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1.
Virol J ; 17(1): 8, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959186

RESUMO

The separation of exfoliated cells from the brushes used during cervico-vaginal smears is difficult, a problem which may affect the quality of ribonucleic acid (RNA) extracted. We compared the results of RNA extraction from cervico-vaginal cytology samples according to the type of tubes, preservative solutions, and storage temperature. The samples included exfoliated cervico-vaginal cytological specimens from patients with human papilloma virus 16, positive for cervical intraepithelial neoplasia or cervical cancer. Exfoliated cells were obtained by shaking a brush in a conventional rigid vial tube or squeezing the brush in a soft vial tube. RNA quantity and quality were compared between the two tubes. The concentration and purity of RNA (A260/A280 and A260/A230 ratios) was compared amongst five groups: Group 1, standard frozen storage; Group 2-4, RNA stabilization reagents with room temperature [RNAlater RNA Stabilization Reagent, RNAprotect cell Reagent and AllProtect Tissue Reagent]; and Group 5, Surepath Preservative fluid. To demonstrate the utility of the extracted RNA for PCR-based cDNA synthesis, GAPDH and E6 were targeted and gel band densities of GAPDH and E6 were measured. The median RNA concentration was significantly higher in the soft tubes compared with the rigid tubes (100.2 vs. 7.1 ng/µL, p = 0.0209). The purity of the RNA was higher in soft vial tubes than in rigid vials, as measured by A260/280 and A260/230 ratios. The RNA concentration, purity, and GAPDH density of groups 1, 2 and 3 were significantly higher than those of groups 4 and 5. Moreover, E6 density of group 1 and 2 was significantly higher than that of group 3, 4 and 5. The use of soft tubes enhanced the mRNA quantity and quality in cervico-vaginal cytology. The products of mRNA extraction using RNAlater RNA Stabilization Reagent and RNAprotect Cell Reagent at room temperature were comparable to those obtained by conventional frozen storage. Our protocol improved the yield and quality of RNA and might produce better results for molecular analysis in cervico-vaginal cytology.

2.
Anticancer Res ; 40(1): 451-458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892600

RESUMO

BACKGROUND/AIM: We evaluated the clinical implications of pre- and post-treatment hematological parameters as prognostic factors in patients with locally advanced cervical cancer (LACC) who received definitive concurrent chemoradiotherapy (CCRT). PATIENTS AND METHODS: We retrospectively analyzed 125 patients with LACC (FIGO stage IIB to IIIB) who received definitive CCRT. Clinical factors and hematological parameters, including neutrophil-to-lymphocyte ratio (NLR) were assessed pre- and post-CCRT. Univariate and multivariate analysis for disease-free survival (DFS) and overall survival (OS) were performed using clinicopathological and hematological parameters. RESULTS: Disease recurred in 46 (36.8%) patients, and 24 patients (19.2%) died. On multivariate analysis, post-treatment NLR, ΔNLR (pre-treatment NLR/post-treatment NLR) and ΔPLR (platelet-to-lymphocyte ratio) (pretreatment PLR/post-treatment PLR) were significant prognostic factors for DFS, and only post-treatment NLR was a significant prognostic factor for OS (p<0.001). However, pre-treatment hematological parameters were not associated with prognosis. CONCLUSION: Post-treatment hematological parameters, particularly NLR, may serve as a prognostic indicator in patients with LACC who received definitive CCRT.


Assuntos
Quimiorradioterapia , Neoplasias do Colo do Útero/sangue , Neoplasias do Colo do Útero/terapia , Intervalo Livre de Doença , Feminino , Humanos , Linfócitos/patologia , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neutrófilos/patologia , Prognóstico , Neoplasias do Colo do Útero/imunologia , Neoplasias do Colo do Útero/patologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31432733

RESUMO

Objective: To assess the effectiveness and safety of non-surgical management for six heterotopic interstitial pregnancies. Material and methods: We retrospectively analyzed the data of six women diagnosed with heterotopic interstitial pregnancies who underwent non-surgical treatment at the CHA Bundang Medical Center between January 2007 and December 2017. Three heterotopic interstitial pregnancies were treated with sono-guided potassium chloride (KCl) injections. Two cases were managed expectantly. One heterotopic quadruplet pregnancy with twin, left interstitial, and tubal pregnancy was treated by sono-guided KCl injection and laparoscopic left salpingectomy. Complications and outcomes were measured. Results: Three cases were treated with sono-guided KCl injection and the intrauterine pregnancy continued to term. Intrauterine pregnancies were vaginally delivered without complications. One case that was treated expectantly was delivered at full term, while the other case resulted in spontaneous abortion. Quadruplet heterotopic pregnancy was successfully managed with sono-guided KCl injection and laparoscopic salpingectomy. Intrauterine twin pregnancy was successfully delivered by elective cesarean section at 37 + 0 weeks of gestation with healthy babies. Conclusions: KCl injection under ultrasonographic guidance could be a safer and more effective treatment option than surgical treatment in hemodynamically stable patients with fetal cardiac activity in interstitial pregnancy. Expectant management could be an option for patients with no fetal cardiac activity.

4.
Cancer Imaging ; 19(1): 43, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234933

RESUMO

BACKGROUND: This study was to evaluate the prognostic value of metabolic parameters on F-18-FDG PET/CT and the status of human papillomavirus (HPV) infection and known prognostic variables for predicting tumor recurrence and investigating a prognostic model in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy (CCRT). METHODS: A total of 129 patients with cervical squamous cell carcinoma who underwent initial CCRT were eligible for this study. Univariate and multivariate analyses were performed using traditional prognostic factors, metabolic parameters, and HPV infection. Classification and regression decision tree (CART) was used to establish new classification. RESULTS: Among 129 patients, 29 patients (22.5%) had recurrence after a median follow-up of 60 months (range, 3-125 months). Tumor size, para-aortic lymph node metastasis, nodal SUVmax, and HPV infection status were identified as independent prognostic factors by multivariate analysis. The CART analysis classified the patients into three groups. The first node was nodal SUVmax, and HPV status was the second node for patients with nodal SUVmax ≤7.49; Group A (nodal SUVmax ≤7.49 and HPV positive, HR 1.0), Group B (nodal SUVmax ≤7.49 and HPV negative, HR 3.56), and Group C (nodal SUVmax > 7.49, HR 10.13). Disease-free survival was significantly different among the three groups (p < 0.001). CONCLUSION: The nodal SUVmax on F-18 FDG PET/CT and HPV infection status before CCRT are powerful independent prognostic factors for the prediction of disease-free survival in patients with cervical squamous cell carcinoma who underwent initial CCRT. We also suggest a simple prognosis prediction model using pre-treatment FDG PET/CT and HPV genotyping; however, it needs further validation in an independent dataset.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias do Colo do Útero/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Alphapapillomavirus , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/virologia , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Prognóstico , Compostos Radiofarmacêuticos , Neoplasias do Colo do Útero/terapia , Neoplasias do Colo do Útero/virologia
5.
J Ovarian Res ; 12(1): 12, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717813

RESUMO

BACKGROUND: The aim of this study was to (1) evaluate the ability of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters to predict suboptimal cytoreduction and (2) to create a risk model for predicting suboptimal cytoreduction in advanced ovarian cancer. From 2011 to 2015, 51 patients underwent primary cytoreductive surgery for advanced ovarian cancer were enrolled. A residual disease with maximal diameter >  1 cm was considered a suboptimal surgical result. The SUVmax values for nine abdominal regions, the sum of 9 regional SUVmax (WB1SUVmax) and WB2SUVmax (WB1SUVmax plus SUVmax of lymph nodes) were used for PET parameter. Multiple logistic regression analysis was used to determine the predictive value of PET and clinical parameters for risk model. In addition, assessments of disease-free survival (DFS) and overall survival (OS) were performed. RESULTS: Seventeen of the 51 patients (33.3%) underwent suboptimal cytoreduction. The ECOG status (OR, 4.091), SUVmax of central (OR, 5.250), right upper (OR, 4.148), left upper (OR, 5.921) and WB2SUVmax (OR, 4.148) were associated with suboptimal cytoreduction. The risk model can divide the risk groups of suboptimal cytoreduction (area under the curve (AUC), 0.775; p = 0.0001). The DFS and OS in the high-risk group were significantly worse than those in the low-risk group (p = 0.0379 for DFS; p = 0.0211 for OS). CONCLUSIONS: The presence of hypermetabolic lesions in the central, right upper, and left upper regions showed predictive value for suboptimal cytoreduction. Our risk model may be helpful for selecting patients who may show suboptimal cytoreduction.


Assuntos
Modelos Biológicos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos de Citorredução , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Risco
6.
Gynecol Endocrinol ; 35(6): 498-501, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30626229

RESUMO

To compare the genetic distributions of 14G protein-coupled receptor 30 (GPR30) single-nucleotide polymorphisms (SNPs) between women with and without uterine adenomyosis. The study population comprised 69 Korean women. Uterine tissues from the adenomyosis and non-adenomyosis groups were used for DNA extraction. Pre-designed PCR/Sanger or Sequencing Primer and TaqMan® SNP Genotyping Assays were used for the SNP genotyping of the GPR30 gene. Immunohistochemical staining was performed to confirm the GPR30 expression. Differences in genotype and allele frequencies between the two groups were calculated using Fisher's exact test. The rs3802141 CT genotype was more common in the control group (p = .02), and the rs4266553 CC genotype was more common in the adenomyosis group (p = .02). The C allele of the SNP rs4266553 was more common in the adenomyosis group (p = .02). GPR30 expression was confirmed in 69 individuals in both groups. GPR30 gene polymorphism is presumed to affect the risk of adenomyosis with limited sample size. Further large-scale study is needed to explain the genetic influence of GPR30 gene polymorphism.


Assuntos
Adenomiose/genética , Polimorfismo de Nucleotídeo Único , Receptores Estrogênicos/genética , Receptores Acoplados a Proteínas-G/genética , Adulto , Idoso , Alelos , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Pessoa de Meia-Idade , República da Coreia
7.
Int J Gynecol Cancer ; 29(1): 10-16, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640677

RESUMO

OBJECTIVE: The aim of this study was to detect high risk human papillomavirus in cervical cancer with a pretreatment negative high risk human papillomavirus DNA genotype test and to evaluate clinicopathologic characteristics and survival outcomes according to high risk human papillomavirus status. METHODS: We investigated high risk human papillomavirus status in surgical specimens from 30 cases of cervical cancer using polymerase chain reaction. Polymerase chain reaction primers were set to detect the presence of the common L1 and E7 regions of human papillomavirus types 16, 18, 31, 33, 45, 52, and 58. We analyzed the following clinicopathologic parameters to evaluate their relationships with high risk human papillomavirus status: age, histology, stage, tumor size, invasion depth, lymphovascular invasion, and recurrent status. RESULTS: Among 30 cases with a pretreatment negative DNA genotype test, high risk human papillomavirus was detected in 12 (40.0%), whereas 18 (60.0%) were negatives. Of 12 high risk human papillomavirus positive cases, 10 (33.3%) were positive for the L1 region, 6 (20.0%) of the 7 types were positive for the E7 region, and 4 (13.1%) were positive for both L1 and E7 regions. According to a multiple logistic regression model, tumor size (odds ratio 7.80; 95% confidence interval 1.476 to 41.216; P=0.0097) and stage (odds ratio 7.00; 95% confidence interval 1.293 to 37.910; P=0.0173) were associated with negative high risk human papillomavirus DNA status. Kaplan-Meier survival plots showed that negative high risk human papillomavirus status was associated with worse disease free survival in contrast with positive high risk human papillomavirus status (P=0.0392). CONCLUSIONS: Negative high risk human papillomavirus was found in 60% of cervical cancers with a pretreatment negative DNA genotype test. Moreover, the negative high risk human papillomavirus group was associated with worse survival outcome.


Assuntos
Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , DNA Viral/genética , Feminino , Seguimentos , Genótipo , Humanos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Prevalência , Prognóstico , República da Coreia/epidemiologia , Fatores de Risco , Taxa de Sobrevida , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/cirurgia
8.
Vector Borne Zoonotic Dis ; 19(2): 121-127, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30300113

RESUMO

A new quantitative RT-PCR assay was developed to differentiate Rift Valley fever (RVF) Smithburn vaccine strain from Clone 13 vaccine strain. The new qRT-PCR assay targeting the S segment (NSs and N gene) was tested on synthesized standard RNA and MP-12 strain viruses. The detection limit of the new qRT-PCR assay is 1 copy/µL of NSs and N, and is able to differentiate the Smithburn vaccine strain of RVF from the Clone 13 vaccine strain. No cross-reactivity with other vector-borne viruses was observed, a factor that is especially important in the Republic of Korea (ROK). To examine the performance of the qRT-PCR, intra- and inter-assay variability data were analyzed and showed high reproducibility. These results indicate that the new qRT-PCR can be used as a safe and cost-effective test. Furthermore, this result suggests the possibility of differentiation between infected and vaccinated animals diagnostic test in RVF-free countries including ROK.


Assuntos
Febre do Vale de Rift/prevenção & controle , Vírus da Febre do Vale do Rift/genética , Vacinas Virais/imunologia , Animais , Anticorpos Antivirais , Reprodutibilidade dos Testes , República da Coreia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Febre do Vale de Rift/virologia , Vírus da Febre do Vale do Rift/imunologia , Sensibilidade e Especificidade
9.
Nutrients ; 10(12)2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30558262

RESUMO

As postmenopausal women experience a rapid increase in cardiovascular disease (CVD) risk with an increase in abdominal fat, dietary interventions to reduce CVD risk have been emphasized. This study was aimed at investigating the effect of a high-fat diet (HFD) in combination with an ovariectomy on liver and adipose tissue fat metabolism. The efficacy of carnosic acid (CA) supplementation in the suppression of HFD- and ovariectomy-induced obesity was also evaluated. Ovariectomized (OVX) or sham-operated mice at eight weeks of age were fed with a normal diet (ND), HFD, ND and 0.02% CA, or HFD and 0.02% CA for 12 weeks. All of the animals were sacrificed at the age of 20 weeks. The blood and tissue markers of the lipogenesis and adipocyte differentiation were measured. As expected, ovariectomy decreased the uterus weight and serum 17ß-estradiol concentration. The HFD and ovariectomy significantly contributed to increases in the body weight and total fat mass, which were effectively inhibited by CA supplementation. The circulating concentrations of insulin, leptin, and TG (triglyceride) were significantly higher in the HFD group, and the concentrations were two to five times higher in the OVX and HFD group compared with those of the ND group. The CA supplementation significantly lowered the insulin, leptin, and TG concentrations in the OVX and HFD mice. The hepatic protein expressions of pAMPK and pACC were up-regulated by CA supplementation in OVX mice fed either ND or HFD. The expressions of hepatic SREBP1c and FAS mRNA were the highest in the OVX and HFD group, which were suppressed by CA supplementation. The adipose tissue PPARγ, aP2, and lipoprotein lipase (LPL) mRNA expressions were up-regulated by a HFD or ovariectomy, while they were significantly reduced in the mice fed a CA supplemented diet. The TNF-α and IL-6 mRNA levels in the adipose tissue were decreased by providing CA in the OVX groups. These results suggest that HFD and ovariectomy independently contribute to body fat accumulation, and CA effectively alleviated the ovariectomy-induced increases in lipogenesis and adipocyte differentiation. Further human trials are required in order to evaluate the efficacy of rosemary-derive CA as natural anti-adipogenic compounds, especially in postmenopausal women.


Assuntos
/farmacologia , Tecido Adiposo/efeitos dos fármacos , Dieta Hiperlipídica , Lipogênese/efeitos dos fármacos , Fígado/efeitos dos fármacos , Obesidade , Pós-Menopausa/fisiologia , Adipócitos/efeitos dos fármacos , Adipogenia/efeitos dos fármacos , Tecido Adiposo/citologia , Tecido Adiposo/metabolismo , Animais , Peso Corporal , Diferenciação Celular/efeitos dos fármacos , Dieta , Suplementos Nutricionais , Feminino , Insulina/sangue , Leptina/sangue , Fígado/metabolismo , Camundongos Endogâmicos C57BL , Obesidade/metabolismo , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Ovariectomia , Fitoterapia , Extratos Vegetais/farmacologia , Rosmarinus/química , Triglicerídeos/sangue
10.
Ann Rehabil Med ; 42(4): 575-583, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30180527

RESUMO

OBJECTIVE: To investigate changes of cardiac and muscle damage markers in exercise-induced hypertension (EIH) runners before running (pre-race), immediately after completing a 100-km ultramarathon race, and during the recovery period (24, 72, and 120 hours post-race). METHODS: In this observational study, volunteers were divided into EIH group (n=11) whose maximum systolic blood pressure was ≥210 mmHg in graded exercise testing and normal exercise blood pressure response (NEBPR) group (n=11). Their blood samples were collected at pre-race, immediately after race, and at 24, 72, and 120 hours post-race. RESULTS: Creatine kinase (CK) and cardiac troponin I (cTnI) levels were significantly higher in EIH group than those in the NEBPR group immediately after race and at 24 hours post-race (all p<0.05). However, lactate dehydrogenase (LDH), creatine kinase-myocardial band (CKMB), or CKMB/CK levels did not show any significant differences between the two groups in each period. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in EIH group than those in NEBPR group immediately after race and at 24 and 72 hours postrace (all p<0.05). A high sensitivity C-reactive protein (hs-CRP) level was significantly higher in EIH group than that in NEBPR group at 24 hours post-race (p<0.05). CONCLUSION: The phenomenon of higher inflammatory and cardiac marker levels in EIH group may exaggerate cardiac volume pressure and blood flow restrictions which in turn can result in cardiac muscle damage. Further prospective studies are needed to investigate the chronic effect of such phenomenon on the cardiovascular system in EIH runners.

11.
Clin Nucl Med ; 43(9): e296-e303, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30036243

RESUMO

PURPOSE: Cervical cancer may recur after concurrent chemoradiotherapy (CCRT), even in patients with metabolic complete response (mCR) on post-CCRT F-FDG PET. We retrospectively analyzed the value of metabolic parameters, measured by pretreatment PET, as prognostic factors for predicting recurrence and death in cervical cancer patients with mCR. METHODS: In 61 patients who reached mCR on post-CCRT, metabolic PET parameters including SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors, as well as those of the metastatic lymph nodes, were measured by pre-CCRT PET. Total MTV and total TLG were also measured from primary tumors and metastatic lymph nodes. Survival analyses for disease-free survival (DFS) and overall survival (OS) were performed. RESULTS: Eleven patients (18.0%) presented with recurrence of cervical cancer, and 12 (19.7%) died during follow-up. SUVmax, MTV, TLG of metastatic lymph nodes, and total TLG could significantly predict DFS, and nodal SUVmax could predict OS. Para-aortic lymph node metastasis also significantly correlated with both DFS and OS. In multivariate analysis, nodal SUVmax and para-aortic lymph nodes metastasis were prognostic factors for DFS, and the best predictor was nodal SUVmax. For OS, nodal MTV and para-aortic lymph node metastasis were significant prognostic factors in multivariate analysis, and the best predictor was para-aortic lymph node metastasis. CONCLUSIONS: Metabolic PET parameters, SUVmax or MTV values of metastatic lymph nodes, may be surrogate prognostic markers for recurrence or death in patients with locally advanced cervical cancer who reached mCR after definitive CCRT.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Quimiorradioterapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Neoplasias do Colo do Útero/diagnóstico por imagem , Adulto , Idoso , Carcinoma de Células Escamosas/terapia , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Neoplasias do Colo do Útero/terapia
12.
Cancer Genomics Proteomics ; 15(4): 337-342, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29976639

RESUMO

BACKGROUND/AIM: This study was designed to identify candidate proteins which can be used for visualization of pelvic autonomic nerve during nerve-sparing surgery. MATERIALS AND METHODS: Both soft tissue and vesical branch of the inferior hypogastric nerve from five women were collected during surgery. These 10 tissue specimens were analysed using liquid chromatography-mass spectrometry (LC-MS) and Human Protein Atlas (HPA) for protein expression. The existence of nerve fibres was confirmed using haematoxylin and eosin (H&E) and anti-S-100 staining. RESULTS: A total of 413 proteins were detected. There were three proteins (isoform 1 of fibronectin, protein S100-A8 and A9) which implied a relation with pelvic autonomic nerve. In nerve tissue from one case, the existence of nerve fibre was not confirmed. CONCLUSION: Further large studies are expected to present more nerve-specific candidate proteins which can be used for the easy and safe identification of autonomic nerves.


Assuntos
Histerectomia , Tratamentos com Preservação do Órgão , Proteoma/análise , Proteômica/métodos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Vias Autônomas/metabolismo , Vias Autônomas/patologia , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pelve/fisiologia , Neoplasias do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/patologia
13.
Int J Gynecol Cancer ; 28(2): 226-232, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29303929

RESUMO

OBJECTIVES: To compare the long-term oncological outcomes, complication rates, and recurrence patterns of robotic radical hysterectomy (RRH) with laparoscopic radical hysterectomy (LRH) for the treatment of early-stage cervical cancer. METHODS: Between January 2008 and December 2013, 65 consecutive patients underwent RRH during the learning period, and 60 consecutive patients underwent LRH during the experienced period. RESULTS: Both groups were similar with respect to clinicopathologic characteristics. The mean operative time in the RRH group was significantly longer than that in the LRH group (277.8 ± 57.3 vs 199.6 ± 45.0 minutes; P < 0.0001). Postoperative complication rates were significantly higher in the RRH group than in the LRH group (47.7% vs 27.1%; P = 0.0188). No difference in the estimated disease-free survival rates was observed between the 2 groups (P = 0.3152); however, the estimated overall survival of RRH was lower than that of LRH with marginal significance (P = 0.0762). There was no significant difference in terms of recurrence pattern between the 2 groups (P = 0.7041). However, peritoneal recurrences occurred only in the RRH group. CONCLUSIONS: Despite RRH being performed by an experienced laparoscopic oncologist, RRH showed inferior long-term oncological outcomes and postoperative complication rates compared with those of LRH during the learning period.


Assuntos
Adenocarcinoma/cirurgia , Competência Clínica , Histerectomia/educação , Laparoscopia/educação , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/educação , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Fatores de Tempo , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
14.
Gynecol Oncol ; 148(1): 97-102, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29153540

RESUMO

OBJECTIVE: Although the relationship between human papilloma virus (HPV) and cervical cancer is well established, the prognostic value of HPV status has not been determined, largely because previous studies have yielded conflicting results. This study aimed to investigate the prognostic value of pre-treatment HPV DNA for predicting tumor recurrence in cervical cancer. METHODS: The study included 248 eligible patients who provided cervical cell specimens for HPV genotyping before surgery or concurrent chemoradiotherapy (CCRT). Of these 248 patients, 108 were treated with radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA cervical cancer, and 140 were treated with CCRT for FIGO stage IB2-IV cervical cancer. RESULTS: HPV 16 and 18 were the two most common HPV types detected, with prevalence rates of 52.4% and 12.5%, respectively. The pre-treatment HPV DNA test showed that 18.5% of cervical cancers were HPV negative. Multivariate analysis showed that HPV negativity was associated with poorer disease-free survival (DFS) than HPV-positive status (hazard ratio [HR], 3.97; 95% confidence interval [CI], 1.84-8.58; p=0.0005), and patients with HPV 16-positive cancers had better DFS (HR, 0.41; 95% CI, 0.23-0.72; p=0.0019). In the surgery group, only HPV 16 positivity was significantly correlated with DFS (HR, 0.34; 95% CI, 0.12-0.96; p=0.0416). In the CCRT group, only HPV negativity was significantly correlated with DFS (HR, 3.75; 95% CI, 1.78-7.90; p=0.0005). CONCLUSIONS: Pre-treatment HPV DNA status may be a useful prognostic biomarker in cervical cancer. The presence of HPV 16 DNA was associated with better DFS, and HPV negativity was associated with worse DFS. However, larger sample sizes and more comprehensive studies are required to verify our findings.


Assuntos
DNA Viral/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/virologia , Biomarcadores Tumorais/genética , Intervalo Livre de Doença , Feminino , Técnicas de Genotipagem , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/virologia , Estadiamento de Neoplasias , Infecções por Papillomavirus/epidemiologia , Prevalência , Prognóstico , Análise de Sobrevida , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
15.
J Obstet Gynaecol Res ; 44(3): 547-555, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29239059

RESUMO

AIM: This study was conducted to evaluate the clinical feasibility of robotic-assisted transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) in patients with endometrial cancer. METHODS: From June 2006 to October 2016, we retrospectively analyzed 42 patients who underwent laparoscopic (n = 16) or robotic-assisted (n = 26) staging operations, including TIPAL for endometrial cancer. Perioperative data including age; body mass index; operation duration; the number of lymph nodes retrieved and the ratio of time to lymph node retrieval during pelvic, infrarenal para-aortic and total lymphadenectomy; estimated blood loss and postoperative complications were compared. RESULTS: The operative duration of pelvic (21.7 ± 5.31 vs 30.7 ± 10.8 min; P = 0.002), and total (62.6 ± 14.0 vs 87.0 ± 30.4 min; P = 0.010) lymphadenectomy was significantly shorter in the robotic-assisted than the laparoscopic group, whereas there was no statistical difference in the duration of infrarenal para-aortic lymphadenectomy. By contrast, the number of infrarenal para-aortic lymph nodes retreived was significantly higher (29.4 ± 10.7 vs 23.3 ± 9.16; P = 0.016) in the robotic-assisted group. Consequently, the ratio of time to number of lymph nodes retrieved during infrarenal (1.51 ± 0.49 vs 2.62 ± 1.34; P = 0.002) and total (1.43 ± 0.48 vs 2.15 ± 0.93; P = 0.014) lymphadenectomy was lower in the robotic-assisted compared to the laparoscopic group. CONCLUSIONS: The robotic-assisted approach took less time per infrarenal para-aortic and total lymph nodes retrieved compared to the conventional laparoscopic approach. Robotic-assisted TIPAL could be feasible and effective for the staging and treatment of patients with endometrial cancer.


Assuntos
Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
16.
J Minim Access Surg ; 14(1): 74-75, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28695884

RESUMO

Extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon; and, pelvic metastasis, in particular, is extremely rare. A 71-year-old woman was admitted for evaluation of pelvic solitary solid mass. She had undergone a left lobectomy 28 years previously. Magnetic resonance imaging of the abdomen and pelvis demonstrated a heterogeneous mass in the right pelvic cavity, whereas no space-occupying lesions or ascites were detected in the liver. CA 125 levels were within normal limits; however, serum alpha-fetoprotein levels were markedly elevated. She underwent laparoscopic pelvic mass excision, total hysterectomy, and bilateral salpingo-oophorectomy. Histopathologic findings and immunochemical staining results indicated metastatic HCC. Herein, we report an unusual case of a patient with solitary recurrence in the pelvic cavity 28 years after initial diagnosis and treatment.

17.
Anticancer Res ; 37(12): 7087-7093, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29187500

RESUMO

BACKGROUND/AIM: We evaluated the clinical feasibility and surgical outcomes of robotic-assisted transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) in patients with gynecological malignancies. PATIENTS AND METHODS: The perioperative outcomes in 90 patients with gynecological malignancies who underwent laparoscopic (n=43) or robotic-assisted (n=47) TIPAL were compared retrospectively. RESULTS: The operative time for pelvic and total lymphadenectomy were significantly shorter in the robotic-assisted approach, whereas the time for infrarenal para-aortic lymphadenectomy did not differ statistically. In contrast, the number of infrarenal para-aortic lymph nodes was significantly higher in the robotic-assisted approach. We compared the time per retrieved lymph node in both approaches, and those for pelvic, infrarenal para-aortic, and total lymphadenectomy were significantly shorter in the robotic-assisted approach. CONCLUSION: In our study, the robotic-assisted TIPAL took less time to retrieve a lymph node than the laparoscopic approach. The robotic-assisted approach for TIPAL is feasible for the staging and treatment of patients with gynecological malignancies.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Linfonodos , Metástase Linfática , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Oncotarget ; 8(52): 90402-90412, 2017 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-29163839

RESUMO

Objective: To evaluate the prognostic value for predicting tumor recurrence of intratumoral metabolic heterogeneity and traditional quantitative metabolic parameters on pre-treatment F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: Ninety-three patients with biopsy-proven cervical cancer and treated with CCRT (FIGO stage IIB-IV) were enrolled in this study. The traditional metabolic parameters of the primary tumor, regional lymph node, and whole body (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis), and intratumoral heterogeneity factor (HF) were measured on pre-treatment 18F-FDG PET/CT images. Univariate and multivariate analyses for disease-free survival (DFS) were performed using clinical and metabolic parameters. The additional HF prognostic value was evaluated by means of time-dependent receiver operating characteristic curve, integrated discrimination improvement, and net reclassification improvement. Results: On multivariate analysis, nodal SUVmax (hazard ratio 3.60; 95% CI, 1.66-7.85; p = 0.0012) and whole body MTV (WBMTV; hazard ratio 3.15; 95% CI, 1.17-8.53; p = 0.0236) were significant prognostic factors for DFS. When HF was combined with nodal SUVmax and WBMTV, a significant improvement in discrimination for recurrence was observed compared with nodal SUVmax alone (area under curve 0.817 vs. 0.732; p = 0.0028). Conclusions: HF did not show superiority over traditional metabolic parameters. However, when HF was combined with nodal SUVmax and WBMTV, the predictive value for tumor recurrence improved. Therefore, HF may be a useful additional prognostic biomarker to improve the prognostic value of traditional metabolic parameters on 18F-FDG PET/CT.

19.
Wideochir Inne Tech Maloinwazyjne ; 12(3): 264-270, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29062447

RESUMO

INTRODUCTION: Single-port total laparoscopic hysterectomy (TLH) has not been widely used because of its technical difficulty and steep learning curve, especially the laparoscopic suturing of the vaginal stump. Barbed suturing is a new technology that has the potential to greatly facilitate laparoscopic suturing. AIM: To compare surgical outcomes and vaginal vault healing between barbed sutures and traditional sutures in the repair of the vaginal vault during single-port TLH. MATERIAL AND METHODS: Between August 2013 and June 2015, we performed single-port TLH in 85 consecutive patients for benign or premalignant gynecological conditions. The first 48 patients underwent single-port TLH with traditional interrupted sutures, and the next 37 patients underwent single-port TLH with absorbable unidirectional knotless barbed sutures for repair of the vaginal vault. RESULTS: The patient characteristics (age, body mass index), procedures performed, uterine weight, and uterine disease were similar between the groups. There were no differences in blood loss, hemoglobin change, length of hospital stay, or perioperative complications. Operative time and the time required for vaginal cuff suturing were significantly shorter in the barbed suture group than in the traditional suture group (57.8 ±13.5 vs. 80.1 ±18.7 min, p < 0.001; 5.5 ±1.7 vs. 12.9 ±3.5 min, p < 0.001). Moreover, the use of barbed sutures significantly reduced the incidence of vaginal granulation tissue formation (2.7% vs. 35.4%, p < 0.001). CONCLUSIONS: Use of barbed sutures in single-port TLH reduced the operative time, suturing time of the vaginal vault, and formation of vaginal granulation tissue. Barbed suturing may help overcome surgical difficulties and vaginal cuff complications.

20.
Obstet Gynecol Sci ; 60(4): 383-386, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28791272

RESUMO

Ovarian dermoid cysts are one of the most common benign neoplasms in women. Rectal fistula formation due to an ovarian dermoid cyst, particularly a benign dermoid cyst, is extremely rare. A 17-year-old girl with symptoms of lower abdominal pain, passage of sebaceous materials in the stool, and hematochezia was found to have an 11-cm dermoid cyst complicated with a rectal fistula formation. Laparoscopic repair of the rectal fistula was performed successfully with bilateral ovarian cystectomies. This case presents the rare formation of a fistula between a benign dermoid cyst and the rectum and its treatment using laparoscopic repair without laparotomy.

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