Does an aptitude for surgery exist and can we predict it? an experimental study.

BACKGROUND: The selection and allocation of surgeons with a greater potential for high surgical performance are essential aspects of improving the quality, safety and effectiveness of surgical procedures. Objective of this trial was to determine the existence of basic skills and traits that would predict better performance in surgery, and those predictive factors that constitute a driving force in different stages of training. MATERIALS AND METHODS: The randomized crossover training trial took place from January 2021 to December 2021 and was conducted at an educational training center for minimally invasive surgery. A total of n=87 physicians (residents and experts) from surgical disciplines and n=239 fifth-year medical students were studied. The participants underwent extensive neuropsychological testing and surgical training, which was performed with conventional as well as robot-assisted laparoscopy by way of identical brief tasks conducted six times in a randomized crossover setting. Main Outcome was the latent factor structure of "psychomotor skills", "personality" and "motivation" based on structural equation modeling. RESULTS: The training performance of both students and physicians was significantly explained by the interaction of the three factors (explained variance: 8.2% for students, 23.8% for physicians). In students, motivation (explained variance 8.4%) and personality (explained variance 4.5%) revealed the highest contribution to surgical training performance (explained variance through psychomotor skills 1.1%). In physicians, psychomotor skills (explained variance 27.4%) made the greatest contribution to surgical training performance (explained variance through motivation 2.3%; explained variance through personality 10.5%). CONCLUSION: The study showed that surgical performance is sensitive to, and fragile in regard of non-surgery-related general individual traits. This aligns with the notion that early selection of surgeons with prospects of high surgical performance is possible, and perhaps even necessary in order to keep up with future demands on the medical system.

Deciphering resistance mechanisms and novel strategies to overcome drug resistance in ovarian cancer: a comprehensive review.

Ovarian cancer is among the most lethal gynecological cancers, primarily due to the lack of specific symptoms leading to an advanced-stage diagnosis and resistance to chemotherapy. Drug resistance (DR) poses the most significant challenge in treating patients with existing drugs. The Food and Drug Administration (FDA) has recently approved three new therapeutic drugs, including two poly (ADP-ribose) polymerase (PARP) inhibitors (olaparib and niraparib) and one vascular endothelial growth factor (VEGF) inhibitor (bevacizumab) for maintenance therapy. However, resistance to these new drugs has emerged. Therefore, understanding the mechanisms of DR and exploring new approaches to overcome them is crucial for effective management. In this review, we summarize the major molecular mechanisms of DR and discuss novel strategies to combat DR.

Autophagy-related genes polymorphism in hepatitis B virus-associated hepatocellular carcinoma: A systematic review.

BACKGROUND: Chronic hepatitis B (CHB) virus is the most common risk factor for developing liver malignancy. Autophagy is an essential element in human cell maintenance. Several studies have demonstrated that autophagy plays a vital role in liver cancer at different stages. In this systematic review, we intend to investigate the role of polymorphism and mutations of autophagy-related genes (ATGs) in the pathogenesis and carcinogenesis of the hepatitis B virus (HBV). MATERIALS AND METHODS: The search was conducted in online databases (Web of Science, PubMed, and Scopus) using Viruses, Infections, Polymorphism, Autophagy, and ATG. The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS: The primary search results led to 422 studies. By screening and eligibility evaluation, only four studies were relevant. The most important polymorphisms in hepatocellular carcinoma were rs2241880 in ATG16L1, rs77859116, rs510432, and rs548234 in ATG5. Furthermore, some polymorphisms are associated with an increased risk of HBV infection including, rs2241880 in ATG16L1 and rs6568431 in ATG5. CONCLUSION: The current study highlights the importance of rs2241880 in ATG16L1 and rs77859116, rs510432, and rs548234 in ATG5 for HBV-induced HCC. Additionally, some mutations in ATG16L1 and ATG5 were important in risk of HBV infection. The study highlights the gap of knowledge in the field of ATG polymorphisms in HBV infection and HBV-induced HCC.

Role of NADPH Quinone Reductase 1 (NQO1) Polymorphism in Prevention, Diagnosis, and Treatment of Gastrointestinal Cancers.

Most cancer deaths are related to gastrointestinal (GI) cancers. Several environmental and genetic factors are effective in the occurrence of GI cancers, such as esophageal, stomach, colorectal, liver, and pancreatic cancers. In addition to risk factors related to lifestyle, reactive oxygen species (ROS) also play a role in GI cancers, and an increase in the amount of free radicals can lead to oxidative stress and increase the probability of malignancies. NQO1 is part of the body's antioxidant defense system that protects cells against mutagenesis and carcinogenesis. NQO1 is responsible for reducing quinones to hydroquinone and preventing the generation of ROS by catalyzing the reaction. The existence of single nucleotide polymorphisms (SNPs) of NADPH Quinone Reductase 1 (NQO1), such as 609C>T NQO1, leads to a decrease in NQO1 enzyme activity. Some NQO1 polymorphisms may increase the risk of gastrointestinal cancer. So, the C609T polymorphism in the NQO1 gene has been found to be effective in causing gastrointestinal cancers. On the other hand, it is very important to know the role of biomarkers in the prognosis and management of cancer treatment. Therefore, this study investigated the role of NQO1 as a biomarker in the management of gastrointestinal cancers (prevention, diagnosis and treatment).

Inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: now and the future.

INTRODUCTION: This Expert Opinion covers recent updates in the use of Inositol in polycystic ovary syndrome (PCOS) and type II diabetes and gives support to researchers and clinicians. AREAS COVERED: This article discusses the role of Myo-Inositol (MI) and D-Chiro-Inositol (DCI) in physiological function, the use of MI in PCOS, the risks of using DCI in reproductive conditions, the 40:1 combination of MI/DCI in PCOS. Furthermore, we discuss the issues of insulin resistance and how α-lactalbumin may increase the intestinal bioavailability of MI. The paper then transitions to talk about the use of inositols in diabetes, including type II diabetes, Gestational Diabetes Mellitus (GDM), and double diabetes. Literature searches were performed with the use of PubMed, Google Scholar, and Web of Science between July and October 2023. EXPERT OPINION: Inositol therapy has grown in the clinical field of PCOS, with it demonstrating an efficacy like that of metformin. The use of α-lactalbumin has further supported the use of MI, as issues with intestinal bioavailability have been largely overcome. In contrast, the effect of inositol treatment on the different PCOS phenotypes remains an outstanding question. The use of inositols in type II diabetes requires further study despite promising analogous data from GDM.

The global incidence, mortality, and burden of uterine cancer in 2019 and correlation with SDI, tobacco, dietary risks, and metabolic risk factors: An ecological study.

Background and Aim: Endometrial cancer (EC) is the sixth most common cancer among women worldwide. Since global studies are based on awareness of the incidence trend, mortality, geographical diversity, and level of social development and income of countries, this study was conducted to investigate the trend of uterine cancer (UC) in the world in 2019. Methods: Age-standardized rates (ASR) of incidence, deaths, prevalence, and disability-adjusted life years (DALYs) of UC, as well as targeted risk factors, were extracted from the Global Burden of Disease (GBD) online database 2019. Pearson correlation coefficient and SPSS 16 were used to calculate the correlation between risk factors and ASR of epidemiological indicators. Statistical significance was considered as p < 0.05. Results: In 2019, the age-specific incidence and death rate of UC was peaking at 60-64 and 65-69 years, respectively. The highest age-standardized incidence rate per 100,000 people for UC has been reported in the Northern Mariana Islands, high sociodemographic index (SDI) countries, World Bank High-Income category, Europe continent and among World Health Organization (WHO) regions were found in the European Region. The highest age-standardized death rate per 100,000 people for UC has been reported in Grenada, high SDI countries, the World Bank High-Income category, Europe continent, and among WHO regions found in the European Region. In 2019, the age-standardized DALYs rate was 53.54 per 100,000 inhabitants, of which 48.49 cases were related to years of life lost (YLLs) and 5.05 cases were related to years lived with disability. Conclusion: According to GBD-2019, the highest incidence, mortality, and DALY of UC are in Europe. The evidence and traces of diversity can be seen in the inequalities of UC. Race, ethnicity, economic status, level of education and awareness, co-morbidities, access, grade, and histological type of tumor are the most important causes of this inequality.

The Feasibility of Practical Training in Minimally Invasive Surgery at Medical School-A Prospective Study on the Pelvitrainer.

Background and Objectives: The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises (p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.

Cancer incidence in Iran in 2016: A study based on the Iranian National Cancer Registry.

BACKGROUND: Cancer poses an escalating public health challenge, necessitating a comprehensive understanding of cancer incidence to formulate effective control strategies. AIMS: This study aims to present a comprehensive overview of cancer incidence in Iran, utilizing data from the Iranian National Population-based Cancer Registry (INPCR) for the year 2016. METHODS: The study employed INPCR data to compute crude and age-standardized incidence rates (ASR) per 100 000 for the most common cancers among men and women across Iran's 31 provinces. Data analysis utilized Excel (2019) and STATA 14. RESULTS: In 2016, 124 833 new cancer cases were registered, with 65 495 (52.90%) occurring in men and 58 312 (47.10%) in women. ASRs for all cancers in the total population were 177.48, with specific rates for men and women at 192.96 and 162.33, respectively. The five most common cancers in men were prostate (23.25), stomach (21.56), colon (19.30), bladder (16.20), and lung (13.15). Among women, the leading cancers were breast (40.60), colon (14.64), thyroid (10.84), stomach (10.25), and lung (5.63). West Azarbaijan had the highest incidence among men, while Yazd topped the list for women. Age-specific incidence rates revealed peaks in the 67-74 age group for men and the 40-50 age group for women. CONCLUSION: This study affirms that while Iran exhibits a lower cancer incidence compared to global averages, there has been a temporal increase. Disparities in ASR exist across sexes and provinces, with shifts in the ranking of common cancers by sex compared to previous reports.

Molecular Determinants of Uterine Receptivity: Comparison of Successful Implantation, Recurrent Miscarriage, and Recurrent Implantation Failure.

Embryo implantation is one of the most remarkable phenomena in human reproduction and is not yet fully understood. Proper endometrial function as well as a dynamic interaction between the endometrium itself and the blastocyst-the so-called embryo-maternal dialog-are necessary for successful implantation. Several physiological and molecular processes are involved in the success of implantation. This review describes estrogen, progesterone and their receptors, as well as the role of the cytokines interleukin (IL)-6, IL-8, leukemia inhibitory factor (LIF), IL-11, IL-1, and the glycoprotein glycodelin in successful implantation, in cases of recurrent implantation failure (RIF) and in cases of recurrent pregnancy loss (RPL). Are there differences at the molecular level underlying RIF or RPL? Since implantation has already taken place in the case of RPL, it is conceivable that different molecular biological baseline situations underlie the respective problems.

18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature.

OBJECTIVE: Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies. SEARCH STRATEGY: We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science. SELECTION CRITERIA: All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study. DATA COLLECTION AND ANALYSIS: We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized. MAIN RESULTS: After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14). CONCLUSIONS: FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.

Mapping of Iranian midwifery curriculum according to the International Confederation of midwives competencies.

BACKGROUND: Evaluating the curriculum based on its success rate in preparing skilled midwives proficient in performing professional skills is a fundamental component of the midwifery education system. This study aimed to evaluate the content, strengths, and weaknesses of the midwifery curriculum in Iran based on the most recent ICM midwifery education standards in all competence areas, as well as to obtain expert feedback on the necessary courses or lessons for the curriculum using the Delphi method. METHODS: This research was conducted in two phases: comparative analysis and the Delphi method. In the comparative analysis, the curriculum mapping tool was used to compare Iran's midwifery curriculum for bachelor's degrees to the international standards for midwifery education proposed by ICM in 2019 by a four-point Likert scale (adequate- relatively adequate- relatively inadequate- inadequate). Two individuals evaluated the curriculum independently for the presence of theoretical and clinical courses for attaining each relevant competency. In case of disagreement, the opinion of a third person was used. After identifying the academic deficiencies and weaknesses of the curriculum, the Delphi technique was used with the cooperation of the midwifery board members and directors of midwifery groups from across the country to collect feedback about new courses or lessons that need to be incorporated into the curriculum. RESULTS: After a comparative analysis, 24 out of 315 essential competencies for ICM in the midwifery curriculum were found to be inadequate or relatively inadequate based on the three experts' opinions after reviewing the programmatic courses and lessons in the curriculum. In 79.5% of the knowledge area and 71.6% of the skill area, the curriculum for midwifery in Iran corresponded to ICM essential competencies. After surveying expert members during multiple Delphi rounds, the members agreed to add some lessons to the midwifery curriculum, design a new course, and hold related workshops to cover the competencies identified as inadequate or relatively inadequate in the comparative analysis. CONCLUSION: The Iranian midwifery curriculum for acquiring 24 items of ICM essential competencies was deemed inadequate or relatively inadequate. Therefore, it seems in addition to revising Iran's midwifery curriculum following ICM competencies, providing midwifery policymakers with infrastructure and additional support to develop and implement effective midwifery training programs is necessary to ensure that midwives are trained and equipped with the necessary competencies for practice.

How do new mothers describe their postpartum sexual quality of life? a qualitative study.

BACKGROUND: Sexuality plays a critical role in a woman's postpartum quality of life and also has a strong impact on the quality of her relationship. Given the sparse body of published literature on the subject, we aimed to explore how new mothers explain their postpartum sexual quality of life. METHOD: A qualitative study was carried out in Iran and Switzerland from December 2018 to March 2019. Focus groups and semi-structured in-depth interviews (IDIs) were conducted with mothers in the first four months after parturition. Mothers who were older than 18 years, were married or in a stable relationship, and experienced a low-risk vaginal birth or cesarean section participated in the study. We used Graneheim and Lundman's approach for analyzing the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the rigor of the data. RESULTS: We achieved data saturation after two focus group discussions (FGDs), 15 IDIs in Iran, and 13 IDIs in Switzerland. We extracted three themes for postpartum sexual quality of life: (a) sexual worldview, (b) interpersonal relationship, and (c) postpartum sex storm. The participants described sexual worldview as "sexual beliefs", "sexual perceptions", and "sexual behaviors". The interpersonal relationship consists of "changes in postpartum interpersonal relationships" and "supportive role of the husbands/partners". The last one, postpartum sex storm, has three categories including "direct changes in sexual life", "indirect changes in sexual life", and "resumption of sexual intercourse". Differences between the two cultures were identified in some subcategories such as "sexual interests", "comparable to the first intercourse in life", "negative sexual behaviors of husbands/partners", "positive sexual behavior of mothers", "helping with child care and housework", and "emotional support". CONCLUSION: New mothers explained postpartum sexual quality of life as a three-theme phenomenon. Although most results were similar in both cultures, there were some differences. Our study's results suggest that sexual quality of life is a topic that encompasses international as well as cultural aspects.

External Genitalia Myiasis in a 40-Year-Old Woman.

Human myiasis is an infestation produced by fly larvae invading the tissues. We present a case of a 40-year-old virgin woman with vulvar myiasis. She reported at the gynecology clinic with a bloody discharge, severe pain, and swelling of the genital area for six days. Her menstrual history revealed the use of folded clothes. She had no specific gynecological disease. At the examination of the external genitalia, a tender mass measuring 6 cm × 4 cm and an ulcer measuring 1 cm × 1 cm on the surface of the labia majora were found. The patient was hospitalized. Serology, blood, and urine tests were requested; all laboratory tests were normal. The patient was transferred to the operating room (OR) with the diagnosis of necrotizing fasciitis. In the OR, we performed a longitudinal incision on the mass and removed nearly 30 visible maggots. After washing with normal saline, the patient was transferred to the ward without wound suturing. Debridement of the necrotic vulvar mass along with daily washing was performed for 7 days. The wound was sutured on the seventh day at the OR. Antibiotic therapy was continued for 4 days, and the patient was discharged with normal laboratory tests on the eleventh day after admission. We believe that poor sanitary hygiene was the cause of vulvar myiasis in our patient. We conclude that appropriate measures must be taken to reduce the risk of human myiasis, especially in tropical rural regions.

Circulating tumor cells and circulating tumor DNA in breast cancer diagnosis and monitoring.

Liquid biopsy, including both circulating tumor cells and circulating tumor DNA, is becoming more popular as a diagnostic tool in the clinical management of breast cancer. Elevated concentrations of these biomarkers during cancer treatment may be used as markers for cancer progression as well as to understand the mechanisms underlying metastasis and treatment resistance. Thus, these circulating markers serve as tools for cancer assessing and monitoring through a simple, non-invasive blood draw. However, despite several study results currently noting a potential clinical impact of ctDNA mutation tracking, the method is not used clinically in cancer diagnosis among patients and more studies are required to confirm it. This review focuses on understanding circulating tumor biomarkers, especially in breast cancer.

Current status and temporal trend in incidence, death, and burden of esophageal cancer from 1990-2019.

BACKGROUND: Esophageal cancer (EC) is one of the world's most unknown and deadly cancers. This study aimed to provide updated epidemiological indicators and the recent trend of EC by age group, gender, and geographical region in the world. METHODS: Annual case data and age-standardized rates (ASRs) of epidemiological indicators of EC were collected from the 2019 Global Burden of Disease (GBD) study from 1990 to 2019 in 204 countries and territories based on the sociodemographic index (SDI). Relative difference (%), average annual percentage change (AAPC), and the male/female ratio were calculated. Data are reported in values and 95% confidence interval (CI). RESULTS: EC age-standardized incidence rates (ASIR) decreased by 19%, age-standardized death rates (ASDR) decreased by 25%, and disability-adjusted life-years ASR (DALYs ASR) decreased by 30% from 1990 to 2019. The higher number of EC cases was in men aged 50 to 69 years and in women aged over 70. From 1990 to 2019, Middle SDI countries experienced a decline in the ASIR and ASDR of EC. The High SDI countries had an increasing ASDR trend. In World Bank High-Income countries, the ASIR of EC has remained unchanged and decreased in other regions. The Asia continent has the highest rate of incidence, mortality, and burden of EC and the highest rate of reduction. East Asia, Southern Sub-Saharan Africa, and Eastern Sub-Saharan Africa respectively have the highest ASIR of EC. Central Asia has experienced the greatest decrease in the ASIR and ASDR of EC, the countries of Central Europe had a steady ASIR and High-Income North America had an increasing trend in ASIR and ASDR. The burden of EC shows a decreasing trend worldwide. Central and East Asia regions have the highest rate and the highest increase in the burden of EC. CONCLUSION: Based on great variation in the geographical distribution of epidemiological indicators of EC, investigating the reasons for this diversity requires more studies to be conducted in the field of prevention, distribution of risk factors, and implementation of screening methods with high cost-effectiveness, and access to treatment methods. The provision of regional solutions may be more effective than global strategies.

Diagnostic and Management Performance of ChatGPT in Obstetrics and Gynecology.

OBJECTIVES: The use of artificial intelligence (AI) in clinical patient management and medical education has been advancing over time. ChatGPT was developed and trained recently, using a large quantity of textual data from the internet. Medical science is expected to be transformed by its use. The present study was conducted to evaluate the diagnostic and management performance of the ChatGPT AI model in obstetrics and gynecology. DESIGN: A cross-sectional study was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was conducted in Iran in March 2023. Medical histories and examination results of 30 cases were determined in six areas of obstetrics and gynecology. The cases were presented to a gynecologist and ChatGPT for diagnosis and management. Answers from the gynecologist and ChatGPT were compared, and the diagnostic and management performance of ChatGPT were determined. RESULTS: Ninety percent (27 of 30) of the cases in obstetrics and gynecology were correctly handled by ChatGPT. Its responses were eloquent, informed, and free of a significant number of errors or misinformation. Even when the answers provided by ChatGPT were incorrect, the responses contained a logical explanation about the case as well as information provided in the question stem. LIMITATIONS: The data used in this study were taken from the electronic book and may reflect bias in the diagnosis of ChatGPT. CONCLUSIONS: This is the first evaluation of ChatGPT's performance in diagnosis and management in the field of obstetrics and gynecology. It appears that ChatGPT has potential applications in the practice of medicine and is (currently) free and simple to use. However, several ethical considerations and limitations such as bias, validity, copyright infringement, and plagiarism need to be addressed in future studies.

Burden of esophageal cancer between 2010 and 2019 in Asian countries by geographical region and sociodemographic index: A comparison with global data.

BACKGROUND: The aim of this study was to describe the trends in incidence, mortality, and burden of esophageal cancer (EC) in Asia from 2010 through 2019 and compare with other global continental data. METHODS: We collected EC data from the 2019 Global Burden of Disease study from 2010 to 2019 in 49 countries and territories in Asia based on the sociodemographic index (SDI). For all locations, annual case data and age-standardized rates (ASRs) were extracted to investigate the EC incidence, prevalence, mortality, and disability-adjusted life-years (DALYs). The ASR relative difference (%) between years and the male/female (M/F) ratio were calculated. Data are reported in values and 95% uncertainty interval (UI). RESULTS: In 2019, more than 70% of EC new cases, deaths, prevalence, and DALYs occurred in Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALY number of EC increased over 1.10-, 1.07-, 1.14-, and 1.03-fold, in Asia. During this period, the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (DALYs ASR) of EC decreased by 18, 21, 14, and 22%, respectively. The rate of decline in Asia is higher than in the world and other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of EC cancer peaked at 65-74, 70-74, 65-69, and 65-69 years, respectively. In 2019, the highest ASIR, ASDR, ASPR, and DALYs ASR of EC were observed in East Asian countries, while having the highest decreasing trend. In 2019, among high SDI Asian countries, Taiwan had the highest ASIR, ASPR, and DALYs ASR, and the United Arab Emirates had the highest ASDR. Among high-middle SDIs, Kazakhstan had the highest ASIR, ASPR, ASDR, and DALYs ASR; among middle SDIs, China had the highest ASIR, ASDR, and ASPR, and Viet Nam had the highest DALYs ASR; among low-middle SDIs, Mongolia had the highest ASIR, ASDR, ASPR, and DALY ASR of EC cancer. Among low SDI Asian countries, Pakistan had the highest ASIR and ASPR, and DALY ASR for EC cancer. For four indicators, in most countries, the ratio of men was higher than women, and in some countries, this ratio reached more than 10 times. CONCLUSION: Although the rate of decline in incidence, death, prevalence and burden of EC in Asia was higher than in other areas in the last 10 years, more than 70% of these amounts occur in Asia. Therefore, it appears that adopting appropriate strategies in the field of identifying and controlling modifiable risk factors for EC, implementing screening programs, and timely diagnosis and treatment will help in reducing the burden of this disease in Asian countries.

Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review.

OBJECTIVE: The purpose of the review was to evaluate and compare outcomes after total or subtotal hysterectomy in women with endometriosis or adenomyosis. METHODS: We searched four electronic databases: Medline (PubMed), Scopus, Embase, and Web of Science (WoS). The first aim of the study was to compare outcomes after total and subtotal hysterectomy in women with endometriosis, and the second aim was to compare the two procedures in women with adenomyosis. Publications that reported short- and long-term outcomes after total and subtotal hysterectomy were included in the review. The search was not subject to any limitation in terms of time or method. RESULTS: After screening 4948 records, we included 35 studies published from 1988 to 2021; the studies were based on various methodologies. With regard to the first aim of the review, we found 32 eligible studies and divided these into the following four categories: postoperative short- and long-term outcomes, recurrence of endometriosis, quality of life and sexual function, and patient satisfaction after total or subtotal hysterectomy in women with endometriosis. Five investigations were deemed eligible for the second aim of the review. No differences were seen in terms of postoperative short- and long-term outcomes after subtotal or total hysterectomy in women with endometriosis or adenomyosis. CONCLUSIONS: Preservation or removal of the cervix in women with endometriosis or adenomyosis appears to have no effect on short- or long-term outcomes, recurrence of endometriosis, quality of life and sexual function, or patient satisfaction. Nevertheless, we lack randomized blinded controlled trials on these aspects. Such trials will be needed to enhance our comprehension of both surgical approaches.

Appendiceal Endometriosis: A Comprehensive Review of the Literature.

Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.

Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study.

PURPOSE: Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. METHODS: In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. RESULTS: One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). CONCLUSIONS: This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.