Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. METHODS: This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. RESULTS: Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). CONCLUSIONS: With the Salman-Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis.

PURPOSE: The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the #ENZIAN score. METHODS: This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the #ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. RESULTS: MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100%, 100-100%, and 97-100%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14%, 76%, 70%, and 7%, respectively). CONCLUSION: We demonstrated that the #ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.

Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries.

PURPOSE: The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. METHODS: All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. RESULTS: A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. CONCLUSION: Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

ProDy 2.0: increased scale and scope after 10 years of protein dynamics modelling with Python.

SUMMARY: ProDy, an integrated application programming interface developed for modelling and analysing protein dynamics, has significantly evolved in recent years in response to the growing data and needs of the computational biology community. We present major developments that led to ProDy 2.0: (i) improved interfacing with databases and parsing new file formats, (ii) SignDy for signature dynamics of protein families, (iii) CryoDy for collective dynamics of supramolecular systems using cryo-EM density maps and (iv) essential site scanning analysis for identifying sites essential to modulating global dynamics. AVAILABILITY AND IMPLEMENTATION: ProDy is open-source and freely available under MIT License from https://github.com/prody/ProDy. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms.

OBJECTIVE: This review aimed to categorize thoracic endometriosis syndrome (TES) according to whether the presenting symptoms were catamenial and to evaluate whether such a categorization enables a better management strategy. DATA SOURCES: An electronic search was conducted using the PubMed/Medline database. METHODS OF STUDY SELECTION: The following keywords were used in combination with the Boolean operators AND OR: "thoracic endometriosis syndrome," "thoracic endometriosis," "diaphragm endometriosis," and "catamenial pneumothorax." TABULATION, INTEGRATION, AND RESULTS: The initial search yielded 445 articles. Articles in non-English languages, those whose full texts were unavailable, and those that did not present the symptomatology clearly were further excluded. After these exclusions, the review included 240 articles and 480 patients: 61 patients in the noncatamenial group and 419 patients in the catamenial group. The groups differed significantly in presenting symptoms, surgical treatment techniques, and observed localization of endometriotic loci (p <.05). CONCLUSION: This review points out the significant differences between patients with TES with catamenial and noncatamenial symptoms. Such categorization and awareness by clinicians of these differences among patients with TES can be helpful in designing a management strategy. When constructing management guidelines, these differences between patients with catamenial and noncatamenial symptoms should be taken into consideration.

The Comparison of Transvaginal Natural Orifice Transluminal Endoscopic Surgery and Conventional Laparoscopy in Opportunistic Bilateral Salpingectomy for Permanent Female Sterilization.

STUDY OBJECTIVE: To compare the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach with conventional laparoscopy (CL) in opportunistic bilateral salpingectomy (BS) alone for permanent female sterilization as an opportunistic cancer prevention strategy. DESIGN: Prospective cohort study. SETTING: Two-centered tertiary hospitals. PATIENTS: Ninety-six women with a nonprolapsed uterus seeking definitive surgical permanent contraception. INTERVENTIONS: Patients were scheduled for BS and assigned to a study arm in a 2:1 fashion (CL:vNOTES allocation ratio) concerning patient's choice. MEASUREMENTS AND MAIN RESULTS: Patients were followed at their postoperative first week and first month. The visual analog score (VAS), Patient Global Impression of Improvement, and Female Sexual Function Index scales were used to assess the pain, patient satisfaction, and discomfort/pain after vaginal penetration, respectively. Patients who underwent to vNOTES had a significantly higher number of previous abdominal surgery (median difference, 1.97; 95% confidence interval [CI], 1.12-3.48; p = .016). Compared with CL, vNOTES was associated with lower 6-hour (rate ratio [RR], 0.63; 95% CI, 0.50-0.77) and 24-hour (RR, 0.33; 95% CI, 0.23-0.46) postoperative VAS scores and less amount of postoperative analgesics (RR, 0.54; 95% CI, 0.36-0.78). The slope of change in postoperative VAS scores was in a shorter time in the vNOTES group (RR, 0.47; 95% CI, 0.36-0.60). The rate of postoperative improvement was higher in the vNOTES group than the CL group at the postoperative first week (87.5% vs 68.2%, χ2 = 4.232, p = .032) and first month (96.9% vs 87.9%, χ2 = 2.091, p = .140). The rate of patients reporting postoperative decline in Female Sexual Function Index /pain scores (RR, 0.97; 95% CI, 0.47-1.96) was found to be similar in both of the study groups, and no postoperative complication was observed in either group. CONCLUSION: Women seeking permanent sterilization and who underwent BS for ovarian cancer risk reduction purposes had higher satisfaction, less postoperative pain, lower analgesic requirement, and similar surgical outcomes in the vNOTES group than the CL group, even in patients with previous surgeries and a nonprolapsed uterus. vNOTES approach could be the preferred method for the opportunistic BS in female sterilization.

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope?

AIM: To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. METHODS: A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. RESULTS: Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. CONCLUSION: In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.

Inactivated COVID-19 vaccine hesitancy among midwifery students: a prospective online survey.

Limited information on vaccines' reliability and lack of sufficient scientific data may cause suspicion among individuals concerning the Coronavirus Disease-2019 (COVID-19) vaccines. This study aimed to investigate the attitudes of midwifery students to an inactivated COVID-19 vaccine. This prospective online survey was conducted between 01 March and 01 May 2021 with 172 midwifery students. An anonymous online survey was developed by the researchers, taking into account the studies in the literature examining the attitudes of individuals towards the vaccine. The online survey included a total of 19 questions, covering five main topics. The study revealed that 118 (68%) of 172 midwifery students were hesitant to get vaccinated. There was a significant difference between the vaccine-hesitant and -accepting groups regarding the general attitude towards the vaccine (respectively; <0.001, 0.001). It was determined that 48.1% of the vaccine-accepting participants strongly agreed that this vaccination should be mandatory for all midwifery students working in a clinical practice internship. Higher vaccination willingness levels are expected in students who attend health curricula due to the high literacy level in health-related issues. In conclusion, healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.IMPACT STATEMENTWhat is already known on this subject? Limited information on vaccines' reliability and lack of sufficient scientific data caused suspicion about the COVID-19 vaccines among many people .What do the results of this study add? Almost half of the participants in both groups agreed that the vaccine could be ineffective if the virus is mutated. Nearly half of the hesitant group thought that the COVID-19 vaccine might not be effective and were concerned about serious side effects.What are the implications of these findings for clinical practice and/or further research? This study reveals that healthcare professionals who are in contact with patients should be informed more accurately about newly developed vaccines.

The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model.

This study aimed to investigate the protective effect of ozone therapy on ovarian reserve, number of ovarian follicles, ovarian morphology in a rat ischaemia reperfusion (IR) injury model. Twenty-four, Wistar Hannover rats were included. The rats were divided into three groups as control, detorsion-only, and ozone therapy + detorsion groups. There was a statistically significant difference in the follicular damage and inflammation scores between the study groups (p = .019, p = .002, respectively). The highest AMH decrease was observed in the detorsion-only group (p = .012). The total damage score was higher in the detorsion-only group than the ozone therapy + detorsion group. Preantral, small and large antral follicle numbers were less in the detorsion-only group than the ozone therapy + detorsion group. The highest postoperative day 7 TAS level was in the ozone therapy + detorsion group. TOS levels did not differ significantly between the study groups. The combination of the ozone therapy with ovarian detorsion is more effective in protecting the ovarian reserve than ovarian detorsion-only.Impact StatementWhat is already known on this subject? Adnexal torsion is a common gynecological emergency in reproductive-age women. The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire.What do the results of this study add? The combination of the medical ozone therapy with conventional surgical ovarian detorsion is more effective in the protection of the ovarian reserve compared to surgical ovarian detorsion.What are the implications of these findings for clinical practice and/or further research? This study speculates that medical ozone therapy in addition to conventional surgical ovarian detorsion could preserve ovarian reserve and function if confirmed in further clinical studies.

Serum sestrin 2 levels in patients with uterine leiomyomas.

Our aim was to evaluate SESN2 levels in patients with uterine leiomyomas by comparing serum SESN2 levels in myoma patients with the levels in healthy women to deepen our understanding of the pathophysiology of uterine leiomyomas. Patients 18-50 years of age who applied to the University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital between January and March 2021 and who were diagnosed with uterine leiomyoma were defined as the 'myoma group'. The control group included patients without any sign of leiomyomas in routine ultrasonography. The patients' demographic features, gynecological symptoms, myoma volume and classification were recorded. Serum SESN2 concentrations in venous blood samples were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) kit.The study included 31 patients in the myoma group and 30 in the control group. The mean age/gravid/parity or BMI values did not differ significantly between the groups. The only gynecological symptom that showed a significant difference was menorrhagia. Serum SESN2 levels were significantly higher in the myoma group then the control groups (11.7 ± 2.5) (p < 0.001). In conclusion, although uterine leiomyoma is the most common benign tumour in women of reproductive age, there are no known markers for predicting the development of leiomyomas. Based on the results of the current study, SESN2 could be such a marker.IMPACT STATEMENTWhat is already known on this subject? Uterine leiomyoma is the most common type of benign tumour in women of reproductive age as well as the most common indication for a hysterectomy. Symptoms associated with uterine leiomyoma include abnormal bleeding, chronic pelvic pain, menorrhagia, dysmenorrhoea, dyspareunia and anaemia, which adversely affect the patient's quality of life. Sestrins are a family of metabolic regulator proteins that play a potential role in carcinogenesis.What the results of this study add? This is the first study evaluating the role of sestrin in the development of uterine leiomyomas. Significantly higher levels of sestrin 2 (SESN2) were detected in patients with leiomyomas.What are the implications of these findings for clinical practice and/or further research? Although uterine leiomyoma is the most common type of benign tumour in women of reproductive age, there are still many unknowns regarding its pathophysiology. Further, there are still no known markers for predicting the development of leiomyomas. Hence, primary prevention is not possible. Based on the results of the current study SESN2, could be such a marker. Further studies are needed to confirm the results of this study.

Comparison of vNOTES technique with conventional laparoscopy in gynecological emergency cases.

BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive approach. This study aimed to evaluate the feasibility and surgical outcomes of the vNOTES method and compare it with conventional laparoscopy (CL) in gynecological emergency cases. MATERIAL AND METHODS: A retrospective study was conducted to compare vNOTES with CL regarding pre-/intra-/postoperative outcomes. The women who were operated on for emergency indications such as ectopic pregnancy, ovarian torsion, ovarian cyst rupture and acute abdominal pain were evaluated. Patients' age, gravidity, parity, medical/surgical history, height, weight, blood pressure, heart rate, pre-/postoperative hemoglobin and hematocrit levels, the quantity of aspirated hemoperitoneum, visual analog scale (VAS) pain scores six and 12 h postoperatively, duration of surgery and hospital stay were recorded. RESULTS: The study was conducted with 90 women. Sixty of them underwent CL, while 30 women had vNOTES. The vNOTES group had a significantly shorter duration of surgery -28.5 min (15-48 min) vs. 77 min (29-155 min), respectively, p < .001), shorter hospital stay - 32 h (11-125 h) vs. 38 h (12-201 h), respectively, p = .007), lower VAS scores after 6 h - 5 (4-7) vs. 6 (2-8), respectively, p < .001), and after 12 h - 2 (1-3) vs. 2 (1-5), respectively, p < .001) and a lower dose of postoperative analgesic administration - 2 (2-3) vs. 3 (1-5), respectively, p < .001) than the CL group. CONCLUSION: vNOTES surgeries can be considered an alternative technique to CL by providing shorter surgery duration, lower postoperative pain scores, shorter hospital stays and better cosmetic outcomes.

Recurrent Rearrangements in PRKACA and PRKACB in Intraductal Oncocytic Papillary Neoplasms of the Pancreas and Bile Duct.

BACKGROUND & AIMS: Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas and bile duct contain epithelial cells with numerous, large mitochondria and are cystic precursors to pancreatic ductal adenocarcinoma (PDAC) and cholangiocarcinoma (CCA), respectively. However, IOPNs do not have the genomic alterations found in other pancreatobiliary neoplasms. In fact, no recurrent genomic alterations have been described in IOPNs. PDACs without activating mutations in KRAS contain gene rearrangements, so we investigated whether IOPNs have recurrent fusions in genes. METHODS: We analyzed 20 resected pancreatic IOPNs and 3 resected biliary IOPNs using a broad RNA-based targeted sequencing panel to detect cancer-related fusion genes. Four invasive PDACs and 2 intrahepatic CCAs from the same patients as the IOPNs, were also available for analysis. Samples of pancreatic cyst fluid (n = 5, collected before surgery) and bile duct brushings (n = 2) were analyzed for translocations. For comparison, we analyzed pancreatobiliary lesions from 126 patients without IOPN (controls). RESULTS: All IOPNs evaluated were found to have recurring fusions of ATP1B1-PRKACB (n = 13), DNAJB1-PRKACA (n = 6), or ATP1B1-PRKACA (n = 4). These fusions also were found in corresponding invasive PDACs and intrahepatic CCAs, as well as in matched pancreatic cyst fluid and bile duct brushings. These gene rearrangements were absent from all 126 control pancreatobiliary lesions. CONCLUSIONS: We identified fusions in PRKACA and PRKACB genes in pancreatic and biliary IOPNs, as well as in PDACs and pancreatic cyst fluid and bile duct cells from the same patients. We did not identify these gene fusions in 126 control pancreatobiliary lesions. These fusions might be used to identify patients at risk for IOPNs and their associated invasive carcinomas.

Association between overactive bladder and serum nerve growth factor concentrations in women with high-grade uterine prolapse.

INTRODUCTION AND HYPOTHESIS: The association between overactive bladder (OAB) and uterine prolapse remains unclear. The extent of the role of serum nerve growth factor (NGF) levels in this relationship is also not known. Therefore, our study evaluated the association among OAB, high-grade uterine prolapse and serum NGF levels. METHODS: A total of 90 patients participated in our study and were grouped as follows. Group I included patients with high-grade uterine prolapse and OAB, group II included patients with only high-grade uterine prolapse, and group III included healthy women without uterine prolapse or OAB. Serum NGF level analysis was performed in all groups. RESULTS: Serum NGF levels varied greatly among the three groups, with significantly higher levels in group 1 than in groups 2 and 3 (p < 0.001). Serum NGF levels with a cutoff point of 120.49 pg/ml identified women with significant OAB symptoms to discriminate among groups with a sensitivity of 80%, specificity of 86.7%, positive predictive value of 75.0%, negative predictive value of 89.7% and positive likelihood ratio of 6.01 (p < 0.001). CONCLUSIONS: Our study showed that NGF-related pathways may play an active role in the pathophysiology of OAB with high-grade uterine prolapse patients based on obstruction hypothesis.

Serum X-box-binding protein 1 levels in PCOS patients.

OBJECTIVE: X-box binding protein-1 (XBP1) is a possible indicator of metabolic syndrome and diabetes. This study aimed to evaluate the relationship between serum XBP1 levels and polycystic ovary syndrome (PCOS). METHOD: A prospective observational study was conducted with 88 patients. The first group was defined as the control group with ovulatory and normal-BMI patients (n = 28). The second group comprised of nonobese PCOS patients (n = 30). The third group included overweight/obese patients with PCOS (n = 30). Fasting plasma glucose, serum lipids, follicle stimulating hormone, luteinizing hormone, total testosterone, dehydroepiandrosterone and XBP1 levels l were evaluated in all groups. RESULTS: There was a significant difference in XBP1 levels between the study groups, and higher levels were observed both in the nonobese and obese PCOS groups than in the healthy controls (p < .001). The median level of XBP1 was 73.7 pg/ml in the control group, 114.11 pg/ml in the nonobese PCOS group, and 151.61 pg/ml in the overweight/obese PCOS group. A cutoff level of XBP1 at 95.79 pg/ml level was determined with a significant AUC (area under the curve) level of 99% and high specificity and sensitivity rates to predict PCOS. Also, a significant positive correlation was observed between XBP1 levels and BMI, waist circumference, fasting plasma glucose and triglyceride levels (p < .05). CONCLUSIONS: XBP1 levels were significantly higher in PCOS patients, particularly in overweight/obese PCOS patients, than in the controls. Also, the parameters associated with metabolic syndrome were related to XBP1 levels.

The effect of new cross linked hyaluronan gel on quality of life of patients after deep infiltrating endometriosis surgery: a randomized controlled pilot study.

In this prospective randomised placebo-controlled study, we aimed to evaluate the effect of New Cross linked Hyaluronan Gel (NCH gel) on the quality of life of patients who underwent laparoscopic surgery due to Deep Infiltrating Endometriosis (DIE). The intervention group received 40 mL of NCH gel, and the control group had a 40 mL sterile saline solution instilled into the peritoneal cavity following standard laparoscopic procedures. The patients were called in the third and sixth postoperative months and requested to fill the Visual Analogue Scale (VAS), Endometriosis Health Profile (EHP-5), and Short Form for Mental and Physical Health (SF-12) questionnaires. There was a significant reduction in dysmenorrhoea, dyschezia, dyspareunia VAS scores at 3rd, and 6th-month visits in NCH gel group. The postoperative 6th-month EHP-5 scores were significantly lower (1.16 ± 1.51, p-value: .02) in NCH gel group. Besides, NCH gel group had higher SF-12 mental and SF-12 physical scores. Clinical Trials registration number: NCT04023383IMPACT STATEMENTWhat is already known on this subject? Application of solid or liquid physical barriers is believed to be a promising strategy to reduce adhesions after laparoscopic endometriosis surgery. However, comparable data regarding the effects of adhesion barriers are still lacking.What the results of this study add? We revealed that there was a significantly higher decrease in VAS and EHP-5 scores and an increase in SF-12 physical-mental ratings after surgery in NCH gel group.What are the implications of these findings for clinical practice and/or further research? Using NHC gel in addition to standard surgical procedure improves postoperative VAS scores, and provides better quality of life scores.

Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study.

Hysterectomy is one of the most frequent gynaecological procedures performed for various uterine pathologies. There are several approaches for conducting hysterectomies, including abdominal, vaginal, laparoscopic and robotic. Recently, natural orifices transluminal endoscopic surgery (NOTES) has emerged as an alternative approach for conducting hysterectomies. In this study, we aimed to compare the results of total laparoscopic hysterectomy (TLH) and vaginally assisted-NOTES (vNOTES) hysterectomy procedures for the treatment of benign gynaecological diseases. Ninety-nine patients, who underwent conventional TLH or vNOTES hysterectomies, were included in this study. The operation time, presence of per/postoperative complications, visual analogue scale (VAS) scores at postoperative sixth and 24th hours, and the duration of hospital stays were all analysed. The duration of surgery was significantly shorter in the vNOTES hysterectomy group (79.56 ± 32.54 min) compared to the TLH group (120.67 ± 38.35 min) (p: < .001). Also, postoperative hospital stays were significantly shorter in favour of the vNOTES hysterectomy group (44 ± 16.47 h) compared to the TLH group (57.86 ± 21.31 h) (p: .002). These results indicate that vNOTES hysterectomy can be a promising approach for treating a variety of different uterine pathologies and, furthermore, that it can be an alternative to TLH.Impact statementWhat is already known on this subject? A hysterectomy can be done in a variety of different ways, such as abdominal, laparoscopic, vaginal, and robotic. Even though the standard practice guidelines recommend that a vaginal hysterectomy (VH) should be the first choice of treatment, it can be challenging in cases of non-descendent and large uteruses. In such cases, NOTES hysterectomy can be an alternative option.What do the results of this study add? The study has shown that vNOTES is associated with a shorter operation and briefer postoperative hospitalisation time, in comparison to TLH.What are the implications of these findings for clinical practice and/or further research? This study speculates that vNOTES is an approach which may offer better outcomes than a conventional laparoscopy. Further randomised controlled trials with larger sample sizes, however, should be conducted in order to establish the place of vNOTES in hysterectomy surgeries.

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life.

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statementWhat is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion.What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy.What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

KRAS amplification in metastatic colon cancer is associated with a history of inflammatory bowel disease and may confer resistance to anti-EGFR therapy.

Mutations in RAS occur in 30-50% of metastatic colorectal carcinomas (mCRCs) and correlate with resistance to anti-EGFR therapy. Consequently, mCRC biomarker guidelines state RAS mutational testing should be performed when considering EGFR inhibitor treatment. However, a small subset of mCRCs are reported to harbor RAS amplification. In order to elucidate the clinicopathologic features and anti-EGFR treatment response associated with RAS amplification, we retrospectively reviewed a large cohort of mCRC patients that underwent targeted next-generation sequencing and copy number analysis for KRAS, NRAS, HRAS, BRAF, and PIK3CA. Molecular testing was performed on 1286 consecutive mCRC from 1271 patients as part of routine clinical care, and results were correlated with clinicopathologic findings, mismatch repair (MMR) status and follow-up. RAS amplification was detected in 22 (2%) mCRCs and included: KRAS, NRAS, and HRAS for 15, 5, and 2 cases, respectively (6-21 gene copies). Patients with a KRAS-amplified mCRC were more likely to report a history of inflammatory bowel disease (p < 0.001). In contrast, mutations in KRAS were associated with older patient age, right-sided colonic origin, low-grade differentiation, mucinous histology, and MMR proficiency (p ≤ 0.017). Four patients with a KRAS-amplified mCRC and no concomitant RAS/BRAF/PIK3CA mutations received EGFR inhibitor-based therapy, and none demonstrated a clinicoradiographic response. The therapeutic impact of RAS amplification was further evaluated using a separate, multi-institutional cohort of 23 patients. Eight of 23 patients with KRAS-amplified mCRC received anti-EGFR therapy and all 8 patients exhibited disease progression on treatment. Although the number of KRAS-amplified mCRCs is limited, our data suggest the clinicopathologic features associated with mCRC harboring a KRAS amplification are distinct from those associated with a KRAS mutation. However, both alterations seem to confer EGFR inhibitor resistance and, therefore, RAS testing to include copy number analyses may be of consideration in the treatment of mCRC.

The effect of being diagnosed with human papillomavirus infection on women's sexual lives.

PROBLEM: Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with human papillomavirus (HPV) infection. METHOD OF STUDY: The study comprised 80 sexually active women diagnosed with a high-risk HPV infection. These patients were divided into four groups as follows: group 1, HPV 16/18-positive and normal cytology; group 2, HPV 16/18-positive and abnormal cytology; group 3, non-16/18 HPV-positive and abnormal cytology; and group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck anxiety inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later. RESULTS: There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients. CONCLUSION: HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores.

Diagnostic value of preoperative ultrasonography, cervical length measurement, and POP-Q examination in cervical elongation estimation.

INTRODUCTION AND HYPOTHESIS: Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS: Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS: There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION: Cervical length measurement with a Foley catheter may be preferred for estimation of CE.