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Abstract Several protocols are actually available for in Vitro Fertilization and Embryo Transfer. The review summarizes the main differences and the clinic characteristics of the protocols in use with GnRH agonists and GnRH antagonists by emphasizing the major outcomes and hormonal changes associated with each protocol. The majority of randomized clinical trials clearly shows that in “in Vitro” Fertilization and Embryo Transfer, the combination of exogenous Gonadotropin plus a Gonadotropin Releasing Hormone (GnRH) agonist, which is able to suppress pituitary FSH and LH secretion, is associated with increased pregnancy rate as compared with the use of gonadotropins without a GnRH agonist. Protocols with GnRH antagonists are effective in preventing a premature rise of LH and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol. However, a different synchronization of follicular recruitment and growth occurs with GnRH agonists than with GnRH antagonists. Future developments have to be focused on timing of the administration of GnRH antagonists, by giving a great attention to new strategies of stimulation in patients in which radio-chemotherapy cycles are needed.

Background and Aims: To describe cross-sectional associations of BMI-adjusted handgrip strength with the presence of diabetes and hypertension in a community setting., Methods and Results: Between 2016 and 2018, 601 consecutive elderly active women (70.7 ± 6.9 years) were enrolled. Nutritional status was evaluated by the Mini Nutritional Assessment (MNA) score. Muscle strength and level of fitness were assessed by standardized physical functional tests and handgrip strength (HGS). The majority of participants were overweight or obese (80% with BMI > 25). Prevalence of diabetes and hypertension was 13 and 60%, respectively. Participants in the lowest quartile of BMI-adjusted HGS (RHGS) had significantly higher prevalence of diabetes and hypertension compared with those in the top quartile (20.7 vs 5.3% and 49.3 vs 39.3%, respectively, p < 0.01 for both), without significant differences in nutritional status. Association with the presence of diabetes was significantly weaker in women with higher vs lower RHGS values (OR 0.77; 0.59-0.86 CI95%; p = 0.002), independent of age, abdominal adiposity, and presence of hypertension. RHGS was positively correlated with most of the physical functional tests performed., Conclusion: RHGS is an easy-to-obtain measure of muscular strength, independently associated with the presence of diabetes in overweight active elderly women. Prospective studies are required to assess its predictive value to identify adults at risk of developing diabetes.

Background: The study aims to analyze and quantify the improvements of some physical skills in a group of subjects over 65 years old who practice regular activities in the gym and in a microgravity environment., Methods: The study included 132 subjects (68.9±5.5 years, 72.7±14.4 kg, 155.3±9.2, 30.6±5 kg/m2) who perform regular physical activity adapted and controlled for the elderly twice a week (50' per session) for a period of 8 months. The tests evaluate flexibility, abdominal and leg strength and balance. The groups, in baseline, are homogeneous between them to anthropometric parameters and the initial performance of motor skills analyzed. A mixed between-within subject ANOVA was conducted to assess the impact of the training regimens. Data from this study showed an increase in muscular strength (leg and abdominal muscles), body balance and muscular flexibility after 8 months of both training methods., Results: Both experimental groups had significant improvements in motor skills considered and interesting results were observed in water activity, overall, in balance (+66%, P<0.001) and abdominal muscular strength (+16%, P<0.001) where the water group showed a significant within and between improvement., Conclusions: Current results indicate that the water and land programs improved motor skills in the elderly. Furthermore, when the effectiveness of the training programs was compared, it was verified that the water group has recorded major changes, overall on abdominal strength and balance test statistically significant versus the land group.

Background: The aim of this study was to confirm the effects of long term (chronic) stimulating surface (textured insole) on body balance of elderly people., Methods: Twenty-four healthy elderly individuals were randomly distributed in two groups: control and experimental (67.75±6.04 years, 74.55±12.14 kg, 163.7±8.55 cm, 27.75±3.04 kg/m2). Over one month, control group (CG) used smooth insoles and the experimental group (ExG) used textured insoles every day. Velocity net (Vnet), anteroposterior (VA/P), mediolateral (VM/L) and sway path of CoP were assessed in different eye conditions before and after the experimental procedure., Results: A mixed between-within subject ANOVA was conducted to assess the impact of soft and textured insoles and two visual conditions (vision vs. no vision) across two time periods (α≤0.05). The results showed any statistical difference between groups in each parameter assessed in this study. CoP, Vnet and VM/L in the experimental group showed a statistically significant effect of textured insoles only without vision (CoP: P=0.002; η2=0.35), Vnet P=0.02; η2=0.24, VM/L P=0.04; η2=0.177) whereas VA/P showed no statistically significant effect in the same group and condition. There was no significant effect in Vnet, VA/P, VM/L and COP in control group that used smooth insole for both eye conditions., Conclusions: The results confirm that postural stability improved in healthy elderly individuals, increasing somatosensory information's from feet plantar mechanoreceptors. Long term stimulation with textured insoles decreased CoP, Vnet and VM/L with eyes closed.

Background: Aging is characterized by a physiological reduction in physical activity, which is inversely correlated with survival., Aims: Aim of the present study is to evaluate the cardiovascular, central hemodynamic and autonomic responses to a single bout of adapted physical exercise in octogenarian subjects., Methods: We studied cardiovascular, hemodynamic and autonomic responses to adapted physical activity in 33 subjects by a noninvasive methodology (Nexfin ® , Edwards Lifesciences Corporation)., Results: Our octogenarians presented a significant increase in mean arterial pressure (p < 0.01) and heart rate (p < 0.005) in response to exercise, while both are reduced during the early recovery phase. Central hemodynamic showed a significant increase in stroke volume (p < 0.05), cardiac output (p < 0.01) and left ventricle contractility index (p < 0.01), whereas systemic vascular resistance showed a significant decrease (p < 0.001). We found a reduction in baroreflex control of the sinus node during exercise., Discussion: Our data demonstrate that in very old people adapted physical activity is able to activate cardiovascular system and to induce a postexercise hypotension similarly to adults. The baroreflex control of sinus node seems to contribute in the physiological mechanism of these cardiovascular adaptations., Conclusions: In very old people, physical activity induces cardiovascular and hemodynamic responses not significantly different from those induced in adult even though some cautions particularly in the early recovery phase after exercise should be exercised.

This study aimed to investigate the influence of three stimulating surfaces based on center of pressure (CoP), anteroposterior sway velocity (V(A/P)), and medio-lateral sway velocity (V(M/L)) of 40 elderly subjects. CoP and V(M/L) showed a significant decrease in all visual conditions only in the stimulating surface whereas V(A/P) showed a significant decrease only on the same surface with eyes open. Results confirm the importance of multisensory stimulation in postural control in the elderly.

Objective: this paper reports an association between an increased Nuchal Translucency (NT) and Osteogenesis Imperfecta (OI), a type of skeletal dysplasia. Measurement of fetal NT at 10-14 weeks of gestation is a sensitive and effective screening method for chromosomal abnormalities., Methods: a 35-year- old Caucasian woman in her fourth pregnancy was referred to our clinic for an ultrasound scan at 12 weeks of gestation, that confirmed increased Nuchal Translucency. Chorionic villi sampling was performed, showing a normal karyotype. The patient was evaluated by a team of experienced ultra sonographers for pregnancy follow-up at our Department, that is a tertiary center., Results: in our case the ultrasound scan at 12 week of gestation revealed only an increased NT (3 mm). Cytogenetic analysis on chorionic villi demonstrated a normal male karyotype. US follow-up, performed every 3-4 weeks, confirmed normal anthropometric parameters except for shortening of both femurs, but at 23 weeks an incorrect attitude of the feet was revealed. A clinical and radiographic diagnosis of OI type III was made only at birth, and through follow-up continuing to date., Discussion: NT screening was successful for chromosomal abnormalities at 11-14 weeks of gestation. An increased NT thickness is also associated with numerous fetal anomalies and genetic syndromes in a chromosomally normal fetus. In our case there were no sonographic signs of imperfect osteogenesis in the first trimester, although there was an increased NT with a normal karyotype., Conclusion: currently, in literature, there are not other cases of OI type III associated with an increased NT. Our report is the first to suggest an association between an increased nuchal translucency, short femur length and osteogenesis imperfecta type III.

The effect of elevated body mass index (BMI) on the oocyte quality was investigated in women undergoing in vitro fertilization (IVF) cycles. A total of 268 patients classified on the basis of BMI subject to the first reproductive treatment were included in this study: the normal weight (NW) group consisted of 160 patients with BMI 19-24.9 kg/m(2) and the overweight (OW) group consisted of 108 patients with BMI ≥ 25 kg/m(2). All women were treated with a standard long luteal protocol. The oocyte features were classified as extracytoplasmic or cytoplasmic abnormalities. Outcomes were oocyte morphology, embryo quality, fertilization and implantation rates, and the ovarian response to stimulation. A higher percentage of oocytes with granular cytoplasm was found in women with BMI ≥ 25 (p = 0.04). However, percentages of mature, immature oocytes and germinal vesicle were similar in both groups. No differences were found in fertilization and cleavage rates and percentages of embryo quality. The implantation rate (p < 0.001) was significantly lower in the OW group than in the NW group. The amount of gonadotrophins was significantly higher in OW group (p = 0.003). These findings suggest that the poor reproductive outcome of obese women is influenced by the release of ova with reduced fertilization potential.

Purpose: To evaluate the activity and toxicity of the combination of cisplatin and vinorelbine in patients with recurrent carcinoma of the vulva that has not been previously treated with chemotherapy., Patients and Methods: Sixteen women with a median age of 65 years (range 43-79) with recurrent vulvar carcinoma were enrolled in the study. Nine patients had local recurrent disease (perineum, vagina and/or vulva), whereas 7 had disease in the groin; 9 patients had received prior radiotherapy. Cisplatin was administered intravenously on day 1 and vinorelbine was given on day 1 immediately after cisplatin and on day 8., Results: A total of 68 cycles of chemotherapy were administered. Fifteen women were assessed for response. Objective responses were recorded in 6 patients (40%) - with 4 patients (27%) achieving a complete response and 2 (13%) achieving a partial response -, whereas 4 patients (27%) had stable disease and 5 had progressive disease. The median progression-free survival was 10 months (range 3-17), whereas the overall survival from the beginning of the chemotherapy was 19 months (range 1-30). Due to the small number of patients, no significant correlation with site of recurrence could be found., Conclusion: The combination of cisplatin and vinorelbine is a well-tolerated and active regimen in the treatment of patients with recurrent vulvar carcinoma., (Copyright 2009 S. Karger AG, Basel.)