Giovanni Scambia

Policlinico Universitario Agostino Gemelli, Roma, Latium, Italy

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Publications (972)3598.75 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the learning curve associated with tele-assisted surgery. We performed a training box-based study, describing speed and accuracy in volunteers performing basic and complex laparoscopic tasks, to assess performance and in the skill acquisition of inexperienced users, using the Telelap Alf X system. Ten surgeons in gynaecology who had never received formal instruction on this new surgical device, completed four modules during a consecutive 3 day training programme. All the participants completed the training programme with a good learning curve. Use of the TELELAP Alf X advanced surgical robotic system is associated with a rapid learning curve among experienced surgeons. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 06/2015; DOI:10.1002/rcs.1672
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    ABSTRACT: To explore the effects of intraperitoneal (i.p.) infusion of catumaxomab, a bispecific monoclonal antibody (anti-EpCAM x anti-CD3), on T cells, NK cells and macrophages in ascites of cancer patients and to understand how ascitic immune cells can be activated despite the pervasive immunosuppressive ability of ascites microenvironment. Six patients with malignant ascites received i.p. catumaxomab infusion. Ascitic immune cells were profiled by flow cytometry and gene expression at baseline and after i.p. catumaxomab infusion. In vitro experiments enabled investigations on the adverse effect of ascites microenvironment on catumaxomab-stimulated immune cells. I.p. catumaxomab infusion enhanced the expression of the CD69 and CD38 activation molecules in CD4(+) and CD8(+) T cells, NK cells and macrophages, and favoured CD8(+)T cell accumulation into the peritoneal cavity. An analogous immune cell activation as well as IFN-γ and IL-2 production was induced by catumaxomab in vitro. In vitro experiments showed that the immunosuppressive milieu of ascites abrogated all the immunostimulatory activities of catumaxomab. Adding EpCAM(+) tumour cells to the culture permitted both catumaxomab Fab regions to engage cognate antigens and restored immunostimulatory catumaxomab activity. This is the first demonstration in a clinical setting that i.p. catumaxomab infusion activates NK cells and macrophages in addition to T cells in ascites and favours CD8(+)T cell accumulation into the peritoneal cavity. Moreover, our findings indicate that the concomitant binding of both catumaxomab Fab regions delivers an activation signal that is strong enough to activate immune cells despite the prevailing immunosuppressive environment of malignant ascites. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 06/2015; DOI:10.1016/j.ygyno.2015.06.003
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    ABSTRACT: The aim of this study was to compare the toxicity, perioperative outcomes of interval debulking surgery (IDS), and duration of progression-free survival (PFS) in women with unresectable high-grade serous advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NACT) with or without bevacizumab. Twenty-five patients with high-grade serous AOC treated with bevacizumab-based NACT (cases) were matched according to initial disease extension assessed by laparoscopy, and age, in a 1:2 ratio, with 50 high-grade serous AOC patients treated with standard NACT without bevacizumab (controls). Both groups received a median of four NACT cycles before IDS (p = 0.867), and the median time interval between NACT and IDS was 27 days in both groups (p = 0.547). Twenty-two cases (88.0 %) showed complete/partial radiologic response compared with 36 controls (72.3 %; p = 0.054). A higher percentage of cases showed complete serological response (48 vs. 35.1 %; p = 0.041). At IDS, complete cytoreduction was achieved in 20 cases (80.0 %) and 36 controls (72.3 %) [p = 0.260]. No differences were observed between groups in terms of surgical complexity score, perioperative outcomes, surgical complications, and chemotherapy-related adverse events. One death due to gastrointestinal perforation was observed among cases. Cases showed a longer median PFS compared with controls (18 months vs. 10 months; p = 0.001), and the administration of bevacizumab (hazard ratio 3.786; p = 0.001) retained a prognostic role for longer PFS at multivariate analysis. The incorporation of bevacizumab in NACT prolongs PFS without affecting the safety of IDS. The risk of gastrointestinal perforation should be considered prior to attempting bevacizumab-based NACT in women with diffuse bowel involvement at initial laparoscopic evaluation.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4651-8
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    ABSTRACT: From the whole plant of Euphorbia cyparissias, two new diterpenes based on jatrophane skeleton, named cyparissins A and B (1 and 2) were isolated. Their chemical structures were established through a combination of nuclear magnetic resonance spectroscopy and mass spectrometric methods. The new compounds cyparissins A and B were tested to evaluate their ability to inhibit P-glycoprotein-mediated multidrug resistance and their cytotoxic activity against A2780 human ovarian cancer cells, both WT and ADR. Compounds 1 and 2 showed moderate inhibitory effects on P-glycoprotein while showing a significant concentration-depending cytotoxic activity for both cancer cell lines. These isolated compounds are based on a new chemical structure that expands the knowledge base for this class of bioactive metabolites. Copyright © 2015. Published by Elsevier B.V.
    Fitoterapia 05/2015; 104. DOI:10.1016/j.fitote.2015.05.012
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    ABSTRACT: This prospective single-institutional clinical trial sought to assess the safety and feasibility of laparoscopic benign ovarian cyst enucleation with a novel robot-assisted laparoscopic system. In this study, we report a series of 10 cases treated using Telelap ALF-X in the first clinical application on patients at the Division of Gynaecologic Oncology, Catholic University of the Sacred Heart of Rome. The primary inclusion criterion was the presence of monolateral ovarian cyst without a preoperative assessment suspicious for malignancy. Intra-operative data such as docking time, operative time, estimated blood loss, intra and peri-operative complications, and conversion to either standard laparoscopy or laparotomy were collected. The cysts were removed using the ovary sparing technique with respect to conservative surgical principles. The median operative time was 46,3 min, and patients without post-operative complications were discharged either 1 or 2 days after the procedure. Telelap Alf-X laparoscopic enucleation of benign ovarian cysts with ovary sparing techniques is feasible, safe and effective. However, more clinical data are needed to assess whether this approach would offer any other benefits compared to other minimally invasive surgical techniques. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 05/2015; DOI:10.1016/j.jmig.2015.05.007
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    ABSTRACT: Phase II study on total TELELAP ALF-X hysterectomy. safety, feasibility and perioperative outcomes analysis. Phase II study. Canadian Task Force II-2. Catholic University of the Sacred Heart, Rome, Italy. From October 2013 to May 2014, 80 women underwent total TELELAP ALF X hysterectomy. The study population was divided in two groups according to surgical procedures: total hysterectomy ± bilateral salpingo-oophorectomy (Group 1), and endometrial cancer patients staged also with pelvic lymphadenectomy (Group 2). Total TELELAP ALF-X hysterectomy ± bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy. Median age was 51 years (range 48-79), and median BMI was 24 kg/m2 (range 17.3 - 34.2). Forty-five patients (56.2%) had previous surgery. Median operative time was 140 minutes (range 58-320) in the Group 1 and 197 minutes (range 129-290) in the Group 2 (p < .001). Median docking time was 8 minutes (range 3-25). During the study period, a significant trend in the operative time reduction was observed. Procedures were successfully performed without conversion in 93.7% of cases. We observed 2 (2.5%) intraoperative complications, 3 (3.7%) conversions to standard laparoscopy and 2 (2.5%) to laparotomy. Median time to discharge was 2 days (range 1-5). One patient (1.2%) was readmitted the early post-operative period. As new technology evolves, critical appraisal of patient-related outcomes, utilization, cost, and access to minimally invasive hysterectomy must remain a priority. Despite the relative small number of our series, we showed the feasibility and safety of total TELELAP ALF-X hysterectomy for benig and malignant disease. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 05/2015; DOI:10.1016/j.jmig.2015.05.004
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    ABSTRACT: In post-menopausal period vulvo-vaginal atrophy (VVA)-related symptoms may seriously affect women's quality of life. Hormonal replacement therapy effectively relieves these symptoms but it is not always safe or accepted, and a non-hormonal treatment is often needed instead. Over a period of 12 weeks, we tested the effect of a twice-a-week vulvo-vaginal application of a hyaluronic acid, AC collagen, isoflavones and vitamins-based cream (Perilei Pausa®) on 35 women in post-menopausal period, reporting VVA-related symptoms. After 12 weeks of treatment with Perilei Pausa® a significant improvement in vaginal dryness, vulvo-vaginal itching, dyspareunia (P < 0.001), dysuria (P = 0.02), nocturia (P = 0.009) and pollakiuria (P = 0.005) was reported by the women. Colposcopical score assessing the intensity of atrophic colpitis, cervico-vaginal paleness and petechiae was also reduced (P = 0.037, P = 0.016 and P = 0.032, respectively). No significant difference in terms of maturation value of cervico-vaginal epithelium was observed. In conclusion, Perilei Pausa® may represent an effective and safe alternative treatment of symptomatic VVA in post-menopausal women.
    Journal of Obstetrics and Gynaecology 05/2015; DOI:10.3109/01443615.2015.1014326
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    ABSTRACT: Alternatives to the use of fetal bovine serum (FBS) have been investigated to ensure xeno-free growth condition. In this study we evaluated the efficacy of human platelet lysate (PL) as a substitute of FBS for the in vitro culture of some human cell lines. PL was obtained by pools of pathogen inactivated human donor platelet (PLT) concentrates. Human leukemia cell lines (KG-1, K562, JURKAT, HL-60) and epithelial tumor cell lines (HeLa and MCF-7) were cultured with either FBS or PL. Changes in cell proliferation, viability, morphology, surface markers and cell cycle were evaluated for each cell line. Functional characteristics were analysed by drug sensitivity test and cytotoxicity assay. Our results demonstrated that PL can support growth and expansion of all cell lines, although the cells cultured in presence of PL experienced a less massive proliferation compared to those grown with FBS. We found a comparable percentage of viable specific marker-expressing cells in both conditions, confirming lineage fidelity in all cultures. Functionality assays showed that cells in both FBS- and PL-supported cultures maintained their normal responsiveness to adriamycin and NK cell-mediated lysis. Our findings indicate that PL is a feasible serum substitute for supporting growth and propagation of haematopoietic and epithelial cell lines with many advantages from a perspective of process standardization, ethicality and product safety.
    Cytotechnology 05/2015; DOI:10.1007/s10616-015-9878-5
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    ABSTRACT: Recurrence of disease represents a clinical challenge in cervical cancer patients, especially when all available treatment modalities have been used in the primary setting. The aim of this study was to analyse the patterns of recurrence and their association with clinical outcome in locally advanced cervical cancer (LACC) patients submitted to primary chemoradiation (CTRT) followed by radical surgery (RS). This study was conducted on 364 LACC patients treated with CTRT plus RS since January 1996 to July 2012. For each relapse, information on date of clinical/pathological recurrence, and pattern of disease presentation were retrieved. Post-relapse survival (PRS) was recorded from the date of recurrence to the date of death for disease or last seen. Survival probabilities were compared by the log rank test. Cox's regression model with stepwise variable selection was used for multivariate prognostic analysis for PRS. Within a median follow-up of 42 months, 75 recurrences (20.6%) and 54 disease-associated deaths (14.8%) were recorded. By analysing the pattern of relapse, most of the recurrences were outside the irradiated field (n=43, 57.3%) and the most frequently observed site was visceral (n=16, 21.3%). Among the parameters of the recurrence associated with PRS including the pattern of recurrence, the size of recurrence, SCC-Ag serum levels at recurrence, and secondary radical surgery, only the last one retained an independent predictive role in reducing the risk of death (p=0.037). The feasibility of secondary radical resection positively impacts on PRS of LACC patients submitted to multimodality primary treatments. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 05/2015; DOI:10.1016/j.ygyno.2015.04.035
  • Gynecologic Oncology 05/2015; 138:1-2. DOI:10.1016/j.ygyno.2015.04.017
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    ABSTRACT: To compare prognosis of advanced epithelial ovarian cancer (AEOC) patients based on where the first surgical assessment was performed. Retrospective analysis of primary AEOC patients was performed and three groups were formed based on where the decision of primary treatment was taken: Internal, if the decision was carried out at our Institution (PDS (Primary Debulking Surgery), I-IDS (Internal-Interval Debulking Surgery)) and Referred in case women were referred after neoadjuvant chemotherapy (NACT) from other Centers (R-IDS (Referred-Interval Debulking Surgery)). Among 573 AEOC, 279 (48.7%) were PDS and 294 (51.3%) IDS. In particular, 134 of 294 (45.6%) were R-IDS and 160 (54.4%) were I-IDS. Median progression-free survival (PFS) was 26 months in PDS, 14 months in I-IDS and 17 months in R-IDS. The difference was statistically significant (p<0.05) among all groups. IDS can represent a suitable approach only when the first complete debulking is not achievable in a tertiary referral hospital. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    Anticancer research 05/2015; 35(5):3027-32.
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    ABSTRACT: The purpose of this multicenter, open label, randomized phase III study was to determine whether ixabepilone resulted in improved overall survival (OS) compared with commonly used single-agent chemotherapy (doxorubicin or paclitaxel) in women with locally advanced, recurrent, or metastatic endometrial cancer with at least one failed prior platinum-based chemotherapeutic regimen. Patients were randomized 1:1 to ixabepilone (40 mg/m(2)), or either paclitaxel (175 mg/m(2)) or doxorubicin (60 mg/m(2)), every 21 days. Patients that had previously received an anthracycline were randomized to ixabepilone or paclitaxel; all other patients were randomized to ixabepilone or doxorubicin. An interim analysis of futility for OS was planned. At the time of database lock, 496 patients were randomized to receive ixabepilone (n = 248) or control (n = 248); nine patients in the control arm were not treated. The interim analysis of futility for OS (219 events) favored the control chemotherapy arm (hazard ratio = 1.3 [95% confidence interval: 1.0-1.7], stratified log rank test P = 0.0397), indicating that the study would not meet its primary objective. The study was discontinued based on the interim OS results. The frequency of adverse events was comparable between the treatment arms. The study did not meet its primary objective of improving OS in the ixabepilone arm compared to the control chemotherapy arm. A favorable risk/benefit ratio was not observed for ixabepilone versus control at the time of the interim analysis. The safety results were consistent with the known safety profiles of ixabepilone and control. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 04/2015; 138(1). DOI:10.1016/j.ygyno.2015.04.026
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    ABSTRACT: We previously showed an unfavorable prognostic role of the cytoplasmic estrogen receptor β2 (cERβ2) in serous ovarian cancer. Here we aimed to investigate molecular determinants in cell survival function of cERβ2 in this malignant disease. We used immunohistochemistry to evaluate differences in apoptosis (quantified by the expression of cleaved caspase-3) and cell proliferation (quantified by the expression of Ki-67) in 56 advanced serous ovarian cancer cases, stratified according to the absence or presence of estrogen receptor β2 (ERβ2) protein in the cytoplasmic compartment (31 cERβ2- and 25 cERβ2+ cases, respectively). Thereafter, by immunofluorescence, we visualized the subcellular distribution of ERβ2, and by the proximity ligation assays, we characterized in situ its ability to interact with other proteins specifically involved in the apoptosis cascade. Finally, we assessed cytochrome c expression by immunohistochemistry. We demonstrated that, although not affecting tumor proliferation, cytoplasmic ERβ2 expression was indeed associated to a lower apoptotic rate in ovarian cancer cases. Then, we proved that cERβ2 is targeted to mitochondria where it interacts as a binding partner with BAD (B-cell lymphoma [Bcl] 2-associated death promoter). This interaction, precluding the Bcl-xL (B-cell lymphoma extra large)/BAD heterodimer formation, inhibited Bax (Bcl-2-like protein 4) oligomerization, the release of cytochrome c, and ultimately apoptosis. In conclusion, we provide in vivo mechanistic evidence for an antiapoptotic function of mitochondrial ERβ2, a finding supporting the value of its cytoplasmic expression as an unfavorable prognostic biomarker for serous ovarian cancer. Copyright © 2015. Published by Elsevier Inc.
    Human pathology 04/2015; DOI:10.1016/j.humpath.2015.03.016
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    ABSTRACT: Inhibition of angiogenesis is a valuable treatment strategy for ovarian cancer. Pazopanib is an anti-angiogenic drug active in ovarian cancer. We assessed the effect of adding pazopanib to paclitaxel for patients with platinum-resistant or platinum-refractory advanced ovarian cancer. We did this open-label, randomised phase 2 trial at 11 hospitals in Italy. We included patients with platinum-resistant or platinum-refractory ovarian cancer previously treated with a maximum of two lines of chemotherapy, Eastern Cooperative Oncology Group performance status 0-1, and no residual peripheral neurotoxicity. Patients were randomly assigned (1:1) to receive weekly paclitaxel 80 mg/m(2) with or without pazopanib 800 mg daily, and stratified by centre, number of previous lines of chemotherapy, and platinum-free interval status. The primary endpoint was progression-free survival, assessed in the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01644825. This report is the final analysis; the trial is completed. Between Dec 15, 2010, and Feb 8, 2013, we enrolled 74 patients: 37 were randomly assigned to receive paclitaxel and pazopanib and 37 were randomly assigned to receive paclitaxel only. One patient, in the paclitaxel only group, withdrew from the study and was excluded from analyses. Median follow-up was 16·1 months (IQR 12·5-20·8). Progression-free survival was significantly longer in the pazopanib plus paclitaxel group than in the paclitaxel only group (median 6·35 months [95% CI 5·36-11·02] vs 3·49 months [2·01-5·66]; hazard ratio 0·42 [95% CI 0·25-0·69]; p=0·0002). We recorded no unexpected toxic effects or deaths from toxic effects. Adverse events were more common in the pazopanib and paclitaxel group than in the paclitaxel only group. The most common grade 3-4 adverse events were neutropenia (11 [30%] in the pazopanib group vs one [3%] in the paclitaxel group), fatigue (four [11%] vs two [6%]), leucopenia (four [11%] vs one [3%]), hypertension (three [8%] vs none [0%]), raised aspartate aminotransferase or alanine aminotransferase (three [8%] vs none), and anaemia (two [5%] vs five [14%]). One patient in the pazopanib group had ileal perforation. Our findings suggest that a phase 3 study of the combination of weekly paclitaxel plus pazopanib for patients with platinum-resistant or platinum-refractory advanced ovarian cancer is warranted. National Cancer Institute of Napoli and GlaxoSmithKline. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet Oncology 04/2015; 16(5). DOI:10.1016/S1470-2045(15)70115-4
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    ABSTRACT: Due to continuous rise of cesarean section (CS) rate in recent decades to analyze this trend using Robson Ten Group Classification System (RTGCS) and identify the main contributor of the CS rate in an Italian tertiary level hospital. A total of 17,886 deliveries in six (1998, 1999, 2004, 2005, 2010, 2011) of a 13-year period was analyzed using RTGCS. From 1998 to 2011 a rising CS birth rate from 38.7 to 43.7 per 100 births was calculated (p<0.001) in association with a significant reduction of vaginal delivery (VD) (59.7 vs. 53.7%; p<0.001). In multiparous women with a previous CS (Group 5) a repeat CS was performed routinely, resultant the most contributor of CS rate (15.4 vs. 16.2%; p<0.001). Nulliparous women with singleton cephalic full-term pregnancy in spontaneous or induced labor onset resulted the second contributor (Group 1, 3.3 vs. 4.7%; p<0.001; Group 2, 3.6 vs. 4.5%; p<0.001). The RTGCS allows easy identification of the leading contributing patients groups. To propose and evaluate interventions for improving the labor management in nulliparous women and promote vaginal delivery after cesarean (VBAC) could help to mitigate further increases in the future. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of obstetrics, gynecology, and reproductive biology 04/2015; 189. DOI:10.1016/j.ejogrb.2015.03.030
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    ABSTRACT: To evaluate the safety and feasibility of the new robotic TELELAP ALF-X platform in a heterogeneous series of gynecological procedures. Between September 2013 and May 2014, 146 patients were enrolled in this Phase II study trial. Patients with presumed benign or borderline adnexal disease, and benign and early stage malignant uterine disease were prospectively included. Median age was 52 years (range 19-79 years), and median BMI was 23.7 (range 17.3-34.0 kg/m(2)). Sixty-two patients (32.5 %) underwent mono/bilateral salpingo-oophorectomy or cyst removal (Group A), four patients (2.7 %) myomectomy (Group B), 46 patients (31.5 %) total hysterectomy (Group C), and 34 (23.3 %) endometrial cancer staging (Group D). Median docking time was 7 min (range 3-36). Median OT was 35 min (range 17-145) in the Group A, 40 min (range 10-50) in the Group B, 133 min (range 58-320) in the Group C, and 160 min (range 69-290) in the Group D. Reduction in OT over the study period for hysterectomy (p < 0.001) and adnexal surgery (p < 0.002) was observed. We registered two laparoscopic conversion (3.2 %) in the Group A and two (4.3 %) in the Group C. In the Group D, we showed one (2.9 %) laparoscopic and two (5.8 %) laparotomic conversions. One patient (2.17 %) in the Group C was readmitted in the early postoperative period for severe vaginal bleeding. We report the first series of a novel robotic approach for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, TELELAP ALF-X is feasible and safe. Further studies are mandatory to define the benefits, advantages, and costs of this new robotic approach with respect to others minimally invasive approaches.
    Surgical Endoscopy 04/2015; DOI:10.1007/s00464-015-4187-9
  • Gynecologic Oncology 04/2015; 137:133-134. DOI:10.1016/j.ygyno.2015.01.332
  • Gynecologic Oncology 04/2015; 137:134. DOI:10.1016/j.ygyno.2015.01.333
  • Gynecologic Oncology 04/2015; 137:167-168. DOI:10.1016/j.ygyno.2015.01.420
  • Gynecologic Oncology 04/2015; 137:147-148. DOI:10.1016/j.ygyno.2015.01.369

Publication Stats

17k Citations
3,598.75 Total Impact Points

Institutions

  • 1996–2015
    • Policlinico Universitario Agostino Gemelli
      Roma, Latium, Italy
  • 1984–2015
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 1981–2015
    • Catholic University of the Sacred Heart
      • • School of Obstetrics and Gynecology
      • • School of Oncology
      • • Institute of Clinical Obstetrics and Gynecology
      • • Institute of Histology and General Ebryology
      • • Institute of Clinical Otorhinolaryngology
      • • Institute of Pathological Anatomy
      • • Laboratory for Molecular Oncology
      Milano, Lombardy, Italy
  • 2014
    • Clinica Mediterranea
      Napoli, Campania, Italy
  • 2013
    • Danbury Hospital
      Danbury, Connecticut, United States
  • 2009–2013
    • Columbus-Gemelli University Hospital
      Roma, Latium, Italy
    • Ospedale Sacro Cuore di Gesù
      Benevento, Campania, Italy
    • Università degli studi di Cassino e del Lazio Meridionale
      • Department of Sports Science and Health
      Cassino, Latium, Italy
  • 2008–2010
    • Università degli Studi di Torino
      Torino, Piedmont, Italy
  • 2002–2010
    • Sapienza University of Rome
      • • Department of Gynecology-Obstetrics & Urology
      • • Department of Experimental Medicine
      Roma, Latium, Italy
    • University of California, Santa Barbara
      • Department of Molecular, Cellular, and Developmental Biology
      Santa Barbara, CA, United States
  • 2007
    • Università degli Studi di Palermo
      Palermo, Sicily, Italy
    • The American University of Rome
      Roma, Latium, Italy
  • 2006
    • Gynecologic Oncology Group
      Buffalo, New York, United States
  • 2003–2006
    • Sacred Heart University
      Феърфилд, Connecticut, United States
    • Jefferson College
      Хиллсборо, Missouri, United States
  • 2005
    • Temple University
      • Department of Biology
      Philadelphia, PA, United States
  • 2004–2005
    • University of Naples Federico II
      Napoli, Campania, Italy
    • Università degli Studi di Siena
      Siena, Tuscany, Italy
  • 1994–2003
    • Università di Pisa
      Pisa, Tuscany, Italy
  • 2001
    • Università degli Studi dell'Insubria
      Varese, Lombardy, Italy
    • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
      Meldola, Emilia-Romagna, Italy
    • Jackson Memorial Hospital
      Miami, Florida, United States
    • Johns Hopkins Medicine
      • Department of Gynecology & Obstetrics
      Baltimore, Maryland, United States
    • Azienda Ospedaliera San Camillo Forlanini
      Roma, Latium, Italy
  • 1994–2001
    • Istituto Superiore di Sanità
      Roma, Latium, Italy
  • 1990
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
  • 1988
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      Chieta, Abruzzo, Italy
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1985–1988
    • University of Ferrara
      • Department of Audiology
      Ferrare, Emilia-Romagna, Italy
  • 1986–1987
    • Università degli studi di Cagliari
      Cagliari, Sardinia, Italy