Policlinico Abano Terme

Data on the occurrence of gestational diabetes mellitus (GDM) and related offspring macrosomia are limited in women with low and delayed fertility, both of which are increasingly common in high-income countries. We evaluated the occurrence of GDM among women who delivered in Abano Terme, Italy, between January 2020 and August 2023. Baseline and clinical characteristics of women with GDM (GDM group) and those with a normal oral glucose tolerance test (control group) were analyzed in relation to neonatal macrosomia (>4000 g). Among 2600 women with low and late fertility included in the analysis, 231 (9.9%) were diagnosed with GDM. Women in the GDM group were older than control subjects (36.0 [31.5-39.0] vs. 33.0 [30.0-37.0] years; P<0.001), whereas parity did not differ between groups (2.00 [1.00-2.00] vs. 1.00 [1.00-2.00, P>0.5]). Pre-pregnancy BMI was significantly higher in the GDM group (63 [56-73] vs. 59 [54-66] kg, P<0.001), while height (164 [160-170] vs. 165 [160-170] cm, P<0.024] and gestational weight gain (GWG) (11 [8.5-14.0] vs. 13 [11.0-16.0] kg; P<0.001), P<0.001) were significantly lower. Neonatal birth weight (3400 [3080-3640] vs. 3360 [3100-3640] g; P>0.09) and the prevalence of macrosomia >4000 g (19 [8.2%] vs. 188 [8.1%]; P>0.9) did not differ between groups (P>0.09). In multivariate logistic regression analysis, the risk of GDM was significantly higher among women with low and late fertility or delayed fertility alone (odds ratios 2.3 and 1.9, respectively; P<0.001). Among maternal variables, only obesity at delivery (BMI ≥30 kg/m2) was independently associated with an increased risk of neonatal macrosomia (odds ratio 1.59; P=0.003). In women with low and late fertility, appropriate GWG may play a key role in mitigating the risk of neonatal macrosomia, even in the presence of GDM.

Background: Dysregulation of the hypothalamic-pituitary-adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with "low and late" fertility, remains poorly characterized. Methods: We compared the risk of postpartum depressive symptoms, assessed on the second postpartum day using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score ≥ 12, and the Anhedonia, Anxiety, and Depression subscales, between Northeast Italian women with GDM and control participants with normal oral glucose tolerance tests (OGTT), classified as having "low and late fertility". Results: Among the 2560 women included in the analysis, 231 (9.02%) had GDM. Compared with controls with normal OGTT, women with GDM were older (36.0 vs. 33.0 years, p < 0.001) and had higher pre-pregnancy BMI (23.4 vs. 21.6 kg/m2, p < 0.001), but lower gestational weight gain (GWG) (11.0 vs. 13.0 kg, p < 0.001), with no difference in parity [2.00 vs. 1.00, p = 0.5. In addition, GDM was not associated with increased postpartum depressive symptoms (15% EPDS scores ≥12 in both groups, p > 0.9) or with Anhedonia, Anxiety, or Depression subscale scores (p = 0.7). Conclusions: Advanced maternal age and reduced parity, hallmarks of women postponing childbearing, do not appear to confer an increased risk of early postpartum mood comorbidities in the context of GDM. Promoting healthy physical and mental well-being among women in this demographic category requires integrated strategies encompassing nutrition, healthcare, and education.

Objectives: To evaluate perioperative outcomes, renal function preservation, and short-term oncologic results of off-clamp, sutureless, or selectively sutured robotic-assisted partial nephrectomy (RAPN) in patients with renal tumors treated at multiple high-volume centers. Methods: This multicenter retrospective study included 250 patients who underwent off-clamp, sutureless/selectively sutured RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors > 7 cm, or prior renal surgery were excluded. All procedures were performed without renal artery clamping, using hemostatic agents and selective suturing when necessary. Perioperative, functional, and oncologic outcomes were compared with 313 patients who underwent standard RAPN with parenchymal suturing. Results: The median operative time was 110 min (IQR 100–140), and the median estimated blood loss was 180 mL (IQR 100–250). The overall complication rate was 8.4%, predominantly Clavien–Dindo grade I–II, with no conversions to open surgery. The median decline in estimated glomerular filtration rate (eGFR) at three months was 5.5% (IQR 3.5–8.9; p = 0.56), and no cases of acute kidney injury were recorded. The positive surgical margin rate was 3.7%, and no tumor recurrences were observed during the 12-month follow-up period. Conclusions: Off-clamp, sutureless or selectively sutured robotic-assisted partial nephrectomy (RAPN) was not associated with increased perioperative risk, renal functional decline, or compromised short-term oncologic control compared with conventional sutured RAPN. These findings indicate that the technique is feasible and safe in appropriately selected patients, although prospective studies with longer follow-up are needed to confirm long-term outcomes and refine patient selection criteria.

Restless legs syndrome is a sensorimotor disorder of sleep/wake regulation that frequently coexists with migraine, affecting patients' quality of life. This study aimed to estimate the prevalence of restless legs syndrome in individuals with migraine and to explore the associated clinical, demographic and behavioural aspects. A systematic review and meta-analysis of the existing literature was conducted. Articles were included if they provided data on individuals with migraine, with or without restless legs syndrome and these proportions were used to estimate the prevalence of restless legs syndrome in migraine. A total of 30 studies were included in the meta-analysis. The overall pooled prevalence of restless legs syndrome among individuals with migraine was 20% (95% confidence interval [CI] = 17%-23%). The pooled prevalence of restless legs syndrome was affected by migraine duration (higher prevalence with longer duration), disability (higher prevalence with greater migraine-related disability) and age (higher prevalence in older individuals). A significant association was found between restless legs syndrome, migraine with aura and chronic migraine. No significant sex-related differences were observed. Among behavioural factors, depression, pain and poor sleep quality were significantly associated with restless legs syndrome. These findings suggest that restless legs syndrome is a common comorbidity in migraine with aura and chronic migraine, with a higher prevalence than that reported in the general population. Moreover, specific demographic, clinical and behavioural characteristics may help identify individuals at higher risk. Further studies are needed to clarify the underlying pathophysiological mechanisms and to identify potential therapeutic targets.

BACKGROUND: Maternal satisfaction is an emotional response with a key role in the puerperium, and it is essential for monitoring and improving service quality.METHODS: We explored new mothers’ satisfaction with the quality of transitional care of their infant, testing for emotional causality, by a descriptive, non-experimental correlational design. The data collection was based on 380 postpartum interviews using the Swedish Pyramid Questionnaire (Quality of Patient Care Questionnaire - parents’ version), including a Visual Analogue Scale (VAS) 1-to-10 of the “Quality of care,” coupled with the Edinburg Postnatal Depression Scale (EPDS).RESULTS: The Pyramid Questionnaire total score was 69.73±0.83, while the concurrent satisfaction of “Quality of care,” defined by VAS 1-to-10, was 9.20±0.83, significantly correlated to the Pyramid Questionnaire total score (R=-0.58, P<0.0001). According to multivariate analysis of covariance, maternal age of primiparous women who delivered vaginally (r=0.18; P=0.03) and vaginal delivery of primiparous and multiparous women (r=0.26; P=0.0017 and r=0.19; P=0.02, respectively) exerted a significant minor effect on the Pyramid Questionnaire total scores. In addition, emotional causality tested by EPDS exerted a significant negative effect on Pyramid Questionnaire total scores (r=0.22; P=1.7e-05). Finally, a Random Forest classifier analysis revealed that maternal age, longer hospital stays, and EPDS total scores, were statistically significant predictors of maternal satisfaction (mean decreases in impurity >0.2).CONCLUSIONS: Women’s satisfaction concerning neonatal transitional care quality is moderated by maternal age, gestational age, delivery mode, and by affective disorders. Emotional causality should always be considered when evaluating the quality of newborns’ healthcare and maternal satisfaction.

Sinonasal and skull base tumor surgery-related morbidity has been reduced by the use of endoscopic endonasal skull base surgery (EESBS). Postoperative radiation therapy (poRT) requires precise definition of target volumes. To enhance the accuracy of poRT planning, histological and radiological correlations are necessary to locate the tumor attachment on poRT CT scans. An accurate atlas of structures resected or identified during EESBS could serve for the interdisciplinary postoperative management of patients, personalizing poRT by adequate radiation dose delivery. The objective of this study was to achieve a consensual segmentation atlas on CT scan with surgeons practicing EESBS and radiation oncologists. The sinonasal structures relevant for poRT of sinonasal malignancies were determined by a two-round Delphi process. A rating group of 25 European experts in sinonasal malignancies was set up. Consensual structures emerged and were used to determine the anatomical limits of the retained structures to draft an atlas with expert based relevant structures. The atlas was then critically reviewed, discussed, and edited by another 2 skull base surgeons and 2 radiation oncologists. After the two rating rounds, 46 structures obtained a strong agreement, 7 an agreement, 5 were rejected and 5 did not reach consensus. The atlas integrating all the selected structures is presented attached. Consensual segmentation atlas on CT scan might allow, through careful poRT planning to limit the morbidity of poRT while maintaining good local control. Prospective studies are necessary to validate this potential precision medicine-based approach.