Fetal Dilated Jugular Lymphatic Sacs on First-Trimester Ultrasound and Their Implications in Antenatal Screening Ruxanda Rusu, Daniel L. Rolnik, Valentina De Robertis, Maurizio Guido, Tamara Stampalija, et al. Fetal Diagnosis and Therapy, 2026 Introduction: The aim of this study was to investigate clinical significance, rate of genetic anomalies, and fetal malformations in fetuses with dilated jugular lymphatic sacs (JLS) in the first trimester, overall and according to nuchal translucency (NT) thickness. Methods: This is a retrospective multicenter cohort study of fetuses with dilated JLS at the first-trimester scan. NT thickness, genetic evaluation, and fetal malformation data were collected. Logistic regression analysis was performed to evaluate impact of NT measurement on adverse outcomes. Results: Eighty-four fetuses were included. Dilated JLS was associated with an increased NT in 75 (89.3%) fetuses; fetal structural malformations in 38 (45.2%); and genetic anomalies in 49 (64.5%). NT measurement remains the strongest predictor of genetic or structural abnormalities (OR 1.567, 95% confidence interval: 1.226–2.124; p = 0.001). Significantly fewer live births observed in the group with NT >99th percentile (p < 0.001). Among cases with isolated JLS, a normal postnatal outcome was reported in 6 (66.7%). Conclusion: The first-trimester dilated JLS are highly associated with genetic disorders and/or fetal malformations, but an increased NT remains the most important predictive factor. In cases with normal NT, dilated JLS is mostly a transient finding but approximately one-third of cases are at increased risk of adverse outcomes.
Supra Occipital Flattening: A Key Sign for Antenatal Diagnosis of Isolated Sagittal Craniosynostosis Paola Quaresima, Lorenzo Figà Talamanca, Lech Dudarewicz, Giampiero Russo, Michele Morelli, et al. Journal of Clinical Ultrasound, 2026 Craniosynostosis is an isolated finding in most cases, involving either the metopic or the sagittal suture. It is detected only sporadically during prenatal ultrasound, in the third trimester for non‐isolated cases. When synostosis of the sagittal suture occurs, head shape growth proceeds in an anteroposterior direction, leading to scaphocephaly (long, narrow, boat‐shaped skull). Moreover, the reduced vertical growth of the skull vault causes a supra‐occipital flattening, detectable at the profile view. Fetuses' head shape diagnosed as dolicocephalic should be carefully studied for the presence of the supra‐occipital bone flattening; this sign may lead to the suspicion of a sagittal craniosynostosis.
Semen Quality in Patients with Hematological Malignancies: A Retrospective Monocentric Study in the Perspective of Personalized Oncofertility Medicine Federica Cariati, Maria Grazia Orsi, Anna Capasso, Delia Pagano, Francesca Bagnulo, et al. Journal of Personalized Medicine, 2026 Background/Objectives: The hypothalamic-pituitary-testis axis is known to be dysregulated in patients with hematological malignancies. However, data on the association between the type of hematological malignancies and semen quality are discordant. In the era of personalized medicine, identifying disease-specific patterns of reproductive impairment is crucial to optimize fertility preservation strategies. While patients with leukemia often show a clear deterioration in semen quality, studies on Hodgkin and non-Hodgkin lymphomas have shown that spermatogenesis is not always compromised. Indeed, some patients may present normospermia before treatment. This study aimed to assess semen parameters in males affected by hematological malignancies compared with a non-cancer population and to explore implications for individualized fertility preservation counseling. Methods: We performed a retrospective monocentric study including all patients affected by hematological malignancies who underwent fertility preservation at the Maternal and Child Department, Gynecology and Obstetrics, Oncofertility Unit, Federico II of Naples, from January 2017 through December 2024. In total, 247 patients with hematological malignancies and 63 non-cancer males undergoing in vitro fertilization for female tubal factor, selected as a control group, were included in the analysis. Sperm parameters (semen volume, sperm concentration, motility, and morphology) were first compared between the hematological malignancy group and the control group, and then among hematological malignancies classified as Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and leukemia (L). Results: Overall, according to World Health Organization (WHO, 2021) criteria, semen parameters of patients with hematological malignancies were at the 25th percentile, except for motility, which was below the 5th percentile. Significant differences were observed in sperm concentration/mL, total sperm number, and percentage of total sperm motility between the hematological malignancy group and the control group (p = 0.0004; p = 0.0003; p < 0.0001). Based on disease classification, 158 patients had Hodgkin lymphoma, 54 had non-Hodgkin lymphoma, and 35 had leukemia. Significant differences in concentration/mL and total sperm number were found between the Hodgkin lymphoma group and the control group (p = 0.003; p = 0.001). The percentage of total sperm motility was significantly decreased in all subtypes of hematological malignancies compared with controls, especially in the leukemia group (HL p = 0.001; NHL p = 0.004; L p < 0.001). Conclusions: These findings highlight significant impairment of semen quality, particularly motility, reinforcing the role of personalized medicine in tailoring fertility preservation strategies according to malignancy subtype and baseline reproductive risk.
Comparing endometrial preparation protocols and clinical outcomes: lessons learned from 3507 vitrified-warmed euploid transfers Erika Pittana, Alessandro Ruffa, Giosuè Giordano Incognito, Federica Battista, Federica Innocenti, et al. Journal of Assisted Reproduction and Genetics, 2026 Purpose To evaluate whether artificial endometrial preparation using hormone replacement therapy (HRT) influences clinical and neonatal outcomes compared with modified natural cycles (mNC) in single euploid vitrified–warmed blastocyst transfers. Methods This retrospective cohort study analyzed single euploid vitrified–warmed blastocyst transfers performed at a single IVF center over an 11-year period. Endometrial preparation was conducted either through HRT or mNC. Clinical and neonatal outcomes were compared between groups. Statistical analyses included multivariable logistic regression models, adjusted for relevant confounders, with generalized estimating equations to account for repeated embryo transfers (ETs) within patients. Results A total of 3507 ETs were conducted in 2257 patients. Mean age was 37.5 ± 3.2 years at oocyte pick-up and 37.8 ± 3.3 years at ET. HRT was associated with a higher miscarriage rate ( N = 167/1034, 16.2% vs N = 70/700, 10%; OR 1.72, 95% CI 1.27–2.33) and a lower live birth rate ( N = 867/2129, 40.7% vs N = 630/1378, 45.7%; OR 0.83, 95% CI 0.72–0.96) than mNC. Additionally, HRT was associated with a higher prevalence of large for gestational age newborns. Conclusions mNC endometrial preparation may show some clinical benefit compared to HRT. The latter remains necessary in specific cases, such as hypothalamic amenorrhea (excluded in this study), but mNC protocols should be preferred whenever possible. Randomized controlled trials in Preimplantation Genetic Testing for Aneuploidy (PGT-A) cycles are essential to confirm these findings.
Medical clinical minds meet artificial intelligence: Italian physicians' knowledge, attitudes, and concordance between Italian physicians and AI-generated diagnoses. A national cross-sectional study Vincenza Cofini, Mario Muselli, Laura Piccardi, Eugenio Benvenuti, Ginevra Di Pangrazio, et al. Frontiers in Digital Health, 2026 Background Artificial Intelligence has increasingly been integrated into clinical practice, yet its adoption and perception among medical professionals remain poorly understood, particularly in the Italian healthcare system. To investigate Italian physicians' knowledge, attitudes, and clinical concordance with AI-generated diagnostic recommendations, using a validated questionnaire and a clinical scenario processed by ChatGPT. Methods A national, cross-sectional web-based survey was conducted among 587 Italian physicians using an online validated questionnaire. The first part of the questionnaire assessed self-reported knowledge, prior experience, attitudes, and willingness to adopt AI in medicine. The second part assessed clinical concordance between AI proposals and physicians about clinical cases evaluated by ChatGPT. Results Most participants reported basic AI knowledge ( n = 380, 64.8%) and minimal exposure to AI training (18.4%). Only 21.6% reported they used AI in clinical practice, and the most familiar application was diagnostic imaging (35.4% of AI users; 7.7% of the total sample). Major perceived barriers included lack of training (76.7%) and resistance to change (50.9%). In the universal clinical scenario, physicians showed the highest agreement with ChatGPT's correct diagnosis (mean = 4.07) compared to incorrect alternatives (mean = 2.57 and 1.82, p < 0.001). For correct diagnosis, the agreement rate was very high at 89% [86%–91%]. Conclusion Italian physicians showed a strong interest in adopting AI tools, despite significant knowledge gaps and limited practical experience. The high concordance between physicians' evaluations and ChatGPT's diagnostic insights suggests potential for AI-based decision support in clinical workflows. Targeted training and institutional support are essential to bridge the gap between enthusiasm and readiness for AI integration.
Kidney and Pregnancy: A Comprehensive Review Luca Piscitani, Paolo Sipari, Lorenzo Ottavio Di Pietro, Sofia Bussolaro, Maurizio Guido, et al. Clinics and Practice, 2025 During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues arising in one organ will disrupt this fundamental balance, inevitably involving all associated organs. The purpose of this review is to gather all possible nephrological conditions that may arise during pregnancy, as well as pre-existing conditions that may become apparent or worsen during this period. This review describes the natural history, treatment, and impact of these conditions on pregnancy itself. Among the most common conditions are preeclampsia and HELLP syndrome, severe complications characterized by hypertension, proteinuria, and multiorgan damage that require immediate clinical attention. Additionally, women with chronic kidney disease are at higher risk of developing maternal–fetal complications, such as preterm birth and intrauterine growth restriction. Common causes of acute renal failure are also analyzed, including thrombotic microangiopathy, acute fatty liver of pregnancy, acute onset or flare of systemic lupus erythematosus, and catastrophic antiphospholipid antibody syndrome. Given the importance of proper renal function during pregnancy, it is essential to have a thorough understanding of nephrological diseases that may affect this phase of women’s lives. This knowledge is crucial for managing these conditions effectively to avoid risks to the survival of both the mother and the newborn.
A WHO 2021-based comprehensive scheme outlining sperm parameters’ associations with IVF outcomes in PGT-A cycles Rossella Mazzilli, Danilo Cimadomo, Federica Innocenti, Marilena Taggi, Greta Chiara Cermisoni, et al. Andrology, 2025 ObjectiveTo examine the association between semen parameters, assessed according to World Health Organization (WHO)‐2021 criteria, and paternal body mass index (BMI) and age, with embryological and clinical outcomes in ICSI cycles involving preimplantation genetic testing for aneuploidy (PGT‐A).DesignRetrospective study at a private in vitro fertilization (IVF) clinic.Subjects3101 couples undergoing 4013 intracytoplasmic sperm injection (ICSI) + PGT‐A cycles with own‐oocytes (years 2013–2021).InterventionWe performed trophectoderm biopsy, and comprehensive chromosome testing to report uniform aneuploidies and vitrified‐warmed euploid single‐blastocyst‐transfers. Regression analyses adjusted for relevant confounders were conducted to outline putative associations of semen analysis and characteristics and paternal BMI and age with all embryological/clinical outcomes.ResultsMaternal age was the only significant confounding variable affecting euploidy blastocyst rate (EBR) (primary embryological outcome). When categorized, motility < 5th‐percentile (‐2.5%, 95%CI ‐4.9 to ‐0.2%, p = 0.03), concentration plus morphology < 5th‐percentile (‐2.7%,95%CI ‐4.8 to ‐0.6%, p = 0.01), concentration plus morphology plus motility < 5th‐percentile (‐4.0%,95%CI ‐5.5 to ‐2.6%, p < 0.01), obstructive‐azoospermia [OA] (‐5.5%,95%CI ‐9 to ‐2%, p = 0.02) and non‐obstructive azoospermia (NOA) (‐5.8%,95%CI ‐10.9 to ‐0.6%, p = 0.03) showed significantly lower results compared to all parameters > 5th‐percentile. Furthermore, after adjusting for maternal age and the number of metaphase‐II‐oocytes inseminated, the only significant confounding variable affecting the chance of obtaining ≥ 1 live birth among completed cycles (primary clinical outcome) was basal and post sperm processing motility. When categorized, concentration plus morphology plus motility < 5th‐percentile (multivariable‐OR: 0.73, 95%CI 0.58–0.93, p = 0.01) and OA (multivariable‐OR: 0.47, 95%CI 0.24–0.92, p = 0.03) showed significantly lower chances compared to all parameters > 5th‐percentile. Advanced paternal age (defined as > 44 years) was associated only with lower day 5‐blastocyst and Gardner's AA‐grade (i.e., top quality) blastocyst rates.ConclusionsThis comprehensive analysis provides IVF professionals with useful figures to counsel infertile couples about their chances of success, taking into account the impact of semen characteristics and paternal BMI and age. These estimates are valuable for personalized decision‐making about the most effective reproductive strategies to adopt, especially not underestimating male factor, by improving sperm concentration and motility whenever possible before assisted reproductive technologies.
A State-of-the-Art Review of Ophthalmological Indications for a Cesarean Section: Is There a Patient for Whom a Cesarean Section Is Really Indicated? Paola Quaresima, Giuseppe Covello, Giovanna Bitonti, Costantino Di Carlo, Michele Morelli, et al. Diagnostics, 2025 Purpose: Our purpose was to review the current literature regarding ophthalmologic indications for cesarean section (CS). Methods: A literature search was conducted using MEDLINE, Embase, and the Cochrane Library from inception through October 2024. The databases were searched using the following keywords: “Caesarean section” OR “Caesarean section” OR “delivery” OR “pregnancy” AND “eyes” OR “eye disorders” OR “ocular disease” OR “diabetic retinopathy” OR “myopia” OR “retinal detachment” OR “glaucoma” OR “keratoconus”. Studies were considered eligible if they described pregnancy management in women affected by an eye disorder, with insight into the mode of delivery. Results: A total of 8383 results were identified, including only 1 specific guideline and no randomized controlled trials. After a manual review, 38 manuscripts were selected for inclusion. Based on the available evidence, an elective CS may be considered on a case-by-case basis in the presence of specific ophthalmic conditions, such as high-grade myopia with subretinal neovascularization, proliferative diabetic retinopathy, advanced glaucoma, or advanced keratoconus. These conditions are rare among women of childbearing age. Conclusions: Currently, only a limited number of highly specific ophthalmic conditions may benefit from an elective CS. Considering the potential short- and long-term implications of a CS, and in line with the current World Health Organization recommendations, this surgical procedure should be reserved for cases with a clear indication. Given the paucity of data in the available literature, further prospective randomized controlled trials are necessary to enhance the quality of evidence.
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