Temperature-Dependent Olive Pomace Extraction for Obtaining Bioactive Compounds Preventing the Death of Murine Cortical Neurons.

High-pressure and temperature extraction (HPTE) can effectively recover bioactive compounds from olive pomace (OP). HPTE extract obtained by extracting OP with ethanol and water (50:50 v/v) at 180 °C for 90 min demonstrated a pronounced ability to preserve intracellular calcium homeostasis, shielding neurons from the harmful effects induced by N-methyl-d-aspartate (NMDA) receptor (NMDAR) overactivation, such as aberrant calpain activation. In this study, the extraction temperature was changed from 37 to 180 °C, and the extracts were evaluated for their antioxidant potency and ability to preserve crucial intracellular Ca2+-homeostasis necessary for neuronal survival. Additionally, to verify the temperature-induced activity of the extract, further extractions on the exhausted olive pomace were conducted, aiming to identify variations in the quality and quantity of extracted phenolic molecules through HPLC analysis. The results revealed a significant increase in bioactive compounds as a function of temperature variation, reaching 6.31 ± 0.09 mgCAE/mL extract for the extraction performed at 180 °C. Subsequent extraction of the exhausted residues yielded extracts that remained active in preventing calcium-induced cell death. Moreover, despite increased antiradical power, extracts re-treated at 180 °C did not display cell protection activity. Our results indicate that the molecules able to maintain physiological Ca2+-homeostasis in murine cortical neurons in conditions of cytotoxic stimulation of NMDAR are wholly recovered from olive pomace only following extraction performed at 180 °C.

Looking for appropriateness in follow-up CT of oncologic patients: Results from a cross-sectional study.

PURPOSE: The objective of this study was to assess the inappropriateness rate of oncological follow-up CT examinations. METHODS: Out of 7.000 oncology patients referred for follow-up CT examinations between March and October 2022, a random sample of 10 % was included. Radiology residents assessed the appropriateness using the Italian Society of Medical Oncology (AIOM) guidelines, supervised by senior radiologists. Association between inappropriateness and clinical variables was investigated and variables influencing inappropriateness were analyzed through a binary logistic regression. RESULTS: Three-hundred-eighty-eight examinations (56.1 %) were consistent with AIOM guidelines. An additional 100 (14.5  %) examinations did not follow the recommended schedule but were nevertheless considered appropriate because of suspected recurrence/progression (10.7 %) or adverse event requiring imaging assessment (3.8 %). Two-hundred-four (29.4 %) examinations were rated as inappropriate. Inappropriateness causes were as follows: CT not included in the relevant guideline (n = 47); CT extended to additional anatomical regions (n = 59); CT requested at a shorter time-interval (n = 98). No statistically significant difference was found in age, sex, scan region, and primary cancer between appropriate and inappropriate examinations. The only variable significantly associated with inappropriateness was being referred by a specific hospital unit named "unit 2" in the study (p = 0.009), which was demonstrated to be the only appropriateness independent predictor (OR 1.952). CONCLUSION: This study shows that majority of oncological patients referred for follow-up CT follows standard guidelines. However, a non-negligible proportion was rated as inappropriate, mainly due to the shorter time-interval. No clinical variable was associated with inappropriateness, except for referral by a specific hospital unit.

The chemical composition of the aerial parts essential oil of Achillea cretica L. (Asteraceae) growing wild in Crete (Greece).

Achillea cretica (L.) (Asteraceae) is a suffruticosa camefite plant, mainly distributed in Crete, Aegean Islands, and eastern Mediterranean area. In the present study, the chemical composition of the essential oil from aerial parts of a not previously investigated accession of Achillea cretica, collected in Crete, was analysed by GC-MS. The results showed the presence of large quantity of α-bisabolol (53.88%) followed by the related compound α-bisabolol-oxide (2.76%), and spathulenol (5.94%). Based on the composition of the essential oils of all the other Achillea taxa, several consideration have been carried out.

The chemical composition of the aerial parts essential oil of Lonas annua (L.) Vines & Druce (Asteraceae).

Lonas annua (L.) Vines & Druce (Asteraceae), commonly known as African Daisy or Yellow Ageratum is a rare therophyte native to northwestern Africa (Algeria, Morocco, and Tunisia) and Italy (Sicily and Sardinia). In the present study, the chemical composition of the essential oil from aerial parts of Lonas annua was analyzed by GC-MS. No one report has been previously published on the essential oil of this species. The results showed the presence of large quantity of two unusual metabolites 2,3-dihydrofarnesol (41.64%), and acenaphthene (36.18%). Chemotaxonomic considerations were carried out in order to confirm the phylogenetic reconstructions of Anthemideae.

The chemical composition of the aerial parts essential oil of Ammi crinitum Guss. (Apiaceae) endemic of Sicily (Italy).

Ammi L. is a small genus of economically important plants belonging to Apiaceae family that includes only six taxa. In the present study the chemical composition of the essential oil from aerial parts of Ammi crinitum Guss., a very rare plant, endemic of Sicily, was analyzed by GC-MS. No previously paper has been published on this species. The results showed the presence of large quantity of monoterpene hydrocarbons with sabinene (63.9%), as the most abundant component. Other metabolites present in good quantity were γ-terpinene (8.0%), and 4-terpineol (3.7%). Based on the composition of the essential oil of all the other Ammi taxa, several considerations have been carried out.

Using network analysis to explore the association between eating disorders symptoms and aggressiveness in Bulimia nervosa.

Aggressive behaviors have been reported to be more frequent in people with eating disorders (ED), especially bulimia nervosa (BN). Network Analysis (NA) is particularly useful or examining the interactions among symptoms of comorbid conditions through the identification of "bridge symptoms," defined as those symptoms playing a key role in the connection between two syndromic clusters. The aim of the present study was to investigate the association of ED core symptoms and ED-related psychopathology with aggressiveness in a clinical sample of women with BN through NA. Two hundred and seventy-nine women with BN completed the Eating Disorder Inventory-2 and the Buss-Durkee Hostility Inventory. A NA was conducted, including ED symptoms and aggressiveness measures. The bridge function was implied to identify symptoms bridging ED symptoms and aggressiveness. The most connected nodes among communities were asceticism and impulsivity from ED-related psychopathology, drive for thinness from ED-core psychopathology and guilt and suspicion from aggressiveness domain. In particular, drive for thinness connected ED-core community to verbal hostility, while impulsivity connected ED-related symptoms to guilt and suspicion of aggressiveness community. In conclusion the present study showed that in people with BN guilt is the specific negative emotion of the hostile dimensions that may be bidirectionally associated with ED symptoms.

Adult attachment style and salivary alpha-amylase and emotional responses to a psychosocial stressor in women with eating disorders.

BACKGROUND: The fine-tuning of the endogenous stress response system, which includes the hypothalamus-pituitary-adrenal axis and the sympathetic nervous system (SNS), is influenced by early attachment relationships. A higher prevalence of insecure attachment has been detected in people with eating disorders (EDs). Thus, we investigated the emotional and the SNS reactivity to the Trier Social Stress Test (TSST) in women with EDs in relation to their attachment profiles. METHODS: Fifty women with EDs and 20 healthy women participated into an experimental study. Attachment was evaluated by Experience in Close Relationship questionnaire. Salivary α-amylase (sAA) levels were measured to assess the SNS reactivity to TSST while the emotional response was measured by the STAI state scale. RESULTS: Compared to women with EDs and low attachment anxiety and healthy controls, women with EDs and high attachment anxiety showed lower TSST-induced sAA production without difference in anxiety scores. Women with EDs and high attachment avoidance showed similar sAA response to TSST but higher levels of anxiety scores compared to those with low attachment avoidance and healthy controls. CONCLUSIONS: Our findings corroborate the idea that adult attachment may be associated with variability in emotional and biological responses to a psychosocial stressor in women with EDs.

Cortisol awakening response in bipolar patients with comorbid type 2 diabetes mellitus.

OBJECTIVES: Bipolar disorder (BD) is frequently associated with type 2 diabetes mellitus (T2DM). The functioning of the hypothalamic-pituitary-adrenal (HPA) axis has been never investigated in BD with respect to the glucose metabolic status. Therefore, we assessed the cortisol awakening response (CAR) in bipolar patients with or without comorbid T2DM. METHODS: Twenty euglycemic bipolar patients [12 males and eight females; mean age (±SD): 47.4 ± 14.4 years; mean (±SD) duration of illness: 18.3 ± 12.1 years], 16 BD patients with T2DM [11 males and five females; mean age (±SD): 63.6 ± 12.8 years; mean (±SD) duration of bipolar illness: 17.1 ± 10.8 years; mean (±SD) duration of T2DM: 5.2 ± 5.3 years], 18 healthy subjects [seven males and 11 females; mean age (±SD): 45.0 ± 12.1 years] and 12 non-psychiatric subjects with T2DM [eight males and four females; mean age (±SD): 56.7 ± 11.2 years; mean (±SD) duration of T2DM: 5.2 ± 3.5 years] were recruited. Saliva cortisol was measured at awakening and after 15, 30, and 60 min. RESULTS: With respect to both healthy controls and controls with T2DM, euglycemic and diabetic BD patients exhibited a CAR occurring at significantly lower levels. No significant difference emerged in the CAR between the two groups of bipolar patients. Controls with T2DM had an overall post-awakening cortisol production significantly higher than healthy controls. CONCLUSIONS: Our results show that the CAR of patients with BD is reduced in terms of overall cortisol production but normal in terms of cortisol reactivity independently from the occurrence of comorbid T2DM. The dampened CAR points to a tuning down of the functioning of the HPA axis. in both euglycemic and diabetic BD patients, which may be a factor of vulnerability, since a preserved HPA axis functioning is essential to deal with stressors, which may precipitate affective episodes.

The chemical composition of the flowers essential oil of Inula crithmoides (Asteraceae) growing in aeolian islands, Sicily (Italy) and its biocide properties on microorganisms affecting historical art crafts.

Essential oils have been used for a long time in several fields of interest. Recently, they have also been applied in the conservation of Cultural Heritage to contrast biodeterioration replacing the most current biocides toxic for humans and environment. Inula crithmoides L. (syn. Limbarda crithmoides (L.) Dumort) is a halophyte species distributed along the Mediterranean coasts and it is used as an edible vegetable since the young leaves or shoots are eaten raw or cooked. Several biological properties have been determined for this plant including antimicrobial activities. In this study the volatile composition of the aerial part of an accession from the Aeolian Islands, Sicily (Italy) is described. Furthermore, the in vitro antibacterial assay against four species of bacteria isolated from a XX century Tholu Bhommalu, a leather painted puppet from Andhra Pradesh (India), was showed by the Agar disc diffusion method.

PNC2 (SLC25A36) Deficiency Associated With the Hyperinsulinism/Hyperammonemia Syndrome.

CONTEXT: The hyperinsulinism/hyperammonemia (HI/HA) syndrome, the second-most common form of congenital hyperinsulinism, has been associated with dominant mutations in GLUD1, coding for the mitochondrial enzyme glutamate dehydrogenase, that increase enzyme activity by reducing its sensitivity to allosteric inhibition by GTP. OBJECTIVE: To identify the underlying genetic etiology in 2 siblings who presented with the biochemical features of HI/HA syndrome but did not carry pathogenic variants in GLUD1, and to determine the functional impact of the newly identified mutation. METHODS: The patients were investigated by whole exome sequencing. Yeast complementation studies and biochemical assays on the recombinant mutated protein were performed. The consequences of stable slc25a36 silencing in HeLa cells were also investigated. RESULTS: A homozygous splice site variant was identified in solute carrier family 25, member 36 (SLC25A36), encoding the pyrimidine nucleotide carrier 2 (PNC2), a mitochondrial nucleotide carrier that transports pyrimidine as well as guanine nucleotides across the inner mitochondrial membrane. The mutation leads to a 26-aa in-frame deletion in the first repeat domain of the protein, which abolishes transport activity. Furthermore, knockdown of slc25a36 expression in HeLa cells caused a marked reduction in the mitochondrial GTP content, which likely leads to a hyperactivation of glutamate dehydrogenase in our patients. CONCLUSION: We report for the first time a mutation in PNC2/SLC25A36 leading to HI/HA and provide functional evidence of the molecular mechanism responsible for this phenotype. Our findings underscore the importance of mitochondrial nucleotide metabolism and expand the role of mitochondrial transporters in insulin secretion.

The Application of the Essential Oils of Thymus vulgaris L. and Crithmum maritimum L. as Biocidal on Two Tholu Bommalu Indian Leather Puppets.

The chemical profile of the Thymus vulgaris (Lamiaceae) essential oil (EO) was investigated in order to evaluate its biological properties against microorganisms affecting two Tholu Bommalu, typical Indian leather puppets stored at the International Puppets Museum "Antonio Pasqualino" of Palermo, Italy. A GC-MS analysis, using both polar and apolar columns, was used to determine the chemical composition of the essential oil. The aim of this study was to evaluate the antimicrobial effectiveness of the Thymus vulgaris and Crithmum maritimum essential oils in vapor phase to disinfect heritage leather puppets. Pieces of leather artifacts that were affected by different bacterial colonies were exposed to EO under vacuum and static evaporation conditions. The results presented showed that the vaporization of essential oil was an efficient method in the disinfection of natural skins, eradicating microorganism in short times. T. vulgaris EO in the 50% solution showed excellent inhibitory activity against isolated bacteria with both methods, but the obtained results suggest that the vacuum method allowed for faster exposition of the artifacts to the biocide. Furthermore, the biocidal properties of the essential oil of a Sicilian accession of Crithmum maritimum (Apiaceae) aerial parts were compared and investigated. The results of the latter essential oil showed a poor activity against the isolated micro-organisms.

Perceived parental bonding and cortisol awakening response in people with eating disorders.

It is widely acknowledged that early life experiences may have an impact on hypothalamic-pituitary-adrenal (HPA) axis functioning in eating disorders (EDs). Parental bonding is defined as the parental contribution of care and control to parent-child relationships. We evaluated whether perceived care and protection of parental bonding in childhood and adolescence were associated with HPA axis functioning in adult patients with EDs. Sixty-four women with EDs participated in the study, 37 with anorexia nervosa and 27 with bulimia nervosa. Parental care and control (separately for the mother and father) were evaluated by the Parental Bonding Instrument. The activity of the HPA axis was assessed by measuring the salivary cortisol awakening response (CAR). Parental care and control did not differ significantly between the two diagnostic groups. High and low maternal care were associated with significantly different time patterns of CAR without any significant difference in the overall post-awakening production of cortisol. Maternal control, paternal care and paternal control were not associated with any difference in the CAR. Our results showed for the first time an association of perceived maternal care with the time pattern of CAR in female patients with EDs, while perceived parental control was not associated with any CAR feature. These findings support the idea that perceived characteristics of parental bonding in childhood and adolescence may influence the HPA axis activity in adults with EDs.

Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study.

Objectives: Bipolar disorder (BD) has been suggested to be a risk factor for the development of Parkinson's disease (PD). Standard treatment of BD includes drugs that are known to induce drug-induced parkinsonism (DIP). Clinical differentiation between PD and DIP is crucial and might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway. Methods: Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123I-ioflupane dopamine transporter single-photon emission computer tomography (SPECT). Imaging data of BD patients with pathological scans were further compared to a population of 40 de novo PD patients. Results: Four BD patients had abnormal scans, but their clinical features and cumulative exposure to both antipsychotic drugs and lithium were similar to those of BD patients with normal dopamine transporter imaging. BD patients with pathological scans had putaminal binding ratio and putamen-to-caudate ratios higher than those of PD patients despite a similar motor symptom burden. Conclusions: Up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which would not be due to cumulative exposure to offending drugs and is ostensibly higher than expected in the general population. This supports the evidence that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism, the nature of which needs to be elucidated.

Childhood maltreatment and clinical response to mood stabilizers in patients with bipolar disorder.

OBJECTIVE: The association between childhood maltreatment (CM) and clinical response to mood stabilizers has been scarcely investigated in bipolar disorder (BD). Therefore, we assessed whether CM affects the response to lithium or anticonvulsant treatments in BD patients. METHODS: A retrospective assessment of clinical response to mood stabilizers was conducted in 97 euthymic patients with BD by means of the Alda scale. History of CM was investigated through the Childhood Trauma Questionnaire. RESULTS: Thirty-seven patients (24 with a history of CM and 13 without CM) were on stable lithium treatment while sixty (35 with a history of CM and 25 without CM) were on stable anticonvulsant treatment. Clinical response to drug treatment did not differ between BD with CM and those without CM in the whole sample as well as in the anticonvulsant-treated subgroup. In the lithium-treated subgroup, a significant negative correlation emerged between childhood physical abuse and clinical response and patients with CM showed a significantly reduced Alda score. CONCLUSIONS: In BD patients, CM did not influence the clinical response to anticonvulsant mood stabilizers whereas it was associated with a poorer response to lithium with childhood physical abuse playing a major role in this effect.

Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder.

OBJECTIVES: Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis. METHODS: One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM-). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. RESULTS: Sixty-two patients had a history of childhood maltreatment and 44 had not. Maltreatment was significantly more frequent in females than males. CM+ patients showed a significant higher body mass index, a significant higher number of suicide attempts, and more severe mania symptoms than CM- ones. Logistic regression indicated a significant association between lifetime suicide attempts and any type of childhood maltreatment and between emotional abuse and the presence of psychotic symptoms or mixed mood episodes. CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM- ones. DISCUSSION: Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatments and show for the first time that childhood trauma exposure is associated to an impaired CAR in adults with BD.

Impaired glucose metabolism in bipolar patients and response to mood stabilizer treatments.

BACKGROUND: Metabolic dysfunctions in patients with bipolar disorder (BD) are critical factors that interfere with outcome, but only one study evaluated the influence of glucose dysmetabolism on the response to treatment with lithium. We aimed to investigate the potential impact of glucose metabolic status on clinical characteristics of BD patients and their response to treatment with different mood stabilizers in monotherapy or in combination. METHODS: 45 BD patients with insulin resistance (IR) or type 2 diabetes mellitus (DM2) and 46 patients with normal glucose metabolism, treated with mood stabilizers for at least one year were assessed by diagnostic and rating instruments. Their clinical characteristics were compared and an ordinal logistic regression model was adopted to identify possible predictors of response to mood stabilizer treatments. RESULTS: Compared to patients with normal glucose metabolism, BD patients with impaired glucose metabolism showed a worse clinical presentation of their psychiatric illness and a worse response to mood stabilizers. Ordinal logistic regression analysis evidenced that impaired glucose metabolism was the only predictor of poor response to mood stabilizers (OR 4.3; 95% CI: 1.7-11.1; p < 0.002). LIMITATIONS: Cross-sectional design and the relatively small sample size, are the main limitations of our study. CONCLUSIONS: Our findings expand literature data suggesting that BD patients with impaired glucose metabolism are at a greater risk of not responding to lithium as well as to different mood stabilizer treatments.

Translocator protein ligand-PLGA conjugated nanoparticles for 5-fluorouracil delivery to glioma cancer cells.

Translocator protein 18 kDa (TSPO) is a promising target for molecular imaging and for targeted drug delivery to tumors overexpressing TSPO. In our previous work, new macromolecular conjugates with a high affinity and selectivity for TSPO were prepared by conjugating the biodegradable poly(d,l-lactic-co-glycolic acid) (PLGA) polymer with two potent and selective TSPO ligands, namely, compounds 1 and 2. Based on this, nanoparticle delivery systems (NPs), employing TSPO ligand-PLGA conjugated (PLGA-TSPO) polymers, were prepared. Furthermore, to evaluate the ability of the new NPs to be used as a drug delivery systems for anticancer therapy, PLGA-TSPO NPs were loaded with 5-fluorouracil (5-FU), chosen as a model hydrophilic anticancer drug. The main goal of this work was to investigate the synergistic potential of using NP conjugates PLGA-TSPO, TSPO ligands being pro-apoptotic agents, to simultaneously deliver a cytotoxic anticancer drug. To better highlight the occurrence of synergistic effects, dual drug loaded PLGA NPs (PLGA NPs/5-FU/1) and dual drug loaded PLGA-TSPO NPs (PLGA-TSPO NPs/5-FU/1), with 5-FU and TSPO ligand 1 physically incorporated together, were also prepared and characterized. The particle size and size distribution, surface morphology, and drug encapsulation efficiency, as well as the drug release kinetics, were investigated. In vitro cytotoxicity studies were carried out on C6 glioma cells overexpressing TSPO, and to evaluate the potential uptake of these nanoparticulate systems, the internalization of fluorescent labeled PLGA-TSPO NPs (FITC-PLGA-TSPO NPs) was also investigated by fluorescence microscopy. Results demonstrated that PLGA-TSPO NPs/5-FU and dual drug loaded PLGA NPs/5-FU/1 and PLGA-TSPO NPs/5-FU/1 could significantly enhance toxicity against human cancer cells due to the synergistic effect of the TSPO ligand 1 with the anticancer drug 5-FU.

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma.

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.

Combined transurethral approach with Versapoint(®) and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up.

BACKGROUND: When endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1-2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint(®) and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up. METHODS: We performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint(®)). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o'clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE(®). The bladder hole was repaired with a continuous 3-0 monofilament two-layer suture. RESULTS: Operating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up. CONCLUSIONS: A combined transurethral approach with Versapoint(®) and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.