Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety

BACKGROUND

In this study, the impact of a multimodal integrative oncology pre- and intraoperative intervention on pain and anxiety among patients undergoing gynecological oncology surgery was explored.

METHODS

Study participants were randomized to three groups: Group A received preoperative touch/relaxation techniques, followed by intraoperative acupuncture; Group B received preoperative touch/relaxation only; and a control group (Group C) received standard care. Pain and anxiety were scored before and after surgery using the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR-15) questionnaires, using Part B of the QOR to assess pain, anxiety, and other quality-of-life parameters.

RESULTS

A total of 99 patients participated in the study: 45 in Group A, 25 in Group B, and 29 in Group C. The three groups had similar baseline demographic and surgery-related characteristics. Postoperative QOR-Part B scores were significantly higher in the treatment groups (A and B) when compared with controls (p = .005), including for severe pain (p = .011) and anxiety (p = .007). Between-group improvement for severe pain was observed in Group A compared with controls (p = .011). Within-group improvement for QOR depression subscales was observed in only the intervention groups (p <0.0001). Compared with Group B, Group A had better improvement of MYCAW-reported concerns (p = .025).

CONCLUSIONS

A preoperative touch/relaxation intervention may significantly reduce postoperative anxiety, possibly depression, in patients undergoing gynecological oncology surgery. The addition of intraoperative acupuncture significantly reduced severe pain when compared with controls. Further research is needed to confirm these findings and better understand the impact of intraoperative acupuncture on postoperative pain.

PLAIN LANGUAGE SUMMARY

Integrative oncology programs are increasingly becoming part of supportive/palliative care, with many working within the Society for Integrative Oncology. This study examined the impact of a multimodal integrative oncology program on pain and anxiety among 99 patients undergoing gynecological oncology surgery. Participants were randomized to three groups: preoperative touch/relaxation treatments, followed by intraoperative acupuncture; preoperative touch/relaxation without acupuncture; and a control group receiving standard care only. The preoperative touch/relaxation intervention significantly reduced perioperative anxiety, with the addition of intraoperative acupuncture significantly reducing severe pain as well, when compared with controls. Further research is needed to confirm these findings.

[GESTATIONAL TROPHOBLASTIC DISEASE: THE NEED FOR CENTRALIZATION OF TREATMENT CENTERS IN ISRAEL]

Gestational trophoblastic disease comprises a spectrum of pregnancy-related disorders, consists of premalignant disorders of complete and partial hydatidiform mole, and malignant disorders such as invasive mole, choriocarcinoma, and the rare placental-site trophoblastic tumor/epithelioid trophoblastic tumor. These malignant forms are termed Gestational Trophoblastic Neoplasia (GTN). Until the early 1960's, hysterectomy was the treatment of choice for women with malignant trophoblastic diseases. The five-year survival rate was 40% for local disease, and around 20% in women with metastases. Chemotherapy, treatment according to the various risk factors and the use of β-hCG values as a marker for monitoring the disease, resulted in a cure rate exceeding 98%, while preserving patient's fertility. Due to its` extremely low incidence with relatively complex treatment protocols, in the presence of high potential for side effects, in most countries there are tertiary centers that coordinate the treatment and follow-up of these diseases. In this review, we will summarize strategies for the primary management of gestational trophoblastic disease, the evaluation and management of malignant gestational trophoblastic neoplasia (GTN) and surveillance after treatment.

Group B Streptococcus real-time PCR may potentially reduce intrapartum maternal antibiotic treatment

BACKGROUND

Protocols for preventing early-onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real-time polymerase chain reaction (PCR) can provide a result within 30-60 min and has been found to be specific and sensitive for defining intrapartum GBS status.

OBJECTIVE

To evaluate whether implementation of GBS fast real-time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics.

METHODS

This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35-37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real-time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration.

RESULTS

Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real-time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1).

CONCLUSIONS

Compared with antepartum universal culture screening or intrapartum risk-factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real-time PCR, without compromising the sensitivity of GBS detection.

Maternal and Neonatal SARS-CoV-2 Immunoglobulin G Antibody Levels at Delivery After Receipt of the BNT162b2 Messenger RNA COVID-19 Vaccine During the Second Trimester of Pregnancy

IMPORTANCE

BNT162b2 messenger RNA (mRNA) COVID-19 vaccination in the third trimester was found to be associated with a strong maternal humoral IgG response that crossed the placenta and approached maternal titers in the newborn.

OBJECTIVE

To evaluate maternal and neonatal SARS-CoV-2 immunoglobulin G (IgG) antibody levels at birth after mRNA COVID-19 vaccination during the second trimester of pregnancy.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study, conducted at a single medical center in Haifa, Israel, from May to July 2021, included women with a singleton pregnancy over 24 weeks of gestation at least 7 days after receipt of their second COVID-19 vaccine dose who were not known to be previously infected with COVID-19.

EXPOSURES

BNT162b2 (Pfizer/BioNTech) vaccination.

MAIN OUTCOMES AND MEASURES

The primary outcomes were SARS-CoV-2 IgG antibody titers measured in the parturient at admission and in the umbilical cord blood within 30 minutes after delivery. Secondary outcomes were the correlation between antibody titers, feto-maternal characteristics, maternal adverse effects after vaccination, and time interval from vaccination to delivery.

RESULTS

Antibody levels were measured for 129 women (mean [SD] age, 31.9 [4.9] years) and 114 neonates, with 100% of the tests having positive results. The mean (SD) gestational age at administration of the second vaccine dose was 24.9 (3.3) weeks. Neonatal IgG titers were 2.6 times higher than maternal titers (median [range], 3315.7 [350.1-17 643.5] AU/mL vs 1185.2 [146.6-32 415.1] AU/mL). A positive correlation was demonstrated between maternal and neonatal antibodies (r = 0.92; 95% CI, 0.89-0.94). Multivariable analysis revealed that for each week that passed since receipt of the second vaccine dose, maternal and neonatal antibody levels changed by -10.9% (95% CI, -17.2% to -4.2%; P = .002) and -11.7% (95% CI, -19.0 to -3.8%; P = .005), respectively. For each 1-year increase in the mother's age, maternal and neonatal antibody levels changed by -3.1% (95% CI, -5.3% to -0.9%; P = .007) and -2.7% (95% CI, -5.2% to -0.1%; P = .04), respectively.

CONCLUSIONS AND RELEVANCE

In this cohort study, receipt of the BNT162b2 mRNA COVID-19 vaccine during the second trimester of pregnancy was associated with maternal and neonatal humoral responses, as reflected in maternal and neonatal SARS-CoV-2 IgG antibody levels measured after delivery. These findings support COVID-19 vaccination of pregnant individuals during the second trimester to achieve maternal protection and newborn safety during the pandemic.

[PARP INHIBITORS FOR ADJUVANT TREATMENT FOR OVARIAN CANCER]

Treatment for ovarian cancer has been challenging for many years. It is composed of debulking surgery and chemotherapy. During the first line of treatment most patients are sensitive to primary platinum-based chemotherapy, however, unfortunately, most of them will suffer from recurrence in 36 months. About 20-25% of ovarian cancer patients exhibit a germ line mutation in the pathway of double strand DNA repair including BRCA. Poly ADP ribose polymerase inhibitors (PARP Inhibitors) may inhibit enzymes responsible for single strand DNA repair, thus leaving the BRCA mutated cell without a repair mechanism for DNA damage leading to synthetic lethality. Recently, phase 3 studies have shown that ovarian cancer patients with recurrent, platinum sensitive disease who were treated with PARP inhibitors have shown statistically significant improvement in progression free survival. A recent pivotal trial has shown the addition of PARP inhibitor, as a maintenance treatment after first line chemotherapy to ovarian cancer patients with BRCA mutation, had significantly increased the progression-free survival. The side effect profile of PARP inhibitors was tolerable and manageable, although they should be well familiar to care givers. Following these studies, the FDA and the European authorities granted an accelerated approval for the use of PARP inhibitors as maintenance treatment after first line treatment, for BRCA carriers, and at the recurrence for platinum sensitive patients. Subsequently, it was added to the benchmark medications for recurrent platinum sensitive BRCA carriers (germ line or somatic) by the Ministry of Health in Israel. The future seams to provide new combination treatments of PARP inhibitors with immunological agents and vascular endothelial growth factors inhibitors aiming to improve the poor prognosis of ovarian cancer patients.

Social interaction context shapes emotion recognition through body language, not facial expressions

The social context-seeing people emotionally interacting-is one of the most common contexts in which emotion perception occurs. Despite its importance, emotion perception of social interactions from a 3rd-person perspective is poorly understood. Here we investigated whether emotion recognition of fear and anger is facilitated by mere congruency (the contextual figure exhibits the same emotion as the target) or by functional relations (the contextual figure exhibits a complementary emotion to the target). Furthermore, we examined which expression channel, face or body, drives social context effects. In the 1st 2 experiments (Studies 1a and 1b), participants in an online survey platform (N = 146) or university students (N = 34), viewed interacting figures displaying fear or anger, presented either as faces, bodies, or both. Participants were instructed to categorize the target figure's emotions while the other figure served as context. Results showed that fear recognition was facilitated by an interacting angry figure more strongly than by an interacting fearful figure. Moreover, this effect occurred when participants viewed the figures' bodies (with or without the faces), but not when they viewed the figures' faces alone. A 3rd online experiment (Study 2) established that this context effect was stronger when participants (N = 464) watched the figures interacting (facing each other) than when figures were not interacting (facing away from each other), suggesting that social context influences emotion perception by revealing the interactants' relation. Our findings demonstrate that emotional perception is grounded in the broader process of social interaction and highlight the role of the body in interpersonal context effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Synthesis and characterization of functionalized magnetic maghemite nanoparticles with fluorescent probe capabilities for biological applications

Nanoparticles with innovative optical, chemical, and magnetic properties combined in a single nanoparticle may be useful as biosensors, targeting agents, and therapeutic agents in the biomedical field. This study describes new magnetic nanoparticles (MNPs) containing the fluorescent dye rhodamine isothiocyanate (RITC) covalently encapsulated within the nanoparticles. These nanoparticles have been prepared by nucleation followed by controlled growth of iron oxide layers onto iron oxide/gelatin-RITC nuclei. The formed RITC labeled MNPs (R-MNPs) are of narrow size distribution, exhibit the fluorescent spectrum of RITC, yet are more photostable. Because of the covalent encapsulation of RITC within the MNPs no detectable leakage of the fluorescent dye into the aqueous continuous phase was observed. This manuscript also demonstrates that the surface of the R-MNPs retains similar ligand binding efficiency as the equivalent nonfluorescent MNPs. Specific cell labeling was obtained by incubating glia cells with R-MNPs conjugated to glial cell line-derived neurotrophic factor (GDNF) protein. We further showed that the R-MNPs may be used for pH sensing between the pH range of 5 and 9. This feature may enable the use of the R-MNPs as a pH sensor of animal tissues and cell compartments. Thus, these functional narrow size distribution R-MNPs with both magnetic and fluorescent properties may provide an important research tool for biological sensing.

On improved calibrations of unknowns in a system of quality-controlled assays

Two new estimators for calibrating unknowns from dose-response curves, in a system of quality-controlled assays, are examined. In contrast with the conventional estimator which uses only the results of the one assay in which the response of the unknown dose is measured, the new estimators also utilize the results of all other assays through the replications of the control samples in the system. The first estimator is based on maximizing the likelihood of the given system (with respect to the different dose-response parameters, the levels of the control samples and the levels of the unknowns) when response errors are normally distributed. The second estimator is a regression-like estimator obtained by subtracting from the conventional estimator its estimated regression on the deviation of the calibrated control levels in the given assay from their average values in the system. Evaluations of the reductions in bias and variance attained by the new estimators show when substantial reductions in mean square error can be expected. The new estimators are illustrated with a system of 22 hFSH radioimmunoassays.