Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis

Objective: To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC). Methods: The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Randomeffects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS). Findings: Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19–0.41, P = 0.00, I 2 = 97.81), nerve injury 1% (95%CI 0.00–0.03, I 2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I 2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I 2 = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I 2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01– 0.03, I 2 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I 2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I 2 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, 2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy. Conclusion: This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation

Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled noninferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study

Introduction: Adenocarcinoma in situ (AIS) of the uterine cervix is the precursor to invasive endocervical adenocarcinoma. An excisional biopsy such as a cold knife cone biopsy (CKC) should be performed to exclude invasive adenocarcinoma. Loop electrosurgical excision procedure (LEEP) is an alternative modality to CKC but is controversial in AIS. There is a perception that there is a greater likelihood of incomplete excision of AIS with LEEP because the depth of excised tissue tends to be smaller and the tissue margins may show thermal artefact which can interfere with pathology assessment. In the USA, guidelines recommend that any treatment modality can be used to excise AIS, provided that the specimen remains intact with interpretable margins. However, there are no high-quality studies comparing LEEP with CKC and well-designed prospective studies are needed. If such a study were to show that LEEP was non-inferior to CKC for the outcomes of post-treatment persistence, recurrence and adenocarcinoma, LEEP could be recommended as an appropriate treatment option for AIS in selected patients. This would benefit women because, unlike CKC, LEEP does not require general anaesthesia and may be associated with reduced morbidity. Methods and analysis: The proposed exploratory study is a parallel group trial with an allocation ratio of 2:1 in favour of the intervention (LEEP: CKC). Participants are women aged ≥18 to ≤45 years diagnosed with AIS on cervical screening and/or colposcopically directed biopsy in Australia and New Zealand, who are to receive excisional treatment in a tertiary level centre. Ethics and dissemination: Ethical approval for the study has been granted by the St John of God Healthcare Human Research Ethics Committee (reference number #1137)

Review of gynaecological cancer among Aboriginal and/or Torres Strait Islander people in Australia

Gynaecological cancers bear a significant burden on the health of Australians. Whilst Australia has made great strides in reducing the overall gynaecological cancer burden nationally, Aboriginal and/or Torres Strait Islander women continue to experience disproportionately high rates of gynaecological cancers. This review focuses on the social, cultural, and historical contexts that contribute to inequitable gynaecological cancer rates among Aboriginal and/or Torres Strait Islander women. An in-depth discussion on cervical cancer, ovarian cancer, and uterine cancer are described; including the incidence, mortality, survival, and management of these diseases for Aboriginal and/or Torres Strait Islander women. It highlights both the persistent barriers and facilitators relating to Aboriginal and/or Torres Strait Islander women’s uptake of preventative measures and treatments, including their use of services and programs relating to the management of gynaecological cancers. This review summarises past and current policies and strategies implemented by the Australian Government and other cancer related peak bodies that aim to address this health issue. It recommends that critical attention be given to risk reduction, participation in cancer screening programs, and improved access to culturally appropriate, high quality primary health care and tertiary specialist services. This would address inequitable differences faced by Aboriginal and/or Torres Strait Islander people and reduce the overall burden of gynaecological cancers

Exploring the tumour extracellular matrix by in vivo Fast Field Cycling relaxometry after the administration of a Gadolinium-based MRI contrast agent

Funding Information European Cooperation in Science and Technology. Grant Number: 15209 Horizon 2020 Framework Programme. Grant Number: 668119 European Union's Horizon 2020 research and innovation programme. Grant Number: 668119Peer reviewedPublisher PD

Amide conjugates of the DO3A-N-(alpha-amino)propionate ligand: leads for stable, high relaxivity contrast agents for MRI?

A novel synthetic methodology for preparing amide conjugates of the DO3A-N-(alfa-amino)propionate chelator is described, using the synthesis of the DO3A-N-(alfa-benzoylamido)propionate chelator as an illustrative example. The model Gd(DO3A-N-(alfa-benzoylamido)propionate) chelate displays accelerated water exchange, stability in a wide pH range and inertness towards transmetallation by Zn2+. The Gd(DO3A-N-(alafa-benzoylamido)propionate) complex is mainly excreted via the kidneys, producing a significant increase of the kidney medulla/cortex enhancement ratio in MR images of Wistar rats, reflecting probably its increased hydrophobicity compared to Gd(DTPA). The results presented suggest that Gd(DO3A-N-(alfa-amido)propionate) chelates can be valuable leads for preparing potentially safe high relaxivity MRI contrast agents.This work was financially supported by Fundação para a Ciência e a Tecnologia, Portugal: project PTDC/QUI/70063/2006, including a grant to C.I.O.M., grant SFRH/BD/63994/2009 to M.F.F. and grant SFRH/BD/46370/2008 to A.F.M. and Rede Nacional de RMN (REDE/1517/RMN/2005) for the acquisition of the Varian VNMRS 600 NMR spectrometer in Coimbra. T.B.R. was supported by a Marie Curie Fellowship (FP/-PEOPLE-2009-IEF 254380) and an EMBO Fellowship (ALTF 1145-2009). Financial support from La Ligue Contre le Cancer, France (E. T.), and from Ministerio de Ciencia e Innovación, Spain: projects SAF2011-23622 (S.C.) and CTQ2010-20960-C02-02 (P.L.-L.), and Comunidad de Madrid, Spain, project S2010/BMD-2349 (S.C. and P.L.-L). This work was carried out in the frame of the COST D38 Action “Metal Based Systems for Molecular Imaging” and COST TD1004

Finding needles in haystacks: linking scientific names, reference specimens and molecular data for Fungi

DNA phylogenetic comparisons have shown that morphology-based species recognition often underestimates fungal diversity. Therefore, the need for accurate DNA sequence data, tied to both correct taxonomic names and clearly annotated specimen data, has never been greater. Furthermore, the growing number of molecular ecology and microbiome projects using high-throughput sequencing require fast and effective methods for en masse species assignments. In this article, we focus on selecting and re-annotating a set of marker reference sequences that represent each currently accepted order of Fungi. The particular focus is on sequences from the internal transcribed spacer region in the nuclear ribosomal cistron, derived from type specimens and/or ex-type cultures. Re-annotated and verified sequences were deposited in a curated public database at the National Center for Biotechnology Information (NCBI), namely the RefSeq Targeted Loci (RTL) database, and will be visible during routine sequence similarity searches with NR_prefixed accession numbers. A set of standards and protocols is proposed to improve the data quality of new sequences, and we suggest how type and other reference sequences can be used to improve identification of Fungi

Risk of high-grade serous ovarian cancer associated with pelvic inflammatory disease, parity and breast cancer

Background: Ovarian carcinoma is not a single disease, but rather a collection of subtypes with differing molecular properties and risk profiles. The most common of these, and the subject of this work, is high-grade serous ovarian carcinoma (HGSC). Methods: In this population-based study we identified a cohort of 441,382 women resident in Western Australia who had ever been admitted to hospital in the State. Of these, 454 were diagnosed with HGSC. We used Cox regression to derive hazard ratios (HRs) comparing the risk of disease in women who had each of a range of medical diagnoses and surgical procedures with women who did not. Results: We found an increased risk of HGSC associated with a diagnosis of pelvic inflammatory disease (PID) (HR 1.47, 95% CI 1.04–2.07) but not with a diagnosis of infertility or endometriosis with HRs of 1.12 (95% CI 0.73–1.71) and 0.82 (95% CI 0.55–1.22) respectively. A personal history of breast cancer was associated with a three-fold increase in the rate of HGSC. Increased parity was associated with a reduced risk of HGSC in women without a personal history of breast cancer (HR 0.57; 95% CI 0.44-0.73), but not in women with a personal history of breast cancer (HR 1.48; 95% CI 0.74–2.95). Conclusions: Our finding of an increased risk of HGSC associated with PID lends support to the hypothesis that inflammatory processes may be involved in the etiology of HGSC

Hyperfine coupling constants on inner‐sphere water molecules of GdIII‐based MRI contrast agents

[Abstract] Herein we present a theoretical investigation of the hyperfine coupling constants (HFCCs) on the inner‐sphere water molecules of [Gd(H2O)8]3+ and different GdIII‐based magnetic resonance imaging contrast agents such as [Gd(DOTA)(H2O)]−, [Gd(DTPA)(H2O)]2−, [Gd(DTPA‐BMA)(H2O)] and [Gd(HP‐DO3A)(H2O)]. DFT calculations performed on the [Gd(H2O)8]3+ model system show that both hybrid‐GGA functionals (BH&HLYP, B3PW91 and PBE1PBE) and the hybrid meta‐GGA functional TPSSh provide 17O HFCCs in close agreement with the experimental data. The use of all‐electron relativistic approaches based on the DKH2 approximation and the use of relativistic effective core potentials (RECP) provide results of essentially the same quality. The accurate calculation of HFCCs on the [Gd(DOTA)(H2O)]−, [Gd(DTPA)(H2O)]2−, [Gd(DTPA‐BMA)(H2O)] and [Gd(HP‐DO3A)(H2O)] complexes requires an adequate description of solvent effects. This was achieved by using a mixed cluster/continuum approach that includes explicitly two second‐sphere water molecules. The calculated isotropic 17O HFCCs (Aiso) fall within the range 0.40–0.56 MHz, and show deviations from the corresponding experimental values typically lower than 0.05 MHz. The Aiso values are significantly affected by the distance between the oxygen atom of the coordinated water molecule and the GdIII ion, as well as by the orientation of the water molecule plane with respect to the Gd‐O vector. 1H HFCCs of coordinated water molecules and 17O HFCCs of second‐sphere water molecules take values close to zero.Ministerio de Educación y Ciencia; CTQ2009‐10721Xunta de Galicia; IN845B‐2010/06