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Unexplained recurrent pregnancy loss (uRPL) is a clinical condition for which there is a lack of evidenced-based therapies. However, in clinical practice, low molecular weight heparin (LMWH) has been widely used as an empirical therapy since immune effects have been hypothesized in modulating immune tolerance at the fetal-maternal interface. Epigenetic mechanisms are involved in establishing of immune tolerance, at fetal-maternal interface. To investigate potential induced immune-epigenetic changes at maternal periphery level, which could reflect the maternal-fetal interface condition, seems to open up new therapeutical strategies, since microRNAs circulating in maternal plasma and in peripheral blood mononuclear cells (PBMCs) may be specific and sensitive immunological markers/predictors of adverse pregnancy outcomes such as RPL. Our aim in this pilot study is to evaluate potential LMWH effects on genes regulating immunological response key mechanisms related to maternal-fetal tolerance processes, by studying circulating miRNAs in maternal peripheral blood. We tested a panel of selected miRNAs on three groups: 18 healthy pregnant women, 20 pregnant women affected by uRPL, 18 pregnant women affected by uRPL, treated with LMWH. The majority of differentially expressed miRNAs (miR 374a-5p, 19a-3p, 30e-5p, 128-3p, 155-5p and 200c-3p) were found to be modulated by LMWH, which seems to have a positive function in RPL patients, by bringing patients' values back to those comparable to the control ones. Selected microRNA panels would appear to be an effective clinical tool for uRPL diagnosis and management. LMWH-modified miRNA expression levels could be targets for immunotherapy, as LMWH would appear to restore physiological miRNA levels, which are dysregulated in uRPL.

Head and neck squamous cell carcinoma of the (HNSCC) represents approximately 5% of malignant tumours in Italy. HNSCC are commonly treated with surgery or radiotherapy, or a combination of such therapies. The objectives of treatment are maximum cure rate balanced with organ preservation, restoration of form and function, reduction of morbidities and improvement or maintenance of the patient's quality of life. Immediate reconstructive surgery: local, regional or free flaps are now widely advised in the treatment of these patients. Microsurgical transfer requires expertise, is time and resource consuming, and as a whole requires substantial costs. These considerations introduce some concerns about the wide or indiscriminate use of free flap reconstructive surgery. When considering cost-benefit outcomes of such treatment, the main objective is undoubtedly, survival. This data is underreported in the current literature, whereas functional outcomes of free flaps have been largely diffused and accepted. This study collects data from 1178 patients treated with free flap reconstructive surgery following ablation of HNSCC in a group of Italian tertiary hospitals, all members of the HeadNeck Group affiliated with the Italian Society of Microsurgery. According to many authors, free flap surgery for HNSCC seems to be a beneficial option for treatment even in terms of survival.I tumori spinocellulari del distretto Cervico Facciale rappresentano circa il 5% dei tumori maligni in Italia. Essi sono comunemente trattati con chirurgia o radioterapia, o entrambi le terapie. La ricostruzione rappresenta un momento fondamentale della terapia nel rispetto della qualità di vita di questi pazienti. La microchirurgia ricostruttiva rappresenta la tecnica che offre i migliori risultati funzionali ma è oggetto di discussione in un rapporto costo-benefici. In questo lavoro sono raccolti ed analizzati i dati di 1178 pazienti provenienti dai membri del gruppo testa e collo, affiliato alla società Italiana di Microchirurgia, e i cui dati sono rapportati primariamente alla sopravvivenza.

We have applied the digital pulse shape acquisition to readout the signals coming from the position-sensitive start detector of the MAGNEX spectrometer in order to obtain the position coordinates using digital signal processing.

At the Cranio-Maxillo-Facial Surgery Unit of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan, Italy between 1987 and 1999 200 anterior cranio-facial resections were performed on malignant ethmoid tumors involving the anterior cranial base and extending to the nasal fossae and, at times to the orbit and maxillary and sphenoid sinuses. In the second portion of this case study the authors simplified their surgical technique. The frontal craniotomy was made rectangular and low, performed with an oscillating saw and scalpel, without drilling holes. The osteotomy of the cranial base was modulated according to tumor extension. Typically a paralateronasal facial incision was performed without opening the upper lip. Whenever the maxillary sinus and/or orbit were involved, the skin incision and osteotomy was consequently modified. Repair of the cranial base was performed with a pedicled pericranial flap. In this case study there were 6 post-operative deaths in the first 30 patients and only 2 in the remaining 170. The male/female ratio was 145/55, mean age 55 years (12-80) and average follow-up 38 months (2-117). There were 120 primary tumors while the remaining 80 patients presented recurrences from prior treatments. There were 96 adenocarcinomas, 42 spinocellular carcinomas, 21 esthesioneuroblastoma 15 adenoid-cystic carcinomas, 9 melanomas and 17 rare tumors. Our classification identified the following stages: 69 T2, 54 T3 and 77 T4 while the UICC-AJCC staging system indicated: 25 T1, 16 T2, 68 T3 and 91 T4. The NED survival according to tumor stage (INT classification) was: T262.3%, T3 44.4% and T4 29.9%. The NED survival for patients who had not previously undergone treatment was: T2 71.7%, T3 58.8% and T4 42.5%. On the other hand the NED survival for the cases of recurrence was: T2 43.5%, T3 20% and T4 16.2%. These results lead to the conclusion that the surgical technique currently used is valid and that the anterior cranio-facial resection should always be performed in patients with ethmoid tumors coming into contact with, or eroding, the cribriform plate. For all staging classes, the prognosis for those patients undergoing surgery for recurrence from prior, inadequate treatment was significantly worse than that for the primary tumors.

The Authors examine serum levels of HPRL in basal conditions and after TRH and sulpiride test in 15 patients with endometrial lesions (hyperplasia) and in 15 patients with endometrial adenocarcinoma included in a age range between 44 and 62 years, in which 7 patients present obesity, 10 patients present hypertension and 2 patients are hyperglycemic. The same examination is carried out in a control group of 30 healthy patients. Then the 15 patients with adenocarcinoma and 3 patients with adenomatosa hyperplasia are subjected to surgery and they estimate HPRL levels in endometrium. The results prove that there is no correlation between HPRL plasma levels and endometrium lesions and between endometrium HPRL. The Authors conclude that HPRL does not play a significant role in the pathogenesis of endometrial lesions; use of HPRL plasma levels as a marker of endometrial lesions is not possible.

Background Increased incidence of central precocious puberty (CPP) after coronavirus infectious disease-19 lockdown has been reported. Our study aims in investigating changes in CPP rates and in sleep patterns in CPP and healthy controls. Methods CPP were retrospectively evaluated from April 2020 to April 2021. Parents of girls diagnosed with CPP during lockdown and of matched healthy controls filled out a questionnaire about sleep disturbances (SDSC questionnaire) and sleep schedules. Results Thirty-five CPP and 37 controls completed the survey. Incidence of new CPP cases significantly increased in 2020–2021 compared to 2017–2020 (5:100 vs 2:100, p = 0.02). Sleep disturbance rates did not differ between CPP and healthy controls before lockdown. During lockdown, CPP reported higher rates of sleep disturbs for total score (p = 0.005), excessive somnolence (p = 0.049), sleep breathing disorders (p = 0.049), and sleep–wake transition disorders (p = 0.005). Moreover, CPP group more frequently shifted toward later bedtime (p = 0.03) during lockdown compared to controls. Hours of sleep and smartphone exposure around bedtime did not differ between groups. Conclusions Our study confirms the observation of increased incidence of CPP after lockdown measures. Additionally, CPP showed higher rates of sleep disturbances and later bedtime compared to controls. The causality link between sleep disturbances and CPP should be further investigated to gain knowledge in this association.