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This article, published in the journal "Ultrasound in Obstetrics & Gynecology," examines the microvascular function in pregnancies complicated by pre-eclampsia and fetal growth restriction (FGR) compared to uncomplicated pregnancies. The study involved 25 women with pre-eclampsia and/or FGR and 25 uncomplicated pregnancies as controls. The researchers used laser speckle contrast imaging (LSCI) combined with post-occlusive reactive hyperemia (PORH) to assess microvascular function. The results showed that microvascular function was impaired in pregnancies with placental-related diseases, particularly pre-eclampsia. The authors suggest further investigation into the use of LSCI as a tool for predicting and diagnosing pre-eclampsia. [Extracted from the article]

Objective: To assess whether repeat cervical-length (CL) measurement in women discharged from hospital after their first episode of threatened preterm labor can predict their risk of spontaneous preterm birth.Methods: This was a secondary analysis of a randomized controlled trial of maintenance tocolysis, in which CL was measured on transvaginal ultrasound at the time of hospital discharge and after 2, 4, 8 and 12 weeks, in women who remained undelivered after their first episode of threatened preterm labor. After univariate analysis, multivariate logistic regression analysis was used to assess whether CL < 10 mm at the time of hospital discharge or at any follow-up evaluation could predict spontaneous delivery prior to 37 weeks of gestation.Results: Of 226 women discharged after a diagnosis of threatened preterm labor, 57 (25.2%) delivered spontaneously prior to 37 weeks' gestation. The risk of spontaneous preterm birth was higher among women with CL < 10 mm at hospital discharge compared to those with CL ≥ 10 mm (adjusted odds ratio (aOR), 3.3; 95% CI, 1.2-9.2). Moreover, spontaneous preterm delivery was more common when CL < 10 mm was detected up to 2 weeks (aOR, 2.9; 95% CI, 1.1-7.3) or up to 4 weeks (aOR, 7.3; 95% CI, 2.3-22.8) post discharge, as compared with when CL was persistently ≥ 10 mm. The association was not significant when considering CL measurements at 8 weeks, and there was insufficient information to assess the effect of measurements obtained at 12 weeks.Conclusions: Women who remain undelivered after their first episode of threatened preterm labor continue to be at high risk of spontaneous preterm birth if their CL is below 10 mm at the time of hospital discharge or at any follow-up visit up to 4 weeks later. CL measurement could be included in the antenatal care of these women in order to stratify their risk of preterm birth, rationalize resource utilization and help clinicians improve pregnancy outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

AIM: We hypothesized that elevated vaginal levels of matrix metalloproteinase-8 (MMP-8), interleukin-8 (IL-8) and the 70kDa heat shock protein (hsp70), compounds involved in infl ammatory responses, correlated with a short cervix in pregnant women. METHODS: This prospective cohort study used a convenience sample of 64 women in their early third trimester with a singleton pregnancy. A short cervical length was present in 35 women (54.7 %). Vaginal fl uid was tested for levels of MMP-8, IL-8 and hsp70 by enzyme-linked immunosorbent assay (ELISA). A receiver operating charasteristic (ROC) analysis was used to calculate the area under the curve (AUC) for each mediator in predicting short cervical length. RESULTS: MMP-8 (109 vs 29.6 ng/ml, p=0.014), IL-8 (689 vs 330 pg/ml, p=0.007) and hsp70 (4.4 vs 2.9 ng/ml, p=0.036) were all elevated in vaginal samples from women with a short cervix. In addition, there was a negative association between the concentration of each compound in vaginal fl uid and cervical length p≤0.026). The vaginal IL-8 concentration had the highest negative correlation with a short cervix (AUC=0.7, p=0.007). CONCLUSION: MMP-8, hsp70 and IL-8 contribute to a pro-infl ammatory cervico-vaginal milieu that weakens cervical integrity and leads to a shortening in cervical length (Tab. 4, Fig. 1, Ref. 27). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To understand the role of fetal spine position in determining a fetal head position at the time of birth and modality of delivery. PATIENTS AND METHODS: This was a multicenter prospective observational study. Fetal occiput and spine position were evaluated by intrapartum ultrasound. Eighty-six women were eligible for inclusion in the study. Occiput rotational movements and modality of delivery in relation to the fetal spine position were investigated. RESULTS: At the beginning of labor, fetal occiput was in a posterior position in 52.3% of cases and, in 81.5% of cases the spine was in an anterior transverse position. At birth, occiput and spine were both in an anterior position in 90.4% of cases. The rate of cesarean sections in the SP group was significantly higher than the rate in the SAT group (50% vs. 8%, p < 0.0007). Instead, the rate of vaginal deliveries without intervention in the SP group was significantly lower than the rate in the SA group (14% vs. 71%, p < 0.0001). CONCLUSIONS: Fetal spine position could have an important role in determining fetal occiput position at birth. Spine position might play a crucial role in the outcome of delivery. [ABSTRACT FROM AUTHOR]

Background: Several randomized controlled trials (RCTs) compared induction of labour with expectant management in non-diabetic women with suspected fetal macrosomia.Objective: To evaluate the effects of labour induction for suspected fetal macrosomia.Search Strategy: Literature search in electronic databases.Selection Criteria: We included all RCTs of suspected fetal macrosomia comparing labour induction with expectant management in term pregnancy.Data Collection and Analysis: The primary outcome was the incidence of caesarean delivery.Main Results: Four RCTs, including 1190 non-diabetic women with suspected fetal macrosomia at term, were analysed. Pooled data did not show a significant difference in incidence of caesarean delivery [relative risk (RR) 0.91, 95% confidence interval (CI) 0.76-1.09], operative and spontaneous vaginal delivery, shoulder dystocia, intracranial haemorrhage, brachial plexus palsy, Apgar score <7 at 5 min, cord blood pH <7, and mean birth weight comparing women who received induction of labour with those who were managed expectantly. The induction group had a significantly lower time to delivery (mean difference -7.55 days, 95% CI -8.20 to -6.89), lower rate of birth weight ≥4000 g (RR 0.50, 95% CI 0.42-0.59) and ≥4500 g (RR 0.21, 95% CI 0.11-0.39), and lower incidence of fetal fractures (RR 0.17, 95% CI 0.03-0.79) compared with expectant management group.Conclusion: Induction of labour ≥38 weeks for suspected fetal macrosomia is associated with a significant decrease in fetal fractures, and therefore can be considered as a reasonable option. TWEETABLE ABSTRACT: #Induction of labour for #macrosomia improves neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the rate of women with polyhydramnios who eventually screened positive to infectious disease by serum screening testing for TORCH and parvovirus B19.Methods: This is a retrospective observational study on singleton pregnancies with a diagnosis of polyhydramnios and who had serum screening for TORCH and parvovirus B19. Patients were followed with serial ultrasounds between 2006 and 2013. Maternal characteristics, medical and obstetric history were reviewed. Ultrasound parameters, including amniotic fluid index and fetal anomalies, and the results of serologic tests were reviewed.Results: Two hundred ninety patients met the inclusion criteria. Of these, 56 (19%) presented one of the following pathological conditions associated with polyhydramnios: diabetes (13% of total cases), obstructive gastrointestinal lesions (5%), Rhesus isoimmunization (0.3%), chromosomal abnormalities or genetic syndromes (1%). Among the remaining 234 patients, only three had a positive test result for infectious disease (1%, 95% Confidence Interval (CI) 0-4%): two women were positive for parvovirus B19 and one for toxoplasmosis infection. In none of them the fetus was affected, as confirmed by serum testing after birth and by 3 years follow-up.Conclusions: Infectious disease screening does not seem beneficial in pregnancies with isolated polyhydramnios. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in locally advanced rectal cancer (LARC) 8 weeks after neoadjuvant chemoradiotherapy (CRT). Methods and materials: A total of 28 patients with LARC underwent magnetic resonance imaging (MRI) prior to and 8 weeks after CRT. Tumor volume (TV) was calculated on T2-weighted MRI scans as well as the apparent diffusion coefficient (ADC) was calculated using Echo-planar DWI-sequences. All data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. Post-treatment difference ADC (%ΔADC) and TV (%ΔTV) changes at 8 weeks were compared complete response (CR; TRG1) and non-complete response tumors (non-CR; TRG2–5). Results: The mean % ADC increase of CR group was significantly higher compared to non-CR group (77.2 ± 54.63% vs. 36.0 ± 29.44%; p = 0.05). Conversely, the mean % TV reduction did not significantly differ in CR group from non-CR group (73.7% vs. 63.77%; p = 0.21). Accordingly, the diagnostic accuracy of the mean % ADC increase to discriminate CR from non-CR group was significantly higher than that of the mean % TV reduction (0.913 vs. 0.658; p = 0.022). No correlation was found between mean % TV reduction and TRG (rho = 0.22; p = 0.3037), whereas a negative correlation between mean % ADC increase and TRG was recorded (r = −0.69; p = 0.006). Conclusion: The mean % ADC increase appears to be a reliable tool to differentiate CR from non-CR after CRT in patients with LARC. [ABSTRACT FROM AUTHOR]

Objective: To confirm the role of fetal growth restriction (FGR) as a cause of stillbirth, and to compare diagnostic accuracy of customized fetal growth and population-based standards in identifying FGR within a pathological population of early and late stillbirths. Methods: Retrospective study on a cohort of 189 stillbirths occurred in single pregnancy between January 2006 and September 2011. Unexplained stillbirths, defined by Aberdeen-Wigglesworth and ReCoDe classifications, were evaluated on the basis of fetal birthweight with both Tuscany population and Gardosi customized standards. Unexplained stillbirths have been classified as early or late depending on the gestational age of occurrence. Results: Aberdeen-Wigglesworth classification, applied to the 189 cases of stillbirth, left 94 unexplained cases (49.7%), whereas the ReCoDe classification left only 40 (21%). By applying population standards to the 94 unexplained stillbirths we have identified 31 FGRs (33% of sample), while customized standards identified 54 FGRs (57%). Customised standards identified a larger number of FGRs with respect to population standards during the third trimester (i.e. 51% vs. 25% respectively) than in the second trimester (73% vs. 54% respectively) ( p = 0.05). Conclusions: Customized standards have a higher diagnostic accuracy in identifying FGRs especially during the third trimester. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) is a disease condition leading to right-sided cardiac hypertrophy and, eventually, right-sided heart failure. Cardiac troponin I (cTnI) is a circulating biomarker of cardiac damage. Hypothesis: Myocardial damage can occur in dogs with precapillary and postcapillary PH. Animals: One hundred and thirty-three dogs were examined: 26 healthy controls, 42 dogs with mitral valve disease (MVD) without PH, 48 dogs with pulmonary hypertension associated with mitral valve disease (PH-MVD), and 17 dogs with precapillary PH. Methods: Prospective, observational study. Serum cTnI concentration was measured with a commercially available immunoassay and results were compared between groups. Results: Median cTnI was 0.10 ng/mL (range 0.10–0.17 ng/mL) in healthy dogs. Compared with the healthy population, median serum cTnI concentration was increased in dogs with precapillary PH (0.25 ng/mL; range 0.10–1.9 ng/mL; P < .001) and in dogs with PH-MVD (0.21 ng/mL; range 0.10–2.10 ng/mL; P < .001). Median serum cTnI concentration of dogs with MVD (0.12 ng/mL; range 0.10–1.00 ng/mL) was not significantly different compared with control group and dogs with PH-MVD. In dogs with MVD and PH-MVD, only the subgroup with decompensated PH-MVD had significantly higher cTnI concentration compared with dogs with compensated MVD and PH-MVD. Serum cTnI concentration showed significant modest positive correlations with the calculated pulmonary artery systolic pressure in dogs with PH and some echocardiographic indices in dogs with MVD and PH-MVD. Conclusions and Clinical Importance: Serum cTnI is high in dogs with either precapillary and postcapillary PH. Myocardial damage in dogs with postcapillary PH is likely the consequence of increased severity of MVD. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of canine diabetic ketoacidosis (DKA) usually is based on measurement of urinary acetoacetate (ketonuria). In humans, this test is less sensitive and specific than blood 3-β-hydroxybutyrate (ketonemia) evaluation. Hypothesis: Ketonemia measurement using a portable meter is more accurate than ketonuria determination with a dipstick to diagnose canine DKA. Animals: Seventy-two client-owned diabetic dogs with ketonemia, ketonuria, or both. Methods: Prospective observational study. Based on blood bicarbonate concentration and anion gap, dogs were divided into 2 groups: patients with DKA ( n= 25); patients with diabetic ketosis ( n= 47). Sensitivity, specificity, and positive and negative likelihood ratio (LR) at different cut-off points were determined for both ketonemia and ketonuria. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of each diagnostic test to diagnose DKA. Results: With regard to ketonemia, cut-off values of 2.3 and 4.3 mmol/L revealed 100% sensitivity and 100% specificity, respectively, whereas cut-off values of 2.8 and 3.5 mmol/L showed a −LR of 0.05 and a + LR of 13.16, respectively. With regard to ketonuria, a cut-off value of 1+ revealed 92% sensitivity, 40% specificity, and −LR of 0.20, whereas a cut-off value of 3+ revealed 44% sensitivity, 94% specificity, and +LR of 6.89. The areas under the ROC curves for the ketonemia and ketonuria tests were significantly different (0.97 and 0.81, respectively, P= .003). Conclusions and Clinical Importance: Measurement of ketonemia is accurate and more effective than measurement of ketonuria to diagnose canine DKA. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Lower GI (colon, rectum, anus) PO-1093: Defecography for sphincter evaluation in rectal cancer patients irradiated with dose intensification C. Rosa, M. Di Tommaso, B. Seccia, A. Delli Pizzi, R. Cianci, R. Basilico, A. Di Pilla, M. Taraborrelli, L. Caravatta, D. Genovesi. [Extracted from the article]

Waldenström Macroglobulinemia is a low-grade immunosecretory disorder associated with lymphoid tumours, which is rarely reported in veterinary medicine. In this study, we describe two clinical cases of this rare syndrome in dogs, each characterized by a different onset and clinical course. In one case, a hyperacute onset and aggressive behaviour of the neoplasm was observed. Absolute serum viscosity (SV) was retrospectively evaluated in order to explain clinical findings. Rotational viscosimetry showed good precision in measuring SV. Both dogs had SV values higher than a control groups of healthy dogs although only one subject developed hyperviscosity symptoms and complications. At high paraprotein concentrations, a slight reduction of the M-component was associated with a marked decrease in SV. Thus, this work suggests that SV assessment is a relevant tool for managing monoclonal gammopathies, whose usefulness should be further confirmed in larger cohorts of dogs. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Lower GI (colon, rectum, anus) PO-1094: Pathological complete response and outcomes in rectal cancer patients with treatment intensification C. Rosa, M. Di Tommaso, L. Caravatta, M. Taraborrelli, D. Fasciolo, A. Augurio, R. Cianci, M. Di Nicola, D. Genovesi. [Extracted from the article]

Purpose To present In-Vivo Dosimetry (IVD) results obtained elaborating EPID images by a commercial software. Methods 8474 IVD tests for 386 cancer patients treated with 3DCRT, IMRT and VMAT techniques, were performed using the SOFTDISO software. SOFTDISO uses EPID-images to calculate for each beam (i) the R index, i.e. the ratio between daily reconstructed dose and the planned one at isocenter point and (ii) a γ -like analysis between the reference EPID image and that obtained in a daily fraction. γ -like analysis supplies two indexes: the percentage of points with γ < 1 (γ %) and the mean γ value, ( γ mean). For each test, the pass criteria for the signals (S) agreement Δ S% and distance to agreement Δ d, were: 0.95 ⩽ R ⩽ 1.05, γ % ⩾ 90% and γ mean ⩽ 0.5. Results The results of R ratios, the γ -like analysis and the visual inspection of out of tolerance tests, together with the patient anatomical images, permitted to individuate 2 classes of errors: class-1, due to inadequate standard quality controls and class-2, due to patient morphological changes. Depending on the technique and anatomical site, a maximum of 18% of tests had at least one index out of tolerance level (OTL). Once removed the causes of class-1 errors, all patients (except four lung and two breast cancer patients treated with 3DCRT) presented mean indexes values ( R ¯ , γ ¯ % and γ ¯ mean ) within tolerance at the end of treatment course. Class-2 errors were found in some patients. As an example, the Table reports the results of 1810 tests for prostate and H&N tumours treated with VMAT technique with 163 OTL tests (9%). As regards the workload, it took 20 min for 10 patients per day. Conclusions The IVD procedure with SOFTDISO resulted easily implementable and able to individuate errors with a limited workload. [ABSTRACT FROM AUTHOR]

An abstract of the article "Association between isolated mild ventriculomegaly and fetal infections: a six-year experience" by G. Masini and colleagues is presented.

An abstract of the article "Infection's screening and polyhydramnios: our experience on 342 cases" by C. Gaini and colleagues is presented.

F. Patani, D. Fasciolo, A. Allajbej, M. Trignani, M. Di Tommaso, A. Augurio, A. Vinciguerra, L. Caravatta, D. Genovesi, Poster: Clinical track: Prostate PO-1183: Do we need sigma constraints in era of intensity-modulated radiation therapy for prostate cancer?. [Extracted from the article]

Poster discussion: CL: Gynaecology PD-0656: A contouring atlas on MRI of emerging pelvic female organs at risk for daily practice radiotherapy A. Allajbej, F. Patani, L. Gasparini, F.C. Di Guglielmo, C. Bonfiglio, D. Fasciolo, C. Rosa, M. Trignani, A. Vinciguerra, L. Caravatta, M. Di Tommaso, R. Cianci, R. Basilico, A. Augurio, D. Genovesi. [Extracted from the article]