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  1. Article: Endometriosis-associated infertility: From pathophysiology to tailored treatment.

    Bonavina, Giulia / Taylor, Hugh S

    Frontiers in endocrinology

    2022  Volume 13, Page(s) 1020827

    Abstract: Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic ... ...

    Abstract Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients' phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.
    MeSH term(s) Female ; Humans ; Endometriosis/complications ; Endometriosis/therapy ; Infertility, Female/etiology ; Infertility, Female/therapy ; Reproductive Techniques, Assisted/adverse effects ; Ovarian Reserve ; Causality
    Language English
    Publishing date 2022-10-26
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2592084-4
    ISSN 1664-2392
    ISSN 1664-2392
    DOI 10.3389/fendo.2022.1020827
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery.

    Bonavina, Giuseppe / Zackova, Monika / Bet, Luciano / Bonavina, Luigi

    Annals of surgery open : perspectives of surgical history, education, and clinical approaches

    2023  Volume 4, Issue 1, Page(s) e252

    Language English
    Publishing date 2023-03-15
    Publishing country United States
    Document type Journal Article
    ISSN 2691-3593
    ISSN (online) 2691-3593
    DOI 10.1097/AS9.0000000000000252
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  3. Article ; Online: Comment on: Prophylactic salpingectomy for prevention of ovarian cancer at the time of elective laparoscopic cholecystectomy.

    Bonavina, G / Bocciolone, L / Candiani, M / Bonavina, L

    The British journal of surgery

    2020  Volume 107, Issue 9, Page(s) e354

    MeSH term(s) Cholecystectomy, Laparoscopic ; Elective Surgical Procedures ; Female ; Humans ; Ovarian Neoplasms/prevention & control ; Ovarian Neoplasms/surgery ; Salpingectomy
    Language English
    Publishing date 2020-06-22
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11768
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  4. Article ; Online: Bone marrow mesenchymal stem cell-derived exosomes shuttle microRNAs to endometrial stromal fibroblasts that promote tissue proliferation /regeneration/ and inhibit differentiation.

    Bonavina, Giulia / Mamillapalli, Ramanaiah / Krikun, Graciela / Zhou, Yuping / Gawde, Nimisha / Taylor, Hugh S

    Stem cell research & therapy

    2024  Volume 15, Issue 1, Page(s) 129

    Abstract: Background: Human bone marrow-derived stem cells (hBMDSCs) are well characterized mediators of tissue repair and regeneration. An increasing body of evidence indicates that these cells exert their therapeutic effects largely through their paracrine ... ...

    Abstract Background: Human bone marrow-derived stem cells (hBMDSCs) are well characterized mediators of tissue repair and regeneration. An increasing body of evidence indicates that these cells exert their therapeutic effects largely through their paracrine actions rather than clonal expansion and differentiation. Here we studied the role of microRNAs (miRNAs) present in extracellular vesicles (EVs) from hBMDSCs in tissue regeneration and cell differentiation targeting endometrial stromal fibroblasts (eSF).
    Methods: Extracellular vesicles (EVs) are isolated from hBMDSCs, characterized by transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA) techniques. Extracted total RNA from EVs was subjected to RNA seq analysis. Transfection and decidualization studies were carried out in endometrial stromal fibroblasts (eSF). Gene expression was analyzed by qRTPCR. Unpaired t-test with Welch's correction was used for data analysis between two groups.
    Results: We identified several microRNAs (miRNAs) that were highly expressed, including miR-21-5p, miR-100-5p, miR-143-3p and let7. MiR-21 is associated with several signaling pathways involved in tissue regeneration, quiescence, cellular senescence, and fibrosis. Both miR-100-5p and miR-143-3p promoted cell proliferation. MiR-100-5p specifically promoted regenerative processes by upregulating TGF-ß3, VEGFA, MMP7, and HGF. MiR-100-5p blocked differentiation or decidualization as evidenced by morphologic changes and downregulation of decidualization mediators including HOXA10, IGFBP1, PRL, PR-B, and PR.
    Conclusion: EVs delivered to tissues by hBMDSCs contain specific miRNAs that prevent terminal differentiation and drive repair and regeneration. Delivery of microRNAs is a novel treatment paradigm with the potential to replace BMDSCs in cell-free regenerative therapies.
    MeSH term(s) Humans ; MicroRNAs/metabolism ; MicroRNAs/genetics ; Female ; Mesenchymal Stem Cells/metabolism ; Mesenchymal Stem Cells/cytology ; Cell Differentiation ; Cell Proliferation ; Exosomes/metabolism ; Endometrium/metabolism ; Endometrium/cytology ; Fibroblasts/metabolism ; Fibroblasts/cytology ; Regeneration/genetics ; Bone Marrow Cells/metabolism ; Bone Marrow Cells/cytology
    Chemical Substances MicroRNAs
    Language English
    Publishing date 2024-05-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2548671-8
    ISSN 1757-6512 ; 1757-6512
    ISSN (online) 1757-6512
    ISSN 1757-6512
    DOI 10.1186/s13287-024-03716-1
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  5. Article ; Online: Vesicouterine Fistula After Cesarean Delivery at Full Cervical Dilation.

    Bulfoni, Alessandro / Bonavina, Giulia / Acerboni, Stefano / Schirripa, Irene / Casale, Paolo / Busnelli, Andrea

    Urogynecology (Philadelphia, Pa.)

    2023  Volume 29, Issue 12, Page(s) 974–979

    Abstract: Importance: Vesicouterine fistula (VUF) is an iatrogenic consequence of cesarean section in the vast majority of cases. The worldwide increase of cesarean delivery rates is likely to be accompanied by a rise of this complication, and surgery is the ... ...

    Abstract Importance: Vesicouterine fistula (VUF) is an iatrogenic consequence of cesarean section in the vast majority of cases. The worldwide increase of cesarean delivery rates is likely to be accompanied by a rise of this complication, and surgery is the mainstay treatment.
    Objective: The aim of the study is to assess current evidence on VUF pathogenesis and management.
    Study design: The study is a case report and literature review on PubMed and Embase spanning over the past 2 decades.
    Results: An early VUF developed after a cesarean section at full cervical dilation and concurrent incidental bladder injury. A transabdominal extravesical repair was performed 3 months after cesarean delivery. Both the cystotomy and hysterotomy were repaired in a double-layer fashion with no interposition flap. A contemporary literature review including 25 patients showed that VUF was repaired transabdominally in 21 patients (84%), and an open approach was adopted in 18 patients (85.7%). In most patients, the uterine side was closed with a single-layer suture and an interposition flap was used to reinforce the repair. Concomitant hysterectomy was performed in 6 patients (24%). Overall, successful term pregnancies were reported in 2 patients after VUF repair.
    Conclusions: Vesicouterine fistula is a rare event and is commonly associated with cesarean sections, especially those with a concurrent bladder injury. Careful and meticulous surgical technique may prevent the occurrence of this condition. Delayed repair and double-layer closure of both bladder and uterus, with or without an interposition flap, are recommended.
    MeSH term(s) Female ; Humans ; Pregnancy ; Abdominal Injuries/complications ; Cesarean Section/adverse effects ; Dilatation ; Fistula/etiology ; Urinary Bladder Diseases/complications ; Urinary Bladder Fistula/etiology ; Uterine Diseases/etiology
    Language English
    Publishing date 2023-07-29
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ISSN 2771-1897
    ISSN (online) 2771-1897
    DOI 10.1097/SPV.0000000000001398
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  6. Article ; Online: Opportunistic salpingectomy at the time of vaginal hysterectomy: A systematic review and meta-analysis.

    Bonavina, Giulia / Busnelli, Andrea / Salmeri, Noemi / Cavoretto, Paolo I / Salvatore, Stefano / Candiani, Massimo / Bulfoni, Alessandro

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2024  

    Abstract: Background: Despite the rising rates of opportunistic salpingectomy at the time of surgery for non-malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated.: Objectives: The ... ...

    Abstract Background: Despite the rising rates of opportunistic salpingectomy at the time of surgery for non-malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated.
    Objectives: The aim of the primary study was to determine the feasibility of bilateral opportunistic salpingectomy at the time of VH. Secondary aims included surgical outcomes, factors associated with patient selection, and the prevalence of incidental tubal malignancies.
    Search strategy: In this systematic review and meta-analysis we searched Pubmed, Embase and ClinicalTrials.gov databases from inception to September 1, 2023, using relevant keywords.
    Selection criteria: Original articles with no language restriction reporting outcomes of women undergoing planned VH with opportunistic salpingectomy, were considered eligible. Studies including patients undergoing VH with and without opportunistic salpingectomy were also included.
    Data collection and analysis: The Newcastle-Ottawa scale was used to assess quality of observational studies. DerSimonian-Laird random effects meta-analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I
    Results: Seven observational cohort studies including 4808 women undergoing opportunistic salpingectomy at the time of VH and 10 295 patients undergoing VH alone were selected. The pooled proportion of success was 81.83 per 100 observations (95% CI: 75.35-87.54). Opportunistic salpingectomy at the time of VH, when feasible, was associated with a significant reduction in intraoperative complications (OR 0.06, 95% CI: 0.01, -0.37, P = 0.03) and total operative time (95% CI: -17.80, -1.07, P = 0.03) compared to those where it failed. Successful salpingectomy was significantly hindered by nulliparity (OR 0.12, 95% CI: -17.69, -1.21, P < 0.001) and favored by pelvic organ prolapse (OR 3.20, 95% CI: 1.35, 7.55, P = 0.008). Immunohistochemical tubal abnormalities were found in 13/579 (2.1%) patients. The overall quality of the evidence, according to the GRADE assessment, was low.
    Conclusion: Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes.
    Language English
    Publishing date 2024-01-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.15386
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    Zs.A 355: Show issues Location:
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  7. Article ; Online: Surgical repair of post-cesarean vesicouterine fistula: A systematic review and a plea for prevention.

    Bonavina, Giulia / Busnelli, Andrea / Acerboni, Stefano / Martini, Alberto / Candiani, Massimo / Bulfoni, Alessandro

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2023  

    Abstract: Background: Vesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.: Objectives: To assess current evidence on VUF ... ...

    Abstract Background: Vesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.
    Objectives: To assess current evidence on VUF pathogenesis and surgical management.
    Search strategy: Pubmed and Embase databases were searched from January 2000 to January 2023 using relevant key words.
    Selection criteria: Only original articles including either transabdominal or transvaginal surgical routes for post-cesarean VUF repair, in English language, were included.
    Data collection and analysis: Two authors independently screened the references for eligibility, data extraction, and assessment of methodologic quality. All available surgical outcomes were recorded.
    Main results: Of the 1160 studies retrieved, 67 were selected for analysis. Most of these were case reports, case series, or observational cohort studies including a total of 284 patients. The majority (78.6%) of patients had more than one cesarean section, and approximately 10% of them experienced an overt bladder injury and/or uterine rupture at the time of cesarean delivery. The supratrigonal part of the bladder was most commonly involved (92.5%). The majority of patients (88.8%) underwent delayed VUF repair through laparotomy. Length of stay and blood loss were significantly less in patients treated via a minimally invasive approach (P < 0.001 and P = 0.02, respectively). Most patients had double-layer bladder repair and single-layer uterine repair. The overall success rate was 100% on first attempt for each independent combination of different surgical approaches and techniques. Live birth following VUF repair was reported in 23 patients.
    Conclusions: Paying close attention to surgical details is crucial to reduce the incidence of this complication and recurrence rates. Double-layer bladder closure and delayed timing of repair of VUF are recommended.
    Language English
    Publishing date 2023-12-06
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.15256
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  8. Article: Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis.

    Bonavina, Giulia / Lina Spinillo, Silvia / Sotiriadis, Alexandros / Bulfoni, Alessandro / Kaltoud, Randa / Salvatore, Stefano / Candiani, Massimo / Ivo Cavoretto, Paolo

    Heliyon

    2024  Volume 10, Issue 8, Page(s) e29336

    Abstract: Background: Controversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta- ... ...

    Abstract Background: Controversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide.
    Methods: We searched
    Results: 14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I
    Conclusions: These results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae.
    Language English
    Publishing date 2024-04-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2835763-2
    ISSN 2405-8440
    ISSN 2405-8440
    DOI 10.1016/j.heliyon.2024.e29336
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  9. Article ; Online: Female Genital Mutilation and Cutting and Obstetric Outcomes.

    Bonavina, Giulia / Kaltoud, Randa / Ruffolo, Alessandro Ferdinando / Candiani, Massimo / Salvatore, Stefano

    Obstetrics and gynecology

    2022  Volume 140, Issue 1, Page(s) 87–90

    Abstract: The aim of this prospective study was to investigate the association of type III female genital mutilation/cutting (FGM/C) and de-infibulation with immediate maternal and neonatal outcomes. Women with type III FGM/C were compared with women with type I ... ...

    Abstract The aim of this prospective study was to investigate the association of type III female genital mutilation/cutting (FGM/C) and de-infibulation with immediate maternal and neonatal outcomes. Women with type III FGM/C were compared with women with type I or II FGM/C or no FGM/C. Only uncomplicated singleton, full-term pregnancies with the fetus in vertex presentation were included. There was a greater frequency of postpartum hemorrhage and the use of mediolateral episiotomy in women with type III FGM/C. Mediolateral episiotomy was associated with a reduced rate of any spontaneous perineal laceration as well as third-degree and fourth-degree lacerations in women with type III FGM/C who underwent de-infibulation.
    MeSH term(s) Circumcision, Female/adverse effects ; Episiotomy/adverse effects ; Female ; Humans ; Infant, Newborn ; Lacerations/complications ; Lacerations/surgery ; Obstetric Labor Complications/etiology ; Obstetric Labor Complications/surgery ; Postpartum Hemorrhage/etiology ; Pregnancy ; Prospective Studies
    Language English
    Publishing date 2022-06-07
    Publishing country United States
    Document type Letter
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000004830
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  10. Article ; Online: Burden of Colovesical Fistula and Changing Treatment Pathways: A Systematic Literature Review.

    Froiio, Caterina / Bernardi, Daniele / Asti, Emanuele / Bonavina, Giulia / Conti, Andrea / Carmignani, Luca / Bonavina, Luigi

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2022  Volume 32, Issue 5, Page(s) 577–585

    Abstract: Purpose: Colovesical fistula (CVF) is a rare complication of sigmoid diverticulitis causing significant morbidity and quality of life impairment. Aim of this study was to analyze contemporary literature data to appraise the current standard of care and ... ...

    Abstract Purpose: Colovesical fistula (CVF) is a rare complication of sigmoid diverticulitis causing significant morbidity and quality of life impairment. Aim of this study was to analyze contemporary literature data to appraise the current standard of care and changes of treatment algorithms over time.
    Materials and methods: A systematic review of the literature on surgical management of CVF was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines.
    Results: Fourteen papers published between 2014 and 2020 and including 1061 patients were analyzed. One-stage colonic resection with primary anastomosis, with or without loop ileostomy, was the most common surgical procedure. A laparoscopic or robotic approach was attempted in 39.5% of patients, and conversion rate to open surgery was 7.8%. Clavien-Dindo grade ≥3 complication rate, 30-day mortality, and recurrence rate were 7.4%, 1.5%, and 0.5%, respectively.
    Conclusions: Minimally invasive sigmoidectomy with primary anastomosis is safe and should be the first-choice approach for CVF. Bladder repair is not necessary after a negative intraoperative leak test. A standardized perioperative care can improve clinical outcomes and reduce the length of hospital stay and the duration of Foley catheterization.
    MeSH term(s) Colon, Sigmoid/surgery ; Conversion to Open Surgery ; Diverticulitis, Colonic/surgery ; Humans ; Intestinal Fistula/complications ; Intestinal Fistula/surgery ; Laparoscopy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Quality of Life ; Treatment Outcome
    Language English
    Publishing date 2022-10-01
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/SLE.0000000000001099
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