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In the lower atmosphere, CO2 emissions impact human health and ecosystems, making data at this level essential for addressing carbon-cycle and public-health questions. The atmospheric concentration of CO2 is crucial in urban areas due to its connection with air quality, pollution, and climate change, becoming a pivotal parameter for environmental management and public safety. In volcanic zones, geogenic CO2 profoundly affects the environment, although hydrocarbon combustion is the primary driver of increased atmospheric CO2 and global warming. Distinguishing geogenic from anthropogenic emissions is challenging, especially through air CO2 concentration measurements alone. This study presents survey results on the stable isotope composition of carbon and oxygen in CO2 and airborne CO2 concentration in Naples' urban area, including the Campi Flegrei caldera, a widespread hydrothermal/volcanic zone in the metropolitan area. Over the past 50 years, two major volcanic unrests (1969-72 and 1982-84) were monitored using seismic, deformation, and geochemical data. Since 2005, this area has experienced ongoing unrest, involving the pressurization of the underlying hydrothermal system as a causal factor of the current uplift in the Pozzuoli area and the increased CO2 emissions in the atmosphere. To better understand CO2 emission dynamics and to quantify its volcanic origin a mobile laboratory was used. Results show that CO2 levels in Naples' urban area exceed background atmospheric levels, indicating an anthropogenic origin from fossil fuel combustion. Conversely, in Pozzuoli's urban area, the stable isotope composition reveals a volcanic origin of the airborne CO2. This study emphasizes the importance of monitoring stable isotopes of atmospheric CO2, especially in volcanic areas, contributing valuable insights for environmental and public health management.

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Gas leakage from deep geologic storage formations to the Earth's surface is one of the main hazards in geological carbon sequestration and storage. Permeable sediment covers together with natural pathways, such as faults and/or fracture systems, are the main factors controlling surface leakages. Therefore, the characterization of natural systems, where large amounts of natural gases are released, can be helpful for understanding the effects of potential gas leaks from carbon dioxide storage systems. In this framework, we propose a combined use of high-resolution geoelectrical investigations (i.e. resistivity tomography and self-potential surveys) for reconstructing shallow buried fracture networks in the caprock and detecting preferential gas migration pathways before it enters the atmosphere. Such methodologies appear to be among the most suitable for the research purposes because of the strong dependence of the electrical properties of water-bearing permeable rock, or unconsolidated materials, on many factors relevant to CO2 storage (i.e. porosity, fracturing, water saturation, etc.). The effectiveness of the suggested geoelectrical approach is tested in an area of natural gas degassing (mainly CH4) located in the active fault zone of the Bolle della Malvizza (Southern Apennines, Italy), which could represent a natural analogue of gas storage sites due to the significant thicknesses (hundreds of meters) of impermeable rock (caprock) that is generally required to prevent carbon dioxide stored at depth from rising to the surface. The obtained 3D geophysical model, validated by the good correlation with geochemical data acquired in the study area and the available geological information, provided a structural and physical characterization of the investigated subsurface volume. Moreover, the time variations of the observed geophysical parameters allowed the identification of possible migration pathways of fluids to the surface.

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OBJECTIVE: To analyze the cost and time requirement per achieved pregnancy in optimized modified natural cycle in vitro fertilization (mNC-IVF) based on a treatment protocol with very few consultations and to compare those with conventional gonadotropin-stimulated aVF (clVF) cycles. STUDY DESIGN: Mono centric prospective trial. Eighty infertile patients each received 1 modified mNC-IVF cycle using low doses of the clomiphene citrate. Based on the number of consultations and the clinical pregnancy rate per cycle, the total costs and required time to achieve a pregnancy were analyzed and compared with cIVF. Calculations for cIVF were based on standard therapy protocols and outcomes of European registries. RESULTS: Patients (21-42 years old, 35.4 +/- 4.7 years) undergoing mNC-IVF required on average 1.2 consultations before follicle aspiration. Pregnancy rate per transfer and per initiated cycle were 25% and 13.6%, respectively. Multiple pregnancies did not occur. According to the calculations, total costs per pregnancy rate were around 15% lower with mNC-IVF as compared to cIVF. In contrast, time to achieve an equal pregnancy rate was calculated to take around 30% longer with mNC-IVF as compared to cIVF. CONCLUSION: mNC-IVF using very low dosages of clomiphene citrate avoids multiple pregnancies and is less expensive but more time consuming per achieved pregnancy when compared to clVF.

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Follicle flushing has been proved to be ineffective in polyfollicular in vitro fertilization. To analyze the effect of flushing in monofollicular in vitro fertilization we aspirated and then flushed the follicles in 164 cycles. Total oocyte yield/aspiration was 44.5% in the aspirate, 20.7% in the 1(st) flush, 10.4% in the 2(nd) flush and 4.3% in the 3(rd) flush. By flushing, the total oocyte yield increased (p < 0.01) by 80.9%, from 44.5 to 80.5%. The total transfer rate increased (p < 0.01) by 91.0%, from 20.1 to 38.4%. The results indicate that the oocyte yield and the number of transferable embryos can be increased significantly by flushing.

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OBJECTIVE: To analyze the vascularization of the endometrium via hysteroscopy and to assess its correlation with angiogenic factor gene expression and embryo implantation rate. DESIGN: Cross-sectional study. SETTING: Public university hospital. PATIENT(S): Patients undergoing hysteroscopy for supposed infertility. INTERVENTION(S): Endometrial quality assessment according to Sakumoto-Masamoto, performed in the early secretory phase of the cycle. Collection of an endometrial tissue biopsy. MAIN OUTCOME MEASURE(S): RNA extraction, reverse transcription, and determination of gene expression of angiogenesis- and implantation-relevant factors using quantitative polymerase chain reaction. Retrieval of pregnancy information from the medical records. RESULT(S): Good quantity/quality RNA with infertility history was obtained from 63 participating women. Those with a "good" endometrium and subsequent pregnancy showed increased gene expression for placenta growth factor when compared with patients with a "bad" endometrium and who did not succeed with pregnancy to date. Nonpregnant women with a "good" endometrium presented an intermediate result. No significant differences were observed for several other genes tested, but trends in the same direction were observed. CONCLUSION(S): This study demonstrates for the first time that endometrial PLGF expression corresponds to the hysteroscopic appearance of the endometrium, and therefore has potential as a clinically relevant prognosticator for infertility treatment success.

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OBJECTIVE: To evaluate the prevalence of prolapse and related bladder, bowel, and sexual problems in transsexual patients (TS) after sex reassignment surgery. DESIGN: A cross-sectional study. SETTING: A tertiary referral center. PATIENT(S): 55 transsexuals, comprising 52 male-to-female and 3 female-to-male patients. INTERVENTION(S): Gynecologic examination with pelvic floor testing, measurements for pelvic organ prolapse applying International Continence Society pelvic organ prolapse (ICS-POP) staging, and the Sheffield prolapse questionnaire to assess prolapse symptoms, and bladder, bowel, and sexual function. MAIN OUTCOME MEASURE(S): ICS-POP score and Sheffield prolapse questionnaire. RESULT(S): Of the 55 transsexuals who participated in this study (52 male-to-female and 3 female to male), 7.5% showed a prolapse greater than or similar to ICS-POP stage 2, and 3.8% required surgical intervention. For bladder symptoms, 47% reported voiding difficulties, 24.6% urgency, 17% urge incontinence, and 23% stress incontinence. Fecal urgency and incomplete emptying of the bowel occurred in 9.4% and 7.6% of patients, respectively. In addition, 23% reported that they were never satisfied with their sexual function. CONCLUSION(S): Pelvic floor symptoms may occur in transsexuals involving the bladder, bowel, and sexual function. Surgical corrective options should be determined on an individual basis as with other patients who have prolapse symptoms.

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Increasing evidence supports GnRH agonists to be an effective treatment to preserve ovarian function during chemotherapy, but the initial flare-up of FSH during the first week after GnRH agonist application still limits its use. The combination of GnRH agonists with GnRH antagonists might solve this problem to some extent as the addition of GnRH antagonists at least significantly reduces the FSH flare-up.

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A prospective, randomized, placebo-controlled study was conducted in a baboon model to determine if a thiazolidinedione agonist of peroxisome proliferator-activated receptor-gamma, pioglitazone, can impede the development of endometriosis. Endometriosis was induced using laparoscopic, intrapelvic injection of eutopic menstrual endometrium, previously incubated with placebo or pioglitazone for 30 min, in 12 female baboons with a normal pelvis that had undergone at least one menstrual cycle since the time of captivity. At this point, the 12 baboons were randomized into two groups and treated from the day of induction. They received either PBS tablets (n = 6, placebo control, placebo tablets once a day by mouth) or pioglitazone (n = 6, test drug, 7.5 mg by mouth each day). A second and final laparoscopy was performed in the baboons to record the extent of endometriotic lesions between 24 and 42 d after induction (no difference in length of treatment between the two groups, P = 0.38). A videolaparoscopy was performed to document the number and surface area of endometriotic lesions. The surface area and volume of endometriotic lesions were significantly lower in pioglitazone treated baboons than the placebo group (surface area, 48.6 vs. 159.0 mm(2), respectively, P = 0.049; vol, 23.7 vs. 131.8 mm(3), respectively, P = 0.041). The surface area (3.5 vs. 17.8 mm(2), P = 0.017, pioglizatone vs. placebo) and overall number (1.5 vs. 9.5, P = 0.007, pioglizatone vs. placebo) of red lesions were lower in the pioglitazone group. A peroxisome proliferator-activated receptor-gamma ligand, pioglitazone, effectively reduced the initiation of endometriotic disease in the baboon endometriosis model. Using this animal model, we have shown that thiazolidinedione is a promising drug for preventive treatment of endometriosis.

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BACKGROUND: This study aimed to compare the safety and efficacy of laparoscopy and laparotomy in the surgical treatment of early endometrial cancer, especially in obese women. METHODS: The results obtained after laparoscopic surgical treatment of early endometrial cancer (International Federation of Gynecology and Obstetrics (FIGO) stage 1 or 2) in patients between 1996 and 2007 were compared with an age- and tumour-matched historical group of patients treated with laparotomy between 1988 and 1996. All the patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic + or - paraaortic lymphadenectomy. RESULTS: Both groups included 120 patients with a preoperative diagnosis of early endometrial cancer. The postoperative diagnosis was endometrial cancer stage 1 or 2 for 89% of the cases in both groups. The mean operating time was 170 min for the laparotomy group compared with 178 min for the laparoscopy group (nonsignificant difference). The estimated intraoperative blood loss was significantly greater in the laparotomy group, and the hospital stay was significantly shorter in the laparoscopy group. CONCLUSIONS: The results show that early endometrial cancer can be treated effectively by laparoscopy. Because of this study's retrospective design, the results should be interpreted with caution. However, the advantages of this method for obese patients are evident. The age and weight of these patients should not be used as a contraindication for laparoscopy.

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OBJECTIVE: To prove safety and feasibility of an intra-abdominal endoscopic evaluation via an iatrogenic uterine perforation that occurred during operative hysteroscopy. DESIGN: Clinical case report. SETTING: University Hospital. PATIENT(S): A multimorbid woman with postmenopausal bleeding with iatrogenic uterine perforation during hysteroscopic resection of an endometrial polyp. INTERVENTION(S): Intra-abdominal endoscopic evaluation via the iatrogenic uterine perforation site with use of a standard diagnostic hysteroscope. MAIN OUTCOME MEASURE(S): Visibility, technical feasibility, clinical course, and hematologic follow-up of the patient. RESULT(S): A sufficient assessment of the intra-abdominal cavity and the uterine defect was possible with use of a small-diameter diagnostic hysteroscope during the workup of an iatrogenic uterine perforation. No additional intervention-related side effects occurred. CONCLUSION(S): This technique was safe and feasible to gain operative access to the abdominal cavity, allowing a complete diagnostic intra-abdominal inspection for lesions of the adjacent organs. IOTES bears the potential to become a time-saving low-risk alternative to diagnostic standard laparoscopy.

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QUESTIONS UNDER STUDY: Traumatic brain injury (TBI) remains an important cause of mortality and morbidity in children. Medical management is constantly being refined, and thus results should improve. The aim of the present study was to analyse our data of recent years and to compare them with previous series (1978-83 and 1988-92). PATIENTS AND METHODS: The data of 51 children (1 month to 16 years old) with severe blunt TBI treated in our unit from 1994 to 1998 were analyzed retrospectively. Severe TBI was defined by immediate loss of consciousness and an admission Glasgow coma scale (GCS) <8. Outcome was classified by using the Glasgow outcome scale (GOS) 6 to 12 months after injury. RESULTS: 35 patients (69%) showed a good outcome (GOS 4 and 5), 14 died (GOS 1), one survived in a permanent vegetative state (GOS 2), and another was severely disabled (GOS 3) (GOS 1-3 = bad outcome, 31%). Bad outcome was associated with low GCS (i.e. 3 and 4), fixed and dilated pupils at admission, invisible basal cisterns on first computerized tomography, and presence of coagulopathy. Moderate to severe intracranial hypertension was also significantly related to bad outcome in the 26 patients with intracranial pressure monitoring. Compared to our first series severity of TBI was unchanged, and the incidence of multiple injury and consumption coagulopathy was less frequent. Intubation rate prior to admission to the centre increased from 35% to 94%. Intensive care measures (duration of mechanical ventilation, use of hypothermia, mannitol, thiopentone etc.) were less aggressive. The rate of good outcome remained unchanged (69% vs. 60%). CONCLUSIONS: Despite changing management policies, results were comparable with those of our former series. This fact underlines the importance of primary injury and the secondary role of intensive care management on final outcome.

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