Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis.

BACKGROUND: Previous research has indicated the inverse association between physical activity (PA) and gestational diabetes mellitus (GDM). However, the dose-response relationship currently remains undetermined. This study aims to explore the dose-response relationship between PA during the first and second trimesters of pregnancy and GDM risk. METHODS: Studies on the relationship between PA during pregnancy and GDM risk published before April 25, 2023, were searched for in six databases. According to the inclusion and exclusion criteria, all literature was screened for eligibility. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Publication bias was examined using funnel plots, Begg's and Egger's tests, as well as trim-and-fill analysis. We harmonized exposure estimates of PA during pregnancy to the common unit of the metabolic equivalent of task (MET)-h/week. Restricted cubic splines were used to model the dose-response relationship. The criteria from the World Cancer Research Fund were used to assess the certainty of evidence across outcomes. All analyses were performed using Stata 15.1. RESULTS: The results indicated that in contrast with the lowest level of PA, promoting the highest PA level lowers the risk of GDM by 36% (RR = 0.64, 95%CI: 0.53 ~ 0.78). We found a curvilinear dose-response association between PA during the first trimester and incident GDM (Pnonlinearity = 0.012). Compared to inactive pregnant women, for those who achieved the guidelines-suggested minimum level (10 MET-h/week) of PA during the first trimester, the GDM risk was decreased by 13% (RR = 0.87, 95%CI: 0.79 ~ 0.96). A linear relationship was found between PA during the second trimester and the GDM risk (Pnonlinearity = 0.276). The results with a restricted cubic spline model suggested that pregnant women who accumulate 10 MET-h/week have a 1% reduced risk of GDM compared to completely inactive individuals. Twice (20 MET-h/week) or a higher amount of PA (50 MET-h/week) contributed to further reductions in GDM risk. CONCLUSION: There is a dose-response relationship between higher levels of PA in both the first and second trimesters and reduced risk of GDM; the relationship is stronger in the first trimester. Increasing PA during pregnancy can prevent the development of GDM. PROSPERO REGISTRATION NUMBER: CRD42023420564.

Evaluation of the detection of 14 high-risk human papillomaviruses with HPV 16 and HPV 18 genotyping for cervical cancer screening.

The American Society for Colposcopy and Cervical Pathology (ASCCP) suggests that women ≥30 years old, with a negative cytopathological test but a positive high-risk (HR) human papillomavirus (HPV) test should undergo HPV 16 and HPV 18 genotyping. If this test is positive, immediate cervical pathology is required. Therefore, the aim of this study was to evaluate the effectiveness and clinical value of testing for 14 HR HPVs with HPV 16 and HPV 18 genotyping for cervical cancer (CC) screening. A total of 424 females from the China-Japan Friendship Hospital were selected and randomly divided into two groups (A and B). All participants underwent two different testing methods: the liquid-based cytology test (LCT) and a HPV DNA test. For the HPV DNA test, participants in group A underwent the hybrid capture II (HC-II) testing method while participants in group B were tested using the quantitative polymerase chain reaction (qPCR; HBRT-H14) method. The sensitivity, specificity, positive predictive value and negative predictive value for the detection of cervical intraepithelial neoplasia (CIN) grade II or greater using HBRT-H14 were 96.30, 78.17, 23.21 and 99.68%, respectively. In Group B, compared with other HR HPV types, HPV 16 and HPV 18 infection led to the increased possibility of cervical lesions graded CIN II or higher (8.11 and 51.28%, respectively). A significant difference in the rates of CC and CIN II or higher was observed among women who were i) infected with HPV 16 and/or HPV 18, ii) infected with other HR HPV types and iii) diagnosed as negative for HR HPV infection (χ2=93.976, P=0.0001). In conclusion, HBRT-H14 is applicable for CC screening with the advantage of genotyping for HPV 16 and HPV 18, which may help to improve triage management for women with negative cytology.

[Evaluation of variable methods for HPV testing].

OBJECTIVE: To evaluate clinical efficacy of different HPV methods in screening of cervical cancers. METHODS: Between August 2011 and November 2011, 424 women in the China-Japan Friendship Hospital were enrolled in this study. All participants were undergone liquid-based cytology test (LCT), Hybrid capture II (HC-II) and real-time (RT) PCR high risk HPV DNA test for HPV16 and HPV18 genotyping. Those results were classified into two group: 424 women at HC-II group with LCT and HC-II test and 421 women at PCR group with LCT and PCR test. All women with atypical squamous cell of undetermined significance (ASCUS) or above in cytological result with high risk HPV positive at two group underwent cervical biopsy by colposcopy.In the mean time, women with negative in cytological results and with HPV 16 and(or) HPV 18 positive also underwent histo-pathological examination by and colposcopy. The results in two groups were discussed:LCT+HC-II group (424 patients) and LCT+PCR12+2 group (421 patients). RESULTS: (1) There was no significant difference in cervical intraepithelial neoplasia (CIN) II or above disease between LCT+HC-II group and LCT+PCR12+2 group (χ(2) = 3.35, P > 0.05).Sensitivity, specificity, positive predictive value and negative predictive value for detection of CINII or above using HC-II and PCR12+2 were 77.8%, 79.4%, 20.4%, 98.1% and 96.3%, 78.2%, 23.2%, 99.7%, respectively. (2) In LCT+PCR12+2 group, it was found 34 women with HPV16 positive, 5 women with HPV 18 positive including 1 women combined with HPV 16 positive, 74 women with other high risk HPV positive and 309 women with HPV negative. Compared to the infection of other high-risk HPV types, HPV 16 and HPV 18 infection leads to a higher chance of cervical lesions with CIN II or above [51.3% (20/39) and 8.1% (6/74) ]. (3) A significant difference of causing cervical cancer and CINII or above was found among women who were infected with HPV 16 and/or HPV 18 infection, with other high-risk HPV types and negative in high-risk HPV infection (χ(2) = 93.98, P < 0.01). CONCLUSION: LCT combined with PCR genotyping HPV could identify CIN II or above disease efficiently.

Evaluation of a novel real-time fluorescent polymerase chain reaction assay for high-risk human papilloma virus DNA genotypes in cytological cervical screening.

It has been confirmed that detection of high-risk human papillomavirus (HR HPV) DNA is useful in cervical cancer (CC) screening. Recently, a new real-time fluorescent polymerase chain reaction (PCR) assay was developed to detect HR HPV. This assay can synchronize nucleic acid amplification and testing using specific primers for 13 types of HR HPV genomes, combined with specific TaqMan fluorescent marker probe techniques through the fluorescence automatic PCR instrument. Furthermore, it uses TaqGold™ DNA polymerase, which minimizes the amount of non-specific amplification and increases the sensitivity of the assay. The aim of this study was to evaluate the analytical and clinical performance of the real-time fluorescent PCR assay in CC screening, compared to the Qiagen Hybrid Capture® II High-Risk HPV DNA test® (HC II). In total, 1,252 cervical specimens were collected from women between 19 and 71 years of age. The specimens were examined with three different assays, real-time fluorescent PCR assay and HC II for HR HPV detection combined with liquid-based cytology. Women with cytological abnormalities or HR HPV-positive results underwent colposcopy and cervical biopsy. This study demonstrated good overall agreement between HC II and real-time fluorescent PCR assay (overall agreement, 92.25%; Cohen's κ=0.814). For the detection of high-grade cervical intraepithelial neoplasias (CIN) and CC, the sensitivity of HC II and real-time fluorescent PCR was 94.48 and 92.82%, respectively, and the negative predictive value was 98.85 and 98.54%, respectively. High HR HPV infection rate of the high-grade CIN and CC group was detected (P<0.05). In conclusion, real-time fluorescent PCR assay provides similar results compared to the HC II test for HR HPV detection and could be used in CC screening in clinic.

Feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy in gynecologic malignancies.

OBJECTIVE: The aim of this study is to evaluate the feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy (LEPL) in gynecologic malignancies. METHODS: Twenty-nine women with cervical, ovarian or endometrial cancer underwent laparoscopic extraperitoneal pelvic lymphadenectomy between July 2008 and December 2010. The operating time, nodal yield, blood loss and complications were recorded. RESULTS: The number of patients with cervical, ovarian and endometrial carcinoma was 14, 3 and 12, respectively. The median age of patients was 48.9±12.6 years. The median body mass index was 25.6±4.8. Conversion to the transperitoneal laparoscopic approach was necessary in 6 patients for peritoneal tears causing CO(2) gas leakage. Among the remaining 23 patients, the median operating time for laparoscopic extraperitoneal pelvic lymphadenectomy was 69 min (range 50-126 min), and the median estimated blood loss was 20 ml (range 5-105 ml). The median total number of resected nodes was 26 (range 14-42), and complications related to the procedure were rare. CONCLUSIONS: Laparoscopic extraperitoneal pelvic lymphadenectomy is a feasible and safe procedure. It can be used in gynecologic malignancies.

Hybrid capture II for high-risk human papillomavirus DNA testing to detect cervical precancerous lesions: A qualitative and quantitative study.

Hybrid capture II (HC-II) is the only technique that can be used in clinical human papillomavirus (HPV) DNA detection. However, there is controversy in regards to how to analyze and assess the viral load of high-risk (HR)-HPV by use of HC-II and the relation between viral load and cervical lesions. In this study, we analyzed the results of a sequential screening of outpatients at the Department of Obstetrics and Gynecology of the China-Japan Friendship Hospital, and we aimed to explore the relationship between HR-HPV viral load and the severity of cervical lesions, and to clarify the clinical significance of the titer of HR-HPV DNA determined by HC-II. Using HC-II, 2,761 women were screened for HR-HPV DNA combined with cytological testing using liquid-based cytology. All women with HR-HPV-positive results or abnormalities in cytology underwent a cervical biopsy through colposcopy. Cervical biopsies were taken in 1,051 women. The HR-HPV infection rate was 78.35% (76/97) in HPV-associated lesions, 87.33% (193/221) in cervical intraepithelial neoplasia (CIN) I, 94.74% (144/152) in CIN II, 100% (178/178) in CIN III and 100% (20/20) in invasive cervical cancer (ICC), respectively (P<0.05). Based on the criteria of histopathology, the sensitivity of HR-HPV DNA testing by HC-II for detecting high-grade cervical lesions was 97.71%, the specificity was 79.64%, the positive-predictive value was 41.06% and the negative-predictive value was 99.59%. The viral loads of HR-HPV DNA were 512.15±764.19 in HPV-associated lesions, 753.95±978.27 in CIN I, 871.08±1003.52 in CIN II, 603.40±740.25 in CIN III and 466.44±673.05 in ICC, respectively. In conclusion, the positive rate of HR-HPV increased significantly in accordance with the severity of cervical lesions. The viral loads of cervical inflammatory lesions were markedly lower than CINs and ICC. The viral loads of HR-HPV DNA tested by HC-II had no correlation with the grade of cervical lesions.