26 research outputs found

    A score system for complete cytoreduction in selected recurrent ovarian cancer patients undergoing secondary cytoreductive surgery: predictors- and nomogram-based analyses

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    Objective: To test the applicability of the Arbeitsgemeinschaft Gyn\ue4kologische Onkologie (AGO) and Memorial Sloan Kettering (MSK) criteria in predicting complete cytoreduction (CC) in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer (ROC). Methods: Data of consecutive patients undergoing SCS were reviewed. The Arbeitsgemeinschaft Gyn\ue4kologische Onkologie OVARian cancer study group (AGO-OVAR) and MSK criteria were retrospectively applied. Nomograms, based on AGO criteria, MSK criteria and both AGO and MSK criteria were built in order to assess the probability to achieve CC at SCS. Results: Overall, 194 patients met the inclusion criteria. CC was achieved in 161 (82.9%) patients. According to the AGO-OVAR criteria, we observed that CC was achieved in 87.0% of patients with positive AGO score. However, 45 out of 71 (63.4%) patients who did not fulfilled the AGO score had CC. Similarly, CC was achieved in 87.1%, 61.9% and 66.7% of patients for whom SCS was recommended, had to be considered and was not recommended, respectively. In order to evaluate the predictive value of the AGO-OVAR and MSK criteria we built 2 separate nomograms (c-index: 0.5900 and 0.5989, respectively) to test the probability to achieve CC at SCS. Additionally, we built a nomogram using both the aforementioned criteria (c-index: 0.5857). Conclusion: The AGO and MSK criteria help identifying patients deserving SCS. However, these criteria might be strict, thus prohibiting a beneficial treatment in patients who do not met these criteria. Further studies are needed to clarify factors predicting CC at SC

    Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

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    BACKGROUND: The gold standard treatment for early-stage endometrial cancer (EC) is hysterectomy with bilateral salpingo-oophorectomy (BSO) with lymphadenectomy. In selected patients desiring pregnancy, fertility-sparing treatment (FST) can be adopted. Our review aims to collect the most incisive studies about the possibility of conservative management for patients with grade 2, stage IA EC. Different approaches can be considered beyond demolition surgery, such as local treatment with levonorgestrel-releasing intra-uterine device (LNG-IUD) plus systemic therapy with progestins. STUDY DESIGN: Our systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, EMBASE, and Scopus databases were consulted, and five studies were chosen based on the following criteria: patients with a histological diagnosis of EC stage IA G2 in reproductive age desiring pregnancy and at least one oncological outcome evaluated. Search imputes were ‚Äúendometrial cancer‚ÄĚ AND ‚Äúfertility sparing‚ÄĚ AND ‚Äúoncologic outcomes‚ÄĚ AND ‚ÄúG2 or stage IA‚ÄĚ. RESULTS: A total of 103 patients were included and treated with a combination of LNG-IUD plus megestrol acetate (MA) or medroxyprogesterone acetate (MPA), gonadotrophin-releasing hormone (GnRH) plus MPA/MA, hysteroscopic resectoscope (HR), and dilation and curettage (D&C). There is evidence of 70% to 85% complete response after second-round therapy prolongation to 12 months. CONCLUSIONS: Conservative measures must be considered temporary to allow pregnancy and subsequently perform specific counseling to adopt surgery. Fertility-sparing management is not the current standard of care for young women with EC. It can be employed for patients with early-stage diseases motivated to maintain reproductive function. Indeed, the results are encouraging, but the sample size must be increased

    Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

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    Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+

    Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

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    Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74¬∑0%) had emergency surgery and 280 (24¬∑8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26¬∑1%) patients. 30-day mortality was 23¬∑8% (268 of 1128). Pulmonary complications occurred in 577 (51¬∑2%) of 1128 patients; 30-day mortality in these patients was 38¬∑0% (219 of 577), accounting for 81¬∑7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1¬∑75 [95% CI 1¬∑28‚Äď2¬∑40], p\textless0¬∑0001), age 70 years or older versus younger than 70 years (2¬∑30 [1¬∑65‚Äď3¬∑22], p\textless0¬∑0001), American Society of Anesthesiologists grades 3‚Äď5 versus grades 1‚Äď2 (2¬∑35 [1¬∑57‚Äď3¬∑53], p\textless0¬∑0001), malignant versus benign or obstetric diagnosis (1¬∑55 [1¬∑01‚Äď2¬∑39], p=0¬∑046), emergency versus elective surgery (1¬∑67 [1¬∑06‚Äď2¬∑63], p=0¬∑026), and major versus minor surgery (1¬∑52 [1¬∑01‚Äď2¬∑31], p=0¬∑047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

    Can Food Safety Practices and Knowledge of Raw Fish Promote Perception of Infection Risk and Safe Consumption Behavior Intentions Related to the Zoonotic Parasite <i>Anisakis</i>?

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    The study of the zoonotic parasites of the genus Anisakis and human anisakiasis is an increasingly hot topic in evolutionary biology and epidemiological studies carried out on natural and accidental (human) hosts, given the risk of this parasite to human health. However, the assessment of social-psychological factors relevant to Anisakis’ risky consumption of human behavior is still an understudied topic. Given the centrality of the topic, highlighted by its presence in Goals 2 (subgoal 2.1, achieve food security and improve safe nutrition) and 3 (health and well-being) of the 2030 Agenda, it appears necessary to deepen our social-psychological knowledge regarding this specific topic. There is plenty of psychological research focused on antecedents of fish and seafood consumption; however, parasite risk is not often specifically examined. This research is aimed at increasing the safety of consumers’ seafood products by examining their psychological aspects, such as knowledge, perception, awareness, and concern about Anisakis. Past and future behavior intentions were also investigated. Analyses were carried out on a sample of 251 subjects, and a path analysis model was used to explain possible relations assumed among the variables. The results of the study showed that habits related to raw fish consumption and self-perceived health were, respectively, positively, and negatively correlated with a higher perceived risk of contracting anisakiasis. This perceived risk in turn correlates positively with a greater willingness to pay for Anisakis-free fish. Similarly, prior knowledge of the disease was found to be associated with prior avoidance of fish consumption, which in turn was found to be positively correlated with a greater willingness to pay for Anisakis-free fish

    Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

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    The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases

    The role of human papillomavirus vaccines in cervical cancer: Prevention and treatment

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    Human papillomavirus (HPV) is the most common sexually transmitted disease, worldwide. Primary prevention thorough vaccination si able to reduce the burden of HPV-related lesions. Ten years ago the Food and drug Administration (FDA) approved the first vaccine against HPV. In the last decades, growing data on safety and effectiveness have been collected. In the present review we report the current knowledge on vaccine against HPV, highlighting the current value and prospective regarding the widespread diffusion of HPV vaccines. The role of emerging therapeutic vaccines is reviewed
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