An update on the management of acute pelvic inflammatory disease

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Psychometric properties of a Chinese version of the medical outcomes study family and marital functioning measures in Hong Kong Chinese childbearing families

The aim of the study was to evaluate the psychometric properties of the Chinese version of Medical Outcomes Study Family and Marital Functioning Measures (C-MOS-FMFM) in Hong Kong Chinese childbearing families. A cross-sectional survey was conducted using a convenience sample of 128 childbearing couples recruited from antenatal clinics. The C-MOS-FMFM demonstrated good internal consistency (Cronbach's alpha = 0.79) and test-retest reliability (intraclass correlation coefficient = 0.74). Significant correlations with Medical Outcomes Study-Social Support Survey (r = 0.38, P<0.01) and Trait Anxiety Inventory (r = -0.48, P<0.01) supported construct validity. Factor analysis identified one factor corresponding to family functioning and two factors corresponding to marital functioning. The C-MOS-FMFM has satisfactory psychometric properties. It has the potential to be used as a clinical and research instrument for measuring family and marital functioning in the Chinese population. © Springer Science+Business Media, LLC 2011.published_or_final_versionSpringer Open Choice, 21 Feb 201

Fetal Fibronectin Test On Chinese Women With Symptoms Of Preterm Labour: A Pilot Study

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Surgical Management of Adnexal Masses in Pregnancy

Background and Objectives: Our objective was to review the surgical management, surgical outcomes, and obstetric outcomes of adnexal masses in pregnancy. Methods: A retrospective review was performed of pregnant women before 20 weeks of gestation who underwent laparoscopy or laparotomy for management of an adnexal mass during the period of January 2005 to June 2012 at a university-affiliated hospital. Results: Thirty-five pregnant women underwent surgical removal of adnexal masses during the 7.5-year study period: 21 (60.0%) underwent laparoscopic surgery, and 14 (40.0%) underwent laparotomy. The left upper quadrant entry technique was used in 20 women. Conversion to laparotomy was required in 2 women because of extensive pelvic adhesions. The mean gestational age at surgery was 15.2 ± 1.9 weeks. All women had undergone ovarian cystectomy. A malignant mass was found in 3 (8.6%) women. The laparoscopy group had a significantly less blood loss (67.4 ± 55.8 vs 153.6 ± 181.0 mL, P = .048) and shorter mean hospital stay (2.8 ± 1.0 vs 3.8 ± 1.1 days, P = .006) than the laparotomy group. One woman miscarried soon after surgery. There was no significant difference in obstetric outcomes between the laparoscopy and laparotomy groups. Conclusion: Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for the mother and the fetus.published_or_final_versio

Second trimester termination of pregnancy after previous classical caesarean section for uterine fibroid

E-poster - EP13: Early Pregnancy: no. EP13.05This journal suppl. entitled: Special Issue: Abstracts of the RCOG World Congress 2013, 24–26 June 2013, Liverpool, United KingdomOBJECTIVES: To report the successful termination of pregnancy in a patient with history of previous classical caesarean section performed because of uterine fibroid obstructing the lower segment. METHODS: The patient had classical caesarean section performed for transverse lie, uterine fibroid 14 months prior to presentation requesting termination of pregnancy at 14 weeks maturity. During the operation, a 16 cm broad ligament fibroid was found posteriorly in the left side. The patient was treated with the following regimen 1. Insertion of hygroscopic cervical dilator the night before 2. Misoprostol 50 microgram vaginally, then 100 microgram vaginally 4 hours after initial dose, then 150 microgram vaginally 8 hours after initial dose, then 200 microgram ...published_or_final_versio

Experience of using bevacizumab in epithelial ovarian, fallopian tube and primary peritoneal cancers in a single centre

Objectives: To review the use of bevacizumab in epithelial ovarian, fallopian tube and primary peritoneal cancers in our centre. Methods: Patients receiving bevacizumab for epithelial ovarian, fallopian tube and primary peritoneal cancer at the Division of Gynaecological Oncology, Queen Mary Hospital, The University of Hong Kong between January 2011 and December 2015 were included. A retrospective chart review was performed. Main outcome measures were adverse events and progression-free survival. Results: Overall, 41 patients received bevacizumab for epithelial ovarian, fallopian tube or primary peritoneal cancer, of which 24 were for primary treatment and 17 for recurrent disease. Of 24 patients who received bevacizumab as primary treatment, the median age was 52 years, and 12.5% of the patients had early-stage high-risk disease, 87.5% had FIGO stage III or IV disease, 45.8% had a serous adenocarcinoma, and 54.2% had residual disease after debulking surgery. Of 17 patients who received bevacizumab for recurrent disease, the median age was 52 years, and 94.1% of the patients were having their first recurrence, 64.7% had platinum-sensitive disease and 41.2% had a serous adenocarcinoma. Grade 2 or higher hypertension and proteinuria occured in 24.4% and 12.2% of patients, respectively. Bevacizumab was discontinued in 7.3% of patients due to adverse events and 31.7% due to inadequate therapeutic response. The median progression free survival was 18.0 months (95% CI 13.6 to 22.4) for primary treatment and 11.0 months (95% CI 8.4 to 13.6) for recurrent disease. Conclusions: With acceptable toxicity, combination of bevacizumab and chemotherapy may be considered as treatment modality in newly diagnosed suboptimally debulked stage III or stage IV ovarian cancer as well as in recurrent ovarian cancer.postprin

Dysmenorrhoea among Hong Kong university students: prevalence, impact, and management

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GRO-α and IL-8 enhance ovarian cancer metastatic potential via the CXCR2-mediated TAK1/NFκB signaling cascade

Intraperitoneal metastasis is a common occurrence and is usually involved in the poor prognosis of ovarian cancer. Its specific metastatic pattern implies that certain indispensable microenvironmental factors secreted in the peritoneal cavity can direct metastatic ovarian cancer cells to permissive niches for secondary lesion formation. However, the underlying molecular mechanisms are ill defined. Herein, we report that GRO-α and IL-8 are predominately upregulated in culture media derived from either normal or cancerous omenta and are associated with increased ovarian cancer aggressiveness. Methods: OCM was established from culture medium of fresh human omental tissues. Primary and metastatic ovarian cancer cell lines were generated from human tumor tissues and verified by specific antibodies. The functional roles of GRO-α, IL-8, and their specific receptor CXCR2 were examined by neutralizing antibodies, shRNA gene knockdown, CRISPR/Cas9 gene knockout and pharmaceutical CXCR2 inhibitor SB225002. The oncogenic properties of ovarian cancer cells were examined by in vitro and in vivo mouse models. Results: Both GRO-α and IL-8 can activate TAK1/NFκB signaling via the CXCR2 receptor. Intriguingly, TAK1/NFκB signaling activity was higher in metastatic ovarian cancer cells; this higher activity makes them more susceptible to OCM-induced tumor aggressiveness. Treatment of ovarian cancer cells with GRO-α and IL-8 neutralizing antibodies or ablation of CXCR2 by shRNA gene knockdown, CRISPR/Cas9 gene knockout, or CXCR2 inhibitor SB225002 treatment significantly attenuated TAK1/NFκB signaling and decreased in vitro and in vivo oncogenic and metastatic potential, suggesting CXCR2 plays a key role in the GRO-α and IL-8-governed metastatic spreading of ovarian cancer cells in the intraperitoneal cavity. Conclusion: This study highlights the significance of GRO-α and IL-8 as the key chemokines in the peritoneal tumor microenvironment and suggests the utility of targeting their receptor CXCR2 as a potential target-based therapy for peritoneal metastases of ovarian cancer.published_or_final_versio

Methylation-associated silencing of miR-193a-3p promotes ovarian cancer aggressiveness by targeting GRB7 and MAPK/ERK pathways

Human growth factor receptor-bound protein-7 (GRB7) is a pivotal mediator involved in receptor tyrosine kinase signaling and governing diverse cellular processes. Aberrant upregulation of GRB7 is frequently associated with the progression of human cancers. However, the molecular mechanisms leading to the upregulation of GRB7 remain largely unknown. Here, we propose that the epigenetic modification of GRB7 at the post-transcriptional level may be a crucial factor leading to GRB7 upregulation in ovarian cancers. Methods: The upstream miRNA regulators were predicted by in silico analysis. Expression of GRB7 was examined by qPCR, immunoblotting and immunohistochemical analyses, while miR-193a-3p levels were evaluated by qPCR and in situ hybridization in ovarian cancer cell lines and clinical tissue arrays. MS-PCR and pyrosequencing analyses were used to assess the methylation status of miR-193a-3p. Stable overexpression or gene knockdown and Tet-on inducible approaches, in combination with in vitro and in vivo tumorigenic assays, were employed to investigate the functions of GRB7 and miR-193a-3p in ovarian cancer cells. Results: Both miR-193a-3p and its isoform, miR-193b-3p, directly targeted the 3' UTR of GRB7. However, only miR-193a-3p showed a significantly inverse correlation with GRB7-upregulated ovarian cancers. Epigenetic studies revealed that methylation-mediated silencing of miR-193a-3p led to a stepwise decrease in miR-193a-3p expression from low to high-grade ovarian cancers. Intriguingly, miR-193a-3p not only modulated GRB7 but also ERBB4, SOS2 and KRAS in the MAPK/ERK signaling pathway to enhance the oncogenic properties of ovarian cancer cells in vitro and in vivo. Conclusion: These findings suggest that epigenetic silencing of miR-193a-3p by DNA hypermethylation is a dynamic process in ovarian cancer progression, and miR-193a-3p may be explored as a promising miRNA replacement therapy in this disease.published_or_final_versio

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty