Velamentous cord insertion (VCI) is a rare placental abnormality in which the umbilical cord enters the chorionic membranes instead of the placenta, leaving the umbilical vessels unprotected. This pathological condition carries an increased risk of adverse perinatal outcomes, such as fetal growth restriction, preterm delivery, abnormal fetal heart rate patterns during labor, and perinatal morbidity, which often lead healthcare professionals to choose cesarean section to reduce postnatal risks. Early prenatal diagnosis using color Doppler imaging and comprehensive ultrasound is of utmost importance for proper risk assessment and birth planning. This case study presents a 28-year-old woman in whom screening for abnormalities during the second trimester of pregnancy detected a prenatally detected velamentous umbilical cord insertion. The pregnancy was closely monitored, and the patient chose vaginal delivery despite the multidisciplinary team's recommendations for a cesarean section, with continuous intrauterine monitoring of the fetus. At 38 weeks of gestation, a successful vaginal delivery was performed with vacuum assistance, without complications for the pregnant woman or the newborn. A postnatal examination of the placenta revealed velamentous attachment of the umbilical cord, and both the mother and the newborn recovered without complications. In pregnancies complicated by velamentous umbilical cord insertion, vaginal delivery may be a safe and feasible option when accompanied by appropriate prenatal evaluation and continuous intrauterine monitoring. These findings are supported by other case studies following a comprehensive review of the existing literature. Instead of preferring cesarean section, individualized obstetric care can improve outcomes while respecting the mother's preferences. However, further extensive research is needed to develop evidence-based guidelines on the best methods of delivery for such pregnancies.

Aim of the studyTo define the impact of cervical fibroids (CFs) localization, size, and their combined presence on the feasibility of performing cervical intracapsular myomectomy (CIME) by using a vaginal approach.ObjectiveEvaluation of the feasibility of conducting CIME via the transvaginal approach.Materials and methodsThis retrospective cohort observational study included 32 patients who underwent CIME. The findings were evaluated by comparing them with the outcomes of 1,204 patients with CFs reported in the English and Chinese literature.ResultsThe study demonstrated that CIME by vaginal approach can be successfully performed on CFs with a mean size of 8.08 cm (95% CI: 7.44–8.73 cm) for extracervical anterior and posterior sites, 7.61 cm (95% CI: 7.09–8.14 cm) for extracervical and intracervical lateral localizations, and 5.36 cm (95% CI: 4.71–6.35 cm) for combined CFs in two different localization sites. The feasibility and efficiency of the suggested CIME technique were confirmed through a comparative analysis of perioperative endpoints from 326 vaginal, 643 laparoscopic, and 235 laparotomic myomectomies documented in the literature.ConclusionThe findings highlight key issues related to the suggested original CIME technique performed via a direct vaginal approach. They also provide a comprehensive classification of CFs along with the CFs’ clinical manifestations based on the type of growth direction, locations, and fibroid maturity. These findings may have implications for managing patients with CFs.

Uterine rupture constitutes a critical obstetric emergency that presents substantial risks to both the maternal and fetal populations. This investigation evaluated the surgical interventions available for uterine rupture, emphasizing laparoscopic repair subsequent to uterine rupture. Laparoscopic repair serves as a fertility-sustaining alternative to conventional laparotomy, demonstrating comparable operative durations of 80 min (interquartile range [IQR] 60-114) for laparoscopic procedures versus 78 min (IQR 58-114) for laparotomy interventions. Nevertheless, laparoscopic approaches confer significant advantages, including a reduced incidence of intensive care unit (ICU) admissions (14.2% vs. 40% for laparotomy), a diminished requirement for blood transfusions (14.2% vs. 60%), and abbreviated hospital stays (median of 3 days vs. 5 days for laparotomy). The investigation explored the contentious discourse surrounding single-layer versus double-layer suturing methodologies, noting that barbed sutures significantly decrease uterine closure times (224 ± 46 vs. 343 ± 75 s for traditional sutures). Single-layer suturing is advocated as sufficient for maintaining uterine integrity in suitably selected cases. The necessity of meticulous postoperative monitoring, particularly concerning the assessment of recurrence in subsequent pregnancies, is emphasized, with recurrence rates varying from 4.8% to 19.4%. Finally, authors also proposed a feasible laparoscopic technique to repair a uterine rupture (the "CHEESE" method [closure of hemodynamically stable, early uterine rupture, via endoscopic surgery after spontaneous delivery]), appropriate for hemodynamically stable patients with minor ruptures. This review underscores the progressive role of minimally invasive techniques in the management of uterine rupture and seeks to optimize clinical outcomes for both maternal and neonatal health.

Borderline phyllodes tumor is a rare and benign form of breast cancer with malignant potential. According to the World Health Organization (WHO), phyllodes tumor is classified into three categories: benign, borderline, and malignant. The treatment of phyllodes tumor is wide focal excision combined with radiotherapy and chemotherapy in certain cases. Herein, we report a 47-year-old female who presented with a giant borderline mass approximately 19.5 x 16.9 x 9.3 cm in size. From medical history, we noticed that the mass begun to develop during puberty. Wide focal excision of the tumor and immediate implant-based reconstruction with free nipple graft was performed, with the tumor specimen measuring 16.5 x 14.2 x 8.7 cm. Histological examination reported a borderline phyllodes tumor, and in this case, the patient did not undergo adjuvant treatment.

This research analyzes the impact of the COVID-19 pandemic on consumer service pricing within the European Union, focusing on the Transportation, Accommodation, and Food Service sectors. Our study employs various machine learning models, including multilayer perceptron, XGBoost, CatBoost, and random forest, along with genetic algorithms for comprehensive hyperparameter tuning and price evolution forecasting. We incorporate coronavirus cases and deaths as factors to enhance prediction accuracy. The dataset comprises monthly reports of COVID-19 cases and deaths, alongside managerial survey responses regarding company estimations. Applying genetic algorithms for hyperparameter optimization across all models results in significant enhancements, yielding optimized models that exhibit RMSE score reductions ranging from 3.35% to 5.67%. Additionally, the study demonstrates that XGBoost yields more accurate predictions, achieving an RMSE score of 17.07.

Abstract This retrospective cohort observational study involved 15 patients who underwent cervical intracapsular myomectomy (CIM). The study aimed to assess the localization sites and sizes of cervical fibroids (CFs) and their impact on the feasibility of performing CIM using the vaginal approach. CFs originated from extra cervical-anterior-posterior localizations (EAPL) in six cases, extra-intracervical lateral locations (EILL) in five women, and combined cervical fibroids locations (CCFL) in two different sites in four patients. The most frequent cases were single CFs of EAPL or EILL, compared to CCFL. The localization or size of CFs did not substantially influence the safety and efficacy of the CIM technique, whether they occurred singly or in combination. The broader context of the findings of this study was estimated by comparative analysis of them with the outcomes of 1181 patients with CFs from the English and Chinese literature. The study identified the main issues of this problem that warrant attention, such as the original CIM technique performed through a direct vaginal approach and classifying CFs as growing and mature with comprehensive descriptions of their miscellaneous clinical manifestations depending on size, growth directions, localization sites, and depth of lesions. These findings may have implications for managing patients with CFs.

Purpose To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. Materials and methods 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. Results 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. Conclusion Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.

Introduction: Intrapartum ultrasound (IU) is used in the delivery ward; even if IU monitors the labouring women, it could be perceived as a discomfort and even as an" obstetric violence", because it is a young technique, not often well "accepted". A group of clinicians aimed at obtain an informed consent from patients, prior to perform a translabial ultrasound (TU). The aim of this study was to evaluate the acceptance of both translabial and transabdominal IU. Methods: In this study, performed at the University Hospital of Bari (Unit of Obstetrics and Gynecology), were enrolled 103 patients in the first or second stage of labor in singleton cephalic presentation. A statistical frequency and an association analysis were performed. As a significant result, we consider the peace of mind/ satisfaction and the" obstetric violence". IU was performed both transabdominal and translabial to determine the presentation, head positions, angle of progression and head perineum distance. During the first and second stage of labor, the ASIUG questionnaires (Apulia study intrapartum ultrasonography group) were administered. Results: 74 (71, 84%) patients underwent IU and 29 had a vaginal examination (28, 15%). Significant less "violence" has been experienced with a IU (73 out 74/98, 65%) and only one person (1 /1, 35%) recorded that. On the contrary, 10 patients (10/29) perceived that "violence" (34, 48%) while 19 (65, 52%) did not respond on a similar way, after a vaginal examination (VE). More patients felt satisfaction (71 out 74/95, 95%) with the use of IU and only 3 (3/4, 05%) felt unease. A different picture was evident in the vaginal examination group. Only 17 patients (17 out 29/58, 62%) felt comfort while 12 (41, 38%) felt unease. Conclusions: In our study, IU use is well accepted by most of patients, because it could reassure women about their fetal condition. Moreover, they can see the fetus on the screen, while the obstetrician is performing the US and this is important for a visual feedback, in comparison with the classical VE.

Many researchers have reported on the high prevalence of anxiety and depression during pregnancy as well as the influence on delivery outcomes during the past decade. Preterm birth and premature labor, bleeding, higher frequency of cesarean section (CS), low birth weight, preeclampsia, stillbirth, miscarriage, NICU hospitalization, and a low Apgar score are the most commonly referenced outcomes assessed. Clarifying the relationship between exposure and result may help us to understand the risk factors and guide us to future clinical and research practices. The purpose of this narrative review is to search the following databases: PubMed, Research Gate, Scopus, Medline Plus, and present the most recent, comprehensive literature on the effects of stress and anxiety on pregnancy outcomes. Articles published from 01/01/2000 to 26/11/2022 were obtained from the previous databases. Anxiety and depression-related disorders are common nowadays, and they are frequently correlated with poor pregnancy outcomes. These problems are caused by a number of factors, including health social determinants, the individual obstetric situation, access to healthcare facilities, etc. The effects of each of these factors on birth outcomes range from major, such as preterm labor, congenital deformities, and low birth weight, to minor, such as mutations in the fetal epigenome. Both direct and indirect pathways of substantial interactions between depression, anxiety and stress, risk variables, and delivery problems were identified. Women's health practitioners and mental physicians must provide adequate support to these women in order to improve outcomes for both mothers and infants.

Artificial intelligence (AI) is an extensive scientific field, part of which is the concept of deep learning, belonging to broader family of machine learning (ML) methods, based on artificial neural networks (ANNs). ANNs are active since the 1940s and are applied in many fields. There have been actions around the world for the digital transformation of the public sector and the use of new innovative technologies, but the trajectory and degree of adoption of artificial intelligence technologies in the public sector have been unsatisfactory. Similar issues must be handled, and these problems must be classified. In the present work, preparatory searches were made on Scopus and IEEE bibliographic databases in order to obtain information for the progress of the adoption of ANNs in the public sector starting from the year 2019. Then, a systematic review of published scientific articles was conducted using keywords. Among the 2412 results returned by the search and the application of the selection/rejection criteria, 10 articles were chosen for analysis. The conclusion that emerged after reading the articles was that while the scientific community has a lot of suggestions and ideas for the implementation of ANNs and their financial effects, in practice, there is no appropriate use of them in the public sector. Occasionally, there are cases of implementation funded by state or non-state bodies without a systematic application and utilization of these technologies. The ways and methods of practical application are not further specified, so there are no indications for the systematic application of specialized deep learning techniques and ANNs. The legal framework for the development of artificial intelligence applications, at least in the European Union (EU), is under design, like the necessary ISO standards from an international perspective, and the economic impact of the most recent AI-based technologies has not been fully assessed.

This study examines how the coronavirus pandemic may affect the price of consumer services in the Transportation, Accommodation and Food Service sections in the European Union over the next period utilizing Machine Learning. For the purpose of the study, the authors use monthly reports of coronavirus cases and deaths along with a nominal sample size of 44.000 units, mainly national institutes, from the Joint Harmonized EU Programme of Business and Consumer Surveys by Directorate-General for Economic and Financial Affairs of European Commission. The dataset contains balanced answers from surveys asking for positive and negative replies measuring managers’ assessment of their company’s turnover from past experience and future estimations. The authors present evidence that it is possible to forecast future expectations on service price evolution during the pandemic utilizing Neural Network models. These models can predict a balanced percentage which can further be used for a systematic decision-making process. This percentage depends on the number of cases and deaths in each country but not in the same analogy to others. Each country performs differently in every sub-category of economic activity presented. To the best of our knowledge, this is a first attempt to investigate and predict the impact of coronavirus on consumer service price. These predictions concern the evolution of economic indicators using Neural Networks. In case of emergency situations, such as during pandemic, it is difficult to have enough data to make reliable predictions using other statistical models, therefore utilizing machine learning methods seems appropriate.

Asynclitism, the most feared malposition of the fetal head during labor, still represents to date an unresolved field of interest, remaining one of the most common causes of prolonged or obstructed labor, dystocia, assisted delivery, and cesarean section. Traditionally asynclitism is diagnosed by vaginal examination, which is, however, burdened by a high grade of bias. On the contrary, the recent scientific evidence highly suggests the use of intrapartum ultrasonography, which would be more accurate and reliable when compared to the vaginal examination for malposition assessment. The early detection and characterization of asynclitism by intrapartum ultrasound would become a valid tool for intrapartum evaluation. In this way, it will be possible for physicians to opt for the safest way of delivery according to an accurate definition of the fetal head position and station, avoiding unnecessary operative procedures and medication while improving fetal and maternal outcomes. This review re-evaluated the literature of the last 30 years on asynclitism, focusing on the progressive imposition of ultrasound as an intrapartum diagnostic tool. All the evidence emerging from the literature is presented and evaluated from our point of view, describing the most employed technique and considering the future implication of the progressive worldwide consolidation of asynclitism and ultrasound.

Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.

OBJECTIVE The study aimed to demonstrate that the risk of Cesarean Scar Pregnancy (CSP) for patients with isthmocele decreases when the embryo transfer is performed on day 5 at the blastocyst stage. PATIENTS AND METHODS From January 2014 to December 2021, 167 patients who previously had an IVF treatment and delivered by cesarean section, were selected. The isthmocele was found in 98 of them. Firstly, we evaluated whether the isthmocele increases the risk of CSP. Subsequently, we investigated the possible correlation between the risk of the CSP with the day of the embryo transfer. Hence, the selected patients were divided into two groups: Group A where the embryo transfer was performed at the cleavage stage on day 3 and Group B where the embryo was transferred at the blastocyst stage on day 5. RESULTS The outcomes show that the isthmocele does not seem to increase the risk of CSP, while the embryo transfer on day 3 increases its rate. CONCLUSIONS When the isthmocele is diagnosed, according to our results, an embryo transfer on day 5 at the blastocyst stage seems to minimize the risk of the CSP.

Authors investigated the catecholaminergic neurotransmitters (chNs) quantitative modifications in pregnant uterine Lower Uterine Segment (LUS) during prolonged labor (PL) with the fetus in an occiput-posterior position (OPP), in occiput transverse position (OTP) and in fetal head asynclitism, all diagnosed by Intrapartum Ultrasonography (IU). The chNs neurotransmitters, particularly adrenaline (or epinephrine-A) and noradrenaline (or norepinephrine-N), were evaluated in LUS fragments sampled during CS of 34 patients undergoing urgent cesarean section (CS) in PL, compared to chNs fibers in the LUS of 36 women submitted to elective CS. All results were statistically analyzed to understand the differences in neurotransmitters morphological analysis by scanning electronic microscopy examination (SEM). The LUS fragments analysis revealed a reduction of A and N fibers in LUS during PL, compared with the expression of A and N fibers in LUS during elective CS. The PL for OPP, the OTP and asynclitism, all positions causing dystocia in labor lead to a reduction in neurotransmitters in LUS, with a uterine vascularization modification and a reduction in the contractility of smooth uterine cells. The A and N neurotransmitters reduction observed in PL negatively interferes with uterine contraction during labor.

Objective To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. Methods Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. Results Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. Conclusion Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.

Purpose: The purpose of this paper is twofold. At first, to examine the role of political influence in public administration using the non-productive occupational conflicts in Municipal Sport Organizations (M.S.Os). At second, to investigate which might be the particular aspects of conflict creation.Design/methodology/approach: The study used information extracted from semi-constructed interviews. Interviewed participants were employees of different municipal sports organizations of the Region of Attica Greece. They also belong to different occupational levels.Findings: The results indicated that the employees in municipal sports organizations detect the roots of interior conflicts in the political influence, which is a practice as an indirect pressure of the elected management members of the board, to implement a certain policy. The results also revealed a new source of non-productive occupational conflict referred to as “the man close to the President”.Practical implications: Conflicts in the interior of a municipal sports organization adds extra cost. Having knowledge of the deeper causes of a conflict, managers and board members can work in advance in certain procedures to avoid the creation of such situations. This will guide the board and the management of the organization in wiser funds use, and it will help in the creation of a much better organizational environment.Originality/value: This study fills a significant gap in the existing literature. Concerns both the political influence of elected members of a municipal sports organization board as causes of conflicts and particular aspects, which provoke conflict, detected and named as the man next to the president.

Objectives: The aim of this study was to evaluate intrauterine adhesion formation after laparoscopic and laparotomic myomectomy. Design: This is a prospective, multicenter, observational study (ClinicalTrials.gov ID: NCT04030273). Methods: We included patients after laparotomic and laparoscopic myomectomy. All patients underwent postsurgical diagnostic hysteroscopy, after 3 months. The intrauterine adhesion rate and associated factors were investigated. Results: Between January 2020 and December 2020, 38 and 24 consecutive patients underwent laparoscopic and laparotomic myomectomy, respectively. All diagnostic hysteroscopies were performed in the office setting without complications. Intrauterine adhesions were identified in 19.4% of women (95% CI: of 9-29%). Factors univariately associated (p < 0.2) with the presence of intrauterine adhesions after myomectomy were previous uterine surgery, the surgical approach (laparoscopic or laparotomic), the number of removed fibroids, the type and diameter of the largest myoma, and the opening of the uterine cavity. In the multivariable analysis, only the opening of the uterine cavity (odds ratio [OR] 51.99; 95% confidence interval [CI]: 4.53-596.28) and the laparotomic approach (OR, 16.19; 95% CI: 1.66-158.35) were independently associated with the identification of intrauterine adhesions after myomectomy. Limitations: One of the main limitations of our study is that we used uterine manipulator only in the laparoscopic group; in addition, we did not perform a preoperative hysteroscopy to evaluate the rate of intrauterine adhesions potentially present even before the myomectomy. Conclusions: The prevalence of intrauterine adhesions after 3 months from surgery was significantly associated with the opening of the uterine cavity and the laparotomic approach.