Retraction: Human Papilloma Virus' Life Cycle and Carcinogenesis.

[This retracts the article , PMID: 28465751.].

Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome.

OBJECTIVE: The objective of this study is to assess retrospectively the predictive value of fetal scalp pH and base excess (BE) for fetal acidosis and poor neonatal outcome in term, low-risk, spontaneous deliveries with suspicious or pathological intrapartum cardiotocography (CTG) tracings. METHODS: Umbilical artery pH and BE values obtained immediately after delivery and Apgar score were the outcomes under consideration. Statistics included receiver-operating characteristic curve (ROC) and multiple logistic regression analysis. RESULTS: Four hundred and six deliveries were included in the study. Scalp pH < 7.20 predicted umbilical pH ≤7.1 with 64.3% sensitivity and 92.9% specificity (p < .001). The corresponding positive-predictive value (PPV) was 24.3% and the negative-predictive value (NPV) was 98.6%. Scalp BE ≤ -7 mmol/l (a cut-off value provided by ROC curve analysis) predicted Apgar score ≤ 7 at 5 min with 61.9% sensitivity and 91.7% specificity (p < .001). The corresponding PPV and NPV were 29.5 and 97.7%, respectively. Neither scalp pH nor BE was significantly associated with umbilical BE values. Infants with intrapartum BE ≤ -7 mmol/l were 30 times on an average more likely to get a low Apgar score, independently of intrapartum pH values. CONCLUSION: Our study supports the consideration of both scalp pH and BE values, when fetal blood sampling (FBS) is used.

Ovarian reserve after fibroid embolization in premenopausal women.

OBJECTIVE: To investigate the effect of uterine artery embolization (UAE) for fibroids on ovarian pool of premenopausal women. STUDY DESIGN: Prospective case control study. MATERIAL AND METHODS: One-hundred and twenty premenopausal women, aged between 40 and 50 years, who underwent UAE for symptomatic uterine fibroids and the same number of women, aged between 40 and 50 years, with symptomatic uterine fibroids, who were not offered treatment were recruited for this study. Hormonal status and ovarian reserve were evaluated by means of anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH) pre-procedural, three months, six months and 12 months after UAE. RESULTS: No statistically significant decrease was noted in AMH values 12 months post procedure and no statistical significant alterations in AMH values between the two groups. CONCLUSIONS: Even though the study results may not be able to confirm the preservation of ovarian reserve and normal menstruation after UAE in premenopausal women, it should be considered as a friendly to normal menstruation treatment option of symptomatic fibroids.

Preoperative assessment in endometrial cancer. Is triage for lymphadenectomy possible?

PURPOSE: We sought to examine whether a preoperative assessment with usual means, available in most hospitals (preoperative histology, pelvic MRI, serum CA-125) can confidently exclude from a full staging surgical procedure low-risk endometrial carcinoma (EC) patients according to ESMO-ESTRO-ESGO criteria (stage I endometrioid EC, grade 1 or 2, myometrial invasion <50% and negative lymphovascular space invasion). METHODS: We retrospectively identified all EC patients that underwent total hysterectomy with bilateral salpingo-oophorectomy (TH-BSO) plus lymph node dissection (LND) as primary treatment for endometrioid tumors from January, 2000 to December, 2010. Extensive review was made through patients' medical records. Having set the final pathology report as the "gold standard", we applied the ESMO-ESGO-ESTRO criteria to classify patients into risk categories (low-risk and non-low risk). We also evaluated preoperative risk status using combined data from preoperative biopsy, pelvic MRI and serum CA-125. We classified patients according to the following criteria: grade 1 or 2 on preoperative histology, myometrial invasion on MRI <50% and serum CA-125 <35 IU/ml, in low risk group. Receiver operating characteristic (ROC) curves were plotted. The area under the ROC curve (AUC), quantifying the overall ability of the combined preoperative assessment to discriminate between patients at low and non-low risk, was the primary outcome of our study. False negative rate was the secondary outcome. RESULTS: Preoperative data on histology, MRI and CA-125 levels were available for 292 patients. The sensitivity and specificity of combined preoperative assessment to discriminate between low- and non-low risk EC patients according to ESMO-ESTRO-ESGO criteria were 96.1% and 73.6% respectively. AUC of the corresponding ROC curve was 0.849. False negative rate was 3.8% (9/235). Among the 9 patients falsely classified as low-risk, one patient had nodal metastasis (1/9, 11.1%) after full staging. CONCLUSION: A selective LND strategy for EC patients based on preoperative assessment is possible and would probably be cost-effective, while not jeopardizing patients' survival or patient quality of life (QoL).

Paraaortic lymphadenectomy in intermediate to high risk uterine endometrioid cancer : a retrospective evaluation.

PURPOSE: To investigate the impact on survival of paraaortic lymph node dissection (PALND) added to pelvic lymph node dissection (PLND) in patients with intermediate to high-risk endometrioid endometrial cancer (EC ). Surgical parameters and perioperative morbidity have been explored as well. METHODS: We retrospectively identified all eligible patients that received LND as part of their primary treatment at a single institution from January 2000 to December 2010. Survival curves for overall (OS), disease-specific (DSS) and disease-free (DFS) survival were plotted by the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards regression was used for multivariable analysis for OS and DSS. RESULTS: 93 patients underwent PLND plus PALND in their initial operation (PALND group) and 177 patients underwent PLND only (no-PALND group). Patients in the non-PALND group were older, more obese and had higher rates of comorbidities. The median number of PLN and PALN retrieved were 26 and 13 respectively. Isolated PALN metastasis was seen in 2 (2.1%) patients. PALND was associated with longer operative time, higher transfusion rate and longer hospital stay. PALND group had a benefit in OS (p=0.033), which did not persist in DSS or DFS. Furthermore, the type of LND did not significantly improve either OS or DSS according to the multivariate analysis results. CONCLUSION: PALND had no therapeutic value per se in women with intermediate to high risk endometrioid tumors and the improvement seen in OS should rather be attributed to the better medical status of women who received PALND.

Contraceptive behaviour of Christian and Muslim teenagers at the time of abortion and post-abortion in Thrace, Greece.

OBJECTIVES: The aims of the study were to compare the contraceptive behaviour of Christian and Muslim adolescents who had an abortion in Thrace, Greece, and to examine whether extensive contraceptive counselling at the time of abortion modified their subsequent contraceptive practices. METHODS: Adolescents, aged 14-19 years, who had undergone an elective abortion in our department, were included in a prospective 12-year study. Extensive contraceptive counselling was offered before discharge from the hospital. Attitudes to contraception were assessed by means of a simple questionnaire at the time of abortion and at 1-year follow-up. RESULTS: The study population comprised of 95 Christian Orthodox adolescents (Group A) and 79 Muslim adolescents (Group B). At the time of abortion, contraceptive behaviour differed significantly between the two groups (p = .004). Contraceptive methods used in Group A in comparison with Group B were as follows: oral contraceptives (27.4% vs. 12.7%), condoms (22.1% vs. 38.0%), interrupted coitus (18.9% vs. 20.3%), periodic abstinence (16.8% vs. 25.3%) and emergency contraception (14.7% vs. 3.8%). The commonest source of information on contraception in Group A was the gynaecologist (17.9%) and family planning clinic (15.8%), whereas in Group B it was the individual's partner (25.3%) and parents (16.4%). Contraceptive behaviour was significantly modified in both groups at post-abortion follow-up (both p < .001). The original difference between the groups, however, persisted (p = .006). In Group A, oral contraceptives were the dominant method (48.4%), followed by condoms (30.5%), whereas in Group B, the order was still the reverse (24.1% and 46.8%, respectively). CONCLUSION: Cultural differences significantly affect the contraceptive behaviour. Nevertheless, interventions that promote contraception can still be successful in different populations.

Controversies on Transvaginal Ultrasound Screening for Endometrial Cancer in Asymptomatic Postmenopausal Women.

Endometrial cancer (EC) in postmenopausal women is usually associated with abnormal vaginal bleeding. However, asymptomatic cases of EC have been reported. The incidence of EC has been estimated to 1.3-3.05 per 1,000 screened postmenopausal asymptomatic women, the most significant ultra-sonographic feature being the thickened endometrium. We reviewed the literature on the accuracy of endometrial thickness measurement by transvaginal sonography (TVS) in predicting EC in asymptomatic postmenopausal women. The use of endometrial thickness as a sole screening test was found not to be of high predictive value and it should be combined with the evaluation of EC risk factors and followed by hysteroscopy and biopsy in suspicious cases. The lack of a universal cut-off value for endometrial thickness that could be correlated to EC is pointed out.

Human Papilloma Virus' Life Cycle and Carcinogenesis.

RATIONALE: Considering that the loss of cell cycle and apoptosis control constitutes a central event in human papilloma virus' (HPV)-mediated carcinogenesis, the reason of this study is to insight to the HPV life cycle. OBJECTIVE: The purpose of the study is to analyze the HPV molecular biology and cervical cancer association. METHODS AND RESULTS: Brief review of current literature on the HPV life cycle and cervical carcinogenesis. DISCUSSION: Among the HPV associated cancers, cervical cancer still ranks number two in the global cancer incidence of women. A central component of the association between HPV and cervical carcinogenesis is the ability of HPV to persist in the lower genital tract for long periods of time without being cleared because of its evasion mechanisms.

Painful elastofibroma dorsi: a report of a case and a brief review of the literature.

Elastofibroma dorsi (ED) is an uncommon, slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. Though many patients are asymptomatic, ED can cause local deformity and symptoms such as periscapular pain or discomfort. Herein we report a case of a 65-year-old woman with painful ED. Clinical features, radiodiagnostic, intraoperative, and pathologic findings, and a brief review of the literature are performed.