Impact of treatment modality on overall survival in women with advanced endometrial cancer: A National Cancer Database analysis

ObjectiveTo evaluate overall survival (OS) in women with advanced endometrial cancer (EC) following chemotherapy alone (CT), neoadjuvant chemotherapy and interval debulking surgery (NACT + IDS) or primary cytoreductive surgery and chemotherapy (PCS + CT).MethodsThe National Cancer Database (NCDB) was queried for patients with stage III/IV EC from 2004 to 2015. Univariable and multivariable Cox proportional hazards analyses assessed the impact of treatment modality upon OS.ResultsOf 48,179 women identified, 5531 received CT (11.5%), 2614 NACT + IDS (5.4%) and 40,034 PCS + CT (83.1%). Median OS was 11.1 months for CT, 25.1 months for NACT + IDS and 60.9 months for PCS + CT (p < 0.001). On multivariate analysis, NACT + IDS (HR 0.44 (0.40, 0.49); p < 0.001) and PCS + CT (HR 0.32 (0.30, 0.35); p < 0.001) were associated with improved OS vs. CT alone. Age, African American race, income, higher Charlson comorbidity index and grade were predictors of worse OS (p < 0.001). On subgroup analysis by stage (III/IV) and histology (Type I/II), PCS + CT improved OS for all patients, compared to NACT + IDS (p < 0.001) and CT (p < 0.001). NACT + IDS was associated with improved OS vs. CT in stage III type I (HR 0.50; 95% CI 0.38, 0.67; p < 0.001), stage IV type I (HR 0.43; 95% CI 0.35, 0.52; p < 0.001), and stage IV type II EC (HR 0.43; 95% CI 0.36, 0.51; p < 0.001), but not stage III type II EC (HR 0.76; 95% CI 0.56, 1.03; p = 0.08).ConclusionsIn women with advanced EC, PCS + CT is associated with improved OS compared to NACT + IDS or CT alone, regardless of stage or histology. Additionally, NACT + IDS is associated with superior OS in stage III type I and all stage IV EC compared to CT alone. Where feasible, surgery should be incorporated into treatment planning in women with advanced EC.     

Possible candidate population for neoadjuvant chemotherapy in women with advanced ovarian cancer

ObjectiveTo examine trends and outcomes related to neoadjuvant chemotherapy (NACT) use for advanced ovarian cancer based on patient and tumor factors.MethodsThis retrospective cohort study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program to examine women with stage III-IV high-grade serous ovarian carcinoma from 2010 to 2016. Propensity score inverse probability of treatment weighting was used to assess the age-, cancer stage-, and tumor extent-specific survival estimates related to NACT use.ResultsUtilization of NACT has significantly increased in older women (≥65 years; 48.4% relative increase), followed by stage IV disease (35.2% relative increase), and stage III disease (25.0% relative increase) (all, P-trend < 0.05). Women who received NACT had overall survival (OS) similar to those who had primary cytoreductive surgery (PCS) in older women (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.95–1.20, P = 0.284), stage IV disease (HR 0.96, 95%CI 0.84–1.10, P = 0.564), and more disease extent cases (T3/N1/M1, HR 1.06, 95%CI 0.84–1.32, P = 0.640). Moreover, NACT use was associated with decreased other cause mortality risk compared to PCS in the older women (sub-distribution HR 0.61, 95%CI 0.40–0.94, P = 0.025) and stage IV disease (sub-distribution HR 0.49, 95%CI 0.27–0.90, P = 0.021). In contrast, women who received NACT had decreased OS compared to those who had PCS in the younger group (HR 1.22, 95%CI 1.07–1.38, P = 0.004), stage III disease (HR 1.26, 95%CI 1.13–1.41, P < 0.001), and lesser disease extent cases (T3/N0/M0, HR 1.38, 95%CI 1.20–1.58, P < 0.001).ConclusionOur study suggests that survival effect of NACT for advanced ovarian cancer may differ based on patient and tumor factors. In older women, stage IV disease, and greater disease extent, NACT was associated with similar OS compared to PCS.     

Ovarian reserve markers after discontinuing long-term use of combined oral contraceptives

Research questionHow early do the ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) normalize after discontinuation of the long-term use of combined oral contraceptives (COC).DesignThis was a prospective cohort study of 68 women with a history of long-term COC use. Serum AMH concentrations, ovarian volume and AFC were measured during COC use and serially in a 4-month period after discontinuing COC: 1 and 2 weeks after discontinuation, and on cycle day 2–5 during three consecutive menstrual cycles. Changes in AMH and AFC were investigated using linear mixed models of repeated measurements adjusted for relevant covariates.ResultsMean age was 29.4 years and mean duration of COC use 8.0 years. Baseline median AMH concentrations during COC use of 13 pmol/l (interquartile range [IQR] 8.4–22 pmol/l) increased to a median of 22.5 pmol/l (IQR 11–37 mol/l) 3 months after discontinuation. The estimated average increase was 53% (95% confidence interval [CI] 1.40–1.68, P < 0.001). AFC increased from a median value of 17 (IQR 11–25) to 24 (IQR 17–34). The estimated average increase was 41% (95% CI 1.30–1.52, P < 0.001). Ovarian volume increased from 2.4 to 5.8 ml (P < 0.001). The ovarian reserve markers increased continuously from baseline measurements until 2 months after discontinuation. Thereafter a plateau was reached.ConclusionAfter discontinuation of COC, AMH increased by 53% and AFC by 41%, with values returning to normal within 2 months. This study provides clinicians with the highly relevant knowledge that AMH and AFC can be measured 2 months after discontinuation of COC without having to account for their influence.     

Improving Capacity at School-based Health Centers to Offer Adolescents Counseling and Access to Comprehensive Contraceptive Services

Study ObjectivesMany pediatric providers serving adolescents are not trained to offer comprehensive contraceptive services, including intrauterine devices (IUDs) and implants, despite high safety and satisfaction among adolescents. This study assessed an initiative to train providers at school-based health centers (SBHCs) to offer students the full range of contraceptive methods.DesignSurveys were administered at baseline pre-training and at follow-up 3 months post-training. Data were analyzed using generalized estimating equations for clustered data to examine clinical practice changes.SettingEleven contraceptive trainings at SBHCs across the United States from 2016-2019.ParticipantsA total of 260 providers from 158 SBHCs serving 135,800 students.InterventionsOn-site training to strengthen patient-centered counseling and to equip practitioners to integrate IUDs and implants into contraceptive services.Main Outcome MeasuresThe outcomes included counseling experience on IUDs and implants, knowledge of patient eligibility, and clinician method skills.ResultsAt follow-up, providers were significantly more likely to report having enough experience to counsel on IUDs (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.62-6.36]) and implants (aOR, 3.06; 95% CI, 2.05-4.57). Provider knowledge about patient eligibility for IUDs, including for adolescents, increased (P < .001). Providers were more likely to offer same-visit IUD (aOR, 2.10; 95% CI, 1.41-3.12) and implant services (aOR, 1.66; 95% CI, 1.44-1.91). Clinicians’ skills with contraceptive devices improved, including for a newly available low-cost IUD (aOR, 2.21; 95% CI, 1.45-3.36).ConclusionsOffering evidence-based training is a promising approach to increase counseling and access to comprehensive contraceptive services at SBHCs.     

Effects of Pelvic Floor Muscle Training on Sexual Dysfunction,Sexual Satisfaction of Partners,Urinary Symptoms,and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study

BackgroundIn women with overactive bladder (OAB), sexual dysfunctions and sexual satisfaction of their partners have been problems that are as important as urinary symptoms.AimTo investigate the effects of pelvic floor muscle training (PFMT) on sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and pelvic floor muscle strength (PFMS) in women with OAB.MethodsWomen with OAB were randomized into 2 groups: 6-week PFMT (n = 21) (home exercise program) and a control group (n = 22) (did not receive any treatment for OAB).OutcomesSexual dysfunction, sexual satisfaction of partner, urinary symptoms, and PFMS were assessed at baseline and after 6 weeks with the Female Sexual Function Index (FSFI), a Visual Analogue Scale (VAS), the OAB-Version8 (OAB-V8), and the Modified Oxford Scale (MOS), respectively.ResultsAfter 6 weeks, there was an increase in FSFI domains [desire (95% CI: 0.18 to 0.64; P:.001, d: 0.88); arousal (95% CI: 0.42 to 1.24, P:<.001, d: 1.17); orgasm (95% CI:0.85 to 1.47; P:<.001, d:1.89); satisfaction (95% CI: 0.85 to 1.44; P:<.001, d: 2.29); sexual pain (95% CI:0.80 to 1.52; P:<.001, d:1.47); total score (95% CI: 3.70 to 5.94; P:<.001, d: 2.55)], sexual satisfaction of partners (95% CI: 1.80 to 2.85; P:<.001, d:2.83) and PFMS scores (95% CI: 1.10 to 1.55; P:<.001, d:3.18), and a decrease in the OAB-V8 score (95% CI: -13.01 to -7.10; P:<.001, d:2.19) in the PFMT group compared to the control group. There was a significant decrease in sexual dysfunction in the PFMT group compared to the control group (P:.046).Clinical ImplicationsIn order to improve sexual function, sexual satisfaction of the partners, urinary symptoms, and PFMS in women with OAB, PFMT should be added to the rehabilitation program in clinics.Strengths & LimitationsThe strength of this study was that it is a randomized controlled trial investigating the effect of PFMT in improving sexual function in OAB. The limitations of our study were the lack of a long-term (6 months-1 year) follow-up and the inability to blind.ConclusionPFMT was effective in improving sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and PFMS in women with OAB.Celenay ST, Karaaslan Y, Ozdemir E. Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study. J Sex Med 2022;19:1421–1430.     

Sexting and Young Adolescents: Associations with Sexual Abuse and Intimate Partner Violence

Study ObjectiveTo explore whether sexting by young adolescent girls and boys is associated with adverse life experiences including exploitative or violent sexual relationships.Design and SettingCross-sectional, anonymous survey of a convenience sample of minor adolescents younger than age 18 years recruited while waiting for care in clinics affiliated with a children's hospital in a low-resource, high-poverty, urban community.ParticipantsFive hundred fifty-five adolescents aged 14-17 years, 63% girls and 37% boys.Main Outcome MeasuresWe measured sexting by asking, “Have you ever sent a sexually suggestive or naked picture of yourself to another person through text or e-mail?” The survey also measured risk behaviors, sexual abuse, intimate partner violence (IPV), and arrest and included a validated depression scale.ResultsMean age was 15.6 ± 1.1 years; 59% were Hispanic, 28% were black; 44% of girls and 46% of boys ever had sex; 24% of girls and 20% of boys ever sent a sext. More girls than boys reported sexual abuse (16% vs 3%; P < .01), IPV victimization (15% vs 7%; P < .01), and depression (33% vs 17%; P < .01). More boys than girls reported arrest (15% vs 7%; P < .01). Independent associations with sexting for girls were: ever had sex (odds ratio [OR], 4.59; 95% confidence interval [CI], 2.29-9.19; P < .001); sexual abuse (OR, 3.81; 95% CI, 1.80-8.05; P < .001); IPV victim (OR, 2.72; 95% CI, 1.11-6.62; P < .05), and for boys: ever had sex (OR, 4.26; 95% CI, 1.47-12.32; P < .01); sexual abuse (OR, 38.48; 95% CI, 1.48-999.46; P < .05); IPV perpetration (OR, 16.73; 95% CI, 1.64-170.75; 95% CI, P < .05), as well as cannabis use, older age, other race, and arrest.ConclusionFor young adolescents, sexting is independently associated with exploitative and abusive sexual relationships including sexual abuse and IPV with similarities and differences in predictors of sexting for girls and boys.     

Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study

BackgroundAlthough hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking.AimTo document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women.MethodsA cross-sectional study of 10,554 women, aged 18–79 years, recruited from the community was performed.Main Outcome MeasuresLow desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11.Clinical TranslationClinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife.ResultsThe majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18–24 years to 75–79 years (27.4%, 95% CI 25.5–29.3 vs 91.6%, 95% CI 88.3–94.1, P < .001). Just over half of all participants aged 25–39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18–24 years (12.2%, 95% CI 10.8–13.7) to 40–44 years (33.4%, 95% CI 28.5–38.8), remained constant until 60–64 years (33.1%, 95% CI 28.3–38.4), and progressively declined to 7.3% (95% CI 4.8–10.9) by 75–79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001).Strengths & LimitationsThis study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index.ConclusioneHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD.Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885–1895.     

Prevalence and Risk Factors for Urinary and Fecal Incontinence Four Months After Vaginal Delivery

ObjectiveTo determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery.MethodsAll patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence.ResultsOf 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients ≥30 years of age (26.2%) compared with patients < 30 years of age (19.3%) (RR 1.4; 95% CI 1.0–1.8, P = 0.05). Urge incontinence was increased in patients who had a forceps delivery (21%) compared with no forceps delivery (9%) (RR 2.2; 95% CI 1.4–3.6, P = 0.005), an episiotomy (32.4%) compared with no episiotomy (18.7%) (RR 1.9; 95% CI 1.2–2.9, P < 0.01) and a longer second stage of labour (108 min vs. 77 min, P = 0.01). The prevalence of any urinary incontinence was increased with forceps delivery (15.5%) compared with no forceps delivery (8.7%) (RR 1.5; 95% CI 1.1–2.1, P = 0.01) and maternal age of ≥30 years (34.1%) compared to < 30 years (23.5%) (RR 1.5; 95% CI 1.1–1.9, P = 0.003). In multivariate analysis, the two variables that remained significant for any urinary incontinence were maternal age ≥30 years (P < 0.01) and forceps delivery (P < 0.01). There were no identified risk factors for fecal incontinence.ConclusionUrinary incontinence is common in women at four months post partum. Fecal incontinence is less common. Maternal age and forceps assisted delivery were risk factors for urinary incontinence.     

CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis

BackgroundGenitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image.AimWe aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM.MethodsMEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121.OutcomesEffects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods.ResultsA total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I²:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I²:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I²:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I²:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I²:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I²:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I²:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I²:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported.Clinical ImplicationsVaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them.Strengths & LimitationsThe strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies.ConclusionThe data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is “very low” or “low”.Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452–470.     

Non-steroidal anti-inflammatory drugs and endometrial cancer risk in the VITamins And Lifestyle (VITAL) cohort

ObjectiveChronic inflammation may be an important factor in the initiation and promotion of endometrial cancer. Use of non-steroidal anti-inflammatory drugs (NSAIDs), however, has been inconsistently associated with endometrial cancer risk.Methods22,268 female residents of western Washington State, ages 50–76, completed a baseline questionnaire in 2000–2002 and reported on their use of individual NSAIDs over the past 10 years. Use was categorized as none, low (< 4 days/week or < 4 years), and high (≥ 4 days/week and ≥ 4 years). Over 9 years of follow-up, 262 incident invasive endometrial cancers were identified. Multivariable proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).ResultsRelative to non-use, high use of aspirin was inversely associated with endometrial cancer risk (HR 0.64, 95% CI: 0.41–1.01; P trend = 0.03). Findings were stronger for regular-strength than low-dose aspirin. High use of non-aspirin NSAIDs (HR 1.15, 95% CI: 0.68–1.95), including ibuprofen (HR 1.29, 95% CI: 0.73–2.28), and naproxen (HR 1.08, 95% CI: 0.39–2.95) was not associated with risk. In subgroup analyses, findings for aspirin were strongest for cancers of endometrioid histology and were restricted to non-smokers.ConclusionsThis study provides additional evidence that use of aspirin, but not non-aspirin NSAIDs, may reduce the risk of endometrial cancer, especially in estrogen-mediated cases; however additional prospective studies with high-quality measurement of NSAID use are needed. Aspirin should continue to be examined as a potential agent for cancer chemoprevention.     

Acupuncture in treating obesity combined with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled clinical trials

Backgroundand purpose: Most type 2 diabetes mellitus (T2DM) patients are accompanied by overweight or obesity, and it is difficult to concurrently solve these two issues with conventional treatment regimens without experiencing adverse effects. While clinical practice demonstrates that acupuncture is beneficial in treating obesity combined with T2DM, there is a lack of evidence-based medicine to support this claim. The study aims to systematically evaluate the efficacy and safety of acupuncture in treating obesity combined with T2DM.MethodsBy searching eight electronic databases, we collected randomized controlled trials on acupuncture in treating obesity combined with T2DM. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 13 randomized controlled trials (RCTs) involving 993 patients were eventually included. Meta-analysis results demonstrated the effective rate of clinical symptoms: [RR = 1.19, 95% CI: 1.11, 1.28, P < 0.00001]; body mass index: [MD = −2.11, 95% CI: −2.56, −1.66, P < 0.00001]; fasting plasma glucose: [MD = −1.09, 95% CI: −1.60, −0.59, P < 0.00001]; haemoglobin A1c: [MD = −0.58, 95% CI: −0.95, −0.20, P = 0.002]; triglyceride: [MD = −0.29, 95% CI: −0.46, −0.11, P = 0.001]; waist circumference: [MD = −5.36, 95% CI: −8.68, −2.05, P = 0.002]; body fat rate: [MD = −3.59, 95% CI: −4.28, −2.90, P < 0.00001].ConclusionCurrent evidence suggests that acupuncture has advantages in treating obesity combined with T2DM. However, due to low-quality evidence of included research, additional large-sample and high-quality research are required to validate the findings of this study.     

Physical Activity and PDE5 Inhibitors in the Treatment of Erectile Dysfunction: Results of a Randomized Controlled Study

IntroductionPhysical activity (PhA) has proven to be a protective factor for normal erectile function in numerous epidemiological studies.AimThe aim of this study was to establish if PhA could have a therapeutic role in the treatment of erectile dysfunction (ED).MethodsThis was a randomized, open-label study. A total of 60 patients complaining of ED were studied. Patients were assessed at baseline and after 3 months of study treatment. At baseline, patients were randomized to receive phosphodiesterase type 5 inhibitor (PDE5i) alone (group A) or PDE5i plus regular (≥3 hours/week), aerobic, non-agonistic PhA (group B).Main Outcome MeasuresAll subjects completed the International Index of Erectile Function (IIEF-15) questionnaire and performed total testosterone (TT).ResultsMean PhA was 3.4 hours/week in group B vs. 0.43 in group A; mean energy expenditure in group B was 1,868 kcal/ week or 22.8 metabolic equivalent (MET)/week. IIEF restoration of ED occurred in 77.8% (intervention group) vs. 39.3% (control) (P < 0.004). The IIEF-15 score resulted in statistical improvement in intervention group in all the domains but one (orgasm): erectile function 24.7 vs. 26.8 (P = 0.003); confidence (Q15) 3.53 vs. 4.07 (P = 0.006); sexual desire 6.46 vs. 7.18 (P = 0.028); intercourse satisfaction 9.85 vs. 11.25 (P = 0.001); total satisfaction 7.17 vs. 8.07 (P = 0.009); total score 56.2 vs. 61.07 (P = 0.007). TT was statistically similar in the two groups; separate analysis in each group showed statistical increase in group B 4.24 vs. 4.55 (P = 0.012). At multivariate logistic regression analysis, PhA was the only independent variable for normal erection (P = 0.010) (95% confidence interval [CI] 0.036–0.643), higher sexual satisfaction (P = 0.022) (95% CI 0.084–0.821) and normal total IIEF-15 score (P = 0.023) (95% CI 0.85–0.837).ConclusionIn this randomized controlled pilot study, PDE5i plus PhA was more effective than PDE5i alone in the treatment of ED. Maio G, Saraeb S, and Marchiori A. Physical activity and PDE5 inhibitors in the treatment of erectile dysfunction: Results of a randomized controlled study.     

The Impact of an Adolescent Gynecology Provider on Intrauterine Device and Subdermal Contraceptive Implant Use Among Adolescent Patients

Study ObjectiveTo assess how the addition of a pediatric and adolescent gynecologist (PAG) in an area where one has not previously been available affects the use of long-acting reversible contraception (LARC) among adolescent and adult women 13-24 years of age.DesignRetrospective chart review.SettingAcademic practice including 12 general practice obstetric/gynecologists (GP) and 1 PAG, and Title X clinics in 3 neighboring counties in West Virginia.ParticipantsPatients receiving an intrauterine device (IUD) or implant during 2010-2016.InterventionsSubject charts were reviewed for age and date at insertion, provider (GP, PAG, and Title X), device type, parity, discontinuation, and sequential LARC placement.Main Outcome MeasuresFrequencies of LARC and relative risks (RR) with 95% confidence intervals were calculated for the 13- to 17-year and 18- to 24-year age groups and compared between provider type.ResultsThe frequency of LARC increased over time for all providers for participants age 13-24; the PAG had the highest frequency of LARC among participants aged 13-17 years. The RR for IUD provision for the PAG provider among those aged 13-17 years was 3.1 and 32.5 times greater compared to GP and Title X (P < .001). Title X providers were 2.9 (2.27, 3.79) and 2.8 (2.06, 3.81) times more likely to provide implants to patients aged 13-17 years compared to PAG and GP, respectively (P < .001).ConclusionsA PAG provider can have a positive impact on LARC uptake among adolescents in a community where this specialist has not previously been available. This is most noted among 13- to 17-year-old patients receiving IUDs.     

Impact of Minimally Invasive Gynaecology Fellowship Training on Quality Performance Metrics for Hysterectomy

ObjectiveTo evaluate differences in quality metrics between hysterectomies performed by fellowship-trained surgeons and those performed by generalists.MethodsRetrospective review of 2845 consecutive hysterectomies by 75 surgeons (23 fellowship-trained, 52 generalists) at 7 hospitals in Ontario, Canada. The primary outcome was a composite of any complication or return to the emergency department (ED) within 30 days of hysterectomy. Secondary outcomes were 2 quality outcome measures (grade of complication and return to ED within 30 days) and 4 quality process measures (minimally invasive hysterectomy rate, rate of preoperative anemia, same-day discharge for laparoscopic hysterectomy [LH], and performing cystoscopy at LH).ResultsFellowship-trained surgeons were more likely to perform concurrent resection of endometriosis, bilateral ureterolysis, lysis of adhesions, uterine/internal iliac artery ligation, and morcellation (all P < 0.001). Generalists performed more vaginal procedures, including vaginal repair, vault suspension, and insertion of mid-urethral sling (all P < 0.001). After controlling for patient and surgical factors, there was no difference in the primary outcome (adjusted odds ratio [aOR] 1.07; 95% CI 0.79–1.45, P = 0.667). Fellowship-trained surgeons were more likely to perform minimally invasive hysterectomy (aOR 2.38; 95% CI 1.15–4.93, P = 0.020), had higher rates of same-day discharge for LH (aOR 2.23; 95% CI 1.31–3.81, P = 0.003), and were more likely to perform cystoscopy (unadjusted OR 2.94; 95% CI 2.30–3.85, P < 0.001). There were no differences in the rates of preoperative anemia, surgical complications, and ED visits.ConclusionDifferences exist between fellowship-trained surgeons and generalists regarding case mix and process quality metrics. Postoperative complications and readmissions were comparable for both groups of surgeons.     

The Importance of Surgical Staging in Women With Uterine Serous Carcinoma: Experience in a Single Institution Reveals a Survival Benefit

ObjectiveTo assess the appropriate extent of surgical staging in women with clinically early stage uterine serous carcinoma (USC).MethodsWe conducted a single-institution retrospective cohort study of all women with USC between 2007 and 2012. Treatment practices, outcomes, and factors affecting survival were analyzed using univariate and multivariate analysis.ResultsEighty-four patients were identified, 76 of whom were included in the analysis. Preoperative pathology correctly identified USC in 73.3% of cases. Surgical stage distribution was 44.7% stage I, 7.9% stage II, 31.6% stage III, and 15.8% stage IV. Women thought to have early stage disease preoperatively encompassed 84.2% (64) of the cohort. Fifty-two (81.3%) of these women with clinically early stage disease had complete surgical staging. Thirty-four (53.1%) were determined to have surgical stage I, and the remaining 30 (46.9%) had occult advanced stage disease. Median follow-up was 43.2 months. Univariate analysis found a significant increase in progression-free survival and overall survival for women with clinically early stage disease with positive lymphovascular space invasion (P < 0.001 and P = 0.002, respectively), positive peritoneal cytology (P = 0.022 and P = 0.04, respectively), early stage (P < 0.001 and P = 0.004, respectively), and elevated serum CA125 at diagnosis (P = 0.003 and P = 0.001, respectively). On multivariate analysis, early stage (hazard ratio [HR] 9.87; 95% CI 2.79 to 34.92, P < 0.001) and complete surgical staging (HR 2.96; 95% CI 1.05 to 8.37, P = 0.040) were associated with prolonged progression-free survival, while overall survival was not affected by complete surgical staging (HR 1.92; 95% CI 0.64 to 5.76, P = 0.79).ConclusionComplete surgical staging prolongs the progression-free survival of women with clinical early-stage uterine serous cancer. Although this does not extend to overall survival, this enables patients to have an improved quality of life with a longer interval without the burden of disease.     

Overexpression of LILRA2 indicated poor prognosis of ovarian carcinoma: A new potential biomarker and therapeutic target

ObjectiveThis study aimed to assess the role of leukocyte immunoglobulin-like receptor A2 (LILRA2) in ovarian carcinoma (OC) oncogenesis and prognosis.Materials and methodsUsing the Cancer Genome Atlas, Genotype-Tissue Expression, and Gene Expression Omnibus databases, the association between clinicopathological profiles and LILRA2 expression was investigated using logistic regression analysis. Kaplan–Meier analysis, Cox regression analysis, and column plots predicted the clinical outcomes of patients with OC and determine the predictive value of LILRA2. The biological functions of LILRA2 were assessed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses. We used single-sample Gene Set Enrichment Analysis to investigate the relationship between immune cell infiltration and LILRA2 expression.ResultsLILRA2 expression in OC tumors was significantly higher than in normal tissue (P < 0.05). The high LILRA2 expression in OC was correlated with lymphatic invasion (P = 0.014). The results showed consistency indices of 0.611 [95% confidence interval (CI), 0.572–0.649] and 0.623 (95% CI, 0.584–0.663) for the overall and disease-specific survival nomograms, respectively. Cox regression analysis showed that LILRA2 was an independent risk factor for overall survival (hazard ratio [HR], 1.511; P = 0.002) and disease-specific survival (HR, 1.537; P = 0.003). Functional annotation revealed enrichment with immunoglobulin-corresponding pathways when LILRA2 expression was high.ConclusionBy evaluating gene expression profiles, we demonstrated that LILRA2 has considerable potential to act as a therapeutic target and prognostic biomarker in OC.     

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend,and Adverse Outcomes

Study ObjectiveAdolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents.DesignA 6-year retrospective register analysis.SettingBuea Regional Hospital.ParticipantsBirth records from 2007 to 2012.InterventionsNone.Main Outcome MeasuresPrevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes.ResultsThe overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6 years (P trend = .8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .01), low birth weight (defined as birth weight <2600 g; OR, 1.8; 95% CI, 1.4-2.3; P < .01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; P < .01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents.ConclusionOne of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.     

Early-stage clear cell ovarian cancer compared to high-grade histological subtypes: An outcome exploratory analysis in two oncology centers

Objectiveadvanced stage clear cell ovarian cancer (CCOC) carries a higher risk of relapse and death compared to other histological subtypes. The prognosis of early-stage CCOC is controversial.MethodsEarly-stage high-grade OC patients from two Italian oncologic centers were included. Patients with early-stage CCOC were compared with those with high-grade endometrioid (HGE) and serous (HGS) OC in terms of relapse-free interval (RFI), cancer-specific survival (CSS) and post relapse cancer-specific survival (prCSS). The Cox proportional hazard model and the restricted mean survival time were used.ResultsBetween 1981 and 2012, 134 patients with CC, 152 with HGE and 160 with HGS were treated at two referral centers. Median follow-up was 11.5 years. Ten years RFI rates were 80.6%, 72.1%, 60.6%, and CSS rates were 84.3%, 82.6%, 81.7% respectively. Adjuvant chemotherapy significantly improved RFI (aHR 0.61, 95%CI 0.40 to 0.91, P = 0.015). In the multivariable analysis HGS histotype was associated with a shorter RFI compared to CC, (Hazard Ratio [HR]: 1.81; 95%CI: 1.12–2.93; P = 0.016), whereas CSS was not statistically different. prCSS was longer in HGS compared to CCOC (HR, 0.36; 95% CI, 0.17–0.74; P = 0.006).According to the stage, IA/IB/IC1 HGSOC had a shorter RFI (HR, 2.13; 95% CI, 1.14–3.99; P = 0.018) compared to IA/IB/IC1 CCOC, but similar CSS. For prCSS, CC compared to HGS conferred a worse prognosis regardless of the initial stage.ConclusionsEarly-stage CCOC is associated with a longer RFI, similar CSS and a shorter prCSS compared to HGSOC. No prognostic differences were observed between CC and HGE OC. The relapse risk was the lowest in IA/IB/IC1 CC compared to HGS, whereas CC displayed poor sensitivity to chemotherapy after relapse.