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In Piemonte (north-western Italy), an intense extraction activity of ornamental stones widely used for historical buildings, developed throughout centuries. This is due to the wide geodiversity of the region, characterised by mostly metamorphic and magmatic rocks in the Western Alps and by terrigenous and carbonate sedimentary rocks in the Alps-Apennines syn-orogenic basins. The work presents the description and classification of the main Piemonte ornamental stones, referring to a simplified lithological Map Legend. To enhance the remarkable historical and contemporary stone heritage of the region a database (DB) was developed addressing a proper cataloguing of the ornamental stones and related quarries. The classified instances have been referred to the geologic units of a regional-scale, interactive geological map, in which each ornamental stone was attributed to few geo-lithological classes. The map was developed as a WebGIS service hosted on a geoportal () that allows interactive querying and download of the DB information, regarding the main rock types and the corresponding quarries, as well as their historical-architectural uses, to underline their value as witness of cultural heritage. The WebGIS service is progressively fed by new data, in order to become a relevant source of information for those working in the field of cultural heritage and geo-environmental sciences. [ABSTRACT FROM AUTHOR]

Placental protein 13 (PP13) exhibits a plasma concentration that increases gradually during normal gestation, a process that is disrupted in preeclampsia, which is characterized by elevated vascular resistance, reduced utero-placental blood flow, and intrauterine growth restriction. This study investigated PP13's role in vascular tone regulation and its molecular mechanisms. Uterine and subcutaneous arteries, isolated from both pregnant and non-pregnant women, were precontracted with the thromboxane analogue U46619 and exposed to PP13 using pressurized myography. The molecular mechanisms were further investigated, using specific inhibitors for nitric oxide synthase (L-NAME+LNNA at 10−4 M) and guanylate cyclase (ODQ at 10−5 M). The results showed that PP13 induced vasodilation in uterine arteries, but not in subcutaneous arteries. Additionally, PP13 counteracted U46619-induced vasoconstriction, which is particularly pronounced in pregnancy. Further investigation revealed that PP13's mechanism of action is dependent on the activation of the nitric oxide–cGMP pathway. This study provides novel insights into the vasomodulatory effects of PP13 on human uterine arteries, underscoring its potential role in regulating utero-placental blood flow. These findings suggest that PP13 may be a promising candidate for improving utero-placental blood flow in conditions such as preeclampsia. Further research and clinical studies are warranted to validate PP13's efficacy and safety as a therapeutic agent for managing preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) is a common urological condition affecting aging men worldwide. Among the treatment options available for BPH, transurethral resection of the prostate (TURP) is the gold-standard invasive intervention. To reduce the TURP-related non-negligible morbidity, loss-of-ejaculation rate, hospitalization, blood loss and catheterization time several laser techniques have been developed, such as the Thulium Laser Enucleation of the Prostate (ThuLEP). To investigate the efficacy outcomes of the ThuLEP as a treatment option for benign prostatic hyperplasia (BPH) we performed a retrospective observational study at Moriggia Pelascini Hospital (Como, Italy) between January 2015 and September 2018. We included 265 patients who underwent ThuLEP at a specific hospital between defined dates. Data on various parameters, including post-void residue volume, peak urinary flow rate (Qmax), International Prostate Symptom Score (IPSS) for urinary symptoms, IPSS Quality of Life (QoL) score, and International Index of Erectile Function (IIEF) score for erectile dysfunction, were collected at baseline and follow-up. The analysis revealed significant improvements in voiding efficiency, urinary flow, urinary symptoms, quality of life, and erectile function following ThuLEP. Furthermore, certain baseline characteristics, such as post-void residue, peak urinary flow rate, age, prostate volume, and aspirin usage, were found to influence treatment outcomes. Despite the study's limitations, these findings contribute to understanding ThuLEP's effectiveness in managing BPH and can aid in making informed clinical decisions for patient care. Prospective studies with longer follow-up periods are recommended to validate and extend these results. [ABSTRACT FROM AUTHOR]

Partial nephrectomy (PN) is the primary surgical method for renal tumor treatment, typically involving clamping the renal artery during tumor removal, leading to warm ischemia and potential renal function impairment. Off-clamp approaches have been explored to mitigate organ damage, yet few results have emerged about the possible effects on hemoglobin loss. Most evidence comes from retrospective studies using propensity score matching, known to be sensitive to PS model misspecification. The energy balancing weights (EBW) method offers an alternative method to address bias by focusing on balancing all the characteristics of covariate distribution. We aimed to compare on- vs. off-clamp techniques in PN using EB-weighted retrospective patient data. Out of 333 consecutive PNs (275/58 on/off-clamp ratio), the EBW method achieved balanced variables, notably tumor anatomy and staging. No significant differences were observed in the operative endpoints between on- and off-clamp techniques, although off-clamp PNs showed slight reductions in hemoglobin loss and renal function decline, albeit with slightly higher perioperative blood loss. Our findings support previous evidence, indicating comparable surgical outcomes between standard and off-clamp procedures, with the EBW method proving effective in balancing baseline variables in observational studies comparing interventions. [ABSTRACT FROM AUTHOR]

Angular pregnancies are rare and difficult to diagnose. Evidence suggests they are associated with a higher risk of intrauterine growth restriction and abnormal third stage of labor due to a retained placenta. The lack of standardized AP diagnostic criteria impacts on their correct identification and makes the treatment of potential complications challenging. We present a case of the successful conservative surgical management of a retained placenta after a term AP also complicated by intrauterine growth restriction. Moreover, to identify the best evidence regarding AP diagnostic criteria and retained placenta therapeutic approaches, we have realized an expert literature review. [ABSTRACT FROM AUTHOR]

Introduction The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers. Material and methods Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant. Results Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-- 6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15--8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3). Conclusions Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact on erectile and ejaculatory function following transrectal ultrasound-guided biopsies of the prostate (TRUS-Bx) in sexually active men. Methods: Monocentric prospective study from May 2021 to January 2022 of consecutive patients with suspected prostate cancer [elevated prostate specific antigen (PSA) level and/or abnormal digital rectal examination] undergoing TRUS-Bx. The 15-item version of the International Index of Erectile Function (IIEF-15), Premature Ejaculation Diagnostic Tool (PDET) and short form of Male Sexual Health Questionnaire (MSHQ-EjD Short Form) were assessed before, one and three months after TRUS-Bx. The primary endpoint was to evaluate the risk of temporary post-biopsy erectile and/or ejaculatory dysfunctions. The statistical significance was set as p value < 0.05. Results: A total of 276 consecutive patients were included in the study. The median age, PSA and biopsy cores were 65 years (IQR 59-69), 7 ng/ml (IQR 5-9.7) and 16 (IQR 12-16), respectively. We compared the IIEF subdomains before TRUS-Bx vs. one or three months: the erectile function (EF) decreased after one month (p<0.001) but recovered after three months (p=0.833); the Orgasmic Function (OF), the Sexual Desire (SD), the Intercourse Satisfaction (IS), the Overall Satisfaction (OS), and Total IIEF decreased significantly after both one and three months compared to pre-biopsy values (p < 0.05). As for ejaculatory function (EjF), PDET, MSHQ-EjD Short Form 1, 2, 3 and MSHQ-EjD Short Form 4 scores decreased significantly after one month (p < 0.001), but they returned to pre-biopsy values after 3 months: p = 0.538, p = 0.071 and p = 0.098, respectively. Conclusions: Our study proved that EF, assessed through IIEF-15, and ejaculatory function, assessed through PDET and MSHQ-EjD Short Form, were negatively affected by TRUS-Bx one month after the procedure and recovered after three months. Interestingly, the other IIEF-15 subdomains (OF, SD, IS, OS and Total) resulted as significantly reduced also after 3 months: this issue highlights the importance of carefully considering the indication to TRUS-Bx. [ABSTRACT FROM AUTHOR]

Objective: Bladder cancer (BC) is considered one of the malignancies with moderate-high incidence, high rate of recurrence and costly management. Diagnosis and staging are thus important for therapeutic purposes. Considering the risk of residual tumour and understaging, in specific cases, international guidelines recommend performing a second transurethral resection of the bladder (reTURB). Our study aimed to evaluate the impact of hexaminolevulinate Photodynamic Diagnostics (PDD) at first TURB on the rate of residual tumour. Materials and Methods: We retrospectively analysed patients undergoing TURB in our centre between 2012 and 2020. Eightytwo patients had a re-TURB after a first complete TURB with a delay < 3 months. Patients who had an incomplete first resection were excluded. We compared patients who underwent standard white light cystoscopy/TURB and then hexaminolevulinate PDDguided reTURB (group A, n = 49) and patients with PDD-cystoscopy/TURB at the first procedure then white light cystoscopy/reTURB (group B, n = 33). The residual tumour rate at reTURB as well as median recurrence-free survival (RFS) were compared between the two groups. Results: Residual tumour at reTURB was detected in 48.8% of cases in our cohort, with a significant difference between the two groups (71.4% in group A versus 12.5% in group B, p < 0.001). After a median follow-up of 22 months, the median RFS was 15 months in Group A and 32 months in Group B, but this difference was not significant (p = 0.7). Conclusions: Using PDD at the time of the initial TURB had a statistically significant impact on the rate of residual tumour at the reTURB. Nevertheless, the percentage of residual tumour even with the use of PDD does not allow for safely omitting second resection. Performing a reTURB with PDD for patients who did not have it initially, provides the same benefit in terms of recurrence-free survival. [ABSTRACT FROM AUTHOR]

We consider a free-space optical (FSO) communication link for packet-based transmissions over a turbulence fading channel. The modulation format is on-off keying (OOK) and a unique-word (UW) composed by a known synch pattern is periodically inserted in the data stream to identify the start of frame. Since an avalanche photo-diode (APD) is used for direct detection of the OOK symbols, the photocurrent signal provided by the APD is plagued by a mixture of thermal and shot noise with signal-dependent power. Our goal is the detection of the UW position in the received stream, along with the estimation of the unknown channel attenuation and noise variances. The aforementioned problem has recently been studied by ignoring any information conveyed by data symbols surrounding the UW. In this work, further investigation is conducted in order to determine the maximum likelihood (ML) solution that, in addition to the UW, exploits all the information-bearing symbols belonging to the observation window. The relevant Cramér-Rao bound (CRB) is also evaluated to establish the ultimate accuracy achievable in the estimation process. Since the true ML estimator leads to a computationally intractable multi-dimensional optimization problem, we develop suitable approximations that enable accurate frame synchronization with affordable complexity. We also present an iterative solution to refine the channel and noise power estimates provided by the UW detection procedure. Numerical simulations demonstrate the superiority of the proposed synchronization and estimation schemes with respect to existing alternatives. [ABSTRACT FROM AUTHOR]

We performed a monocentric longitudinal study on sexually active male patients, from May 2021 to October 2021, with SARS-CoV-2 infection confirmed with a nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR). The questionnaires were delivered by email. The study period was divided into the periods before getting tested (T1), during quarantine (T2), 1 month after a negative test (T3), and 3 months after a negative test (T4). All participants were invited to complete these questionnaires: 10- and 6-item questionnaires, a sexual distress schedule (SDS), and the international index of erectile function questionnaire of 15 items (IIEF-15). The primary endpoint was to evaluate the impact of quarantine on male sexual function (SF) during and after the SARS-CoV-2 infection. A total of 22 male patients met the inclusion criteria. The differences for both SDS and IIEF-15 scores, between T1–T2 (27 (IQR 24.0–32.2) vs. 37.5 (IQR 34.2–45.5), 45 (IQR 38.0–50.2) vs. 28.5 (IQR 19.5–38.0)), T2–T3 (37.5 (IQR 34.2–45.5) vs. 28 (IQR 24.0–31.0), and 28.5 (IQR 19.5–38.0) vs. 39.5 (IQR 35.5–44.2)) were statistically significant (p < 0.001), respectively. Moreover, between T1–T4, no statistically significant difference (p > 0.05) was recorded in both SDS (27 (IQR 24.0–32.2) vs. 26.5 (IQR 24–30.2)) and IIEF-15 (45 (IQR 38.0–50.2) vs. 28.5 (IQR 19.5–38.0)). In 20 patients (90.9%), SARS-CoV-2 had a huge impact on relationship and sexual life, but no patient attended a clinic for sexual difficulties. In conclusion quarantine has negatively influenced SF in infected patients; however, 3 months after the rRT-PCR negative test, a promising return to the preinfection SF values is observed. [ABSTRACT FROM AUTHOR]

Fast and reliable synchronization in free-space optical (FSO) communications is a crucial task that has received little attention so far. Since in these applications the data rate is much higher than in traditional radio-frequency (RF) systems, novel technological constraints may arise in the design of the synchronization algorithms, as for example the need to operate at symbol rate instead with an oversampled data stream. In this work, we consider an FSO link and investigate the problem of channel estimation, symbol timing recovery and frame detection using a known synch pattern. The modulation format is on-off keying (OOK) and the received signal is plagued by a mixture of thermal and shot noise. By applying the least-squares criterion, we derive a novel synchronization scheme that can jointly retrieve all the unknown parameters using symbol-spaced samples. Although designed without taking the noise statistics into account, the estimator performance is assessed in a realistic scenario where shot noise is present. Comparisons are made with the relevant Cramér-Rao bound for the joint estimation of the synchronization parameters and signal-dependent noise variances. Numerical simulations and complexity analysis indicate that the resulting scheme performs satisfactorily with an affordable processing load. Hence, it represents a promising solution for fast synchronization in high-speed FSO communications. [ABSTRACT FROM AUTHOR]

Objectives: To assess the long-term clinical outcomes and identify factors predicting success of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) after kidney transplantation. Patients and methods: A retrospective chart review of all patients who had a symptomatic VUR after renal transplantation at our centre between January 2000 and December 2020 was performed. VUR was documented by retrograde cystography and was determined by at least one episode of acute graft pyelonephritis (AGPN). Endoscopic injections of polydimethylsiloxane (MacroPlastique™) or dextranomer/hyaluronic acid copolymer (Deflux™) were performed by expert urologists via rigid cystoscopy with a bevelled needle system. The results of endoscopic treatment were evaluated by cystography at three months. The primary endpoint was clinical efficacy as defined by the absence of AGPN during follow-up. Radiological success was defined by the absence of VUR at the three months follow-up cystography. Results: Out of 2135 kidney transplantations, a total of 117 (5.5%) patients had symptomatic VUR: 100 (85.5%) underwent Deflux™ and 17 (14.5%) MacroPlastique™. Preoperative high-grade VUR was recorded in 71% of patients. One postoperative complication was observed, Clavien > II. After a median follow-up of 11.2 years (IQR 6.5–14.4), clinical success was achieved in 73 patients (62.4%). Radiological success was obtained in 42 patients (36%). Multivariable analysis failed to identify predictors of endoscopic treatment success, which was independent of the preoperative grade of VUR and the type of bulking agent used. Conclusion: Endoscopic treatment of VUR is a simple and well-tolerated procedure with long-term clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective. Primary non-Hodgkin's lymphomas of the cervix are rare; they represent about 1% of all cases. There are no available guidelines regarding the safest mode of delivery after treatment and resolution of a cervical lymphoma. Case Report. We report the first case of a successful vaginal delivery after induction of labour in a woman recovered from a primary large B-cell lymphoma of the cervix and a literature review. Conclusion. In carefully selected patients with fully treated non-Hodgkin's lymphoma of the cervix with no residual disease, induction of labour via prostaglandins pessary may be a safe option if indicated. [ABSTRACT FROM AUTHOR]

Frequency estimation of a single complex exponential signal embedded in additive white Gaussian noise is a major topic of research in many engineering areas. This work presents further investigations on this problem with regards to the fine estimation task, which is accomplished through a suitable interpolation of the discrete Fourier transform (DFT) coefficients of the observation data. The focus is on fast real-time applications, where iterative estimation methods can hardly be applied due to their latency and complexity. After deriving the analytical expression of the Cramér-Rao bound (CRB) for general values of the system parameters, we present a new DFT interpolation scheme based on the weighted least-squares (WLS) rule, where the optimum weights are precomputed through a numerical search and stored in the receiver. In contrast to many existing alternatives, the proposed method can employ an arbitrary number of DFT samples so as to achieve a good trade-off between system performance and complexity. Simulation results and theoretical analysis indicate that, at sufficiently high signal-to-noise ratios, the estimation accuracy is close to the relevant CRB at any value of the frequency error. This provides some advantage with respect to non-iterative competing schemes, without incurring any penalty in processing requirement. [ABSTRACT FROM AUTHOR]

Introduction: The association between obesity and clinically significant prostate cancer (PCa) is still a matter of debate. In this study, we evaluated the effect of body mass index (BMI) on the prediction of pathological unfavorable disease (UD), positive surgical margins (PSMs), and biochemical recurrence (BCR) in patients with clinically localized (≤cT2c) International Society of Urological Pathology (ISUP) grade group 1 PCa at biopsy. Methods: 427 patients with ISUP grade group 1 PCa who have undergone radical prostatectomy and BMI evaluation were included. The outcome of interest was the presence of UD (defined as ISUP grade group ≥3 and pT ≥3a), PSM, and BCR. Results: Statistically significant differences resulted in comparing BMI with prostate-specific antigen (PSA) and serum testosterone levels (both p < 0.0001). Patients with UD and PSM had higher BMI values (p < 0.0001 and p = 0.006, respectively). BCR-free survival was significantly decreased in patients with higher BMI values (p < 0.0001). BMI was an independent risk factor for BCR and PSM. Receiver-operating characteristic analysis testing PSA accuracy in different BMI groups, showed that PSA had a reduced predictive value (area under the curve [AUC] = 0.535; 95% confidence interval [CI] = 0.422–0.646), in obese men compared to overweight (AUC = 0.664; 95% CI = 0.598–0.725) and normal weight patients (AUC = 0.721; 95% CI = 0.660–0.777). Conclusion: Our findings show that increased BMI is a significant predictor of UD and PSM at RP in patients with preoperative low-to intermediate-risk diseases, suggesting that BMI evaluation may be useful in a clinical setting to identify patients with favorable preoperative disease characteristics harboring high-risk PCa. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of ureteral reimplantation (UR) after failure of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) in renal transplant recipients. Methods: We conducted a monocentric retrospective study that included all renal transplant recipients with failure of Deflux™ as first-line treatment of VUR from January 2007 to December 2020. Failure of Deflux™ was defined by: VUR on retrograde cystography and at least one acute pyelonephritis of the renal graft. The preferred surgical treatment was native ureteropyelostomy (NPUS) in the recent years. If the native ureter could not be used, ureteroneocystostomy (UNC) was performed. The primary outcome was the clinical efficacy of UR defined as the absence of acute graft pyelonephritis during follow-up. Results: Out of 1565 kidney transplantations, 119 (7.6%) had symptomatic VUR treated with bulking agent. 35 (29.4%) had Deflux™ failure and were addressed to UR: 21/35 (60%) NPUS and 14/35 (40%) UNC. The median estimated blood loss, operative time, and length of stay were 120 mL, 90 min, and 7 days, respectively. After a median follow-up of 7.1 (IQR 4.1–9.8) years, UR was clinically successful in a total of 32 patients (91.4%): 20 (95.2%) and 12 (85.7%) patients in the NPUS and UNC groups, respectively (p = 0.55). Three (8.5%) high-grade complications have been reported. No nephrectomy of native kidney was required in the NPUS group. Conclusions: After failure of Deflux™ for VUR of renal graft, surgical treatment with native ureteropyelostomy or ureteroneocystostomy is associated to a high success rate and few high-grade complications. [ABSTRACT FROM AUTHOR]

Objectives: To compare the detection rate of Bacillus Calmette–Guérin (BCG) refractory tumors between white light cystoscopy (WL-C) and Photodynamic Diagnosis cystoscopy (PDD-C). Materials and Methods: We performed a monocentric retrospective study that included all consecutive patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) diagnosed from January 2017 to January 2021. All patients had an initial transurethral resection of bladder tumor (TURBT) with photodynamic diagnosis ± restaging TURBT if needed, followed by full-dose BCG induction. Within 8 weeks following BCG induction, all patients had both WL-C and PDD-C under general anesthesia ± TURBT in case of suspicious lesion. The primary end point was the detection of bladder cancer (BC) at post-BCG cystoscopy. Results: A total of 136 consecutive patients met inclusion criteria. Initial BC characteristics were: 35.6% of T1 tumor, 92.6% high grade, and 48.6% associated CIS. BC was diagnosed in 33/136 cases (24%) at early PDD-C after BCG induction: 77% Ta, 23% T1, 56% associated CIS, 68% high grade, and 6% muscle-invasive bladder cancer. Sensibility and Specificity of WL-C and PDD-C: 41% vs 91% (p < 0.001) and 86% vs 75% (p = 0.001). PDD-C detected 16 additional tumors: 81.3% Ta, 18.7% T1, 75% associated CIS, and 75% high grade. Conclusions: Systematic use of PDD after BCG induction increased the detection of BCG-refractory tumors and led to significant modification in the treatment of high-risk NMIBC. Future studies are needed to evaluate long-term oncologic benefit of early PDD reevaluation and its cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding.Method: This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5).Results: Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they've demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers.Conclusions: Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women's level of awareness on glycaemic control. [ABSTRACT FROM AUTHOR]

Vesicouterine fistula (VUF) is a rare extra-anatomical communication developing between the uterus or cervix and the urinary bladder, most commonly after an iatrogenic injury during a cesarean section. Patients with VUF may have various clinical presentations, ranging from Youssef's syndrome (vaginal urine leakage, amenorrhea, and menouria) to urinary tract infection and infertility. Quality of life for patients having this pathology is strongly affected owing to the psychological burden. Treatment is surgery based because low success rates have been reported for conservative or minimally invasive approaches. Herein, we present a case of a 35-year-old woman successfully treated by a minimally invasive endoscopic repair procedure with the injection of microfragmented autologous adipose tissue (Lipogems®). [ABSTRACT FROM AUTHOR]

In long-term evolution (LTE) systems, there is an option to extend the size of the cyclic-prefix (CP) when the propagation environment is characterized by severe time dispersion. Such a peculiar feature makes the system more resilient against multipath distortions, but inevitably complicates the downlink synchronization task, which cannot be accomplished through conventional techniques devised for a specified CP size. In this paper, we study the problem of CP length detection in the LTE downlink in the presence of a timing uncertainty and frequency offset. In contrast to previous investigations based on heuristic arguments, our approach relies on the maximum likelihood (ML) estimation criterion. Furthermore, it accounts for the irregular LTE symbol (characterized by a different CP size), which is present in the normal CP operation mode. The resulting scheme operates in the time-domain and computes a different metric for each possible position of the irregular symbol within the observation window. Due to its flexibility, the proposed ML approach can be applied to any future multicarrier standard for the design of a CP length detection algorithm, either in the presence or in the absence of irregular symbols. [ABSTRACT FROM AUTHOR]

Massive multiple-input multiple-output (MIMO) systems, where base stations (BSs) are equipped with hundreds of antennas, are an attractive way to handle the rapid growth of data traffic. As the number of user equipments (UEs) increases, the initial access and handover in contemporary networks will be flooded by user collisions. In this paper, a random access protocol is proposed that resolves collisions and performs timing estimation by simply utilizing the large number of antennas envisioned in massive MIMO networks. UEs entering the network perform spreading in both time and frequency domains, and their timing offsets are estimated at the BS in closed form using a subspace decomposition approach. This information is used to compute channel estimates that are subsequently employed by the BS to communicate with the detected UEs. The favorable propagation conditions of massive MIMO suppress interference among UEs, whereas the inherent timing misalignments improve the detection capabilities of the protocol. Numerical results are used to validate the performance of the proposed procedure in massive MIMO networks, under uncorrelated and correlated fading channels. With $2.5 \times 10^{3}$ UEs that may simultaneously become active with probability 1%, a total of 16 frequency–time codes, and 100 antennas, a given UE is detected with probability 75%, and the accuracy of its timing estimate is on the order of few samples. [ABSTRACT FROM AUTHOR]

Background: The Double-J stent is one of the most commonly used devices in urologic practice. Due to its widespread use, numerous common complications have been reported, such as irritative symptoms, infection, and encrustation. More rare complications have also been described, such as up or downward migration and displacement outside the urinary tract. We present a rare case of downward migration of a Double-J stent in a 21-year-old Caucasian female. Case Presentation: A 21-year-old female with a solitary kidney presented to the emergency department with acute renal failure, left flank pain, and fever. She had undergone left Double-J stenting 1 week earlier in her homeland for left renal colic and anuria. A kidney–ureter–bladder X-ray revealed a 10-mm lumbar ureteral stone and the proximal coil of the Double-J stent making multiple loops along the ureter, resulting in a helical appearance. She underwent surgery to remove the previous stent and to place a new one. She was discharged 2 days later and her renal function had returned to normal values at her 1-week follow-up. Conclusions: Double-J Stent placement is a common procedure in the management of urinary tract diseases but is not devoid of life-threatening complications. Regular follow-up of stents and on-time evaluation of clinical complaints are mandatory for an aggressive treatment of complications. [ABSTRACT FROM AUTHOR]

The direct conversion receiver (DCR) architecture has received much attention in the last few years as an effective means to obtain user terminals with reduced cost, size, and power consumption. A major drawback of a DCR device is the possible insertion of in-phase/quadrature imbalances in the demodulated signal, which can seriously degrade the performance of conventional synchronization algorithms. In this paper, we investigate the problem of carrier frequency offset (CFO) recovery in an orthogonal frequency-division multiplexing receiver equipped with a DCR front-end. Our approach is based on maximum likelihood (ML) arguments and aims at jointly estimating the CFO, the useful signal component, and its mirror image. In doing so, we exploit knowledge of the pilot symbols transmitted within a conventional repeated training preamble appended in front of each data packet. Since the exact ML solution turns out to be too complex for practical purposes, we propose two alternative schemes which can provide nearly optimal performance with substantial computational saving. One of them provides the CFO in closed-form, thereby avoiding any grid-search procedure. The accuracy of the proposed methods is assessed in a scenario compliant with the 802.11a WLAN standard. Compared to existing solutions, the novel schemes achieve improved performance at the price of a tolerable increase of the processing load. [ABSTRACT FROM PUBLISHER]

Before establishing a communication link with the serving base station (eNodeB), user equipment (UE) operating in a long-term evolution (LTE) multi-cellular network must acquire some specific information, including the sector identity and cell group identity. For this purpose, two training sequences called primary synchronization signal (PSS) and secondary synchronization signal (SSS) are periodically transmitted in the downlink to convey such information. In this work, we present a novel maximum likelihood (ML) approach for SSS detection assuming that the PSS has been successfully identified at an earlier stage. As we shall see, the resulting scheme turns out to be too complex for practical implementation as it requires perfect knowledge of the channel covariance matrix. Therefore, we look for simpler solutions and propose two reduced-search methods that operate in a mismatched mode. The first scheme exploits channel state information emerging from both the primary and secondary synchronization signals, while the second scheme operates using only the secondary synchronization signal. Numerical analysis indicates that the proposed methods outperform existing alternatives and can be successfully applied even in a severe propagation scenario. The price for such an advantage is a certain increase of the processing requirement. [ABSTRACT FROM PUBLISHER]

High-Grade Serous Ovarian Carcinoma (HGSOC) is the predominant histotype of epithelial ovarian cancer (EOC), characterized by advanced stage at diagnosis, frequent TP53 mutation, rapid progression, and high responsiveness to platinum-based-chemotherapy. To date, standard first-line-chemotherapy in advanced EOC includes platinum salts and paclitaxel with or without bevacizumab. The major prognostic factor is the response duration from the end of the platinum-based treatment (platinum-free interval) and about 10-0 % of EOC patients bear a platinum-refractory disease or develop early resistance (platinum-free interval shorter than 6 months). On these bases, a careful selection of patients who could benefit from chemotherapy is recommended to avoid unnecessary side effects and for a better disease outcome. In this retrospective study, an immunohistochemical evaluation of Aurora Kinase A (AURKA) was performed on 41 cases of HGSOC according to platinum-status. Taking into account the number and intensity of AURKA positive cells we built a predictive score able to discriminate with high accuracy platinum-sensitive patients from platinum-resistant patients (p < 0.001). Furthermore, we observed that AURKA overexpression correlates to worse overall survival (p = 0.001; HR 0.14). We here suggest AURKA as new effective tool to predict the biological behavior of HGSOC. Particularly, our results indicate that AURKA has a role both as predictor of platinum-resistance and as prognostic factor, that deserves further investigation in prospective clinical trials. Indeed, in the era of personalized medicine, AURKA could assist the clinicians in selecting the best treatment and represent, at the same time, a promising new therapeutic target in EOC treatment. [ABSTRACT FROM AUTHOR]

This paper investigates the problem of carrier frequency offset (CFO) recovery in an OFDM receiver affected by frequency-selective in-phase/quadrature (I/Q) imbalances. The analysis is based on maximum-likelihood (ML) methods and relies on the transmission of a training preamble with a repetitive structure in the time domain. After assessing the accuracy of the conventional ML (CML) scheme in a scenario characterized by I/Q impairments, we review the joint ML (JML) estimator of all unknown parameters and evaluate its theoretical performance. In order to improve the estimation accuracy, we also present a novel CFO recovery method that exploits some side-information about the signal-to-interference ratio. It turns out that both CML and JML can be derived from this scheme by properly adjusting the value of a design parameter. The accuracy of the investigated methods are compared with the relevant Cramer–Rao bound. Our results can be used to check whether conventional CFO recovery algorithms can work properly or not in the presence of I/Q imbalances and also to evaluate the potential gain attainable by more sophisticated schemes. [ABSTRACT FROM AUTHOR]

Before establishing a communication link in a cellular network, the user terminal must activate a synchronization procedure called initial cell search in order to acquire specific information about the serving base station. To accomplish this task, the primary synchronization signal (PSS) and secondary synchronization signal (SSS) are periodically transmitted in the downlink of a long term evolution (LTE) network. Since SSS detection can be performed only after successful identification of the primary signal, in this work, we present a novel algorithm for joint PSS detection, sector index identification, and integer frequency offset (IFO) recovery in an LTE system. The proposed scheme relies on the maximum likelihood (ML) estimation criterion and exploits a suitable reduced-rank representation of the channel frequency response, which proves robust against multipath distortions and residual timing errors. We show that a number of PSS detection methods that were originally introduced through heuristic reasoning can be derived from our ML framework by simply selecting an appropriate model for the channel gains over the PSS subcarriers. Numerical simulations indicate that the proposed scheme can be effectively applied in the presence of severe multipath propagation, where existing alternatives provide unsatisfactory performance. [ABSTRACT FROM PUBLISHER]

Background: In the last decade, both endocrine and ultrasound data have been tested to verify their usefulness for assessing ovarian reserve, but the ideal marker does not yet exist. The purpose of this study was to find, if any, a statistical advanced model able to identify a simple, easy to understand and intuitive modality for defining ovarian age by combining clinical, biochemical and 3D-ultrasonographic data. Methods: This is a population-based observational study. From January 2012 to March 2014, we enrolled 652 healthy fertile women, 29 patients with clinical suspect of premature ovarian insufficiency (POI) and 29 patients with Polycystic Ovary syndrome (PCOS) at the Unit of Obstetrics & Gynecology of Magna Graecia University of Catanzaro (Italy). In all women we measured Anti Müllerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Estradiol (E2), 3D Antral Follicle Count (AFC), ovarian volume, Vascular Index (VI) and Flow Index (FI) between days 1 and 4 of menstrual cycle. We applied the Generalized Linear Models (GzLM) for producing an equation combining these data to provide a ready to use information about women ovarian reserve, here called OvAge. To introduce this new variable, expression of ovarian reserve, we assumed that in healthy fertile women ovarian age is identical to chronological age. Results: GzLM applied on the healthy fertile controls dataset produced the following equation OvAge = 48.05 - 3.14*AHM + 0.07*FSH - 0.77*AFC - 0.11*FI + 0.25*VI + 0.1*AMH*AFC + 0.02*FSH*AFC. This model showed a high statistical significance for each marker included in the equation. We applied the final equation on POI and PCOS datasets to test its ability of discovering significant deviation from normality and we obtained a mean of predicted ovarian age significantly different from the mean of chronological age in both groups. Conclusions: OvAge is one of the first reliable attempt to create a new method able to identify a simple, easy to understand and intuitive modality for defining ovarian reserve by combining clinical, biochemical and 3D-ultrasonographic data. Although design data prove a statistical high accuracy of the model, we are going to plan a clinical validation of model reliability in predicting reproductive prognosis and distance to menopause. [ABSTRACT FROM AUTHOR]

Background: The study aim was to assess the reliability in the diagnosis of superficial endometriosis of the combined evaluation of 2 parameters: modifications of serum CA125 and VAS pain score following 1 dose of GnRH analog (GnRH-a). Methods: Women with chronic pelvic pain (CPP) were managed by GnRH-a administration and diagnostic laparoscopy. Serum CA125 and VAS pain score were assessed for each patient at the early follicular phase and 2 months after the administration of 11.25 mg GnRH-a. Following laparoscopy, subjects were grouped into groups A (72 women with endometriosis) and B (46 women without endometriosis). A multivariate model for CA125 and VAS reduction and for the combination of the 2 markers was calculated using logistic regression and diagnostic performance was evaluated as the AUC of ROC curve. Main outcome measure was the accuracy of the modifications of serum CA125 levels and VAS score following GnRH-a, in patients with histological diagnosis of superficial endometriosis. Results: At baseline, both groups showed similar CA125 levels and VAS scores. Two months after GnRH-a, a significant reduction (delta [Δ]) in CA125 levels and VAS pain score was observed in group A only. AUCs for ΔCA125, ΔVAS score and for combination of these 2 deltas were 0.90, 0.83 and 0.97, respectively. Conclusions: The assessment of serum CA125 and VAS pain score following GnRH-a demonstrates good reliability to exclude superficial endometriosis in patients with CPP. The response to GnRH-a administration in these women could therefore be employed as an ex juvantibus criterion for endometriosis diagnosis. [ABSTRACT FROM AUTHOR]

In-phase/quadrature (I/Q) imbalances are front-end impairments which may greatly complicate the synchronization task in a low-cost direct-conversion receiver (DCR). In this paper we investigate the possibility of using the space-alternating generalized expectation-maximization (SAGE) algorithm to recover the carrier frequency offset in OFDM terminals with a DCR architecture. Our study leads to a novel scheme that operates in a recursive fashion and exploits a conventional OFDM training preamble composed by several repeated parts. At each iteration, interference arising from I/Q impairments is subtracted from the received samples before updating the frequency estimate. The performance of the new scheme is assessed in terms of estimation accuracy and processing load by considering a wireless local area network (WLAN) compliant with the IEEE 802.11a standard. The main goal is to check whether the SAGE approach exhibits some advantages compared to existing alternatives. [ABSTRACT FROM PUBLISHER]

In multi-cellular WiMAX systems based on orthogonal frequency-division multiple-access (OFDMA), the training preamble is chosen from a set of known sequences so as to univocally identify the transmitting base station. Therefore, in addition to timing and frequency synchronization, preamble index identification is another fundamental task that a mobile terminal must successfully complete before establishing a communication link with the base station. In this work we investigate the joint maximum likelihood (ML) estimation of the carrier frequency offset (CFO) and preamble index in a multicarrier system compliant with the WiMAX specifications, and derive a novel expression of the relevant Cramer-Rao bound (CRB). Since the exact ML solution is prohibitively complex in its general formulation, suboptimal algorithms are developed which can provide a reasonable trade-off between estimation accuracy and processing load. Specifically, we show that the fractional CFO can be recovered by combining the ML estimator with an existing algorithm that attains the CRB in all practical scenarios. The integral CFO and preamble index are subsequently retrieved by a suitable approximation of their joint ML estimator. Compared to existing alternatives, the resulting scheme exhibits improved accuracy and reduced sensitivity to residual timing errors. The price for these advantages is a certain increase of the system complexity. [ABSTRACT FROM PUBLISHER]

Over the last years, there has been growing interest in making user terminals more efficient in terms of cost, size, and power consumption. A step forward in this direction is represented by direct-conversion receiver (DCR) architectures, which directly convert the received waveform from the radio frequency (RF) to baseband, thereby avoiding any intermediate frequency (IF) stage. One major issue of DCR devices is the presence of RF impairments, which greatly complicate fundamental receiver functions, including the synchronization task. In this paper we propose a carrier frequency offset (CFO) recovery scheme for OFDM DCRs plagued by frequency-selective In-phase/Quadrature (I/Q) imbalances. Our approach is based on the ESPRIT algorithm and relies on the transmission of a typical OFDM training preamble having a repetitive structure in the time domain. Numerical simulations indicate that the proposed scheme outperforms existing state-of-the-art alternatives at the price of a certain increase of the processing load. [ABSTRACT FROM PUBLISHER]

Choroid plexus, a fetal organ developing approximately from the sixth week of gestation, plays a fundamental role in developing fetal brain organization. As relatively little is known about the relationship between anomalies of choroid plexuses structure and their role in brain function, we examined cases of bifid choroid plexus ( BCP) and discussed their potential association with lateral ventriculomegaly, other abnormal ultrasound findings, and their potential role as markers of fetal chromosomal abnormalities. In the present study, we described 23 cases of fetal BCP found in 2145 routine second trimester ultrasounds. For each patient 2 D and 3 D ultrasound volumes were acquired. BCP was defined as a choroid plexus whose body was divided into two portions (arms) differently located and oriented on the three spatial axes in correspondence to the lateral ventricle, in one or both sides. The entity of the separation and reciprocal orientation of the two arms was examined. The presence of BCP in a low-risk population of pregnant women undergoing routine second trimester ultrasound was showed. Lateral ventricles significantly increased in the presence of BCP. Malformations were found in four of 23 fetuses with BCP. Pregnancy outcome was favorable only in one of these four cases. We suggest that in the presence of mono or bilateral BCP without associated abnormal ultrasound findings, a closer look at fetal brain or extra-cranial structures is recommended. If no related abnormalities are found, serial prenatal and postnatal sonographic follow-up should be considered. In the presence of concomitant abnormal findings, genetic counseling, fetal karyotyping and magnetic resonance imaging, if possible by gestational age, are strongly advised. [ABSTRACT FROM AUTHOR]

Aim In recent years, both dienogest, a fourth-generation progestin, and levonorgestrel-releasing intrauterine device have been found to be effective in terms of endometriosis-related pelvic pain improvement. No data, however, are available about their efficacy in terms of postoperative recurrence prevention in women recently submitted to surgery for endometriosis at every stage. Our objective was to compare two postoperative medical approaches for pain control and reduction of recurrences in patients undergoing surgery for endometriosis. Material and Methods Ninety-two patients undergoing surgery for endometriosis and subsequent treatment by estradiol valerate + dienogest ( EP) (group A) or levonorgestrel-releasing uterine device ( LNG-IUD) (Group B) between January 2009 and June 2010 were retrospectively analyzed. The primary endpoints were pain relapse and disease recurrence rate at 12 and 24 months. The secondary endpoint was patient satisfaction with the therapy at 24 months. Results Forty-eight patients in Group A and 44 in Group B were examined. At 12 and 24 months a statistically greater reduction both in Ca125 levels and VAS score was seen in women treated with EP compared to LNG-IUD. The recurrence rate at 12 and 24 months follow-up was slightly lower, but not at a significant level, in Group A than in Group B. Finally, satisfaction with treatment at 24 months was significantly higher in Group B. Conclusion EP administration is significantly more effective than LNG-IUD in reducing pelvic pain and more effective in reducing recurrence rate but not at a significant level. LNG-IUD, however, has significantly higher patient satisfaction. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the improvement in catamenial chronic pelvic pain (CPP) after Gonadotropin Releasing Hormone analogue (GnRH-a) administration in women affected by adenomyosis or endometriosis. We retrospectively analysed clinical data of 63 premenopausal women with clinical suspect of adenomyosis (15 women, Group A) or endometriosis (48 women, Group B), which received GnRH-a in order to reduce CPP intensity during the time on surgery waiting list. Main outcome measures were variation of CPP intensity, numbers of days requiring analgesics and lost work productivity before and three months after GnRH-a administration. Compared to baseline, a significant decrease in CPP intensity ( p < 0.05) was observed in both groups, even if this reduction was significantly higher in Group A than in Group B ( p < 0.001). In both groups, moreover, a significant reduction in number of days requiring analgesics ( p < 0.05) and lost work productivity ( p < 0.05) was detected. In conclusion, GnRH-a administration in women with clinical suspect of adenomyosis induces a greater reduction in CPP when compared to women with endometriosis, thus representing a potential ex adiuvantibus criteria, helping TV-US in the clinical diagnosis of adenomyosis. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the efficacy of levonorgestrel intrauterine system-releasing (LNG-IUS) insertion in preventing atypical endometrial hyperplasia (AH) and endometrial cancer (EC) in symptomatic postmenopausal overweight/obese women. A total of 34 overweight/obese postmenopausal women, presenting abnormal uterine bleeding (AUB) and endometrial hyperplasia (EH), and who were submitted to LNG-IUS insertion, were identified from registry data. Endometrial histology at LNG-IUS insertion showed simple EH in 20 cases (58.8%), complex EH in 14 cases (41.2%). At 36 months, 91% of patients showed no recurrence of AUB and a significant reduction in the mean endometrial thickness (from 8.2 ± 2.2 to 3.2 ± 1.5 mm, p < 0.05) was observed. Histologic regression of EH was observed in 27 (79.4%) and 33 (97.5%) cases at 12 and 36 months, respectively. None of the women in which EH persisted, reported cellular atypia or cancer progression at 12 and 36 months of follow-up. LNG-IUS represents an effective treatment option to manage postmenopausal obese women affected by AUB and EH. The device seems to be able to prevent the onset of AH and EC in women at high risk. Further prospective controlled studies in a well selected group of women are needed. [ABSTRACT FROM AUTHOR]

The IEEE 802.16 family of standards for nomadic wireless metropolitan area networks adopts orthogonal frequency-division multiple-access as an air interface. In these systems, timing errors between the uplink signals and the base station time reference give rise to interchannel interference as well as multiple-access interference with an ensuing degradation of the error-rate performance. To mitigate this problem, users that intend to establish a communication link go through a synchronization procedure called Initial Ranging (IR) by which uplink signals can arrive at the base station synchronously and with approximately the same power level. In this work, a novel IR scheme compliant with the IEEE 802.16 specifications is presented. In contrast to existing methods, our solution operates on the basis of a generalized likelihood ratio test (GLRT) and provides improved timing and power estimates by properly taking into account the channel correlation across the signal bandwidth. In order to increase the resilience to multiple access interference, the GLRT approach is also exploited to derive a two-stage interference cancellation scheme. Numerical simulations and theoretical analysis are used to demonstrate the effectiveness of the proposed solutions and to make comparisons with existing alternatives. [ABSTRACT FROM PUBLISHER]

The study aim was to evaluate our personal experience regarding the use and the reproductive effect of metformin administration in a large population of infertile patients with polycystic ovary syndrome (PCOS) undergoing gonadotropins ovarian stimulation for in vitro fertilization (IVF). Infertile patients with PCOS undergoing gonadotropins ovarian stimulation with (metformin group, n = 191) or without (control group, n = 187) metformin and IVF were evaluated. Treatment characteristics, patients' data and reproductive outcomes were evaluated. In all cases, metformin with an immediate-release formulation was administered, and in most of cases it was given as pre- and co-treatment (74.9%) and at a dosage of 1700 mg/day (59.7%). Stimulation length and gonadotropins doses were significantly ( p < 0.05) higher in metformin group than in control group. The number of dominant follicles on day of ovarian maturation triggering and peak oestradiol levels were significantly ( p < 0.05) lower in metformin group than in control group. Cycle cancellation rate under metformin resulted significantly influenced by interaction with body mass index (BMI), age and basal follicle-stimulating hormone (FSH) levels. Notwithstanding, metformin use in infertile PCOS patients who receive gonadotropins for IVF is not standardized, it seems to modulate the ovarian response to stimulation. This effect may benefit or harm on the basis of ovarian reserve and patients' characteristics. [ABSTRACT FROM AUTHOR]