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Valentina Mascaro,1 Lorena Squillace,1 Carmelo GA Nobile,2 Rosa Papadopoli,1 Thijs Bosch,3 Leo M Schouls,3 Francesco Casalinuovo,4 Rosanna Musarella,4 Maria Pavia11Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy; 2Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy; 3Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 4Section of Catanzaro, Institute for Experimental Veterinary Medicine of Southern Italy, Catanzaro, ItalyCorrespondence: Maria PaviaDepartment of Health Sciences, University of Catanzaro “Magna Græcia”, Via Tommaso Campanella, Catanzaro 88100, ItalyTel +39 96 171 2367Fax +39 96 171 2382Email pavia@unicz.itPurpose: We conducted a cross-sectional study to measure the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization, with a particular focus on livestock associated (LA)-MRSA in farmers working in contact with livestock (sheep) in one Italian region. Furthermore, we have assessed the antimicrobial resistance pattern of isolates and the association of carriage with specific characteristic of farms and working tasks.Patients and methods: Demographic data, occupational history, and contact with animals information was collected. Nasal and oropharyngeal swabs were collected and all samples were tested for the isolation and identification of S. aureus. Isolates were examined for antimicrobial susceptibility and all MRSA strains underwent molecular analyses through multiple-locus variable number of tandem repeat analysis (MLVA).Results: A total of 115 sheep farms and 275 sheep farmers were enrolled. MRSA colonized workers were found in three farms; S. aureus was isolated in 97 workers (35.5%), whereas MRSA was isolated in 3 (1.1%) workers. All MRSA isolates were classified as multidrug resistant. Two of the MRSA isolates were resistant to quinupristin/dalfopristin (QDA), mupirocin, erythromycin, and tetracycline. Among methicillin-susceptible S. aureus (MSSA), 32 (34%) were resistant to tetracycline, 31 (33%) to erythromycin, 26 (27.6%) to QDA, and 22 (23.4%) to linezolid and clindamycin. One MRSA belonged to MLVA complex (MC) 001, found to colonize both humans and animals.Conclusion: The picture of MRSA transmission among sheep farmers does not seem to be critical, although there is the need to improve adequate control measures to prevent and minimize any biological risk in sheep farms for both animal and human health. Specific monitoring/surveillance programs would help in better understanding the epidemiology of resistant strains.Keywords: methicillin-resistant Staphylococcus aureus, antimicrobial resistance, sheep farmers, colonization, epidemiology

Victoria Verstraeten,1,2 Karlien Vossaert,2 Thierry Van den Bosch1 1Obstetrics & Gynaecology - UZ Leuven Gasthuisberg, Leuven, Belgium; 2Obstetrics & Gynaecology – AZ Sint- Blasius Dendermonde, Dendermonde, BelgiumCorrespondence: Victoria Verstraeten, Email victoria.verstraeten@gmail.comAbstract: Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1– 2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.Keywords: uterine perforation, missing IUD, long-acting reversible contraceptive, complication

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications, such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step‐by‐step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step‐by‐step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low‐lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life‐threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e‐learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Preoperative sonographic staging in patients with suspected parametrial endometriosis is essential to plan surgical intervention and anticipate the need for a multidisciplinary approach, and thus optimize surgical outcome. The results of a recent meta‐analysis suggest that there is a need to define more accurately the ultrasonographic criteria for parametrial involvement in endometriosis. This addendum to the International Deep Endometriosis Analysis (IDEA) consensus highlights the sonographic characteristics of the parametrium and identifies ultrasound techniques to diagnose deep endometriosis in this area. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To assess the ability of the International Endometrial Tumor Analysis (IETA)‐1 polynomial regression model to estimate the risk of endometrial cancer (EC) and other intracavitary uterine pathology in women without abnormal uterine bleeding. Methods: This was a retrospective study, in which we validated the IETA‐1 model on the IETA‐3 study cohort (n = 1745). The IETA‐3 study is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in one of seven ultrasound centers between January 2011 and December 2018. The ultrasonography was performed either as part of a routine gynecological examination, during follow‐up of non‐endometrial pathology, in the work‐up before fertility treatment or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology, or with results of clinical and ultrasound follow‐up of at least 1 year if endometrial sampling was not performed. The IETA‐1 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: (1) EC or endometrial intraepithelial neoplasia (EIN); (2) endometrial polyp or intracavitary myoma; (3) proliferative or secretory endometrium, endometritis, or endometrial hyperplasia without atypia; and (4) endometrial atrophy. The predictors in the model are age, body mass index and seven ultrasound variables (visibility of the endometrium, endometrial thickness, color score, cysts in the endometrium, non‐uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver‐operating‐characteristics curve (AUC); polytomous discrimination index (PDI)) and evaluated calibration of its risk estimates (observed/expected ratio). Results: The median age of the women in the IETA‐3 cohort was 51 (range, 20–85) years and 51% (887/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), proliferative or secretory endometrium, endometritis, or hyperplasia without atypia in 144 (8%) and endometrial atrophy in 265 (15%) women. The endometrial sample had insufficient material in five (0.3%) cases. In 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1 year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA‐1 model had an AUC of 0.81 (95% CI, 0.73–0.89, n = 1745) for discrimination between malignant (EC or EIN) and benign endometrium, and the observed/expected ratio for EC or EIN was 0.51 (95% CI, 0.32–0.82). The model was able to categorize the four histological outcomes with considerable accuracy: the PDI of the model was 0.68 (95% CI, 0.62–0.73) (n = 1532). The IETA‐1 model discriminated very well between endometrial atrophy and all other intracavitary uterine conditions, with an AUC of 0.96 (95% CI, 0.95–0.98). Including only patients in whom the endometrium was measurable (n = 1689), the model's AUC was 0.83 (95% CI, 0.75–0.91), compared with 0.62 (95% CI, 0.52–0.73) when using endometrial thickness alone to predict malignancy (difference in AUC, 0.21; 95% CI, 0.08–0.32). In postmenopausal women with measurable endometrial thickness (n = 848), the IETA‐1 model gave an AUC of 0.81 (95% CI, 0.71–0.91), while endometrial thickness alone gave an AUC of 0.70 (95% CI, 0.60–0.81) (difference in AUC, 0.11; 95% CI, 0.01–0.20). Conclusion: The IETA‐1 model discriminates well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimates the risk of malignancy. It also discriminates well between the four histological outcome categories. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The article discusses the misuse of the term "arteriovenous malformation" (AVM) to describe myometrial vascularity after a recent intrauterine pregnancy. The authors argue that the term "enhanced myometrial vascularity" (EMV) should be used instead, as AVM and EMV are two different entities with distinct pathophysiologies and management approaches. AVMs are rare congenital vascular malformations that require surgery or interventional radiology, while EMV is a normal physiological condition associated with retained pregnancy tissue. The article provides guidance on the management of EMV, emphasizing the importance of accurate preoperative mapping and surgical removal of retained tissue. [Extracted from the article]

The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill‐defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth‐muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two‐dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two‐ and three‐dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

3 Sladkevicius P, Opolskiene G, Valentin L. Prospective temporal validation of mathematical models to calculate risk of endometrial malignancy in patients with postmenopausal bleeding. Endometrial thickness as measured with transvaginal ultrasound is commonly used to estimate the risk of endometrial malignancy in women with postmenopausal bleeding. [Extracted from the article]