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Abstract Objectives Evaluate the role of platelet-rich fibrin (PRF) as a natural carrier for antibiotics delivery through the analysis of drug release and antimicrobial activity. Materials and methods PRF was prepared according to the L-PRF (leukocyte- and platelet-rich fibrin) protocol. One tube was used as control (without drug), while an increasing amount of gentamicin (0.25 mg, G1; 0.5 mg, G2; 0.75 mg, G3; 1 mg, G4), linezolid (0.5 mg, L1; 1 mg, L2; 1.5 mg, L3; 2 mg, L4), vancomycin (1.25 mg, V1; 2.5 mg, V2; 3.75 mg, V3; 5 mg, V4) was added to the other tubes. At different times the supernatant was collected and analyzed. Strains of E. coli, P. aeruginosa, S. mitis, H. influenzae, S. pneumoniae, S. aureus were used to assess the antimicrobial effect of PRF membranes prepared with the same antibiotics and compared to control PRF. Results Vancomycin interfered with PRF formation. Gentamicin and linezolid did not change the physical properties of PRF and were released from membranes in the time intervals examined. The inhibition area analysis showed that control PRF had slight antibacterial activity against all tested microorganisms. Gentamicin-PRF had a massive antibacterial activity against all tested microorganisms. Results were similar for linezolid-PRF, except for its antibacterial activity against E. coli and P. aeruginosa that was comparable to control PRF. Conclusions PRF loaded with antibiotics allowed the release of antimicrobial drugs in an effective concentration. Using PRF loaded with antibiotics after oral surgery may reduce the risk of post-operative infection, replace or enhance systemic antibiotic therapy while preserving the healing properties of PRF. Further studies are needed to prove that PRF loaded with antibiotics represents a topical antibiotic delivery tool for oral surgical procedures.

Abstract Background Cancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ. Methods This multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients’ data were retrospectively collected from the clinical charts of seven recruiting Italian centres. Results MRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed. Conclusions This is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ.

Autotransplantation is a successful technique to replace compromised teeth. This study presents a computer-guided surgical approach for preparing the receiving socket for a mature mandibular third molar donor tooth with a wait-and-see approach instead of prophylactic endodontic treatment. A 42-year-old woman developed root resorption of tooth 3.7. Extraction of 3.7 and autotransplantation of 3.8 was planned, following a 6-week orthodontic phase for periodontal ligament activation and teeth mobilization. Due to the different root morphology between the compromised and donor teeth and the high mandibular bone density, the receiving socket preparation was performed using guided surgery templates. Two surgical splints were designed with a surgical planning software. Tooth 3.7 was extracted, the recipient site was guided-milled, and tooth 3.8 was transplanted into the new socket in approximately one second of extra-alveolar time. The rapidity of the extra-alveolar time facilitated complete healing without resorting to root canal treatment. Five-year radiological control does not show any periapical lesion or root resorption. The surgical procedure for tooth autotransplantation is fundamental: it must be as atraumatic as possible to preserve the periodontal ligament of the tooth and the receiving socket, and the dentist must minimize the extra-alveolar time. Guided surgery is a reliable solution to combine all these aspects.

The erythrocyte sedimentation rate (ESR) has been used in canine medicine in several disorders, above all, to evaluate levels of inflammation. This study evaluated the ESR in canine leishmaniosis (CanL) and other inflammatory conditions. Three groups of dogs were examined: CanL affected dogs without clinical signs (INFECTED group, #25) or with clinical signs (SICK group, #43) and dogs affected by acute or acute-on-chronic conditions (OTHER DISEASE group, #65). The ESR was compared with acute phase proteins or reactants either positive or negative (leukogram, fibrinogen, iron, unsaturated iron binding capacity, ferritin, haptoglobin, and albumin) and immunological markers (gamma-globulins, IgG, and IgM). The ESR was higher in the SICK group than in the INFECTED group (median 39 vs. 11 mm/h; p < 0.0001), as well as in the OTHER DISEASE than in the INFECTED groups (median 41 vs. 11 mm/h; p < 0.0001). The ESR appeared outside the reference range for all dogs in the SICK and OTHER DISEASE groups and almost with similar values (mm/h; median 39, 95% CI 31–51 vs. 41, 95% CI 12–87; p > 0.05). The extent of changes in ESR can help to establish the severity of CanL and other inflammatory disorders. As a point-of-care test, the ESR can be used to screen dogs for unhealthy conditions, and its values correlate with the severity of any disease, including CanL.

Background: Endometrial cancer (EC) is the most common gynecological malignancy in both Europe and the USA. Approximately 3–5% of cases occur in women of reproductive age. Fertility-sparing treatment (FST) options are available, but very limited evidence regarding grade 2 (G2) ECs exists in the current literature. This systematic review aimed to comprehensively evaluate reproductive and oncologic outcomes among young women diagnosed with stage IA or G2EC disease who underwent FST. Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded. Results: Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST. Conclusions: The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.

Human genital papilloma virus infection is the most prevalent sexually transmitted infection in the world. It is estimated that more than 75% of sexually active women contract this infection in their lifetime. In 80% of young women, there is the clearance of the virus within 18–24 months. In developed countries, oral squamous cell carcinoma (OSCC) is now the most frequent human papilloma virus (HPV)-related cancer, having surpassed cervical cancer, and it is predicted that by 2030 most squamous cell carcinomas will be the HPV-related rather than non-HPV-related form. However, there are currently no screening programs for oral cavity infection. While the natural history of HPV infection in the cervix is well known, in the oropharynx, it is not entirely clear. Furthermore, the prevalence of HPV in the oropharynx is unknown. Published studies have found wide-ranging prevalence estimates of 2.6% to 50%. There are also conflicting results regarding the percentage of women presenting the same type of HPV at two mucosal sites, ranging from 0 to 60%. Additionally, the question arises as to whether oral infection can develop from genital HPV infection, through oral and genital contact or by self-inoculation, or whether it should be considered an independent event. However, there is still no consensus on these topics, nor on the relationship between genital and oral HPV infections. Therefore, this literature review aims to evaluate whether there is evidence of a connection between oral and cervical HPV, while also endorsing the usefulness of the screening of oral infection in patients with high-risk cervical HPV as a means of facilitating the diagnosis and early management of HPV-related oral lesions. Finally, this review emphasizes the recommendation for the use of the HPV vaccines in primary prevention in the male and female population as the most effective means of successfully counteracting the increasing incidence of OSCC to date.

Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the “see and treat” approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through “see and treat” hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.

The Mediterranean Sea is considered a “litmus paper” of pollution risks for any parameter, including faecal contamination. Giardia duodenalis is one of the most important protozoan parasites responsible for diarrhoea in a wide range of hosts, including humans, domestic and wild animals, worldwide. The degree of contamination related to the protozoan's resistant forms on land, and the consequent transport through rivers from point sources to the sea are important aspects to better understand the processes involved in the microbiological pollution of aquatic ecosystems. However, land-sea transfer routes and the complex transmission patterns often remain neglected. This contribution deals with the contamination by G. duodenalis of the Mediterranean Sea through its inhabitants (shellfish, marine mammals, fishes), and provides data on the origin of such contamination on land from humans and animals to soil, fresh produce and waters; this scenario allows to understand the long journey of the protozoan following the drainage basins (i.e., natural watersheds) from the mainland towards the final destination. The Mediterranean Sea contamination is also explained in the light of the Giardia survival in water and the effects of climatic change with the related consequences. Addressing faecal contamination threats in the Mediterranean Sea is a difficult task, but a number of mitigation measures need to be implemented and/or in some countries even applied. Effective management must become a priority in the agenda of policy makers of all Mediterranean Countries for the implementation of successful measures and can only be applied in the perspective of the One Health approach.

Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.

Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.

Abstract Background The use of dental implants in the prosthetic rehabilitation of the posterior atrophic maxilla might be a challenge procedure because of low bone quantity and quality. This study aimed to report cases of implant displacement or migration into the maxillary sinus treated from 2008 to 2021. Materials and methods All patients with unintentional insertion and/or displacement of dental implants into the maxillary sinus cavity that underwent surgical removal were included. Variables assessed included the patients’ characteristics, past medical history, clinical and radiological findings at presentation, surgical approach (transoral, transnasal, combined), and outcome. Results A total of forty patients (23 male, 17 female) underwent surgical removal of dental implant displaced in the maxillary sinus. The mean age was 52,3 + 11,3 years. Seven patients presented with oro-antral fistula (OAF). In 15 cases, an ostium obstruction was diagnosed. Twenty-five patients underwent transoral surgery under local anesthesia. Eleven patients were treated solely via transnasal endoscopic approach, and four patients who had an associated OAF underwent surgery through a combined transnasal and transoral approach. All patients healed uneventfully without complications. Conclusion These results and recent literature validate that transoral and transnasal approach, or a combination of these procedures, can be used safely to treat complications following displacement/migration of dental implants in the maxillary sinus. Early surgical removal minimizes sinus inflammation and prevents more invasive procedures. Each procedure presents specific indications that must be carefully evaluated prior to treatment choice to optimize intervention outcomes.

The purpose of this study was to evaluate short- and long-term changes in growing patients with Class II malocclusion and open bite after rapid maxillary expansion (RME). A retrospective cohort study was conducted with 16 growing patients with open-bite malocclusion enrolled in a group treated with a rapid maxillary expander (RME) with a crib (TG), and 16 untreated patients with similar malocclusion in the control group (CG). Cephalograms were recorded before starting the treatment (T0), at the end of the latency phase (T1), and before the fixed therapy (T2) in order to analyze skeletal and dental changes in vertical, transversal, and sagittal relationships. Statistical analysis was performed with α = 0.05 as level of significance. At the end of the active expansion (T1), all subjects in the TG showed a corrected overbite with a statistically significant difference compared to the CG (p > 0.05). A significant decrease in jaw divergence was found in the TG compared to the CG (p < 0.05). At T2, all treated patients maintained a correct overbite. Statistical analysis revealed a significant decrease in maxillary, mandibular, and intermaxillary divergence in the TG compared to the CG (p < 0.05). This protocol could be effective in growing open-bite patients, showing a long-term decrease in facial divergence. The fixed crib allowed to normalize myofunctional activity.

In the field of oral and maxillofacial surgery, continuous advances have ushered in a new era of innovation, profoundly influencing this branch of medicine [...]

Ground motion modification over large areas is generally evaluated by focusing on source effects disregarding local lithostratigraphic site conditions. Hence, amplification maps of peak ground acceleration and peak ground velocity are proposed to improve the forecast of ground motion on a national scale. Topological information about litho-type successions and soil mechanical behaviour were retrieved from the Italian database of seismic microzonation and more than 30 million of seismic site response analyses were performed to quantify the amplification factors (i.e. the ratio between expected ground motion at the site of interest and that at the outcropping engineering bedrock). The maximum value of the amplified peak ground acceleration on the Italian territory results in about twice as much as the value expected at the outcropping of the engineering bedrock. Finally, damage scenario maps based on the amplified ground motion could be produced as a supporting tool for urban planning and emergency system management.

Abstract Background Oral lichen planus (OLP) is an immune-mediated inflammatory chronic disease of the oral mucosa, with different patterns of clinical manifestations which range from keratotic manifestations (K-OLP) to predominantly non-keratotic lesions (nK-OLP). The aim of the study was to analyze the differences in the clinical, psychological profile and symptoms between Italian patients of the North and Central-South with K-OLP and nK-OLP. Methods 270 K-OLP and 270 nK-OLP patients were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered. Results The Central-South K-OLP (CS-K-OLP) patients reported a higher frequency of pain/burning compared with the K-OLP patients of the North (N-K-OLP) with higher scores in the NRS and T-PRI (p value

Objectives To explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP).Design and setting A retrospective cohort study employing administrative health data from the Tuscany region, Italy.Participants All women over 40 years hospitalised for apical/multicompartmental POP reconstructive surgery (excluding anterior/posterior colporrhaphy without concomitant hysterectomy) from January 2017 to December 2019.Outcomes We first computed treatment rates just for women residing in Tuscany (n=2819) and calculated the Systematic Component of Variation (SCV) to explore variation in access to care among health districts. Then, using the full cohort (n=2959), we ran multilevel models for the average length of stay and reoperations, readmissions and complications, and computed the intraclass correlation coefficient to assess the individual and hospital determinants of efficiency and quality of care provided by hospitals.Results The 5.4-fold variation between the lowest-rate (56/100 000 inhabitants) and the highest-rate (302/100 000) districts and the SCV over 10% confirmed high systematic variation in the access to care. Higher treatment rates were driven by greater provisions of robotic and/or laparoscopic interventions, which showed highly variable usage rates. Both individual and hospital factors influenced quality and efficiency provided by hospitals, but just low proportions of variation were explained by hospital and patient characteristics.Conclusions We found high and systematic variation in the access to POP surgical care in Tuscany and in quality and efficiency provided by hospitals. Such a variation may be mainly explained by user and provider preferences, which should be further explored. Also, supply-side factors may be involved, suggesting that wider and more uniform dissemination of robotic/laparoscopic procedures may reduce variation.

Vaginal approach remains one of the safest and easiest surgical procedures to treat many gynaecological pathologies such as cervico-vaginal fibroids or vaginal septum. These classical procedures are, however, hindered by the disruption of the integrity of the hymen, an issue that remains controversial if not unfavourable in certain conservative geographical areas such as the Middle East. Herein, we describe 3 alternative surgical laparoscopic techniques to deal with the issue of hymen conservation. In the first 2 cases we suggest a laparoscopic approach through an anterior or a posterior colpotomy to treat large cervico-vaginal fibroids. In the third case, we propose a laparoscopic technique for the resection of a vaginal septum in a young girl with obstructed hemivagina and ipsilateral renal agenesis syndrome.

Background: Macro-geometry and surgical implant site preparation are two of the main factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to assess the initial stability of various implant macro-designs using both magnetodynamic and traditional osteotomy techniques in low-density bone. The parameters examined included peak insertion torque (PIT), implant stability quotient (ISQ), and peak removal torque (PRT). Methods: Four groups of 34 implants each were identified in accordance with the surgery and implant shape: T5 group (Five implant and osteotomy using drills); M5 group (Five implant and magnetodynamic osteotomy using Magnetic Mallet); TT group (TiSmart implant and osteotomy with drills); and MT group (TiSmart implant and magnetodynamic osteotomy). Every implant was placed into a low-density bone animal model and scanned using CBCT. The PIT and PRT were digitally measured in Newton-centimeters (Ncm) using a torque gauge device. The ISQ was analyzed by conducting resonance frequency analysis. Results: The PIT values were 25.04 ± 4.4 Ncm for T5, 30.62 ± 3.81 Ncm for M5, 30 ± 3.74 Ncm for TT, and 32.05 ± 3.55 Ncm for MT. The average ISQ values were 68.11 ± 3.86 for T5, 71.41 ± 3.69 for M5, 70.88 ± 3.08 for TT, and 73 ± 3.5 for MT. The PRT values were 16.47 ± 4.56 Ncm for T5, 26.02 ± 4.03 Ncm for M5, 23.91 ± 3.28 Ncm for TT, and 26.93 ± 3.96 Ncm for MT. Based on our data analysis using a t-test with α = 0.05, significant differences in PIT were observed between TT and T5 (p < 0.0001), M5 and T5 (p < 0.0001), and MT and TT (p = 0.02). Significant differences in the ISQ were found between TT and T5 (p = 0.001), M5 and T5 (p < 0.001), and MT and TT (p = 0.01). The PRT also exhibited significant differences between TT and T5, M5 and T5, and MT and TT (p < 0.0001). Conclusion: Our data showed favorable primary implant stability (PS) values for both implant macro-geometries. Furthermore, the magnetodynamic preparation technique appears to be more effective in achieving higher PS values in low-density bone.

The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.

The use of nutraceutical products to enhance male sexual performance has a long history, especially with regard to the treatment of erectile dysfunction (ED). Alternative treatments for ED are becoming increasingly popular, with growing interest from consumers, as well as increased revenue for manufacturers. Dietary supplements (DSs), which are a mixture of active ingredients, are mainly sold online. In randomized controlled trials, the molecules contained in DSs have demonstrated varying degrees of effectiveness, or even have no evidence to support their use. However, none of the studies carried out provided sufficient evidence to consider these products a first-line therapy. Therefore, the combination of the various active ingredients, especially in relation to the daily dose, leaves doubts about the real effectiveness. In order to evaluate the potential efficacy of DS formulations, we analyzed the products marketed in Italy using a scoring approach. A systematic review of the literature was performed to evaluate the effect of DS and to detect the active ingredients able to improve erectile function—called effective ingredients (EIs)—and their minimal effective daily dose (mED). A metanalysis identified some nutraceuticals, such as Panax ginseng, Tribulus terrestris and L-arginine, that are able to improve male sexual function. Based on the scoring system, 2 (8%) supplements matched with the cluster of higher expected efficacy, 3 (12%) with the lower efficacy cluster and 20 (80%) matched with the criterion of no expected efficacy. DSs marketed in Italy are usually blends of many substances that are frequently employed at a negligible dose or without any evidence.

Second-trimester 2D ultrasound (US) assessment of the fetal anatomy, as proposed by worldwide guidelines, allows detecting the majority of fetal malformation. However, the detection rates of fetal facial anomalies seem to still be low, mostly in cases of isolated facial malformation. The purpose of this research was to assess and analyze the concordance between the antenatal imaging findings from second-trimester US screening and the results of fetal postmortem autopsy. Between January 2010 and January 2020, there were 43 cases where fetuses with prenatal ultrasound diagnosis of a face abnormality, associated or not with a genetic syndrome or chromosomal disorder, following intrauterine death (IUD) or termination of pregnancy (TOP) after the 13 weeks of pregnancy, underwent autopsy in the Pathological Anatomy section of Bari Polyclinic specializing in feto-placental autopsies. The diagnosis of the fetal facial defects at ultrasound was compared with the findings at autopsy in all cases. A very high level of agreement between prenatal ultrasound and autopsy findings was found for facial abnormalities associated with genetic syndromes or numerical abnormality of chromosomes. A lower level of concordance was instead found in isolated facial defects or those associated with other organ anomalies, but not associated with genetic syndrome or numerical chromosome anomaly. A detailed examination of aborted fetuses led to successful quality control of early-second-trimester ultrasound detection of facial anomalies; however, it was less accurate for the isolated ones. It is, thus, reasonable to propose a systematic early-second-trimester prenatal ultrasound screening for facial anatomy by operators specialized in fetal medicine field, using 2D, 3D, and 4D techniques (two-, three-, and four-dimensional ultrasound).

Bisphenol A (BPA), an endocrine-disrupting compound with estrogenic behavior, is of great concern within the scientific community due to its high production levels and increasing concentration in various surface aquifers. While several materials exhibit excellent capacity for the photocatalytic degradation of BPA, their powdered nature and poor chemical stability render them unsuitable for practical application in large-scale water decontamination. In this study, a new class of nanocomposite membranes based on sulfonated polyethersulfone (sPES) and multiwalled carbon nanotubes decorated with TiO2 nanoparticles (MWCNTs-TiO2) were investigated as efficient and scalable photocatalysts for the photodegradation of BPA in aqueous solutions. The MWCNTs-TiO2 hybrid material was prepared through a facile and inexpensive hydrothermal method and extensively characterized by XRD, Raman, FTIR, BET, and TGA. Meanwhile, nanocomposite membranes at different filler loadings were prepared by a simple casting procedure. Swelling tests and PFG NMR analyses provided insights into the impact of filler introduction on membrane hydrophilicity and water molecular dynamics, whereas the effectiveness of the various photocatalysts in BPA removal was monitored using HPLC. Among the different MWCNTs-TiO2 content nanocomposites, the one at 10 wt% loading (sP-MT10) showed the best photoactivity. Under UV irradiation at 254 nm and 365 nm for 240 min, photocatalytic oxidation of 5 mg/L bisphenol A by sP-MT10 resulted in 91% and 82% degradation, respectively. Both the effect of BPA concentration and the membrane regenerability were evaluated, revealing that the sP-MT10 maintained its maximum BPA removal capability over more than 10 cycles. Our findings indicate that sP-MT nanocomposite membranes are versatile, scalable, efficient, and highly reusable photocatalysts for the degradation of BPA, as well as potentially for other endocrine disruptors.

Mercury is a global pollutant, very dangerous for the aquatic ecosystems and for human health. The sources of mercury in the environment are either anthropogenic or natural. However, historical mining activities and current anthropogenic activities, have led to a significant increase of its level in the environment. Its removal by efficient and cost-effective technologies, is of the utmost importance in order to help restore it back towards natural levels. Here we show that a novel cellulose citrate biopolymer, produced by the reaction of cellulose and citric acid, is an efficient adsorbent of inorganic mercury with a distribution constant close to 105 l/g and an estimated record high maximum adsorption capacity of 1600 mg/g. Moreover, due to the large fraction of citrate moieties on its surface, its adsorption selectivity toward inorganic mercury, is the highest after that for Pb(II), among a series of divalent heavy metals, in different aqueous matrices. Finally, cellulose citrate can be reused for several adsorption cycles by a simple regeneration process without significant adsorption performance loss.

During pregnancy, reactive oxygen species (ROS) serve as crucial signaling molecules for fetoplacental circulatory physiology. Oxidative stress is thought to sustain the pathogenesis and progression of hypoxic-ischemic encephalopathy (HIE). A retrospective study was performed on the brains and placentas of fetuses and newborns between 36–42 weeks of gestation (Group_1: Fetal intrauterine deaths, Group_2: Intrapartum deaths, Group_3: Post-partum deaths, Control group sudden neonatal death); all groups were further divided into two subgroups (Subgroup_B [brain] and Subgroup_P [placenta]), and the study was conducted through the immunohistochemical investigations of markers of oxidative stress (NOX2, 8-OHdG, NT, iNOS), IL-6, and only on the brain samples, AQP4. The results for the brain samples suggest that NOX2, 8-OHdG, NT, iNOS, and IL-6 were statistically significantly expressed above the controls. iNOS was more expressed in the fetal intrauterine death (Group_1) and less expressed in post-partum death (Group_3), while in intrapartum death (Group_2), the immunoreactivity was very low. IL-6 showed the highest expression in the brain cortex of the fetal intrauterine death (Group_1), while intrapartum death (Group_2) and post-partum death (Group_3) showed weak immunoreactivity. Post-partum death (Group_3) placentas showed the highest immunoreactivity to NOX2, which was almost double that of the fetal intrauterine death (Group_1) and intrapartum death (Group_2) placentas. Placental tissues of fetal intrauterine death (Group_1) and intrapartum death (Group_2) showed higher expression of iNOS than post-partum death (Group_3), while the IL-6 expression was higher in the fetal intrauterine death (Group_1) than the post-partum death (Group_3). The AQP4 was discarded as a possible marker because the immunohistochemical reaction in the three groups of cases and the control group was negative. The goal of this study, from the point of view of forensic pathology, is to provide scientific evidence in cases of medical liability in the Obstetric field to support the clinical data of the timing of HIE.

The latest classification from the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) has reclassified type 3 myomas, changing their classification from intramural to submucosal. While hysteroscopic myomectomy is considered the gold standard treatment for patients experiencing symptoms from submucosal myomas, there are currently no specific guidelines available for managing type 3 myomas, and the optimal surgical approach remains uncertain. Methods: The search for suitable articles published in English was carried out using the following databases (PROSPERO ID CRD42023418602): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database, Web of Science and search register. Only original studies reporting data on hysteroscopic myomectomy of type 3 myoma were considered eligible. The main outcomes investigated were the effectiveness and feasibility of hysteroscopic myomectomy and reproductive outcomes after surgical treatment. Results: Two hundred and sixty-one studies were screened and nineteen of these were read for eligibility. Three studies encompassing 56 patients in total were included. Among the overall population studied, three patients needed an additional procedure to completely remove the myoma and five cases of post-surgical synechiae were recorded. No complications were reported. Of 42 patients wishing for pregnancy, the cumulative live birth rates before and after the hysteroscopic myomectomy were 14.3% and 42.9%, respectively. Conclusions: Hysteroscopic myomectomy appears to be a safe and feasible approach. Nevertheless, data reported in the literature are extremely scarce and based on studies with few patients enrolled. New evidence is needed to assess the safety and effectiveness of hysteroscopic treatment for FIGO type 3 myomas.

To date, studies focusing on oral health in obese adolescents have provided controversial data. The aim of this cross-sectional study was to investigate systemic and oral health parameters in eutrophic and overweight/obese adolescents. In total, 100 adolescents, mean aged 13.33 ± 2.04 years, were divided into two groups: 59 overweight/obese adolescents in the study group (SG) and 41 eutrophic-weight adolescents in the control group (CG). Chi-squared and Fisher exact tests were performed to compare dichotomous and categorical variables between the two groups. The subjects in the SG (mean aged 13.21 ± 2.21) reported a body mass index (BMI) of 29.05 ± 4.09 kg/m2, corresponding to over 95° percentile for both genders, and the subjects in the CG (mean aged 13.49 ± 1.77) reported a BMI of 18.26 ± 4.81 kg/m2, corresponding to 25° percentile for both genders. In the SG, the serum level of 25-hydroxy-vitamin D was significantly lower (p-value < 0.001), whereas fasting blood glucose (p = 0.006), waist circumference, and hip circumference were significantly higher (p-value < 0.001). Plaque Index (PI), Plaque Control Record (PCR), Oral Hygiene Index (OHI), Gingival Index (GI), and Gingival bleeding index (GBI) depicted a significantly worse level of oral health in the SG. Moreover, the number of subjects with caries was significantly higher in the SG. Nutritional and physical activity status according to the Mediterranean Diet Quality Index for children and teenagers (KIDMED test) and the International Physical Activity Questionnaire (IPAQ-Adolescent) were reported to be significanlty better in the CG. In light of our results, obesity and poor oral health coexist in a cohort of adolescents. A screening of oral health status should be considered in obese subjects to focus resources on therapeutic interventions aiming at improving oral health.

The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.

In the present case–control study, the impact of medication-related osteonecrosis of the jaws (MRONJ) on patients’ oral health-related quality of life (OHRQoL), overall quality of life (QoL), and psychological status was evaluated using a set of questionnaires. These questionnaires included the Oral Health Impact Profile-14 (OHIP-14), the Short Form 36 Health Survey Questionnaire (SF-36), and the hospital anxiety and depression scale (HADS). A total of 25 MRONJ patients and 25 controls were included in the study. The results showed that MRONJ patients had a significantly poorer OHRQoL (OHIP-14 score p-value: 0.003) and lower general QoL, particularly in the domains of “physical functioning”, “physical role”, “body pain”, “general health”, and “vitality” in the SF-36 questionnaire (p-values: 0.001, 0.001, 0.013, 0.001, and 0.020). Although there were no significant differences between the groups in the SF-36 domains of “social functioning”, “emotional role”, and “mental health”, the mean sub-scores of the HADS, specifically the depression and anxiety scores (HADS-D and HADS-A), were significantly higher in MRONJ patients (p-values: 0.002 and 0.009). However, the “mental health” domain of the SF-36 questionnaire showed a correlation with both HADS-A and HADS-D scores (p-values: 0.003 and 0.031). Therefore, a comprehensive clinical examination of MRONJ patients should include the assessment of OHRQoL, overall QoL, and psychological profile using different questionnaires. This approach aims to gather detailed information about patients’ physical and psychological well-being, enabling the development of tailored treatments.

Fertility preservation (FP) is becoming a critical issue in transgender men who desire biological offspring in the future. The prevalence of transgender individuals in the United States is increasing, and as a result, the demand for gender-affirming surgeries (GAS) and associated FP techniques is rising. Despite the growing demand, there is currently no personalized approach to FP for transgender men, and the available techniques have limitations that require further investigation. In the present review we carefully examine the existing literature on this topic to highlight the shortcomings of current methods and areas where additional research is needed to advance the field. Hormonal therapy (HT), which is an integral part of gender transition in transgender men, can have a significant impact on fertility and may increase the risk of various diseases. Moreover, GAS usually leads to permanent sterility in these patients. Therefore, it is essential to provide patients with accurate information about the benefits and potential risks of different FP techniques, taking into account the patient’s reproductive goals. This review underscores the complex and multifaceted nature of FP in transgender men and emphasizes the need for further research to develop more effective and personalized approaches to FP for this population.

One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost–benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient’s needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.

The aim of the study was to evaluate the accuracy of zygomatic implant placement using customized bone-supported laser-sintered titanium templates. Pre-surgical computed tomography (CT) scans allowed to develop the ideal virtual planning for each patient. Direct metal laser-sintering was used to create the surgical guides for the implant placement. Post-operative CT scans were taken 6 months after surgery to assess any differences between the planned and placed zygomatic implants. Qualitative and quantitative three-dimensional analyses were performed with the software Slicer3D, recording linear and angular displacements after the surface registration of the planned and placed models of each implant. A total of 59 zygomatic implants were analyzed. Apical displacement showed a mean movement of 0.57 ± 0.49 mm on the X-axis, 1.1 ± 0.6 mm on the Y-axis, and 1.15 ± 0.69 mm on the Z-axis for the anterior implant, with a linear displacement of 0.51 ± 0.51 mm on the X-axis, 1.48 ± 0.9 mm on the Y-axis, and 1.34 ± 0.9 mm on the Z-axis for the posterior implant. The basal displacement showed a mean movement of 0.33 ± 0.25 mm on the X-axis, 0.66 ± 0.47 mm on the Y-axis, and 0.58 ± 0.4 mm on the Z-axis for the anterior implant, with a linear displacement of 0.39 ± 0.43 mm on the X-axis, 0.42 ± 0.35 mm on the Y-axis, and 0.66 ± 0.4 mm on the Z-axis for the posterior implant. The angular displacements recorded significative differences between the anterior implants (yaw: 0.56 ± 0.46°; pitch: 0.52 ± 0.45°; roll: 0.57 ± 0.44°) and posterior implants (yaw: 1.3 ± 0.8°; pitch: 1.3 ± 0.78°; roll: 1.28 ± 1.1°) (p < 0.05). Fully guided surgery showed good accuracy for zygomatic implant placement and it should be considered in the decision-making process.

Periodontitis is a gingiva disease sustained by microbially associated and host-mediated inflammation that results in the loss of the connective periodontal tissues, including periodontal ligament and alveolar bone. Symptoms include swollen gingiva, tooth loss and, ultimately, ineffective mastication. Clinicians utilize regenerative techniques to rebuild and recover damaged periodontal tissues, especially in advanced periodontitis. Human periodontal ligament stem cells (hPDLSCs) are considered an appealing source of stem cells for regenerative therapy in periodontium. hPDLSCs manifest the main properties of mesenchymal stem cells, including the ability to self-renew and to differentiate in mesodermal cells. Significant progress has been made for clinical application of hPDLSCs; nevertheless, some problems remain, including the small number of cells isolated from each sample. In recent decades, hPDLSC ex vivo expansion and differentiation have been improved by modifying cell culture conditions, especially with the supplementation of cytokines’ or growth factors’ mix, chemicals, and natural compounds, or by using the decellularized extracellular matrix. Here, we analyzed the changes in stemness properties and differentiation potential of hPDLSCs when culturing in alternative media. In addition, we focused on the possibility of replacing FBS with human emoderivates to minimize the risks of xenoimmunization or zoonotic transmission when cells are expanded for therapeutic purposes.

This study aimed to provide information on the presence and frequency of viral and parasitic agents in wildlife presented to a Veterinary Teaching Hospital in 2020–2021. Serum and faecal samples were collected from 50 rescued animals (roe deer, fallow deer, foxes, badgers, pine martens, and porcupines) and examined by serological, molecular, and parasitological techniques. Transtracheal wash (TTW) was also collected post-mortem from roe deer. Overall, the results of the different techniques showed infections with the following viral and parasitic agents: Bovine Viral Diarrhea Virus, Small Ruminant Lentiviruses, Kobuvirus, Astrovirus, Canine Adenovirus 1, Bopivirus, gastrointestinal strongyles, Capillaria, Ancylostomatidae, Toxocara canis, Trichuris vulpis, Hymenolepis, Strongyloides, Eimeria, Isospora, Dictyocaulus, Angiostrongylus vasorum, Crenosoma, Dirofilaria immitis, Neospora caninum, Giardia duodenalis, and Cryptosporidium. Sequencing (Tpi locus) identified G. duodenalis sub-assemblages AI and BIV in one roe deer and one porcupine, respectively. Adult lungworms collected from the TTW were identified as Dictyocaulus capreolus (COX1 gene). This is the first molecular identification of G. duodenalis sub-assemblage AI and D. capreolus in roe deer in Italy. These results show a wide presence of pathogens in wild populations and provide an overview of environmental health surveillance.

Background: In recent times, different novel GnRH-antagonist protocols with various combinations of gonadotropins and other molecules (e.g., aromatase inhibitors, selective estrogen receptor modulators) have been proposed for expected normal ovarian responders undergoing assisted reproductive treatments. The purpose of this study was to evaluate the effectiveness of a novel ovarian stimulation protocol based on the combination of corifollitropin-alfa plus five days of letrozole in E-NOR women undergoing IVF as compared with a daily recombinant-FSH regimen. Methods: We conducted a retrospective-controlled study on 182 couples undergoing their first IVF attempt. In Group A (experimental), letrozole (2.5 mg daily) was administered from day 2 (up to day 6 of the cycle), followed by corifollitropin-alfa on day 3 and daily recombinant FSH from day 10. In Group B, recombinant FSH from day 2 were administered (150 IU-225 IU daily). Statistical analysis was completed using SPSS Statistics. The primary outcome was the total number of MII oocytes retrieved. Results: Group A showed similar results compared to Group B in terms of MII oocytes, live birth, implantation, and clinical pregnancy rates (p = ns). Nevertheless, the experimental group was associated with a trend towards a higher number of developing follicles, total oocytes, and embryos (p < 0.05) with lower estradiol and progesterone values at ovulation induction compared to Group B, resulting in an increased chance of performing a fresh embryo transfer (p < 0.05). Conclusions: The combination of CFα plus five days of letrozole was associated with a trend towards a higher number of developing follicles, total oocytes, and obtained embryos. Moreover, the experimental protocol resulted in lower estradiol and progesterone values at ovulation induction compared to daily rFSH, with an increased chance of performing a fresh embryo transfer (with no OHSS occurrence). Given the observational design of our study, further well-conducted RCTs are needed.

Periodontal diseases are oral inflammatory diseases affecting the tissues supporting and surrounding the teeth and include gingivitis and periodontitis. Oral pathogens may lead to microbial products spreading into the systemic circulation and reaching distant organs, while periodontal diseases have been related to low-grade systemic inflammation. Gut and oral microbiota alterations might play a role in the pathogenesis of several autoimmune and inflammatory diseases including arthritis, considering the role of the gut–joint axis in the regulation of molecular pathways involved in the pathogenesis of these conditions. In this scenario, it is hypothesized that probiotics might contribute to the oral and intestinal micro-ecological balance and could reduce low-grade inflammation typical of periodontal diseases and arthritis. This literature overview aims to summarize state-of-the-art ideas about linkages among oral–gut microbiota, periodontal diseases, and arthritis, while investigating the role of probiotics as a potential therapeutic intervention for the management of both oral diseases and musculoskeletal disorders.

This pilot split-mouth study aimed to evaluate and compare early postoperative discomfort and wound healing outcomes in post-extraction sockets after dental extraction performed with a Magnetic Mallet (MM), piezosurgery, and conventional instruments (EudraCT 2022-003135-25). Twenty-two patients requiring the extraction of three non-adjacent teeth were included. Each tooth was randomly assigned to a specific treatment (control, MM, or piezosurgery). Outcome measures were the severity of symptoms after surgery, wound healing assessed at the 10-days follow-up visit, and the time taken to complete each procedure (excluding suturing). Two-way ANOVA and Tukey’s multiple comparisons tests were performed to evaluate eventual differences between groups. There were no statistically significant differences between the compared methods in postoperative pain and healing, and no additional complications were reported. MM required significantly less time to perform a tooth extraction, followed by conventional instruments and piezosurgery, in increasing order (p < 0.05). Overall, the present findings suggest the use of MM and piezosurgery as valid options for dental extractions. Further randomized controlled studies are needed to confirm and extend this study’s results, facilitating the selection of the optimal method for an individual patient depending on the patient’s needs and preferences.

The objective of this work is the elaboration of a methodology to develop STEAM projects (Science (S), Technology (T), Engineering (E), Art (A) and Mathematics (M)). The methodology proposed in this article is part of the results of the project ERASMUS+DART4City (2020-1-ES01-KA227-SCH-095545) “Empowering Arts and creativity for the cities of tomorrow”, whose objective is to design a methodology in order to develop STEAM projects from European curricula. The proposed methodology emerges after analysing, among others, the curricula from Spain, Italy, Cyprus, France, Finland and Germany, taking into account the international perspective of STEAM education, their priorities and problems. The proposal has two variants: “forward” and “backward”. Both variants begin with the analysis of the curriculum in which the contents are grouped by similarity, classified according to STEAM disciplines so that the thematic areas can be obtained. Subsequently, in the “forward” variant, the thematic areas with most connections are selected as areas of opportunity; for the development of the STEAM project, so from the “forward” methodology, the teacher will be able to select an area of opportunity and develop the project around it, so, the concept or project idea comes from an area of oportunity. The “backward” variant starts from a concept considered interesting for society or just for the teacher and which will become the main theme of the STEAM project and, from that concept, we will select the thematic areas of the curriculum that can be included in the project. The main difference bewteen both methodologies is that in the “forward” variant, the STEAM project concept comes from an area of oportunity detected in the curriculum meanwhile in the “backward” variant the concept of the STEAM project comes from the teacher, without taking into acount, initially, the curriculum. This article shows an example of application of each variant. From the “forward” variant, the STEAM project “Sustainable City” is shown for years 4, 5 and 6 of Primary Education, which has been carried out from the opportunity area “Sustainability”. From the “backward” variant, we develop the STEAM project, whose main theme is cooking, in which, based on this theme, 10 tests are developed, each of them related to different thematic areas of the Spanish curriculum.

Introduction: Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism. Objectives: We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and metabolic results in patients who underwent SADI-S both as a primary or revisional procedure. Methods: One hundred twenty-one patients were scheduled for SADI-S as a primary or revisional procedure from July 2016 to February 2020 and completed at least 2 years of follow-up. Demographic features, bariatric, nutritional, and metabolic results were analyzed during a stepped follow-up at 3 months, 6 months, 1 year and 2 years. Results: Sixty-six patients (47 female and 19 male) were included. The median preoperative BMI was 53 (48–58) kg/m2. Comorbidities were reported in 48 (72.7%) patients. At 2 years, patients had a median BMI of 27 (27–31) kg/m2 (p < 0.001) with a median %EWL of 85.3% (72.1–96.1), a TWL of 75 (49–100) kg, and a %TWL of 50.9% (40.7–56.9). The complete remission rate was 87.5% for type 2 diabetes mellitus, 83.3% for obstructive sleep apnea syndrome and 64.5% for hypertension. The main nutritional deficiencies post SADI-S were vitamin D (31.82%) and folic acid deficiencies (9.09%). Conclusion: SADI-S could be considered as an efficient and safe procedure with regard to nutritional status, at least in mid-term (2 years) results. It represents a promising bariatric procedure because of the excellent metabolic and bariatric outcomes with acceptable nutritional deficiency rates. Nevertheless, larger studies with longer follow-ups are necessary to draw definitive conclusions.

BackgroundThe COVID-19 pandemic has significantly impacted the management of solid organ transplant recipients and on clinical evolution in post-transplantation. Little is known on the impact of SARS-CoV-2 infection in these patients. The severity and lethality of this disease in solid organ transplant patients are higher thanin the general population. This study aims to describe clinical characteristics of SARS-CoV-2 infection in solid organ transplant recipients followed in our center.MethodsIn this observational study, we enrolled all kidney transplant recipientsattending the A.O.U. Federico II of Naples from March 2020 to January 2021. For each patient we evaluated the epidemiological and clinical characteristics as well as outcome.ResultsWe enrolled 369 kidney transplant patients (229, male, 62%). Of these, 51 (13.8%) acquired SARS-CoV-2 infection and 29 showed symptomatic disease. Of the 51 patients with the infection, 48 (94.11%) had at least one comorbidity and such comorbidities did not constitute a risk factor for a more severe disease. Hospitalization was necessary for 7 (13.7%) patients. Of these, 2 required low-flow oxygen supplementation, 3 non-invasive/high flow ventilation and 2 invasive ventilation. Finally, 2 patients died.ConclusionsOur study shows a lower mortality and hospitalization rate compared to figures available in the literature (4% vs. 13–30% and 14% vs. 32–100%, respectively). Furthermore, the comorbidities examined (hypertension, dyslipidemia, and diabetes) did not constitute a risk factor for a more severe disease condition in this patient category. Further studies with larger sample size are necessary to confirm these data.

This systematic review aims to evaluate the effectiveness of pharmacological and non-pharmacological strategies for pain relief in women during contrast-enhanced ultrasound for the assessment of tubal patency and uterine disease, compared with placebo or no intervention. In December 2021, we searched the electronic databases (Pubmed, Embase, Sciencedirect, the Cochrane library and Clinicaltrials.gov) without date restriction: We identified 10 randomized control trials (RCTs) (2098 women) eligible for this systematic review, after applying our inclusion and exclusion criteria. Among these, five studies compared the use of painkillers with the placebo, two studies compared different catheter positions in the cervix or in the uterine cavity, and two others considered different temperatures of the contrast medium, as a method to reduce pain. Topical lidocaine applied before the procedure may be associated with effective pain relief during hysterosonography, though the quality of this evidence is low. New echogenic contrast agents and their temperature at 37 °C ensure a less painful procedure. There is insufficient evidence to draw conclusions on the efficacy of other analgesics or strategies.