Research question Does reproductive outcome differ among the various subgroups of poor ovarian responders according to the Bologna criteria? Design This was a retrospective, cohort study including poor ovarian responders according to Bologna criteria, undergoing an ICSI cycle from January 2011 until December 2017. Patients were divided into four groups: 1) age ≥ 40 years and abnormal ovarian response test, 2) age ≥ 40 years, abnormal ovarian reserve test and one previous poor response to stimulation 3) age ≥ 40 years and one previous poor response 4) abnormal ovarian reserve test and one previous poor response. Result(s) Overall, 846 cycles in 706 Bologna poor ovarian responders were included: 310 cycles in group 1, 169 in group 2, 52 in group 3 and 315 in group 4. There were significant differences in age, antral follicle count, antimüllerian hormone, cycle cancellation rates and number of retrieved oocytes between the four groups. Live birth and cumulative live birth rate differed significantly between groups and were highest in Group 4 (Live birth rate: 7.4% (1) vs. 4.1% (2) vs. 5.8% (3) vs. 13.4% (4), p =0.001 and Cumulative live birth rate: 8.3% (1) vs. 4.1 % (2) vs. 9.6% (3) vs. 16.8% (4) p<0.001). The multivariate GEE analysis revealed that the number of MIIs and the Bologna criteria pattern were the variables which were significantly associated with cumulative live birth rate. Conclusion(s) Poor ovarian responders represent a heterogeneous population. The young subpopulation has a better clinical prognosis in terms of fresh and cumulative live birth rate.
Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of −1.97 (95% CI: −3.12, −0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
The purpose of this study was to develop nomograms for predicting the probability of overall survival (OS) and progression-free survival (PFS) in locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical surgery.Nomograms to predict the 5-year OS rates and the 2-year PFS rates were constructed. Calibration plots were constructed, and concordance indices were calculated. Evaluated variableswere body mass index, age, tumor size, tumor histology, grading, lymphovascular space invasion, positive parametria, and positive lymph nodes.In total 245 patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy and radical surgery were included for the construction of the nomogram. The 5-year OS and PFS were 72.6% and 66%, respectively. Tumor size, grading, and parametria status affected the rate of OS, whereas tumor size and positive parametria were the main independent PFS prognostic factors.We constructed a nomogram based on clinicopathological features in order to predict 2-year PFS and 5-year OS in locally advanced cervical cancer primarily treated with neoadjuvant chemotherapy followed by radical surgery. This tool might be particularly helpful for assisting in the follow-up of cervical cancer patients who have not undergone concurrent chemoradiotherapy.
il rapporto presenta, per le annualita 2016 e 2017 lo stato di avanzamento dell’occupazione in apprendistato nel nostro paese e i dati della partecipazione alla formazione pubblica, sulla base dell’offerta programmata dalle regioni e province autonome. il primo capitolo propone un’analisi sull’evoluzione dell’occupazione in
apprendistato nel periodo 2015-2017 realizzata dall’inps e basata sui propri archivi amministrativi; il secondo illustra i dati relativi alla partecipazione ai percorsi formativi degli apprendisti delle tre tipologie contrattuali ed organizzati nell’ambito dell’offerta di formazione pubblica dalle regioni e provincie autonome, con un approfondimento sulle risorse finanziarie impegnate e spese. nel terzo capitolo viene presentata un’analisi per ciascuna tipologia di apprendistato relativamente all’evoluzione delle regolamentazioni regionali in materia. sono inoltre esaminati gli accordi interconfederali e i ccnl che le parti sociali hanno sottoscritto nel corso del 2016, per disciplinare gli aspetti relativi al rapporto di lavoro in apprendistato alla luce delle modifiche introdotte dal d.lgs. n. 81/2015. viene, infine, proposta una sintesi dei lavori realizzati nell’ambito della definizione del repertorio nazionale dei profili dell’apprendistato. l'apprendistato tra continuita e innovazione : 18. rapporto di monitoraggio anna d'arcangelo alessia romito
Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically nonsuspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.
Il presente working paper presenta una sintesi dei risultati della ricerca L’evoluzione del mercato del lavoro del comparto sanitario nel contesto della digitalizzazione dei servizi e delle prestazioni. A partire dalle evidenze di una ricerca qualitativa realizzata nel 2020, questa indagine ha coinvolto direttamente i lavoratori del settore sanitario, con una rilevazione CAWI diretta a medici, infermieri e operatori sociosanitari (OSS). La finalità del nuovo studio, realizzato nel 2022, era quella di approfondire il tema delle connessioni tra invecchiamento della forza lavoro e innovazione tecnologica in un settore di servizi alla persona particolarmente significativo, sia per il progressivo aumento dell’età media dei lavoratori, sia per le opportunità di sviluppo connesse all’introduzione delle tecnologie digitali. L’evoluzione demografica di questo comparto e alcune specifiche difficoltà di turnover delle risorse umane, infatti, possono rappresentare nel medio termine un reale rischio di labour shortage, a fronte di una domanda di servizi di cura e assistenza sempre più crescente per il progressivo e veloce invecchiamento della nostra popolazione. In tale contesto, la digitalizzazione dei servizi è considerata una condizione necessaria per lo sviluppo del settore, ma la transizione digitale in sanità procede ancora molto lentamente, nonostante la spinta derivata dall’avvento della pandemia. I risultati offrono molteplici informazioni sulle condizioni di lavoro in sanità in una prospettiva di prolungamento della vita lavorativa, sulla motivazione al lavoro e i livelli di soddisfazione degli operatori, sulle loro aspettative future e sui cambiamenti determinati dall’avvento della crisi pandemica; interessanti, in una prospettiva di sviluppo della sanità digitale, sono i dati sull’uso delle nuove tecnologie, le difficoltà incontrate e le strategie adottate per superarle, sulla formazione al digitale, gli ostacoli alla partecipazione e la valutazione della sua efficacia espressa dagli operatori.
