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STUDY QUESTION Do patients with polycystic ovary syndrome (PCOS) have macroscopic and/or microscopic placental alterations? SUMMARY ANSWER The placental structure in patients with PCOS, even in those with uncomplicated pregnancy, is altered. WHAT IS KNOWN ALREADY The spectrum of pregnancy complications seems to have a common denominator: a defective trophoblast invasion and placentation. In women with PCOS, alterations in endovascular trophoblast invasion related to insulin resistance and hyperandrogenism have been observed. STUDY DESIGN, SIZE, DURATION For this prospective case–control study, 30 pregnant patients with PCOS (cases) and 60 healthy pregnant women without PCOS features (controls) were enrolled and studied until delivery. Clinical, biochemical, ultrasonographic and obstetric data were recorded. The baseline clinical and biochemical data for screening for PCOS and for inclusion/exclusion were obtained before the seventh week of gestation. At delivery, placentas were collected and detailed macroscopic and microscopic analyses were performed. PARTICIPANTS, SETTING, METHODS Cases and controls were matched for age and BMI (all <30 kg/m2). The matching procedure was one-to-two. Only subjects with spontaneous conception and uncomplicated pregnancies were included in the final analysis. MAIN RESULTS AND THE ROLE OF CHANCE Placental weight (P = 0.04), thickness (P = 0.02), density (P = 0.02) and volume (P = 0.01) were significantly inferior in women with, compared with those without PCOS. The placentas from patients with PCOS more frequently had an irregular shape (P = 0.03) and a higher cord coiling index (P = 0.02). Differences between cases and controls also concerned the extent of villous (P = 0.04) and intervillous (P = 0.01) spaces, the extent of fibrosis (P = 0.03), endovascular trophoblast (depth, extension and morphometry) (P < 0.05) and mitotic activity (P = 0.01). The percentage of patients with lesions [22/30 (73.3%) versus 25/60 (41.7%), respectively; P = 0.01] and the mean number of placental lesions (3.5 ± 2.1 versus 1.4 ± 1.1, respectively; P = 0.02) were higher in the PCOS than the control group. The odds ratio for placental alterations, adjusted for weight gain, was 2.8 (95% confidence interval 1.3–9.9). LIMITATIONS, REASONS FOR CAUTION The main limitation of the study was the selection of a specific PCOS sample, which is probably not representative of the PCOS phenotype as a whole. In fact, we excluded patients with PCOS who were obese and who achieved a pregnancy following the use of ovulation inductors or assisted reproduction techniques. WIDER IMPLICATIONS OF THE FINDINGS The present study is the first to demonstrate that the morphology and microscopic structure of placenta in patients with PCOS with an uncomplicated pregnancy are altered. Further studies are needed to assess a correlation of these changes with the increased risk of obstetric complications observed in some pregnancies of women with PCOS. STUDY FUNDING/COMPETING INTEREST(S) The authors declare no conflict of interest and no financial support for the research. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

We propose a mechanical (Hamiltonian) interpretation of the so-called spectrality property introduced by Sklyanin and Kuznetsov in the context of Bäcklund transformations (BTs) for finite-dimensional integrable systems. This property turns out to be deeply connected with the Hamilton-Jacobi separation of variables and can lead to the explicit integration of the corresponding model using the BTs. We show that once such a construction is given, we can interpret the Baxter Q-operator defining the quantum BTs as the Green's function or the propagator of the time-dependent Schrödinger equation for an interpolating Hamiltonian. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS).Research Design and Methods: The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM).Results: At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82-6.58).Conclusions: Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM. [ABSTRACT FROM AUTHOR]

Background: Clomiphene citrate (CC) is the first-line therapy for the induction of ovulation in infertile women with polycystic ovary syndrome (PCOS), but ∼20% of patients are unresponsive. The aim of the current study was to test the hypothesis that a 6-week intervention that consisted of structured exercise training (SET) and hypocaloric diet increases the probability of ovulation after CC in overweight and obese CC-resistant PCOS patients.Methods: A cohort of 96 overweight and obese CC-resistant PCOS patients was enrolled consecutively in a three-arm randomized, parallel, controlled, assessor-blinded clinical trial. The three interventions were: SET plus hypocaloric diet for 6 weeks (Group A); 2 weeks of observation followed by one cycle of CC therapy (Group B); and SET plus hypocaloric diet for 6 weeks, with one cycle of CC after the first 2 weeks (Group C). The primary end-point was the ovulation rate. Other reproductive data, as well as anthropometric, hormonal and metabolic data, were also collected and considered as secondary end points.Results: After 6 weeks of SET plus hypocaloric diet, the ovulation rate was significantly (P =0.008) higher in Group C [12/32 (37.5%)] than in Groups A [4/32 (12.5%)] and B [3/32 (9.4%)] with relative risks of 3.9 [95% confidence interval (CI) 1.1-8.3; P = 0.035] and 4.0 (95% CI 1.2-12.8; P = 0.020) compared with Groups A and B, respectively. Compared with baseline, in Groups A and C, a significant improvement in clinical and biochemical androgen and insulin sensitivity indexes was observed. In the same two groups, the insulin sensitivity index was significantly (P < 0.05) better than that in Group B.Conclusions: In overweight and obese CC-resistant PCOS patients, a 6-week intervention of SET and a hypocaloric diet was effective in increasing the probability of ovulation under CC treatment. The study was registered at Clinicaltrials.gov:NCT0100468. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Palomba S, Falbo A, Russo T, Battista L, Tolino A, Orio F, Zullo F. Uterine blood flow in pregnant patients with polycystic ovary syndrome: relationships with clinical outcomes. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02525.x. Objective To study the impedance to blood flow through the uterine artery in pregnant women with polycystic ovary syndrome (PCOS), and to evaluate its predictive value for adverse pregnancy and perinatal outcomes in this population. Design Prospective case-control study. Setting Academic Departments of Obstetrics and Gynaecology in Italy. Population Seventy-three pregnant women with ovulatory PCOS (PCOS group) and 73 age- and body mass index-matched healthy pregnant controls (control group). Methods Serial Doppler velocimetry measurements of the uterine artery. Main outcome measures Blood flow impedance indices and pregnancy/perinatal outcomes. Results A significantly ( P < 0.05) higher rate of subjects with abnormal velocimetry findings was observed in the PCOS group than in the control group. In the PCOS group, the pulsatility index (PI) at first ( P = 0.042) and mid-second ( P = 0.039) trimesters of pregnancy, and bilateral notch at first ( P = 0.025) and mid-second ( P = 0.007) trimesters of pregnancy, were the strongest independent predictors of adverse outcomes. Conversely, in the control group, PI at the first trimester of pregnancy was a predictor of adverse outcomes only when combined with bilateral notch ( P = 0.042), whereas at mid-second trimester of pregnancy PI ( P = 0.033) and bilateral notch ( P = 0.048) were independent predictors of adverse outcomes. Conclusions Uterine artery Doppler indices are more commonly altered in pregnant patients with PCOS than in controls, showing a high predictive value for abnormal pregnancy/perinatal outcomes. [ABSTRACT FROM AUTHOR]

Dilatation and curettage (D&C) biopsy is a "gold standard" to confirm the histology and grade of endometrial cancer but the concordance rate was only 70% between D&C and hysterectomy. We retrospectively reviewed 187 cases of endometrial cancer that were treated at our institution from January 2017 to June 2019. We analyzed all patients who underwent Trans Cervical mini-Resectoscopy (TCR) or D&C biopsy at our institution and received laparoscopic/laparotomic hysterectomy or staging as the treatment by our surgical team. We categorized the patients into the TCR group or the D&C group. For each group, we compared the biopsy histological grade and histology with the final hysterectomy of all patients. We analyzed 187 cases of endometrial cancer aged from 29 to 81 years. TCR was carried out, with lidocaine local cervical injection and awake sedation. Resectoscopy was performed with a 7mm bipolar resectoscope. D&C was carried out in general anesthesia and the cervix is dilated up to 10mm Hegar dilators. Two different pathologies analyzed the initial and hysterectomy specimens. Endometrial biopsy was obtained by D&C in 103 (55%) cases and by TCR in 84 (45%) of cases. the median operative time was 17,5 for TCR and 17,41 for D&C without significant differences between the two methods (p<0,99). The second stage was preoperative detective only with the use of TCR biopsy 5 (100% of cases) respect none of D&C. Among 72 patients who underwent TCR biopsy, only 4 patients have been grading misdiagnosed in the final pathology, which gives a rate of 5,5% (K 0,918 IC 95% 0,958-0,878 p<0,001). In the D&C group of 87 patients, 17 (19,5%) patients have been grading misdiagnosed (K 0,699 IC 95% 0,764 - 0,634 p<0,001). Our data, although retrospective, demonstrate that Trans cervical mini-resectoscopy provides a more accurate reflection of FIGO grade than D&C endometrial sampling. [ABSTRACT FROM AUTHOR]

To compare the success rate of hysteroscopic resection vs dilation and curettage (D&C) for treatment of cesarean scar pregnancy (CSP). Parallel-group randomized clinical trial conducted from February 2020 to February 2021 (Clinicaltrials.gov NCT04205292) Women admitted with diagnosis of CSP at a single center in Italy. Inclusion criteria were women with singleton CSP and positive embryonic/fetal heart activity, gestational age <8 weeks and 6 days at the time of randomization, and thickness of myometrial layer ≥1mm. Patients were randomized 1:1 to receive either hysteroscopic resection or D&C. A sample size of 54 women was planned. After one year of enrollment an interim analysis was performed, and 17 women were included. In both groups, 50mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) was injected intramuscularly at the time of randomization (day 1) and another dose at day 3. A third dose of MTX was planned in case of persistence of positive fetal heart activity at day 5. Women received D&C or hysteroscopic resection using 15 Fr bipolar mini resectoscope from 3 to 7 days after the second or third dose of MTX. Ultrasound guidance was used in both groups, if needed. The primary outcome was the success rate of the treatment protocol, defined as no further treatment required until the complete resolution of the CSP. Success rate was 100% in the hysteroscopic resection group and 75.0% in the D&C group (OR 7.31, 95% CI 0.30-178.57) (Table). Hysteroscopic resection was associated with increase in success rate of treatment of CSP, even if the statistical significance was not reached in this preliminary analysis. [ABSTRACT FROM AUTHOR]

Highlights from the article: At the histological examination, eutopic endometrial tissue was characterized by the presence of typical PRMs associated endometrial changes (PAEC), with irregular glands and extensive cystic dilatation. These histological features, frequent in the eutopic endometrium of women treated by UPA, were diagnosed also in the ovarian cyst, and particularly in the endometriosis wall, in the deep nodule and in the adenomyotic foci of the uterine myometrium. PRMs seems to induce PAEC both in eutopic and in every localization of ectopic endometrium and induces specific sonographic features also in the ovarian endometriosis.

• Thirty years after the institution of the most important protected areas of the country, the political world and the Italian environmental movement are still discussing the main role that national parks should play: sources of economic development of the territory or means of conservation of biodiversity and landscape. • But Italian national parks almost all insist on mountain areas, which have been involved in serious economic and social crisis for decades, and research shows that the national park brand has not managed to relieve these areas from this crisis, despite their extremely high quality environmental. • Consequently, territorial policy must commit resources to preserve their biodiversity and their fundamental role as reservoirs of ecosystem services. After thirty years of the framework legislation for parks, their effect on the territories and social communities that created new national park institutes in 1991 was investigated. Some significant indicators were used, such as demography, the structure of records and income conditions, and it emerged that the National Parks did not lead to a clear separation from the dynamics that were already in effect after World War II, and which are typical of the disadvantaged areas in which they are established, in all of that time. There are undoubtedly many causes for this, and they also differ from park to park. In a country like Italy, these certainly depend on the geographic location, since significant socio-economic differences are found along its latitudinal line. [ABSTRACT FROM AUTHOR]

Background: Gamete intra-Fallopian transfer (GIFT) is a successful technique for infertile women, and is performed almost exclusively by laparoscopy under general anaesthesia.Methods: We performed a prospective randomized study of 67 infertile patients to assess the efficacy of minilaparoscopic GIFT under conscious sedation/local anaesthesia (group A) compared with general anaesthesia (group B). Operative and discharge times and pregnancy outcome were evaluated in both groups.Results: Operative time was similar in both groups. The rate of patients discharged 2 h after surgery was significantly higher in group A. The necessity for postoperative analgesics was significantly higher in group B. No significant differences were noted between the two study groups in terms of pregnancy outcome.Conclusions: Conscious sedation and local anaesthesia will allow us to perform an outpatient minilaparoscopic GIFT without the need for general anaesthesia. The simplicity of the method, and the quicker discharge time in comparison with general anaesthesia, offer a detectable benefit for patients. [ABSTRACT FROM AUTHOR]