Highly Sensitive Microsatellite Instability and Immunohistochemistry Assessment in Endometrial Aspirates as a Tool for Cancer Risk Individualization in Lynch Syndrome.

Women with Lynch syndrome (LS) are at increased risk of endometrial cancer (EC), among other tumors, and are characterized by mismatch repair (MMR) deficiency and microsatellite instability (MSI). While risk-reducing gynecologic surgeries effectively decrease EC incidence, doubts arise regarding the appropriate timing of the surgery. We explored the usefulness of highly sensitive MSI (hs-MSI) assessment in endometrial aspirates for individualizing gynecologic surveillance in LS carriers. Ninety-three women with LS, 25 sporadic EC patients (9 MMR-proficient and 16 MMR-deficient), and 30 women with benign gynecologic disease were included in this study. hs-MSI was assessed in prospectively collected endometrial aspirates in 67 LS carriers, EC cases, and controls. MMR, PTEN, ARID1A, and PAX2 protein expression patterns were evaluated in the LS samples. Follow-up aspirates from 8 LS carriers were also analyzed. Elevated hs-MSI scores were detected in all aspirates from MMR-deficient EC cases (3 LS and 16 sporadic) and negative in aspirates from controls and MMR-proficient EC cases. Positive hs-MSI scores were also detected in all 4 LS aspirates reported as complex hyperplasia. High hs-MSI was also present in 10 of 49 aspirates (20%) from LS carriers presenting a morphologically normal endometrium, where MMR protein expression loss was detected in 69% of the samples. Interestingly, the hs-MSI score was positively correlated with MMR-deficient gland density and the presence of MMR-deficient clusters, colocalizing PTEN and ARID1A expression loss. High hs-MSI scores and clonality were evidenced in 2 samples collected up to 4 months before EC diagnosis; hs-MSI scores increased over time in 5 LS carriers, whereas they decreased in a patient with endometrial hyperplasia after progestin therapy. In LS carriers, elevated hs-MSI scores were detected in aspirates from premalignant and malignant lesions and normal endometrium, correlating with MMR protein loss. hs-MSI assessment and MMR immunohistochemistry may help individualize EC risk assessment in women with LS.

Towards socialVR: evaluating a novel technology for watching videos together.

Social VR enables people to interact over distance with others in real-time. It allows remote people, typically represented as avatars, to communicate and perform activities together in a shared virtual environment, extending the capabilities of traditional social platforms like Facebook and Netflix. This paper explores the benefits and drawbacks provided by a lightweight and low-cost Social VR platform (SocialVR), in which users are captured by several cameras and reconstructed in real-time. In particular, the paper contributes with (1) the design and evaluation of an experimental protocol for Social VR experiences; (2) the report of a production workflow for this new type of media experiences; and (3) the results of experiments with both end-users (N = 15 pairs) and professionals (N = 22 companies) to evaluate the potential of the SocialVR platform. Results from the questionnaires and semi-structured interviews show that end-users rated positively towards the experiences provided by the SocialVR platform, which enabled them to sense emotions and communicate effortlessly. End-users perceived the photo-realistic experience of SocialVR similar to face-to-face scenarios and appreciated this new creative medium. From a commercial perspective, professionals confirmed the potential of this communication medium and encourage further research for the adoption of the platform in the commercial landscape. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00651-5.

Robotic-assisted para-aortic lymphadenectomy: Technique and indications in gynecological oncology.

The benefits of minimally-invasive surgeries have been documented, and they have been established as the preferred approach for gynecological surgeries. With the development of robotic surgery, many highly complex surgeries can benefit from these advantages. Due to the complexity of aortocaval lymphadenectomy, surgical technique protocols have been described to reduce risks by maximizing benefits. We describe the technique using five ports (4 robotic arms and an assistant) to work the upper abdominal field, and different instruments recommended in each of their positions to reduce errors and optimize surgical time. After the "step by step" description, we summarize indications of aortocaval lymphadenectomy for every gynecological cancer in different stages.

Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study.

INTRODUCTION: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS: A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. RESULTS: A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. CONCLUSION: The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.

Intervención comunitaria con población magrebí en Crevillent (Alicante): prevención de hepatitis A en migrantes viajeros / Community-based intervention with a Maghreb population in Crevillent (Alicante): hepatitis A prevention in immigrant travellers

Objetivos: En este artículo describimos una iniciativa surgida desde salud pública para prevenir casos de hepatitis A en población magrebí de Crevillent que fuese a viajar a su país próximamente. El objetivo principal fue contribuir a reducir la incidencia de casos importados de hepatitis A en migrantes viajeros magrebíes.Metodología. Iniciativa implementada en dos ámbitos: sanitario (envío de circular a centros de Atención Primaria con recomendaciones desde salud pública para identificar y vacunar de hepatitis A a migrantes viajeros no inmunes); comunitario (charlas grupales adaptadas a la población diana).Resultados. La intervención comunitaria (94 participantes) tuvo muy buena acogida y se involucraron tanto líderes comunitarios como mediadores interculturales. El número de primeras dosis de vacuna pediátrica de hepatitis A administradas el mes siguiente a la intervención fue muy superior al del mes previo.Conclusión. La intervención interdisciplinar aquí presentada mostró eficacia tanto a nivel sanitario como a nivel comunitario. (AU)

Objectives: In this article we report a public health initiative to prevent cases of hepatitis A in the Maghrebi population of Crevillent who were going to travel to their country in the near future. The main aim was to contribute to reduce the incidence of hepatitis A imported cases among Maghrebi immigrant travellers.Methods. The initiative was implemented in two areas: healthcare (by sending a circular to primary care centres with public health recommendations to identify and vaccinate non-immune migrant travellers against hepatitis A); community (informative group talks tailored to the target population).Results. The community intervention (94 participants) was very well received and involved both community leaders and intercultural mediators. The number of initial doses of paediatric hepatitis A vaccine administered in the month following the intervention was much higher than in the previous month.Conclusion. The interdisciplinary intervention presented here revealed efficacy at both healthcare and community levels. (AU)

Negative HPV testing among patients with biopsy-proven cervical intraepithelial neoplasia grade 2/3 or cervical cancer.

OBJECTIVE: To determine the proportion of patients diagnosed with cervical cancer or cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3) despite testing negative for HPV. METHODS: A prospective study was conducted at a university hospital in Barcelona, Spain, between March 2003 and January 2015 among women with abnormal cytology results according to the Bethesda classification system. All participants underwent HPV testing, cytology, and colposcopy. RESULTS: Among 1376 participants, 609 (44.3%) were diagnosed with CIN 2/3. Of these women, 74 (12.2%) tested negative for HPV. Among 479 women with colposcopy-guided biopsy sampling showing CIN 2/3, cone biopsy results that were negative for CIN 2/3 were more frequent among patients with negative HPV testing (13/61 [21.3%]) than among those with positive HPV tests (58/418 [13.9%]; P=0.03). Additionally, among 59 patients diagnosed with cervical cancer, 9 (15.3%) tested negative for HPV. CONCLUSION: The HPV test was negative for 12% and 15% of patients diagnosed with biopsy-proven CIN 2/3 and cervical cancer, respectively.

Lupus eritematós sistèmic pediàtric / No disponible

No disponible