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Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. Methods: Report of a case of EXIT-to-airway procedure. Results: A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed reducing the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. Conclusions: The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.

Objectives To evaluate the learning climate (LC) and quality of training in postgraduate training courses in gynecology and obstetrics in Italy, as essential element to improve the training quality of future medical specialists. Study Design Web-based anonymous survey sent to all Italian trainees in gynecology and obstetrics to assess LC and quality of postgraduate training courses. This included sociodemographic information, details regarding training positions, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale). At the same time, the 24-items Fifth Year Training Questionnaire (FYT-Q) was submitted to all trainees at the fifth year of training to assess quality of life (burnout and depression), quality of training and final achieved competency level. Descriptive statistics were used to describe the main characteristics of the study population and for the D-RECT and the FYT-Q results. Results One hundred seventy-eight trainees’ responses were included from 13 departments, yielding a department response rate of 33%. The mean composite score of the D-RECT was 3.185 (SD 0.305). The subscales “Formal education” and “Role of specialty tutor” scored a mean of 2.751 (SD 0.123) and 2.757 (SD 0.130), respectively. Sixty-four FYT-Q evaluations were completed. The 33% of trainees reported more than 56 weekly working hours. At least one burnout episode during the training was reported by 61% of the trainees, and the 45% of them reported one or more episode of depression. More than 50% of trainees reported adequate autonomy for gynecologic ultrasound, obstetrics first level ultrasound, hysteroscopy, and cesarean section. In FYT-Q adequacy of training, teaching, surgical teaching, and tutoring values resulted equal to or less than 3 in a 1–5 Likert scale. Conclusions D-RECT and FYT-Q questionnaires show a training that requires improvement, although the results do not seem to be completely consistent. D-RECT emphasizes the need for a better formal teaching and specialty tutors to ensure training with better LC. Interventions are needed to improve LC and quality of training in postgraduate training courses in gynecology and obstetrics in Italy.

A pregnancy related cancer is defined as a neoplasm diagnosed in a woman during gestation or within 12 months following childbirth or abortion. Breast, thyroidal, melanoma, cervical and hematological malignancies are those most commonly diagnosed during pregnancy, with a reported incidence considered lower than those estimated of 1 case on 1000 pregnancies. The clinical complexity is generated by the co-presence of mother and fetus, and the consequent conflict represented by the need to identify a therapeutic strategy that is effective for the maternal prognosis and, at the same time, safeguards the fetal well-being. Moreover, the counseling, diagnosis, staging and management of these cases are further complicated because most of the scientific literature consists in case reports or small retrospective studies and lacks in guidelines and prospective clinical trials. On that basis, the Study Group on Cancer in Pregnancy (members of S.I.G.O.-Italian Society of Gynecology and Obstetrics) presents the TIGRE Trial, an Italian multicenter observational study aimed at establishing a shared database for the collection of epidemiological and clinical data of the patients affected by pregnancy related cancer in Italy, with the final objective to improve the outcome of a mother and a child involved in a such pathology.

Introduction Antithrombin levels are often reduced in preeclampsia and infusion of antithrombin concentrates has been reported to prolong gestation in severe preeclampsia. We aimed to evaluate efficacy and safety of high-dose antithrombin (ATIII) supplementation in patients with single pregnancies and preeclampsia occurring before 30 weeks of gestation. Materials and methods In November 2004 a double-blind, placebo-controlled trial (code KB033) was started in 13 Italian centers. The planned sample size was of 240 patients (intention-to-treat, ITT population) to detect a 30% relative risk reduction of the primary endpoint, composite perinatal morbidity. Eligible patients were randomized to high dose AT (3000 IU/daily, ATIII Kedrion S.p.A., Italy), or placebo (1% glycine) for 7 days or less until delivery, whichever came first. The per-protocol (PP) population was restricted to patients receiving at least two days of treatment. Results The study was terminated by the sponsor in October 2007 after the enrolment of 38 evaluable patients – 20 randomized to high dose AT and 18 to placebo, 27 treated for 2 days or more – out of 164 screened patients. Enrolment failures were mainly represented by requirement for immediate delivery and consent refusal (91 patients). The primary endpoint occurred in 15 of 38 patients (39.5%), with a relative risk in the AT arm of 0.85 (95% CI 0.42–1.75) and 0.79 (95% CI 0.30-2.11) in the ITT and PP populations, respectively. Living neonates in the two arms had similar weight at birth, Apgar scores, and duration of hospitalization in neonatal ICU. In mothers, AT supplementation was associated with reduced blood loss at delivery and with surrogate laboratory markers (LDH, d -dimer). Conclusions The results of this markedly underpowered trial, albeit suggestive of a potential maternal benefit, cannot support high-dose AT supplementation to improve fetal/neonatal outcomes in early preeclampsia.

To assess the predictive value of sonographic cervical-length (CL) measurement in mid-gestation for spontaneous preterm birth (PTB) in asymptomatic triplet pregnancy.This was a retrospective study of asymptomatic triplet pregnancies followed at five Italian tertiary referral centers, between 2002 and 2015. CL was measured transvaginally between 18 and 24 weeks' gestation. Pregnancies with medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated by PTB were analyzed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. Performance of CL measurement in prediction of PTB 28, 30 and 32 weeks of gestation was assessed.A total of 120 triplet pregnancies were included in the final analysis. Median CL was 35 (interquartile range (IQR), 29-40) mm measured at a median gestational age of 20 + 2 (IQR, 20 + 0 to 23 + 4) weeks. Overall, 23 (19.2%), 17 (14.2%) and eight (6.7%) patients had a CL 25, 20 and 15 mm, respectively. Spontaneous PTB 32 weeks occurred in 41 (34.2%) cases, 30 weeks in 23 (19.2%) and 28 weeks in 12 (10%) cases. CL 15 mm was significantly more frequent in the group of patients who delivered 28 (P = 0.03) and 30 (P = 0.01) weeks' gestation, compared with those who delivered after 28 and after 30 weeks, respectively, while CL 20 mm was more common in triplet pregnancies with delivery 32 weeks compared with those delivered ≥ 32 weeks (P = 0.03). Logistic regression analysis was possible only for PTB 32 weeks due to the small number of cases that delivered 30 and 28 weeks. After adjustment for confounders, CL was not significantly associated with PTB 32 weeks (adjusted odds ratio, 0.97; 95% CI, 0.94-1.01). CL measurement had an area under the receiver-operating characteristics curve of 0.41 (95% CI, 0.20-0.62), 0.41 (95% CI, 0.26-0.56) and 0.42 (95% CI, 0.31-0.54) for the prediction of spontaneous PTB 28, 30 and 32 weeks, respectively.CL assessed in mid-gestation is a poor predictor of PTB 28, 30 and 32 weeks' gestation in asymptomatic triplet pregnancy. Copyright © 2017 ISUOG. Published by John WileySons Ltd.

Indirect questioning (IQ), i.e., asking respondents to predict the behavior of others, has been employed in stated preference studies as WTP elicitation technique. This technique, also referred to as Inferred Valuation, represents a promising approach for reducing hypothetical bias when it is not possible to sell actual goods to participants and when the social desirability bias is a potential problem (e.g., preferences for sustainable food attributes). To date, several issues associated to the use of IQ have not been adequately investigated. We carried out a Discrete Choice Experiment on field to verify the effects on estimated WTPs of: i) different IQ framing; ii) monetary incentives associated to predictions; and iii) the order of presentation. First, by employing two different question formats (e.g. asking to predict others’ behavior in a real market situation or in hypothetical situations) we uncover how respondents are able to anticipate the tendency of others to provide socially desirable answers. Second, monetary incentives create a rewarding environment that indirectly affects WTPs obtained from direct questions. Third, we uncover a potential ‘debiasing’ effect on WTPs of asking respondents to make predictions about others’ before stating their own preferences, which could have interesting implications for practitioners.

Risk of needlestick injuries (NSIs) is high in surgical staff. Medical students and trainees have reported the highest rate of NSIs, and Obstetrics and Gynecology is considered a high-risk specialty. The risk associated to NSIs is further increased by the high prevalence of blood borne pathogens in the population. Nevertheless, the degree of concern about contraction of these serious infections has been reported significantly lower over time, showing diminishing attitudes toward prevention of exposure and lack of consideration as a major problem, in fact most of NSIs resulted unreported. Therefore, education is fundamental to change individual attitudes and behaviors, to improve awareness and increase the use of standard protections, in order to reduce the injury rate and implement reporting to hospital surveillance systems. The proposed study aims to assess NSIs in trainees currently attending residency programs in Obstetrics and Gynecology in all academic hospitals of Italy, with a standardized, pre-piloted, national- based survey. At this purpose, we developed the Obstetrics Needlestick Injury Questionnaire (ONSI-Q), a 40-items survey that will be completed via a web- based platform. The ONSI-Q investigates real incidence of NSIs, adopted protection practices, presence of associated risk factors, and attitudes and rate of the reported accidents among trainees during obstetric procedures (suture of perineal tear/episiotomy and cesarean section). These results will provide the opportunity to investigate an underestimated priority, in order to encourage educational practices with the aim to improve prevention and reporting strategies, and therefore increase occupational safety in this high-risk surgical specialty.

We outline work to be carried out within the framework of an impending EC project. The goal is to construct a language-independent information system for a specific domain (environment/ecology) anchored in a language-independent ontology that is linked to WordNets in several languages. For each language, information extraction and identification of lexicalized concepts with ontological entries will be done by text miners ("Kybots"). The mapping of language-specific lexemes to the ontology allows for crosslinguistic identification and translation of equivalent terms. The infrastructure developed within this project will enable long-range knowledge sharing and transfer to many languages and cultures, addressing the need for global and uniform transition of knowledge beyond the domain of ecology and environment addressed here.

Importance To date, a comprehensive review on the safety and effectiveness of hysteroscopic metroplasty for T-shaped uterus is still missing. Objective To provide a robust synthesis of the available studies investigating reproductive outcomes after hysteroscopic metroplasty for T-shaped uterus. Evidence acquisition We performed a systematic review and meta-analysis (CRD42019143291), using the proportion method with 95% confidence interval (CI). Statistical heterogeneity was assessed by Higgins test (I2). Results We included 11 cohort studies embedding 937 women who underwent hysteroscopic metroplasty. After surgery, the pooled percentage of live birth was 44.54% (95% CI, 36.12%-53.12%; I2 = 46.22%) and 56.88% (95% CI, 46.48%-66.98%; I2 = 36.38%) in women with primary infertility and recurrent miscarriage, respectively. In women with recurrent miscarriage, the pooled proportion of miscarriage was 21.46% (95% CI, 15.09%-28.61%; I2 = 30.18%). The pooled clinical pregnancy proportion in women with primary infertility was 57.19% (95% CI, 43.83%-70.03%; I2 = 77.81%). The pooled rate of surgical complications was 0.65% (95% CI, 0.20%-1.33%; I2 = 11.44%). Conclusions The hysteroscopic correction of T-shaped uteri was associated with high live birth rate and low miscarriage rate, both in case of primary infertility and recurrent miscarriage. Relevance Hysteroscopic metroplasty can be considered a safe and effective strategy to improve reproductive outcomes in case of T-shaped uterus.

Interpretazione di un passo del Trinummus, sulla scorta di una rilettura di Cicerone e di Lattanzio

Il tema del valore giuridico della parola viene affrontato ricercandone testimonianza nel teatro romano e verificando l'originaria valenza magico-sacrale anche in esso attribuitale. Si prendono in particolare in considerazione il verbo 'occentare', attraverso tre testi tratti dal teatro plautino, e 'nuncupare', per il quale vengono in rilievo testimonianze tratte da tragedie di Pacuvio. La pur breve disamina vale ad evidenziare come i brani teatrali, voce vivente della cultura popolare e, conseguentemente, anche della 'law in action', che intride la vita quotidiana, costituiscano una fonte interessante al fine di delineare il milieu culturale nell'ambito del quale termini tecnici giuridici, specialmente molto antichi come quelli qui considerati, trovano origine e sviluppo.

Analisi ad ampio raggio delle motivazioni e delle modalità di citazione dei frammenti superstiti della «Fabula Atellana» (Pomponio e Novio) da Cicerone ai grammatici tardoantichi. Risulta trattarsi di testi praticati essenzialmente in contesti retorici e/o eruditi (non scolastici), per motivi prevalentemente lessicali. Particolare attenzione è dedicata all'interpretazione delle testimonianze di Frontone, dei metricologi, di Festo, Carisio, Prisciano e del 'peripatetico' Nonio.

Il lavoro analizza i differenziali di costo che gravano sulle strutture sanitarie pubbliche presenti nei territori di montagna della Regione Molise, della Regione autonoma Valle d’Aosta e della Provincia autonoma di Trento. Alla luce delle logiche e delle metodologie aziendali introdotte dai processi di riforma in ambito sanitario, il contributo si propone di esaminare, attraverso il supporto di dati empirici, come le caratteristiche montane dei territori analizzati possano influire sull’offerta dei sistemi sanitari pubblici e sulle performance delle strutture erogatrici. In particolare, il lavoro sintetizza un’analisi analitica dei costi, attraverso strumenti del controllo di gestione, finalizzata alla costruzione di specifici indicatori sintetici che evidenziano il maggiore costo dei servizi sanitari sopportato dalle tre realtà territoriali di tipo montuoso. La ricerca ha evidenziato che, data la particolarità del bacino d’utenza, nei territori di montagna gli elevati costi sostenuti per garantire l’offerta e l’accessibilità ai servizi per la salute non trovano una giustificazione economica appropriata ma solo una giustificazione di tipo etico ed assistenziale.

The objective of this study was to clarify which is the better surgical conservative treatment for recurrent endometriosis. We compared two consecutive surgical series at a tertiary care centre for the cure of endometriosis. The patients were 81 women with recurrent endometriosis, 41 reoperated at laparotomy from 1986 to 1991 and 40 reoperated at laparoscopy from 1992 to 1996. Follow-up after the second operation included clinical and ultrasound examinations performed at least once a year to evaluate the recovery of fertility and the reappearance of symptoms and signs of the disease. The cumulative probability of recurrence of dysmenorrhoea (34 and 43 respectively), and the frequency of recurrence of pelvic pain and dyspareunia and of clinical findings suggestive of the disease were not significantly different in the two groups. The rate of recurrence of dyspareunia was higher in the patients operated at laparotomy as was the number requiring a third operation. However, this could be due to the longer follow-up of this group. No significant difference was observed between the cumulative pregnancy rates at 24 months in the two groups (45 in the laparotomy and 54 in the laparoscopy group). We conclude that operative laparoscopy seems as efficacious as conservative surgery at laparotomy in the treatment of recurrent endometriosis.