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Abstract Background The precursors of clear cell endometrial carcinoma (CC-EC) are still undefined. Here, we deal with the diagnostic issues related to CC-EC precursors by presenting a morphological, immunophenotypical and molecular study of two representative cases and discussing the relevant literature. Case presentation Our and previous cases suggest that clear cell endometrial intraepithelial carcinoma (CC-EIC) is a real entity, which may be distinguished from metaplastic/reactive changes and from its serous counterpart. CC-EIC appears associated with atrophic polyps and may be diagnosed based on morphological and immunophenotypical features of CC-EC in the absence of invasive disease. We described a p53-mutant putative precursor characterized by high-grade nuclei in the absence of other distinctive features. Two putative low-grade precursors resembled atypical tubal metaplasia and endometrial intraepithelial neoplasia, although immunohistochemistry could not support their relationship with CC-EC. Conclusions In conclusion, pathologists should be aware of the existence of CC-EIC, since its correct diagnosis may be crucial for a correct patient management. Although several putative earlier precursors have been described, they does not show univocal features that allow their recognition in the common practice. Further studies are necessary in this field.

Data about the oncological outcomes in women with borderline ovarian tumor (BOT) undergoing uterine-sparing surgery without ovarian preservation are poor. We aimed to assess the oncological outcomes in women with BOT undergoing uterine-sparing surgery without ovarian preservation. A multi-center observational retrospective cohort study was performed including all consecutive postmenopausal patients who underwent surgical treatment for BOT at three tertiary level referral centers for gynecologic oncology from January 2005 to December 2016. Patients were divided into two groups for comparisons: patients undergoing hysterectomy (hysterectomy group) and patients undergoing uterine-sparing surgery (no hysterectomy group). Study outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and surgical complications rate. Ninety-eight patients were included: 44 in the hysterectomy group and 54 in the no hysterectomy group. The 5- and 10-year DFS rates were 97.7% (95% CI: 84.9–99.7) and 92.3% (95% CI: 69.7–98.2), in the hysterectomy group, and 86.8% (95% CI: 74.3–93.5) and 86.8% (95% CI: 74.3–93.5), in the no hysterectomy group, respectively, without significant differences (p=0.16). Hazard ratio for DFS was 0.26 (95% CI: 0.06–1.68) for the hysterectomy group. The 5- and 10-year OS rates were 100.0% (95% CI: -) and 100.0% (95% CI: -), in the hysterectomy group, and 98.2% (95% CI: 87.6–99.7) and 94.4% (95% CI: 77.7–98.7), in the no hysterectomy group, respectively, without significant differences (p=0.23). No significant difference in complication rate was reported among the groups (p=0.48). As hysterectomy appears to not impact survival outcomes of women with BOT, it might be avoided in the surgical staging.

ObjectiveWe aimed to assess the prognostic value of preoperative ultrasound tumor size in EC through a single center, observational, retrospective, cohort study.MethodsMedical records and electronic clinical databases were searched for all consecutive patients with EC, preoperative ultrasound scans available to ad hoc estimate tumor size, and a follow-up of at least 2-year, at our Institution from January 2010 to June 2018. Patients were divided into two groups based on different dimensional cut-offs for the maximum tumor diameter: 2, 3 and 4 cm. Differences in overall survival (OS), disease specific survival (DSS) and progression-free survival (PFS) were assessed among the groups by using the Kaplan–Meier estimator and the log-rank test.Results108 patients were included in the study. OS, DSS and PFS did not significantly differ between the groups based on the different tumor diameter cut-offs. No significant differences were found among the groups sub-stratified by age, BMI, FIGO stage, FIGO grade, lymphovascular space invasion status, myometrial invasion, lymph nodal involvement, histotype, and adjuvant treatment.ConclusionsPreoperative ultrasound tumor size does not appear as a prognostic factor in EC women.

Chronic endometritis (CE) is the persistent inflammation of the endometrial lining associated with infertility and various forms of reproductive failures. The diagnosis of CE is based on the histological evidence of stromal plasma cells; however, standardized methods to assess plasma cells are still lacking. In the present paper, we aimed to determine the most appropriate plasma cell threshold to diagnose CE based on pregnancy outcomes. Three electronic databases were searched from their inception to February 2022 for all studies comparing pregnancy outcomes between patients with CE and patients without CE. The relative risk (RR) of pregnancy, miscarriage, and/or live birth rates were calculated and pooled based on the plasma cell threshold adopted. A p-value < 0.05 was considered significant. Nine studies adopting different thresholds (1 to 50 plasma cells/10 HPF) were included. In the meta-analysis, we only found a significant association between miscarriage rate and a plasma cell count ≥ 5/10 HPF (RR = 2.4; p = 0.007). Among studies not suitable for meta-analysis, CE showed an association with worsened pregnancy only when high thresholds (10 and 50/10 HPF) were adopted. In conclusion, our study suggests that the presence of plasma cells at low levels (

Introduction TRD is a highly disabling condition, often responsible for chronic clinical course, high number of relapses and elevated suicide risk. Intranasal esketamine is currently the only available pharmacological therapy specifically indicated for TRD, as add-on therapy to antidepressant treatment with SSRI or SNRI. Objectives The purpose of the study was to evaluate the safety and efficacy of intranasal esketamine associated with CBT in a complex clinical case of TRD, over a six-month follow-up. Methods A 67-year-old patient with TRD was selected for treatment with intranasal esketamine+CBT as add-on to antidepressant therapy. Before each treatment session the HAM-D rating scale was administered. The patient underwent weekly CBT sessions throughout the 6 months follow-up. The effect on physical well-being and social functioning was evaluated by means of Short-Form-Health-Survey-36. Results After the first two administrations of intranasal esketamine the total score on HAM-D decreased by 10 units (from 26 to 16). After 6 weeks of treatment decreased from 26 to 12 with the disappearance of suicidal ideation present at T0. After 6 months the total HAM-D score decreased from 26 to 8. Treatment was well tolerated, with mild adverse effects, confined to the first two hours post-administration. In particular, mild sedation, dizziness, slight transient blood pressure rise were reported, never required medical intervention and resolved spontaneously during the observation period. Conclusions Intranasal esketamine add-on therapy + CBT was an effective and safe treatment allowing to achieve and maintain symptomatic remission in a complex case of TRD, improving quality of life, social functioning, and reducing suicidal ideation over a six-month follow-up. Disclosure No significant relationships.

Abstract Meditation practice is suggested to engage training of cognitive control systems in the brain. To evaluate the functional involvement of attentional and cognitive monitoring processes during meditation, the present study analysed the electroencephalographic synchronization of fronto-parietal (FP) and medial-frontal (MF) brain networks in highly experienced meditators during different meditation states (focused attention, open monitoring and loving kindness meditation). The aim was to assess whether and how the connectivity patterns of FP and MF networks are modulated by meditation style and expertise. Compared to novice meditators, (1) highly experienced meditators exhibited a strong theta synchronization of both FP and MF networks in left parietal regions in all mediation styles, and (2) only the connectivity of lateralized beta MF networks differentiated meditation styles. The connectivity of intra-hemispheric theta FP networks depended non-linearly on meditation expertise, with opposite expertise-dependent patterns found in the left and the right hemisphere. In contrast, inter-hemispheric FP connectivity in faster frequency bands (fast alpha and beta) increased linearly as a function of expertise. The results confirm that executive control systems play a major role in maintaining states of meditation. The distinctive lateralized involvement of FP and MF networks appears to represent a major functional mechanism that supports both generic and style-specific meditation states. The observed expertise-dependent effects suggest that functional plasticity within executive control networks may underpin the emergence of unique meditation states in expert meditators.

Background: Proper health education and lifestyle information to be adopted during pregnancy are crucial for the well-being of the pregnant women and the health of the child. The aim of our study was to evaluate the impact of proper health education and lifestyle information to be adopted during pregnancy on obstetrical, neonatal and infant outcomes. Methods: A retrospective single-center cohort study was carried out including all consecutive pregnant women admitted to our Institution, from December 2019 to February 2021. The study outcomes were the difference in obstetrical, neonatal and infant outcomes between women differentiated by Body Mass Index (BMI) at the end of pregnancy (i.e., normal weight vs overweight, and normal weight vs obese), physical activity (yes vs no), and smoking during pregnancy (yes vs no). Results: Ninety-one women were included. Compared with normal weight women, obese women showed an increased incidence of major maternal pathologies (p = 0.048) and caesarean delivery (p = 0.042). Regarding physical activity, significant differences were observed between pregnant women who do and do not perform physical activity with a lower value of the incidence of spontaneous vaginal delivery (p = 0.025) in sedentary women. Compared with non-smoking groups, smoking women showed significantly higher BMI at the end of pregnancy (p = 0.036), lower neonatal weight (p = 0.001) and lower Apgar index (p = 0.033). Lastly, the percentage of infants with weight and height percentiles within the mean value did not differ significantly among mothers stratified by BMI, physical activity and smoking. Conclusions: Our data, in agreement with the literature, confirm that the proper information and education about lifestyle changes, particularly regarding BMI and smoking during pregnancy, can improve the health of the women and newborn.

Simple Summary: This article explores the impact of chemotherapy on ovarian function in female cancer survivors, emphasizing the importance of preserving fertility alongside cancer treatment. Chemotherapy-induced ovarian failure (CIOF) poses a significant concern, affecting patients' quality of life. The study aims to identify genetic markers predictive of CIOF through a systematic review of existing literature. The review identifies four relevant studies focusing on genetic factors associated with CIOF. Findings suggest potential associations between genetic variations, like CYP3A4*1B and GSTA1, and CIOF risk. Moreover, BRCA mutations may influence ovarian reserve recovery post-chemotherapy. While current assessment methods rely on biochemical tests and ultrasound imaging, genetic testing holds promise for personalized fertility preservation strategies. Integrating genetic markers into clinical practice could revolutionize decision making in fertility preservation for female cancer survivors, enhancing reproductive potential preservation. Background: Recent advances in cancer diagnosis and treatment have significantly improved survival rates among women of reproductive age facing cancer. However, the potential iatrogenic loss of fertility caused by chemotherapeutic agents underscores the need to understand and predict chemotherapy-induced ovarian damage. This study addresses this gap by systematically reviewing the literature to investigate genetic markers associated with chemotherapy-induced ovarian failure (CIOF). Objective: The primary objective is to identify genetic markers linked to CIOF, contributing to a comprehensive understanding of the factors influencing fertility preservation in female cancer survivors. Methods: A systematic review was conducted using PubMed, EMBASE, Web of Science, Scopus, and OVID electronic databases from inception through December 2023. Studies were included if they featured genomic assessments of genes or polymorphisms related to CIOF in women with histologically confirmed tumors. Exclusion criteria comprised in vitro and animal studies, reviews, and pilot studies. The resulting four human-based studies were scrutinized for insights into genetic influences on CIOF. Results: Of the 5179 articles initially identified, four studies met the inclusion criteria, focusing on alkylating agents, particularly cyclophosphamide, and anthracyclines. Su et al. explored CYP3A41B variants, revealing modified associations with CIOF based on age. Charo et al. investigated GSTA1 and CYP2C19 polymorphisms, emphasizing the need to consider age and tamoxifen therapy in assessing associations. Oktay et al. delved into the impact of BRCA mutations on anti-Müllerian hormone (AMH) levels post-chemotherapy, supported by in vitro assays. Van der Perk et al. focused on childhood cancer survivors and revealed significant associations of CYP3A43 and CYP2B6*2 SNPs with AMH levels. Conclusions: This systematic review analyzes evidence regarding genetic markers influencing CIOF, emphasizing the complex interplay of age, specific genetic variants, and chemotherapy regimens. The findings underscore the need for a personalized approach in assessing CIOF risk, integrating genetic markers with traditional ovarian reserve testing. The implications of this study extend to potential advancements in fertility preservation strategies, offering clinicians a comprehensive baseline assessment for tailored interventions based on each patient's unique genetic profile. Further research is essential to validate these findings and establish a robust framework for integrating genetic markers into clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: We systematically reviewed the literature on port site metastases in low- and intermediate-risk endometrial carcinoma. We searched six electronic databases and compared data on PSM from the included studies, finding seven studies and 13 cases of PSM in patients with low- or intermediate-risk endometrial carcinoma. Local resection and radiotherapy appear to be the most appropriate treatment approaches. Unfortunately, no consensus has been reached about treatment, and the prognosis appears poor. Background: Port site metastasis (PSM) has been reported as a rare metastasis in women with endometrial carcinoma (EC). However, even more rarely, it has also been described in patients with low- or intermediate-risk EC. Unfortunately, knowledge appears limited on the topic. Objectives: Our objective was to systematically review the literature on PSM in low- or intermediate-risk EC. Search Strategy: A systematic review of the literature was performed by searching six electronic databases from their inception to January 2023. Selection Criteria: We included in our research all peer-reviewed studies which reported PSM in low- or intermediate-risk EC women. Data Collection and Analysis: Data on PSM were collected from the included studies and compared. Results: Seven studies with 13 patients (including our case) were included in the systematic review. PSM was reported in patients with low- or intermediate-risk EC independently from tumor histologic characteristics, endoscopic approach, lymph node staging type, number and site of the port, route of specimen removal, prevention strategies for PSM, and concomitant metastases. Among several proposed treatments, local resection and radiotherapy with or without chemotherapy might be the most appropriate ones. Nevertheless, the prognosis appears poor. Conclusions: In patients with low- or intermediate-risk EC, PSM can occur as a rare metastasis, regardless of tumor characteristics or surgical strategy. Unfortunately, no consensus has been reached regarding treatment, and the prognosis appears poor. Additional cases are needed in order to confirm and further explore this rare EC metastasis. [ABSTRACT FROM AUTHOR]

The electrochemical reduction of CO2 (CO2RR) has the potential to allay the greenhouse gas effect while also addressing global energy challenges by producing value-added fuels and chemicals (mostly C2 molecules such as ethylene and ethanol). However, due to the complicated chemical pathways involved, achieving high selectivity and efficiency towards specific reduction products remains challenging. In fact, the design of more selective and efficient catalysts often relies on trial-and-error approaches, which are very time consuming and resource intensive. In response, driven by the inherent importance of CO adsorption energy in the conversion of CO2 into C2+ hydrocarbons and alcohols, we propose a two-step approach employing machine learning classification and regression algorithms to predict CO binding energies on CuM(111)/(100) (M = Al, Ti, V, Fe, Co, Ni, Zn, Nb, Mo, Ru, Pd, Ag, Cd, Sn, Sb, Hf, W, Ir, Pt, Au) bimetallic surfaces. Firstly, we assess the stability of each adsorption site by utilizing classification algorithms. Subsequently, focusing exclusively on the stable sites, we employ regression models to predict the adsorption energies of CO. Remarkably, by employing a Gradient Boosting Classifier for classification, together with a Gradient Boosting Regressor for regression, we predict CO binding energies with a high level of robustness and accuracy for Cu bimetallic alloys with up to 17% surface impurity concentrations. The accuracy of our models is demonstrated by F1 scores exceeding 96% and a mean square error below 0.05 eV² for the classification and regression parts, respectively. These remarkable results highlight the adaptability of our approach and its capability for efficiently screening Cu-based CO2RR electrocatalysts, enabling rapid evaluation of promising candidates for future in-depth explorations. [ABSTRACT FROM AUTHOR]