From Infection to Malignancy: Tracing the Impact of Human Papillomavirus on Uterine Endometrial Cancer in a Nationwide Population-Based Cohort Study.

Uterine endometrial cancer (EC) is the most common gynecological malignancy in Taiwan. This study aimed to investigate the association between human papillomavirus (HPV) infection and the development of uterine EC among Taiwanese women. A nationwide population cohort research approach was employed, leveraging longitudinal health insurance databases (LHID 2007 and 2015) from the National Health Insurance Research Database alongside data from the Taiwan Cancer Registry datasets. A comparative analysis examined 472,420 female patients with HPV infection and 944,840 without HPV infection. The results demonstrated that the HPV cohort exhibited a significantly elevated risk of uterine EC, as evidenced by an adjusted hazard ratio (aHR) of 1.588 (95% CI: 1.335-1.888). Furthermore, this elevated risk extended to type 1 EC with an aHR of 1.671 (95% CI: 1.376-2.029), specifically the endometrioid adenocarcinoma subtype with an aHR 1.686 (95% CI: 1.377-2.065). Importantly, these findings were statistically significant (p < 0.001). In conclusion, this research unveils a potential association between HPV infection and an increased risk of uterine EC, particularly the type 1 endometrial cancer subtype, within the Taiwanese female population. These findings have implications for preventive measures and screening programs targeting HPV infection to reduce the risk of this prevalent gynecological malignancy in Taiwan.

ß-catenin inhibitor ICG-001 suppress cell cycle progression and induce autophagy in endometrial cancer cells.

The incidence of endometrial cancer has been rising in recent years. Gene mutation and high protein expression of ß-catenin are commonly detected in endometrioid endometrial cancer. ICG-001 is a ß-catenin inhibitor via blocking the complex formation of ß-catenin and cAMP response element-binding protein (CREB)-binding protein (CBP). This study aims to investigate the effect of ICG-001 on endometrial cancer inhibition. First, endometrial carcinoma patient-derived xenograft (PDX)-derived organoids and primary cells were used to verify the inhibiting ability of ICG-001 on endometrial cancer. Furthermore, endometrial cancer cell lines were used to investigate the anticancer mechanism of ICG-001. Using MTT assay and tumor spheroid formation assay, ICG-001 significantly reduced the cell viability of HEC-59 and HEC-1A cells. ICG-001 enhanced cisplatin-mediated cytotoxicity. ICG-001 decreased cancer stem cell sphere formation. ICG-001 decreased the protein expressions of CD44, hexokinase 2 (HK2), and cyclin A. ICG-001 lowered the cell cycle progression by flow cytometer analysis. Autophagy, but no apoptosis, was activated by ICG-001 in endometrial cancer cells. Autophagy inhibition by ATG5 silencing enhanced ICG-001-mediated suppression of cell viability, tumor spheroid formation, and protein expression of cyclin A and CD44. This study clarified the mechanism and revealed the clinical potential of ICG-001 against endometrial cancer.

Induction of immunogenic cell death effect of licoricidin in cervical cancer cells by enhancing endoplasmic reticulum stress-mediated high mobility group box 1 expression.

Licoricidin (LCD) is an activity compound of the roots of Glycyrrhiza uralensis, which has therapeutic efficacy, including anti-virus, anti-cancer, and enhanced immunity in Traditional Chinese Medicine. Herein, this study aimed to clarify the effect of LCD on cervical cancer cells. In the present study, we found that LCD significantly inhibited cell viability via inducing cell apoptosis and companies with cleaved-PARP protein expression and caspase-3/-9 activity. Cell viability was markedly reversed these effects by pan-caspase inhibitor Z-VAD-FMK treatment. Furthermore, we showed that LCD-induced ER (endoplasmic reticulum) stress triggers upregulating the protein level of GRP78 (Bip), CHOP, and IRE1α, and subsequently confirmed the mRNA level by quantitative real-time polymerase chain reaction. In addition, LCD exhibited the release of danger-associated molecular patterns from cervical cancer cells, such as the release of high-mobility group box 1 (HMGB1), secretion of ATP, and exposure of calreticulin (CRT) on the cell surface, which led to immunogenic cell death (ICD). These results provide a novel foundation that LCD induces ICD via triggering ER stress in human cervical cancer cells. LCD might be an ICD inducer of immunotherapy in progressive cervical cancer.

Combination treatment with cyclosporin A and arsenic trioxide induce synergistic cell death via non-apoptotic pathway in uterine cervical cancer cells.

Cyclosporin A is an immunosuppressive drug with anti-cancer effect. Arsenic trioxide (As2O3), a well-known cancer-inhibiting drug, induced cytotoxicity via apoptosis and autophagy. The aim of this study is to evaluate the effect of combinational treatment with cyclosporin A and arsenic trioxide on cell viability inhibition in cervical cancer cells. Using MTT assay and combination index, combinational treatment with cyclosporin A and arsenic trioxide induced a synergistic cytotoxic effect in Caski and SiHa cells. Cyclosporin A and arsenic trioxide triggered cell death via non-apoptotic pathway by using annexin V/propidium iodide (PI) assay. Cyclosporin A and arsenic trioxide combined treatment decreased mitochondrial membrane potential and increase reactive oxygen species (ROS) generation. This co-treatment increased LC3B-II expression and autophagosome formation in cervical cancer cells. This study first demonstrated that combinational treatment with cyclosporin A and As2O3 trigger synergistic cytotoxic effect via autophagy in cervical cancer cells.

Angelol-A exerts anti-metastatic and anti-angiogenic effects on human cervical carcinoma cells by modulating the phosphorylated-ERK/miR-29a-3p that targets the MMP2/VEGFA axis.

AIMS: Angelol-A (Ang-A), a kind of coumarins, is isolated from the roots of Angelica pubescens f. biserrata. However, AA exerts antitumor effects and molecular mechanism on cervical cancer cells is unknown. MAIN METHODS: Cell viability was determined using the MTT assay, and the cell cycle phase was assessed by PI staining with flow cytometry. Ang-A-treated cells with/without Antago-miR-29a-3p (miR-29a-3p inhibitor) or U0126 (MEK inhibitor) were assessed for the expression of miR-29a-3p, in vitro migration/invasion, and angiogenesis using qRT-PCR, a chemotaxis assay, and tube formation assay, respectively. The expression of mitogen-activated protein kinases/MMP2/MMP9/VEGFA was determined by western blot analysis with applicable antibodies. KEY FINDINGS: Ang-A significantly inhibited MMP2 and VEGFA expression, cell migration, and invasive motility in human cervical cancer cells. Conditioned medium inhibited tube formation in HUVECs. Ang-A principally inhibited invasive motility and angiogenesis by upregulating the expression of miR-29a-3p that targets the VEGFA-3' UTR. The role of miR-29a-3p was confirmed using Antago-miR-29a-3p, which reversed the Ang-A-inhibited expression of MMP2 and VEGFA, invasive motility, and angiogenesis in human cervical cancer cells. The ERK pathway was implicated in mediating the metastatic and angiogenic action of Ang-A. Combined treatment with Ang-A treated and U0126 exerted a synergistic inhibitory effect on the expression of MMP2 and VEGFA and the metastatic and angiogenic properties of human cervical cancer cells. SIGNIFICANCE: These findings are the first to indicate that in human cervical cancer cells, Ang-A exerts anti-metastatic and anti-angiogenic effects via targeting the miR-29a-3p/MMP2/VEGFA axis, mediated through the ERK pathway.

Timosaponin AIII Inhibits Migration and Invasion Abilities in Human Cervical Cancer Cells through Inactivation of p38 MAPK-Mediated uPA Expression In Vitro and In Vivo.

Cervical cancer is one of the most common gynecologic cancers globally that require novel approaches. Timosaponin AIII (TSAIII) is a steroidal saponin that displays beneficial effects in antitumor activities. However, the effect of TSAIII on human cervical cancer remains unknown. In this study, we found that TSAIII showed no influence on cell viability, cytotoxicity, cell cycle distribution and apoptosis induction in human cervical cancer cells. TSAIII was revealed to have a significant inhibitory effect on cell migration and invasion through the downregulation of invasion-related uPA expression and p38 MAPK activation in both human cervical cancer cells and cervical cancer stem cells (CCSCs), indicating that the p38 MAPK-uPA axis mediated the TSAIII-inhibited capacity of cellular migration and invasion. In a synergistic inhibition assay, a TSAIII plus p38 siRNA cotreatment revealed a greater inhibition of uPA expression, migration and invasion in human cervical cancer cells. In an immunodeficient mouse model, TSAIII significantly inhibited lung metastases from human cervical cancer SiHa cells without TSAIII-induced toxicity. These findings first revealed the inhibitory effects of TSAIII on the progression of human cervical cancer through its downregulation of p38 MAPK-uPA axis activation. Therefore, TSAIII might provide a potential strategy for auxiliary therapy in human cervical cancer.

Different Influences of Endometriosis and Pelvic Inflammatory Disease on the Occurrence of Ovarian Cancer.

To compare the rate and risk of ovarian cancer in patients with endometriosis or pelvic inflammatory disease (PID). A nationwide population cohort research compared the risk of ovarian cancer in 135,236 age-matched comparison females, 114,726 PID patients, and 20,510 endometriosis patients out of 982,495 females between 1 January 2002 and 31 December 2014 and ended on the date of confirmation of ovarian cancer, death, or 31 December 2014. In order to reduce the unbalanced characteristics, propensity score matching (PSM) was performed for 20,478 females in each subgroup. The incidence rate (per 100,000 person-years) of ovarian cancer was 8.74 (95% CI, 7.16-10.66) in comparison, 9.26 (7.54-11.39) in PID, and 28.73 (21.07-39.16) in endometriosis cohorts. The adjusted hazard ratio (aHR) of ovarian cancer was 1.17 (p = 0.296) in PID and 3.12 (p < 0.001) in endometriosis cohorts, compared with the comparison cohort in full cohort, using the multiple Cox regression model. The aHR of ovarian cancer was 0.83 (p = 0.650) in PID and 3.03 (p = 0.001) in endometriosis cohorts, compared with the comparison cohort after performing PSM. In the full cohort and PSM population, the cumulative incidence rate of ovarian cancer was significantly higher in patients with endometriosis than in those with PID or in the comparison cohort (p < 0.001 and p < 0.001). In conclusion, after considering the differences in the impacts of exposure to endometriosis or PID, patients with endometriosis were more likely to develop ovarian cancer.

The impact of Aurora kinase A genetic polymorphisms on cervical cancer progression and clinicopathologic characteristics.

The aims of this study were to explore the involvement of Aurora kinase A (AURKA) gene single nucleotide polymorphisms (SNPs) in uterine cervical cancer that has not yet been investigated. One hundred and six patients with cervical invasive cancer and 94 patients with precancerous lesions, and 302 Taiwanese female individuals were included. AURKA SNPs rs2273535, rs6024836, rs2064863 and rs1047972 were analyzed for genotypic distributions using real-time polymerase chain reaction. There were no statistically significant differences in the genetic frequencies of AURKA SNPs among patients with invasive cancer and those with precancerous lesions of uterine cervix and control women. There were no associations among AURKA SNPs and clinicopathologcal variables and recurrence and survival events. However, in a multivariate analysis, cervical cancer patients with adenocarcinoma (HR: 3.18, 95% CI: 1.23-8.23; p=0.017) and larger tumor (HR: 5.61, 95% CI: 2.10-14.95; p=0.001) had poorer recurrence-free survival. In conclusion, tumor size and pelvic lymph node status rather than AURKA SNPs were the most obvious independent parameter that could significantly predict 5 years survival rate in Taiwanese women with cervical cancer.

An early moderate recommendation for energy intake based on nutritional status and clinical outcomes in patients with cancer: A retrospective study.

OBJECTIVES: We investigated the nutritional status and clinical outcomes of patients with cancer based on their energy intake after nutritional recommendations. METHODS: This study was a retrospective study. Body weight, nutritional status, dietary intake, and clinical outcomes were collected from medical records. We assessed the data according to energy intake: <50% of the recommended intake was insufficient energy intake (IEI group), 50% to 79% was moderate energy intake (MEI group), and ≥80% was adequate energy intake (AEI group). RESULTS: A total of 111 patients with cancer were enrolled in the present study. After nutritional recommendation, the number of subjects in the IEI and MEI groups were significantly decreased as patients shifted to the after-AEI group (P < 0.01). A significantly high proportion of patients had lower malnutrition universal screening tool and patient-generated subjective global assessment scores in the after-AEI group (P < 0.01). Subjects in the after-MEI and after-AEI groups showed slight gains in body weight (P = 0.07) and positively correlated with the energy (ß = 0.05; P = 0.07) and protein intake (ß = 0.04; P = 0.01). Significantly low proportions of patients with cancer died during hospitalization in the after-MEI and after-AEI groups, but significantly high proportions of patients with cancer in the after-MEI and after-AEI groups reached their ideal body weight (P = 0.03) compared with that in the after-IEI group. CONCLUSIONS: Patients with cancer who comply with a moderate energy intake recommendation (50%-79%) within at least 28 d may limit body weight decrease and improve nutritional status and clinical outcomes.

Engineering Antifouling and Antibacterial Stainless Steel for Orthodontic Appliances through Layer-by-Layer Deposition of Nanocomposite Coatings.

In this study, a nanocomposite coating composed of polydopamine, functionalized poly(3,4-ethylenedioxythiophene) (PEDOT), and silver nanoparticles (AgNPs) was synthesized through layer-by-layer deposition. Biomimitic polydopamine and hydroxyl-functionalized PEDOT were used to enhance the adhesion strength. The deposition of PEDOT functionalized with zwitterionic phosphorylcholine can contribute to the antifouling property. After immersion in the AgNO3 solution, Ag+ ions were adsorbed on PEDOT films and further reduced to form AgNPs spontaneously, which conferred antibacterial properties on these nanocomposite films. Escherichia coli and Streptococcus mutans were chosen to represent two common Gram-negative and Gram-positive oral pathogens. We further conducted inductively coupled plasma mass spectrometry to confirm that the Ag+ ions released from these nanocomposite films did not exert adverse effects on the human body. These results suggested that, when applied to stainless steel orthodontic appliances, these durable antifouling and antibacterial coatings may be useful for avoiding bacterial infection.

Combined treatment for big submucosal myoma with High Intensity Focused Ultrasound and hysteroscopic resection.

OBJECTIVE: Big submucosal myoma often causes heavy menstrual bleeding and are complicated in hysterscopic surgery. High Intensity Focused Ultrasound (HIFU), is a method for myoma ablation therapy, which may benefit on size reduction, and assist following hysterscopic myomectomy. CASE REPORT: Two cases, case one,. 44-year-old female with 3.8 cm submucosal myoma, STEPW (Size, Topography, Extension, Penetration and Wall) score 6 and case 2. 48-year-old female, with 6.0 cm submucosal myoma, STEPW score 8, both received HIFU treatment before hysterscopic myomectomy was done. The myomas reduced after 5 months with improvement of anemia. The following hysterscopic myomectomy shows less operative time and fewer blood loss. CONCLUSION: HIFU reduce size of submucosal myoma and may improve anemia after months. Less operating time and blood loss were demonstrated in the following hysterscopic myomectomy. For well selected patients, combined treatment with HIFU and hysteroscopic resection may decrease complication rate.

Intravenous leiomyomatosis of the uterus: A clinicopathological analysis of nine cases and literature review.

OBJECTIVE: Intravenous/intravascular leiomyomatosis is characterized by intravenous proliferation of a histologically benign smooth muscle cell tumor mass that is non-tissue-invasive. Although benign, intravenous leiomyomatosis may cause remarkable systematic complications, presents significant diagnostic difficulties, and also is characterized by a relatively increased possibility of recurrence. We determine patients' characteristics, and recurrence and treatment of intravenous leiomyomatosis. MATERIALS AND METHODS: Prognostic factors are analyzed with univariate analysis. Differences in categorical data are evaluated by the X2 test. A P value below 0.05 is regarded as indicating a significant difference. RESULTS: The data results accord with the widely held view that complete excision of intravenous leiomyomata achieves favorable prognoses regarding remission. The efficacy of using Gonadotropin releasing hormone agonists to prevent growth or recurrence of tumors in unresected or incompletely resected intravenous leiomyomatosis foci. CONCLUSION: If complete surgical resection is not possible, partial resection followed by hormone therapy using gonadotropin-releasing hormone agonists is recommended, which in this study achieved the same favorable prognosis with regard to remission.

Accessibility and surgical outcomes of transumbilical single-port laparoscopy using straight instruments for hysterectomy in difficult conditions.

OBJECTIVES: To evaluate the accessibility of transumbilical single-port laparoscopy for hysterectomy in difficult conditions. MATERIALS AND METHODS: This prospective observational study recruited patients with benign diseases who were scheduled for laparoscopic hysterectomy between March 2010 and October 2011 to undergo the transumbilical single-port approach with straight instruments and a laparoscope. RESULTS: In total, 109 patients were included with a mean [± standard error of the mean (SEM)] age of 45.9 ± 0.4 years and mean body mass index of 23.9 ± 0.3 kg/m(2). The yielded mean uterine weight was 403.4 ± 25.3 g, with 28 (25.7%) weighing ≥500 g, including four specimens >1000 g, and 44 (40.4%) needed concurrent adhesiolysis. The operative time was 117.2 ± 4.2 minutes, estimated blood loss was 270.3 ± 22.9 mL, and the postoperative hospital stay was 2.8 ± 0.1 days. Patients with a uterus weighing ≥500 g had a higher intraoperative blood loss in comparison with those with a uterus weighing <500 g (375.4 ± 55.3 mL vs. 234.0 ± 23.0 mL; p < 0.05) and a higher incidence of blood transfusion (17.9% and 6.2%, respectively). The single-port approach was abandoned in four (3.7%) patients with severe pelvic adhesion--an additional port was opened for extensive adhesiolysis. None of the patients with a voluminous uterus needed an additional port. There were no major intraoperative or postoperative complications. CONCLUSION: The single-port approach using straight, conventional laparoscopic instruments was feasible and safe in the majority of the patients undergoing hysterectomy, and was found to be accessible even in cases with a large uterus. The patients benefitted from this approach and had less abdominal wounds. However, patients with a voluminous uterus tended to have more intraoperative blood loss, and in some cases with severe adhesions, additional port(s) were required for surgical effectiveness.

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients.

STUDY OBJECTIVE: To evaluate the feasibility and safety of hysterectomy in benign disease using transvaginal natural orifice transluminal endoscopic surgery (NOTES). DESIGN: Prospective observational study (Canadian Task Force classification II-3). SETTING: Tertiary referral medical center. PATIENTS: From May 2010 to August 2011, consecutive patients who were scheduled to undergo laparoscopic hysterectomy and without virginity or suspected pelvic inflammation or cul-de-sac obliteration were included. INTERVENTION: Total hysterectomy via transvaginal NOTES. MEASUREMENTS AND MAIN RESULTS: The study included 137 patients, with mean (SEM) age 46.0 (0.4) years and body mass index 24.7 (0.4). Transvaginal NOTES was successfully performed in 130 patients (94.9%). Fifteen patients underwent concurrent adhesiolysis, and 17 underwent adnexal procedures. Mean (SEM) uterine weight was 450.0 (24.1) g; in 45 patients (34.6%), uterine weight was >500 g, and in 7 (5.4%) it was >1000 g. Operative time was 88.2 (4.1) minutes, with blood loss of 257.7 (23.9) mL. In 2 patients there was intraoperative hemorrhage or unintended cystotomy, and in another 5 transvaginal colpotomy failed because of a narrow vagina, cul-de-sac obliteration by bowel adhesions, or mass obstruction. Complications in these 7 patients (5.1%) were successfully managed via transabdominal laparoscopy. Five patients (3.6%) experienced postoperative urinary retention or febrile morbidity, and recovered uneventfully with conservative treatment. CONCLUSION: Transvaginal NOTES is a feasible technique for performance of hysterectomy and can be used in procedures that are difficult to complete via conventional vaginal surgery because posterior colpotomy is achievable. This procedure was not impeded by uterine volume, and had the advantage of no abdominal incision.

Long-term survival outcome of laparoscopic staging surgery for endometrial cancer in Taiwanese experience.

OBJECTIVE: This study aims to evaluate the long-term safety and efficacy of laparoscopic staging surgery (LSS) for endometrial cancer in Taiwanese women. MATERIALS AND METHODS: This is a longitudinal study of prospectively registered 105 patients who underwent LSS for endometrial cancer between June 1995 and June 2008. RESULTS: The mean duration of surgery was 186.8 minutes, and the mean intraoperative blood loss was 220.38 mL. The median number of retrieved pelvic lymph nodes was 18. The intraoperative complication rate was 4.8%, including two cases of ureteral injury and one case each of bladder injury, bowel injury, and vascular injury. No patient required conversion to laparotomy. During the median follow-up of 55.3 months, six cases of recurrence (5.7%) and three tumor-related deaths (2.9%) were recorded. The 5-year disease-free survival and the overall survival were 93.39% and 98.05%, respectively. CONCLUSION: The study revealed favorable perioperative outcomes and better long-term survival than reported in the Taiwan Cancer Registry, and similar good surgical results to those reported in the Western studies. Therefore, LSS by experienced surgeons for endometrial cancer is a feasible and efficacious alternative to laparotomy.

Early detection and minimally invasive management of intramural pregnancy.

Intramural pregnancy is a rare form of ectopic pregnancy, wherein the fetus is implanted within the myometrium, separate from the endometrial cavity. In the early reported cases, a diagnosis was only possible after an operation for uterine rupture; however, recent developments in ultrasonography and magnetic resonance imaging assist in early diagnosis. Early diagnosis prevents potential life-threatening hemorrhage and preserves fertility. Both medical therapy and surgery are used to treat intramural pregnancy: surgery is often performed via laparotomy and includes hysterectomy. Here, we report the first case of successfully combining hysteroscopy and laparoscopy in the early diagnosis and management of intramural pregnancy. Our experience reveals that the minimally invasive procedure is safe and effective in select cases where advanced endoscopic expertise is available.

Single-port laparoscopic myomectomy: initial operative experience and comparative outcome.

OBJECTIVE: To present the initial operative outcome and comparative data among patients undergoing single-port laparoscopic myomectomy (SPLM). MATERIALS AND METHODS: A prospective, observational study of all patients who underwent SPLM was performed. The demographic and operative data, including age, body mass index, operative indications, operative time, estimated blood loss, complications, and postoperative hospital stay were recorded. A match cohort of patients undergoing traditional LM was also retrospectively compared. RESULTS: SPLM was successfully performed in all ten patients from April 2010 to October 2010. The two groups (SPLM and traditional LM) were matched by age, body mass index, size, and weight of fibroids. The median operating time (196.5 vs. 82.5 min, P < 0.001) and length of hospitalization (3 vs. 2 days, P = 0.042) were significantly longer in SPLM group than in traditional LM group. The median operative blood loss was not significantly different. No patients in either group had serious complications. CONCLUSION: Despite the increased operating time, SPLM is feasible and offers comparable surgical outcomes and superior cosmesis compared with traditional LM.

Clinical outcome after laparoscopic assisted vaginal hysterectomy with transvaginal uterosacral ligament fixation.

OBJECTIVE: We report here the clinical outcome of a simplified method to suspend the vaginal cuff during laparoscopic assisted vaginal hysterectomy. MATERIALS AND METHODS: This is a retrospective study. Fifty patients underwent laparoscopic assisted vaginal hysterectomy and received transvaginal uterosacral ligament fixation for vaginal cuff support (LAVHUS). Follow-up examinations were conducted for at least 24 months and included vaginal examination with prolapse grading using the POP-Q system. Subjective outcomes were measured using a questionnaire that asked patients to describe postoperative lower urinary tract symptoms and satisfaction with the procedure. RESULTS: The mean follow-up duration was 106 weeks (range 102-120 weeks).The postoperative POP-Q point C and total vaginal length were effectively sustained during this period. There were no intraoperative or postoperative complications, and no adverse postoperative lower urinary tract symptoms were reported. CONCLUSION: The present study demonstrated satisfactory subjective and objective clinical outcomes following LAVHUS.

Pierce and push: a simplified method to facilitate laparoscopic myomectomy.

BACKGROUND: The aim of this study was to present our experience with a novel approach called the pierce and push (PP) method which uses a stainless steel centimeter probe instead of a 5 mm claw forceps to enucleate fibroids in a laparoscopic myomectomy (LM). METHODS: A retrospective chart review of 90 women with symptomatic uterine fibroids who underwent an LM was performed. Cases of LM with the PP method were compared with a matched control group of LM with a 5 mm claw forceps. The operative time, tumor separation time, specimen removal time, amount of blood loss, requirement for blood transfusion and length of hospital stay were compared between groups. RESULTS: The two groups were matched by age, body mass index, previous cesarean delivery, main fibroid size, and number and weight of fibroids. The tumor separation time was significantly shorter in the PP group than the claw forceps group (9.7 ± 3.1 minutes versus 17.1 ± 4.4 minutes, p < 0.001). The length of the operation, hospitalization time, specimen removal time, amount of blood loss, and requirement for blood transfusion were not significantly different between groups. CONCLUSION: A stainless steel centimeter probe has an advantage over a 5 mm claw forceps in pushing and pulling fibroids. Our findings indicate that the PP method was much more effective in excision of fibroids than a 5 mm claw grasper in LM.

Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia.

OBJECTIVE: To evaluate the efficacy and toxicity of topical imiquimod for the treatment of persistent human papillomavirus (HPV) infection in patients with or without cervical/vaginal intraepithelial neoplasia (CIN/VAIN). METHODS: Patients with persistent HPV infection (≥ 1 year) after a history of treatment for cervical or vaginal neoplasm but normal histology and cytology, abnormal Papanicolaou (Pap) smears without abnormal histology, and untreated histology-documented CIN/VAIN Grade 1/2/3 with HPV-positive testing were recruited. Patients were instructed to apply 250 mg of 5% imiquimod cream intravaginally on consecutive days or at least twice weekly on an outpatient basis for a minimum of 12 doses. A group of age- and previous diagnosis-matched, imiquimod-untreated historical controls (n = 20) were selected. The main outcome measures included HPV DNA detection, cytology, and colposcopy/histology at 6 months after treatment. RESULTS: A total of 72 patients were eligible for analysis. At a median follow-up of 33.6 months, 37 patients (51.4%) had cytological/histological regression and tested HPV-negative. Six patients (8.3%) had progressive cytology/histology with persistent HPV infections. Of the 72 treated patients, 26 patients who had a normal Pap test but were persistently HPV-positive for at least 1 year had a complete regression rate of 65.4%, which was significantly different from the rate (30%) observed in the untreated historical control (p = 0.036). Six patients with histologically proven CIN2/3 or VAIN2/3 had a complete regression rate of 66.6% (4/6). CONCLUSIONS: The tolerability of intravaginal self-administered imiquimod is confirmed. Its efficacy in the treatment of women with persistent HPV infection and normal cytology warrants further randomized, controlled trials to determine appropriate dosages and scheduling.