Disparities in the Diagnosis, Treatment, and Survival Rate of Cervical Cancer among Women with and without Disabilities.

INTRODUCTION: Not much is known regarding the disparities in cancer care between women with and without disabilities. OBJECTIVES: The aim of this study was to investigate the potential disparities in the diagnosis, treatment, and survival of women with cervical cancer with and without disabilities. METHODS: We performed a retrospective cohort study and linked the National Disability Database, Korean Central Cancer Registry, and Korean National Health Insurance claims database. Charlson comorbidity index was used for adjusting the comorbidity. The study population comprised 3 185 women with disabilities (physical/brain, communication, mental, cardiopulmonary, and other impairment) who were diagnosed with cervical cancer and 13 582 age- and sex-matched women without disability who were diagnosed with cervical cancer for comparison. RESULTS: Distant metastatic stage (7.7% vs 3.7%) and unknown stage (16.1% vs 7.0%) were more common in cervical cancer women with grade 1 disabilities, compared with women without disabilities. Women with cervical cancer with disabilities were less likely to undergo surgery (adjusted odds ratio (aOR) 0.81, 95% confidence interval (CI) 0.73-0.90) or chemotherapy (aOR 0.86, 95% CI 0.77-0.97). Lower rate of surgery was more evident in patients with physical/brain impairment (aOR 0.46, 95% CI 0.37-0.58) and severe mental impairment (aOR 0.57, 95% CI 0.41-0.81). The overall mortality risk was also higher in patients with disabilities (adjusted hazard ratio (aHR) 1.36, 95% CI 1.25-1.48). CONCLUSION: Women with cervical cancer with disabilities, especially with severe disabilities, were diagnosed at later stages, received less treatment, and had higher mortality rates, compared with patients who lacked disabilities. Social support and policies, along with education for women with disabilities, their families, and healthcare professionals, are needed to improve these disparities.

Myometrial relaxation of mice via expression of two pore domain acid sensitive K(+) (TASK-2) channels.

Myometrial relaxation of mouse via expression of two-pore domain acid sensitive (TASK) channels was studied. In our previous report, we suggested that two-pore domain acid-sensing K(+) channels (TASK-2) might be one of the candidates for the regulation of uterine circular smooth muscles in mice. In this study, we tried to show the mechanisms of relaxation via TASK-2 channels in marine myometrium. Isometric contraction measurements and patch clamp technique were used to verify TASK conductance in murine myometrium. Western blot and immunehistochemical study under confocal microscopy were used to investigate molecular identity of TASK channel. In this study, we showed that TEA and 4-AP insensitive non-inactivating outward K(+) current (NIOK) may be responsible for the quiescence of murine pregnant longitudinal myometrium. The characteristics of NIOK coincided with two-pore domain acid-sensing K(+) channels (TASK-2). NIOK in the presence of K(+) channel blockers was inhibited further by TASK inhibitors such as quinidine, bupivacaine, lidocaine, and extracellular acidosis. Furthermore, oxytocin and estrogen inhibited NIOK in pregnant myometrium. When compared to non-pregnant myometrium, pregnant myometrium showed stronger inhibition of NIOK by quinidine and increased immunohistochemical expression of TASK-2. Finally, TASK-2 inhibitors induced strong myometrial contraction even in the presence of L-methionine, a known inhibitor of stretch-activated channels in the longitudinal myometrium of mouse. Activation of TASK-2 channels seems to play an essential role for relaxing uterus during pregnancy and it might be one of the alternatives for preventing preterm delivery.

Mechanism of Relaxation Via TASK-2 Channels in Uterine Circular Muscle of Mouse.

Plasma pH can be altered during pregnancy and at labor. Membrane excitability of smooth muscle including uterine muscle is suppressed by the activation of K(+) channels. Because contractility of uterine muscle is regulated by extracellular pH and humoral factors, K(+) conductance could be connected to factors regulating uterine contractility during pregnancy. Here, we showed that TASK-2 inhibitors such as quinidine, lidocaine, and extracellular acidosis produced contraction in uterine circular muscle of mouse. Furthermore, contractility was significantly increased in pregnant uterine circular muscle than that of non-pregnant muscle. These patterns were not changed even in the presence of tetraetylammonium (TEA) and 4-aminopyridine (4-AP). Finally, TASK-2 inhibitors induced strong myometrial contraction even in the presence of L-methionine, a known inhibitor of stretchactivated channels in myometrium. When compared to non-pregnant myometrium, pregnant myometrium showed increased immunohistochemical expression of TASK-2. Therefore, TASK-2, seems to play a key role during regulation of myometrial contractility in the pregnancy and provides new insight into preventing preterm delivery.

Elevated CA 19-9 levels in mature cystic teratoma of the ovary.

The purpose of this study was to evaluate the clinical value of serum tumor markers in patients with ovarian mature cystic teratoma (MCT). We retrospectively evaluated 163 women who underwent surgery for MCT of the ovary between March 2003 and August 2007 and who provided preoperative blood samples for the measurement of CA 19-9 and CA 125. The rates of elevated serum CA 19-9 and CA 125 levels were 31.9% (52/163) and 13.5% (22/163), respectively. The rate of ovarian torsion was 12.9% (21/163). There were significant differences between the elevated CA 19-9 group and the normal CA 19-9 group in the diameters of the tumors and the rates of ovarian torsion. Elevated serum CA 19-9 levels correlated with larger tumor diameters and higher torsion rates. CA 19-9 may be a useful tool for the diagnosis of ovarian MCT. Elevated CA 19-9 levels appear to correlate with larger tumor diameters and higher rates of ovarian torsion.

Regulation of myometrial contraction by ATP-sensitive potassium (KATP) channel via activation of SUR2B and Kir 6.2 in mouse.

ATP-sensitive potassium (KATP) channels are well characterized in cardiac, pancreatic and many other muscle cells. In the present study, functional expression of the KATP channel was examined in non-pregnant murine longitudinal myometrium. Isometric contraction measurements and Western blot were used. KATP channel openers (KCOs), such as pinacidil, cromakalim, diazoxide and nicorandil, inhibited spontaneous myometrial contractions in a reversible and glibenclamide-sensitive manner. KCOs inhibited oxytocin (OXT)- and prostaglandin F2α (PGF2α)-induced phasic contractions in a glibenclamide-sensitive manner. SUR2B and Kir6.2 were detected by Western blot, whereas SUR1, SUR2A and Kir6.1 were not. These results show that pinacidl, cromakalim, diazoxide and nicorandil-sensitive KATP channels exist in murine myometrium, which are composed of SUR2B and Kir6.2. Based on the modulatory effects of the KATP channel on spontaneous contraction, OXT- and PGF2α-induced contractions, KATP channels seem to play an essential role in murine myometrial motility via activation of SUR2B and Kir6.2.

CEACAM6 as detected by the AP11 antibody is a marker notable for mucin-producing adenocarcinomas.

A new monoclonal antibody recognizing CEACAM6, which we named AP11, was generated by immunizing BALB/c mice with phytohemagglutinin-activated human peripheral blood mononuclear cells. This study aims to evaluate whether CEACAM6 can serve as a tumor marker using AP11. We examined the expression of CEACAM6 with AP11 in 11 human carcinoma cell lines by flow cytometry and 439 human tissues including 282 tumor tissues and 157 normal tissues by immunohistochemistry. CEACAM6 epitope recognized by AP11 was well preserved in formalin-fixed and paraffin-embedded tissues. Adenocarcinomas of the stomach (86%), colorectum (95%), pancreas (100%), and lung (83%), urinary bladder (100%), and mucinous ovarian tumors (88%) had a high rate of CEACAM6 immunoreactivity. We observed a variable expression of CEACAM6 in hepatocellular carcinomas (35%), squamous cell carcinomas of the lung (60%), renal cell carcinomas (14%), urothelial carcinomas (13%), serous carcinomas of the ovary (17%), and breast carcinomas (11%). Small-cell carcinomas of the lung, prostatic adenocarcinomas, papillary thyroid carcinomas, malignant melanomas, giant cell tumors, and osteosarcomas were negative for CEACAM6. All normal tissues of various organs were negative for CEACAM6. In conclusion, CEACAM6 as detected by AP11, may serve as a marker for mucin-producing adenocarcinomas of the gastrointestinal tract and ovary as well as non-small cell lung cancer. Thus, AP11 represents a valuable diagnostic tool for detecting CEACMA6-positive cancers.

Triplet cervical pregnancy treated with intraamniotic methotrexate.

BACKGROUND: Multifetal cervical pregnancy is very rare. We are reporting a case of a triplet cervical pregnancy that was treated with direct intraamniotic instillation of methotrexate. CASE: A young multiparous woman was diagnosed as having three gestational sacs in her uterine cervix with embryonic cardiac activity observed within one of the sacs. She became pregnant by natural ovulation and coitus. After initial failure with a single-dose intramuscular injection, the patient was successfully treated with an intra-amniotic methotrexate injection under the guidance of transvaginal ultrasonography. Her reproductive capability was preserved. CONCLUSION: Direct intraamniotic injection can be considered as treatment for multifetal cervical pregnancy.

Application of Mini-abdominoplasty after Conservative Excision of Extensive Cesarean Scar Endometriosis.

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9×6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

Discordance in perceived needs between patients and physicians in oncology practice: a nationwide survey in Korea.

PURPOSE: Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient-physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient-physician concordance. PATIENTS AND METHODS: A national, multicenter, cross-sectional survey of patient-physician dyads was performed, and 97 oncologists (participation rate, 86.5%) and 495 patients (participation rate, 87.4%) were included. A short form of the Comprehensive Needs Assessment Tool for Cancer Patients was independently administered to patients and their oncologists. Concordance and agreement rates between physicians and patients were calculated. Mixed logistic regression was used to identify predictors of concordance and to explore the association of concordance with patient satisfaction and trust in physicians. RESULTS: Physicians systematically underestimated patient needs and patient-physician concordance was generally poor, with weighted κ statistics ranging from 0.04 to 0.15 for individual items and Spearman's ρ coefficients ranging from 0.11 to 0.21 for questionnaire domains. Length of experience as oncologist was the only significant predictor of concordance (adjusted odds ratio for overall concordance [aOR] = 2.09; 95% CI, 1.02 to 4.31). Concordance was not significantly associated with overall patient satisfaction (aOR = 1.24; 95% CI, 0.74 to 2.07) or trust in physician (aOR = 1.17; 95% CI, 0.76 to 1.81). CONCLUSION: Our findings revealed significant underestimation of patient needs and poor concordance between patients and physicians in assessing perceived needs of supportive care. The clinical implications of this discordance warrant further investigation.