Late third trimester diagnosis of congenital giant hemangioma complicated by the Kasabach-Merritt phenomen: a case report and literature review.

Objective. To describe the case of a large cervical mass diagnosed in the late third trimester with development of Kasabach-Merritt phenomenon (KMP) in the immediate postnatal period, along with a literature review.Methods. Description of case-report and literature search through Medline/Pubmed, performed from inception to December 2022 for articles relating to the pre and postnatal diagnosis of KMP.Results. A 36-year-old multiparous woman was admitted to hospital for contractions at 40 weeks of gestation, in an otherwise uneventful pregnancy. Admission's ultrasound showed the presence of a voluminous mass of 14x15 cm of the posterior side of the neck, highly vascularized, and no signs of hemodynamic imbalance. Postnatally, blood tests showed the presence of severe anemia and thrombocytopenia requiring several transfusions of blood, plasma, platelets and clotting factors. Due to the association of congenital hemangioma and thrombocytopenia a diagnosis of KMP was made. After attempts of conservative treatment, surgical removal was needed to stop the hematological cascade with regression of symptoms. The review of the literature identified 14 articles including 9 cases of prenatally suspected KMP and 6 diagnosed in the immediate postnatal period and without signs of fetal hydrops. Adverse perinatal outcome, in terms of postnatal death/termination of pregnancy, was observed in 67% of cases (6/9) in the prenatally suspected group and 33% of cases in those with a postnatal diagnosis of KMP. Fetal hydrops was present in 83% of cases with adverse perinatal outcome.Conclusions. The Kasabach-Merrit syndrome is a rare condition, which can have a dangerous evolution when it develops in utero or in the immediate postnatal period carrying a risk of perinatal mortality of approximately 50%. Even if the fetus shows no signs of anemia or heart failure, the risk of developing it in the immediate postnatal period is high and should be mentioned to the couple.

Neurovascular alterations of muscularis propria in the human anterior vaginal wall in pelvic organ prolapse.

In the pathophysiology and progression of pelvic organ prolapse (POP), it has been demonstrated that there is a reorganisation of the muscularis propria of the anterior vaginal wall due to a phenotypic smooth muscle cell to myofibroblast switch. An abnormal deposition of collagen type III seems to be influenced by the involvement of advanced glycation end-products. The aim of the present study was to evaluate the hypothesis that this connective tissue remodelling could also be associated with neurovascular alterations of the muscularis in women with POP compared with control patients. We examined 30 women with POP and 10 control patients treated for uterine fibromatosis. Immunohistochemical analysis, using glial fibrillary acidic protein, S-100 protein, receptor tyrosine kinase, neurofilament and α-smooth muscle actin antibodies, was performed. S-100, receptor tyrosine kinase and neurofilament were also evaluated using Western blot analysis. We observed a decrease in all neurovascular-tested markers in nerve bundles, ganglia and interstitial cells of Cajal from POP samples as compared with controls. Even if the processes responsible for these morphological alterations are still not known, it is conceivable that collagen III deposition in the anterior vaginal wall affects not only the architecture of the muscle layer but could also modify the intramuscular neurovascularisation and account for an alteration of the neuromuscular plasticity of the layer.

Influence of experimental conditions on atom column visibility in energy dispersive X-ray spectroscopy.

Here we report the influence of key experimental parameters on atomically resolved energy dispersive X-ray spectroscopy (EDX). In particular, we examine the role of the probe forming convergence semi-angle, sample thickness, lattice spacing, and dwell/collection time. We show that an optimum specimen-dependent probe forming convergence angle exists to maximize the signal-to-noise ratio of the atomically resolved signal in EDX mapping. Furthermore, we highlight that it can be important to select an appropriate dwell time to efficiently process the X-ray signal. These practical considerations provide insight for experimental parameters in atomic resolution energy dispersive X-ray analysis.

Practical aspects of diffractive imaging using an atomic-scale coherent electron probe.

Four-dimensional scanning transmission electron microscopy (4D-STEM) is a technique where a full two-dimensional convergent beam electron diffraction (CBED) pattern is acquired at every STEM pixel scanned. Capturing the full diffraction pattern provides a rich dataset that potentially contains more information about the specimen than is contained in conventional imaging modes using conventional integrating detectors. Using 4D datasets in STEM from two specimens, monolayer MoS2 and bulk SrTiO3, we demonstrate multiple STEM imaging modes on a quantitative absolute intensity scale, including phase reconstruction of the transmission function via differential phase contrast imaging. Practical issues about sampling (i.e. number of detector pixels), signal-to-noise enhancement and data reduction of large 4D-STEM datasets are emphasized.

Quantitative atomic resolution elemental mapping via absolute-scale energy dispersive X-ray spectroscopy.

Quantitative agreement on an absolute scale is demonstrated between experiment and simulation for two-dimensional, atomic-resolution elemental mapping via energy dispersive X-ray spectroscopy. This requires all experimental parameters to be carefully characterized. The agreement is good, but some discrepancies remain. The most likely contributing factors are identified and discussed. Previous predictions that increasing the probe forming aperture helps to suppress the channelling enhancement in the average signal are confirmed experimentally. It is emphasized that simple column-by-column analysis requires a choice of sample thickness that compromises between being thick enough to yield a good signal-to-noise ratio while being thin enough that the overwhelming majority of the EDX signal derives from the column on which the probe is placed, despite strong electron scattering effects.

Changes in muscularis propria of anterior vaginal wall in women with pelvic organ prolapse.

The objective of this study was to evaluate the morphological and immunohistochemical alterations of tissue removed from the upper third of anterior vaginal wall in a sample group of the female population presenting homogenous risk factors associated with Pelvic Organ Prolapse (POP). The case study consisted of 14 patients with POP and there were 10 patients in the control group. Patient selection was carried on the basis of specific criteria and all of the patients involved in the study presented one or more of the recognized POP risk factors. Samples were taken from POP patients during vaginal plastic surgery following  colpohysterectomy, and from control patients during closure of the posterior fornix following hysterectomy. Samples were processed for histological and  immunohistochemical analyses for Collagen I and Collagen III, α-Smooth Muscle Actin (α-SMA), Platelet-Derived-Growth-Factor (PDGF), matrix metalloproteinase 3 (MMP3), Caspase3. Immunofluorescence analyses for Collagen I and III and PDGF were also carried out. In prolapsed specimens our results show a disorganization of smooth muscle cells that appeared to have been displaced by an increased collagen III deposition resulting in rearrangement of the muscularis propria architecture. These findings suggest that the increase in the expression of collagen fibers in muscularis could probably due to a phenotypic switch resulting in the dedifferentiation of smooth muscle cells into myofibroblasts. These alterations could be responsible for the compromising of the dynamic functionality of the pelvic floor.

Addressing preservation of elastic contrast in energy-filtered transmission electron microscopy.

Energy-filtered transmission electron microscopy (EFTEM) images with resolutions of the order of an Ångström can be obtained using modern microscopes corrected for chromatic aberration. However, the delocalized nature of the transition potentials for atomic ionization often confounds direct interpretation of EFTEM images, leading to what is known as "preservation of elastic contrast". In this paper we demonstrate how more interpretable images might be obtained by scanning with a focused coherent probe and incoherently averaging the energy-filtered images over probe position. We dub this new imaging technique energy-filtered imaging scanning transmission electron microscopy (EFISTEM). We develop a theoretical framework for EFISTEM and show that it is in fact equivalent to precession EFTEM, where the plane wave illumination is precessed through a range of tilts spanning the same range of angles as the probe forming aperture in EFISTEM. It is demonstrated that EFISTEM delivers similar results to scanning transmission electron microscopy with an electron energy-loss spectrometer but has the advantage that it is immune to coherent aberrations and spatial incoherence of the probe and is also more resilient to scan distortions.

Analgesia: effects on the first and second stages of labor.

BACKGROUND: This controlled observational study aimed at evaluating the effects of epidural analgesia on the first and second stages of delivery in nulliparous women, referred to the birth centers of the Sant'Omero "Val Vibrata" Hospital and the "San Salvatore" Hospital in L'Aquila, selected in accordance with specific inclusion criteria. MATERIALS AND METHODS: Between May Ws, 2012 and April 3 1s, 2013, 363 patients were enrolled at the birth centres of the "Val Vibrata" Hospital in Sant'Omero (TE) and of the "San Salvatore" Hospital in L'Aquila. 139 patients received epidural analgesia during labor at the "Val Vibrata" Hospital; 224 patients constituted the control group and went through natural delivery without analgesia at the "Val Vibrata" and "San Salvatore" hospitals. RESULTS: Dilation time was different in the two groups: in the group with analgesia, the median was 2.30 and 3.35 in the control group. The median expulsion time was 2.05 in the analgesia group and 0.40 in the control group. DISCUSSION: The statistical analysis of the study has highlighted the fact the analgesia influences the dilation and expulsion time of labor, confirming on the one hand the clinical evidence, and on the other, adding important results that have not been analyzed by other scientific studies. The results have shown that in nulliparous women, with spontaneous onset of labor, analgesia causes a major reduction in the dilation time of the cervical canal with respect to the control group.

Surface determination through atomically resolved secondary-electron imaging.

Unique determination of the atomic structure of technologically relevant surfaces is often limited by both a need for homogeneous crystals and ambiguity of registration between the surface and bulk. Atomically resolved secondary-electron imaging is extremely sensitive to this registration and is compatible with faceted nanomaterials, but has not been previously utilized for surface structure determination. Here we report a detailed experimental atomic-resolution secondary-electron microscopy analysis of the c(6 × 2) reconstruction on strontium titanate (001) coupled with careful simulation of secondary-electron images, density functional theory calculations and surface monolayer-sensitive aberration-corrected plan-view high-resolution transmission electron microscopy. Our work reveals several unexpected findings, including an amended registry of the surface on the bulk and strontium atoms with unusual seven-fold coordination within a typically high surface coverage of square pyramidal TiO5 units. Dielectric screening is found to play a critical role in attenuating secondary-electron generation processes from valence orbitals.

Optimal ADF STEM imaging parameters for tilt-robust image quantification.

An approach towards experiment design and optimisation is proposed for achieving improved accuracy of ADF STEM quantification. In particular, improved robustness to small sample mis-tilts can be achieved by optimising detector collection and probe convergence angles. A decrease in cross section is seen for tilted samples due to the reduction in channelling, resulting in a quantification error, if this is not taken into account. At a smaller detector collection angle the increased contribution from elastic scattering, which initially increases with tilt, can be used to offset the decrease in the TDS signal.

Energy dispersive X-ray analysis on an absolute scale in scanning transmission electron microscopy.

We demonstrate absolute scale agreement between the number of X-ray counts in energy dispersive X-ray spectroscopy using an atomic-scale coherent electron probe and first-principles simulations. Scan-averaged spectra were collected across a range of thicknesses with precisely determined and controlled microscope parameters. Ionization cross-sections were calculated using the quantum excitation of phonons model, incorporating dynamical (multiple) electron scattering, which is seen to be important even for very thin specimens.

How does early cognitive behavioural therapy reduce postpartum depression?

Postpartum depression (PPD) is a frequent mood disorder. Early identification of mothers at risk is crucial to successful prevention. Cognitive Behavioural Therapy (CBT) is an effective preventing therapy. Objectives of this study are to identify mothers at risk for PPD using the Edinburgh Postnatal Depression Scale (EPDS) and evaluate the efficacy of CBT for the prevention of PPD in these mothers. Women were recruited during their second postpartum day. Two groups were selected: mothers with high risk (EPDS score ≥ 10) and mothers with low risk (EPDS score < 10) of PPD. The first group underwent CBT. Follow up was carried out at 40 days, three, six, and 12 months after childbirth. APGAR score, neonatal hospitalization, delayed breastfeeding, and cesarean section were significant obstetric risk factors. Mothers at high risk of PPD presented a statistically valid improvement of EPDS score. Mothers with low risk of PPD did not have CBT and showed a higher EPDS score than mother at high risk at 12 months. PPD prevention is possible through early identification of mothers at risk and early cognitive behavioural therapy.

Leiomyosarcoma: a rare malignant transformation of a uterine leiomyoma.

The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.

Modelling the inelastic scattering of fast electrons.

Imaging at atomic resolution based on the inelastic scattering of electrons has become firmly established in the last three decades. Harald Rose pioneered much of the early theoretical work on this topic, in particular emphasising the role of phase and the importance of a mixed dynamic form factor. In this paper we review how the modelling of inelastic scattering has subsequently developed and how numerical implementation has been achieved. A software package µSTEM is introduced, capable of simulating various imaging modes based on inelastic scattering in both scanning and conventional transmission electron microscopy.

Direct observation of depth-dependent atomic displacements associated with dislocations in gallium nitride.

We demonstrate that the aberration-corrected scanning transmission electron microscope has a sufficiently small depth of field to observe depth-dependent atomic displacements in a crystal. The depth-dependent displacements associated with the Eshelby twist of dislocations in GaN normal to the foil with a screw component of the Burgers vector are directly imaged. We show that these displacements are observed as a rotation of the lattice between images taken in a focal series. From the sense of the rotation, the sign of the screw component can be determined.

Placental site trophoblastic tumor on endometrial polyp: a case report.

Placental site trophoblastic tumor (PSTT) is the least common form of gestational trophoblastic disease (GTD), and is biologically different from other forms of GTD. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. The authors document a case of PSTT on an endometrial polyp. A 51-year-old woman had abnormal vaginal bleeding for the duration of two months. Her past history included a vaginal delivery in 1998. Her physical examination was normal. Tumor markers were at normal levels. Serum beta- human chorionic gonadotropin (hCG) level was 19 mIU/ml and human placental lactogen (hPL) level was in the normal range. The patient underwent an operative hysteroscopy. On examination the uterine cavity appeared to be occupied by a pedunculated polypoid neoformation measuring about 2.5 cm in diameter which was removed and later determined to be a PSTT. There were occasional mitotic figures (0-1/10 high power field). The patient underwent hysterectomy and bilateral salpingo-oophorectomy. The patient has no evidence of disease six months after surgery. The authors conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT. Hysterectomy represents the gold standard of treatment in all cases of disease confined to the uterus.

Impact of surgery and radiotherapy in women with uterine malignancies.

According to the National Health and Social Life Survey, sexual dysfunction affects about 43% of perimenopausal women. A diagnosis of cancer has a profound physical, emotional, and social impact, influencing the relationship with the body, the perception of illness and death, family, social and professional relationships, and the relationship with the partner and, consequently, sexuality. Loss of desire, dyspareunia, orgasmic disorder, difficulties in emotional and physical closeness to the partner, feelings of shame, and inadequacy commonly occur after treatment for uterine cancer; however, if these problems are associated with surgery or with radiotherapy, still remains unclear. According to this study, the authors may conclude that the experience of cancer could lead patients to a rediscovery of. their own sexuality and to an improvement in the relationship with their partner, showing that, sometimes, the relational and psychological factors assume greater importance than physical effects on sexuality, and they can somewhere compensate the morphofunctional failure.

Probe integrated scattering cross sections in the analysis of atomic resolution HAADF STEM images.

The physical basis for using a probe-position integrated cross section (PICS) for a single column of atoms as an effective way to compare simulation and experiment in high-angle annular dark-field (HAADF) scanning transmission electron microscopy (STEM) is described, and the use of PICS in order to make quantitative use of image intensities is evaluated. It is based upon the calibration of the detector and the measurement of scattered intensities. Due to the predominantly incoherent nature of HAADF STEM, it is found to be robust to parameters that affect probe size and shape such as defocus and source coherence. The main imaging parameter dependencies are on detector angle and accelerating voltage, which are well known. The robustness to variation in other parameters allows for a quantitative comparison of experimental data and simulation without the need to fit parameters. By demonstrating the application of the PICS to the chemical identification of single atoms in a heterogeneous catalyst and in thin, layered-materials, we explore some of the experimental considerations when using this approach.

The interaction of a nanoscale coherent helium-ion probe with a crystal.

Thickness fringing was recently observed in helium ion microscopy (HIM) when imaging magnesium oxide cubes using a 40 keV convergent probe in scanning transmission mode. Thickness fringing is also observed in electron microscopy and is due to quantum mechanical, coherent, multiple elastic scattering attenuated by inelastic phonon excitation (thermal scattering). A quantum mechanical model for elastic scattering and phonon excitation correctly models the thickness fringes formed by the helium ions. However, unlike the electron case, the signal in the diffraction plane is due mainly to the channeling of ions which have first undergone inelastic thermal scattering in the first few atomic layers so that the origin of the thickness fringes is not due to coherent interference effects. This quantum mechanical model affords insight into the interaction of a nanoscale, focused coherent ion probe with the specimen and allows us to elucidate precisely what is needed to achieve atomic resolution HIM.

New horizons in the non-invasive diagnosis of endometriosis.

Endometriosis is a chronic disorder, clinically associated with chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility. Its socio-economic impact is extensive, given the large number of affected women in reproductive age, its symptomatology (that interferes with normal social life and the patient's ability to work), and its frequent association with infertility. Nonetheless, the diagnosis of endometriosis is still difficult and late in the evolution of the disorder. The authors have used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria to make a systematic review of the literature of the last 28 years, seeking to identify potential biomarkers useful for a non-invasive diagnosis of endometriosis. The authors have highlighted more than 50 biomarkers in the studies included in the present report, but they have not succeeded in identifying a clinically useful non-invasive diagnostic biomarker or panel of biomarkers. More studies are needed before biomarkers can be introduced in clinical practice.