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Background Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding. Method This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5). Results Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they’ve demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers. Conclusions Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women’s level of awareness on glycaemic control.

In this letter, we investigate the problem of frame synchronization in a free-space optical (FSO) communications link, where a known synch pattern is periodically embedded in the transmitted bitstream. The modulation format is on-off keying (OOK) and the electrical signal provided by the photo-detector is plagued by a mixture of thermal and shot noise with signal-dependent power. Due to atmospheric turbulence, channel attenuation can exhibit large random fluctuations, so that no prior knowledge of the signal level and noise variances is assumed. These parameters, together with the start-of-frame, are jointly estimated using a simplified maximum likelihood (ML) approach. Numerical simulations indicate that the proposed scheme is able to effectively exploit the presence of shot noise to improve its detection capability, and outperforms the standard frame synchronization method tailored for an AWGN channel with signal-independent noise power.

An interdisciplinary study has been adopted to investigate the upper Maira Valley (Western Alps, Italy). A geological map of an unmapped area, of about 12 km2, at scale 1:10.000, has been realized. The combination of field surveys, GIS database creation, aerial photo observation, local archival data consultation, geo-structural analysis and drillholes re-interpretation outlined a relationship between structures and landforms. A ductile and brittle deformation history with the definition of four discontinuity systems (F1-F4) has been detected. Where the fracturation is intense, rock-falls and topplings are triggered. In area associated with a homogeneous presence of weathered cover, debris flows were identified. The geo-structural pattern obtained from the surveys in the upper Maira Valley allowed characterizing detachment zones of the slope overlooking Acceglio town. The Gollone Landslide is an excellent case study to unravel the structural-morphological interaction and the kinematic evolution due to its framework.

Background. To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer. Methods. This is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer before (period I: 01/01/2016-06/01/2018) and after (period II: 01/01/2019-06/01/2021) the publication of the results of the LACC trial. Results. Charts of 1295 patients were evaluated: 581 (44.9%) and 714 (55.1%) before and after the publication of the LACC trial, respectively. After the publication of the LACC trial, the number of patients treated with minimally invasive radical hysterectomy decreased from 64.9% to 30.4% (p < 0.001). Overall, 90-day complications occurred in 110 (18.9%) and 119 (16.6%) patients in the period I and period II, respectively (p = 0.795). Similarly, the number of severe (grade 3 or worse) complications did not differ between the two periods (38 (6.5%) vs. 37 (5.1%); p = 0.297). Overall and severe 90-day complications were consistent between periods even evaluating stage IA (p = 0.471), IB1 (p = 0.929), and IB2 (p = 0.074), separately. Conclusions. The present investigation highlighted that in referral centers the shift from minimally invasive to open radical hysterectomy does not influence 90-day surgery-related morbidity. (c) 2022 Elsevier Inc. All rights reserved.

Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p, Synopsis The prevalence of patients with early-stage endometrial cancer (EC) has been lower during coronavirus disease 2019 (COVID-19) pandemic than before its onset. Further evidence is needed to assess the impact of COVID-19 pandemic on survival outcomes of EC patients.

In long-term evolution (LTE) systems, there is an option to extend the size of the cyclic-prefix (CP) when the propagation environment is characterized by severe time dispersion. Such a peculiar feature makes the system more resilient against multipath distortions, but inevitably complicates the downlink synchronization task, which cannot be accomplished through conventional techniques devised for a specified CP size. In this paper, we study the problem of CP length detection in the LTE downlink in the presence of a timing uncertainty and frequency offset. In contrast to previous investigations based on heuristic arguments, our approach relies on the maximum likelihood (ML) estimation criterion. Furthermore, it accounts for the irregular LTE symbol (characterized by a different CP size), which is present in the normal CP operation mode. The resulting scheme operates in the time-domain and computes a different metric for each possible position of the irregular symbol within the observation window. Due to its flexibility, the proposed ML approach can be applied to any future multicarrier standard for the design of a CP length detection algorithm, either in the presence or in the absence of irregular symbols.

Massive MIMO systems, where base stations are equipped with hundreds of antennas, are an attractive way to handle the rapid growth of data traffic. As the number of user equipments (UEs) increases, the initial access and handover in contemporary networks will be flooded by user collisions. In this paper, a random access protocol is proposed that resolves collisions and performs timing estimation by simply utilizing the large number of antennas envisioned in Massive MIMO networks. UEs entering the network perform spreading in both time and frequency domains, and their timing offsets are estimated at the base station in closed-form using a subspace decomposition approach. This information is used to compute channel estimates that are subsequently employed by the base station to communicate with the detected UEs. The favorable propagation conditions of Massive MIMO suppress interference among UEs whereas the inherent timing misalignments improve the detection capabilities of the protocol. Numerical results are used to validate the performance of the proposed procedure in cellular networks under uncorrelated and correlated fading channels. With $2.5\times10^3$ UEs that may simultaneously become active with probability 1\% and a total of $16$ frequency-time codes (in a given random access block), it turns out that, with $100$ antennas, the proposed procedure successfully detects a given UE with probability 75\% while providing reliable timing estimates., 30 pages, 6 figures, 1 table, submitted to Transactions on Communications

Before establishing a communication link with the serving base station (eNodeB), user equipment (UE) operating in a long-term evolution (LTE) multi-cellular network must acquire some specific information, including the sector identity and cell group identity. For this purpose, two training sequences called primary synchronization signal (PSS) and secondary synchronization signal (SSS) are periodically transmitted in the downlink to convey such information. In this work, we present a novel maximum likelihood (ML) approach for SSS detection assuming that the PSS has been successfully identified at an earlier stage. As we shall see, the resulting scheme turns out to be too complex for practical implementation as it requires perfect knowledge of the channel covariance matrix. Therefore, we look for simpler solutions and propose two reduced-search methods that operate in a mismatched mode. The first scheme exploits channel state information emerging from both the primary and secondary synchronization signals, while the second scheme operates using only the secondary synchronization signal. Numerical analysis indicates that the proposed methods outperform existing alternatives and can be successfully applied even in a severe propagation scenario. The price for such an advantage is a certain increase of the processing requirement.

This paper investigates the problem of carrier frequency offset (CFO) recovery in an OFDM receiver affected by frequency-selective in-phase/quadrature (I/Q) imbalances. The analysis is based on maximum-likelihood (ML) methods and relies on the transmission of a training preamble with a repetitive structure in the time domain. After assessing the accuracy of the conventional ML (CML) scheme in a scenario characterized by I/Q impairments, we review the joint ML (JML) estimator of all unknown parameters and evaluate its theoretical performance. In order to improve the estimation accuracy, we also present a novel CFO recovery method that exploits some side-information about the signal-to-interference ratio. It turns out that both CML and JML can be derived from this scheme by properly adjusting the value of a design parameter. The accuracy of the investigated methods are compared with the relevant Cramer–Rao bound. Our results can be used to check whether conventional CFO recovery algorithms can work properly or not in the presence of I/Q imbalances and also to evaluate the potential gain attainable by more sophisticated schemes.

Before establishing a communication link in a cellular network, the user terminal must activate a synchronization procedure called initial cell search in order to acquire specific information about the serving base station. To accomplish this task, the primary synchronization signal (PSS) and secondary synchronization signal (SSS) are periodically transmitted in the downlink of a long term evolution (LTE) network. Since SSS detection can be performed only after successful identification of the primary signal, in this work, we present a novel algorithm for joint PSS detection, sector index identification, and integer frequency offset (IFO) recovery in an LTE system. The proposed scheme relies on the maximum likelihood (ML) estimation criterion and exploits a suitable reduced-rank representation of the channel frequency response, which proves robust against multipath distortions and residual timing errors. We show that a number of PSS detection methods that were originally introduced through heuristic reasoning can be derived from our ML framework by simply selecting an appropriate model for the channel gains over the PSS subcarriers. Numerical simulations indicate that the proposed scheme can be effectively applied in the presence of severe multipath propagation, where existing alternatives provide unsatisfactory performance.

Polycystic ovary syndrome (PCOS) is the most common metabolic disorder in reproductive aged women, affecting approximately 5–15% of this population.[1]The Rotterdam Criteria [2] have been accepted ...

Objective To evaluate the misdiagnosis between endometrial biopsy and definitive surgical pathology and to assess whether the failure in recognizing preoperatively high-risk endometrial carcinoma (EC) can impact oncological outcomes. Study design A retrospective study was conducted to evaluate patients with EC diagnosed by preoperative endometrial biopsy who subsequently underwent surgical staging between 2006 and 2013 at our institution. In patients with a surgical diagnosis of high-risk EC, histotype and grade change between the endometrial biopsy and surgical specimen (discordance diagnosis) were evaluated and correlated to survival outcomes. Cox's regression model for multivariable analysis was used to evaluate the effect of several variables (age, stage, discordance in diagnosis, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy) on the survival rate. Results Data from 447 patients were reviewed. Among 109 women with surgical diagnosis of high-risk EC, 35 (32.1%) were preoperatively misdiagnosed. Of these 35 women, 24 (68.6%) cases were upgraded to grade 3, and 11 (3.4%) were upgraded to serous or clear cell type in the definitive specimen. The 5-year overall survival (OS; 70.2 vs. 86.8%; p =0.029), disease-specific survival (DSS; 72.5 vs. 88.2%; p =0.039) and recurrence free survival (RFS; 62.6 vs. 82.5%; p =0.024) were significantly lower in the high-risk EC patients who were preoperatively undiagnosed in the endometrial biopsy compared with patients with an appropriate preoperative histological diagnosis. Controlling for age, stage, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy, multivariable analysis revealed that discordance in diagnosis was associated with poorer survival outcomes. Conclusion Failure to recognize preoperatively high-risk ECs is associated with worse outcomes.

Collection and sharing of geoheritage information are nowadays enhanced by using digital tools and IT (Information Technology) applications that allow homogeneous storing of data, building of sharable databases, and transfer of knowledge between experts and communities. In the frame of the PROGEO-Piemonte project (PROactive management of GEOlogical heritage in the PIEMONTE region), the geological and geomorphological trail in the Monviso Massif (Western Alps) is an example of how IT-applications may support management of geoheritage information. The trail particularly allows walking across the meta-ophiolite succession of an ancient ocean and on glacial landforms. Its realization was supported by different tools that allow (i) capturing of data via GPS handheld mobile device, (ii) managing of field data by means of GIS (Geographic Information Systems) applications, and (iii) virtual visualization of data by means of GIS-based 3D viewer. The different (virtual) views of the geology along the trail can be implemented by adding photos and bookmarks and easily shared through web mapping tools that ensure wide accessibility of geoheritage information.

ObjectiveThe objectives of this study were to characterize the well-defined endometrial cancer (EC) type I (endometrioid [EEC] G1-G2) versus the prototype of EC type II (serous [ESC]) and to evaluate the expression of specific biomarkers differentially expressed between 2 well-defined types, in those EC subtypes (such as EEC G3) disputed between types I and II.MethodsData from 25 patients (10 EEC G1-G2, 8 EEC G3, 5 ESC, and 2 clear cell) submitted to the surgical treatment were collected. Two-dimensional electrophoresis and mass spectrometry (MS) analysis were performed on 5 EEC G1-G2 and 5 healthy endometrial samples of the same patients. Differentially expressed proteins, such as DJ-1, were validated by Western blot. In patients with EEC G1-G2, serum levels of DJ-1, an overexpressed oncoprotein related to EC pathogenesis and progression, were evaluated and then compared with levels identified in patients with ESC and healthy controls. The DJ-1 immunohistochemical (IHC) staining was performed on neoplastic and healthy endometrium collected from the same patients. The 8 stored samples of EEC G3 were submitted to DJ-1 IHC assays.ResultsThe 2-dimensional electrophoresis analysis identified 1040 protein spots differentially expressed in EEC G1-G2 compared with healthy endometrium. Forty-two spots were subjected to liquid chromatography–MS/MS analysis. Thirty-three up-regulated (like an annexin 2 [ANXA2] shorter isoform, CAPG [macrophage-capping protein], DJ-1/PARK7) and 9 down-regulated (like calreticulin and ubiquitin carboxyl-terminal hydrolase isozyme L1) proteins were identified and validated by Western blot. A significant increase in serum DJ-1 levels of EEC G1-G2 versus the healthy controls and in ESC versus EEC patients was observed. DJ-1 IHC score was significantly higher in ESC versus those EEC G1-G2. In 3 cases of EEC G3, the DJ-1 expression was similar to the ESC subtype.ConclusionsThe identification of proteins, such as DJ-1, differentially expressed, between well-defined EC types I and II allows to make a subtype-specific presurgical diagnosis and help surgeon to safely preoperatively choose a proper surgical treatment.

Objective The objective of this study is to compare ovarian function and surgical outcomes between patients affected by benign uterine pathologies submitted to total laparoscopic hysterectomy (TLH) plus salpingectomy and women in which standard TLH with adnexal preservation was performed. Methods We retrospectively compared data of 79 patients who underwent TLH plus bilateral salpingectomy (group A), with those of 79 women treated by standard TLH without adnexectomy (sTLH) (group B). Ovarian reserve modification, expressed as the difference between 3months post-operative and pre-operative values of Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), mean ovarian diameters and Peak Systolic Velocity (PSV), was recorded for each patient. For each surgical procedure, operative time, variation of hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were recorded as secondary outcomes. Results According to our post-hoc analysis , this equivalence study resulted to have a statistical power of 96.8%. Significant difference was not observed between groups with respect to ΔAMH ( p = 0.35 ), ΔFSH ( p = 0.15 ), ΔAFC ( p = 0.09 ), Δ mean ovarian diameters ( p = 0.57 ) and ΔPSV ( p = 0.61 ). In addition, secondary outcomes such as operative time ( p = 0.79 ), ΔHb ( p = 0.41 ), postoperative hospital stay ( p = 0.16 ), postoperative return to normal activity ( p = 0.11 ) and complication rate also did not show any significant difference. Conclusions The addition of bilateral salpingectomy to TLH for prevention of ovarian cancer in women who do not carry a BRCA1/2 mutations do not show negative effects on the ovarian function. In addition, no perioperative complications are related to the salpingectomy step in TLH.

Choroid plexus, a fetal organ developing approximately from the sixth week of gestation, plays a fundamental role in developing fetal brain organization. As relatively little is known about the relationship between anomalies of choroid plexuses structure and their role in brain function, we examined cases of bifid choroid plexus (BCP) and discussed their potential association with lateral ventriculomegaly, other abnormal ultrasound findings, and their potential role as markers of fetal chromosomal abnormalities. In the present study, we described 23 cases of fetal BCP found in 2145 routine second trimester ultrasounds. For each patient 2D and 3D ultrasound volumes were acquired. BCP was defined as a choroid plexus whose body was divided into two portions (arms) differently located and oriented on the three spatial axes in correspondence to the lateral ventricle, in one or both sides. The entity of the separation and reciprocal orientation of the two arms was examined. The presence of BCP in a low-risk population of pregnant women undergoing routine second trimester ultrasound was showed. Lateral ventricles significantly increased in the presence of BCP. Malformations were found in four of 23 fetuses with BCP. Pregnancy outcome was favorable only in one of these four cases. We suggest that in the presence of mono or bilateral BCP without associated abnormal ultrasound findings, a closer look at fetal brain or extra-cranial structures is recommended. If no related abnormalities are found, serial prenatal and postnatal sonographic follow-up should be considered. In the presence of concomitant abnormal findings, genetic counseling, fetal karyotyping and magnetic resonance imaging, if possible by gestational age, are strongly advised.

The geological map of Piemonte Region (Italy) is a graphic representation of the geology of the region, grounded on a large geodatabase, that can be also browsed as an interactive scalable map (GeoPiemonte Map) using a WebGIS application. The Map, produced at 1:250,000 scale, is the first original release of the GeoPiemonte Map project. The geological data represented on the map derive from a thorough revision of available geological maps and literature, integrated with unpublished original data. The revision and harmonisation of existing and new data have been based on explicit criteria used for the classification of geologic units and their representation on the Map. These criteria firstly aimed at providing a lithostratigraphic, hierarchic subdivision of Piemonte geologic units and describing them using shared concepts and vocabularies, consistent with IUGS Descriptive Standards for the Geosciences. Copyright: CC BY

Purpose : Evaluate the role of Magnetic Resonance Imaging (MRI) in the differential diagnosis between degenerated leiomyomas, cellular leiomyomas and uterine sarcomas. Materials and methods: From February 2015 to August 2015, 42 patients were enrolled, aged between 18 and 75 years, suffering from uterine “mass” waiting for surgery and considered at risk and/or uncertain clinical and laboratory investigations and imaging. These patients were submitted to MRI exam of the pelvis that was performed by morphological study, DWI sequences and dynamic sequences post-contrastographic. Results : The analysis of MRI images of the 42 patients made possible to do a diagnosis of uterine sarcomas in 8 patients with the aid of sequences weighted in diffusion and dynamic, proving a sensitivity of 100% and a specificity of 88%. Conclusions: Based on our experience, we may consider that by morphological study with DWI sequences weighted in diffusion and dynamic post-contrastographic sequences, the MRI is a working aid in the differential diagnosis between degenerated leiomyomas and uterine sarcomas.

Study Objective Preliminary data on the effects of prophylactic bilateral salpingectomy (PBS) show that postoperative ovarian function is preserved up to 3 months after surgery. The confirmation of PBS safety on ovarian function even many years after surgery is essential to reassure the medical community that this new strategy, recently proposed for the prevention of ovarian cancer, is at least able to avoid the risk of premature surgical menopause. We investigated whether the addition of PBS during total laparoscopic hysterectomy (TLH) causes long-term effects on ovarian function. Design An observational study (Canadian Task Force classification II-3). Setting Department of Obstetrics and Gynecology, “Magna Graecia” University, Catanzaro, Italy. Patients Seventy-nine patients who underwent TLH plus salpingectomy between September 2010 and September 2012 at our institution have been recalled to be submitted to ovarian reserve evaluation in February 2015. Eight of 79 women refused to participate in this follow-up study. Interventions The ovarian age of PBS patients has been determined through OvAge (OvAge sr., Catanzaro, Italy), a statistical model that combines antimullerian hormone, follicle-stimulating hormone, 3-dimensional antral follicle count, vascular index, flow index, and vascular flow index values. The control group consisted of a large population of 652 healthy women (with intact uterus and adnexa) previously enrolled to build the OvAge model. Comparisons between ovarian ages of PBS patients and the control group have been assessed by analysis of covariance linear statistical modeling. Measurements and Main Results The main outcome measurement was the differences in the behavior within OvAge/age relation between PBS and control women. Descriptive statistics of those 71 enrolled PBS patients are the following: age, 49.61 ± 2.15 years; OvAge, 49.22 ± 2.57 years; follicle-stimulating hormone, 43.02 ± 19.92 mU/mL; antimullerian hormone, 0.12 ± 0.20 ng/mL; 3-dimensional antral follicle count, 1.91 ± 1.28; vascular index, 2.80% ± 5.32%; flow index, 19.37 ± 5.88; and vascular flow index, 0.56 ± 1.12. Analysis of covariance disclosed that PBS and control women do not exhibit different behaviors (p = .900) within OvAge/age relation. Conclusion According to our model, the addition of PBS to TLH in the late reproductive years does not modify the ovarian age of treated women up to 3 to 5 years after surgery.

Spectrum sharing employs dynamic allocation of frequency resources for a more efficient use of the radio spectrum. Despite its appealing features, this technology inevitably complicates the synchronization task, which must be accomplished in an environment that may involve interference. This paper considers the uplink of an orthogonal frequency-division multiple-access (OFDMA)-based spectrum sharing system and provides solutions for estimating the frequency and timing errors of multiple unsynchronized users. In doing so, we exploit suitably designed training blocks and apply maximum likelihood methods after modeling the interference power on each subcarrier as a random variable with an inverse gamma distribution. The resulting frequency estimator turns out to be the extension to a multiuser scenario of a scheme that has previously been proposed for single-user spectrum-sharing systems. Timing recovery is more challenging and leads to a complete search over a multidimensional domain. To overcome such a difficulty, two alternative approaches are proposed. The first one relies on a simplifying assumption about the interference distribution in the frequency domain, while the second scheme operates in an iterative fashion according to the expectation-maximization algorithm.

The use of antenna arrays in wireless communications makes it possible to estimate the directions of arrival (DOAs) of impinging waveforms. The latter can be exploited to enhance channel estimation accuracy or as an input for advanced mobile positioning systems. In this paper, we consider the uplink of a multicarrier code-division multiple-access (MC-CDMA) network in which the base station is endowed with multiple receiving antennas arranged in a uniform linear array. Transmission takes place over a multipath channel, and the goal is the joint estimation of the channel responses and DOAs of the uplink signals. In doing so, we follow a maximum-likelihood (ML) approach and assume that users transmit orthogonal training sequences to facilitate the task of separating the signals. This way, all unknown parameters are estimated independently of each other with affordable complexity. Theoretical analysis and computer simulations are used to assess the performance of the proposed scheme and make comparisons with existing alternatives.

Objective To evaluate whether manualin-bag morcellation could be efficiently proposed as alternative to the uncontained power technique. Design Randomized controlled trial. Setting Academic hospital. Patient(s) One hundred fifty-two premenopausal women eligible for myomectomy were screened, and 104 were randomized. Intervention(s) Patients were randomized into two groups. In the experimental group, "in-bag" protected morcellation was performed. In the control group, patients were treated by uncontained power myoma removal. Main Outcome Measure(s) The primary endpoint was the comparison of morcellation operative time (MOT). The secondary endpoints were the comparisons of total operative time (TOT), simplicity of morcellation (as defined by the surgeon using a visual analogue scale scale), intraoperative blood loss, rate of complications, and postoperative outcomes. Result(s) A sample size of 51 per group (n = 102) was planned. Between March 2014 and January 2015, patients were randomized as follows: 53 to the experimental group and 51 to the control group. Most demographic characteristics were similar across groups. MOT was observed to be similar in both study groups (16.18 ± 8.1 vs. 14.35 ± 7.8 minutes, in the experimental and control groups, respectively). Fibroid size was identified as the principal factor influencing morcellation time (Pearson coefficient 0.484 vs. 0.581, in the experimental and control groups, respectively). No significant difference in TOT, simplicity of morcellation, delta Hb, postoperative pain, and postoperative outcomes were observed between groups. Conclusion(s) The protected manual in-bag morcellation technique represents a time-efficient and feasible alternative, which does not interfere with surgical outcomes in women undergoing laparoscopic myomectomy. Clinical Trial Registration NCT02086435.

Massive MIMO systems, where the base stations are equipped with hundreds of antennas, are an attractive way to handle the rapid growth of data traffic. As the number of users increases, the initial access and handover in contemporary networks will be flooded by user collisions. In this work, we propose a random access procedure that resolves collisions and also performs timing, channel, and power estimation by simply utilizing the large number of antennas envisioned in massive MIMO systems and the inherent timing misalignments of uplink signals during network access and handover. Numerical results are used to validate the performance of the proposed solution under different settings. It turns out that the proposed solution can detect all collisions with a probability higher than 90%, at the same time providing reliable timing and channel estimates. Moreover, numerical results demonstrate that it is robust to overloaded situations., submitted to IEEE Globecom 2016, Washington, DC USA

Background: Buschke-Lowenstein tumor (BLT) or giant condyloma acuminatum (GCA), is a rare disease caused by Human Papilloma virus (HPV) types 6 and 11, more common in immunocompromised males. We describe a rare case of BLT associated with mixed low and high-risk HPV type’s infection in a very young immunocompetent female. Methods: On August 2012, an 18-year old female was admitted to the Unit of Obstetrics and Gynecology, with a 3-4 month history of small excrescences in the perineal/vulvar area which had rapidly increased in size. A diagnosis of BLT was suspected; an incisional biopsy was carried out. On the cervical and vulvar cytobrush samples, Polymerase Chain Reaction (PCR) of specific sequences of the HPV genome L1 region was performed. Surgical treatment was carried out by cold knife excision. Results: Clinically, the tumor presented as exophytic white lesion, characterized by an irregular surface with acuminate excrescenses. Microscopic images are consistent with diagnosis of Buschke-Lowenstein tumor. Performed PCR revealed the presence of HPV types 6, 39 and 53. After surgery the patient showed no signs of recurrence during the 4 years of follow-up. Conclusions: This report a rare case of BLT in a young immunocompetent female, associated with multiple HPV type infection. The studied case suggests that pathologies with a BLT-like clinical and histological presentation and mixed HPV genotypes can be found in young immunocompetent patient.

The problem of frequency synchronization, channel estimation, and data detection for all active users in the uplink of an OFDMA system is investigated in this work. Since the exact maximum likelihood (ML) solution to this problem turns out to be too complex for practical purposes, we derive an alternative scheme that operates in an iterative fashion. At each step, the superimposed signals arriving at the base station (BS) are separated by means of the space-alternating generalized expectation-maximization (SAGE) algorithm. Each separated signal is then passed to an expectation-conditional maximization (ECM)-based processor that updates frequency estimates and performs channel estimation and data detection for each user. The resulting architecture is reminiscent of the parallel interference cancellation (PIC) receiver, where interference is generated and removed from the received signal to improve the system performance. Simulations indicate that the proposed scheme outperforms other benchmark solutions at the price of increased computational complexity

This paper addresses the problem of maximum likelihood (ML) estimation of slot timing, integer carrier frequency offset and primary sequence index for the downlink of Long Term Evolution (LTE) systems. The proposed algorithm is designed to exploit the knowledge of the pilot Zadoff-Chu sequence embedded in the primary synchronization signal (PSS). The estimation process is affected by the presence of a large set of nuisance parameters, which need to be estimated jointly with the parameters of interest. As a consequence, the exact ML solution is extremely complex and we have developed a suboptimal algorithm designed to provide a good balance between estimation accuracy and complexity. In particular, a key finding is a reduced-rank representation for the frequency response of the channel, which is required by the ML estimator but is not available at receiver prior to having acquired synchronization. Compared to existing alternatives, the resulting scheme exhibits improved accuracy in the estimation of all three parameters of interest.

Objective To study the effects of the wide excision of soft tissues adjacent to the ovary and fallopian tube on ovarian function and surgical outcomes in women undergoing laparoscopic bilateral prophylactic salpingectomy. Design Randomized, controlled trial. Setting Teaching hospital. Patient(s) One hundred eighty-six women undergoing laparoscopic surgery for uterine myoma (n = 143) or tubal surgical sterilization (n = 43). Intervention(s) Patients were randomly divided into two groups. In group A (n = 91), standard salpingectomy was performed. In group B (n = 95), the mesosalpinx was removed within the tubes. Prior to and 3 months after surgery, antimullerian hormone (AMH), FSH, three-dimensional antral follicle count (AFC), vascular index (VI), flow index (FI), vascular-flow index (VFI), and OvAge were recorded for each patient. Main Outcome Measure(s) Ovarian reserve modification (Δ) before and after surgery was assessed as the primary outcome. Operative time, variation of the hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were assessed as secondary outcomes. Result(s) No significant difference was observed between groups for ΔAMH, ΔFSH, ΔAFC, ΔVI, ΔFI, ΔVFI, and ΔOvAge. Moreover, the groups were similar for operative time, ΔHb, postoperative hospital stay, postoperative return to normal activity, and complication rate. Conclusion(s) Even when the surgical excision includes the removal of the mesosalpinx, salpingectomy does not damage the ovarian reserve. Moreover, wide salpingectomy with excision of the mesosalpinx did not alter blood loss, hospitalization stay, or return to normal activities. Clinical Trial Registration Number NCT02086370.

The time-division duplex (TDD) component of the universal mobile telecommunications system (UMTS) employs synchronous code-division multiple-access techniques with orthogonal spreading codes to provide protection against cochannel interference. In the presence of multipath propagation, however, the code orthogonality is lost and multiaccess interference is generated at the receiver. In such conditions, an estimate of the channel impulse response is required for reliable detection. In this paper, we propose and compare two pilot-assisted schemes for channel estimation in the downlink of the UMTS-TDD system. Both algorithms also provide estimates of the users' energies, which are needed to perform multiuser detection. Theoretical analysis and computer simulations are used to assess the channel estimation performance in terms of mean-squared errors and bit-error rate. It is shown that the accuracy of the proposed estimators attains the Cramer-Rao bound at intermediate/high signal-to-noise ratios.

Background In the last decade, both endocrine and ultrasound data have been tested to verify their usefulness for assessing ovarian reserve, but the ideal marker does not yet exist. The purpose of this study was to find, if any, a statistical advanced model able to identify a simple, easy to understand and intuitive modality for defining ovarian age by combining clinical, biochemical and 3D-ultrasonographic data. Methods This is a population-based observational study. From January 2012 to March 2014, we enrolled 652 healthy fertile women, 29 patients with clinical suspect of premature ovarian insufficiency (POI) and 29 patients with Polycystic Ovary syndrome (PCOS) at the Unit of Obstetrics & Gynecology of Magna Graecia University of Catanzaro (Italy). In all women we measured Anti Müllerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Estradiol (E2), 3D Antral Follicle Count (AFC), ovarian volume, Vascular Index (VI) and Flow Index (FI) between days 1 and 4 of menstrual cycle. We applied the Generalized Linear Models (GzLM) for producing an equation combining these data to provide a ready to use information about women ovarian reserve, here called OvAge. To introduce this new variable, expression of ovarian reserve, we assumed that in healthy fertile women ovarian age is identical to chronological age. Results GzLM applied on the healthy fertile controls dataset produced the following equation OvAge = 48.05 - 3.14*AHM + 0.07*FSH - 0.77*AFC - 0.11*FI + 0.25*VI + 0.1*AMH*AFC + 0.02*FSH*AFC. This model showed a high statistical significance for each marker included in the equation. We applied the final equation on POI and PCOS datasets to test its ability of discovering significant deviation from normality and we obtained a mean of predicted ovarian age significantly different from the mean of chronological age in both groups. Conclusions OvAge is one of the first reliable attempt to create a new method able to identify a simple, easy to understand and intuitive modality for defining ovarian reserve by combining clinical, biochemical and 3D-ultrasonographic data. Although design data prove a statistical high accuracy of the model, we are going to plan a clinical validation of model reliability in predicting reproductive prognosis and distance to menopause. Electronic supplementary material The online version of this article (doi:10.1186/s13048-015-0149-z) contains supplementary material, which is available to authorized users.

Objective: To study the bone metabolism in postmenopausal women who have been treated with gonadotropin-releasing hormone agonist (GnRH-a) and tibolone. Design: Prospective, open, controlled clinical trial. Setting: Department of Gynecology and Obstetrics, University of Catanzaro, Catanzaro, Italy. Patient(s): One hundred twenty perimenopausal women with symptomatic uterine leiomyomas (groups A and B), and 40 healthy control women who underwent a normal spontaneous menopause (group C). Intervention(s): Treatment for 12 months with leuprolide acetate plus tibolone (group A) or hysterectomy with bilateral oophorectomy (group B). Main Outcome Measure(s): Lumbar spine bone mineral density (BMD) and bone turnover markers at entry into the study, after medical treatment (only group A), and 12 months after discontinuation medical treatment (group A) or after surgery (group B). The same parameters were noted in healthy women before and 12 months after menopause (retrospective control group, group C). Result(s): At the women's entry into the study, no significant difference in BMD and bone turnover markers was detected between groups A and B. In group A, no significant variation in BMD or bone turnover markers was observed 12 months after medical treatment in comparison with baseline. At 12 months after discontinuation of treatment (in women who had achieved menopause) and after surgery, we observed a statistically significant decrease in BMD and in bone turnover markers in both groups in comparison with baseline. At 12 months after they became menopausal, we also observed a statistically significant reduction in BMD and in bone turnover markers in control group C. At the same 12-month follow-up visit, a statistically significant difference in BMD and in bone turnover markers was detected when comparing groups A and B with group C. Conclusion(s): Women previously treated with GnRH-a and tibolone similar to women who are menopausal as a result of surgery, have higher bone loss after menopause.

Novel non data—aided (NDA) algorithms are proposed for joint estimation of timing and carrier phase in MSK—type modulations. They are based on maximum likelihood methods and have a feedforward structure which is suitable to fully digital implementation. Performance with MSK and Gaussian MSK. (GMSK) is assessed by computer simulations and compared with that of other existing estimation schemes.