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This retrospective, multicenter, observational study aimed to refine patient selection criteria for secondary cytoreductive surgery in recurrent endometrial cancer. The objective was to identify preoperative predictors of complete cytoreduction, assess surgical complexity, and propose a preoperative predictive scoring system to identify suitable candidates for secondary cytoreductive surgery.

In mixed-initiative cocreation tasks, wherein a human and a machine jointly create items, it is important to provide multiple relevant suggestions to the designer. Quality-diversity algorithms are commonly used for this purpose, as they can provide diverse suggestions that represent salient areas of the solution space, showcasing designs with high fitness and wide variety. Because generated suggestions drive the search process, it is important that they provide inspiration, but also stay aligned with the designer's intentions. Additionally, often many interactions with the system are required before the designer is content with a solution. In this article, we tackle these challenges with an interactive constrained multidimensional archive of phenotypic-elites system that leverages emitters to learn the preferences of the designer, and then, use them in automated steps. By learning preferences, the generated designs remain aligned with the designer's intent, and by applying automatic steps, we generate more solutions per user interaction, giving a larger number of choices to the designer, and thereby, speeding up the search. We propose a general framework for preference-learning emitters and apply it to a procedural content generation task in the video game Space Engineers. We built an interactive application for our algorithm and performed a user study with players.

The primary endpoint of this study was to compare the disease-free survival of patients undergoing open versus minimally invasive pelvic exenteration. The secondary endpoints were cancer-specific survival and peri-operative morbidity.

Retrospective series have shown minimally invasive secondary cytoreductive surgery is a feasible approach in selected cases of recurrent ovarian cancer. However, no predictors of minimally invasive secondary cytoreductive surgery feasibility are currently available. This study aims to identify predictive factors of minimally invasive secondary cytoreductive surgery feasibility and to compare perioperative and survival outcomes in a matched series of recurrent ovarian cancer patients who underwent secondary cytoreduction via an open or minimally invasive surgical approach.

Introduction: The link between female infertility and gynecological cancer has always been a debated and challenging topic. Although cervical cancer has the worst impact on female fertility, as it is usually diagnosed in patients of reproductive age, endometrial and ovarian cancer are also diagnosed and treated often in relatively younger patients in which fertility preservation is a relevant issue. The aim of this review is to highlight the correlation between therapy for female infertility and the developing cancer’s risk and to describe the fertility sparing treatments in gynecological oncology.Material and methods: A systematic review of the literature through the main scientific search engines (PubMed and Google Scholar) was performed. We selected the most relevant articles based on the largest case series and the latest updates. All selected documents have been listed in the references.Results: Fifty-six relevant articles published between 1996 and 2019 were identified. Results from the available evidence report no significant increased risk of endometrial, cervical, and ovarian cancer in patients having infertility treatments. In young patients diagnosed with gynecological cancer, preservation of fertility is a personalized choice depending on several factors (type, stage, age and desire to conceive, safety of the treatment, and feasibility of fertility sparing surgery). For ovarian cancer FIGO stage IA G1, IA G2 (grade), and IC G1; for endometrial adenocarcinoma grade 1 with no lymphovascular space invasion (LVSI) or myometrial invasion and for early-stage cervical cancer (FIGO stage 2018: IA1-IB1), fertility sparing treatment is possible. The role of fertility sparing treatment with the increase of personalization of therapies therapy is always a theme of discussion and research.Conclusion: At present data regarding the risk of gynecological cancers after infertility treatments are reassuring. Careful evaluation of female fertility-sparing options in young women interested by ovarian, endometrial, or cervical tumors should be carried out involving a multidisciplinary team and ensuring safety and efficacy.

Background: Heart rate variability (HRV) is the physiological variation in the time interval between consecutive heartbeats. Extracellular water (ECW) is the aqueous compartment surrounding cells and has been used as an inflammation index. Medically unexplained symptoms (MUS) refer to persistent psychosomatic bodily complaints, and their presence may be employed as a clinical index of chronic stress and inflammation, useful in distinguishing suffering patients from healthy subjects. Aim: To evaluate the clinical performance of SDNN (standard deviation of intracardiac beat time interval of normal sinus beats) and RMSSD (square root of the mean squared differences of successive NN intervals) as indices of HRV, and their correlation with ECW and MUS. Patients and methods: A large multicenter retrospective study was conducted in 37 Italian medical practices in Caucasian men and women aged 20 to 70 years. SDNN and RMSSD were measured with the PPG Stress Flow® device (BioTekna, Italy), while ECW was determined with the BIA-ACC® device (BioTekna, Italy). All subjects filled in a MUS® questionnaire with 19 “nonspecific” symptom questions. The study sample was stratified by decade of age into five groups. Results: Data from 9246 subjects comprising 3127 males and 6119 females, with a median age of 47 years, were analyzed. HRV index SDNN and RMSSD distributions in the entire sample and in each of the five age groups were significantly greater in subjects with a limited number of MUS (0–5) than in subjects with six or more symptoms, while both distributions correlated negatively with ECW. Conclusion: SDNN and RMSSD and ECW were predictors of MUS and were successfully used to objectively evaluate chronic stress and inflammation.

To evaluate risk factors for cervical intraepithelial neoplasia (CIN0, data were collected in a case-control study based on 366 patients (58 with CIN class 1, 70 with CIN class 2, and 238 with CIN class 3) and 323 control subjects with normal cervical smears interviewed on selected days at the same screening clinics where cases had been identified. No relationship emerged between indicators of socioeconomic status (education and social class) and risk of mild/moderate (considered together) and severe dysplasia. A total of 55 (43%) patients with CIN class 1 or 2, 107 (45%) patients with CIN class 3, and 94 (29%) controls were current smokers. The corresponding relative risk (RR) estimates for current versus never smokers were 1.9 (95% confidence interval [CI] 1.2 to 3.0 for patients with CIN class 1 or 2 and 2.5 (95% CI 1.7 to 3.6) for patients with CIN class 3, and the risk increased with the number of cigarettes smoked per day. No relationship was observed between oral contraceptive use, parity, spontaneous or induced abortions and the risk of CIN, but patients tended to report earlier age at first birth than control subjects. Compared with women reporting their first birth before the age of 20 years, the risk estimates were 0.5 and 0.4, respectively, for patients with CIN 1 or 2 and patients with CIN 3 in women reporting first birth at 20 to 24 years of age. The risk estimates were 0.5 and 0.6 for those reporting their first birth at age 25 or later, but the trends in risk were not statistically significant. The number of sexual partners was directly associated with the risk for both histopathologic subgroups. Compared with women reporting no intercourse or their first intercourse after 22 years of age, women with first intercourse before the age 18 had a RR estimate of CIN class 1 or 2 of 2.3 and of CIN class 3 of 2.4, with the trends in risk being statistically significant. This study confirms considerable similarities in the epidemiology of mild/moderate and severe cervical dysplasia. In addition, it suggests consistency between the epidemiology of intraepithelial and invasive cervical neoplasia for risk factors that are likely to act on one of the first stages of the process of carcinogenesis (i.e., indications of sexual habits) but differences for hormone-mediated factors (i.e., reproductive variables or oral contraceptives). Cancer 1992; 69:2276-2282.

In metazoans, the secreted proteome participates in intercellular signalling and innate immunity, and builds the extracellular matrix scaffold around cells. Compared with the relatively constant intracellular environment, conditions for proteins in the extracellular space are harsher, and low concentrations of ATP prevent the activity of intracellular components of the protein quality-control machinery. Until now, only a few bona fide extracellular chaperones and proteases have been shown to limit the aggregation of extracellular proteins1–5. Here we performed a systematic analysis of the extracellular proteostasis network in Caenorhabditis eleganswith an RNA interference screen that targets genes that encode the secreted proteome. We discovered 57 regulators of extracellular protein aggregation, including several proteins related to innate immunity. Because intracellular proteostasis is upregulated in response to pathogens6–9, we investigated whether pathogens also stimulate extracellular proteostasis. Using a pore-forming toxin to mimic a pathogenic attack, we found that C. elegansresponded by increasing the expression of components of extracellular proteostasis and by limiting aggregation of extracellular proteins. The activation of extracellular proteostasis was dependent on stress-activated MAP kinase signalling. Notably, the overexpression of components of extracellular proteostasis delayed ageing and rendered worms resistant to intoxication. We propose that enhanced extracellular proteostasis contributes to systemic host defence by maintaining a functional secreted proteome and avoiding proteotoxicity.

Non-alcoholic steato-hepatitis (NASH) is a severe disease characterised by liver inflammation and progressive hepatic fibrosis, which may progress to cirrhosis and hepatocellular carcinoma. Clinical evidence suggests that in hepatitis C virus patients steatosis and NASH are associated with faster fibrosis progression and hepatocellular carcinoma. A safe and reliable non-invasive diagnostic method to detect NASH at its early stages is still needed to prevent progression of the disease. We prospectively enrolled 91 hepatitis C virus-positive patients with histologically proven chronic liver disease: 77 patients were included in our study; of these, 10 had NASH. For each patient, various clinical and serological variables were collected. Different algorithms combining squamous cell carcinoma antigen-immunoglobulin-M (SCCA-IgM) levels with other common clinical data were created to provide the probability of having NASH. Our analysis revealed a statistically significant correlation between the histological presence of NASH and SCCA-IgM, insulin, homeostasis model assessment, haemoglobin, high-density lipoprotein and ferritin levels, and smoke. Compared to the use of a single marker, algorithms that combined four, six or seven variables identified NASH with higher accuracy. The best diagnostic performance was obtained with the logistic regression combination, which included all seven variables correlated with NASH. The combination of SCCA-IgM with common clinical data shows promising diagnostic performance for the detection of NASH in hepatitis C virus patients.

The article reports on the U.S. Joint Chiefs of Staff Joe Dunford creating a Globally Integrated Exercise (GIE) structure to achieve global integration to enhance Department of Defense strategic planning and execution. GIE structure focuses on combatant commander and higher authority integration. It is said that modern technology and change in the nature of geopolitical competition have altered the character of war in the 21st century.

Evaluation of the effects of an individualized home-based unsupervised aerobic training on body composition, physical and physiological parameters in female and male obese adults. Two hundred and twenty obese adults (age 47.9 ± 12.4 years; BMI 38.0 ± 7.2 kg/m2) entered the 4-month training program. Body composition, physiological and functional capacities were assessed pre- and post-intervention. All subjects were requested to perform unsupervised aerobic training with the intensity based on heart rate, walking speed and OMNI-RPE score corresponding to the individual ventilatory threshold for at least 5 days/week. After 4-month study period, 40% of patients completed the protocol, 24% had high compliance (HC) (exercise ≥ 3 days/week), while 16% had low compliance (LC) to exercise prescription (exercise < than 3 days/week). In HC group, a significant improvement of body composition variables after training was performed. Moreover, oxygen uptake and metabolic equivalent at peak significantly increased after training. Six-minute walking test (6MWT) distance significantly increased while heart rate during 6MWT was significantly lower after training. No significant differences were found in LC group between pre- and post-intervention in all variables. Interestingly, gender does not influence the effects of training. Our results indicate that subjects, independent of gender, with high compliance to the aerobic training based on a new individualized method can achieve a significant reduction in weight loss and also an improvement in physical and physiological parameters. This innovative personalized prescription could be a valuable tool for exercise physiologist, endocrinologists, and nutritionists to approach and correct life style of obese subjects.

As part of minimally invasive surgery, robotic-assisted approach is becoming increasingly popular in gynecologic oncology. It has been shown to be effective and feasible for staging and treating endometrial and cervical cancer, but its role in the context of primary and recurrent ovarian cancers is presently debated. Scanty data are available in the literature, and the level of evidence supporting its use in ovarian cancer is quite low. However, from a retrospective case–control series, robotic surgery seems to be safe and feasible for early-stage ovarian cancer. Its use in treating patients with advanced-stage or relapsed ovarian cancer is still highly controversial, suggesting the choice of robotic approach in a highly selected population.

Lateral flow assays (LFAs) are the technology behind low-cost, simple, rapid and portable detection devices popular in biomedicine, agriculture, food and environmental sciences. This review presents an overview of the principle of the method and the critical components of the assay, focusing on lateral flow immunoassays. This type of assay has recently attracted considerable interest because of its potential to provide instantaneous diagnosis directly to patients. The range and interpretation of results and parameters used for evaluation of the assay will also be discussed. The main advantages and disadvantages of LFAs will be summarized and relevant future improvements to testing devices and strategies will be proposed. Finally, the major recent advances and future diagnostic applications in the LFA field will be explored.

We discuss the diagnosis and the management of endometrial carcinoma in a single horn of bicornuate uterus in a 64-year-old woman as a case report. The case underwent laparoscopic radical hysterectomy and bilateral iliac lymphadenectomy.

Former US Navy crew members are working for the preservation of an EA-3B aircraft, called the Electronic Whale. This aircraft served from 1956-1992 as an intelligence collection aircraft for the US Navy.

Ovarian cancer (OC) represents one of the most letal cancers in women. The aim of surgical treatment consists of complete cytoreduction in advanced stages and a surgical staging in early stages. Although the guidelines still suggest laparotomy as the standard approach, in recent years minimally invasive surgery (MIS) has become more and more popular in the treatment of OC, especially in early stages, in which the 5-year relative survival exceeds 90% and the patients’ quality of life cannot be overshadowed. However, MIS has been demonstrated to have a role even in advanced stages, in the prediction of optimal cytoreduction, identifying patients who may benefit from neoadjuvant chemotherapy, and, more recently, in the interval debulking surgery, as in selected cases of secondary cytoreduction for recurrent ovarian cancer. The aim of this review is to describe the MIS (especially robotic surgery), with its advantages and pitfalls, in the treatment of OC.

To evaluate the safety and feasibility of the new robotic TELELAP ALF-X platform in a heterogeneous series of gynecological procedures. Between September 2013 and May 2014, 146 patients were enrolled in this Phase II study trial. Patients with presumed benign or borderline adnexal disease, and benign and early stage malignant uterine disease were prospectively included. Median age was 52 years (range 19–79 years), and median BMI was 23.7 (range 17.3–34.0 kg/m2). Sixty-two patients (32.5 %) underwent mono/bilateral salpingo-oophorectomy or cyst removal (Group A), four patients (2.7 %) myomectomy (Group B), 46 patients (31.5 %) total hysterectomy (Group C), and 34 (23.3 %) endometrial cancer staging (Group D). Median docking time was 7 min (range 3–36). Median OT was 35 min (range 17–145) in the Group A, 40 min (range 10–50) in the Group B, 133 min (range 58–320) in the Group C, and 160 min (range 69–290) in the Group D. Reduction in OT over the study period for hysterectomy (p< 0.001) and adnexal surgery (p< 0.002) was observed. We registered two laparoscopic conversion (3.2 %) in the Group A and two (4.3 %) in the Group C. In the Group D, we showed one (2.9 %) laparoscopic and two (5.8 %) laparotomic conversions. One patient (2.17 %) in the Group C was readmitted in the early postoperative period for severe vaginal bleeding. We report the first series of a novel robotic approach for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, TELELAP ALF-X is feasible and safe. Further studies are mandatory to define the benefits, advantages, and costs of this new robotic approach with respect to others minimally invasive approaches.

The aim of the study was to compare the psychophysical effects of rock climbing with a supervised fitness training in adults. Thirty-three healthy participants (Mage = 32yr., SD= 7) participated in rock climbing or in fitness training. The participants' functional fitness, anxiety, and mood states were tested before and after 3 mo. of training. There was significant improvement of physical fitness in both groups after the intervention period. Anxiety significantly decreased after each single training session at the end of both courses. Differential effects in the rock-climbing group, as compared to the fitness group, emerged only on Vigor. Specifically, the rock-climbing group showed a decreasing trend in Vigor while the fitness group showed an increasing trend of Vigor after the intervention.

Prostate cancer is the most common cancer among men except for skin cancer, and the detection at early stages is crucial. In the present work, nanofabricated memristive biosensors are subjected to surface bio-modification targeting at prostate-specific antigen (PSA) IgM detection. The electrical response of the nanofabricated devices examined before and after the bio-modification achieves a label-free detection for three biomarker concentrations. The presence of biomolecules linked to the surface of the nanostructures is detected by a voltage gap appearing in the memristive electrical characteristics. Enzyme-linked immunosorbent assay methodology is further applied to verify the efficiency of the application of diverse biomarker concentrations on the surface. Scanning electron microscopy shows details on the morphology of the nanofabricated structures before and after the bio-modification, and confocal microscopy is implemented to obtain a 3D fluorescent signal distribution of the biomolecules. The system shows the potential for applications in molecular diagnostics and for implementation targeting at the early detection of the prostate cancer disease.

Il presente saggio intende presentare la tematica della costruzione del personaggio letterario di Antonio Tabucchi (1943–2012), da Piazza d’Italia(1975) a Tristano muore(2003), particolarmente alla luce del supporto critico metodologico fornito da Seymour Chatman in Story and Discourse(1978) e alle nozioni di narratore nascosto (covert) e narratore palese (overt). Nonostante i numerosi contributi sull'opera tabucchiana apparsi su questa tematica negli ultimi anni, probabilmente lo studio più esaustivo sul rapporto autore–personaggio in seno alla sua opera resta Antonio Tabucchi: navigazioni in un arcipelago narrativo(2002) di Brizio-Skov. Inoltre, se la critica si è finora maggiormente soffermata sul rapporto tra Tabucchi e Fernando Pessoa (1988–1935), nel presente saggio viene piuttosto sottolineato il rapporto di analogia esistente con Luigi Pirandello (1867–1936) per quanto concerne la creazione del personaggio letterario. Un personaggio inteso come “fantasma” o entità “in cerca d'autore” che rimanda alla memoria le “fantasie umbratili” tabucchiane. Attraversando un secolo di storia, si è potuto osservare il ripresentarsi di una poetica che ha costantemente presentato spunti originali sul rapporto autore–personaggio, e analizzare quanto il contributo tabucchiano abbia influito su nuove generazioni di scrittori, come dimostra l’esempio di Andrea Bajani (1976).

Enough Pseudo-histrionics already!!! I just reread the October JED editorial about linear and impulse tactics in warfare (see 'Army of One,' JED, October 2003, p. 12). That one like past [...]

Aim: this study evaluates the analytical and clinical performances of a new technology, CompleXima HCC Biochip, for the simultaneous serum measurement of alpha-fetoprotein-IgM (AFP-IgM) and squamous cell carcinoma antigen-IgM (SCCA-IgM). Methods: AFP- and SCCA-IgM were measured by both ELISA and CompleXima HCC Biochip in 39 blood donors and in 174 patients (102 liver cirrhosis – LC – and 72 hepatocellular carcinoma – HCC). Results: the intra-assay coefficients of variation were lower than 12% and the inter-assay variations comprised between 14% and 21%. The linearity interval for the CompleXima HCC Biochip was 50–300 AU mL−1for AFP-IgM and SCCA-IgM. The comparison between the prototype and the ELISA test was studied by using the Bland–Altman method and Passing–Bablok regression analyses. Passing–Bablok showed that the Biochip under-estimated AFP-IgM (Intercept A: −165.06; 95% CI: −313.11 to −51.32) and overestimated SCCA-IgM (Intercept A: 26.83; 95% CI: 14.47–35.86) with respect to ELISAs. Both biomarkers were higher in LC and HCC with respect to controls (p< 0.001) with no difference between LC and HCC (p= 0.864 for AFP-IgM and p= 0.214 for SCCA-IgM). The thresholds for AFP-IgM and SCCA-IgM were calculated by means of ROC curves, fixing the specificity at 95%. The sensitivity of AFP-IgM and SCCA-IgM associated with CompleXima in detecting patients with liver diseases was 47% and 46%, respectively. The combined evaluation of macrocomplexes with CompleXima in diagnosing HCC with respect to LC was associated with a sensitivity of 51.4% and a specificity of 48%. Conclusions: AFP-IgM and SCCA-IgM increase in chronic liver disease. The prototype CompleXima HCC Biochip allows their measurement with a good analytical reproducibility.

Optimally, secondary cytoreduction is acknowledged as a valid option in terms of oncologic outcome for patients with platinum-sensitive recurrent ovarian cancer. In cases of localized relapse, a laparoscopic approach has been attempted at various institutions, but studies on its role for this subset of patients still are limited. This report describes the authors’ experience using laparoscopic secondary cytoreduction for patients with localized recurrent ovarian cancer. The results from a retrospective analysis of a prospective case series are reported. Between October 2011 and May 2013, 29 patients with localized recurrent ovarian cancer were selected for a laparoscopic cytoreduction. Two conversions to laparotomy occurred. The analyzed outcome variables included stage and site of disease, type of surgical procedure, operative time, blood loss, length of hospital stay, complications, and oncologic outcome. The median operating time was 188 min. The median estimated blood loss was 150 mL, and the median hospital stay was 4 days. Complete debulking was achieved for 96.2 % of the patients. No intraoperative complications occurred, and postoperative complications were noted in only one patient. The median disease-free survival time was 14 months. For selected patients, laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with localized recurrent ovarian cancer.

ABSTRACTGroup A streptococcus (GAS) is a human pathogen causing a wide repertoire of mild and severe diseases for which no vaccine is yet available. We recently reported the identification of three protein antigens that in combination conferred wide protection against GAS infection in mice. Here we focused our attention on the characterization of one of these three antigens, Spy0269, a highly conserved, surface-exposed, and immunogenic protein of unknown function. Deletion of the spy0269gene in a GAS M1 isolate resulted in very long bacterial chains, which is indicative of an impaired capacity of the knockout mutant to properly divide. Confocal microscopy and immunoprecipitation experiments demonstrated that the protein was mainly localized at the cell septum and could interact in vitrowith the cell division protein FtsZ, leading us to hypothesize that Spy0269 is a member of the GAS divisome machinery. Predicted structural domains and sequence homologies with known streptococcal adhesins suggested that this antigen could also play a role in mediating GAS interaction with host cells. This hypothesis was confirmed by showing that recombinant Spy0269 could bind to mammalian epithelial cells in vitroand that Lactococcus lactisexpressing Spy0269 on its cell surface could adhere to mammalian cells in vitroand to mice nasal mucosa in vivo. On the basis of these data, we believe that Spy0269 is involved both in bacterial cell division and in adhesion to host cells and we propose to rename this multifunctional moonlighting protein as SpyAD (Streptococcus pyogenesAdhesion and Division protein).

The aerial parts of Spergula fallaxafforded four glycosides (1–4) based on two new triterpene aglycones (1aand 2a), along with the known hopane glycoside succulentoside A. Compound 1was identified as belonging to the fernane class, unusual migrated hopane triterpenoids, mainly isolated from ferns and only rarely from higher plants. Compounds 2–4were assigned as gammacerane glycosides, having as aglycone a hydroxylated derivative of tetrahymanol. The structures of the isolated compounds 1–4and their aglycones 1aand 2aobtained by acid hydrolysis were elucidated by spectroscopic data interpretation. The growth inhibitory activity of the isolated compounds and their aglycones was evaluated against the HeLa and DLD-1 cancer cell lines.

This study was designed to compare perioperative outcomes and postoperative pain of standard laparoscopic (S-LPS), minilaparoscopic (M-LPS), and laparoendoscopic single-site (LESS) hysterectomy.A single-institutional, matched, retrospective, cohort study was performed. Between May 2010 and March 2011, 85 consecutive women were submitted to a total laparoscopic hysterectomy by S-LPS, M-LPS, and single-port LESS. Perioperative outcomes of these three techniques were analyzed and compared.Demographics and baseline characteristics of each group were absolutely comparable. The median operative time was longer [105 (range, 75–125) min] in the LESS group compared with the M-LPS group [90 (range, 60–120) min; p< 0.011] and S-LPS [80 (range, 50–110) min; p< 0.001]. No statistically significant differences have been reported for estimated blood loss or intra- and early postoperative complications. Postoperative pain control was better for LESS and M-LPS than S-LPS.M-LPS and LESS hysterectomy can be performed safely, and both seem to be associated with a halving of early postoperative pain with a lower request of analgesics.

The cancellation of the ASPJ project by the Defense Dept in 1992 was untimely, because of the need for better electronic countermeasures against threats to US military aircraft. More advanced air-to-air and surface-to-air missiles pose a formidable threat.

Abstract: Background: In the last few years, technical advances have produced a dramatic shift from traditional open surgery toward a minimally invasive approach, even in oncological procedures. We present our initial experience with laparoendoscopic single-site surgery (LESS) in the surgical treatment of early-stage endometrial cancer patients. Methods: Between July 2009 and May 2010, 20 consecutive low-risk early endometrial cancer patients were enrolled in this single institution prospective cohort trial. Results: The median age of the patients was 57 years (range = 42–68) and median body mass index was 24 kg/m2 (range = 21–30). Median operative time was 105 min (range = 85–155) and median estimated blood loss was 20 ml (range = 10–180). The larger skin and fascial incision required for the single-port approach was 2.5 cm (median = 2.2 cm; range = 2.0–2.5). No laparoscopic/laparotomic conversion was registered, and no insertion of additional ports was necessary. Median ileus was 16 h (range = 12–20) and median time to discharge was 1 day (range = 1–2). All patients were completely satisfied with the cosmetic results and postoperative pain control. Conclusions: Laparoendoscopic single-site surgery could represent a surgical option for extra-fascial hysterectomy in early-stage endometrial cancer patients, with the potential to further decrease invasiveness of the conventional laparoscopic approach.

Many assays aimed to test the inhibitory effects of synthetic molecules, and naturally occurring products on the neuraminidase activity exploit the hydrolysis of 2′-O-(4-methylumbelliferyl)-N-acetylneuraminic acid (4-MUNANA). The amount of the released product, 4-methylumbelliferone (4-MU), is then measured fluorimetrically. The authors attempted an analysis of the inhibitory properties of 35 naturally occurring flavonoids on neuraminidase N3, where only 29 of them were sufficiently soluble in the assay medium. During the analysis, the authors noticed a strong quenching effect due to the test compounds on the fluorescence of 4-MU. The quenching constants for the flavonoids were determined according to the Stern-Volmer approach. The extent of fluorescence reduction due to quenching and the magnitude of the fluorescence reduction measured in the inhibition assays were comparable: for 11 of 29 compounds, the two values were found to be coincident within the experimental uncertainty. These data were statistically analyzed for correlation by calculating the pertinent Pearson correlation coefficient. Inhibition and quenching were found to be positively correlated (r= 0.71, p(uncorr) = 1.5 × 10–5), and the correlation was maintained for the whole set of tested compounds. Altogether, the collected data imply that all of the tested flavonoids could produce false-positive results in the neuraminidase inhibition assay using 4-MUNANA as a substrate.

Abstract: Background: This study aimed to validate the feasibility, efficacy, and safeness of laparoscopic treatment for benign adnexal diseases through a single transumbilical access in a prospective series of patients. Methods: A prospective clinical trial including 30 women was conducted in our teaching and research division. Patients underwent different laparoscopic procedures by the laparoendoscopic single-site (LESS) approach using a multiport trocar, conventional laparoscopic instrumentation, and standardized surgical technique, with evaluation of the multiaccess conversion rate. Results: The patients underwent different laparoscopic procedures (10 bilateral adnexectomies; 22 cystectomies, and 3 chromosalpingographies) by the LESS approach using a multiport trocar and conventional laparoscopic instrumentation with standardization of this innovative minimally invasive technique. The laparoscopic procedures were completed through a single access in 28 cases (93.4%). In two cases, at the end of the intervention, hemostasis required one additional sovra-pubic access. No major intra- or postoperative complications were observed. The mean hospital stay was 1.3 days. Conclusions: The results of this study suggest the feasibility of the LESS approach in gynecologic surgery with a low conversion rate for multi-access laparoscopy, a rapid learning curve, limited complications, and good results in terms of cosmesis and postoperative pain. More clinical data are needed to confirm these advantages over standard laparoscopic technique.

Circulating immune complexes formed by tumor antigens and immunoglobulin M (IgM) represent a novel class of biomarkers with diagnostic value for early cancer detection. The quantitative analysis of these immune complexes is achieved by enzyme-linked immunosorbent assay (ELISA) methods using a purified calibrator from samples of patients with cancer. These complexes obtained from samples of human origin are not suitable for cost-effective production processes with high safety standards. Given the ill-defined biomarker/IgM ratio in these complexes, semisynthesis with retention of functional properties is difficult to achieve and may vary widely according to the batch-to-batch heterogeneity of starting biological preparations. Here the authors describe the development of a combinatorial method for defining the optimal reaction conditions for the reproducible semisynthesis of biomarker-IgM complexes by exploiting the biotin-avidin technology. The method relies on screening by ELISA the 3D composition space defined by the combinatorial variation of biotinylated-biomarker, biotinylated-IgM, and avidin concentrations aiming to select those conditions leading to biomarker-IgM complexes with the highest immunoreactivity. The method allows the reproducible synthesis of species with immunoreactivity comparable to that of natural immune complexes and endowed with sufficient stability to be used as calibrators in ELISA.

To report feasibility of laparoscopic fertility-sparing staging of border line ovarian tumors BOTs by using a laparoendoscopic single-site trocar through a unique transumbilical access.

Background and aims:Diagnosis of dementia is often difficult in subjects with low educational level. Our aim was to evaluate the role of functional performance and the possibility of preferring scores of activities of daily living (ADL) and instrumental activities of daily living (IADL) in screening elderly people for diagnosis of dementia in a rural population of Southern Italy with a very high percentage of non-educated subjects. Methods:a random sample of 300 residents, out of 1089 subjects over 60 years of age living in San Marcellino (Caserta, Campania), received door-to-door visit for information about their medical history, with clinical evaluation of general geriatric conditions, including the cumulative illness rating scale (CIRS). Dementia was diagnosed if subjects had a Clinical Dementia Rating score (CDR) = 1 and according to the criteria of DSM-IV, but not according to scores on the Mini Mental State Examination (MMSE), ADL and IADL. Two hundred and nineteen normal subjects (NS) and 75 patients with dementia (DP) were evaluated. Results:in NS, their mean age- and education-corrected MMSE score was 22.15 (lower than the normal cut-off value of 23.8) and 12.60 in DP (p<0.0001). In NS, the mean ADL score was higher than in DP (5.53 vs 2.64, p<0.0001; only age was correlated with ADL scores (coeff=- 0.44, t=- 4.557, p<0.0001). Assuming age as covariate, ADL scores highly differentiated DP from NS (F(1, 289)=26.083, p<0.0001). In both sexes, mean IADL scores were higher in NS than in DP (4.46 vs 1.80 in men, p<0.0001); 6.85 vs 2.31 in women, p<0.0001. Age and education did not influence IADL scores in men, but age greatly affected performance in women. IADL scores clearly differentiated NS from DP. In NS, a positive correlation was evident between ADL and IADL scores (r=0.234, p<0.0005, but neither scores correlated with the MMSE scores, even when correlation was performed separately for men and women. In DP, a strong correlation was observed between ADL and IADL scores (r=0.709, p<0.0001 and significant correlations were also evident between the scores of MMSE and both ADL (r=0.492,p<0.0001) and IADL (r=0.398, p<0.0004). Conclusions:in a rural community with a high prevalence of non-educated subjects, cognitive impairment is related to education, whereas independent functioning is limited mainly to age and not to cognition, if the latter remains (relatively) unimpaired. These results point to the importance of an “ecological” approach to the evaluation of elderly people, particularly those living in small rural communities, where education and the social environment may give rise to difficulties in diagnosis of dementia. The assessment of functional autonomy by ADL and IADL scales may be a better screening tool in diagnosing dementia than the MMSE scores.

To evaluate the influence of chronological age and pubertal development on the hypothalamus-pituitary-adrenal (HPA) axis response to stress, we studied the possible correlations between male pubertal characteristics and salivary cortisol (C), DHEAS and the DHEAS/ C ratio before (pre-stress) and after acute exercise-stress in young male volunteers (no. 87; 13.3±2.1 yr). In our overall study population, the mean pre-stress salivary C and DHEAS concentrations, significantly increased after exercise-related stress, whereas the DHEAS/C ratio significantly decreased. Pre-stress salivary C was positively correlated with chronological age, and after-stress salivary C concentration variations were negatively correlated with pubertal stage, mean testis volume and pre-stress salivary DHEAS. Furthermore, salivary DHEAS concentrations and the DHEAS/C ratio, before and after exercise stress, were positively correlated with chronological age, pubertal stage, pre-stress salivary testosterone (T), testis volume and body mass index (BMI). In contrast with late pubertal stages (P4, P5), young individuals at early stages of puberty (P1 to P3) showed higher C increase and lower DHEAS/C ratio after exercise-related stress. In conclusion, since C is also a mediator of stress-related negative effects on health and the DHEAS/C ratio has been hypothesized as an index for the degree to which an individual is buffered against the negative effects of stress, these data might suggest potentially increased stress-related risks at early stages of male puberty.

Background and aims:The aim of our study was to understand how demographic and environmental factors may be associated with cognitive functions in a rural population of Southern Italy, with a very high percentage of elderly persons with little formal education. Materials and methods: From the population registry of San Marcellino (province of Caserta), out of 1089 persons aged over 60 years, a random sample of 300 residents received a door-to-door visit. Two hundred and twenty-six subjects were judged as not having significant cognitive impairment, on the basis of their personal history and Clinical Dementia Rating score (<1). They were administered the Mini Mental State Examination (MMSE). Results:A positive statistically significant correlation was observed between MMSE score and education, but not between MMSE score, age and gender. Normative data showed that 90% of the normal population from this area had an adjusted MMSE score of more than 16.20, a value far below the traditional cutoff score of 23/24 for diagnosis of dementia. Subjects living with their families showed better performance than persons living alone or only with spouses. Conclusions:This finding is consistent with other epidemiologic surveys, and suggests the possible role of ecological and environmental factors in preventing or compensating cognitive decline, at least in persons coming from homogeneous rural areas. Low social demands in a protective family environment do not stimulate high intellectual performance, and signs of dementia may not be recognized by persons living in this context until the patient reaches a severe stage of disease.

Most women with epithelial ovarian cancer (EOC) are diagnosed at advanced stages of disease (AEOC) when there is already widespread intraperitoneal disease. Survival rates are low for these women. The standard approach for AEOC patients is primary debulking surgery (PDS) followed by combination platinum-based chemotherapy. An option developed for these patients is use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). A critical prognostic factor for survival in patients with AEOC who receive PDS or NACTIDS is the amount of visible tumor after surgery. Survival rates are higher in patients with no or minimal residual disease (RT).

Presents the recipe for Veal Meatballs With Fried Sage Leaves.