COVID-19 is a challenge for education systems around the world. This study aimed to evaluate the perceived impact of the COVID-19 pandemic on nursing students, by assessing their emotions, the level of concern in contracting the virus and their perceived stress. We conducted an observational cross-sectional study. A total of 709 nursing students completed an anonymous questionnaire. The levels of anxiety and stress were assessed using the generalized anxiety disorder scale and the COVID-19 student stress questionnaire, respectively. In total, 56.8% of the sample often or always found it difficult to attend distance-learning activities. The main difficulty referred to was connection problems (75.7%). The mean generalized anxiety disorder score was 9.46 (SD = 5.4) and appeared almost homogeneous among students across the three years of study; most of the students showed mild (35%) to moderate (27%) levels of anxiety; 19% had severe anxiety. The overall COVID-19 stressor mean scores were 11.40 (SD = 6.50); the majority of the students (47.1%) showed scores indicative of moderate stress, 25% showed low stress levels, and 28% showed high-stress levels. Improvements and investments are needed to ensure high-quality distance learning, adequate connectivity, technical support for students, as well as strategies to promote mental health.

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available.

Epithelial ovarian cancer (EOC) comprises biologically and immunologically distinct histotypes and frequently develops within a chronically inflamed tumor microenvironment, particularly in advanced disease with malignant ascites. This narrative review revisits translational observations from the 1990s–2000s showing impaired lymphomonocyte proliferation, altered Fas/CD25 signaling, and abundant cytokine release in ovarian cancer effusions. These findings are interpreted as direct evidence of dysfunctional immune activation, but not as retrospective proof of T-cell exhaustion according to contemporary molecular, transcriptional, epigenetic, or functional definitions. Modern single-cell and spatial studies provide independent evidence that malignant ascites is a dynamic ecosystem containing heterogeneous T-cell and macrophage states and that immune architecture differs across anatomical compartments and histotypes. Within this framework, cytokine signaling, macrophage plasticity, iron/redox biology, ferroptosis susceptibility, adipocyte–tumor crosstalk, and systemic metabolic dysfunction are considered at different levels of evidentiary strength, with ovarian cancer-specific data distinguished from pan-cancer or preclinical extrapolation. Clinical experience with immune-checkpoint inhibitors further illustrates the distinction between immune-cell presence and effective immunity: single-agent activity has generally been modest, whereas the phase III ENGOT-ov65/KEYNOTE-B96 trial demonstrates that clinically meaningful benefit can emerge in an appropriate therapeutic and biomarker-selected context. We propose that “inflammation without effective immunity” is best viewed as an overarching, histotype- and context-dependent immunometabolic framework rather than a uniform ovarian cancer phenotype. The concept remains hypothesis-generating and requires prospective validation before biomarker or therapeutic implementation.

Introduction: The optimal surgical route for large or potentially malignant ovarian mature cystic teratomas (MCTs) remains debated. Case presentation: We retrospectively included 139 consecutive patients with pathologically confirmed MCT managed laparoscopically at a tertiary center (June 2013–August 2024). Mean cyst size was 9 cm (range 4–20); adnexal torsion occurred in 6%. All procedures were completed minimally invasively; cystectomy and adnexectomy were performed in 40% and 60%, respectively. Intraoperative spillage was 2.2%, with no intra- or postoperative complications. One illustrative case is described: the laparoscopic removal of a giant 8.5-kg MCT and its management. Discussion: With strict containment (controlled decompression, systematic endobagging, sealed extraction) and appropriate expertise, laparoscopy is feasible and oncologically prudent even for giant MCTs and in scenarios at risk of malignant degeneration. Conclusion: In a high-expertise setting using strict no-rupture retrieval protocols, laparoscopy was feasible for MCTs across a broad size range. These results apply to benign-appearing lesions in our single-center series; the accompanying giant cyst is presented as an illustrative case and is not included in pooled outcomes.

Background and Clinical Significance: Rare adnexal tumors with Wolffian or sex cord-like differentiation may undergo major diagnostic reclassification after integrated histologic and molecular review. The contribution of minimally invasive surgery to this process has rarely been described in detail. Case Presentation: We focused on the case of a 33-year-old woman underwent laparoscopic right salpingectomy in October 2021 for a right-sided tubo-adnexal lesion initially diagnosed as adult granulosa cell tumor and later reinterpreted as high-grade endometrioid carcinoma. Completion staging in February 2022 was negative. Positron emission tomography/computed tomography in January 2023 raised concern for recurrence, and exploratory laparoscopy in March 2023 documented peritoneal metastatic disease, followed by four cycles of cisplatin given within the then-prevailing carcinoma-based diagnostic framework. A second laparoscopic reassessment in October 2023 was negative. Because of multifocal abdominal relapse, the patient underwent major cytoreductive surgery in October 2024. Integrated pathologic and molecular review then documented serine/threonine kinase 11 alteration together with forkhead box L2 negativity, favoring classification within the STK11-altered adnexal tumor spectrum. After external review, everolimus plus anastrozole was started in May 2025. Imaging in late 2025 documented persistent pelvic recurrence, and salvage xipho-pubic laparotomy in December 2025 revealed extensive disease involving both ureters, the bladder base, the rectosigmoid wall, and parietal peritoneum; recurrent tissue showed cluster of differentiation 117 positivity. At the most recent available follow-up in April 2026, the patient had no documented death and remained under postoperative surveillance. Discussion and Conclusions: This case illustrates the diagnostic importance of repeated tissue reassessment and the practical value of minimally invasive surgery as a relatively low-burden means of resection, restaging, and tissue acquisition in a rare molecularly reclassified adnexal tumor.

Introduction: Malignant transformation of ovarian mature cystic teratoma is rare, usually presenting as squamous cell carcinoma (SCC). Rupture or spillage may complicate management, although a causal relationship with recurrence cannot be inferred from individual cases. Presentation of case: A 59-year-old woman developed disseminated relapse after excision of an ovarian dermoid cyst with SCC transformation, complicated by intraoperative rupture and pelvic spillage. She presented with an abdominal-wall mass and multifocal pelvic/peritoneal disease, consistent with at least FIGO stage IIIC-equivalent recurrence. She underwent diagnostic laparoscopy, then a complete open cytoreduction, including abdominal-wall resection/reconstruction, omentectomy, multivisceral bowel resections, type C2 radical hysterectomy, rectal resection, and pelvic/para-aortic lymphadenectomy. Histology confirmed a poorly differentiated SCC in a dermoid cyst, with negative margins and 87 negative lymph nodes. Adjuvant carboplatin-paclitaxel was administered without any CTCAE grade ≥1 toxicity. At 4 years, she remains disease-free. Discussion: Reports describe implantation/carcinomatosis after rupture/spillage. Complete cytoreduction, adherence to no-spillage principles, and early expert referral are essential. Conclusion: Strict no-spillage principles and early referral to high-expertise centers are essential when malignancy is suspected.