Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study

To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction

Coping Mechanisms, Psychological Distress, and Quality of Life Prior to Cancer Genetic Counseling

Background: Breast Cancer susceptibility genes 1 and 2 are implicated in hereditary breast and ovarian cancer and women can test for the presence of these genes prior to developing cancer. The goal of this study is to examine psychological distress, quality of life, and active coping mechanisms in a sample of women during the pre-test stage of the genetic counseling process, considering that pre-test distress can be an indicator of post-test distress. We also wanted to identify if subgroups of women, defined based on their health status, were more vulnerable to developing distress during the genetic counseling process.Methods: This study included 181 female participants who accessed a Cancer Genetic Counseling Clinic. The participants were subdivided into three groups on the basis of the presence of a cancer diagnosis: Affected patients, Ex-patients, and Unaffected participants. Following a self-report questionnaire, a battery of tests was administered to examine psychological symptomatology, quality of life, and coping mechanisms.Results: The results confirm that the genetic counseling procedure is not a source of psychological distress. Certain participants were identified as being more vulnerable than others; in the pre-test phase, they reported on average higher levels of distress and lower quality of life. These participants were predominantly Ex-patients and Affected patients, who may be at risk of distress during the counseling process.Conclusions: These findings highlight that individuals who take part in the genetic counseling process are not all the same regarding pre-test psychological distress. Attention should be paid particularly to Ex-patients and Affected patients by the multidisciplinary treating team

On the need for rigorous welfare and methodological reporting for the live capture of large carnivores: A response to de Araujo et al. (2021)

1.De Araujo et al. (Methods in Ecology and Evolution, 2021, https://doi.org/10.1111/2041-210X.13516) described the development and application of a wire foot snare trap for the capture of jaguars Panthera onca and cougars Puma concolor. Snares are a commonly used and effective means of studying large carnivores. However, the article presented insufficient information to replicate the work and inadequate consideration and description of animal welfare considerations, thereby risking the perpetuation of poor standards of reporting. 2.Appropriate animal welfare assessments are essential in studies that collect data from animals, especially those that use invasive techniques, and are key in assisting researchers to choose the most appropriate capture method. It is critical that authors detail all possible associated harms and benefits to support thorough review, including equipment composition, intervention processes, general body assessments, injuries (i.e. cause, type, severity) and post-release behaviour. We offer a detailed discussion of these shortcomings. 3.We also discuss broader but highly relevant issues, including the capture of non-target animals and the omission of key methodological details. The level of detail provided by authors should allow the method to be properly assessed and replicated, including those that improve trap selectivity and minimize or eliminate the capture of non-target animals. 4.Finally, we discuss the central role that journals must play in ensuring that published research conforms to ethical, animal welfare and reporting standards. Scientific studies are subject to ever-increasing scrutiny by peers and the public, making it more important than ever that standards are upheld and reviewed. 5. We conclude that the proposal of a new or refined method must be supported by substantial contextual discussion, a robust rationale and analyses and comprehensive documentation

Assessment of the use of Pap test in a sample of pregnant women

Four hundred and ninety-nine women were interviewed who gave birth in the "L. Mangiagali" Obstetrics-Gynaecological Clinic between March and April 1989. 22% of these women had never had a Pap-test, 37% reported having had 1-2 cervical smears and 41% 3 or more. In the group of patients that contacted a private gynaecologist during pregnancy, the percentage of women who had never had a Pap-test was 18% versus 30% in the group of subjects followed in the public health service. Although pluriparas reported a greater number of Pap-test than primiparas, this difference was not statistically significant. Youth is significantly related to the probability of never having had a cervical smear. Social and economic factors were also clearly important. In particular, women with a low educational level represented the group with the highest risk for the lack of cervical screening. The role of the gynaecologist and preventive programmes aimed at the higher risk levels play an important role in terms of heightening awareness

Risk factors for varicose disease before and during pregnancy

Risk factors for varicose disease before and during pregnancy have been analyzed by use of data from a survey on venous disease in pregnancy conducted in 611 women (mean age thirty years, range fifteen to forty-seven) who consecutively delivered at the Obstetric-Gynecologic Clinic ''L. Mangiagalli'' of Milan between January and April, 1989. In total, 137 women (22%) reported varicose disease before the index pregnancy. The relative risk (RR) of varicose disease before the index pregnancy increased with age, being, as compared with women aged twenty-nine years or less, 1.6 in those aged thirty to thirty-four and 4.1 in those aged thirty-five years or more (chi2(1) trend 29.28, p < 0.001). Compared with nulliparae, women reporting a full-term pregnancy before the index pregnancy had an RR of venous disease of 1.2, and the risk increased to 3.8 in women reporting two or more births (chi2(1), trend 25.28, p < 0.001). A family history of varicose disease was associated with an RR of venous disease of 6.2 (95% confidence interval, CI, from 4.1 to 9.6). No relationship emerged between varicose disease and overweight. Of the 474 women who did not report venous disease before the index pregnancy, 132 (28%) developed venous disease during the index pregnancy. The risk of developing venous disease in pregnancy increased with age, being, as compared with women aged twenty-four years or less, 4.0 in those aged thirty-five years or more, and the trend in risk was statistically Significant (chi2(1) trend 16.25, p < 0.001). To be secondiparae or more was associated with an increased risk of developing venous disease in pregnancy. Compared with primiparae, the estimated RR was 2.0 (95% CI 1.3 to 2.9) in women reported to have given birth to one child or more. Women who developed venous disease in pregnancy reported more frequently a family history of varicose disease than those who did not; the RR estimate was 5.8, (95% CI from 3.8 to 8.9)

Oral contraceptive use and risk of uterine fibroids

The association between oral contraceptive (OC) use and the risk of uterine fibroids was analyzed in a case-control study conducted between 1986-1990. The subjects were 390 patients under 55 years of age with histologically confirmed fibroids and 1136 controls in hospitals for a spectrum of acute conditions (other than gynecologic, hormonal, or neoplastic) apparently unrelated to OC use. A total of 78 cases (20%) and 200 controls (18%) reported OC use. Compared with never-users, the multivariate relative risk for ever-users was 1.1 (95% confidence interval [CI] 0.8-1.5). No direct relationship emerged with duration of use, the estimated relative risk being 1.3 (95% CI 0.9-2.0) in users of OCs for less than 3 years and 0.8 (95% CI 0.5-1.3) in users for 3 years or more. The risk of fibroids was apparently (though not significantly) greater with longer recency of use: The estimated relative risks were 0.9 and 1.5, respectively, in women reporting last OC use less than 10 years before and 10 or more years before diagnosis of the disease. No relationship emerged with latency of use. There was no noteworthy interaction regarding risk of fibroids between OC use and potential covariates. These findings suggest that fibroids are unrelated to the use of OCs

The smoking habit in pregnancy : results of a survey conducted in Milan

The prevalence of smoking in pregnancy has been analyzed in a surveillance of women delivering between February and March 1989 in a large maternity clinic in Milan, Northern Italy. Out of the 411 interviewed women, 133 (32%) were current smokers before and 71 quit smoking during pregnancy. The probability to quit smoking decreased with increasing age and was lower in less educated women; these findings were however not statistically significant. Considering persistent smokers only, the mean number of cigarettes per day decreased from 13 before pregnancy to 8 during gestation; this finding was generally consistent in various subgroups of age and education. These reduction, however, are probably overestimated, since they are based on women's report only. Thus, these findings indicate that there is still ample scope for intervention on smoking in pregnancy, particularly in older and less educated women

Uterine myomas and smoking. Results from an Italian study

OBJECTIVE: To evaluate the relationship between smoking and uterine myomas requiring surgery. STUDY DESIGN: We conducted a case-control study in Milan between 1986 and 1992. Cases were 476 patients under 55 years of age with histologically confirmed myomas. Controls were 1,283 women admitted to the hospital for a spectrum of-acute, other-than-gynecologic, hormonal or neoplastic conditions (30% trauma, 25% nontraumatic orthopedic conditions, 25% surgical, 20% other miscellaneous). RESULTS: Cases were less frequently current smokers (22%) than controls (32%). In comparison with never smokers, the multivariate relative risk (RR) for myomas was 0.5 (95% confidence interval [CI], 0.4-0.7) in smokers. Ex-smokers were 10% of cases versus 7% of controls (RR 1.2, 95% CI 0.9-1.8). No clear trend in risk was observed with the number of cigarettes smoked per day or duration of smoking and risk of fibroids. The estimated RRs were largely consistent when separate analyses were performed in strata of body weight. CONCLUSION: Current smoking seems to reduce the risk of myomas