Διατήρηση γονιμότητας σε αρχόμενο καρκίνο ωοθηκών

Ο καρκίνος των ωοθηκών είναι μια από τις πιο κοινές κακοήθειες του γυναικείου αναπαραγωγικού συστήματος. Χάρη στις σύγχρονες και εξατομικευμένες θεραπείες, οι γυναίκες σε αναπαραγωγική ηλικία έχουν υψηλό ποσοστό επιβίωσης μετά την θεραπεία. Σ’ αυτή την ανασκόπηση εξετάζονται οι προσεγγίσεις που αποσκοπούν στη διατήρηση της γονιμότητας, όταν εντοπίζονται γυναικολογικοί όγκοι σε αρχόμενο στάδιο και υπογραμμίζονται οι εκβάσεις της εγκυμοσύνης. Πραγματοποιήθηκε βιβλιογραφική αναζήτηση στις βάσεις δεδομένων PubMed και Google Scholar για μελέτες στην αγγλική γλώσσα, από την έναρξη της ανασκόπησης έως τον Ιούνιο του 2022. Οι χημειοθεραπευτικές και χειρουργικές προσεγγίσεις που προστατεύουν τη γονιμότητα (FSS), μετά από προσεκτική επιλογή των ασθενών, διατηρούν τη δυνατότητα να εκπληρώσουν την επιθυμία για τη δημιουργία οικογένειας, χωρίς να διακυβεύεται η μακροπρόθεσμη επιβίωση. Όμως, ενώ η μελλοντική διασφάλιση της γονιμότητας έχει καθοριστική σημασία για τις νεαρές γυναίκες με καρκίνο, τα ποσοστά επιτυχίας των επεμβάσεων διατήρησης της γονιμότητας δεν είναι υψηλά. Για ασθενείς με όγκους οριακής κακοήθειας, η FSS θα πρέπει να πραγματοποιείται, ακόμη και αν ανακαλυφθούν περιτοναϊκές εμφυτεύσεις κατά την αρχική επέμβαση. Νέες γυναίκες με ενδομητριοειδές καρκίνωμα ωοθηκών σταδίου Ι, που υποβλήθηκαν σε FSS, εμφάνισαν σχετικά ικανοποιητική πρόγνωση, ίση με εκείνες που υποβλήθηκαν σε συμβατική ριζική χειρουργική επέμβαση. Σε ασθενείς με επιθηλιακό καρκίνωμα ωοθηκών σταδίου IC2/IC3, η FSS δεν συσχετίστηκε με επιδείνωση της συνολικής επιβίωσης. Ωστόσο, το ποσοστό υποτροπής είναι σημαντικό. Σχετικά με την FSS για αρχόμενο καρκίνο των ωοθηκών, που πραγματοποιείται λαπαροσκοπικά, τα στοιχεία που υπάρχουν είναι ακόμη περιορισμένα. Επιπλέον, καθώς τα δεδομένα σχετικά με τα ποσοστά εγκυμοσύνης και τα αποτελέσματα μετά από θεραπείες που προστατεύουν τη γονιμότητα είναι και αυτά περιορισμένα, είναι δύσκολο να παρέχονται με ακρίβεια συμβουλές στις ασθενείς, ώστε να τρέφουν ρεαλιστικές προσδοκίες.Ovarian cancer is one of the most common malignancies of the female reproductive system. Thanks to modern and personalized treatments, women of childbearing potential have a high survival rate after treatment. This review examines approaches aimed at maintaining fertility, when tumors of gynecological interest are identified at an early stage and the outcomes of pregnancy are highlighted. A literature search was conducted in the PubMed and Google Scholar databases for studies in English, from the beginning of the review until June 2022. Chemotherapy and fertility sparing surgery (FSS), after careful selection of patients, retain the ability to fulfill the desire to start a family, without compromising long-term survival. But while ensuring future fertility is crucial for young women with cancer, the success rates of fertility maintenance surgeries are not high. For patients with marginal malignancies, FSS should be performed, even if peritoneal implants are discovered during the initial operation. Young women with endometrial carcinoma of stage I, who underwent FSS, had a relatively good prognosis, equal to those who underwent conventional radical surgery. In patients with stage II ovarian epithelial carcinoma, FSS was not associated with deterioration in overall survival. However, the recurrence rate is significant. Regarding laparoscopic FSS for early ovarian cancer, the available data are still limited. In addition, as data on pregnancy rates and results after fertility treatments are also limited, it is difficult to provide accurate advice to patients in order to meet realistic expectations

Investigating Personalization Methods in Text to Music Generation

In this work, we investigate the personalization of text-to-music diffusion models in a few-shot setting. Motivated by recent advances in the computer vision domain, we are the first to explore the combination of pre-trained text-to-audio diffusers with two established personalization methods. We experiment with the effect of audio-specific data augmentation on the overall system performance and assess different training strategies. For evaluation, we construct a novel dataset with prompts and music clips. We consider both embedding-based and music-specific metrics for quantitative evaluation, as well as a user study for qualitative evaluation. Our analysis shows that similarity metrics are in accordance with user preferences and that current personalization approaches tend to learn rhythmic music constructs more easily than melody. The code, dataset, and example material of this study are open to the research community.Comment: Submitted to ICASSP 2024, Examples at https://zelaki.github.io

Predictive Factors in OCT Analysis for Visual Outcome in Exudative AMD

Background. Reliable predictive factors for therapy outcome may enable treating physicians to counsel their patients more efficiently concerning probability of improvement or time point of discontinuation of a certain therapy. Methods. This is a retrospective analysis of 87 patients with exudative age-related macular degeneration who received three monthly intravitreal ranibizumab injections. Visual acuity before initiation of intravitreal therapy and 4–6 weeks after last intravitreal injection was compared and related to the preoperative visualisation of continuity of the outer retinal layers as assessed by OCT: external limiting membrane (ELM), inner photoreceptor segments (IPS), junction between inner and outer segments (IS/OS), and outer photoreceptor segments (OPS). Results. Visual acuity increased in 40 of 87 (46.0%) patients, it remained stable in 25 (28.7%), and 22 (25.3%) patients had decreased visual acuity four to six weeks after triple intravitreal ranibizumab injections. No statistically significant predictive value could be demonstrated for grade of continuity of outer retinal layers concerning visual acuity development. Conclusions. In our series of AMD patients, grade of continuity of outer retinal layers was not a significant predictive value for visual acuity development after triple ranibizumab injections

Effects on choroidal neovascularization after anti-VEGF Upload using intravitreal ranibizumab, as determined by spectral domain-optical coherence tomography

It is unclear whether anti-VEGF monotherapy in age-related macular degeneration (AMD) achieves morphologic CNV regression or only stops further CNV growth. In this study, spectral domain-optical coherence tomography (SD-OCT) was used to image CNV structure before and after anti-VEGF treatment

Interobserver variability for retreatment indications after Ranibizumab loading doses in neovascular age-related macular degeneration

To assess the interobserver variability (IOV) in indicating retreatment for neovascular Age-related macular degeneration 4 weeks after three Ranibizumab loading doses using spectral domain OCT (SD-OCT) as the primary objective diagnostic tool

Diagnostic value of post-operative platelet-to-white blood cell ratio after splenectomy in patients with advanced ovarian cancer

Introduction Splenectomy-induced thrombocytosis and leukocytosis may obscure the early diagnosis of post-operative infection or sepsis. In trauma patients after splenectomy, a platelet-to-white blood cell ratio of Objective To determine whether the platelet-to-white blood cell ratio can be applied to differentiate between reactive post-operative changes and latent infection. Methods All consecutive patients with ovarian cancer who underwent splenectomy between January 2013 and October 2018 in two large European gynecological cancer centers were retrospectively evaluated. Main outcome measures were white blood cell count, platelet count, and platelet-to-white blood cell ratio on post-operative days 1, 5, and 7. These were correlated with surgical outcome and morbidity according to the Clavien-Dindo classification. A binomial logistic regression was applied to assess the predictive value of day 5 platelet-to-white blood cell ratio, white blood cell count, and platelet count for predicting grade III post-operative sepsis. Results Ninety-five patients with ovarian cancer (mean age 54 years, range 18-75) were identified. Seventeen patients (17.9%) developed a grade III post-operative sepsis. In all post-operative patients, mean white blood cell count on day 5 decreased (from 15.4x10(3)/mu L to 11.4x10(3)/mu L), while the mean platelet count rose (from 260.7x10(3)/mu L to 385.3x10(3)/mu L). A high platelet count (>313x10(3)/mu L) failed to show any predictive value (OR=0.94; 95% CI 0.30 to 3.0; p=0.921). A low platelet-to-white blood cell ratio (<26) (OR=3.49; 95% CI 1.18 to 10.32; p=0.0241) and high white blood cell count (>14.5x10(3)/mu L) on day 5 (OR=11.0; 95% CI 3.3 to 36.2; p<0.001) were significant for predicting sepsis. Despite a significant OR, the sensitivity and specificity were low; day 5 platelet-to-white blood cell ratio at a cut-off point of 26 achieved a sensitivity of 72% and specificity of 53% (area under the curve 0.637, 95% CI 0.480 to 0.796) in predicting grade III post-operative sepsis. Conclusions Platelet-to-white blood cell ratio after cytoreductive surgery for ovarian cancer with splenectomy does not appear to have a strong predictive value in differentiating between sepsis and reactive splenectomy-induced changes. Leukocytosis, in combination with clinical assessment, may remain the most useful tool for prediction of sepsis after cytoreductive surgery with splenectomy

Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology

The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study’s primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71