Abstract OBJECTIVE: To evaluate the alterations in endometrial waves (EW) originating from the contraction of the subendometrial myometrial layer in the periovulatory and midluteal phases in women diagnosed with chronic endometritis (CE). DESIGN: Case-control study. SETTING: University hospital. PATIENT(S): Forty-five women referred for hysteroscopy and diagnosed with CE. INTERVENTION(S): Three-minute recording of transvaginal ultrasound scanning on sagittal uterine plane at periovulatory (cycle days 11-14) and midluteal phase (cycle days 19-22). MAIN OUTCOME MEASURE(S): Direction and frequency of EW measured by transvaginal ultrasound scan. RESULT(S): The direction and frequency of EW were analyzed offline as accelerated (four to eight times normal speed) image sequences using video editing software, and the results were compared with 45 cycling women without CE. The EW pattern was significantly different when comparing the women with CE and controls at both the periovulatory and midluteal phases. During the periovulatory phase, we observed retrograde contractions in 26.7% versus 88%, anterograde in 24% versus 0, opposing in 22.7% versus 12%, not propagated in 13.3% versus 0, and absent in 13.3% versus 0, respectively, in the CE cases versus the control group. During the midluteal phase, we observed not propagated (41.3% vs. 61.3%), opposing (24% vs. 25.4%), absent (16.1% vs. 13.3%), anterograde (13.3% vs. 0), and retrograde (5.3% vs. 0), respectively, in the CE cases versus the control group. CONCLUSION(S): Women with CE show altered EW patterns in both the periovulatory and midluteal phases. Altered uterine contractility may aid in explaining the symptoms related to CE such as pain, abnormal uterine bleeding, infertility, and possibly endometriosis.

The authors report a case of a 61-year-old woman diagnosed with large bladder diverticulum. Diagnosis was performed only after a series of investigations carried out for the occasional finding of hypercreatininaemia. Although the significant volumes of post void residual (PVR) and the relevant urine stagnation in the diverticulum, subjective symptomatology was absent and urinalysis and urine culture were negative. The scheduled therapeutic plan consisted of fosfomycin three grams every ten days for sixmonths, self-catheterization twice a day, voiding on a time schedule, and adequate fluid intake. The monthly scheduled follow-up at one year showed good general health, good compliance with the therapy, no urinary tract infections, a decrease in creatininemia to 1.2 mg/dl, and regression of nephrohydrosis to a mild stage. In conclusion, the absence of symptoms and negative urinalysis or urine culture allows expectant management despite the considerable size of the bladder diverticulum.

PURPOSE: To assess if arylsulfatase A activity (ASA) and sulfatide (SL) concentration in the human endometrium can be predictive of the development of endometrial polyps over the years, since ASA activity reflects the endometrial sensitivity to hormones. METHODS: ASA activity and SL concentration were determined by biochemical procedures on endometrial samples collected between 1990 and 1994 in non-menopausal women. These women underwent a new endometrial sampling following the clinical indication some years after the first endometrial sampling. The histological assessment of the second endometrial specimens found four patients with normal endometrial pattern and 10 patients with one or more endometrial polyps. ASA activity/years elapsed and SL concentration/years elapsed were compared using two tailed Mann-Whitney test for unpaired data between patients with normal pattern and patients with endometrial polyps. RESULTS: Median ASA activities were 2.62 (normal pattern) versus 1.85 (endometrial polyps) nmol hydrolized substrate/ min. Median activity/years elapsed is higher in patients with second endometrial sample presenting normal pattern (p=0.006) and median SL concentration/years elapsed does not differ significantly among groups, even if median SL concentration seems to be higher in patients who subsequently developed polyps (1031 μg/g of fresh tissue versus 341,5 μg/g of fresh tissue). CONCLUSIONS: ASA activity can predict the onset of endometrial polyps over the years.

Abstract BACKGROUND: Cesarean section on maternal request (CSMR) could represent an avoidable quota of cesareans. In Italy, this is a topical problem of health-policy, involving ethical, juridical and medical issues. AIM AND METHODS: A 5-questions questionnaire to quantitatively assess the perspectives of medical, juridical and ethical issues of planned CSMR was administered to obstetricians and gynecologists, midwives, lawyers and pregnant women. It was assessed to what extent those issues matter on the final decision of planning a CSMR. RESULTS: Non-homogeneous answers of stakeholders suggest different perspectives about issues on CSMR. The juridical issue seems to have the greatest impact on the final decision. CONCLUSION: Planning a CSMR associates overall with juridical issues in each group of respondents. Therefore, an obstetrician and gynecologist is unable to counsel a patient on CSMR from a medical point of view. The most direct way for reducing cesareans in Italy could be the formal prohibition of CSMR.

Abstract Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks’ pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hystero- scopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P 1⁄4 .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome.

Study question: Law 40/2004 enacted by the Italian Parliament established a long list of restrictions for ART procedures. We investigated the differences in the delivery rate of all ART cycles performed before and after the introduction of the law. Summary answer: This large and extensive comparative analysis of ART outcomes prior and after the introduction of the Law 40 revealed a significant reduction in pregnancy and delivery rates per cycle, independent of age or other clinical variables, once the law went into effect. What is known and what this paper adds: Several studies have been published on the effect of Law 40/2004 on ART outcomes, some authors demonstrating a negative impact of the law also in relation to specific aetiologies of infertility, other authors showing opposite conclusions. Our study, the first based on the analysis of a so large number of cycles, clearly demonstrated a negative effect of Law 40 restrictions on ART procedures, as an independent factor responsible for the reduced delivery rate of IVF cycles. Design: Retrospective clinical study Partecipants and setting: 10,706 cycles were analysed, 3,808 performed before and 6,898 cycles after the application of the Law. An intention to treat statistical analysis was performed to detect pregnancy and delivery rates (pregnancies ≥ 24 weeks) per started cycle. A p value <0.05 was considered statistically significant. We analysed different outcomes: differences in fertilization, pregnancy, and delivery rate, multiple pregnancies and miscarriage rates between the two time periods. Main results and the role of chance: The delivery rate for started cycle was 20% before and 16.0% after the introduction of the Law representing a 25% reduction (p<0.001). The multivariate analysis, corrected by age, basal FSH level, number of retrieved oocytes and total progressive motile count, showed a 16% lower delivery rate (OR 0.84 CI 0.75-0.94) and confirmed the effect of the Law as an independent factor responsible for the reduced chances of a successful outcome.

The mild cognitive impairment (MCI) is an impairment of cog- nitive abilities that not yet satisfies diagnostic criteria of dementia. Impaired cardiovascular parameters are associated with the risk of cognitive disorders. Low estrogen levels in postmenopause are related to impaired ability of the central nervous system and could explain the high incidence of cognitive disorders in postmenopausal women. The aim of this study was to assess cognitive performances in post- menopausal women affected by MCI and the impact of an HRT combination of low-dose oestradiol plus drospirenone. The evalua- tion of cognitive skills performed with neuropsychological tests showed that women on HRT had higher cognitive performances than controls, in particular they showed higher rates of short and long term memory, attention, verbal fluency and visuospatial perform- ance. These ability are typically involved in the MCI. The beneficial effects of drospirenone on cardiovascular parameters could explain the reduce risk of developing dementia. Introduction Mild cognitive impairment (MCI) identifies a dy- namic transitional state between normal ageing and dementia (1). It is characterized by the impairment of various domains of cognitive performances (memory, attention, language, executive function, visuospatial original article

Study Objective. To compare two procedures for endometrial resection: resectoscopy with monopolar knife versus resectoscopy with bipolar knife. Patients and methods. 76 perimenopausal patients affected by DUB (Dysfunctional Uterine Bleeding), no longer wishing to remain pregnant and having failed to respond to pharmacological treatment, underwent endometrial ablation with monopolar loop (group A: 38 women) or bipolar loop (group B: 38 women). Operative parameters, complication rate, menstrual outcome were considered. Results. Operative time was no different between groups. The amount of distention fluid adsorbed was significantly higher in group A than in group B, and late cumulative complication rate was 44% in group A and 24% in group B. Menstrual cycle was, overall, controlled in both groups. Conclusions. Bipolar electrode is as effective as monopolar electrode for endometrial resection, but was safer than monopolar knife.

Inflammatory pathway in eutopic endometrium of women with endometriosis Scillitani G MD, Neri M MD, Serviddio G, Cantatore S MTL, De Rosario F Obst, Scutiero G MD , Altomare E MD, Greco P MD, and Matteo M MD Endometriosis is a complex disorder among women of reproductive age associated with chronic pelvic pain, debilitating dysmenorrhoea and infertility . These symptoms are thought to be the consequence of an inflammatory environment within the pelvis. Recently, a growing body of evidence indicates that abnormal inflammation is not only present in the pelvic endometriotic lesions but also in the eutopic endometrium of these patients leading to a proinflammatory environment unsuitable for implantation. Hence the aim of this study was to analyze by immunoblotting and by polymerase chain reaction the expression of inflammatory cytokines known to be involved in chronic endometritis (CE), in the eutopic endometrium of women affected by endometriosis. MATERIALS AND METHODS Endometrial samples were obtained from 12 patients 6 women affected by endometriosis and 6 controls. Histological and immunoistochemical study: An immunohistochemical investigation of tissue samples was performed utilizing antibodies anti-TNF, anti-IL-1, anti-IL-6, anti-IL-8, anti-IL-10, anti-MCP-1, and CD 138. Western blot (WB): Approximately 50 mg of endometrium tissue collected were prepared for Western blot. The image was analysed by Uvitec, which detects the chemiluminescent blots of proteins staining (TNF, IL-1, IL-6, IL-8, IL-10, MCP-1). PCR analysis: In 6 out of 12 patients PCR analysis was also performed in order to confirm immunoistochemical and WB analysis RESULTS Histological and immunohistochemical study and Western blotting The examination of endometrium specimens revealed the negative reaction for the antibodies anti-IL-6 and IL-10 in patients and controls; a strong positive reaction for the antibodies anti-IL-1β, IL-8, MCP1, an intermediate positive reaction for the antibodies anti- TNF and CD138 in the endometriosic group. The control group revealed a negative reaction for all immunohistochemical dye. The immunohistochemical results were confirmed by Western blotting and real time PCR CONCLUSIONS Results demonstrated, in the eutopic endometrium from women with endometriosis, an increased expression of cytokines known to be involved in subclinical chronic endometritis. The presence of a chronic pro inflammatory endometrial environment could concur to explain the poor reproductive potential and the other symptoms associated to this complex disorder.

Background. Experimental evidence suggests a relationship between the vasodilatory effect of hCG and the NOS system in the testis. The influence of hCG administration on testicular vascular NOS gene expression has not been fully investi- gated. Objective: This study aimed to evaluate the pres- ence of the nitric oxide syntheses gene in ram testicular arteries and the influence of hCG administration on its expression. Materials and methods: Both testicular arteries of sixteen rams were extracted before and after i.v. administration of 5000 IU of hCG or placebo. The expression of the iNOS gene was investigated by real time PCR. Data were analyzed by means of Wilcoxon and Mann-Whitney tests. A p value of < 0.05 was considered statistically sig- nificant. Results: PCR revealed the presence of iNOS mRNA in all basal samples but the expression of the iNOS gene was significantly reduced in all arteries obtained 24 h after the administration of either hCG or placebo. A signifi- cant reduction in the expression of iNOS gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups. On the other hand hCG stimulation did not significantly influence iNOS expres- sion following its administration compared to a placebo. Conclusion: Ram testicular arteries express the iNOS gene but hCG stimulation did not significantly influence iNOS expression. A significant reduction in the expres- sion of this gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups, suggesting that iNOS expression on the testicular artery could be influenced by the spermatic vessel ligation of the controlateral testis.

Objective: To assess the relationship between chronic endometritis (CE) and proin␣ammatory cytokine levels in menstrual ef␣uents and to develop a simple noninvasive test for screening CE. Design: Case-control study. Setting: Academic center. Patient(s): Sixty-four women referred to our center for infertility. Intervention(s): Of␣ce hysteroscopy; endometrial biopsy; collection of menstrual blood at subsequent cycle. Main Outcome Measure(s): Interleukin (IL) 6, IL-1b, and tumor necrosis factor (TNF) a concentrations in menstrual ef␣uents. Result(s): Thirty-sixoutof64infertilewomenhadhistologicallyprovenCE.Theremaining28womenwereincludedascontrols.IL-6, IL-1b, and TNF-a levels were markedly higher in menstrual ef␣uents of women with CE compared with control subjects. Receiver operating characteristic curve analysis revealed a good CE screening capacity for all of the cytokines. The combined evaluation of either IL-6/TNF-a or IL-6/IL-1b increased the diagnostic capacity of the test, which reached a 100% sensitivity and a negative predictive value of 100 when at least one cytokine was found to exceed its cutoff value; it also reached a 100% speci␣city and a positive predictive value of 100 in cases of positivity of both cytokines. Logistic regression analysis con␣rmed the IL-6/TNF-a– based model as a signi␣cant predictor of CE. Conclusion(s): Proin␣ammatorycytokinelevelsareincreasedinmenstrualef␣uentsofwomen with CE. A test dosing IL-6 and TNF-a seems to have a high screening capacity for CE. (Fertil Steril! 2014;101:242–7. !2014 by American Society for Reproductive Medicine.)

Purpose: Late-preterm births are considered functionally mature but, several line of evidences suggest that, compared with term neonates, they have a higher risk of complications. The aim of this study was to compare the incidence of maior clinical complications of late preterm infants born in our division, compared to those born at term. Methods: We retrospectively analysed late preterm deliveries occurred in a twenty-months period. Late preterms were divided in 3 sub-groups according to gestational age at delivery: 34 0/6 , 35 0/6 , 36 0/6 weeks of gestation. The incidence of maior clinical complications was evaluated. Statistical analysis was performed by using the Z- test. Results: Among term deliveries 17.24% were admitted to the neonatal intensive care unit and 69.01% presented one major adverse outcome: 25.35% jaundice, 25.35% hypoglycemia , 11.26% RDS , 4.22% intraventricular hemorrhage (IVH), 4,22% anemia. The incidence of IVH was significantly higher only at 340/6 weeks of gestation compared to term infants. The incidence of anemia and RDS was significantly higher at 34 0/6 and 35 0/6 weeks of gestation, but it was not significantly different at 36 weeks of gestation, compared to full-term infants. Finally, the incidence of hypoglycemia and jaundice results significantly higher in all the 3 sub groups of late preterms, compared to full term infants. Conclusions: Results demostrated an increased risk of morbidity in the late preterm period. Results also showed that the gestational age at delivery of late preterms can influence the risk of adverse neonatal outcomes.

BACKGROUND: Vitamin D (Vit D) is important for the regulation of reproductive physiology. In humans, maternal Vit D deficiency has been implicated in several reproductive- and pregnancy-related disorders. Very few data are available regarding the Vit D status in male partners of couples attempting pregnancy. This observational study (IRB Prot. N. 078/13) aimed to evaluate whether low Vit D serum levels in males might decrease the rate of successful conception in couples attempting pregnancy. METHODS: Male and female partners of infertile couples (n = 102) were classified into 2 GROUPS according to normal (≥30 ng/ml) or low (below 30 ng/ml) serum Vit D levels in male partners. Semen analysis was performed in each male participant based on the WHO reference criteria. The female partners of both groups were subjected to 3 consecutive cycles of gonadotropin-induced mono-ovulation. The main outcome measures included the clinical pregnancy rate, delivery per patient and per cycle, and miscarriage rate between the 2 groups evaluated at the end of the three-month period of the study. RESULTS: In male partners of both groups, standard semen analysis did not highlight substantial differences in sperm concentration, sperm progressive motility, or typical form. The pregnancy rates per patient and per cycle and delivery rates per patient and per cycle were all significantly higher (p< 0.05) in couples with normal Vit D levels. CONCLUSIONS: These results suggest the existence of a relationship between male Vit D serum levels and semen ability to begin a pregnancy during cycles of timed vaginal intercourse.

Purpose of investigation: The aim of this prospective randomized study was to evaluate a red clover based isoflavones supplementation in the treatment of climacteric syndrome and its effects on cardiovascular risk serum profile. Materials and Methods: The study included 150 healthy postmenopausal women that were randomly assigned to receive phytoestrogens tablets, amounting in a total daily intake of 60.8 mg red clover isoflavones plus 19.2 mg soy isoflavones (n = 75), or placebo (n = 75). The authors evaluated teh following: daily number of hot flushes and Kupperman Index at baseline and after one and three months; serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and antithrombin III (ATIII) at baseline and after three and six months. Results: One hundred twenty-eight patients completed the study: 67 in the active group and 61 in the placebo group. The treatment led to a progressive significant reduction (p < 0.05) of the number of hot flushes in the active group compared to placebo already after one month, while Kupperman Index was statistically reduced after three months. No significant variation in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, PT, PTT, fibrinogen, and ATIII were found. Conclusion: The present findings suggest that a red clover based isoflavones supplementation in healthy postmenopausal women is promptly effective on climacteric syndrome, improves neurovegetative symptoms, safe on cardiovascular risk serum profile, and does not modify lipids and coagulation.

The aim of this prospective randomized study was to evaluate a red clover based isoflavones supplementation in the treatment of climacteric syndrome and its effects on cardiovascular risk serum profile. MATERIALS AND METHODS: The study included 150 healthy postmenopausal women that were randomly assigned to receive phytoestrogens tablets, amounting in a total daily intake of 60.8 mg red clover isoflavones plus 19.2 mg soy isoflavones (n = 75), or placebo (n = 75). The authors evaluated teh following: daily number of hot flushes and Kupperman Index at baseline and after one and three months; serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and antithrombin III (ATIII) at baseline and after three and six months. RESULTS: One hundred twenty-eight patients completed the study: 67 in the active group and 61 in the placebo group. The treatment led to a progressive significant reduction (p < 0.05) of the number of hot flushes in the active group compared to placebo already after one month, while Kupperman Index was statistically reduced after three months. No significant variation in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, PT, PTT, fibrinogen, and ATIII were found. CONCLUSION: The present findings suggest that a red clover based isoflavones supplementation in healthy postmenopausal women is promptly effective on climacteric syndrome, improves neurovegetative symptoms, safe on cardiovascular risk serum profile, and does not modify lipids and coagulation.

Objective: Placenta-specific1 (PLAC1) is a trophoblast-specific gene encoding for a protein that is highly expressed in human placenta, on the surface of the syncytiotrophoblast. PLAC1 was found to elicit spontaneous antibody responses in cancer patients. We aimed to determine the levels of anti-PLAC1 antibodies in infertile women with a history of unexplained repeated implantation failure after IVF cy- cles as compared to fertile women. Study design: An observational caseecontrol clinical study. Main outcome measure(s): Two groups of patients were analysed in two different experimental settings: 21 infertile women and 81 control patients were enrolled in the first group, 16 infertile women and 67 fertile controls in the second group. Anti-PLAC1 antibody levels and ranking were analysed by ELISA test. Results: In both groups of infertile patients enrolled, optical densities (OD) from ELISA test ranked sig- nificantly higher than those of controls (0.27 ` 0.2 vs. 0.13 ` 0.1 respectively; p 1⁄4 0.0009 in the first group), (0.62 ` 0.38 vs. 0.39 ` 0.35 respectively; p 1⁄4 0.0044 in the second experiment). In the first group about one case in four (29%) had OD levels above the 95thpercentile (0.337) for healthy controls (p 1⁄4 0.005). In the second experiment 4 out of 16 cases (25%) had OD levels above the 95th percentile (0.878) for healthy controls (p 1⁄4 0.023). Conclusions: Anti-PLAC1 antibodies could represent a biomarker associated with infertility and with high probability of repeated implantation failure after ovarian stimulation and IVF-ET, greatly improving the diagnostic work up of infertile couples.

Study question: What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome? Summary answer: Chronic endometritis, associated with infection with common bacteria or mycoplasma, common in women complaining of RIF and antibiotic treatment significantly improves the reproductive outcome at a subsequent IVF cycle. What is known already: We have reported that CE is a frequent finding in women with repeated pregnancy loss and a significantly higher rate of successful pregnancies was achieved after adequate antibiotic treatment. Moreover, CE was identified in 30.3% of patients with repeated implantation failure at IVF and women diagnosed with CE had lower implantation rates (11.5%) after IVF cycles. By contrast, other authors reported that the clinical implication of CE should be considered minimal and that the reproductive outcome at IVF/ICSI cycles was not negatively affected by CE. Study design, size, duration: A retrospective study was performed from January 2009 through June 2012 on 106 women with unexplained infertility and a history of RIF. Participants/materials, setting, methods: All patients underwent hysteroscopy and endometrial sampling for histology and microbiological investigations. Women diagnosed with CE underwent antibiotic treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. Within 6 months after treatment all women had a further IVF attempt. The IVF outcomes were compared in women without signs of CE (Group 1) and persistent CE (Group 2) after antibiotic treatment. Main outcome measure(s): Clinical pregnancy rate (PR), live birth rate (LBR) at post-treatment IVF attempt. Main results and the role of chance: Seventy (66.0%) women were diagnosed with CE at hysteroscopy. In 61 (57.5%) CE was confirmed by histology and 48 (45.0%) by cultures. Common bacteria and mycoplasma were the most prevalent agents. In 46 (75.4%) out of 61 women, with diagnosis of CE at hysteroscopy and histology, examinations were normal after appropriate antibiotic treatment control (Group 1) while in 15 (24.6%) cases signs of CE were still present (Group 2). At IVF attempt after treatment, a significantly higher PR and LBR was reported in women from Group 1 compared to women from Group 2 (65.2% versus33.0% p=0.039; 60.8% versus13.3%, p= 0, 02 respectively) Limitations, reasons for caution: possible biases related to retrospective studies, to preferential referral of patients with CE and limited number of cases. Wider implications of the findings: A prospective randomized clinical trial is needed to confirm our findings but in women with RIF a hysteroscopic evaluation of the uterine cavity to exclude CE should be considered and appropriate antibiotic treatment should be given before submitting the patient to a further IVF attempt. Study funding/competing interest(s): this research was funded by the University personal research grants of Ettore Cicinelli. The authors have no competing interests to declare. Key Words: IVF/ICSI outcome, chronic endometritis, antibiotic treatment, repeated implantation failure, hysteroscopy

Primitive omental leiomyomas are very rare. The primitive omental location of the leiomyoma is quite difficult to determine, with the possible presence of "parasite" myomas and of omental metastasizing myomas. Moreover, omental masses may be primitive or secondary metastasis from neoplasms. In this case report a primitive omental leiomyoma is described, and their diagnosis and management are briefly discussed, in order to improve the knowledge of this very uncommon disease.

Objective: The study aimed to explore the type 1 and type 2 cytokines expression in the endometrium from women affected by endometriosis compared to controls. The expression of TSG-6, a multifunctional protein involved in several inflammatory disease, was also evaluated. Patients: 10 patients affected by endometriosis (Endometriosis group) and 11 healthy women (Control group) were enrolled in the study. Patients and controls underwent to an ultrasound transvaginal examination and a diagnostic hysteroscopy in the follicular phase of the menstrual cycle, in order to exclude any uterine abnormality. Both groups, in the secretory phase of the cycle patients underwent endometrial biopsy using a Novak’s curette. Main outcome measures: The endometrial expression of type 1 (IL- 1β, TNF-α, IL-8) and type 2 (IL-10) cytokines, and of TSG-6 was evaluated by immunohistochemistry and by real time PCR. The expression of TSG-6 was confirmed by western blot analysis. Results: Results of PCR analysis and of immunohistochemistry revealed an increased expression of IL-1β, TNF-α, IL-8 and of TSG-6 in the endometrium of patients affected by endometriosis. IL-10 expression did not show any difference. Conclusions: An increased expression of pro-inflammatory type 1 cytokines was demonstrated in the endometrium from patients affected by endometriosis, suggesting an endometrial environment harmful for implantation due to the prevalence of Th1 related immunity. An increased expression of TSG-6 was also demonstrated for the first time. Our findings concur to better define the inflammatory imbalance and the abnormal endometrial receptivity reported in literature, of the eutopic endometrium of women affected by endometriosis.

Aim. To check if the symphysis-fundal height measurement of the uterus may predict some difficulties in the evolution of labor. Methods. A sample of 102 full term healthy women were prospectively enrolled among 2007 and 2008 at the Complex Operative Unit of Obstetrics and Gynecology of Monselice (PD), ULSS 17 -Veneto, at the Complex Operative Unit of Obstetrics and Gynecology of the San Giovanni Battista Hospital of Foligno, ASL 3 - Umbria, and at the Institute of Obstetrics and Gynecology - Ospedali Ri-uniti of Foggia, University of Foggia. The symph-ysis-fundal height was measured at the onset of labor. Logistic regression analyses were built, considering symphysis-fundal height and birth weight as independent variables, while dependent variables were lacerations, episiotomy, oxytocin use, labor outcome. Results. Increasing values of symphysis-fundal height increases the odds of oxytocin infusion and operative birth, both vaginal and abdominal. Those associations are independent from the fetal birth weight. From the other hand, the odds of second degree lacerations and the odds of cervical lacerations are not linked neither to symphysis-fundal height nor to fetal birth weight. Conclusions. It seems that symphysis-fundal height may predict difficult evolutions of labors in term pregnant women, independently from birth weight. ©

Summary The pathogenesis and natural history of endometrial polyps are not very clear. The objective of this study was to assess the opin- ions of international medical literature regarding the factors involved in the pathogenesis of endometrial polyps and to organize the results consistently with what is known about endometrial physiology. Materials and Methods: A systematic review was carried out with the following search engines: PubMed, OVID, Scopus, SCIELO, and AJOL. Two hundreds forty-six abstracts were selected from the literature; of these abstracts, 58 factors were extracted and set as causative, non-causative, unclear or protective link with endometrial polyps. This relation is described through a correspondence analysis and tested with a main effect hierarchical log-lin- ear model. Results: The log-linear model resulted significant for the correspondence found with the following factors: (i) causative link (ageing, bcl-2 protein, excess weight/obesity, tamoxifen regardless of timing, relationship between estrogen receptors and prog- estinics, unbalanced estrogen therapy, estrogen-like effect, and unbalance between estrogens and progestinics), (ii) protective link (progestinics, antiestrogenic action), (iii) unclear link (menopause, ki-67 protein, angiogenesis, tamoxifen for a short time, tamox- ifen for a long time, hormone replacement therapy (HRT), endometritis/inflammation), and (iv) non-causative link (none of the fac- tors specifically). Discussion: Subsequently to a review of the physiology of the endometrium, the onsetting of endometrial polyps was suggested through estrogen-related and non-estrogen related ways; the two ways can overlap. The most implied factors in the development of endometrial polyps are linked with one of these or both ways.

L’invenzione concerne l’uso di anticorpi contro la proteina PLAC 1 come biomarcatori di infertilità, kit diagnostico per la rilevazione della risposta immunitaria contro PLAC1 e uso della proteina PLAC1 in campo terapeutico e contraccettivo

Use of antibodies against PLAC1 protein as biomarkers of infertility, diagnostic kit for the detection of immune response against PLAC1 and use of PLAC1 protein in therapeutic and contraceptive fields The present invention concerns the use of antibodies against PLAC1 protein as biomarkers of infertility, diagnostic kit for the detection of immune response against PLAC1 and use of PLAC1 protein in tolerogenic or immunogenic form in the therapy for infertility or as contraceptive or post-coital interception means, respectively.