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Zhang XY, Zhao LM. The "Hand as foot" teaching method in Uterine artery embolization. Asian J Surg 2024:S1015-9584(24)01457-X. [PMID: 39034251 DOI: 10.1016/j.asjsur.2024.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Xi-Yao Zhang
- Department of Interventional Therapy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Li-Min Zhao
- Department of Interventional Therapy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
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102
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Gaikaiwari RU, Prinsloo C, Grover SR, Wright I, Drever N. Experiences of pelvic and generalized persistent pain syndromes in MRKH: a scoping review. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00254-7. [PMID: 39038531 DOI: 10.1016/j.jpag.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
STUDY OBJECTIVES Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) is characterized by the congenital absence of the uterus and vagina, sometimes with associated extragenital anomalies. Currently there is limited literature on pelvic pain and co-morbid pain syndromes in people with MRKH. The aims of this scoping review were to summarize existing literature on pelvic and generalized persistent pain syndromes associated with MRKH and to identify knowledge gaps for further research into this field. METHODS This scoping review followed the Joanna Briggs Institute framework. The population of interest was patients with a diagnosis of MRKH. MEDLINE, CINAHL, Scopus, Cochrane, Embase and Emcare databases were searched. Excluded were articles that did not meet the inclusion criteria or critical appraisal standards. The resultant articles were reviewed by 2 independent researchers while a third was used in cases of disagreement. A descriptive analytical method was used for data analysis. RESULTS We screened 3348 articles for eligibility, 39 articles met criteria, which described 1353 cases of MRKH. 4 studies described baseline pelvic pain in MRKH, 19 described acute presentations and 13 described post-intervention pain levels. CONCLUSION Despite the paucity of research, this review found that cyclical pelvic pain was mostly present in women with uterine remnants, whilst pelvic pain in those without remnants was poorly understood. There were no studies exploring generalized persistent pain syndromes in MRKH. Further cross-sectional studies are needed to elucidate prevalence and levels of pain syndromes in MRKH.
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Affiliation(s)
| | - C Prinsloo
- James Cook University, Cairns, Queensland, Australia
| | - S R Grover
- Department of Pediatrics, University of Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - I Wright
- James Cook University, Cairns, Queensland, Australia; Department of Pediatrics, Cairns Hospital, Cairns, Queensland, Australia; University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - N Drever
- James Cook University, Cairns, Queensland, Australia; Department of Obstetrics and Gynecology, Cairns Hospital, Cairns, Queensland, Australia
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103
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Antolak SJ. The pudendal syndrome: A photo essay of nerve compression damage visualized at neurolysis in patients with chronic neuropathic pelvic pain. Neurourol Urodyn 2024. [PMID: 39032061 DOI: 10.1002/nau.25555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
AIMS (1) To use intraoperative photographs to visualize and explain pudendal nerve compressions and anatomical variations of compression sites in patients with chronic pelvic pain. (2) To emphasize the diagnostic importance of sensory examination with a safety pin at the six pudendal nerve branches in all patients with chronic pelvic pain; the dorsal nerves (penis or clitoris; the perineal nerves; and the inferior rectal nerves). METHODS Between 2003 and 2014, "definite" pudendal neuropathy was diagnosed by examination and with two neurophysiologic tests. Neurolysis, via a transgluteal approach, was recommended only after 14 weeks of conservative care failed to adequately improve symptoms and validated symptom scores. Photographs of surgical findings were culled for their educational impact. An illustration of each photo clarifies the surgical anatomy. RESULTS The transgluteal incision permits access to pudendal anatomy and compression sites from the subpiriformis area through the interligamentary space and the pudendal canal (Alcock canal). Compressions were acquired or congenital and severity varied significantly. Pinprick sensory testing diagnoses pudendal neuropathy in 92% of both genders. Mid-nerve compression occurred commonly between the sacrotuberous and sacrospinous ligaments less frequently in the Alcock canal, but also at aberrant pathways, for example, between layers of the sacrotuberous ligament; a separate inferior rectal nerve passing through the sacrospinous ligament; at an anomalous lateral pathway posterior to the ischial spine. The results of international surgeons are discussed. CONCLUSIONS Decompression surgery was recommended in approximately 35% of patients in this practice, when pudendal neuropathy (pudendal syndrome), did not respond to two conservative levels of treatment: (1) nerve protection and medications and, (2) a series of three pudendal nerve perineural injections given at 4-week intervals. Significant nerve compression is consistently observed. Pathophysiology includes axonopathy from ischemia and demyelination. Neuropathy is readily diagnosed using a pinprick sensory examination of six pudendal nerve branches. Monitoring with the National Institutes of Health Chronic Prostatitis Symptom Index records cures >13 years.
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Paul-Dehlinger R, Vappereau A, Bras AL, Oliveira J, Favier A, Belghiti J, Uzan C, Durand-Zaleski I, Canlorbe G. Cost-effectiveness of robot-assisted total hysterectomy for benign pathologies compared to laparoscopic surgery: a retrospective study with propensity score. J Gynecol Obstet Hum Reprod 2024:102821. [PMID: 39038739 DOI: 10.1016/j.jogoh.2024.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/21/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Hysterectomy for benign pathologies is one of the most common gynecological surgeries. In recent years, robotic surgery has become an alternative to traditional surgery, but at a higher cost. OBJECTIVE Estimate the cost of benign robot-assisted hysterectomy for the purpose of supporting public decision-making, as well as the additional cost per major postoperative complication (ClavienDindo score ≥ 3) avoided one month after surgery robotic versus traditional laparoscopic. METHODS Single-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019: 99 by robotic approach, and 86 by laparoscopic approach. Comparison of robotic surgery to laparoscopy. Calculation of a cost-effectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups. RESULTS Robotic surgery has a total cost of € 6,615 at 1 month per patient compared to € 3,859 for laparoscopic surgery with an additional cost of € 377,534 per major postoperative complication avoided, longer operating time and an absence of significant difference in terms of complications and length of hospitalization. CONCLUSION In terms of cost-effectiveness, according to this study, the robot does not appear to be better than laparoscopy. In the years to come, we can expect a development of robotic surgery with rationalization of the practice, with appropriate selection of patients for robotic surgery, development of outpatient surgery and a reduction in the cost of the equipment.
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Affiliation(s)
- Richard Paul-Dehlinger
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France; Intercommunal Hospital Center André Grégoire, Montreuil, France
| | - Alexandra Vappereau
- DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alicia Le Bras
- DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joana Oliveira
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Amelia Favier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jeremy Belghiti
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Catherine Uzan
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France; University Institute of Cancerology, AP-HP, Sorbonne University, Paris, France; Saint-Antoine Research Center, INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris, France
| | - Isabelle Durand-Zaleski
- DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Public Health, Henri Mondor-Albert-Chenevier, Créteil, France; CRESS, INSERM, INRA, University of Paris, Paris, France
| | - Geoffroy Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France; University Institute of Cancerology, AP-HP, Sorbonne University, Paris, France; Saint-Antoine Research Center, INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris, France.
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Li Y, Chen X, Wang Q, Wang J. Factors Influencing the Visualization of Fallopian Tubes in Hysterosalpingo-Contrast Sonography (HyCoSy)-The Value of Multimodal HyCoSy in Visualizing the Fallopian Tubes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39031455 DOI: 10.1002/jum.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/28/2024] [Accepted: 07/01/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) can non-invasively evaluate the patency of the fallopian tubes and is increasingly used in clinical practice. However, some factors may lead to false-positive diagnoses. This study aims to analyze the factors affecting clear imaging of the fallopian tubes in 4D-HyCoSy and explore methods to improve the quality of fallopian tube imaging. METHODS A total of 118 patients were enrolled in this retrospective study. After injecting the SonoVue into the uterine cavity, three modes of HyCoSy were completed in sequence: 4D-HyCoSy, 2D-HyCoSy, and second harmonic imaging (SHI). Participants were divided into two groups: the easy visualization group (fallopian tubes could be visualized using only 4D-HyCoSy) and the difficult visualization group (a multimodal combination was required for visualization). The position of the uterus, the relationship between the ovaries and the uterus, endometrial thickness, time of catheterization in the uterine cavity, presence or absence of lesions in the uterine cavity, whether intestinal gas covers the fallopian tubes and the imaging effect of different modes on the fallopian tubes was analyzed, to determine the key factors affecting the clear imaging of the fallopian tubes. RESULTS The positional relationship between the ovary and the uterus (OR = 4.711, 95% CI: 1.322-19.77, P = 0.023), the positioning of the uterus (OR = 3.843, 95% CI: 1.129-15.26, P = 0.04), endometrial thickness (OR = 3.985, 95% CI: 1.168-15.99, P = 0.036), and the duration of intrauterine catheter placement (OR = 3.547, 95% CI: 1.042-13.52, P = 0.05) were independent factors that affecting difficulty in visualizing the fallopian tubes. CONCLUSION Uterine position, the positional relationship between the ovary and the uterus, endometrial thickness, and the time of catheter insertion are factors that affect visualizing the fallopian tubes during 4D-HyCoSy. The combination of multimodal imaging, especially the combination of 4D-HyCoSy with SHI mode, can help improve the quality of fallopian tube visualization.
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Affiliation(s)
- Yan Li
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Xiaoyi Chen
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Qin Wang
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Jingping Wang
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
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Liu R, Hao H, Yin Y, Chen L, Liu Y. Effect of High-Intensity Focused Ultrasound on Different Types of Adenomyosis Based on Magnetic Resonance Imaging Classification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39032000 DOI: 10.1002/jum.16529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/17/2024] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE We aimed to analyze the effect of high-intensity focused ultrasound (HIFU) on different types of adenomyosis (AM) based on magnetic resonance imaging (MRI) classification. METHODS A total of 206 AM patients who underwent HIFU between January 2017 and December 2021 were included in this retrospective study. The size and location of AM were evaluated based on T2-weighted imaging (T2WI) of MRI. Patients were divided into internal (subtype I), external (subtype II), intramural (subtype III), and full-thickness (subtype IV) AM groups. All patients underwent an MRI examination before and one day after HIFU. After ultrasound-guided HIFU ablation, the parameters of ultrasonic energy input during HIFU treatment among different groups were recorded and compared. The adverse reactions and complications among different groups were compared. RESULTS The lesion volume in the subtype IV group was significantly larger than the subtype II and III groups (P < .05). The HIFU irradiation time, treatment time, and total energy input in the subtype IV group were significantly higher than the subtype I and III groups (P < .05). The number of cases of abdominal pain and vaginal fluid in the treatment area in the subtype IV group was significantly higher than in the subtype II group. CONCLUSION Although HIFU has different treatment strategies and parameters for different subtypes of AM, it can achieve a satisfactory ablation rate, which is safe and effective.
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Affiliation(s)
- Ruiqian Liu
- Department of Obstetrics and Gynaecology, Deyang People's Hospital, Deyang City, China
| | - Hongqiang Hao
- Department of Clinical Engineering, Internet Engineering Service, Deyang People's Hospital, Deyang City, China
| | - Yan Yin
- Department of Obstetrics and Gynaecology, Deyang People's Hospital, Deyang City, China
| | - Liang Chen
- Department of Obstetrics and Gynaecology, Deyang People's Hospital, Deyang City, China
| | - Yang Liu
- Department of Obstetrics and Gynaecology, Deyang People's Hospital, Deyang City, China
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Harder C, Velho RV, Brandes I, Sehouli J, Mechsner S. Assessing the true prevalence of endometriosis: A narrative review of literature data. Int J Gynaecol Obstet 2024. [PMID: 39031100 DOI: 10.1002/ijgo.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 07/22/2024]
Abstract
Endometriosis is a gynecologic condition often described as the "chameleon of gynecology" because of its elusive symptoms. The World Health Organization acknowledges its severe impact on quality of life due to pain, fatigue, depression, and infertility. There is limited literature on the prevalence of endometriosis, knowledge of which is essential for effective prevention, treatment strategies, and funding. We aim to structure and present the published data on endometriosis prevalence, synthesizing the discrepancy between health insurance and clinical data. PubMed, Cochrane CENTRAL, and LIVIVO were researched for peer-reviewed articles published between January 2000 and July 2023 on women of reproductive age. Health insurance companies argue that few women (~1%) are affected by endometriosis. Interestingly, the prevalence of clinical data studies (6.8%), population-based surveys/self-reported studies (6.6%), and symptomatic patient data (21%) revealed a different picture. Based on the data gathered, a multi-layered prevalence model has been proposed to illustrate the large discrepancy in the prevalence numbers, leading to the disease being underestimated and underfunded. This variability may be influenced by the heterogeneity in designs and the analyzed data, and clinical complexity. In summary, this narrative review reveals that the prevalence of endometriosis is higher than health insurance and other stakeholders might have previously assumed.
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Affiliation(s)
- Carolin Harder
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Berlin, Germany
| | - Renata Voltolini Velho
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Berlin, Germany
| | - Iris Brandes
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Jalid Sehouli
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Berlin, Germany
| | - Sylvia Mechsner
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Berlin, Germany
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108
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Ghattaura H, Davies J, Becker CM, Lane S, Lakhoo K. Fertility preservation service for children and young adults at high risk of infertility; the hub and spoke model. Pediatr Surg Int 2024; 40:201. [PMID: 39030371 DOI: 10.1007/s00383-024-05770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To evaluate the evolution of fertility preservation surgery in children and young adults at high risk of infertility from a single centre to a networked 'Hub and Spoke' service. METHODS A case note review of patients referred for ovarian or testicular cryopreservation between Jan 2013 and Dec 2023. Demographic data, procurement numbers, and site of procurement were collected. Specialist feedback was obtained to identify the challenges faced. RESULTS Over time, the number of referrals increased from 4 to 349 patients per year with the number of Spoke centres rising to 36 ovarian and 16 testicular. In 2013-2014; 100% of procurement was ovarian as compared to 2023; 51% ovarian, 49% testicular. Of the 395 referrals in 2021, 81% (n = 319) went on to have procurement and storage of tissue. Between 2013 and 2016, 96% of cases were performed at the Hub. In 2023, 53/349 (15%) cases were performed at the Hub with the remaining 296 (85%) procured at Spoke sites. Surgical issues such as access to theatre, variation and availability of surgical equipment, thermal injury to ovarian tissue and variation in the size of the testicular specimen were identified. CONCLUSION The Hub and Spoke model successfully delivers treatment to patients close to home as safely possible within their local treatment centre.
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Affiliation(s)
- Harmit Ghattaura
- Department of Paediatric Surgery, The Children's Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Jill Davies
- Oxford Cell & Tissue Biobank, The John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK
| | - Sheila Lane
- Oxford Cell & Tissue Biobank, The John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
- Department of Paediatric Oncology, The Children's Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Kokila Lakhoo
- Department of Paediatric Surgery, The Children's Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK.
- Nuffield Department of Surgical Sciences, University of Oxford, Level 6, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
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Lyu YH, Liu HX, Han X, Yuan P, Wang MY, He YY, Ge JL, Zou W, Jing R, Xin CS, Yang H, Chen BL, Chen GW, Li J. Clinicopathologic characteristics and prognostic factors of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix: A multicenter retrospective study. Int J Gynaecol Obstet 2024. [PMID: 39031110 DOI: 10.1002/ijgo.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To evaluate the prognostic factors and survival outcomes of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix (NECC). METHODS This multicenter, retrospective study involved 98 cervical cancer patients with stage IA2-IIA2 and IIIC1/2p high-grade NECC. We divided the patients into two groups based on histology: the pure and mixed groups. All clinicopathologic variables were retrospectively evaluated. Cox regression and Kaplan-Meier methods were used for analysis. RESULTS In our study, 60 patients were in the pure group and 38 patients were in the mixed group. Cox multivariate analysis showed that mixed histology was a protective factor impacting overall survival (OS) (P = 0.026) and progression free survival (PFS) (P = 0.018) in surgically treated high-grade NECC. Conversely, survival outcomes were negatively impacted by ovarian preservation (OS: HR, 20.84; 95% CI: 5.02-86.57, P < 0.001), age >45 years (OS: HR, 4.50; 95% CI: 1.0-18.83, P = 0.039), tumor size >4 cm (OS: HR, 6.23; 95% CI: 2.34-16.61, P < 0.001), parity >3 (OS: HR, 4.50; 95% CI: 1.02-19.91, P = 0.048), and perineural invasion (OS: HR, 5.21; 95% CI: 1.20-22.53, P = 0.027). Kaplan-Meier survival curves revealed notable differences in histologic type (OS: P = 0.045; PFS: P = 0.024), chemotherapy (OS: P = 0.0056; PFS: P = 0.0041), ovarian preservation (OS: P = 0.00031; PFS: P = 0.0023), uterine invasion (OS: P < 0.0001; PFS: P < 0.0001), and depth of stromal invasion (OS: P = 0.043; PFS: P = 0.022). CONCLUSION Patients with mixed histologic types who undergo surgery for high-grade NECC have a better prognosis. Meanwhile, ovarian preservation, tumor size >4 cm, parity >3, age >45 years and perineural invasion were poor prognostic predictors. Therefore, patients with high-risk factors should be considered in clinical practice.
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Affiliation(s)
- Yan-Hong Lyu
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Hai-Xia Liu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Obstetrics and Gynecology, Liao Cheng People's Hospital, Liaocheng, Shandong, China
| | - Xue Han
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Peng Yuan
- Department of Gynecology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Ming-Yi Wang
- Department of Gynecology and Obstetrics, General Hospital of Western Theater Command of PLA, Chengdu, Sichuan Province, China
| | - Yuan-Yuan He
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jun-Li Ge
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wei Zou
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Ru Jing
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Cai-Shi Xin
- Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Hong Yang
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Bi-Liang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Gao-Wen Chen
- Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Li
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Daghmouri MA, Chaouch MA, Deniau B, Benayoun L, Krimi B, Gouader A, Oweira H. Efficacy and safety of intraperitoneal ropivacaine in pain management following laparoscopic digestive surgery: A systematic review and meta-analysis of RCTs. Medicine (Baltimore) 2024; 103:e38856. [PMID: 39029019 DOI: 10.1097/md.0000000000038856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery. METHODS We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates. RESULTS We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = -21.93 95% CI [-27.64, -16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = -0.20 95% CI [-0.36, -0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01). CONCLUSION Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach. REGISTRATION The registration number at PROSPERO was CRD42021279238.
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Affiliation(s)
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France; INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
| | - Laurent Benayoun
- Department of Surgery, Perpignan Hospital Center, Perpignan, France
| | - Bassem Krimi
- Department of Anesthesiology, Perpignan Hospital Center, Perpignan, France
| | - Amine Gouader
- Department of Anesthesiology, Perpignan Hospital Center, Perpignan, France
| | - Hani Oweira
- Department of Surgery, Universitäts Medizin Mannheim, Heidelberg University, Mannheim, Germany
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Ianieri MM, Alesi MV, Querleu D, Ercoli A, Chiantera V, Carcagnì A, Campolo F, Greco P, Scambia G. Anatomical-based classification of dorsolateral parametrectomy for deep endometriosis. Correlation with surgical complications and functional outcomes: A single- center prospective study. Int J Gynaecol Obstet 2024. [PMID: 39031095 DOI: 10.1002/ijgo.15781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To evaluate complication rate and functional outcomes of nerve-sparing parametrectomy for deep endometriosis in relation to the extension of the surgical procedure, based on recognizable anatomical landmarks. METHODS This was a prospective single-center study including all patients undergoing parametrectomy for deep endometriosis from September 2020 to June 2023 at our tertiary center. Dorsolateral parametrectomies were divided into parametrectomies medial to the presacral fascia and cranial to the medial rectal artery (superficial parametrectomy), and parametrectomies in which one of the two landmarks was overcome during the surgical procedure, leading to the excision of tissue lateral to the presacral fascia (deep parametrectomy type 1, or DP1) or caudal to the medial rectal artery (DP2). Finally, we used the hypogastric fascia as landmark to define type 3 deep parametrectomy (DP3), when the procedure was deeply lateral to the fascia. RESULTS Bladder voiding deficit occurred in 9.7% of cases, with higher rates in DP2 (20.8%) and DP3 (30%) groups. Regarding postoperative gastrointestinal function, our data showed a significant improvement over time in all groups, with the exception of DP2; instead an improvement in postoperative bladder function was only shown in DP3. Parametrectomy was not associated with a simultaneous improvement in sexual function expressed with the female sexual function index, in any of the four groups. CONCLUSION Our classification constitutes a concrete approach for comparing, in a standardized way, the complications and functional outcomes of parametrectomy, which, even if carried out by expert surgeons, demonstrates a non-negligible rate of bladder voiding deficit.
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Affiliation(s)
- Manuel Maria Ianieri
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Maria Vittoria Alesi
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Denis Querleu
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology of the Adult and Child "Gaetano Barresi", University of Messina, Messina, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonella Carcagnì
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pierfrancesco Greco
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Vissers G, Peek R, Verdurmen WPR, Nap AW. Endometriotic tissue fragments are viable after cryopreservation in an ex vivo tissue model recapitulating the fibrotic microenvironment. Hum Reprod 2024:deae164. [PMID: 39025483 DOI: 10.1093/humrep/deae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
STUDY QUESTION Is it possible to establish an ex vivo endometriosis model using cryopreserved endometriotic tissue fragments? SUMMARY ANSWER Cryopreserved endometriotic tissue fragments remain viable after thawing and during at least 3 days of culture and can therefore be used to establish an ex vivo endometriosis model to efficiently test potential therapeutic agents. WHAT IS KNOWN ALREADY Endometriosis is the most prevalent benign gynecologic disease with an enormous societal burden; however, curative therapies are still lacking. To efficiently test potential new therapies, an ex vivo model based on previously cryopreserved endometriotic tissue that recapitulates the different endometriosis subtypes and their microenvironment is highly desirable. STUDY DESIGN, SIZE, DURATION Endometriotic tissue fragments of three different subtypes were obtained from 28 patients by surgical resection. After cryopreservation and thawing, viability and metabolic activity of these tissue fragments were assessed. Viability was compared with fresh fragments from 11 patients directly after surgical removal. Experimental intervention studies were performed in cryopreserved and thawed tissue fragments from two patients to confirm the usability of these tissues for ex vivo intervention studies. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometriotic tissue fragments (n = 45) were cryopreserved according to three different protocols. After thawing, fragments were cultured for 24 h. A resazurin-based assay was performed to assess the metabolic activity of the tissue fragments. In addition, cell type-specific viability was analyzed by VivaFix, Hoechst 33342, and α-smooth muscle actin immunofluorescence staining and confocal microscopy. The presence of endometriosis was histologically confirmed based on hematoxylin-eosin staining. Cryopreserved and thawed tissue fragments were treated for 72 h with pirfenidone or metformin and COL1A1 and CEMIP gene expressions were assessed using RT-PCR and RT-qPCR, either in the whole tissue fragments or in myofibroblasts isolated by laser capture microdissection. MAIN RESULTS AND THE ROLE OF CHANCE Metabolic activity of endometriotic tissue fragments obtained from peritoneal (PER), ovarian (OMA), and deep (DE) endometriotic lesions was well preserved after cryopreservation in a dimethyl sulfoxide-based medium and was comparable with fresh tissue fragments. Relative metabolic activity compared to fresh tissue was 70% (CI: 92-47%) in PER, 43% (CI: 53-15%) in OMA and 94% (CI: 186-3%) in DE lesions. In fragments from PE lesions 92% (CI: 87-96%), from OMA lesions 95% (CI: 91-98%), and from DE lesions 88% (CI: 78-98%) of cells were viable after cryopreservation and thawing followed by a 24-h culture period. Differences in gene expression of fibrotic markers COL1A1 and CEMIP after 72-h treatment with pirfenidone or metformin could be detected in whole tissue fragments and in isolated myofibroblasts, indicating that cryopreserved and thawed endometriotic tissue fragments are suitable for testing anti-fibrotic interventions. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Viability and metabolic activity of the endometriotic tissue fragments may have been partially compromised by damage sustained during the surgical procedure, contributing to inter-sample variance. WIDER IMPLICATIONS OF THE FINDINGS The storage of viable endometriotic tissue fragments for later usage in an ex vivo model creates the possibility to efficiently test potential new therapeutic strategies and facilitates the exchange of viable endometriotic tissue between different research laboratories. STUDY FUNDING/COMPETING INTEREST(S) This study was not financially supported by external funding. The authors declare no competing interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- G Vissers
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Peek
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W P R Verdurmen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A W Nap
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sun H, Wang J, Fu P, Zhou T, Liu R. Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy. Reprod Biol Endocrinol 2024; 22:84. [PMID: 39026328 PMCID: PMC11256510 DOI: 10.1186/s12958-024-01256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/06/2024] [Indexed: 07/20/2024] Open
Abstract
STUDY OBJECTIVE Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy associated with severe complications, including significant hemorrhage, the potential need for hysterectomy, and life-threatening risks. Currently, two classification methods exist for CSP: Vial (type Ia and IIa) and Chinese Expert's Consensus (type Ib, type IIb, and type IIIb). However, these methods have limitations in guiding the selection of appropriate treatment plans for CSP. The purpose of this study was to systematically evaluate the effectiveness of various treatments for CSP within our clinic. METHOD Our study included 906 patients with CSP from January 2013 to December 2018. The chi-squared test and logistic analysis were used to compare the clinical characteristics. The median and interquartile range (IQR) was calculated. We also analyzed whether preoperative application of methotrexate (MTX) could improve surgical outcomes and the relevant characteristics of misdiagnosed CSP patients. RESULTS There was a significant difference in gestational age, gestational sac diameter, gestational sac width, gestational sac area, remnant myometrial thickness, vaginal bleeding and preoperative hemoglobin levels (p < 0.001) but not in the incidence of residual tissue (p = 0.053). The other factors (intraoperative blood loss, hemoglobin decline, first hemoglobin after operation, total hospital stay, hospital stay after operation, transfusion and duration of catheter drain) were significantly different (p < 0.001). For type Ia and type Ib CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound, respectively. For type IIa and type IIIb CSP, 29.9% and 62.7% of patients were treated with laparotomy, respectively. There were no differences in surgical methods, residual tissue and reoperation between the MTX and non-MTX groups (p = 0.20), but liver damage, hospital stay and pain perception were more remarkable in the MTX group. It is noteworthy that 14% of the patients were misdiagnosed with an intrauterine pregnancy. The incidence of misdiagnosis in type IIa CSP patients was higher than that in type Ia CSP patients (p < 0.001). CONCLUSION For type I CSP patients, D&E under ultrasound or D&E under hysteroscopy should be recommended. For type IIIb CSP patients, operative resection should be used. It is currently difficult to choose the appropriate treatment methods for type IIa or type IIb CSP patients.
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Affiliation(s)
- Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Juan Wang
- Department of Obstetrics and Gynecology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
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Yuan ZL, Ren J, Huang ML, Qi YF, Gao X, Sun YY, He YL, Zhu L, Xue HD. A new magnetic resonance imaging-based PUMCH classification system for congenital cervical malformations: devising a standardised diagnosis pathway. Insights Imaging 2024; 15:177. [PMID: 39020237 PMCID: PMC11255164 DOI: 10.1186/s13244-024-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/26/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To develop an innovative magnetic resonance imaging (MRI)-based PUMCH (Peking Union Medical College Hospital) classification system aimed at standardising the diagnosis of congenital cervical malformations (CCMs) by identifying their distinctive MRI features. METHODS Seventy-nine consecutive patients with CCM underwent pre-treatment pelvic MRI; three experienced gynaecological radiologists retrospectively analysed these images. Qualitative assessments included Rock et al's classification; PUMCH classification; haematometra; cervical signal features; ovarian endometriosis; haematosalpinx; and uterine, vaginal, urinary, and musculoskeletal malformations. Quantitative assessments involved the uterine volume, sagittal cervical length, and maximum ovarian cross-sectional area. The surgical treatment types were also recorded. Statistical methods were used to incorporate differences in clinical features and surgical methods into our classification. RESULTS Morphologically, CCMs were categorised into three types: type I (53%) was characterised by the presence of a cervix with visible cervical canals; type II (23%) featured an existing cervix with concealed cervical canals; and type III (24%) indicated cervical aplasia, which involves a blind end in the lower part of the uterine corpus. Haematometra was significantly more prevalent in patients with type I CCM than in those with type II (p < 0.001). There were three cervical signal patterns: no signal (27%), no evident layer differentiation (21%), and multi-layer differentiation with haematocele (52%). Most patients (94%) had complete vaginal atresia. Type I CCM patients had a higher likelihood of regaining normal uterovaginal anatomy compared to types II and III. CONCLUSIONS Our proposed PUMCH classification system has a high potential for enhancing the efficiency of clinical diagnosis among patients with CCM. CRITICAL RELEVANCE STATEMENT The proposed new PUMCH classification promised to elevate the conventional diagnostic trajectory for congenital cervical malformations, offering a valuable framework to refine the selection and planning of surgical interventions, thereby enhancing overall clinical efficacy. KEY POINTS Effective classification of congenital cervical malformations is desirable to optimise the diagnostic process. We presented a PUMCH classification of congenital cervical malformations using pelvic MRI. The new classification significantly aids clinical triage for congenital cervical malformations.
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Affiliation(s)
- Zhi-Lin Yuan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing Ren
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Meng-Lin Huang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Ya-Fei Qi
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xin Gao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yi-Ying Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.
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Vitale SG, Angioni S, D'Alterio MN, Ronsini C, Saponara S, De Franciscis P, Riemma G. Risk of endometrial malignancy in women treated for breast cancer: the BLUSH prediction model - evidence from a comprehensive multicentric retrospective cohort study. Climacteric 2024:1-7. [PMID: 39023103 DOI: 10.1080/13697137.2024.2376189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This study aimed to evaluate characteristics of endometrial surveillance in women treated for breast cancer to build a clinical prediction model. DESIGN A multicentric retrospective cohort study was conducted at two tertiary-care university hospitals from January 2020 to June 2023. Perimenopausal and postmenopausal women treated for breast cancer were categorized into two groups: patients with and without diagnosis of endometrial malignancy (endometrial carcinoma) or premalignancy (atypical endometrial hyperplasia). Characteristics of breast cancer and ultrasonographic and hysteroscopic examinations were compared. A prediction model for endometrial malignancy was built using logistic regression. Predictive accuracy was assessed using the receiver operating characteristic (ROC) curve and goodness of fit using the Hosmer-Lemeshow test. RESULTS One hundred and thirty-two (28 with premalignancy or malignancy and 104 without malignancy) women were analyzed. A nomogram was produced for prediction model development utilizing the presence and duration in months of abnormal uterine (BL)eeding, ultrasound (US) vascular pattern and echogenicity and (H)ysteroscopic appearance of endometrium (BLUSH) as determined by logistic regression. Sensitivity and specificity were 79.17% and 95.19%, respectively, with an area under ROC curve of 0.965, indicating good accuracy. Good goodness of fit and prediction stability were indicated by the calibration curve and Hosmer-Lemeshow test (χ2 = 26.36; p = 0.999). CONCLUSIONS Breast cancer survivors undergoing endometrial surveillance might benefit from a potentially useful prediction model based on hysteroscopic appearance, ultrasonographic uniformity of endometrium, Doppler flow and presence of abnormal uterine bleeding.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Carlo Ronsini
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Remy K, Raasveld FV, Saqr H, Khouri KS, Hwang CD, Austen WG, Valerio IL, Eberlin KR, Gfrerer L. The neuroma map: A systematic review of the anatomic distribution, etiologies, and surgical treatment of painful traumatic neuromas. Surgery 2024:S0039-6060(24)00368-4. [PMID: 39025690 DOI: 10.1016/j.surg.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND This study analyzed all reported cases of painful traumatic neuromas to better understand their anatomic distribution, etiologies, and surgical treatment. METHODS PubMed, Embase, Cochrane, and Web of Science were searched in October 2023 for articles describing painful traumatic neuromas. RESULTS In total, 414 articles reporting 5,562 neuromas were included and categorized into head/neck, trunk, upper extremity, lower extremity, and autonomic nerves. Distribution was as follows: Head/neck: 82 articles reported on 393 neuromas (93.2% iatrogenic) most frequently involving the lingual (44.3%), cervical plexus (14.9%), great auricular (8.5%), inferior/superior alveolar (8.3%), and occipital (7.2%) nerves. Trunk: 47 articles reported on 554 neuromas (92.9% iatrogenic) most commonly involving the intercostal (35.4%), genitofemoral (14.3%), and pudendal (12.9%) nerves. Upper extremity: 159 articles reported on 2079 neuromas (53.3% after amputation) most frequently involving the digital (46.9%), superficial radial (18.3%), and median (7.0%) nerves. Lower extremity: 128 articles reported on 2,531 neuromas (53.0% after amputation) most commonly involving the sural (17.9%), superficial peroneal (17.3%), and saphenous (16.0%) nerves. Autonomic nerves: 15 articles reported on 53 neuromas (100% iatrogenic) most frequently involving the biliary tract (73.9%) and vagus nerve (14.9%). Compared with the extremities, neuromas in the head/neck and trunk had significantly longer symptom duration before surgical treatment and the nerve end was significantly less frequently reconstructed after neuroma excision. CONCLUSION Painful neuromas are predominantly reported in the extremities yet may occur throughout the body primarily after iatrogenic injury. Knowledge of their anatomic distribution from head to toe will encourage awareness to avoid injury and expedite diagnosis to prevent treatment delay.
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Affiliation(s)
- Katya Remy
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Floris V Raasveld
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Hazem Saqr
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, PA
| | - Kimberly S Khouri
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - William G Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Dedden SJ, Maas JWM, Smeets NAC, van Hamont D, Groenman FA, Lim AC, van Vliet HAAM, van der Steeg JW, Leemans JC, Meijer P, van Kuijk SMJ, Huirne JAF, Bongers MY, Geomini PMAJ. Same-day discharge after laparoscopic hysterectomy for benign/premalignant disease: A multicentre randomised controlled trial. BJOG 2024. [PMID: 39020078 DOI: 10.1111/1471-0528.17911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To evaluate whether physical function and quality of life was influenced by discharge on the same-day after a total laparoscopic hysterectomy. DESIGN Multicentre non-inferiority randomised controlled trial. SETTING Five teaching hospitals and two university hospitals in the Netherlands. POPULATION Patients undergoing laparoscopic hysterectomy for benign or premalignant disease. METHODS Following informed consent, participants were allocated 1:1 either to same-day discharge (SDD) or next-day discharge (NDD). MAIN OUTCOME MEASURES The primary outcome was physical function at 7 days after surgery measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function short Form 10A. Secondary outcomes were physical function and quality of life at 1 and 3 days and 6 weeks after surgery measured with PROMIS short Form 10A and the EuroQol questionnaire (EQ-5D-5L). RESULTS Two hundred and five patients were included of whom 105 were allocated to SDD and 100 to NDD. Physical function 7 days after surgery was 35.95 in the SDD group and 35.63 in the control group (mean difference 0.32; 95% CI [0.07-0.57]). As the upper limit of the 95% CI does not exceed the non-inferiority margin of 4 points, non-inferiority of SDD could be demonstrated. No difference in physical function nor quality of life on Days 1 and 3 and 6 weeks could be found. CONCLUSION This research demonstrates same-day discharge after laparoscopic hysterectomy is non-inferior to next day discharge in physical function 7 days after surgery.
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Affiliation(s)
- Suzanne J Dedden
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Jacques W M Maas
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nicol A C Smeets
- Department of Obstetrics and Gynaecology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Freek A Groenman
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianne C Lim
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Huib A A M van Vliet
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jan Willem van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Jaklien C Leemans
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Patrick Meijer
- Department of Anaesthesiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
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Akhigbe RE, Afolabi OA, Adegbola CA, Akhigbe TM, Oyedokun PA, Afolabi OA. Comparison of the effectiveness of levonorgestrel intrauterine system and dienogest in the management of adenomyosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 300:230-239. [PMID: 39032312 DOI: 10.1016/j.ejogrb.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/12/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Adenomyosis is a gynaecological lesion that impairs female fertility and contributes to reduced quality of life. There are several surgical and medical options for the management of this lesion; however, women who wish to conceive opt for medical therapies such as the levonorgestrel intrauterine device (LNG-IUS) and dienogest, which have various outcomes. To date, there is no consensus regarding which is more effective. OBJECTIVES To compare the effectiveness of LNG-IUS and dienogest for the management of adenomyosis, and explore the risk of occurrence of known side effects for both treatments. DESIGN Systematic review and meta-analysis exploring the effectiveness of LNG-IUS and dienogest for the management of adenomyosis. METHODS A literature search was conducted using PICO guidelines and EMBASE, PubMed/MEDLINE, Scopus and Web of Science databases. Only clinical trials were collected and analysed. RESULTS Of the 792 studies that were initially identified, six were eligible for inclusion in this study. The studies included a total of 707 women; of these, 270 were treated with LNG-IUS, 354 were treated with dienogest, and 83 were controls. All the studies were from Asia (Bangladesh n = 1, China n = 2, India n = 1, Japan n = 1, South Korea n = 1). Dienogest was found to reduce pelvic pain significantly, evidenced by a lower visual analogue scale score, compared with LNG-IUS. Also, dienogest led to a significant reduction in uterine volume compared with LNG-IUS. However, subjects in the LNG-IUS group had significantly higher levels of haemoglobin than those in the dienogest group. Nonetheless, the occurrence of side effects such as weight gain, breast tenderness/distension, headache, insomnia/sleep disorder, depression/mood disorder, skin disorder/acne, and coital discomfort/reduced libido were comparable in both treatment groups. CONCLUSION Dienogest may be more effective than LNG-IUS for the management of adenomyosis, as it shows a superior effect in the reduction of pelvic pain and uterine volume. As only six studies were included in the present meta-analysis due to the paucity of data in the literature, it is recommended that well-designed randomized controlled trials comparing the effectiveness of dienogest with LNG-IUS should be conducted.
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Affiliation(s)
- R E Akhigbe
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria; Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria.
| | - O A Afolabi
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria; Department of Obstetrics and Gynaecology, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - C A Adegbola
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria; Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - T M Akhigbe
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria; Breeding and Genetics Unit, Department of Agronomy, Osun State University, Ejigbo, Osun State, Nigeria
| | - P A Oyedokun
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria; Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - O A Afolabi
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Du Q, Chen B, Zhang X, He H, Qin X, Li L, Du J, He X, Xu S, Xiaojie H. Effects of patient-based self-assessed fatigue intervention on early postoperative ambulation following gynaecological oncology surgery: a randomised controlled non-inferiority trial. BMJ Open 2024; 14:e078461. [PMID: 39019626 PMCID: PMC11256053 DOI: 10.1136/bmjopen-2023-078461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation. DESIGN Prospective randomised controlled trial. SETTING Single-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central Hospital, China. PARTICIPANTS Eligible were adult patients undergoing elective gynaecologic oncologic surgery. INTERVENTIONS The intervention group utilised a modified Borg Rating of Perceived Experience (RPE) scale for self-assessment of fatigue levels. The control group followed fixed-activity distance guidelines postoperatively. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the self-reported the time to first flatus postoperatively. Secondary outcomes encompassed the time to first defecation, incidence of moderate-to-severe abdominal distention, ileus, postambulation adverse events (nausea, vomiting and dizziness), patient satisfaction with early ambulation instructions, compliance with early ambulation and average hospital costs and length of stay. RESULTS Between June 2021 and October 2022, 552 patients were enrolled. The self-assessed fatigue intervention group demonstrated non-inferior the time to first flatus compared with the fixed-activity distance assessment group (25.59±14.59 hours vs 26.10±14.19 hours, pnon-inferiority<0.001). Compliance with activity was higher in the intervention group (49.40% vs 36.02%, p<0.001), although it did not reach 50%. The intervention group also exhibited significantly higher mean hospital costs, length of stay and incidence of moderate-to-severe abdominal distention (p<0.001). CONCLUSIONS The self-assessed fatigue intervention for early postoperative ambulation in gynaecologic oncology patients shows promise as an effective strategy; however, compliance is suboptimal. An intervention based on mandatory, yet reasonable, fixed-activity distance may represent the most viable current approach. Further research is warranted to confirm these findings. TRIAL REGISTRATION NUMBER CTR2100046035.
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Affiliation(s)
- Qian Du
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Bo Chen
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Evidence-Based Medicine Centre, Office of Academic Research, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaohong Zhang
- Department of Nursing, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Hong He
- Department of Nursing, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaomin Qin
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Lin Li
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Junyi Du
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xindi He
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Evidence-Based Medicine Centre, Office of Academic Research, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Huang Xiaojie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Ma Y, Ma J. Prevention of postpartum hemorrhage is essential for patients with placental diseases after hysteroscopic adhesiolysis. Am J Obstet Gynecol 2024:S0002-9378(24)00724-5. [PMID: 39025740 DOI: 10.1016/j.ajog.2024.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Yongdan Ma
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Jingmei Ma
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China.
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Toale C, Morris M, Roche A, Voborsky M, Traynor O, Kavanagh D. Development and validation of a simulation-based assessment of operative competence for higher specialist trainees in general surgery. Surg Endosc 2024:10.1007/s00464-024-11024-1. [PMID: 39020120 DOI: 10.1007/s00464-024-11024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Simulation is increasingly being explored as an assessment modality. This study sought to develop and collate validity evidence for a novel simulation-based assessment of operative competence. We describe the approach to assessment design, development, pilot testing, and validity investigation. METHODS Eight procedural stations were generated using both virtual reality and bio-hybrid models. Content was identified from a previously conducted Delphi consensus study of trainers. Trainee performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure-Based Assessment (PBA) tool. Validity evidence was analyzed in accordance with Messick's validity framework. Both 'junior' (ST2-ST4) and 'senior' trainees (ST 5-ST8) were included to allow for comparative analysis. RESULTS Thirteen trainees were assessed by ten assessors across eight stations. Inter-station reliability was high (α = 0.81), and inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004), while overall mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall's tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all 'senior' trainees passing and 4/6 of junior trainees failing the assessment. CONCLUSION This study reports validity evidence for a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland.
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
| | - Adam Roche
- SIM Centre for Simulation Education and Research, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland
| | - Miroslav Voborsky
- SIM Centre for Simulation Education and Research, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
| | - Dara Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
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Chene G, Parant F, Devouassoux-Shisheboran M, Trecourt A. Letter to the Editor: Cornual adenomyosis in Essure® device users and in patients hysterectomized for other causes-A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 39016244 DOI: 10.1002/ijgo.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
- University Claude Bernard of Lyon 1, EMR 3738 CICLY, Lyon, France
| | - François Parant
- Trace Element Analysis Laboratory, Biochemistry Department, CBAPS, Lyon-Sud University Hospital, Chemin du Grand-Revoyet, University Hospital of Lyon, Pierre-Benite, France
| | - Mojgan Devouassoux-Shisheboran
- Multi-Site Department of Pathology, Lyon Sud University Hospital, Chemin du Grand-Revoyet, University Hospital of Lyon, Pierre-Bénite, France
| | - Alexis Trecourt
- University Claude Bernard of Lyon 1, EMR 3738 CICLY, Lyon, France
- Multi-Site Department of Pathology, Lyon Sud University Hospital, Chemin du Grand-Revoyet, University Hospital of Lyon, Pierre-Bénite, France
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Chene G, Formont C, Sacdpraseuth A, Puyol L, Miguet-Bensouda C, Moret S, Cerruto E, Nohuz E. How to be sure of a complete removal of Essure® implant? A radiological study of Essure® microinserts. J Gynecol Obstet Hum Reprod 2024; 53:102823. [PMID: 39029659 DOI: 10.1016/j.jogoh.2024.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/12/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE Laparoscopic cornuectomy, one of the most performed surgical techniques to remove Essure® implants, is associated with a risk of fragmentation of the device. We aimed to assess the diagnostic accuracy of the intraoperative radiograph of the removed Essure® microinserts compared with intraoperative inspection of the device. STUDY DESIGN In this French retrospective cohort study including 66 patients, two experienced gynecologists and two residents evaluated the intraoperative radiograph in a blind manner. Diagnostic accuracy was calculated for each observer. RESULTS The global sensitivity and specificity for intraoperative radiograph to detect a residual fragment for both senior gynecologists and residents were, respectively 87.5 % (±3.3) and 80.0 % (+/12.2). Pooled positive (PPV) and negative predictive values (NPV) for intraoperative radiograph were respectively 99.2 % (±0.5) and 21.6 % (±6.4). There was a statistically significant difference in intraoperative radiograph analysis between senior gynecologists and residents (sensitivity: 91.4 %±0.8 vs 79.6 %±1.5, p = 0.02; specificity: 100% vs 50.0 %, p < 0.0001; PPV: 100 % vs 98.0 % ±0.1, p = 0.0007; NPV: 26.8 % ±1.8 vs 7.2 % ±0.5, p = 0.009). Sensitivity and specificity of the intraoperative inspection of the removal specimen was respectively 95.3 % and 100 % (PPV and NPV were, respectively 100 and 40 %). There were no statistically significant differences in diagnostic accuracy between intraoperative radiographs analysis and intraoperative inspection of the device for the senior gynecologists. CONCLUSIONS Intraoperative radiograph of the removed Essure® implants analysis is a difficult skill needing specific training. Postoperative pelvic X-ray is still recommended in clinical practice after laparoscopic cornuectomy.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France; Claude Bernard University of Lyon 1, EMR 3738, Lyon 69000, France.
| | - Charlotte Formont
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Aphynia Sacdpraseuth
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Lea Puyol
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Chloe Miguet-Bensouda
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, 59 boulevard Pinel, Lyon 69000, France
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Tordoff DM, Lunn MR, Flentje A, Atashroo D, Chen B, Dastur Z, Lubensky ME, Capriotti M, Obedin-Maliver J. Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth. Andrology 2024. [PMID: 39011578 DOI: 10.1111/andr.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/15/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood. OBJECTIVE Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP. MATERIALS AND METHODS We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map. RESULTS Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP. DISCUSSION AND CONCLUSIONS The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.
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Affiliation(s)
- Diana M Tordoff
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Diana Atashroo
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Urology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Matthew Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Psychology, San Jose State University, San Jose, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social vulnerability and surgery outcomes: a cross-sectional analysis. BMC Public Health 2024; 24:1907. [PMID: 39014400 PMCID: PMC11253435 DOI: 10.1186/s12889-024-19418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. METHODS In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. RESULTS Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. CONCLUSIONS Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
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Wong C, Booth SH, Thein OS, Sahal A. Thoracic endometrial syndrome with unilateral exudative pleural effusion. BMJ Case Rep 2024; 17:e261201. [PMID: 39013620 DOI: 10.1136/bcr-2024-261201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
A woman in her 40s presented with exertional dyspnoea with an absence of haemoptysis, cough, fever and weight loss. The patient had a medical history of extensive endometriosis. Investigations revealed a large right-sided pleural effusion. The effusion was aspirated and was exudative in nature.A contrast-enhanced CT thorax was performed to help exclude dual pathology. The only positive finding was bilateral breast nodules, subsequently found to be benign fibroadenomas on histological analysis of biopsy samples.After malignancy was ruled out as a cause, the patient was referred for medical thoracoscopy for a biopsy and other investigations. Histology demonstrated the presence of endometrial tissue in the pleura and thereby confirmed the diagnosis of thoracic endometrial syndrome.Video-assisted thoracoscopic surgery repair of diaphragm and talc pleurodesis was carried out in an uncomplicated procedure and the patient was discharged with good recovery.
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Affiliation(s)
- Carol Wong
- Respiratory, Birmingham City Hospital, Birmingham, UK
| | | | - Onn Shaun Thein
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Adeel Sahal
- Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Li J, Wei J, Chen S, Wang X, Chen J, Zeng D, Fan L. Prevalence and risk factors for chronic endometritis in patients with adenomyosis and infertility: a retrospective cohort study. BMC Womens Health 2024; 24:403. [PMID: 39014375 PMCID: PMC11251133 DOI: 10.1186/s12905-024-03245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND To explore the incidence of chronic endometritis (CE) in patients with infertility and different forms of adenomyosis and analyze potential high-risk factors for infection. METHODS This retrospective cohort study included 154 patients with infertility in the Liuzhou Maternity and Child Healthcare Hospital. Among them, 77 patients with adenomyosis were divided into four subgroups based on magnetic resonance imaging (MRI): internal, exterior, intramural, and full-thickness. Meanwhile, 77 patients did not have adenomyosis. Hysteroscopy and endometrial biopsy were performed in the proliferative phase. The main outcome measures were the morphology of the endometrium, syndecan-1 (CD138) immunohistochemical staining, clinical characteristics, and prevalence of CE in the adenomyosis subgroups. RESULTS In comparison to the non-adenomyosis group, the adenomyosis group had significantly higher body mass index (BMI) and CA125 levels. The menstrual cycle in the adenomyosis group was significantly shorter, and menarche was significantly earlier. In comparison to the non-adenomyosis group, the adenomyosis group had a significantly higher diagnostic rate of CE (75.3% vs. 46.8% according to hysteroscopy and 74.0% vs. 33.8% according to histopathology, both with p < .050). The incidence of CE was significantly lower in patients with internal adenomyosis when compared with the other three subgroups. Increased BMI contributed to a higher risk of CE. CONCLUSIONS The prevalence of CE was significantly higher in patients with adenomyosis and infertility. The differences in the incidence of CE are closely associated with the classification of adenomyosis. When patients with infertility are diagnosed with adenomyosis, it is recommended to identify the subtype and screen for endometritis.
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Affiliation(s)
- Jingjing Li
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Jiajia Wei
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Saiqiong Chen
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Xindan Wang
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Jing Chen
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Dingyuan Zeng
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China
| | - Li Fan
- Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi, China.
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Melcer Y, Revivo PE, Pekar-Zlotin M, Smorgick N, Maymon R. 3Dimensional sonography for the diagnosis of congenital uterine anomalies in women with eccentric pregnancy implantation: a novel approach. Arch Gynecol Obstet 2024:10.1007/s00404-024-07642-8. [PMID: 39008085 DOI: 10.1007/s00404-024-07642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The eccentric implantation of pregnancies in the upper lateral aspect of the uterine cavity is poorly defined clinically. The aim of the current study was to investigate whether differentiating between uterine anomalies that can lead to cavitary distortion has implications for the management of these pregnancies. METHODS Eight cases of first-trimester eccentric pregnancy implantation within the endometrial cavity (study group) were retrospectively identified. For each woman in the study group, 10 women identified as having a first-trimester concentric pregnancy implantation during the first-trimester US examination were retrieved from our database (control group). After delivery or pregnancy demise, the presence of uterine anomalies was assessed by a 3D-US examination in all patients. RESULTS In the study group patients, an increased incidence of uterine anomalies (50.0% vs. 8.8%, p = 0.007) was found, compared to the controls. In the study group, the eccentric location persisted in half of the pregnancies (n = 4; 50%), whereas the other half migrated to a more centric location within the endometrial cavity (n = 4; 50%). The follow-up examination showed that all the early pregnancy demises occurred in cases where the pregnancy persisted at the eccentric location. Uterine malformations were also detected in all these cases. CONCLUSION The data point to a significantly higher incidence of uterine anomalies in patients diagnosed with eccentric pregnancy implantation within the endometrial cavity. These results advocate for the value of differentiating between eccentric pregnancies in non-anomalous versus anomalous uteri.
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Affiliation(s)
- Yaakov Melcer
- Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel.
| | - Perry Eliassi Revivo
- Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel
| | - Marina Pekar-Zlotin
- Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel
| | - Noam Smorgick
- Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel
| | - Ron Maymon
- Faculty of Medical and Health Sciences, Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the School of Medicine, Tel Aviv University, 70300, Tel Aviv, Zerifin, Israel
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Chen YC, Zuo N, Li MY, Zhang NN. Diagnosis and treatment of disseminated peritoneal leiomyomatosis implanted in the trocar site of a previous laparoscopic surgery. Int J Gynaecol Obstet 2024. [PMID: 39007428 DOI: 10.1002/ijgo.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
SynopsisLaparoscopy combined with retrieval bag is an effective method for disseminated peritoneal leiomyomatosis that can prevent the spreading of tumor fragments.
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Affiliation(s)
- Yong-Chang Chen
- The Second Clinical College of China Medical University, Shenyang, China
| | - Na Zuo
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meng-Yuan Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ning-Ning Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Maki J, Mitoma T, Ooba H, Nakato H, Mishima S, Tani K, Eto E, Yamamoto D, Yamamoto R, Kai K, Tamada T, Akamatsu K, Kawanishi K, Masuyama H. Barbed versus conventional sutures for cesarean uterine scar defects: A randomized clinical trial. Am J Obstet Gynecol MFM 2024:101431. [PMID: 39019212 DOI: 10.1016/j.ajogmf.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/08/2024] [Accepted: 06/15/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The role of barbed sutures in preventing myometrial defects and enhancing postpartum outcomes after cesarean section is uncertain. OBJECTIVE This study compared clinical and ultrasonographic outcomes of uterine scar defects after C-section with barbed and conventional smooth thread sutures. STUDY DESIGN This was a multicenter, parallel-group, randomized, controlled clinical trial. Four obstetrics and gynecology departments across three Japanese healthcare regions were included. The participants were women requiring their first cesarean delivery between May 2020 and March 2023. Of the 1211 participants enrolled, 298 underwent cesarean section and 253 were followed-up until July 2023. Participants with singleton pregnancies were randomly assigned (1:1 ratio) to receive either conventional or spiral thread sutures with a double-layer continuous suture. The study period comprised the time of consent to the 6- to 7-month examination. The primary endpoint was the rate of scar niches >2 mm evaluated using transvaginal ultrasonography at 6 to 7 months after surgery. Additional metrics included the total operative time, suture application time, operative blood loss, number of additional sutures required for hemostasis, maternal surgical complications, postoperative infections, surgeon's years of experience, and individual subscale scores. RESULTS All data of the 220 participants (barbed suture group: 110; conventional suture group: 110) were available, thus enabling a full analysis set. A comparison of the barbed and conventional suture groups, respectively, revealed the following: niche length, 2.45±1.65 mm (range: 1.0-6.7) versus 3.79±1.84 mm (range: 1.0-11.0) (P<0.001); niche depth, 1.78±1.07 mm (range: 1.0-5.7) versus 2.70±1.34 mm (range: 1.0-7.3) (P<0.001); residual myometrial thickness, 8.46±1.74 mm (range: 4.8-13.0) versus 7.07±2.186 mm (range: 2.2-16.2) (P<0.001); and niche width, 1.58±2.73 mm (range: 0.0-14.0) versus 2.88±2.36 mm (range: 0.0-11.0) (P<0.001), respectively. The barbed suture group exhibited no defects and a residual myometrial thickness <3 mm. Furthermore, the barbed suture group had a lower rate of uterine niches (29.1%; n=32/110) than the conventional suture group (68.2%; n=75/110). Secondary outcomes showed no significant differences in operative times, maternal surgical complications, or postoperative complications. CONCLUSIONS Double-layer barbed sutures during cesarean delivery may prevent cesarean section scar defects and postoperative complications.
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Affiliation(s)
- Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hikaru Ooba
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hikari Nakato
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Sakurako Mishima
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Dan Yamamoto
- Department of Obstetrics and Gynecology, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okino-kamicho, Fukuyama City, Hiroshima 720-8520, Japan
| | - Risa Yamamoto
- Department of Obstetrics and Gynecology, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okino-kamicho, Fukuyama City, Hiroshima 720-8520, Japan
| | - Kenji Kai
- Department of Obstetrics and Gynecology, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okino-kamicho, Fukuyama City, Hiroshima 720-8520, Japan
| | - Takashi Tamada
- Department of Obstetrics and Gynecology, Iguchi Perinatal and Obstetrics and Gynecology Hospital, 71-4 Kambe-cho, Fukuyama City, Hiroshima 720-2122, Japan
| | - Kazuyo Akamatsu
- Department of Obstetrics and Gynecology, Iguchi Perinatal and Obstetrics and Gynecology Hospital, 71-4 Kambe-cho, Fukuyama City, Hiroshima 720-2122, Japan
| | - Kunihiro Kawanishi
- Department of Obstetrics and Gynecology, Yashima General Hospital, 2105-17 Yashima-Nishi-machi, Takamatsu City, Kagawa 761-0113, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Lorentzen GM, Łaniewski P, Cui H, Mahnert ND, Mourad J, Borst MP, Willmott L, Chase DM, Roe DJ, Herbst-Kralovetz MM. Cervicovaginal Metabolome and Tumor Characteristics for Endometrial Cancer Detection and Risk Stratification. Clin Cancer Res 2024; 30:3073-3087. [PMID: 38687603 PMCID: PMC11247321 DOI: 10.1158/1078-0432.ccr-23-2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/02/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Endometrial cancer is highly prevalent and lacking noninvasive diagnostic techniques. Diagnosis depends on histological investigation of biopsy samples. Serum biomarkers for endometrial cancer have lacked sensitivity and specificity. The objective of this study was to investigate the cervicovaginal environment to improve the understanding of metabolic reprogramming related to endometrial cancer and identify potential biomarker candidates for noninvasive diagnostic and prognostic tests. EXPERIMENTAL DESIGN Cervicovaginal lavages were collected from 192 participants with endometrial cancer (n = 66) and non-malignant conditions (n = 108), and global untargeted metabolomics was performed. Using the metabolite data (n = 920), we completed a multivariate biomarker discovery analysis. RESULTS We analyzed grade 1/2 endometrioid carcinoma (n = 53) and other endometrial cancer subtypes (n = 13) to identify shared and unique metabolic signatures between the subtypes. When compared to non-malignant conditions, downregulation of proline (P < 0.0001), tryptophan (P < 0.0001), and glutamate (P < 0.0001) was found among both endometrial cancer groups, relating to key hallmarks of cancer including immune suppression and redox balance. Upregulation (q < 0.05) of sphingolipids, fatty acids, and glycerophospholipids was observed in endometrial cancer in a type-specific manner. Furthermore, cervicovaginal metabolites related to tumor characteristics, including tumor size and myometrial invasion. CONCLUSIONS Our findings provide insights into understanding the endometrial cancer metabolic landscape and improvement in diagnosis. The metabolic dysregulation described in this article linked specific metabolites and pathophysiological mechanisms including cellular proliferation, energy supply, and invasion of neighboring tissues. Furthermore, cervicovaginal metabolite levels related to tumor characteristics, which are used for risk stratification. Overall, development of noninvasive diagnostics can improve both the acceptability and accessibility of diagnosis.
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Affiliation(s)
- Georgia M. Lorentzen
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- Department of Biology & Biochemistry, University of Bath, Bath, United Kingdom.
| | - Paweł Łaniewski
- Department of Basic Medical Sciences, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
| | - Haiyan Cui
- UA Cancer Center, University of Arizona, Tucson, Arizona.
| | - Nichole D. Mahnert
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- Banner–University Medical Center, Phoenix, Arizona.
| | - Jamal Mourad
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- Banner–University Medical Center, Phoenix, Arizona.
| | - Matthew P. Borst
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- Banner–University Medical Center, Phoenix, Arizona.
| | | | | | - Denise J. Roe
- UA Cancer Center, University of Arizona, Tucson, Arizona.
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
| | - Melissa M. Herbst-Kralovetz
- Department of Obstetrics and Gynecology, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- Department of Basic Medical Sciences, College of Medicine–Phoenix, University of Arizona, Phoenix, Arizona.
- UA Cancer Center, University of Arizona, Tucson, Arizona.
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Lewin J, Vashisht A, Hirsch M, Al-Wattar BH, Saridogan E. Comparing the treatment of endometriosis-related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study. BJOG 2024. [PMID: 39010306 DOI: 10.1111/1471-0528.17910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms. DESIGN Multicentre prospective cohort. SETTING Eighty-six specialist endometriosis centres. POPULATION Women undergoing rectovaginal endometriosis surgery between 2009 and 2021. METHODS We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow-up. MAIN OUTCOME MEASURES Pain scores, bowel symptoms and quality-of-life measures. RESULTS Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non-cyclical pain (MD: 1.41/10, 95% CI: 1.03-1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71-1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92-1.67, p < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79-11.75, p < 0.001) at 24 months post-operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non-cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80-2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59-1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77-1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07-15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non-cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32-1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56-6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow-up. CONCLUSIONS Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow-up.
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Affiliation(s)
- Jonathan Lewin
- University College London Hospital, London, UK
- Institute for Women's Health, University College London, London, UK
| | - Arvind Vashisht
- University College London Hospital, London, UK
- Institute for Women's Health, University College London, London, UK
| | - Martin Hirsch
- John Radcliffe Hospital, Oxford University Hospital Foundation Trust, Oxford, UK
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Bassel H Al-Wattar
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, Carshalton, UK
- Comprehensive Clinical Trials Unit, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Ertan Saridogan
- University College London Hospital, London, UK
- Institute for Women's Health, University College London, London, UK
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Jahanfar S, Mortazavi J, Lapidow A, Cu C, Al Abosy J, Ciana H, Morris K, Steinfeldt M, Maurer O, Bohang J, Anjali Oberoi R, Ali M. Assessing the impact of hormonal contraceptive use on menstrual health among women of reproductive age - a systematic review. EUR J CONTRACEP REPR 2024:1-31. [PMID: 39007750 DOI: 10.1080/13625187.2024.2373143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Contraceptive methods are well-established in their ability to prevent pregnancy and increase individual agency in childbearing. Evidence suggests that contraceptives can also be used to treat adverse conditions associated with menstruation, including abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders.This review investigates the effects of contraceptive techniques such as contraceptive pills, and long-acting reversible contraceptives (e.g. intrauterine devices, implants) on menstrual morbidity. METHODS Over ten databases with no geographical boundaries were searched from inception until October 2023. Study designs were one of the following types to be included: parallel or cluster randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies, cohort or longitudinal analyses, regression discontinuity designs, and case-control studies. Ten team members screened the papers in pairs with a Kappa score of more than 7, and Covidence was used. Conflicts were resolved by discussion, and the full papers were divided among the reviewers to extract the data from eligible studies. RESULTS Hormonal contraceptives are considered a well-tolerated, non-invasive, and clinically effective treatment for abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders. Our studies investigating quality of life or well-being in women with heavy menstrual bleeding, endometriosis, or uterine fibroids have found improvements in all dimensions assessed. CONCLUSIONS Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids.
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Affiliation(s)
- Shayesteh Jahanfar
- Affiliate of Cochrane, US, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Julie Mortazavi
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Amy Lapidow
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cassandra Cu
- School of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jude Al Abosy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Hartman Ciana
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Morris
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Meredith Steinfeldt
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Olivia Maurer
- School of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jiang Bohang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kapurubandara S, Baekelandt J, Laws P, King J. Adoption of vaginally assisted natural orifice transluminal endoscopic surgery for hysterectomy: A single tertiary experience. Aust N Z J Obstet Gynaecol 2024. [PMID: 39007484 DOI: 10.1111/ajo.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/23/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery. AIMS To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital. MATERIALS AND METHODS Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes. RESULTS The median age of the first 20 participants was 51.5 years (47-57 years of age) and the median body mass index was 33.5 kg/m2 (27.8-38.3 kg/m2). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1-3) where four patients were nulliparous. The median blood loss was 125 mL (100-200 mL) with an operative time of 149 min (138-198 min) and median weight of the specimen of 181.5 g (66.5-219 g). The mean length of stay was 1.4 days (1-2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases. CONCLUSIONS VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised.
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Affiliation(s)
- Supuni Kapurubandara
- University of Sydney, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney West Area Pelvic Surgical Unit (SWAPS), Sydney, New South Wales, Australia
| | - Jan Baekelandt
- The Department of Gynecological Oncology and Minimally Invasive Surgery, Imelda Hospital, Bonheiden, Belgium
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Patrick Laws
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jenny King
- University of Sydney, Sydney, New South Wales, Australia
- Pelvic Floor Unit, Westmead Hospital, Sydney, New South Wales, Australia
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Guloglu H, Cetinkaya D, Oge T, Bilir A. Evaluation of the effect of trendelenburg position duration on intracranial pressure in laparoscopic hysterectomies using ultrasonographic optic nerve sheath diameter measurements. BMC Anesthesiol 2024; 24:238. [PMID: 39010013 PMCID: PMC11247807 DOI: 10.1186/s12871-024-02624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND During laparoscopic surgery, pneumoperitoneum and Trendelenburg positioning applied to provide better surgical vision can cause many physiological changes as well as an increase in intracranial pressure. However, it has been reported that cerebral autoregulation prevents cerebral edema by regulating this pressure increase. This study aimed to investigate whether the duration of the Trendelenburg position had an effect on the increase in intracranial pressure using ultrasonographic optic nerve sheath diameter (ONSD) measurements. METHODS The near infrared spectrometry monitoring of patients undergoing laparoscopic hysterectomy was performed while awake (T0); at the fifth minute after intubation (T1); at the 30th minute (T2), 60th minute (T3), 75th minute (T4), and 90th minute (T5) after placement in the Trendelenburg position; and at the fifth minute after placement in the neutral position (T6). RESULTS The study included 25 patients. The measured ONSD values were as follows: T0 right/left, 4.18±0.32/4.18±0.33; T1, 4.75±0.26/4.75±0.25; T2, 5.08±0.19/5.08±0.19; T3, 5.26±0.15/5.26±0.15; T4, 5.36±0.11/5.37±0.12; T5, 5.45±0.09/5.48±0.11; and T6, 4.9±0.24/4.89±0.22 ( p < 0.05 compared with T0). ). No statistical difference was detected in all measurements in terms of MAP, HR and ETCO2 values compared to the T0 value (p > 0.05). CONCLUSIONS It was determined that as the Trendelenburg position duration increased, the ONSD values increased. This suggests that as the duration of Trendelenburg positioning and pneumoperitoneum increases, the sustainability of the mechanisms that balance the increase in intracranial pressure becomes insufficient. TRIAL REGISTRATION This study was registered at Clinical Trials.gov on 21/09/2023 (registration number NCT06048900).
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Affiliation(s)
- Hulya Guloglu
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
| | - Dilek Cetinkaya
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye.
| | - Tufan Oge
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
| | - Ayten Bilir
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
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Le NT, Brandt ML, Majumder MA. An Ethical Framework for Disclosing the Training Status and Roles of Resident-Level Surgeons to Patients. JOURNAL OF SURGICAL EDUCATION 2024:S1931-7204(24)00293-9. [PMID: 39013670 DOI: 10.1016/j.jsurg.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/11/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
The concept of informed consent includes disclosure of all information that a reasonable patient would need to make a well-informed decision about whether to undergo a surgical procedure. This has traditionally been defined as including diagnosis, details about the procedure, prognosis, potential risks, and alternative treatments. The operating surgeon has final say and responsibility for the case, but the actual operation may be done (under supervision) by a surgeon in training. In this paper, we discuss the ethical dimensions of disclosing resident involvement, reviewing considerations such as established legal and professional standards, consequences for patients and for the surgical educators responsible for preparing future generations of surgeons, and patient rights. We conclude by offering a novel ethical framework intended to serve as a guide to disclosing resident involvement as part of the overall consent process.
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Affiliation(s)
- Nhon T Le
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Mary L Brandt
- Michael E. DeBakey Department of Surgery and Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
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137
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Twidale EK, Neutens S, Hynt L, Dudley N, Streeton C. Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial. Aust N Z J Obstet Gynaecol 2024. [PMID: 39007504 DOI: 10.1111/ajo.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/23/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic. AIMS To study the efficacy and safety of methoxyflurane analgesia during OPH. MATERIALS AND METHODS A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of 'distress'. RESULTS During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite. CONCLUSIONS Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.
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Affiliation(s)
- Emily K Twidale
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Sofie Neutens
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Lyn Hynt
- Department of Computing and Mathematical Sciences, The University of Waikato, Hamilton, New Zealand
| | - Narena Dudley
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Catherine Streeton
- Department of Gynaecology, Abortion and Contraception Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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138
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Tsai NC, Hsiao YY, Su YT, Lin YJ, Kung FT, Chen PH, Lan KC. The efficacy of early office hysteroscopy in preventing intrauterine adhesions after abortion: a randomized controlled trial. BMC Womens Health 2024; 24:400. [PMID: 39003483 PMCID: PMC11245785 DOI: 10.1186/s12905-024-03247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/05/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. METHODS A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. RESULTS The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. CONCLUSIONS Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .
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Affiliation(s)
- Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
| | - Yu-Yang Hsiao
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Yu-Ting Su
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Ping-Ho Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan.
- Department of Obstetrics and Gynecology, Jen-Ai Hospital, Taichung, 41257, Taiwan.
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139
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Polan RM, Ali-Fehmi R, Grace AK, Mattei LH, Tanner EJ, Morris RT. Occult residual ovarian tissue at the time of minimally invasive risk reducing surgery in women with BRCA mutations. Gynecol Oncol 2024; 189:37-40. [PMID: 39003959 DOI: 10.1016/j.ygyno.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To describe extension of ovarian tissue beyond visible and National Comprehensive Cancer Network recommended margins among patients with BRCA mutations undergoing minimally invasive risk-reducing salpingo-oophorectomy. METHODS A prospective study of patients with BRCA mutations who underwent minimally invasive risk-reducing bilateral salpingo-oophorectomy was conducted. Patient enrollment occurred between October 2021 and 2023. Tissue specimens were analyzed according to the Sectioning and Extensively Examining the Fimbriated End protocol. RESULTS Twenty women with BRCA mutations were prospectively enrolled. All patients underwent minimally invasive surgery with 70% undergoing concurrent hysterectomy (n = 14). Approximately half of these procedures were performed with robotic assistance (n = 9, 45%). One patient was admitted overnight (5%); the other nineteen were discharged on the day of surgery (95%). One patient experienced a major complication and required readmission (5%). Extension of ovarian tissue beyond the visible ovary was noted on pathologic examination of six specimens (30%). In one patient this was observed on the left (17%), in three on the right (50%), and in two bilateral extension (33%) was noted. The distance ovarian stroma extended microscopically beyond the visible ovary was between 2 and 14 mm, with a median of 5 mm. Among patients with microscopic extension of ovarian tissue, the majority (n = 5, 83%) had a BRCA2 mutation. CONCLUSION In women with BRCA mutations undergoing risk-reducing minimally invasive surgery, approximately one third had microscopic extension of ovarian stroma beyond the visible ovary. Current guidelines which recommend resection of at least 20 mm of tissue beyond the visible ovary are likely adequate in this population.
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Affiliation(s)
- Rosa M Polan
- Department of Gynecologic Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
| | - Rouba Ali-Fehmi
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Anne K Grace
- Department of Gynecologic Oncology, Northwestern Prentice Women's Hospital, Chicago, IL, USA
| | - Larissa H Mattei
- Department of Gynecologic Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Edward J Tanner
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Robert T Morris
- Department of Gynecologic Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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140
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Manuscript Checklist. J Endod 2024:S0099-2399(24)00302-9. [PMID: 39007795 DOI: 10.1016/j.joen.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the OHStat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials (CONSORT), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and CONSORT harms guidelines and incorporate the SAMPL guidelines for reporting statistics, the CLIP principles for documenting images, and the GRADE indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental research into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research.
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Affiliation(s)
- A M Best
- School of Dentistry and Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virgina
| | - T A Lang
- University of Chicago Medical Writing Program, Chicago, Illinois
| | - B L Greenberg
- Epidemiology and Biostatistics, Touro College of Dental Medicine at New York Medical College, Valhalla, New York
| | - J C Gunsolley
- School of Dentistry, Virginia Commonwealth University, Richmond, Virgina
| | - E Ioannidou
- University of California San Francisco School of Dentistry, San Francisco, California.
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141
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Ji H, Zhou Q, Zhang S, Dong L, Zhao C, Ling XF. Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38993171 DOI: 10.1002/ijgo.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To evaluate the optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) following hysteroscopic polypectomy. METHODS This was a retrospective clinical cohort study involving 464 patients who underwent their first FET after polyp resection between January 2021 and July 2023. The cohorts were categorized into three groups: the natural cycle (NC) group (n = 139), the ovarian induction (OI) group (n = 117), and the hormone replacement therapy (HRT) group (n = 208). RESULTS In the initial unadjusted analysis, both NC and OI cycles exhibited similar pregnancy rates but were associated with significantly higher implantation rate (56.5%, 57.1% vs 42.0%, P < 0.001), clinical pregnancy rate (73.4%, 74.4% vs 57.2%, P = 0.001), and ongoing pregnancy rate (OPR; 67.6%, 63.2% vs 51.0%, P = 0.005) compared to the HRT group. Additionally, the three groups demonstrated comparable abortion rate (7.8%, 14.9% vs 10.9%, P = 0.299). After adjusting for potential confounders in the multiple logistic regression model, the HRT protocol resulted in a 54% significantly lower OPR compared to the NC protocol (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI]: 0.28-0.77; P = 0.003). Meanwhile, the OPR difference between the OI protocol and the NC protocol remained insignificant (OI vs NC: aOR = 0.62, 95% CI: 0.35-1.12; P = 0.112). CONCLUSION The ovulatory-FET scheme (NC and OI) following hysteroscopic polyp resection displayed promising clinical outcomes compared with HRT-FET scheme. The regimen without exogenous estrogen administration should be prioritized for endometrial preparation protocol after polypectomy.
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Affiliation(s)
- Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Qiao Zhou
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Song Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Li Dong
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Xiu-Feng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
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142
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Kamata M, Fusegi A, Kurihara N, Abe A, Nomura H, Kanao H. Effects of tumor spillage prevention in laparoscopic radical hysterectomy for early-stage cervical cancer: a propensity score-matched analysis. J Gynecol Oncol 2024; 36:36.e22. [PMID: 39028154 DOI: 10.3802/jgo.2025.36.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/08/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE Minimally invasive radical hysterectomy has a worse prognosis than open surgery, but the reasons for the poor prognosis remain unclear. Tumor spillage occurs when the tumor is exposed to the surgical field and has been suggested to be related to a poor prognosis. This study aimed to compare the prognostic value of tumor spillage in laparoscopic radical hysterectomy and evaluate whether tumor spillage prevention improves oncological safety. METHODS We compared the prognosis of patients who underwent laparoscopic radical hysterectomy between December 2014 and November 2021 with or without tumor spillage prevention, including surgeries without prevention and those with failed prevention. Prevention consisted of vaginal cuff formation or closure of the vaginal canal with clips to prevent tumor exposure at the time of colpotomy. The primary endpoint was disease-free survival, which was adjusted using propensity scores to compare patients. RESULTS In total, 165 patients received tumor spillage prevention, and 61 did not or failed to receive such prevention. The median follow-up was 4.4 years. Patients who did not undergo prevention or failed prevention had significantly shorter disease-free survival than those who did (hazard ratio [HR]=3.54; 95% confidence interval [CI]=1.23-10.23). The same trend was observed after adjusting for propensity score matching. Patients who did not or failed to receive prevention were more likely to experience local recurrence (HR=4.01; 95% CI=1.13-14.24). CONCLUSION Tumor spillage prevention was associated with longer disease-free survival in laparoscopic radical hysterectomy.
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Affiliation(s)
- Mayumi Kamata
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Nozomi Kurihara
- Department of Clinical Planning and Strategy, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
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143
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Manuscript Checklist. J Dent Res 2024:220345241247028. [PMID: 38993043 DOI: 10.1177/00220345241247028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the OHStat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials (CONSORT), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and CONSORT harms guidelines and incorporate the SAMPL guidelines for reporting statistics, the CLIP principles for documenting images, and the GRADE indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental research into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research.
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Affiliation(s)
- A M Best
- School of Dentistry and Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - T A Lang
- University of Chicago Medical Writing Program, Chicago, IL, USA
| | - B L Greenberg
- Epidemiology and Biostatistics, Touro College of Dental Medicine at New York Medical College, Valhalla, NY, USA
| | - J C Gunsolley
- School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - E Ioannidou
- University of California San Francisco School of Dentistry, San Francisco, CA, USA
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144
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Dolci C, Kerbage Y, Ruffolo AF, Candiani M, Gandon A, Rubod C. Protective defunctioning stoma in bowel segmental resection at the time of total hysterectomy for endometriosis: when less is more. Arch Gynecol Obstet 2024:10.1007/s00404-024-07629-5. [PMID: 38995389 DOI: 10.1007/s00404-024-07629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To compare postoperative complications in women undergoing total hysterectomy with segmental resection (TH-SR) for intestinal endometriosis with or without protective defunctioning stoma (PDS) confection. METHODS Retrospective cohort study conducted at the Gynecologic department of University Hospital of Lille (France) from January 2008 to January 2022 in patients undergone TH-SR for bowel endometriosis. RESULTS 100 women were considered for the analysis. PDS were performed in 56 women. The rate of rectal resections was significantly higher in the PDS group (p = 0.03). The mean operative time, AAGL scores and length of hospital stay were significantly higher in the PDS group (p = 0.002). The rate of grade III complication according to Clavien-Dindo classification was higher in the PDS group (p = 0.03). Among digestive complications, one case of anastomosis leakage (1.8%) and one case of recto-vaginal fistula (2.3%) was recorded in the non-PDS group, 4 cases of anastomosis stenosis were recorded in the PDS group (7.1%). Persisting bladder atony requiring self-catheterization over one month was the most common disturb (4.6% in the non-PDS group and 7.1% in the PDS group, p = 0.58). The distance of digestive lesion from anal margin was the only risk factor for digestive complications, persistent bladder atony, Clavien-Dindo IIIA and IIIB complications at the multivariate analysis (p = 0.04 and p = 0.06 respectively). CONCLUSION No statistically significant differences were found in the rate of digestive complications in case of total hysterectomy and concomitant segmental resection when performing or not preventing stoma.
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Affiliation(s)
- Carolina Dolci
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France.
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Yohan Kerbage
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
| | | | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Anne Gandon
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
| | - Chrystèle Rubod
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
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145
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: manuscript checklist. J Am Dent Assoc 2024:S0002-8177(24)00315-5. [PMID: 39001724 DOI: 10.1016/j.adaj.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the OHStat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials (CONSORT), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and CONSORT harms guidelines and incorporate the SAMPL guidelines for reporting statistics, the CLIP principles for documenting images, and the GRADE indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental research into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research.
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146
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The Oral Health Statistical Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Manuscript Checklist. J Oral Maxillofac Surg 2024:S0278-2391(24)00585-8. [PMID: 39033786 DOI: 10.1016/j.joms.2024.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the Oral Health Statistical (OHStat) Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and Consolidated Standards for Reporting Trials harms guidelines and incorporate the SAMPL guidelines for reporting statistics, the CLIP principles for documenting images, and the GRADE indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental researches into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research.
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Affiliation(s)
- Al M Best
- Professor Emeritus, School of Dentistry and Department of Biostatistics, School of Medicine, Virginia, Commonwealth University, Richmond, VA
| | - Thomas A Lang
- Adjunct Faculty, University of Chicago Medical Writing Program
| | - Barbara L Greenberg
- Adjunct Professor, Epidemiology and Biostatistics, Touro College of Dental Medicine at New York Medical College, Valhalla, NY
| | - John C Gunsolley
- Professor Emeritus, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - E Ioannidou
- Professor and Chair of Orofacial Sciences, UCSF School of Dentistry, San Francisco, CA.
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147
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Lin PW, Chern CU, Li CJ, Lin PH, Tsui KH, Lin LT. Improvement of early miscarriage rates in women with adenomyosis via oxytocin receptor antagonist during frozen embryo transfer-a propensity score-matched study. Reprod Biol Endocrinol 2024; 22:79. [PMID: 38997744 PMCID: PMC11241821 DOI: 10.1186/s12958-024-01255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Dysfunctional uterine peristalsis seems to play a pivotal role in hindering embryo implantation among women diagnosed with adenomyosis. This research aims to investigate whether administering an oxytocin receptor antagonist during a frozen embryo transfer (FET) cycle using a hormone replacement therapy (HRT) protocol can enhance in vitro fertilization (IVF) outcomes for infertile women affected by adenomyosis. METHODS Between January 2018 and June 2022, our reproductive center conducted IVF-FET HRT cycles for infertile women diagnosed with adenomyosis. Propensity score matching was employed to select matched subjects between the two groups in a 1:1 ratio. Following this, 168 women received an oxytocin receptor antagonist during FET, constituting the study group, while the matched 168 women underwent FET without this antagonist, forming the control group. We conducted comparative analyses of baseline and cycle characteristics between the two groups, along with additional subgroup analyses. RESULTS The study group exhibited notably lower rates of early miscarriage compared to the control group, although there were no significant differences in clinical pregnancy rates, ongoing pregnancy rates, and live birth rates between the two groups. Multivariate analysis revealed a negative correlation between the use of oxytocin receptor antagonists and early miscarriage rates in women with adenomyosis. Subgroup analyses, categorized by age, infertility types, and embryo transfer day, showed a substantial decrease in early miscarriage rates within specific subgroups: women aged ≥ 37 years, those with secondary infertility, and individuals undergoing day 3 embryo transfers in the study group compared to the control group. Furthermore, subgroup analysis based on adenomyosis types indicated significantly higher clinical pregnancy rates, ongoing pregnancy rates and live birth rates in the study group compared to the control group among women with diffuse adenomyosis. CONCLUSIONS Administering an oxytocin receptor antagonist during FET may reduce the early miscarriage rates in women with adenomyosis.
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Affiliation(s)
- Po-Wen Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan
| | - Chyi-Uei Chern
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan
| | - Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan
| | - Pei-Hsuan Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung City, Taiwan
- Institute of Biopharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan.
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Institute of Biopharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
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148
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Cao SY, Fan Y, Zhao CY, Zhang YF, Mu Y, Li JK. Comparison of recurrence and survival between patients with pathological stage I epithelial ovarian cancer after laparoscopic or laparotomic surgery: retrospective analysis of a propensity-matched cohort. J Minim Invasive Gynecol 2024:S1553-4650(24)00303-0. [PMID: 39004184 DOI: 10.1016/j.jmig.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To compare oncologic outcomes after laparoscopic or laparotomic surgery to treat epithelial ovarian carcinoma in FIGO stage I. DESIGN Retrospective cohort study. SETTING Gynecological cancer ward in a tertiary hospital. PARTICIPANTS A total of 85 patients with FIGO stage I epithelial ovarian carcinoma who underwent laparoscopic staging surgery and 206 who underwent laparotomic staging surgery at West China Second Hospital, Sichuan University (Chengdu, China) between January 1, 2013 and December 31, 2019. INTERVENTIONS laparoscopic surgery or laparotomic staging surgery. RESULTS Before propensity score-based matching, the laparotomy group showed higher prevalence of preoperative elevated CA125 level (48.5% vs 35.3%, p = .045) and tumors > 15 cm (27.2% vs 5.9%, p < .001). Multivariate analysis associated higher body mass index with better overall survival (adjusted HR 0.83, 95%CI 0.70-0.99, p = .043). Among propensity score-matched patients (82 per group) who were matched to each other according to propensity scoring based on age, body mass index, CA125 level, largest tumor diameter, FIGO stage, history of abdominal surgery, and American Society of Anesthesiologists grade, the rate of progression-free survival at 5 years was similar between the laparoscopy group (87.1%, 95%CI 79.3-95.7%) and the laparotomy group (90.9%, 95%CI 84.7-97.6%, p = .524), as was the rate of overall survival at 5 years (93.9%, 95%CI 88.0-100.0% vs 94.7%, 95%CI 89.8-99.9%, p = .900). Regardless of whether patients were matched, the two groups showed similar rates of recurrence of 9-11% during follow-up lasting a median of 54.9 months. CONCLUSIONS Rates of recurrence and survival may be similar between laparoscopy or laparotomy to treat stage I epithelial ovarian cancer. Since laparoscopy is associated with less bleeding and faster recovery, it may be a safe, effective alternative to laparotomy for appropriate patients.
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Affiliation(s)
- Si-Yu Cao
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yu Fan
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Cheng-Yu Zhao
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yu-Fei Zhang
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yi Mu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Jin-Ke Li
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China.
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149
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Ramadan A, Etrusco A, D'Amato A, Laganà AS, Chiantera V, Zgheib C, Shoucair H, Alakrah W, Yared G, Sleiman Z. Evaluation of the benefit of indocyanine green as an educational and practical tool for ureteral identification in laparoscopic pelvic surgery: a cross-sectional study. MINIM INVASIV THER 2024:1-9. [PMID: 38995862 DOI: 10.1080/13645706.2024.2376837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Indocyanine green (ICG) is a visible near-infrared fluorescent dye. Several studies have reported its benefit in identifying important anatomical structures, tissue vascularization, and sentinel lymph nodes in the case of tumors. Studies have shown that ICG is critical and safe in gynecologic surgeries. However, research on how ICG dye can help surgeons in laparoscopic surgeries correctly identify the course of the ureter has yet to be further investigated. METHOD This cross-sectional study enrolled 62 gynecology attending and resident surgeons who were asked to identify the course of the ureter on images of laparoscopic surgeries. The results were then compared with images in which ICG dye highlighted the course of the ureter. The purpose of this study was to detect the ability of surgical assistants and residents to adequately identify the course of the ureter in laparoscopic pelvic surgeries. RESULTS No statistically significant differences were found in terms of year of residency, years of experience, number of laparoscopic procedures attended, and correct identification of ureter course. ICG proved useful in identifying the correct ureteral trajectory. CONCLUSIONS ICG can be a valuable tool to improve the correct identification of ureters and improve surgical outcomes.
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Affiliation(s)
- Aya Ramadan
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, 'Paolo Giaccone' Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio D'Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari 'Aldo Moro', Policlinico of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, 'Paolo Giaccone' Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Christelle Zgheib
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Hassan Shoucair
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Warda Alakrah
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Georges Yared
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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150
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Wood NJ, Kasoff MR, Muluk SL, Wang R, Tunitsky-Bitton E, Sappenfield EC. The fate of the abstract: presentation and publication characteristics of abstracts presented at the Society of Gynecologic Surgeons Annual Scientific Meetings 2013-2020. J Minim Invasive Gynecol 2024:S1553-4650(24)00304-2. [PMID: 39002658 DOI: 10.1016/j.jmig.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To evaluate what proportion of abstracts presented at the Society of Gynecologic Surgeons (SGS) Annual Scientific Meetings went on to be published in publicly available journals. DESIGN Retrospective observational study SETTING: Single organization PARTICIPANTS: Abstracts (oral presentations, oral posters, video presentations, non-oral posters) presented at the SGS Annual Scientific Meeting from 2013-2020 INTERVENTIONS: Variables were collected pertaining to abstract authors, study type, timing of the session presented, and journal factors. To identify possible publication, abstracts were cross-referenced in PubMed and Google Scholar. MEASUREMENTS AND MAIN RESULTS A total of 912 abstracts were reviewed: 155 oral presentations, 184 oral posters, 79 video presentations, and 490 non-oral posters. 45.8% of abstracts went on to publication in a peer-reviewed journal. Most abstracts (75.0%) were published from institutions with a fellowship presence and at a university-based program (71.5%). The five most represented institutions presented 27.5% of all abstracts during an SGS session. Oral presentations were more likely than oral posters to be structured as randomized controlled trials (20% vs 9%, p=.028), and to be published in a journal with a higher impact factor (6.36 ± 11.74 vs. 3.88 ± 2.72, p=.031). Type of presentation and fellowship presence significantly affected the likelihood of abstract publication (oral presentation OR 0.73, 95% CI [0.466, 1.141], p=0.167; video OR 0.14, 95% CI [0.075, 0.261; non-oral poster OR 0.30, 95% CI [0.204, 0.439]; p<.001; fellowship OR 1.62, 95% CI [1.167, 2.237], p=.004). CONCLUSION Over eight years of the SGS Annual Scientific Meeting, the rate of abstract publication was 45.8%. Abstract origination from an academic institution with a fellowship program significantly affected the likelihood of publication. Abstract presentation at a society meeting is a prestigious opportunity, and prioritization of resources and elimination of barriers should be encouraged to further promote progression of these projects to publication.
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Affiliation(s)
- Nicole J Wood
- Hartford Hospital, Department of Urogynecology. 85 Seymour St, Suite 525, Hartford, CT 06106. U.S.A..
| | - Madison R Kasoff
- University of Connecticut, Department of Obstetrics and Gynecology. 263 Farmington Ave, Farmington, CT 06030. U.S.A..
| | - Sruthi L Muluk
- University of Connecticut, Department of Obstetrics and Gynecology. 263 Farmington Ave, Farmington, CT 06030. U.S.A..
| | - Rui Wang
- Princeton Urogynecology, Department of Obstetrics and Gynecology, Penn Medicine Princeton Medical Center. 10 Forrestal Rd S #205, Princeton, NJ 08540. U.S.A..
| | - Elena Tunitsky-Bitton
- Hartford Hospital, Department of Urogynecology. 85 Seymour St, Suite 525, Hartford, CT 06106. U.S.A..
| | - Elisabeth C Sappenfield
- Hartford Hospital, Department of Urogynecology. 85 Seymour St, Suite 525, Hartford, CT 06106. U.S.A..
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