Publications by authors named "Luigi Cobellis"

73 Publications

Usefulness of atosiban for tocolysis during external cephalic version: Systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2021 Mar 31;258:86-92. Epub 2020 Dec 31.

Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.

Introduction: Breech/transverse presentation is responsible for about 30-50 % of cesarean sections in the world. Cesarean section carries a five-fold greater morbidity than vaginal delivery, deeply impacting on women's health. External Cephalic Version (ECV) is an external manipulation used to convert a non-cephalic to a cephalic presentation. The use of tocolysis might facilitate this procedure; however, it is still controversial which drug should be considered as first choice.

Objective: To assess the effectiveness of tocolysis with atosiban, a competitive oxytocin receptor antagonist, in order to increase the rate of successful ECV.

Study Design: Nine databases (including MEDLINE, CINAHL, LILACS, EMBASE, Scopus, ClinicalTrials.gov, Scielo, PROSPERO, Cochrane at CENTRAL) were searched from the inception to August 2020 using a combination of MeSH terms and keywords regarding "atosiban" and "external cephalic version". We included trials of women with a singleton pregnancy who reached at least 36 weeks of gestation and were scheduled to ECV and tocolysis with atosiban (intervention group) compared to beta-agonists or other drugs (control group). The primary outcome was the incidence of successful ECV. Summary measures were reported as relative risk (RR) with 95 % confidence interval (CI).

Data Collection And Analysis: Four studies (1534 women) were eligible for analysis. ECV success rate was significantly lower in women randomized to atosiban (36.7 % vs 45.3 %; RR 0.78 [95 % CI 0.6 to 0.98]). Cesarean section and vaginal delivery rates did not differ between intervention and control group ((59.8 % vs 52.6 %; RR 1.17 [0.98-1.38] and (38.6 % vs 45.0 %; RR 0.83 [95 % CI 0.69-1.01] respectively). Cephalic (36.9 % vs 44.6 %; RR 0.81 [95 % CI 0.65 to 1.01], or breech/transverse presentation at labor (63.4 % vs 55.1 %; RR 1.18 [95 % CI 0.99-1.40]), APGAR score less than 7 at 5 min (1.6 % vs 2.0 %; RR 1.14 [95 % CI 0.27-4.73], NICU admissions (44.2 % vs 48.1 %; RR 0.92 [95 % CI 0.58-1.46] and Umbilical cord pH were similar in both groups. Drug-related side effects were lower in women randomized to atosiban, compared with control group (16.0 % vs 42.9 %; RR 0.38 [95 % CI 0.31 to 0.47].

Conclusion: The use of atosiban for tocolysis does not improve the rate of successful ECVs when compared to beta-agonists. However, atosiban was associated with a significantly lower incidence of side effects and comparable cesarean section rates.
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http://dx.doi.org/10.1016/j.ejogrb.2020.12.053DOI Listing
March 2021

Is Uterine Myomectomy a Real Contraindication to Vaginal Delivery? Results from a Prospective Study.

J Invest Surg 2020 Oct 26:1-6. Epub 2020 Oct 26.

Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.

Objectives: The main goal of our research was to explore correlations between a history of uterine myomectomy and maternal-fetal outcomes, throughout a comparison between vaginal deliveries in patients with or without a history of uterine myoma excision.

Materials And Methods: A prospective study was carried out at two tertiary care hospitals between January 2019 and January 2020. Women were assigned into two groups according to the history of laparoscopic or laparotomic myomectomy (Group 1) or without myomectomy (Group 2).

Results: 80 women successfully delivered after myomectomy. Pregnancies with previous laparoscopic or laparotomic myomectomy were associated with a minor rate of spontaneous labor onset (RR 1.17; 95% CI 1.04 - 1.31) and with an increased rate of emergency cesarean section (RR 1.22; 95% CI 1.09 - 1.36). Moreover, myomectomy group had a significant number of indications to emergency cesarean section correlated to suspected uterine rupture (RR 1.19; 95% CI 1.02-1.39). There were no uterine ruptures or neonatal deaths recorded. First stage of labor was longer in the myomectomy group (316 vs 204 mins, p = 0.01). No differences in the rates of the prolonged first and second stage of labor, postpartum hemorrhage and vaginal laceration, and no neonatal adverse outcomes were found between groups.

Conclusions: Pregnancies after myomectomy might be associated with an elevated rate of emergency cesarean section only due to a higher percentage of suspected uterine rupture, without a real hazard of adverse obstetric or neonatal outcomes.
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http://dx.doi.org/10.1080/08941939.2020.1836289DOI Listing
October 2020

Non-hormonal Treatments For Menopausal Symptoms and Sleep Disturbances: A Comparison Between Purified Pollen Extracts and Soy Isoflavones.

Curr Pharm Des 2020 ;26(35):4509-4514

Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

Background: Besides hot-flushes, sleep disturbances increase around menopause, impacting on the quality of life. When hormone replacement therapy is contraindicated, it is necessary to provide alternative treatments.

Objectives: This study aimed to observe the effects of an herbal remedy from pollen extracts and soy isoflavones for menopausal complaints, particularly on sleep disorders.

Methods: A six-month prospective observational study was performed in women in natural menopause suffering from menopausal symptoms and sleep disturbances. Three groups were compared: 57 women receiving two tablets/ day containing herbal remedy from pollen extracts (group A), 60 women receiving one tablet/day containing isoflavones 60 mg (group B), 47 women not receiving any treatment (group C). At 3 (T3) and 6 months (T6), the daily number of hot-flushes, Kupperman index for menopausal symptoms, the Pittsburgh Sleep Quality Index (PSQI) test were assessed.

Results: Both groups A and B showed a significant improvement of hot flushes (p<0.001) and Kuppermann Index (p<0.001) from T0 to T3 and from T0 to T6. No significant differences between treatment groups were found at T3, while at T6 group A showed greater decrease of daily hot flashes and better improvement of Kupperman Index as compared to group B (respectively, -48.8% versus -18.4% and -24.4% versus -15.4%; p<0.001). Improvement of global sleep quality was more evident in the pollen treated group compared to isoflavones group at both three (-24.7% versus -9.3%, p<0.001) and six (-52.9% vs -4.0%; p<0.001) months, mainly for the scores related to subjective sleep quality, sleep latency and habitual sleep efficiency.

Conclusion: Non-hormonal treatments can effectively be used in symptomatic menopausal women: among these, after six months of treatment, pollen extracts might achieve a better improvement of hot flushes, sleep disturbances and menopause-related symptoms than soy isoflavones. Herbal remedy from pollen extracts is mainly effective when the quality of sleep is the most disturbing complaint.
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http://dx.doi.org/10.2174/1381612826666200721002022DOI Listing
February 2021

Une masse utérine impressionnante : un cas de lipoléiomyome.

J Obstet Gynaecol Can 2020 Jul 9. Epub 2020 Jul 9.

Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italie; Complex Operative Unit - Obstetrics and Gynecology, Sant'Anna e San Sebastiano Hospital, Caserta, Italie.

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http://dx.doi.org/10.1016/j.jogc.2020.04.009DOI Listing
July 2020

An impressive uterine mass: A case of a lipoleiomyoma.

J Obstet Gynaecol Can 2020 Jul 9. Epub 2020 Jul 9.

Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; Complex Operative Unit - Obstetrics and Gynecology, Sant'Anna e San Sebastiano Hospital, 81100 Caserta, Italy.

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http://dx.doi.org/10.1016/j.jogc.2020.03.019DOI Listing
July 2020

Efficacy of hyoscine butyl-bromide in shortening the active phase of labor: Systematic review and meta-analysis of randomized trials.

Eur J Obstet Gynecol Reprod Biol 2020 Sep 23;252:218-224. Epub 2020 Jun 23.

Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.

Introduction: Prolonged labor increases the risk of maternal and fetal complications. The active management of labor has been proven effective in lowering neonatal and maternal morbidity by shortening the duration of labor. Several pharmaceutical and non-pharmaceutical approaches are currently being used in the active management of labor. Hyoscine Butyl-bromide (HBB) is an antispasmodic and anticholinergic drug that acts as a cervical spasmolytic agent. It has been widely used in everyday practice for shortening the active phase of labor. Nonetheless, only a few trials have been conducted on the topic.

Objective: This review aimed to evaluate whether HBB is effective in decreasing the mean duration of the active phase of labor.

Study Design: An electronic search was conducted on Medline (through PubMed), Scopus, ClinicalTrials.gov, EMBASE, PROSPERO, and Cochrane Library from the beginning of all databases to December 2019. Results were limited to randomized trials. Restriction for English language was applied. Inclusion criteria were: randomized clinical trials regarding primiparae or multiparae women with a singleton vertex pregnancy at term who were randomized to HBB versus placebo or other drugs. Primary outcome evaluated was the mean reduction of the active phase of labor.

Data Collection And Analysis: Eight randomized clinical trials, including 1159 pregnant women, were analyzed. Significant heterogeneity (I = 99 %) between studies was noted for the primary outcome. The active phase of labor duration was significantly reduced in the treatment arm compared to controls [mean difference (MD) -83.93 min (95 % confidence interval (CI) -163.61, -4.25)]. Achieved reduction in primiparae women was -55.09 min [95 % CI -68.83, -41.35; I = 37 %].

Conclusion: HBB is an effective treatment to shorten the duration of the active phase of labor in primiparae and multiparae women.
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http://dx.doi.org/10.1016/j.ejogrb.2020.06.042DOI Listing
September 2020

Impact of Hysteroscopic Metroplasty on Reproductive Outcomes of Women with a Dysmorphic Uterus and Recurrent Miscarriages: A Systematic Review and Meta-Analysis.

J Gynecol Obstet Hum Reprod 2020 Sep 21;49(7):101763. Epub 2020 Apr 21.

Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.

The aim of this systematic literature review and meta-analysis is to assess the impact of hysteroscopic metroplasty for dysmorphic uteri on reproductive outcomes in women with recurrent miscarriages. Available studies were identified through a PubMed, Scopus, and Cochrane search until June 2019. Live-birth rate, clinical pregnancy and miscarriage rate after hysteroscopic metroplasty was evaluated. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2-statistics. Six out of 164 published studies met the inclusion criteria. All (n = 221) women underwent metroplasty, using 5Fr-hysteroscope with bipolar electrodes or 26Fr/28Fr-resectoscope in outpatient or inpatient settings. After 6 to 60-month follow-up, reported live-birth rate was 50% (0.37-0.63 95% CI) from a clinical pregnancy rate of 73% (0.51-0.91 95% CI) and miscarriage rate was 23% (0.15-0.30 95% CI). Hysteroscopic metroplasty for dysmorphic uteri led half of the women who experienced recurrent miscarriages at least one live birth and is correlated to few surgical and obstetric complications. However, randomized clinical trials and case-control studies are unavailable due to ethical constrains; inhomogenity of follow-up durations and standardized protocols regarding preoperative diagnosis and post-surgical management resrict our conclusions.
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http://dx.doi.org/10.1016/j.jogoh.2020.101763DOI Listing
September 2020

Ion Channels in The Pathogenesis of Endometriosis: A Cutting-Edge Point of View.

Int J Mol Sci 2020 Feb 7;21(3). Epub 2020 Feb 7.

Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.

Background: Ion channels play a crucial role in many physiological processes. Several subtypes are expressed in the endometrium. Endometriosis is strictly correlated to estrogens and it is evident that expression and functionality of different ion channels are estrogen-dependent, fluctuating between the menstrual phases. However, their relationship with endometriosis is still unclear.

Objective: To summarize the available literature data about the role of ion channels in the etiopathogenesis of endometriosis.

Methods: A search on PubMed and Medline databases was performed from inception to November 2019.

Results: Cystic fibrosis transmembrane conductance regulator (CFTR), transient receptor potentials (TRPs), aquaporins (AQPs), and chloride channel (ClC)-3 expression and activity were analyzed. CFTR expression changed during the menstrual phases and was enhanced in endometriosis samples; its overexpression promoted endometrial cell proliferation, migration, and invasion throughout nuclear factor kappa-light-chain-enhancer of activated B cells-urokinase plasminogen activator receptor (NFκB-uPAR) signaling pathway. No connection between TRPs and the pathogenesis of endometriosis was found. AQP5 activity was estrogen-increased and, through phosphatidylinositol-3-kinase and protein kinase B (PI3K/AKT), helped in vivo implantation of ectopic endometrium. In vitro, AQP9 participated in extracellular signal-regulated kinases/p38 mitogen-activated protein kinase (ERK/p38 MAPK) pathway and helped migration and invasion stimulating matrix metalloproteinase (MMP)2 and MMP9. ClC-3 was also overexpressed in ectopic endometrium and upregulated MMP9.

Conclusion: Available evidence suggests a pivotal role of CFTR, AQPs, and ClC-3 in endometriosis etiopathogenesis. However, data obtained are not sufficient to establish a direct role of ion channels in the etiology of the disease. Further studies are needed to clarify this relationship.
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http://dx.doi.org/10.3390/ijms21031114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037987PMC
February 2020

NPs-TiO and Lincomycin Coexposure Induces DNA Damage in Cultured Human Amniotic Cells.

Nanomaterials (Basel) 2019 Oct 23;9(11). Epub 2019 Oct 23.

Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy.

Titanium dioxide nanoparticles (NPs-TiO or TiO-NPs) have been employed in many commercial products such as medicines, foods and cosmetics. TiO-NPs are able to carry antibiotics to target cells enhancing the antimicrobial efficiency; so that these nanoparticles are generally used in antibiotic capsules, like lincomycin, added as a dye. Lincomycin is usually used to treat pregnancy bacterial vaginosis and its combination with TiO-NPs arises questions on the potential effects on fetus health. This study investigated the potential impact of TiO-NPs and lincomycin co-exposure on human amniocytes . Cytotoxicity was evaluated with trypan blue vitality test, while genotoxic damage was performed by Comet Test, Diffusion Assay and RAPD-PCR for 48 and 72 exposure hours. Lincomycin exposure produced no genotoxic effects on amniotic cells, instead, the TiO-NPs exposure induced genotoxicity. TiO-NPs and lincomycin co-exposure caused significant increase of DNA fragmentation, apoptosis and DNA damage in amniocytes starting from 48 exposure hours. These results contribute to monitor the use of TiO-NPs combined with drugs in medical application. The potential impact of antibiotics with TiO-NPs during pregnancy could be associated with adverse effects on embryo DNA. The use of nanomaterials in drugs formulation should be strictly controlled in order to minimize risks.
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http://dx.doi.org/10.3390/nano9111511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915627PMC
October 2019

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination.

Diagnostics (Basel) 2019 Oct 7;9(4). Epub 2019 Oct 7.

Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.

The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.
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http://dx.doi.org/10.3390/diagnostics9040142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963519PMC
October 2019

Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery.

Surg Obes Relat Dis 2018 07 21;14(7):1013-1019. Epub 2018 Mar 21.

Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli," Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy.

Background: Previous studies have demonstrated significant advantages from a preoperative dietetic regimen for candidates to bariatric procedure.

Objectives: Evaluation of safety, efficacy, and acceptability of a very low-calorie ketogenic diet in patients before bariatric surgery.

Setting: University Hospital.

Methods: A standardized 30-day sequential preoperative diet regimen has been analyzed, optimizing metabolic response with gradual carbohydrate reintroduction. Patients were given a dedicated KetoStationkit, for use during the first 10 days of the scheme, followed by a hypocaloric scheme for 20 days. The study group underwent routine laboratory tests and anthropometric measurements (percent weight loss, body mass index, waist circumference) at enrollment (T0), after 10 days (T1), and after 30 days (T2). Ketone body levels were measured in the plasma and urine.

Results: Between January 2015 and September 2015, 119 patients were included in the study. Mean body mass index was 41.5 ± 7.6 kg/m. Weight, body mass index, and waist circumference at T0 and T1, T0 and T2, and T1 and T2 decreased significantly (P<.05). A bioelectrical impedance assay determined a significant reduction in visceral fat at T1 and T2. We observed a significant (P<.05) improvement in several clinical parameters, including glycemic and lipid profile parameters. We also observed a mean 30% reduction in liver volume. The majority of patients declared satisfied or very satisfied. The adverse effects were mild, of short duration, and not clinically relevant.

Conclusion: Our results confirm the acceptability, safety, and significant advantage of a very low-calorie ketogenic diet for reducing weight and liver volume of patients in preparation for bariatric surgery.
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http://dx.doi.org/10.1016/j.soard.2018.03.018DOI Listing
July 2018

Different Cell Cycle Modulation in SKOV-3 Ovarian Cancer Cell Line by Anti-HIV Drugs.

Oncol Res 2017 Nov 26;25(9):1617-1624. Epub 2017 Mar 26.

Antiretroviral drugs used for the treatment of human immunodeficiency virus (HIV) have proven to be effective even against cancer. Drawing from this background, the aim of our research project was to evaluate the effects of anti-HIV drugs that belong to the nucleoside and nucleotide reverse transcriptase inhibitor [NRTI; abacavir (ABC) and tenofovir (TDF)], nonnucleoside reverse transcriptase inhibitor [NNRTI; efavirenz (EFV) and etravirine (ETR)], and protease inhibitor [PI; darunavir (DRV)] categories on ovarian adenocarcinoma cell line SKOV-3. Using FACS analysis, we observed that treatment with NRTIs and NNRTIs showed a block in the G0/G1 phase. In particular, ETR displayed a relevant block in the progression of the G0/G1 phase of the cell cycle compared with the other examined drugs, and it also induced differentiation of SKOV-3 cells. In contrast, FACS analysis demonstrated that ABC and the PI inhibitor DRV showed no effect on the proliferation of cancer cells. DAPI (4',6-diamidino-2-phenylindole) staining demonstrated that cells treated with NNRTIs (EFV and ETR) presented more DNA damage compared with other treatments. Immunoblotting analysis demonstrated that TDF, EFV, and ETR were able to obtain a reduction in the expression of cyclin D1 and Rb hypophosphorylation, and an increase in p21 concentration. Finally, we observed that ETR also induced differentiation, as demonstrated by Western blot, with high levels of E-cadherin expression. Therefore, our study provides additional evidence supporting the in vitro cytotoxic effects of ETR and EFV. Furthermore, it promotes the hypothesis for their potential use as therapeutic agents in ovarian cancer.
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http://dx.doi.org/10.3727/096504017X14905635363102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841068PMC
November 2017

Comparative study on the occurrence of polycyclic aromatic hydrocarbons in breast milk and infant formula and risk assessment.

Chemosphere 2017 May 20;175:383-390. Epub 2017 Feb 20.

Department of Veterinary Medicine and Animal Production, University of Naples, Italy. Electronic address:

The study compared the polycyclic aromatic hydrocarbons (PAH) profile of human milk collected from Italian mothers and different brands of infant formula available on Italian market. Levels of 14 PAHs most frequently occurred in food, PAH markers listed by Commission Regulation (EC) No. 1881/2006, and carcinogenic PAHs classified by the International Agency for Research on Cancer, were determined by high-pressure liquid chromatography with fluorescence detector. The average concentrations of total PAHs were 114.93 in breast milk and 53.68 μg kg in infant formula. Furthermore, Benzo(a)pyrene (BaP) and the sum of ∑PAH4 markers (BaP, Chrysene, Benzo(a,h)anthracene and Benzo(b)fluoranthene) were higher than the permissible limit of 1 μg kg in 43% and 86% for breast milk and in 10% and 76% for infant formula samples, respectively. Breast milk showed higher levels (P < 0.05) of carcinogenic, and possible carcinogenic hydrocarbons than infant formula samples. Both in human and commercial milk, data showed the occurrence of low and high molecular weight PAHs, respectively from petrogenic and pyrolytic environmental sources, characterizing the infant and mother exposure. Particularly, waste incineration could have represented an important exposure source for infants during breastfeeding, through exposition of mothers resident in some areas of Southern Italy. High PAH levels detected in infant formula enriched with LC-PUFA might be related to the contamination of the vegetable oils added as ingredients. Results showed a high percentage of samples of both breast milk and infant formulas with margin of exposure (MOE) value indicating a potential concern for consumer health.
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http://dx.doi.org/10.1016/j.chemosphere.2017.02.084DOI Listing
May 2017

Outcomes of monopolar versus bipolar endometrial ablation on uterine bleeding and psychophysical wellbeing.

Minerva Ginecol 2017 Aug 15;69(4):328-335. Epub 2016 Nov 15.

Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.

Background: To compare outcomes of endometrial ablation with monopolar versus bipolar resection on uterine bleeding and psychophysical wellbeing.

Methods: In a prospective randomized study, 100 perimenopausal patients, without desire of pregnancy and with no response to pharmacological treatment, underwent endometrial ablation from 2012 to 2014. They were randomly divided in two groups: 50 patients treated with monopolar electrode resection loop (group A) and 50 patients treated with bipolar electrode resection loop (group B). Operative parameters were immediately assessed. Menstrual outcome parameters and psycho-physical well-being parameters were evaluated after 12 months.

Results: No significant difference in operating time was recorded between the two groups. No serious hysteroscopic complication occurred with a similar immediate cumulative complication rate but two cases of intravasation were recorded in group A. The late cumulative complication rate was higher in group A than group B (44% vs. 24%). Cycle was overall controlled in over the 80% of the cases in the two groups without significant difference. The analysis of Short Form-36 showed an improvement of all assessed items after the endometrial ablation without significant difference.

Conclusions: Hysteroscopic endometrial ablation performed with bipolar loop electrode is as effective as resectoscopy with unipolar loop electrode regarding menstrual and psychophysical wellbeing outcomes. Endometrial ablation with bipolar electrode loop is safer but more expansive than monopolar electrode loop.
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http://dx.doi.org/10.23736/S0026-4784.16.03990-3DOI Listing
August 2017

Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis.

ESMO Open 2016 7;1(2):e000038. Epub 2016 Mar 7.

Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.

Objective: To assess the correlation between presurgery neutrophil to lymphocyte ratio (NLR) and distant metastasis-free survival (DMFS) in patients with early breast cancer.

Design: Retrospective analysis.

Participants: 300 Caucasian patients with early (T1-2, N0-1, non-metastatic) breast cancer who were followed from July 1999 to June 2015 at our Institution.

Main Outcome Measures: Distant metastasis-free survival (DMFS).

Results: Of whole populations (300 patients), 134 and 166 patients were grouped as low and high NLR, respectively, on the basis of NLR value of 1.97, as established by receiver operating characteristic (ROC) curve analysis (area under curve (AUC)=0.625, p=0.0160). The DMFS rates for 1, 3, 6, 9, 12 and 15 years were better in low NLR patients (100%, 98.9%, 91.7%, 82.7%, 82.7%, 82.7%, respectively), than in high NLR patients (99.4%, 94.3%, 84.5%, 69.2%, 66.0%, 51.4%, respectively), with a statistically significant association. On multivariate analysis, premenopausal status (HR=2.78, 95% CI 1.36 to 5.67, p=0.0049), N1 stage (HR=2.31, 95% CI 1.16 to 4.60, p=0.0167) and a high NLR value (HR=2.64, 95% CI 1.22 to 5.638, p=0.0133) were shown to be independent prognostic factors related to poor recurrence rate. To avoid risk of confounding bias, a propensity score-matched analysis was performed and multivariate analysis according to the Cox model confirmed premenopausal status (HR=2.94, 95% CI 1.25 to 6.93, p=0.0136), N1 stage (HR=2.77, 95% CI 1.25 to 6.12, p=0.0117) and high NLR values (HR=2.52, 95% CI 1.11 to 5.73, p=0.0271), as independent prognostic variables of worse outcome.

Conclusions: This is the first study, to our knowledge, to show a significant correlation between high NLR and worse prognosis in Caucasian patients with early breast cancer by means of propensity score-matched analysis. Further well designed prospective trials with a large sample size are needed to verify our findings and to justify introducing NLR assessment in clinical practice for prediction of cancer recurrence.
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http://dx.doi.org/10.1136/esmoopen-2016-000038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070254PMC
March 2016

Thalassemia and infertility.

Hum Fertil (Camb) 2016 Jun 23;19(2):90-6. Epub 2016 Jun 23.

a Department of the Woman, the Child, and General and Specialized Surgery , Second University of Naples , Naples , Italy.

Beta-thalassemia (BTM) major is the most common haemoglobin disorder in the world, with high prevalence in people of Mediterranean, Arab or Asian origin. It has been estimated that about 1.5% of the global population (80-90 million people) are carriers of BTM. In patients with BTM, long-term transfusion therapy for the correction of anaemia leads to toxic iron overload, resulting in significant morbidity including liver damage, cardiac complications and endocrine dysfunction. The commonest abnormality is hypogonadotropic hypogonadism, which presents with primary amenorrhoea, delayed puberty or secondary amenorrhoea with consequent infertility. Nevertheless, current improvements in the management of thalassemia disorders offer patients the possibility of having a regularly functioning reproductive system and increased chances of achieving a pregnancy. The aim of the present review is to analyse all aspects of fertility management in BTM women, by examining the main causes of infertility, in order to give practical tools to ensure a complete diagnostic work-up and discuss intervention options to guarantee maximum reproductive health.
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http://dx.doi.org/10.1080/14647273.2016.1190869DOI Listing
June 2016

Triclosan and bisphenol a affect decidualization of human endometrial stromal cells.

Mol Cell Endocrinol 2016 Feb 19;422:74-83. Epub 2015 Nov 19.

National Laboratory on Endocrine Disruptors of Interuniversity Consortium INBB, Italy; Institute of Biosciences and Bioresources (IBBR), National Research Council (CNR), Naples, Italy.

In recent years, impaired fertility and endometrium related diseases are increased. Many evidences suggest that environmental pollution might be considered a risk factor for endometrial physiopathology. Among environmental pollutants, endocrine disrupting chemicals (EDCs) act on endocrine system, causing hormonal imbalance which, in turn, leads to female and male reproductive dysfunctions. In this work, we studied the effects of triclosan (TCL) and bisphenol A (BPA), two widespread EDCs, on human endometrial stromal cells (ESCs), derived from endometrial biopsies from woman not affected by endometriosis. Cell proliferation, cell cycle, migration and decidualization mechanisms were investigated. Treatments have been performed with both the EDCs separately or in presence and in absence of progesterone used as decidualization stimulus. Both TCL and BPA did not affect cell proliferation, but they arrested ESCs at G2/M phase of cell cycle enhancing cell migration. TCL and BPA also increased gene expression and protein levels of some decidualization markers, such as insulin growth factor binding protein 1 (IGFBP1) and prolactin (PRL), amplifying the effect of progesterone alone. All together, our data strongly suggest that TCL and BPA might alter human endometrium physiology so affecting fertility and pregnancy outcome.
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http://dx.doi.org/10.1016/j.mce.2015.11.017DOI Listing
February 2016

Small leucine rich proteoglycans are differently distributed in normal and pathological endometrium.

In Vivo 2015 Mar-Apr;29(2):217-22

Department of Gynaecology, Obstetric and Reproductive Science, Second University of Studies of Naples, Naples, Italy.

Background: During the woman's fertile period, the non-pregnant uterus is subject to constant cyclic changes. The complex mechanisms that control the balance among proliferation, differentiation, cell death and the structural remodeling of the extracellular matrix can contribute to the benign or malignant endometrial pathological state. The small leucine-rich proteoglycans (SLRPs) are important components of cell surface and extracellular matrices.

Materials And Methods: Using immunohistochemistry, we showed that the distribution patterns of SLRPs were completely modified in the pathological compared to normal endometrium.

Results: The expression of SLRPs was low/absent in all endometrial pathologies examined compared to normal endometrium. We observed an increase of lumican from proliferative to secretory phase of the endometrium and a decrease of fibromodulin, biglycan and decorin. In menopause endometrial tissue, the level of expression of fibromodulin, biglycan, decorin and lumican dramatically decreased.

Conclusion: The results revealed the prominence and importance of proteoglycans in the tissue architecture and extracellular matrix organization.
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December 2015

Exposure to di-2-ethylhexyl phthalate, di-n-butyl phthalate and bisphenol A through infant formulas.

J Agric Food Chem 2015 Apr 23;63(12):3303-10. Epub 2015 Mar 23.

§Department of the Woman, the Child, and General and Specialized Surgery, Second University of NaplesVia Costantinopoli, 104 80138 Naples, Italy.

Phthalates and bisphenol A (BPA) are ubiquitous contaminants identified as endocrine disruptors. Phthalates are worldwide used as plasticizers, in particular to improve the mechanical properties of polymers such as polyvinyl chloride. Because they are not chemically bound to the polymer, they tend to leach out with time and use. Di-2-ethylhexyl phthalate (DEHP) and di-n-butyl phthalate (DnBP) are the two most common phthalates. BPA is an estrogenic compound used to manufacture polycarbonate containers for food and drink, including baby bottles. It can migrate from container into foods, especially at elevated temperatures. Diet is a predominant source of exposure for phthalates and BPA, especially for infants. The aim of this study was to test the presence of DEHP, DnBP, and BPA in infant formulas. DEHP, DnBP, and BPA concentrations were measured in 22 liquid and 28 powder milks by gas chromatography with flame ionization detection and high performance liquid chromatography with fluorimetric detection, respectively. DEHP concentrations in our samples were between 0.005 and 5.088 μg/g (median 0.906 μg/g), DnBP concentrations were between 0.008 and 1.297 μg/g (median 0.053 μg/g), and BPA concentrations were between 0.003 and 0.375 μg/g (median 0.015 μg/g). Concentrations of the investigated contaminants in liquid and powder milks were not significantly different, even though samples were packed in different types of containers. These data point out potential hazards for infants fed with baby formulas. Contamination seems more related to the production of formulas than to a release from containers.
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http://dx.doi.org/10.1021/jf505563kDOI Listing
April 2015

Is it possible to predict office hysteroscopy failure?

Eur J Obstet Gynecol Reprod Biol 2014 Oct 16;181:328-33. Epub 2014 Aug 16.

Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.

Objective: The purpose of this study was to develop a clinical tool, the HFI (Hysteroscopy Failure Index), which gives criteria to predict hysteroscopic examination failure.

Study Design: This was a retrospective diagnostic test study, aimed to validate the HFI, set at the Department of Gynaecology, Obstetric and Reproductive Science of the Second University of Naples, Italy. The HFI was applied to our database of 995 consecutive women, who underwent office based to assess abnormal uterine bleeding (AUB), infertility, cervical polyps, and abnormal sonographic patterns (postmenopausal endometrial thickness of more than 5mm, endometrial hyperechogenic spots, irregular endometrial line, suspect of uterine septa). Demographic characteristics, previous surgery, recurrent infections, sonographic data, Estro-Progestins, IUD and menopausal status were collected. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to identify patients who were correctly identified (true positives) divided by the total number of failed hysteroscopies (true positives+false negatives). Positive and Negative Likelihood Ratios with 95%CI were calculated.

Results: The HFI score is able to predict office hysteroscopy failure in 76% of cases. Moreover, the Positive likelihood ratio was 11.37 (95% CI: 8.49-15.21), and the Negative likelihood ratio was 0.33 (95% CI: 0.27-0.41).

Conclusion: Hysteroscopy failure index was able to retrospectively predict office hysteroscopy failure.
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http://dx.doi.org/10.1016/j.ejogrb.2014.08.007DOI Listing
October 2014

What if axillary lymph node dissection became less fashionable?

Cancer 2014 Aug 20;120(16):2535. Epub 2014 May 20.

Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.

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http://dx.doi.org/10.1002/cncr.28772DOI Listing
August 2014

Biomechanical features of bidirectional-barbed suture: a randomized laboratory analysis.

Surg Technol Int 2014 Mar;24:45-8

Department of the Woman, the Child, and General and Specialized Surgery Second University of Naples Naples, Italy.

The aim of the current prospective study was to evaluate the biomechanical stability of barbed suture vs. conventional suture. Biomechanical stability of a 14x14-cm PDO/polydioxanone, with a half circle and 36-mm needle, bidirectional barbed 0-Quill suture (Angiotech, Vancouver, British Columbia, Canada) vs. 1-Poliglecaprone 25 (Monocryl, Ethicon, Inc, Somerville, NJ) suture was evaluated on biological specimens. The 1-Monocryl suture was chosen because it is widely used by gynecological surgeons in the repair either of the vaginal cuff or the uterine wall defects. Forty specimens of aponeurotic muscle, obtained from abdominal wall of a lamb, were prepared, and randomly assigned to 1 of 2 repair groups: Group A (n = 20) classic repair with 1-Monocryl suture; Group B (n = 20) 0-Quill barbed suture. Each specimen was transected at the midpoint and then repaired. Biomechanical stability of the repaired specimen was verified on a CMT6000 electromechanical universal testing machine (SANS, MTS SYSTEMS, China Co., Ltd., Shenzhen, China), with a 1kN cell. Biomechanical tests showed that maximum force was similar for 1-Monocryl and 0-Quill respectively (p = non-significant). This randomized laboratory study shows that biomechanical stability of the sutures is comparable.
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March 2014

Modulation of wolframin expression in human placenta during pregnancy: comparison among physiological and pathological states.

Biomed Res Int 2014 23;2014:985478. Epub 2014 Jan 23.

Department of Biology, Section of Evolutionary and Comparative Biology, University of Naples "Federico II", Via Mezzocannone 8, 80134 Naples, Italy ; National Institute of Biostructures and Biosystems (INBB), Viale medaglie d'Oro 305, 00136 Rome, Italy.

The WFS1 gene, encoding a transmembrane glycoprotein of the endoplasmic reticulum called wolframin, is mutated in Wolfram syndrome, an autosomal recessive disorder defined by the association of diabetes mellitus, optic atrophy, and further organ abnormalities. Disruption of the WFS1 gene in mice causes progressive β-cell loss in the pancreas and impaired stimulus-secretion coupling in insulin secretion. However, little is known about the physiological functions of this protein. We investigated the immunohistochemical expression of wolframin in human placenta throughout pregnancy in normal women and diabetic pregnant women. In normal placenta, there was a modulation of wolframin throughout pregnancy with a strong level of expression during the first trimester and a moderate level in the third trimester of gestation. In diabetic women, wolframin expression was strongly reduced in the third trimester of gestation. The pattern of expression of wolframin in normal placenta suggests that this protein may be required to sustain normal rates of cytotrophoblast cell proliferation during the first trimester of gestation. The decrease in wolframin expression in diabetic placenta suggests that this protein may participate in maintaining the physiologic glucose homeostasis in this organ.
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http://dx.doi.org/10.1155/2014/985478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920918PMC
October 2014

Bidirectional barbed suture in laparoscopic myomectomy: clinical features.

J Laparoendosc Adv Surg Tech A 2013 Dec;23(12):1006-10

1 Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples , Naples, Italy .

Objective: To compare bidirectional knotless barbed suture versus standard sutures, with either extracorporeal or intracorporeal knots, and to assess the feasibility, safety, and rapidity in repairing a uterine wall defect after laparoscopic myomectomy.

Subjects And Methods: This was a randomized clinical study having a Canadian Task Force Classification of I. In tertiary-care university-based teaching hospitals, 117 women who underwent laparoscopic myomectomy were enrolled. In accord with randomization, uterine wall defects were closed with either extracorporeal (poliglecaprone 25; Monocryl™-1; Ethicon Inc., Somerville, NJ) or intracorporeal (polyglactin 910; Vicryl™-1; Ethicon Inc.) knots or a bidirectional knotless barbed suture (Quill™-0; Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada).

Results: Time required to suture was significantly lower in the group operated on with a bidirectional suture than in groups with traditional sutures (P<.001). No significant difference was observed in operative time among the study groups. The degree of surgical difficulty was significantly lower in the Quill group than in the other groups.

Conclusions: Use of barbed sutures reduces the time required to repair a uterine wall defect during laparoscopic myomectomy. In a follow-up of patients carried out at 3 months, 6 months, and 1 year after the surgery, there were no wound dehiscence, no bleeding, and no other potential major complications.
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http://dx.doi.org/10.1089/lap.2013.0103DOI Listing
December 2013

Minilaparoscopic myomectomy: a mini-invasive technical variant.

J Laparoendosc Adv Surg Tech A 2013 Oct 31;23(10):871-5. Epub 2013 Aug 31.

1 Operative Unit of Obstetrics and Gynaecology, Highly Specialized National Hospital "San Giuseppe Moscati," Avellino, Italy .

Objective: We propose a mini-invasive technical variant for laparoscopic myomectomy, which is currently less invasive and more feasible.

Study Design: This was a prospective, controlled, randomized trial, involving 170 patients, who underwent laparoscopic myomectomy. Patients were randomized into two groups: Group A (n=98) underwent standard laparoscopic myomectomy, and Group B (n=72) underwent the mini-invasive technique. The current mini-invasive variant is performed with a 10-mm umbilical trocar and only two 5-mm ancillary trocars. Morcellation is transumbilical: a 0° 5-mm optical system is used and is inserted either in the left or in the right iliac trocar according to the surgeon's preference.

Results: The degree of surgical difficulty, evaluated using a visual analog scale (VAS), was similar in the two groups (P=nonsignificant). Postoperative pain measured on a VAS scale showed there was less pain experienced in patients in Group B than in Group A (P<.01). Esthetic results measured on a VAS scale showed a higher compliance for patients in Group B than Group A (P<.01).

Conclusions: The mini-invasive laparoscopic myomectomy described is, in our opinion, currently less invasive and more feasible than techniques usually used. Finally, this technique is a valid approach for the surgeon, and it gives women very acceptable aesthetic results.
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http://dx.doi.org/10.1089/lap.2013.0037DOI Listing
October 2013

Localization and modulation of NEDD8 protein in the human placenta.

In Vivo 2013 Jul-Aug;27(4):501-6

Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Via L. Armanni 5, 80138 Naples, Italy.

Background: Neural precursor cell-expressed, developmentally down-regulated-8 (NEDD8) is a 76-amino-acid ubiquitin-like polypeptide. NEDD8 affects the signaling of various molecules but the major cellular target proteins are cullins. The neddylation process is correlated closely with apoptosis, cell-cycle regulation, embryogenesis and development.

Aim: The purpose of the present work was to investigate NEDD8 distribution and expression in the human placenta during gestation.

Materials And Methods: A total of 30 samples, 15 chorionic villous samples from first trimester and 15 from full-term placentae, were used for the immunohistochemical analysis of NEDD8 expression. The gestation period ranged from 5 to 40 weeks.

Results: NEDD8 was highly expressed in the cytotrophoblast of the first trimester of gestation, whereas in the third trimester, it was localized in the endothelial cells and stroma of placental villi.

Conclusion: Our results suggest that NEDD8 may play an important role in the control of proliferation and differentiation of human placenta throughout pregnancy.
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January 2014

Bidirectional barbed suture in total laparoscopic hysterectomy and lymph node dissection for endometrial cancer: technical evaluation and 1-year follow-up of 61 patients.

J Laparoendosc Adv Surg Tech A 2013 Apr;23(4):347-50

Department of Gynaecology, Obstetrics, and Reproductive Science, Second University of Naples, Naples, Italy.

Objective: This randomized clinical study compared the feasibility and safety of the shortest suture for bidirectional knotless barbed versus standard sutures, with either extracorporeal or intracorporeal knots, for vaginal cuff closure following total laparoscopic hysterectomy (TLH) and lymph node dissection for early endometrial cancer.

Subjects And Methods: The study design was Canadian Task Force Classification I. In tertiary-care university-based teaching hospitals, 61 women underwent TLH and lymph node dissection. In accord with randomization, the vaginal cuff in TLH was closed with either extracorporeal or intracorporeal knots (1-Monocryl(®); Ethicon Inc., Somerville, NJ) and a bidirectional knotless barbed suture (0-Quill™; Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada). All patients were evaluated at 3-month, 6-month, and 1-year follow-up.

Results: Time required to suture was significantly lower in the group treated with bidirectional suture than in groups with traditional sutures (P<.001). No significant difference was observed in the operative time between the study groups. The degree of surgical difficulty was significantly lower in the bidirectional barbed suture group than in the other groups. At 1-year follow-up all patients presented no wound dehiscence, no bleeding, dyspareunia, and other potential major complications such as ureteric, bladder, or bowel injury.

Conclusions: Use of a barbed suture reduces the time required to repair the vaginal cuff during TLH. At follow-up of patients, carried out 3 months, 6 months, and 1 year after the surgery, no wound dehiscence, no bleeding, or no other potential major surgical complications had occurred.
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http://dx.doi.org/10.1089/lap.2012.0079DOI Listing
April 2013

Selective salpingography: preliminary experience of an office operative option for proximal tubal recanalization.

Eur J Obstet Gynecol Reprod Biol 2012 Jul 14;163(1):62-6. Epub 2012 May 14.

Department of Gynaecology, Obstetric and Reproductive Science, Second University of Studies of Naples, Naples, Italy.

Objective: To evaluate treatment efficacy and patient acceptability of the new Radiographic Tubal Assessment Set (RTAS) (Cook Ireland Ltd., Limerick, Ireland) for selective salpingography (SSG).

Study Design: 33 women, between 23 and 38 years old, referred to the Fertility Centre of the Department of Obstetrics, Gynecology and Reproductive Science, Second University of Naples, for sterility problems, underwent an office operative SSG with the RTAS. Of the 33 women, 12 had bilateral tubal obstruction (Group A) and 21 had unilateral tubal obstruction (Group B). Patients who did not regain tubal patency were referred for laparoscopic surgery. To verify patient acceptability, a visual analogue score (VAS 1-10) of pain was completed immediately after the procedure.

Results: From a total of 45 obstructed fallopian tubes, 34 were recanalized, giving a success rate for the procedure of 75.6% (p<0.001). Nine patients with bilateral tubal obstruction (Group A) had the tubes recanalized and five obtained a spontaneous pregnancy. Sixteen patients with monolateral tubal obstruction (Group B) had the tubes recanalized and nine obtained a spontaneous pregnancy. A total of seven patients were sent for operative laparoscopy: four of them had the tubes recanalized and two obtained a spontaneous pregnancy. One patient was lost to follow-up. The evaluation of the level of pain felt during the procedure on the 10 cm VAS showed mean pelvic pain 2.9 ± 2.2, and an incidence of no discomfort±low pain significantly higher than moderate±severe pain (p<0.0001).

Conclusion: The RTAS can be considered a safe and effective tool to perform this office operative procedure for tubal recanalization, with a high acceptability for the patient. The "see and treat" approach in patients with proximal tubal obstruction (PTO) suggests for the future the use of this device under sonographic guidance, taking into account accurate patient selection.
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http://dx.doi.org/10.1016/j.ejogrb.2012.03.037DOI Listing
July 2012

Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature.

Acta Haematol 2012 15;128(1):33-8. Epub 2012 May 15.

Division of Hematology, Second University of Naples, Naples, Italy.

Primary lymphoma of the female genital tract is very rare. We report the case of a 36-year-old woman who was referred to our hospital because of an indeterminate Pap smear test. The colposcopy showed a thickening of the posterior vaginal wall and various irregular ulcerated nodular lesions. Histological examination, immunohistochemistry and the staging procedures were conclusive of diffuse large B-cell lymphoma of the vagina, stage IEA. Complete remission was achieved after 6 cycles of immunopolychemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). No relapse has occurred during a follow-up of 71 months. Moreover, we reviewed the 62 previously reported cases of primary extranodal non-Hodgkin's lymphoma of the vagina, focusing on clinicopathological and therapeutic aspects, to better characterize this unusual disease.
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http://dx.doi.org/10.1159/000337336DOI Listing
September 2012

A molecular carrier to transport and deliver cisplatin into endometrial cancer cells.

Chem Biol Drug Des 2012 Jul 27;80(1):9-16. Epub 2012 Apr 27.

NCI of Naples Pascale Foundation, Molecular Biology and Viral Oncogenesis, Naples, Italy.

The leader peptide of a recombinant manganese superoxide dismutase (rMnSOD-Lp) acts as a molecular carrier. Clonogenic tests on normal (MRC-5) and endometrial adenocarcinoma cells (HTB-112) were carried out in the presence of rMnSOD-Lp, cisplatin alone (CC) or cisplatin conjugated to the rMnSOD-Lp (rMnSOD-Lp-CC). The platinum delivered into the cells was measured by atomic spectrophotometric absorbance. The treatments on tumor and normal cells were finally evaluated by LM and TM microscopy. Tumor cell death in the case of 0.5 μM cisplatin on its own was minimal, while in the presence of 0.5 μM rMnSOD-Lp-CC, no tumor cells survived. Atomic absorbance analysis showed that rMnSOD-Lp-CC delivered approximately four times more cisplatin into HTB-112 cells than the amount delivered using cisplatin alone. By LM observation, the cells treated with rMnSOD-Lp-CC showed signs of nuclear and cytoplasmic fragmentation, that is, apoptosis induced by the treatment. The therapeutic effect of rMnSOD-Lp-CC on endometrial cancer cells was significant, while on the normal cells it showed only a minimal toxicity. We believe that rMnSOD-Lp deserves to be considered as a molecular carrier to deliver cisplatin directly into tumor cells, thus transforming its antireplicative activity into a specific and selective antitumor agent.
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http://dx.doi.org/10.1111/j.1747-0285.2012.01337.xDOI Listing
July 2012