , , , ) was studied by bisulfite Next Generation Sequencing (NGS). A Cox proportional hazards model via likelihood-based component-wise boosting was used to evaluate the prognostic power of the CpG sites.

Results: The boosting estimation identified five CpGs with prognostic significance: , , , and . The combination of significant provided promising results for adverse events prediction (Brier score = 0.080, C-index = 0.802 and AUC = 0.850). had a strong prognostic power in patients with early OSCC.

Conclusions: These data confirm that the study of methylation profile provides new insights into the molecular mechanisms of OSCC and can allow a better OSCC prognostic stratification even before surgery.
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http://dx.doi.org/10.3390/ijms21186691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555204PMC
September 2020

Comparison of fertility outcomes after laparoscopic myomectomy for barbed versus nonbarbed sutures.

Fertil Steril 2021 01 12;115(1):248-255. Epub 2020 Sep 12.

Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.

Objective: To assess the impact on women's reproductive outcomes of barbed sutures to repair uterine breaches during laparoscopic myomectomy compared with traditional smooth sutures.

Design: Retrospective, monocentric cohort study, with information on subsequent pregnancies prospectively acquired for some women.

Setting: Tertiary-level academic referral center.

Patient(s): Women older than 18 years who had undergone a laparoscopic myomectomy and had sought pregnancy afterward, divided into two groups based on type of suture used to repair the uterine wall: group A (nonbarbed) and group B (barbed).

Intervention(s): Laparoscopic removal of FIGO types 3, 4, 5, and 6 uterine leiomyomas by use of either only barbed sutures or only traditional smooth sutures to reconstruct the uterine defect.

Main Outcome Measure(s): Pregnancy achievement rates, delivery modes, main pregnancy complications, perioperative complications for both kinds of suture, and the trend of the use of barbed sutures over time at our center.

Result(s): Of 164 patients included, 83 were in group A and 81 in group B. Ninety-one patients (55.5%) experienced at least one postoperative pregnancy, with no differences between the groups (group A 60.5%; group B 50.6%). Of the 103 recorded postoperative pregnancies, 70 (68%) resulted in live births, 29 (28.1%) in first-trimester miscarriages, and 4 (3.9%) were ongoing.

Conclusion(s): Barbed sutures have a similar impact on reproductive outcomes as smooth conventional threads, both in terms of pregnancy and obstetric complication rates, after laparoscopic myomectomy.
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http://dx.doi.org/10.1016/j.fertnstert.2020.07.036DOI Listing
January 2021

Transperineal Ultrasound Visual Feedback Assisted Pelvic Floor Muscle Physiotherapy in Women With Deep Infiltrating Endometriosis and Dyspareunia: A Pilot Study.

J Sex Marital Ther 2020 24;46(7):603-611. Epub 2020 Jun 24.

Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.

A prospective study with the aim to evaluate the effects of pelvic floor physiotherapy was conducted among women with deep infiltrating endometriosis (DIE) and associated dyspareunia. At initial evaluation superficial and deep dyspareunia were assessed using a numerical rating scale, and levator hiatus area (LHA) was assessed with 3-D/4-D transperineal ultrasound. Women underwent five individual sessions of ultrasound visual feedback assisted pelvic floor physiotherapy. One month after the therapy, dyspareunia and LHA were reassessed and compared with pre-therapy data. Pelvic floor physiotherapy seems to improve both superficial and deep dyspareunia and pelvic floor muscle relaxation in women with DIE.
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http://dx.doi.org/10.1080/0092623X.2020.1765057DOI Listing
May 2021

Measuring the quality of care in small countries: the empirical analysis of 30-day mortality following acute myocardial infarction and ischaemic stroke in Latvia.

Health Policy 2020 07 27;124(7):695-700. Epub 2020 May 27.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University di Bologna, Bologna, Italy.

The evaluation of quality of care is a complex task that, over the last decades, has been performed using the Donabedian model as its main conceptual framework. Small countries are an ideal setting in which to make innovative, empirical evaluations of the quality of care. In this research, we discussed the challenges and opportunities of assessing hospital performance in Latvia, a small country in the Baltic region of Northern Europe. The study outcomes were 30-day acute myocardial infarction mortality and 30-day ischaemic stroke mortality. We described how indicator specifications, risk-adjustment, data reliability assessment and graphical representations were tailored to the geographic and institutional context of Latvia. By looking at the impact of structural characteristics on hospital performance, we found that cath labs and large caseloads were significantly associated with lower mortality. This approach allows decision-makers at different governance levels to design and implement actions aimed at improving the quality of care. At the health system level, it may help policy-makers adopt proper strategies to tackle poor outcomes; at the hospital level, it may help managers intervene on structural determinants of performance. Because small countries face some relevant issues that have implications for health care, these analyses might be relevant also for larger countries to improve the design of their health-care services.
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http://dx.doi.org/10.1016/j.healthpol.2020.05.017DOI Listing
July 2020

Analysis of DNA methylation and TP53 mutational status for differentiating feline oral squamous cell carcinoma from non-neoplastic mucosa: A preliminary study.

Vet Comp Oncol 2020 Dec 18;18(4):825-837. Epub 2020 Jul 18.

Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Feline oral squamous cell carcinoma (FOSCC) is characterized by high local invasiveness and early bone lysis. The late diagnosis largely limits the efficacy of therapy and increases treatment-related morbidity. The aim of this exploratory study was to assess the methylation pattern of 10 candidate genes and TP53 mutational status in histologic samples of FOSCC. Results were compared with normal oral mucosa and oral inflammatory lesions, in order to establish a gene panel for FOSCC detection. For 10 cats, the above analyses were also performed on oral brushing samples, in order to explore the utility of these methods for screening purposes. Thirty-one FOSCC, 25 chronic inflammatory lesions and 12 controls were included. TP53 mutations were significantly more frequent in the FOSCC (68%) than in the non-neoplastic oral mucosa (3%; P <.001). Based on lasso regression analysis, a step-wise algorithm including TP53, FLI1, MiR124-1, KIF1A and MAGEC2 was proposed. The algorithm allowed to differentiate FOSCC with 94% sensitivity and 100% specificity (accuracy, 97%). When applying the proposed algorithm on 10 brushing samples, accuracy decreased to 80%. These results indicate that the altered DNA methylation of specific genes is present in FOSCC, together with a significant proportion of TP53 mutations. Such alterations are infrequent in normal oral mucosa and chronic stomatitis in cats, suggesting their involvement in feline oral carcinogenesis and their utility as diagnostic biomarkers. Further studies on a high number of brushing samples will be needed to assess the utility of a screening test for the early detection of FOSCC.
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http://dx.doi.org/10.1111/vco.12624DOI Listing
December 2020

Forecasting COVID-19-Associated Hospitalizations under Different Levels of Social Distancing in Lombardy and Emilia-Romagna, Northern Italy: Results from an Extended SEIR Compartmental Model.

J Clin Med 2020 May 15;9(5). Epub 2020 May 15.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.

The outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China, in December 2019. As of 17 April 2020, more than 2 million cases of COVID-19 have been reported worldwide. Northern Italy is one of the world's centers of active coronavirus cases. In this study, we predicted the spread of COVID-19 and its burden on hospital care under different conditions of social distancing in Lombardy and Emilia-Romagna, the two regions of Italy most affected by the epidemic. To do this, we used a Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model, which encompasses compartments relevant to public health interventions such as quarantine. A new compartment L was added to the model for isolated infected population, i.e., individuals tested positives that do not need hospital care. We found that in Lombardy restrictive containment measures should be prolonged at least until early July to avoid a resurgence of hospitalizations; on the other hand, in Emilia-Romagna the number of hospitalized cases could be kept under a reasonable amount with a higher contact rate. Our results suggest that territory-specific forecasts under different scenarios are crucial to enhance or take new containment measures during the epidemic.
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http://dx.doi.org/10.3390/jcm9051492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290384PMC
May 2020

Sociodemographic and health service organizational factors associated with the choice of the private versus public sector for specialty visits: Evidence from a national survey in Italy.

PLoS One 2020 7;15(5):e0232827. Epub 2020 May 7.

Department of Political and Social Sciences, University of Bologna, Bologna, Italy.

Introduction: Although Italy's NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector.

Materials And Methods: Data were retrieved from the national Istat survey "Health conditions and use of health services" carried out in 2012-2013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis.

Results And Discussion: Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%).

Conclusion: The attitude of the population to use private services for specialist visits is linked both to sociodemographic and health services organizational factors: the former are unmodifiable while the latter are susceptible to managerial and health policy actions. In a public-financed, universal coverage system, policy makers may act upon the organizational factors that make private health facilities more attractive in order to reduce private care use.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232827PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205245PMC
August 2020