Showing papers in "Archives of Gynecology and Obstetrics in 2016"

An Overview of Triple-Negative Breast Cancer

Abstract: Purpose Triple-negative breast cancer (TNBC) is a heterogeneous group of tumors comprising various breast cancers simply defined by the absence of estrogen receptor, progesterone receptor and overexpression of human epidermal growth factor receptor 2 gene In this review, we discuss the epidemiology, risk factors, clinical characteristics and prognostic variables of TNBC, and present the summary of recommended treatment strategies and all other available treatment options

The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications.

Abstract: Molecular pathological research has contributed to improving the knowledge of different subtypes of ovarian cancer. In parallel with the implementation of the new FIGO staging classification, the WHO classification was revised. The latter is mainly based on the histopathological findings and defines the actual type of tumor. It has, therefore, also an important impact on prognosis and therapy of the patient. The new WHO Classification of Ovarian Cancer published 2014 by Robert Kurman and co-authors is summarized. The major changes compared to the hitherto existing classification are presented. The new classification eliminates the previous focus of mesothelial origin of ovarian cancer. Instead, it features a discussion of tubal carcinogenesis of hereditary and some other high-grade serous carcinomas. The previously assumed pathogenesis pathway may be correct for some, but not for all, serous cancers. The new classification was established to classify ovarian cancer in a more consistent way. The earlier transitional cell type of ovarian cancer has been removed while seromucinous tumors have been added as a new entity. The role of some borderline tumors as one possible step in the progression from benign to invasive lesions is incorporated. The article summarizes the essential updates concerning serous, mucinous, seromucinous, endometrioid, clear-cell, and Brenner tumors. The new WHO classification takes into account the recent findings on the origin, pathogenesis, and prognosis of different ovarian cancer subtypes. The tubal origin of hereditary and some non-hereditary high-grade serous cancers is mentioned in contrast to the hitherto theory of mesothelial origin of tumors. Seromucinous tumors represent a new entity.

Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives.

Abstract: Purpose Endometriosis is defined as the presence of endometrial-like endometrial cells, glands and stroma outside the uterus, causing a strong inflammatory-like microenvironment in the affected tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease. Considering the pivotal role of interaction between immune and endometriotic cells, in this paper, we aim to shed light about the role of apoptosis pathways in modulating the fine-regulated peritoneal microenvironment during endometriosis.

Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors.

Abstract: The aim of this study was to evaluate the efficacy of fractional CO2 laser therapy in breast cancer survivors as a therapeutic method for vulvovaginal atrophy (VVA) dyspareunia 50 patients (mean age 533 years) underwent fractional microablative CO2 laser treatment for dyspareunia in oncological menopause (mean time of menopause 66 years) The Gloria Bachmann’s Vaginal Health Index (VHI) score was chosen as system to evaluate the presence of VVA and its improvement after the treatment Intensity of dyspareunia was evaluated using a visual analog scale (VAS) Data indicated a significant improvement in VVA dyspareunia (p < 186e−22) in breast cancer survivors who had undergone 3 sessions of vaginal fractional CO2 laser treatment Moreover, VHI scores were significantly higher 30 days post-treatment (T4) (p < 00001) 76 % of patients were satisfied or very satisfied with the treatment results The majority (52 %) of patients were satisfied after a long-term follow-up (mean time 11 months) No adverse events due to fractional CO2 laser treatment occurred The treatment with fractionated CO2 laser appeared to be a feasible and effective treatment for VVA dyspareunia in breast cancer survivors with contraindications to hormonal treatments

Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis

Abstract: We aimed to investigate the safety, adequacy and oncological outcomes of laparoscopic surgery (LS) and robot-assisted laparoscopic (RALS) approach for the treatment of early-stage ovarian cancer. We performed a multicentric, retrospective cohort study, enrolling patients affected by early-stage ovarian cancer who underwent laparoscopic management for early-stage ovarian cancer between 2006 and 2014. Surgical, pathologic and oncologic outcome data were analyzed to compare LS and RALS performances for early-stage ovarian cancer management. 39 patients underwent laparoscopic staging for presumed stage I ovarian cancer: 23 underwent LS and 16 underwent RALS. The mean operative time was 281 ± 81 min (LS 288 ± 88 min; RALS 270 ± 72 min; p = 0.49). No conversion to laparotomy occurred, and one patient had intraoperative hemorrhage requiring blood transfusion. Four patients (10.2 %) experienced postoperative complications of grade 3 according to the Clavien-Dindo classification. The median hospital stay was 3 days (1–15); the differences were not statistically significant between two groups [LS = 4 (1–15); RALS = 3 (1–7); p = 0.43]. During a mean follow-up period of 19.4 months, tumor recurrence occurred in 3 patients: 2 (8.7 %) in the LS group and 1 (6.25 %) in the RALS group. Overall survival and disease-free survival for the entire cohort were 97.4 and 92.3 %, respectively. LS and RALS seem to be adequate and feasible for the treatment of early-stage ovarian cancer in terms of the surgical outcomes and oncological safety. Furthermore, in our experience, perioperative outcomes are comparable between LS and RALS making them an acceptable approach in selected patients.

Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis.

Abstract: Vitamin D is widely used for bone growth and normal insulin secretion; however, the association between vitamin D status and gestational diabetes risk is controversial. This meta-analysis aimed to quantitatively evaluate the association between vitamin status and risk of gestational diabetes. We performed a systematic search on the PubMed, EmBase, and Cochrane Library databases in January 2015 to obtain observational studies studying gestational diabetes risk in relation to vitamin D status. Odds ratios (ORs) with 95 % confidence intervals (CIs) were used to measure the association between vitamin D status and the risk of gestational diabetes. A total of 20 observational studies were included in the final analysis containing 16,515 individuals. Overall, maternal vitamin D insufficiency was found to be associated with a greater risk of gestational diabetes (RR 1.45; 95 % CI 1.15–1.83; P < 0.001). Subgroup analysis indicated that this association might differ based on countries, study design, assessment of vitamin D levels, sample size, age at baseline, adjusted models, and study quality. This meta-analysis revealed that maternal vitamin D insufficiency is associated with increased risk of gestational diabetes.

Non-tubal ectopic pregnancy

Abstract: 11 per 1000 pregnancies are ectopic (NICE Guidelines, 2012) with 95 % of ectopic pregnancies being tubal in origin, and 80 % of these occurring within the ampulla (The Ectopic Pregnancy Trust). 5% therefore are non-tubal. In this review we aim to collate literature relevant to non-tubal ectopic pregnancy. Literature regarding cornual, ovarian, abdominal, interstitial, cervical and Caesarean scar ectopic pregnancy was reviewed using EMBASE and Medline databases. Non-tubal ectopic pregnancies are often overlooked, diagnosed late and are associated with higher maternal morbidity and mortality. Ultrasound remains the mainstay of diagnosis in corroboration with clinical features. Management may include medical treatment with methotrexate, surgery or expectancy. There is also an increasing interest in the use of minimally invasive radiological approaches. Non-tubal ectopic pregnancy is a rare but potentially life-threatening and often misdiagnosed condition. This is particularly pertinent for Caesarean scar ectopic pregnancies, the prevalence of which is increasing due to the rising proportion of women having Caesarean sections (Litwicka and Greco, 2011). Practitioners should be aware of non-tubal pregnancies to aid more efficient diagnosis, optimise management and increase patient safety.

Pregnancy eHealth and mHealth: user proportions and characteristics of pregnant women using Web-based information sources-a cross-sectional study.

Abstract: To analyze the current proportions and characteristics of women using Internet (eHealth) and smartphone (mHealth) based sources of information during pregnancy and to investigate the influence, this information-seeking behavior has on decision-making. A cross-sectional study was conducted at two major German university hospitals. Questionnaires covering socio-demographic data, medical data and details of Internet, and smartphone application use were administered to 220 pregnant women. Data analysis utilized descriptive statistics and multiple regression analysis. 50.7 % of pregnant women were online information seekers. 22.4 % used an mHealth pregnancy application. Women using eHealth information showed no specific profile, while women using mHealth applications proved to be younger, were more likely to be in their first pregnancy, felt less healthy, and were more likely to be influenced by the retrieved information. Stepwise backward regression analysis explained 25.8 % of the variance of mHealth use. 80.5 % of cases were classified correctly by the identified predictors. All types of Web-based information correlated significantly with decision-making during pregnancy. Pregnant women frequently use the Internet and smartphone applications as a source of information. While Web usage was a common phenomenon, this study revealed specific characteristics of mHealth users during pregnancy. Improved, medically accurate smartphone applications might provide a way to specifically target the mHealth user group. As user influenceability was of major relevance to all types of information, all medical content should be carefully reviewed by a multidisciplinary board of medical specialists.

Pelvic congestion syndrome: the current state of the literature

Abstract: Pelvic congestion syndrome is an uncommon poorly understood and frequently misdiagnosed disorder of the pelvic venous circulation, which causes chronic pelvic pain in women in premenopausal age. This condition has typical features, such as pelvic varicosities, pelvic pain worsened by prolonged standing, coitus, menstruation, and pregnancy. The precise etiology of this syndrome remains uncertain, and it is probably multifactorial. Valvular insufficiency, venous obstruction, and hormones all may play a role in the development of congestion of the pelvic veins. Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly. Once the syndrome has been accurately diagnosed, medical, surgical, or minimally invasive endovascular treatments can improve symptoms in a high percentage of cases. This updated nonsystematic review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment option of this complex condition that affects young women with considerable implications for their daily social and psychological condition.

Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence.

Abstract: Uterine myomas are relative frequent in premenopausal women. The development of advanced minimally invasive surgical techniques proposed robotic-assisted myomectomy as an equally safe and effective treatment option. PubMed, Scopus and Cochrane databases were systematically searched and 15 studies met the inclusion criteria for our meta-analysis. Eight studies compared robotic technique to laparoscopic, while nine studies to open/abdominal technique. In total, 2,027 patients were included. In studies referring to the comparison between the robotic myomectomy and the open one, the robotic technique showed a significant inferiority in operative time [84.85 min per operation (95 % confidence intervals (CI) 60.41–109.29)], but superiority in estimated blood loss [92.78 ml/operation (95 % CI 47.26–138.29)], the need for transfusion [981 patients; odd ratio (OR) 0.20; 95 % CI 0.09–0.43], total complications (1101 patients; OR 0.31; 95 % CI 0.11–0.87) and in the length of hospital stay [1.84 days/patient (95 % CI 1.40–2.29)] over the open myomectomy. Regarding the comparison between robotic assisted and laparoscopic technique, no significant difference was found between the two in comparison groups. Minimally invasive techniques have the advantage of less blood loss, less need for blood transfusion and less hospital stay. Additionally, long-term outcomes still need to be clarified including pain control, fertility and pregnancy rates postoperatively, as well as possible recurrence rates.

Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality.

Abstract: To study the quality of life (QoL) and sexual function changes of women affected by severe cystocele treated using biocompatible porcine dermis graft. 20 women (ranging in age from 47 to 71 years, mean age 58.7) with third- and fourth-degree cystocele (according to Baden and Walker classification) were enrolled. The Short Form-36 questionnaire to assess QoL was administrated at baseline and 12 months after surgical treatment. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to measure the changes of sexual behavior was used at baseline and 12 months after surgical treatment. Each woman underwent translabial color Doppler ultrasonography to measure the clitoral blood flow before and 12 months after surgical treatment. Women reported QoL improvement (P < 0.001). By PISQ-12, improvement of the behavioral emotive factor score, the physical factor score, the partner-related factor score and of the total score during the 12-month follow-up with respect to baseline experience was observed (P < 0.001). Color Doppler measurement showed that the mean pulsatility index, peak systolic velocity, resistance index and end-diastolic velocity of clitoral arteries did not significantly change (P = NS). Biocompatible porcine dermis graft to treat severe cystocele considerably improves QoL and sexual function, and does not influence clitoral blood flow. Our data could add new information about sexual behavior after prolapse treatment using this kind of graft, particularly about the impact on clitoral blood flow changes.

Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review.

Abstract: Vaginal infections are responsible for a large proportion of gynaecological outpatient visits. Those are bacterial vaginosis (BV), vulvovaginal candidosis (VVC), aerobic vaginitis (AV) associated with aerobic bacteria, and mixed infections. Usual treatments show similar acceptable short-term efficacy, but frequent recurrences and increasing microbial resistance are unsolved issues. Furthermore, vaginal infections are associated with a variety of serious adverse outcomes in pregnancy and generally have a major impact on quality of life. Identifying the correct therapy can be challenging for the clinician, particularly in mixed infections. Dequalinium chloride (DQC) is an anti-microbial antiseptic agent with a broad bactericidal and fungicidal activity. Systemic absorption after vaginal application of DQC is very low and systemic effects negligible. Vaginal DQC (Fluomizin®vaginal tablets) has been shown to have equal clinical efficacy as clindamycin in the treatment of BV. Its broad antimicrobial activity makes it appropriate for the treatment of mixed vaginal infections and in case of uncertain diagnosis. Moreover, resistance of pathogens is unlikely due to its multiple mode of action, and vaginal DQC provides also a reduced risk for post-treatment vaginal infections. Vaginal DQC (10 mg) as 6-day therapy offers a safe and effective option for empiric therapy of different vaginal infections in daily practice. This review summarizes the available and relevant pharmacological and clinical data for the therapy of vaginal infections with vaginal DQC and provides the rationale for its use in daily gynaecologic practice.

Restoring vaginal microbiota: biological control of bacterial vaginosis. A prospective case–control study using Lactobacillus rhamnosus BMX 54 as adjuvant treatment against bacterial vaginosis

Abstract: Bacterial vaginosis (BV) is the most prevalent lower genital tract infection in reproductive-age women worldwide. BV is an ecological disorder of the vaginal microbiota characterized microbiologically by replacement of the lactobacilli, predominant vaginal microbiota. It is characterized by a high rate of relapse in sexual active women, and these patients show three or more relapses each year. A healthy vagina is characterized by hydrogen peroxide and acid-producing lactobacilli, which are crucial to maintain the physiological vaginal ecosystem and their depletion speeds up bacterial overgrowth with pH elevation, salidase and amine production, leading to the observed signs and symptoms of BV. The aim of this study is to evaluate the efficacy of long-term vaginal lactobacilli’s implementation in restoring and maintaining vaginal microflora and pH and to collect data about prophylactic approach based on probiotics supplementation with lactobacilli. This is a prospective case–control study, performed between January 2013 and September 2014 at Department of Gynecological Obstetrics and Urologic Sciences of “Sapienza” University of Rome. 250 non-pregnant sexually active women with diagnoses of BV were collected. Patients selected were divided in Group A (125 patients assigned to standard treatment for BV—metronidazole 500 mg orally twice a day for 7 days) and Group B (125 women undergoing the same standard antibiotic regimen followed by vaginal tablets containing Lactobacillus rhamnosus BMX 54). Patients were evaluated after 2, 6, and 9 months (T0, T2, T6, and T9) in term of recurrences rates of BV, vaginal symptoms, re-establishment of healthy vaginal flora, vaginal pH, and treatment tolerability. Vaginal flora was significantly replaced in Group B patients after 2 months comparing with Group A (p = 0.014). These data were confirmed at 6 and 9 months follow-up: patients that underwent prophylactic therapy with NORMOGIN® experienced significantly low rate of recurrences comparing with patients treated with antibiotics only (p < 0.001). During follow-up patients continuing supplementation had significant pH decrease respect to other patients (p < 0.001 at 9 months follow-up visit). Probiotic supplementation with vaginal Lactobacillus rhamnosus BMX54 seems to be useful in hindering bacteria growth especially after antibiotic therapy; therefore this intervention may be considered a new prophylactic treatment for preventing recurrence of BV, in particular in high-risk patients.

Management of osteogenesis imperfecta type I in pregnancy; a review of literature applied to clinical practice

Abstract: Osteogenesis imperfecta (OI) is a rare heritable heterogenous disorder characterized by bone fragility and susceptibility to fractures with a wide spectrum of clinical expression due to defects in collagen type I biosynthesis. The purpose of the review is to highlight the practical norms in pregnancies with osteogenesis imperfecta. We carried out a literature review in MEDLINE on OI during pregnancy, focusing on diagnosis, therapy and delivery. We reviewed 28 articles (case reports, original articles and reviews). Pregnant women affected by type I OI should be closely monitored to assess fetal well-being and detect pregnancy-related complications associated with an increased risk for osteoporosis, restrictive pulmonary disease, cephalopelvic disproportion and other problems related to connective tissue disorders. Mode of delivery remains controversial and should be determined on an individual basis. In conclusion, women affected by type I OI represent a subset of patients whose pregnancies should be considered high risk and warrant a multidisciplinary approach in a referral center.

Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination

Abstract: Placenta accreta is an abnormal adherence of the placenta to the uterine wall. As the incidence of placenta accreta continues to rise, it has been useful to develop standard protocols for the diagnosis and management of affected patients. Pathologists have the opportunity to take an active role in evaluating these resource intensive protocols. We describe methods of gross dissection, microscopic examination and reporting of hysterectomy specimens containing placenta accreta. This protocol facilitates retrospective correlation with surgical and radiographic findings as well as standardized tissue sampling for potential research. Through regular review of such quality measures pathologists can give feedback on the quality of surgical planning and use of imaging.

Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner.

Abstract: Invariant Natural Killer T cells (iNKT) are a specialized subset of T cells that use their T cell receptor to recognize self and foreign lipids presented by CD1d as cognate antigens. iNKT have been shown to have either protective or harmful roles in many pathological states, including microbial infection, autoimmune disease, allergic disease and cancer. Accumulating evidence seems to suggest that this unique T cell subset combines both classically innate and adaptive immunologic characteristic. Considering these recent data, the aim of work was to review the current knowledge about iNKT in eutopic and ectopic endometrium. Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Currently, the immune paradigm of reproduction is gradually changing shape: recent data confirmed that cytokine milieu influences the development and plasticity of different subtype of mononuclear cells, and in turn it can be influenced by the cytokine production of the latter. Among the different NKT cell populations, the recently characterized iNKT seems to share actions typical both of innate and adaptive immunity, being capable of secreting Th1 as well as Th2 cytokine pattern. Moreover, several subtypes of iNKT were identified, who partially express the same master transcription factors of the corresponding T cells counterpart. Although the data about iNKT’s actions in eutopic and ectopic endometrium are still scarce, it is possible to hypothesize that future investigation can shed light on this point, thus allowing a better knowledge about the regulation of these two microenvironments.

Vaginal progesterone for prevention of preterm labor in asymptomatic twin pregnancies with sonographic short cervix: a randomized clinical trial of efficacy and safety.

Abstract: Purpose To evaluate the value of vaginal progesterone therapy for reduction of preterm labor in asymptomatic women with twin pregnancies and sonographic short cervix.

Primary debulking surgery vs. neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer.

Abstract: To compare the survival of patients with stage IIIC or IV epithelial ovarian cancer (EOC) who were treated with neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS), and to investigate how to improve the survival of patients with advanced epithelial ovarian cancer. We retrospectively reviewed 339 patients with stage IIIC or IV EOC from January 2005 to December 2010 treated at West China Women’s and Children’s Hospital wherein 114 and 225 patients underwent NAC followed by IDS and PDS, respectively. No difference was observed in progression-free survival (PFS) or overall survival (OS) between NAC group and PDS group (PFS: 11 vs. 10 months, p = 0.629; OS: 25 vs. 25 months, p = 0.992). Patients with residual tumors that measured 0.1–1 cm at IDS following NAC had a statistically significant lower median OS compared to patients with no residual tumor, but comparable to that with residual tumors that measured >1 cm at IDS following NAC. The independent predictors of OS are size of residual tumor (p < 0.001), FIGO stage (p < 0.001), and age (p = 0.003). NAC followed by IDS provides equal survival compared with PDS. Debulking to small residual tumors with a maximum diameter of less than 1 cm provides a smaller but still significant benefit for patients with PDS but a relatively minor effect with IDS following NAC. To improve the survival of patients with advanced ovarian cancer, the definition of “optimal” in IDS following NAC should be defined as no residual tumor.

Green tea, black tea consumption and risk of endometrial cancer: a systematic review and meta-analysis

Abstract: Several studies have assessed the association between green and black tea consumption and the risk of endometrial cancer (EC) and have yielded inconsistent results. The purpose of this meta-analysis is to systematically analyze the effect of green tea and black tea on EC risk. PubMed, Embase, Cochrane Library and China Biological Medicine Database were searched through February 2, 2015 to identify studies that met pre-stated inclusion criteria. Overall relative risk (RR) was estimated based on the highest and lowest levels of green/black tea consumption. Dose–response relationships were evaluated with the data from categories of green/black tea intake in each study. For green tea, the summary RR indicated that the highest green tea consumption was associated with a reduced risk of EC (RR 0.78, 95 % CI 0.66–0.92). Furthermore, an increase in green tea consumption of one cup per day was associated with an 11 % decreased risk of developing EC. (RR 0.89, 95 % CI 0.84–0.94). For black tea, no statistically significant association was observed in the meta-analysis (highest versus non/lowest, RR 0.99, 95 % CI 0.79–1.23; increment of one cup/day, RR 0.99, 95 % CI 0.94–1.03). The power of the estimate of green tea and black tea with risk of EC was 84.33 and 5.07 %, respectively. The quality of evidence for the association between green and black tea with EC risk was moderate and very low, respectively. The results from this meta-analysis indicate that green tea, but not black tea, may be related to a reduction of EC risk. Large population-based randomized controlled trials and large prospective cohort studies are required to obtain a definitive conclusion and determine the mechanisms underlying this association.

The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis.

Abstract: To review the literature about the effect of endometriosis on in vitro-fertilization and embryo-transfer (IVF-ET). A search in EMBASE, MEDLINE, ClinicalTrial.gov, reference lists from 2000 to 2013 was conducted. Inclusion criteria were: endometriosis confirmed with histologic examination, women undergoing IVF-ET, endometriosis treated or diagnosed by surgery. Women undergoing IVF-ET after surgical removal of endometriosic implants, or a surgical diagnosis of endometriosis without its removal, were compared to women without endometriosis. Main outcomes were clinical pregnancy and delivery rates. Thirteen studies were selected, including 980 women with endometriosis and 5934 controls. Clinical pregnancy rate was lower in women with endometriosis than in controls (OR 0.65; 95 % CI 0.44–0.96), but delivery rate was similar (OR 1.17; 95 % CI 0.69–1.98). When surgery was operative, clinical pregnancy rate after IVF-ET was lower in endometriosis than controls (OR 0.54; 95 % CI 0.34–0.85), but delivery rate was similar (OR 1.12; 95 % CI 0.60–2.07). When surgery was diagnostic, clinical pregnancy (OR 1.15; 95 % CI 0.46–2.84) and delivery rates (OR 1.65; 95 % CI 0.36–7.45) did not differ between the groups. Site of endometriosis was not related to IVF-ET outcomes. Clinical pregnancy rates were similar between stage I-II and controls (OR 0.99; 95 % CI 0.63–1.56) but lower in stage III-IV than controls (OR 0.45; 95 % CI 0.29–0.70), whereas delivery rate was not associated with stage. In the presence of endometriosis, the clinical pregnancy rate after IVF-ET is lower than in controls. The prognosis is better for mild endometriosis compared with more advanced stages. Even after surgical removal of endometriosis, IVF-ET results remain worse than in controls.

Diabetes mellitus and gynecologic cancer: molecular mechanisms, epidemiological, clinical and prognostic perspectives.

Abstract: Introduction Diabetes mellitus, the prevalence of which has increased dramatically worldwide, may put patients at a higher risk of cancer The aim of our study is the clarification of the possible mechanisms linking diabetes mellitus and gynecological cancer and their epidemiological relationship

Therapeutic intervention based on circulating tumor cell phenotype in metastatic breast cancer: concept of the DETECT study program

Abstract: The aim of the ongoing DETECT study program is to evaluate therapeutic intervention based on phenotypes of circulating tumor cells (CTC) in patients with metastatic breast cancer (MBC). Currently (as of July 2015) more than half of the projected about 2000 patients with MBC have already been screened for CTC. Women with HER2-negative primary tumor and presence of CTC are recruited into different DETECT trials according to the HER2-phenotype of CTC. Patients with HER2-positive CTC are randomized to treatment with physicians’ choice therapy (standard chemo- or endocrine therapy) with or without additional HER2-targeted therapy with lapatinib in the DETECT III trial. In DETECT IVa, postmenopausal patients with hormone-receptor positive primary cancer and HER2-negative CTC receive everolimus and standard endocrine therapy. For women with HER2-negative CTC and triple negative MBC or hormone-receptor positive tumor and indication for chemotherapy, a treatment with eribulin is offered (DETECT IVb). The clinical efficacy is investigated by CTC-Clearance and progression-free survival (PFS). The DETECT V/CHEVENDO trial extends the DETECT study program for women with HER2-positive and hormone-receptor positive MBC. The primary objective of this trial is to compare safety and quality of life (QoL) as assessed by the occurrence of adverse events in patients treated with dual (trastuzumab plus pertuzumab) HER2-targeted therapy plus either endocrine or chemotherapy. The translational research projects of the DETECT study program focus on further molecular characterization of CTC and evaluation of markers for their suitability to predict treatment response and to facilitate the development of more personalized treatment options.

Effectiveness and potential mechanisms of intralipid in treating unexplained recurrent spontaneous abortion.

Abstract: Abnormal natural killer (NK) cell activity has been suggested to be a high-risk factor associated with unexplained recurrent spontaneous abortion (URSA). Intralipid, like immunoglobulin, is able to lower the activity of NK cells, which has been reported to be useful for improving URSA outcomes in pregnancy. This study aimed to determine whether intralipid could be used as an alternative treatment to intravenous immunoglobulin (IVIG) which is expensive and has many side-effects. A prospective, randomized clinical trial was conducted from December 2010 to December 2012. Eligible participants were matched and sorted randomly into the intralipid and the IVIG group. The primary outcome was the rate of successful pregnancy. In addition, comparisons of peripheral NK cell activities were accessed by flow cytometry. Moreover, the effects of intralipid on trophoblasts were investigated using a Matrigel assay with the JEG-3 cell line. Seventy-six patients in the intralipid group and 78 in the IVIG group completed the trial. There were no statistically significant differences in successful pregnancy rates between the two groups (92.1 vs 88.2 %, P = 0.415). The reduced NK cell concentrations revealed the cytotoxic effects of the treatments in both groups. The invasive ability of JEG-3 cells was inhibited during co-culture with patient PBMCs. However, the inhibitory effect could be alleviated if the patient PBMCs were stimulated with intralipid. Intralipid can be used as an alternative treatment to IVIG for URSA, and its potential mechanism of action may occur by regulating NK cell function and promoting trophoblast invasion.

Altered FoxO3 expression and apoptosis in granulosa cells of women with polycystic ovary syndrome.

Abstract: To determine the level of apoptosis, and alteration of FoxO3 (forkhead box O3 transcription factor) expression and phosphorylation in human granulosa cells amongst polycystic ovary syndrome (PCOS) patients and control group. We recruited infertile women with PCOS (n = 14) and compared them with infertile women due to tubal blockage or male factor infertility (n = 14, controls). GnRH agonist and gonadotropins were used for ovarian stimulation. Follicular fluids from large follicles (>16 mm) were pooled and granulosa cells (GCs) were isolated using cell strainer methodology. Apoptosis of purified GCs was measured by flow cytometry using Annexin V and propidium iodide. Quantitative real-time PCR and western blotting were performed to assess alteration of FoxO3 expression and phosphorylation in GCs. There were higher percentages of early and late apoptosis in GCs of PCOS patients than in the control group. FoxO3 mRNA level and total FoxO3 protein were significantly higher in PCOS group than in the control group. The ratio of p-FoxO3/total FoxO3 decreased significantly in PCOS than in the control group. It was inferred that unphosphorylated (active form) FoxO3 was higher in GCs of PCOS patients. Apoptosis was significantly and positively correlated with the total FoxO3 and negatively correlated with the p-FoxO3 protein levels in PCOS patients. Activation and overexpression of FoxO3 in granulosa cells of PCOS women correlated with higher apoptosis levels in these cells suggesting that FoxO3 may be a candidate for the higher apoptosis in granulosa cells from women with PCOS.

A systematic review of GLP-1 agonists on the metabolic syndrome in women with polycystic ovaries.

Abstract: Glucagon-like peptides receptor agonists are currently approved as anti-obesity agents, yet the experience with their use in polycystic ovarian syndromes (PCOS)-related obesity and insulin resistance is still limited. We examined the effects of liraglutide on obesity, insulin resistance, and androgen levels in PCOS through a meta-analysis. Seven RCTs where women with PCOS were treated with liraglutide were identified. The variables that were examined before and after a 90-day treatment included waist circumference, body mass index (BMI), fasting insulin concentrations, insulin resistance using homeostatic model (HOMA-IR), serum testosterone, and sex hormone-binding globulin (SHBG). The analysis included 178 women. Only 172 patients had post-treatment measurements. While BMI significantly dropped by −1.65 (0.72–2.58) Kg/m2 after 3 months treatment with liraglutide, waist circumference did not change significantly. Similarly, fasting insulin levels, insulin sensitivity, and SHBG did not change significantly. However, serum testosterone decreased by 0.29 nmol/L in 88 women (P = 0.0003). In a limited number of the women with PCOS, BMI and serum testosterone are only variables that significantly decrease after 3 months of treatment with GLP-1 receptor agonists. Larger sample size studies with longer durations of treatment may be required to examine potential benefits of these medications in improving insulin sensitivity.

Association between maternal, fetal and paternal MTHFR gene C677T and A1298C polymorphisms and risk of recurrent pregnancy loss: a comprehensive evaluation

Abstract: Numerous studies have investigated the associations between methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphisms and risk of recurrent pregnancy loss (RPL); however, the results remain controversial. The aim of this study is to drive a more precise estimation of association between MTHFR gene polymorphisms and risk of RPL. We searched PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated Database for papers on MTHFR gene C677T and A1298C polymorphisms and RPL risk. The pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were used to assess the strength of association in the homozygous model, heterozygous model, dominant model, recessive model and an additive model. The software STATA (Version 13.0) was used for statistical analysis. Overall, 57 articles were included in the final meta-analysis. In maternal group the MTHFR C677T polymorphism showed pooled odds ratios for the homozygous comparison [OR = 2.285, 95 % CI (1.702, 3.067)] and the MTHFR A1298C polymorphism showed pooled odds ratios for recessive model [OR = 1.594, 95 % CI (1.136, 2.238)]. In fetal group the MTHFR C677T polymorphism showed pooled odds ratios for dominant model [OR = 1.037, 95 % CI (0.567, 1.894)] and the MTHFR A1298C polymorphism showed pooled odds ratios for dominant model [OR = 1.495, 95 % CI (1.102, 2.026)]. In summary, the results of our meta-analysis indicate that maternal and paternal MTHFR gene C677T and A1298C polymorphisms are associated with RPL. We also observed a significant association between fetal MTHFR A1298C polymorphism and RPL but not C677T.

Characterization of endometriosis-associated immune cell infiltrates (EMaICI).

Abstract: Objective To identify and characterize endometriosis-associated immune cell infiltrates (EMaICI). Furthermore, to define occurrence and size of EMaICI in various types of endometriosis.

Biglycan enhances the ability of migration and invasion in endometrial cancer

Abstract: This study aimed to confirm that biglycan (BGN) can promote the migration and invasion in endometrial cancer both in vitro and in vivo and the possible therapeutic value of BGN in endometrial cancer. Western blot was used to screen out the higher protein level of BGN in human endometrial cancer cells; BGN knocked down cells were constructed by lentiviral transfection; The effect of BGN in endometrial cancer detected by wound healing, transwell migration, and invasion, endothelial tube formation assay in vitro, and xenograft model in vivo. (1) We found that BGN expression level is higher in the Ishikawa (ISK, high differentiation) and AN3CA (poor differentiation) cells than other endometrial cancer cells. (2) BGN enhances endometrial cancer cell wound healing, invasion, and migration ability and formation ability of endothelial cells in vitro. Xenograft model has confirmed the outcome in vivo. BGN might play an important role on metastasis in human endometrial cancer and it might be a target marker for the molecular therapy of advanced and recurrence endometrial cancer.

Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis.

Abstract: This meta-analysis aimed to estimate the relation between excessive gestational weight gain and macrosomia. We performed a meta-analysis by searching PubMed, EMBASE and the Cochrane library for English-language literature from inception to 1 October 2014. Studies assessing the relationship between excessive gestational weight gain and macrosomia were included. Characteristics including study design, country, sample size, definition of macrosomia, adjusted odds ratios, CIs and adjustment factors were extracted independently by two reviewers. Summary odds ratios were calculated by using a random-effects model meta-analysis. 15 relevant articles were eligible for the meta-analysis. Incorporated by random-effect model before the heterogeneity tests, the value of OR was 2.35 (95 % CI: 1.95, 2.85). Stratified analysis showed no differences regarding different study design, definition of macrosomia and location of study. There was no indication of a publication bias either from the result of Egger’s test (P = 0.572) or Begg’s test (P = 0.572). Our meta-analysis indicated that excessive gestational weight gain might increase the risk of macrosomia.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

Abstract: This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding. Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3–4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman’s ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis. Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance. Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.