OBJECTIVE -Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss.RESEARCH DESIGN AND METHODS -Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-␣, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women.RESULTS -Compared with nonobese women, obese women had increased concentrations of CRP (P Ͻ 0.01), TNF-␣ (P Ͻ 0.01), IL-6 (P Ͻ 0.01), and IL-18 (P Ͻ 0.01). Moreover, obese women had a higher myocardial performance index (P Ͻ 0.02) and lower transmitral Doppler flow (P Ͻ 0.05), pulmonary venous flow analysis (P Ͻ 0.02), and ejection fraction (P Ͻ 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-␣, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P Ͻ 0.01) and CRP (P Ͻ 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity.CONCLUSIONS -In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women. Diabetes Care 27:47-52, 2004D yssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of cardiac mortality in patients with heart failure (1,2). Moreover, cardiac resynchronization reduces mortality from progressive heart failure in patients with symptomatic left ventricular dysfunction and ventricular dyssynchrony (3). Because approximately onehalf of all deaths among patients with heart failure occur because of progressive cardiac dysfunction, it may be important to evaluate heart function among people at risk of heart failure.Obesity is an important risk factor for heart failure in both women and men. Approximately 11 and 14% of heart failure cases among men and women in the community, respectively, are attributable to increased BMI (4). This is associated with altered left ventricular remodeling, possibly owing to increased hemodynamic load, neurohormonal activation, and increased cytokine production (5). Adipocytes synthesize and secrete several cytokines, including tumor necrosis factor (TNF)-␣ (6) and interleukin (IL)-6 (7). Elevated levels of IL-6, TNF-␣, and IL-18 as well as the sensiti...

Introduction Molar pregnancies belong to a group of diseases classified as gestational trophoblastic diseases, which result from an altered fertilization. Partial molar pregnancy with a live fetus is a very rare condition, occurring in 0.005 to 0.01% of all pregnancies; it presents a challenging diagnosis, especially when clinical signs are almost completely absent. Case presentation Here we report a rare case of partial molar pregnancy in which a normal-appearing male fetus with diploid karyotype was delivered at 31 weeks gestation by a 37-year-old white woman. The pregnancy was characterized by an episode of threatened abortion in the first trimester and an ultrasonographic diagnosis of intrauterine growth restriction. Our patient did not report any suspicious symptoms for trophoblastic disease. Due to impaired umbilical artery velocimetry with an absence of the diastolic phase, she underwent an emergency caesarean section at 31 weeks and delivered an 880 g male baby. The male baby was normal without any complications at 3-month and 12-month follow-up and the mother had no evidence of recurrence after 3 and 12 months of follow-up. Pathological examination of the placenta showed changes of partial hydatidiform mole. Conclusion Partial molar pregnancy with a live fetus is a very rare condition that presents a challenging diagnosis. Recognizing it is of primary importance for patient care and the placenta should always be investigated at birth, especially in a newborn with intrauterine growth restriction.

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.

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Background and Objectives: Since the Food and Drug Administration’s (FDA) approval in 2005, the application of robotic surgery (RS) in gynecology has been adopted all over the world. This study aimed to provide an update on RS in benign gynecological pathology by reporting the scientific recommendations and high-value scientific literature available to date. Materials and Methods: A systematic review of the literature was performed. Prospective randomized clinical trials (RCT) and large retrospective trials were included in the present review. Results: Twenty-two studies were considered eligible for the review: eight studies regarding robotic myomectomy, five studies on robotic hysterectomy, five studies about RS in endometriosis treatment, and four studies on robotic pelvic organ prolapse (POP) treatment. Overall, 12 RCT and 10 retrospective studies were included in the analysis. In total 269,728 patients were enrolled, 1721 in the myomectomy group, 265,100 in the hysterectomy group, 1527 in the endometriosis surgical treatment group, and 1380 patients received treatment for POP. Conclusions: Currently, a minimally invasive approach is suggested in benign gynecological pathologies. According to the available evidence, RS has comparable clinical outcomes compared to laparoscopy (LPS). RS allowed a growing number of patients to gain access to MIS and benefit from a minimally invasive treatment, due to a flattened learning curve and enhanced dexterity and visualization.

Background: Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide comprehensive symptoms, treatments, and complications analysis in the pregnant population affected by SPM. Methods: We conducted a comprehensive search of four databases for published papers in all languages from the beginning to 1 September 2021; Results: We included 76 papers with a total of 80 patients. A total of 76% patients were young primiparous, with a median age of 24 ± 5.4 years. The median gestational age was 40 ± 2.4 weeks, with a median duration of labor of 7.4 ± 4.2 h. In 86%, the ethnic origin was not specified. SPM develops in 55% of cases during the second stage of labor. Subcutaneous swelling and subcutaneous emphysema were present in 91.4%. Chest pain and dyspnea were present in 51.4% and 50% of the patients, respectively. We found that 32.9% patients had crepitus, and less common symptoms were dysphonia and tachycardia (14.3% and 14.3%, respectively). Oxygen and bronchodilators were used in 37.7% of the cases. Analgesics or sedatives were administered in 27.1%. Conservative management or the observation was performed in 21.4% and 28.6%, respectively. Antibiotics treatment was offered in 14.3%, whereas invasive procedures such as chest-tube drainage were used in just 5.7% of patients. There were no complications documented in most SPM (70.0%). We found that 16.7% of the SPM developed a pneumothorax and 5% developed a pneumopericardium.; Conclusions: In pregnancy, SPM occurs as subcutaneous swelling or emphysema during the second stage of labor. The treatment is usually conservative, with oxygen and bronchodilators and a low sequela rate. A universal consensus on therapy of spontaneous pneumomediastinum in pregnancy is necessary to reduce the risk of complications.

Infertility treatment is a stressful process and factors like anxiety and preoccupation could affect the success of In Vitro Fertilization (IVF) or other assisted reproductive techniques. Moreover, luteal phase support (LPS) in IVF cycles is recommended. Our aim was to analyze the effects of LPS with intramuscular and subcutaneous progesterone on stress hormones (cortisol and prolactin). We analyzed one hundred-thirty women undergoing their first IVF cycle and then randomized in two groups: group A (65 patients) received 33 mg/day of intramuscular in oil-progesterone from pick-up and 50mg/day from embryo transfer, group B (65 patients), instead, received 25 mg of subcutaneous water soluble-progesterone from pick-up. Cortisol and prolactin serum levels were obtained at day+7 from oocyte retrieval. Our results showed that the values of prolactin and cortisol were statistically significantly higher in group A compared to the group B. Subcutaneous progesterone treatment, in fact, is associated with lower cortisol and prolactin levels, suggesting new therapeutic opportunities in IVF cycles to reduce patients' distress and improve quality of life. SOMMARIOIl trattamento dell'infertilità è un processo stressante e fattori come l'ansia e la preoccupazione potrebbero influenzare il successo della fecondazione in vitro (IVF) o di altre tecniche di riproduzione assistita. Inoltre, il supporto alla fase luteale (LPS) è raccomandato nei cicli di IVF. Il nostro obiettivo è stato quello di analizzare gli effetti sugli ormoni dello stress (cortisolo e prolattina), della LPS con progesterone intramuscolare e sottocutaneo. Abbiamo analizzato centotrenta donne sottoposte al primo ciclo di IVF e le abbiamo randomizzate in due gruppi: il gruppo A (65 pazienti) ha ricevuto 33 mg/die di progesterone intramuscolare dal giorno del pick-up e 50 mg/die dal giorno del trasferimento dell'embrione, il gruppo B (65 pazienti), invece, ha ricevuto 25 mg di progesterone, solubile in acqua, per via sottocutanea dal giorno del pick-up. I livelli sierici di cortisolo e prolattina sono stati valutati dopo sette giorni dal pick-up. I nostri risultati hanno mostrato che i valori di prolattina e cortisolo erano statisticamente più alti nel gruppo A rispetto al gruppo B. Il trattamento sottocutaneo di progesterone, infatti, è associato a livelli più bassi di cortisolo e prolattina, suggerendo nuove opportunità terapeutiche nei cicli di IVF per ridurre lo stress dei pazienti e migliorare la qualità della vita.

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