Early Assessment of the Risk for Gestational Diabetes Mellitus: Can Fasting Parameters of Glucose Metabolism Contribute to Risk Prediction?

Veronica Falcone,Grammata Kotzaeridi,Melanie Hanne Breil,Ingo Rosicky,Tina Stopp,Gülen Yerlikaya-Schatten,Michael Feichtinger,Wolfgang Eppel,Peter Husslein,Andrea Tura,Christian S. Göbl 대한당뇨병학회 2019 Diabetes and Metabolism Journal Vol.43 No.6

Background: An early identification of the risk groups might be beneficial in reducing morbidities in patients with gestational diabetes mellitus (GDM). Therefore, this study aimed to assess the biochemical predictors of glycemic conditions, in addition to fasting indices of glucose disposal, to predict the development of GDM in later stage and the need of glucose-lowering medication. Methods: A total of 574 pregnant females (103 with GDM and 471 with normal glucose tolerance [NGT]) were included. A metabolic characterization was performed before 15+6 weeks of gestation by assessing fasting plasma glucose (FPG), fasting insulin (FI), fasting C-peptide (FCP), and glycosylated hemoglobin (HbA1c). Thereafter, the patients were followed-up until the delivery. Results: Females with NGT had lower levels of FPG, FI, FCP, or HbA1c at the early stage of pregnancy, and therefore, showed an improved insulin action as compared to that in females who developed GDM. Higher fasting levels of FPG and FCP were associated with a higher risk of developing GDM. Moreover, the predictive accuracy of this metabolic profiling was also good to distinguish the patients who required glucose-lowering medications. Indices of glucose disposal based on C-peptide improved the predictive accuracy compared to that based on insulin. A modified quantitative insulin sensitivity check index (QUICKIc) showed the best differentiation in terms of predicting GDM (area under the receiver operating characteristics curve [ROC-AUC], 72.1%) or need for pharmacotherapy (ROC-AUC, 83.7%). Conclusion: Fasting measurements of glucose and C-peptide as well as the surrogate indices of glycemic condition could be used for stratifying pregnant females with higher risk of GDM at the beginning of pregnancy.

Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study

Francesca Falcone,Umberto Leone Roberti Maggiore,Violante Di Donato,Anna Myriam Perrone,Luigi Frigerio,Giuseppe Bifulco,Stephan Polterauer,Paolo Casadio,Gennaro Cormio,Valeria Masciullo,Mario Malzoni 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: ‘The Endometrial Cancer Conservative Treatment (E.C.Co.). A multicentre archive’is a worldwide project endorsed by the Gynecologic Cancer Inter-Group, aimed at registeringconservatively treated endometrial cancer (EC) patients. This paper reports the oncologicaland reproductive outcomes of intramucous, G2, endometrioid EC patients from this archive. Methods: Twenty-three patients (Stage IA, G2, endometrioid EC) were enrolled betweenJanuary 2004 and March 2019. Primary and secondary endpoints were, respectively, completeregression (CR) and recurrence rates, and pregnancy and live birth rates. Results: A median follow-up of 35 months (9–148) was achieved. Hysteroscopic resection(HR) plus progestin was adopted in 74% (17/23) of cases. Seventeen patients showed CR(median time to CR, 6 months; 3-13). Among the 6 non-responders, one showed persistenceand 5 progressed, all submitted to definitive surgery, with an unfavorauble outcome in one. The recurrence rate was 41.1%. Ten (58.8%) complete responders attempted to conceive, ofwhom 3 achieved at least one pregnancy with a live-birth. Two out of the 11 candidate patientsunderwent definitive surgery, while the remaining 9 have so far refused. To date, 22 patientsshow no evidence of disease, and one is still alive with disease. Conclusions: Fertility-sparing treatment seems to be feasible even in G2 EC, although cautionshould be kept considering the potential pathological undergrading or non-endometrioid histology misdiagnosis. The low rate of attempt to conceive and of compliance to definitivesurgery underline the need for a ‘global’ counselling extended to the follow-up period.

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

Francesca Falcone,Giuseppe Laurelli,Simona Losito,Marilena Di Napoli,Vincenza Granata,Stefano Greggi 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.1

Objective: To report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy. Methods: Twenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more. Results: After 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively. Conclusion: The addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

Accessing KNX Devices using USB/KNX Interfaces for Remote Monitoring and Storing Sensor Data

J. A. Nazabal,F. Falcone,C. Fernández-Valdivielso1,S. C. Mukhopadhyay,I. R. Matias 보안공학연구지원센터 2013 International Journal of Smart Home Vol.7 No.2

Survival in clinical stage I endometrial cancer with single vs. multiple positive pelvic nodes: results of a multi-institutional Italian study

Stefano Uccella,Francesca Falcone,Stefano Greggi,Francesco Fanfani,Pierandrea De Iaco,Giacomo Corrado,Marcello Ceccaroni,Vincenzo Dario Mandato,Stefano Bogliolo,Jvan Casarin,Giorgia Monterossi,Ciro Pi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6

Objective: To investigate survival outcomes in endometrioid endometrial cancer (EEC) patients with single vs. multiple positive pelvic lymph nodes. Methods: We performed a retrospective evaluation of all consecutive patients with histologically proven International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1 EEC who underwent primary surgical treatment between 2004 and 2014 at seven Italian gynecologic oncology referral centers. Patients with pre- or intra-operative evidence of extra-uterine disease (including the presence of bulky nodes) and patients with stage IIIC2 disease were excluded, in order to obtain a homogeneous population. Results: Overall 140 patients met the inclusion criteria. The presence of >1 metastatic pelvic node was significantly associated with an increased risk of recurrence and mortality, compared to only 1 metastatic node, at both univariate (recurrence: hazard ratio [HR]=2.19; 95% confidence interval [CI]=1.2–3.99; p=0.01; mortality: HR=2.8; 95% CI=1.24–6.29; p=0.01) and multivariable analysis (recurrence: HR=1.91; 95% CI=1.02–3.56; p=0.04; mortality: HR=2.62; 95% CI=1.13–6.05; p=0.02) and it was the only independent predictor of prognosis in this subset of patients. Disease-free survival (DFS) and disease-specific survival (DSS) were significantly longer in patients with only 1 metastatic node compared to those with more than 1 metastatic node (p=0.008 and 0.009, respectively). Conclusion: The presence of multiple metastatic nodes in stage IIIC1 EEC represents an independent predictor of worse survival, compared to only one positive node. Our data suggest that EEC patients may be categorized according to the number of positive nodes.

Proposal for Improving Connectivity and adding Authentication and Security to KNXNet/IP Protocol

J. A. Nazabal,F. Falcone,C. Fernández-Valdivielso,I. R. Matías 보안공학연구지원센터 2014 International Journal of Smart Home Vol.8 No.2

Evaluation of perioperative management of advanced ovarian (tubal/peritoneal) cancer patients: a survey from MITO-MaNGO Groups

Stefano Greggi,Francesca Falcone,Giovanni D. Aletti,Marco Cascella,Francesca Bifulco,Nicoletta Colombo,Sandro Pignata 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5

Objective: The European Society of Gynaecological Oncology (ESGO)-quality indicators (QIs) for advanced ovarian cancer (AOC) have been assessed only by few Italian centers, and data are not available on the proportion of centers reaching the score considered for a satisfactory surgical management. There is great consensus that the Enhanced Recovery After Surgery (ERAS) approach is beneficial, but there is paucity of data concerningits application in AOC. This survey was aimed at gathering detailed information on perioperative management of AOC patients within MITO-MaNGO Groups. Methods: A 66-item questionnaire, covering ESGO-QIs for AOC and ERAS items, was sent to MITO/MaNGO centers reporting to operate >20 AOC/year. Results: Thirty/34 questionnaires were analyzed. The median ESGO-QIs score was 31.5, with 50% of centers resulting with a score ≥32 which provides satisfactory surgical management. The rates of concordance with ERAS guidelines were 46.6%, 74.1%, and 60.7%, respectively, for pre-operative, intra-operative, and post-operative items. The proportion of overall agreement was 61.3%, and with strong recommendations was 63.1%. Pre-operativediet, fasting/bowel preparation, correction of anaemia, post-operative feeding and early mobilization were the most controversial. A significant positive correlation was found between ESGO-QIs score and adherence to ERAS recommendations. Conclusion: This survey reveals a satisfactory surgical management in only half of the centers, and an at least sufficient adherence to ERAS recommendations. Higher the ESGO-QIs score stronger the adherence to ERAS recommendations, underlining the correlations between case volume, appropriate peri-operative management and quality of surgery. The present study is a first step to build a structured platform for harmonization within MITO-MaNGO networks.

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Jvan Casarin,Giorgio Bogani,Elisa Piovano,Francesca Falcone,Federico Ferrari,Franco Odicino,Andrea Puppo,Ferdinando Bonfiglio,Nicoletta Donadello,Ciro Pinelli,Antonio Simone Laganà,Antonino Ditto,Mari 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the presentstudy, we aimed to investigate the survival implication of the systematic lymphadenectomy inpatients who underwent surgery for apparent early-stage USC. Methods: Consecutive patients with apparent early-stage USC surgically treated at sixItalian referral cancer centers were analyzed. A comparison was made between patients whounderwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs. those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncologicaloutcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival(DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportionalhazard regression and summarized using hazard ratio (HR). Results: One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LNDgroup (compared to LND group) included older patients (median age, 73 vs.67 years) andwith higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). Nodifferences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) wereobserved. At Cox regression analysis lymphadenectomy did not significantly influenceDFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95%CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associatedwith worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31–13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38;95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07;95% CI=1.02–1.13; p<0.001). Conclusions: Although lymphadenectomy did not show survival benefits in patients whounderwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitonealstaging also in this histological subtype.

Android Application for Accessing KNX Devices via IP Connection

J. A. Nazabal,J. Gómez,F. Falcone,C. Fernández-Valdivielso,P. E. Branchi,I. R. Matías 보안공학연구지원센터 2012 International Journal of Smart Home Vol.6 No.4

Is thyroid nodule location associated with malignancy risk?

Valeria Ramundo,Livia Lamartina,Rosa Falcone,Laura Ciotti,Cristiano Lomonaco,Marco Biffon,Laura Giacomelli,Marianna Maranghi,Cosimo Durante,Giorgio Grani 대한초음파의학회 2019 ULTRASONOGRAPHY Vol.38 No.3

Purpose: Nodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location. Methods: The records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems. Results: Between November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047). Conclusion: The risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance.