Modest Impact of a Brief Curricular Intervention on Poor Documentation of Sexual History in University-Based Resident Internal Medicine Clinics

IntroductionProviders need an accurate sexual history for appropriate screening and counseling. While curricula on sexual history taking have been described, the impact of such interventions on resident physician performance of the sexual history remains unknown.AimsOur aims were to assess the rates of documentation of sexual histories, the rates of documentation of specific components of the sexual history, and the impact of a teaching intervention on this documentation by Internal Medicine residents.MethodsThe study design was a teaching intervention with a pre- and postintervention chart review. Participants included postgraduate years two (PGY-2) and three (PGY-3) Internal Medicine residents (N = 25) at two university-based outpatient continuity clinics. Residents received an educational intervention consisting of three 30-minute, case-based sessions in the fall of 2007.Main Outcome MeasuresWe reviewed charts from health-care maintenance visits pre- and postintervention. We analyzed within resident pre- and postrates of sexual history taking and the number of sexual history components documented using paired t-tests.ResultsIn total, we reviewed 369 pre- and 260 postintervention charts. The mean number of charts per resident was 14.8 (range 8–29) pre-intervention and 10.4 (range 3–25) postintervention. The mean documentation rate per resident for one or more components of sexual history pre- and postintervention were 22.5% (standard deviation [SD] = 18.1%) and 31.7% (SD = 20.4%), respectively, P < 0.01. The most frequently documented components of sexual history were current sexual activity, number of current sexual partners, and gender of current sexual partner. The least documented components were history of specific sexually transmitted infections, gender of sexual partners over lifetime, and sexual behaviors.ConclusionAn educational intervention modestly improved documentation of sexual histories by Internal Medicine residents. Future studies should examine the effects of more comprehensive educational interventions and the impact of such interventions on physician behavior or patient care outcomes. Loeb DF, Aagaard EM, Cali SR, and Lee RS. Modest impact of a brief curricular intervention on poor documentation of sexual history in university-based resident internal medicine clinics.     

Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency Programs: A Cross-Sectional Study

Study ObjectiveTo estimate the prevalence of Pediatric and Adolescent Gynecology formal training in the United States Obstetric and Gynecology residency programs.DesignProspective, anonymous, cross-sectional study.ParticipantsUnited States program directors of Obstetrics and Gynecology residency programs, N = 242; respondents 104 (43%).Results104 residency programs responded to our survey. Among the 104 residency programs, 63% (n = 65) have no formal, dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n = 87) have no outpatient Pediatric and Adolescent Gynecology rotation. There is no significant difference in the amount of time spent on a Pediatric and Adolescent Gynecology rotation among residents from institutions with a Pediatric and Adolescent Gynecology fellowship (P = .359), however, the number of surgeries performed is significantly higher than those without a Pediatric and Adolescent Gynecology fellowship (P = .0020). When investigating resident competency in Pediatric and Adolescent Gynecology, program directors reported that residents who were taught in a program with a fellowship-trained Pediatric and Adolescent Gynecology faculty were significantly more likely to be able to interpret results of selected tests used to evaluate precocious puberty than those without (P = .03).ConclusionsResidency programs without fellowship trained Pediatric and Adolescent Gynecology faculty or an established Pediatric and Adolescent Gynecology fellowship program may lack formal training and clinical exposure to Pediatric and Adolescent Gynecology. This information enables residency directors to identify deficiencies in their own residency programs and to seek improvement in resident clinical experience in Pediatric and Adolescent training.     

The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18–26 year old young adults

ObjectivesDespite the Advisory Committee on Immunization Practices (ACIP) recommendations for young adult females and males to receive the three-dose human papillomavirus (HPV) vaccine, most recent findings show that only 30% of the U.S. females aged 19–26, 2.8% of males aged 19–21, and only 1.7% of males aged 22–26 are initiating vaccination. This study evaluates the effects of a brief (5–10 min) group HPV educational intervention on knowledge and intent to vaccinate among young adults.MethodsA sample of 131 18–26 year old females and males was recruited from the 2012 INShape Black and Minority Health Fair in Indiana. We randomized participants into one of two groups: (1) survey completion prior to education (control group) or (2) survey completion following education (intervention group). Written surveys assessed HPV knowledge, vaccination history, and vaccination intent (for unvaccinated participants).ResultsRespondents were primarily female (70%), single (85%), and the majority self-identified as non-Hispanic Black (77%). Thirty-seven percent had initiated HPV vaccination (≥ 1 dose) and 19% had completed the series. The intervention group had higher HPV knowledge scores (M = 9.1; SD = 1.8) than the control group (M = 7.0; SD = 2.9; F = 22.53). Among unvaccinated individuals (n = 79), the intervention group had higher HPV vaccination intent (86%) compared to the control group (67%) (OR = 3.09; 95%CI = 1.02–9.36).ConclusionsDespite ACIP recommendations, young adults continue to have low awareness of vaccine benefits and low vaccination rates. This study suggests that educational interventions to increase HPV awareness and vaccination may help to boost vaccination rates.     

Suivi pédiatrique de 30 grossesses gémellaires monochoriales consécutives traitées par fœticide sélectif

ObjectivesTo describe perinatal and pediatric outcome after selective feticide for complicated monochorionic twin pregnancy.Patients and methodsWe reviewed all consecutive cases of umbilical cord occlusion performed for complicated monochorionic twin pregnancy over a 16-year period. Pediatric follow-up was based on medical records and updated by phone calls to the parents.ResultsThirty procedures were performed. Indications were: twin-to-twin transfusion syndrome (TTTS) progressing despite serial amniodrainage (n = 12) ; twin reversed arterial perfusion (n = 9) ; selective growth restriction (n = 5) ; severe discordant structural anomalies (n = 4). Mean gestational age at procedure was 21.8 ± 3.1 gestational weeks (GW) and 31.8 ± 4.8 GW at birth. Overall survival rate was 87%, i.e. 83%, 100%, 60% and 100% for each indication, respectively. Mean pediatric follow-up was 5 years (range: 6 months to 15 years). Medical charts and parents declared normal development in 88% of surviving children, i.e. 67%, 100%, 100%, and 100% for each indication. Cross-comparison between the four groups revealed that in the TTTS group, gestational age at procedure was more advanced (P = 0.01) while delivery was slightly earlier (P = 0.1), and pediatric development was poorer (P = 0.02).Discussion and conclusionPediatric outcome after selective feticide appeared to be poorer for TTTS progressing despite serial amniodrainage than for other indications.     

Clinical outcome and prognostic markers for patients with gynecologic malignancies in phase 1 clinical trials: A single institution experience from 1999 to 2010

ObjectivesThere is a scarcity of outcome data regarding phase 1 trials for patients with gynecologic malignancy. The objective of this study was to assess toxicity, clinical benefit and prognosticators in gynecologic oncology patients participating in phase 1 trials.MethodsAll phase 1 oncology trials conducted at Albert Einstein Cancer Center from 1999 to 2010 were reviewed and extracted for relevant demographic and clinical data concerning patients with gynecologic malignancy. Cox-proportional and logistic regression modeling were used for multivariate analysis.Results120 distinct patients with gynecologic malignancy participated in 41 trials, constituting 30.6% of all phase 1 patients enrolled in the same time period. The median age is 59 years. Out of the 184 patients enrolled, 160 individual responses were evaluable. Seventeen DLT events (9.2%) occurred, including 1 (0.5%) treatment-related mortality. There were 27.2% ≥ grade 3 hematologic and 24.4% non-hematologic toxicity. Eighty patients had stable disease (SD, 50%), including 21.9% with SD ≥ 4 months, 11 (6.3%) with partial response (PR), and 3 (1.9%) achieving complete response (CR). The clinical benefit rate (CBR = SD + CR + PR) was 58.1%. Albumin (Alb) ≤ 3.5 g/dL and abnormal ANC were independent negative prognosticators of survival. We also found a continuous correlation between changes in Albumin (p = 0.02) and LDH (p = 0.02) and odds of achieving CBR ≥ 4 month.ConclusionsOur clinical outcome and safety data suggested that phase 1 trials may be a reasonable option for patients with advanced and recurrent gynecologic cancer. The potential prognosticators identified should be further validated in larger trials.     

Pertinence de l’imagerie dans l’évaluation préopératoire des patientes avec cancer endométrial

ObjectivesTo investigate the value of transvaginal sonography, computed tomography and magnetic resonance imaging for the preoperative staging of endometrial cancer.Patients and methodsThe patient group consisted of consecutive women undergoing surgery for endometrial cancer in our institution between January 2000, and September 2012. Clinical data included comorbidities, BMI (kg/m²), preoperative imaging findings, surgical procedures, surgical International Federation of Gynecology and Obstetrics stage, histological grade, relevant prognostic factors. The pathological data from surgical staging were compared with the preoperative imaging results.ResultsTwo hundred and forty-four patients with the final diagnosis of endometrial cancer were enrolled. Hundred and ninety-six had preoperative transvaginal ultrasonography, 56 preoperative computed tomography and 158 preoperative MRI assessment. In our analysis, MRI had better sensitivity and specificity for all imaging criteria but lymph node assessment where MRI and CT-scan are equivalent (MRI: Se = 45.45 %, Sp = 79.52 %; CT: Se = 50 %, Sp = 80 %).Discussion and conclusionIn patients with endometrial cancer, preoperative MRI may not accurately diagnose absence of myometrial invasion. This data should be kept in mind before planning the operative treatment modality and particularly before choosing patients for conservative endometrial carcinoma treatment.     

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

AimThe aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.MethodsThis retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23 + 6 and 33 + 6 weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.ResultsNo significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42 days (SD ± 7.462) in group A and 10.5 days (SD ± 8.235) in group B (p = 0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.ConclusionPregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies     

Can the preoperative HE4 level predict optimal cytoreduction in patients with advanced ovarian carcinoma?

ObjectiveOptimal surgical outcome has been proved to be one of the most powerful survival determinants in the management of ovarian cancer patients. Actually, for ovarian cancer patients there is no general consensus on the preoperatively establishment of cytoreducibility.MethodsBetween January 2011 and June 2012 patients affected by suspicious advanced ovarian cancer, referred to the Department of Gynecology of Campus Biomedico of Rome were enrolled in the study. All patients had serum CA125 and HE4 measured preoperatively. After a complete laparoscopy to assess the possibility of optimal debulking surgery defined as no visible residual tumor after cytoreduction (RT = 0), patients were submitted to primary cytoreductive surgery (Group A) or addressed to neoadjuvant chemotherapy (Group B).ResultsAfter diagnostic open laparoscopy, 36 patients underwent optimal primary cytoreductive surgery (Group A) and 21 patients were addressed to neoadjuvant chemotherapy (Group B). In our population, based on ROC curve, the HE4 value of 262 pmol/L is the best cut-off to identify patients candidates to optimal cytoreduction with a sensitivity of 86.1% and a specificity of 89.5% (PPV = 93.9% and NPV = 77%). In addition, CA125 has a sensitivity of 58.3% and a specificity of 84% at cut-off of 414 UI/mL (AUC is 0.68, 95% C.I. = 0.620 to 0.861).ConclusionOur data indicate that preoperative HE4 is a better predictor for optimal cytoreduction compared to CA125. The best combination in predicting cytoreduction is HE4 ≤ 262 pmol/L and ascites < 500 mL with a sensitivity of 100% and a specificity of 89.5% (PPV = 94% and NPV = 100%).     

Identification of Postpartum Depression in an Online Community

ObjectiveTo identify the rate of postpartum depression symptoms in an online community. A secondary purpose was to identify women’s experiences when accessing health care services for postpartum depression (PPD).DesignA quantitative, cross-sectional, survey design.SettingThe setting consisted of nine birth clubs from one online community specifically targeted toward new mothers.ParticipantsA convenience sample of 469 mostly married (n = 373), White (n = 401) mothers with a mean age of 29.3 (SD = 5.3) years took part in this study. The majority (n = 433) reported living in the United States with access to health insurance coverage.MethodsThe Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression symptoms. Mothers indicating a previous diagnosis of PPD also completed the Access to Postpartum Depression Care (APDC) questionnaire.ResultsTotal EPDS scores ranged from 0 to 27 with a median of 7.0. Sixteen percent of participants (n = 75) scored > 13, indicating a high risk for developing PPD. Of these 75 mothers, 18 (24%) indicated having thoughts of harming themselves sometimes and five (7%) indicated having these thoughts quite often. Additionally, 76 mothers indicating a previous history of PPD also completed the APDC questionnaire. Findings suggested mothers often received care that did not meet their expectations. Barriers to PPD care included insurance limitations and insensitive comments from their health care providers.ConclusionsThe rate of depression symptoms noted in this Internet-based population is in agreement with published rates. Therefore, findings of this study support further exploration and evaluation of using online platforms for PPD screening.     

Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia,adenocarcinoma in situ,and microinvasive carcinoma of the uterine cervix

ObjectiveThe aim of this study was to analyze clinico-pathologic factors and the optimal cut-off value of high-risk human papillomavirus (HR-HPV) viral load for predicting high-grade residual/recurrent disease after the conization in cervical intraepithelial neoplasia (CIN 2–3), adenocarcinoma in situ (AIS), and microinvasive carcinoma of the uterine cervix (MICA).MethodsWe retrospectively reviewed data from 701 patients with CIN 2–3, AIS, and MICA who underwent conization between September 2003 and June 2012. Receiver-operating characteristic curve analysis was used to find out the cut-off value of HR-HPV viral load for predicting residual/recurrent disease. Clinico-pathologic variables, including resection margin and HR-HPV status, were evaluated as possible predictors of residual/recurrent disease.ResultsAt a cut-off value of 1.16 RLU/CO for post-cone HR-HPV viral load, the sensitivity was 88.2% and the specificity was 98.3%. Multivariate analysis demonstrated that post-cone cytology (p = 0.001, OR = 83.808, 95% CI = 6.688–1050.232), endocervical margin status (p < 0.001, OR = 80.478, 95% CI = 7.421–872.732), and post-cone HR-HPV status (p < 0.001, OR = 79.660, 95% CI = 8.539–743.129) were significantly associated with residual/recurrent disease. The post-cone HR-HPV positivity was observed more in the patients who showed positive endocervical margin than in the patients with positive ectocervical margin (32.6% vs. 5.3%, p = 0.002).ConclusionsFollow-up using liquid based cytology in combination with HR-HPV test at 12 months after the conization, and not the early HR-HPV test, might be acceptable. Post-cone endocervical margin status combined with post-cone HR-HPV test is critical for predicting residual/recurrent disease and clinical management.     

Predictors of absence of cervical intraepithelial neoplasia in the conization specimen

ObjectiveOver 10% of women who undergo conization for cervical intraepithelial neoplasia (CIN) show no lesion in the surgical specimen. We aimed to determine whether these patients can be identified before conization using clinical, virological and/or cyto-histological characteristics, to avoid unnecessary treatment.MethodsOf 687 women with CIN treated by conization in the Hospital Clinic of Barcelona between 2008 and 2011, all patients (n = 110, 16%) showing no lesion in the surgical specimen were included as the study group. The control group included a series of randomly selected women with CIN in the cone specimen (n = 220). Pre-conization clinical characteristics as well as high-risk human papillomavirus (hr-HPV) status determined by Hybrid Capture 2 were analyzed as possible predictors of absence of lesion.ResultsA negative pre-conization hr-HPV test or a low viral load (< 10 relative light units) significantly increased the probability of absence of CIN in the conization specimen (75.0%, and 52% respectively) compared with patients with a high viral load (26.7%, p < 0.001). This association was confirmed in the multivariate analysis (p < 0.001). The risk of developing persistent/recurrent disease after treatment was significantly lower in patients with negative hr-HPV test or a low viral load (16.1% CIN1, 0% CIN2–3), than in patients with a high viral load (27.6% CIN1, 4.1% CIN2–3, p = 0.031).ConclusionWomen with negative pre-conization hr-HPV test results or a low viral load have a high probability of having no lesion in the conization specimen. These patients should be excluded from immediate surgical excision and considered for follow-up.     

Emergency peripartum hysterectomy: The experience of a tertiary referral hospital

Objective(s)The aim of this study was to review the frequency, indication, associated risk factors, rates of maternal morbidity and mortality as well as neonatal outcome after emergency peripartum hysterectomy at a tertiary care referral hospital.Study designA retrospective observational study carried out from November 2008 to 2011.Patients and methodsThe study comprised of 29 patients at Mansoura University Hospitals a tertiary referral hospital Egypt. Frequency, indications, associated risk factors and maternal morbidity and mortality were reported as well as neonatal survival and outcome.ResultsThe frequency of emergency peripartum hysterectomy in our study period was (29/10000 deliveries = 0.29%) and the mean age and parity of the patients were 36.4 ± 8.9 years and 2.9 ± 1.56 respectively. The mean gestational age at the time of delivery was 35.45 ± 2.9 weeks. Twenty-five patients (86.2%) had a history of previous cesarean delivery(ies) meanwhile the others (4/29 = 13.8%) had vaginal delivery(ies). Abnormally adherent placenta and severe postpartum hemorrhage were the main indication for the procedure (11/29 = 37.9%). Other indications included rupture uterus (7/29 = 24.1%), severe uterine atony (7/29 = 24.1%), multiple uterine fibroid (3/29 = 10.3%) and 1 case with severe uterine infection (1/29 = 3.4%). All women received blood transfusion, 5 cases (17.2%) required intensive care unit admission, and 3 cases (10.3%) developed intraoperative arrest, 5 patients (17.2%) had urinary bladder injuries and 2 cases (6.8%) had wound infection. The maternal mortality occurred in 4 cases (13.8%) while overall neonatal survival rate was 86.2% (25/29).ConclusionEmergency peripartum hysterectomy is still high in our locality representing a significant risk for the mother and the baby; hence health care authorities should raise the problem to decrease this burden.     

Prise en charge et issues des grossesses compliquées d’une rupture prématurée des membranes avant 26 semaines d’aménorrhée

ObjectiveTo evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg).Patients and methodsForty patients were included in a retrospective study from 1998 to 2008.ResultsFifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23 + 6 wg and reached 80% after 24 wg (P = 0.006). Perinatal mortality affected more frequently primigravida women (OR = 5.16; IC95%[0.99–36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1 ± 13.8 vs. 40.3 ± 2.3j; P = 0.01). Chorioamnionitis complicated all pregnancies terminated before 26wg versus 50% of pregnancies terminated after 26 wg (P = 0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P = 0.02; OR = 4.3; IC95%[0,99–22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid.Discussion and conclusionThe gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.     

Combien d’échographies pour le suivi des grossesses à bas risque ?

ObjectivesTo assess the average number of ultrasounds per low-risk pregnancy and estimate the proportion of ultrasound scans without morphological examination of the fetus (non-morphological ultrasounds).Research design and settingRetrospective study conducted among patients who delivered at the University Hospital of Tours (France) between January 2012 and February 2012.ParticipantsWomen with a singleton pregnancy who delivered after 37 weeks’ gestation an eutrophic child.Data collectionDistinction was made between morphological and non-morphological ultrasound examinations. The type of non-morphological ultrasound examination was analyzed.Results and discussionAmong the 300 patients of the study, the average number of scans per patient was five (SD = 1.9), which is higher than the three recommended ultrasounds for these low-risk pregnancies. In this study, 77% of patients were receiving more than three ultrasounds. Moreover, 28.1% of all ultrasound examinations were non-morphological examinations. Among them, 42.2% of examinations were performed in the third trimester of pregnancy. Among these non-morphological ultrasounds performed in the third trimester, there were 51.9% of fetal biometric measurements and cervical length measurements in 18.5% of cases. We believe that resorting to non-morphological ultrasounds during low-risk pregnancies is not censurable in itself and should even be promoted. Nevertheless, we should improve the relevance of all these examinations.     

Factors associated with publication of plenary presentations at the Society of Gynecologic Oncologists annual meeting

ObjectiveTo determine the rate and factors associated with publication of plenary abstract presentations from the Society of Gynecologic Oncologists annual meeting.MethodsPlenary presentations were reviewed from 2000 to 2005. A PubMed search was performed to identify subsequent peer-reviewed publication of these presentations. Chi-squared test and logistic regression were used for statistical analyses.ResultsOf 378 main, focused or express plenary presentations, 173 (45.8%) involved multiple and 205 (54.2%) single institutions. The types of study include: chart review (29.4%), cohort study (28.0%), translational (23.5%), and randomized clinical trial (6.9%). 309 (81.7%) of presentations were subsequently published. The median time from presentation to publication was 14 months (range: 1–85). Studies from multiple vs. single institutions were more likely to be published (87.9% vs. 76.6%; p = 0.005). In addition, randomized controlled trials were more likely to be published compared with chart review, cohort, and translation research (92.3% vs. 83.8%, 77.4%, and 74.2%; p < 0.01). On multivariate analysis, multi-institutional studies (OR = 2.28, 95% CI = 1.28–4.04; p = 0.005) and type of study (OR = 1.64, 95% CI = 1.19–2.26; p = 0.002) were independent factors associated with publication. In addition, multi-institutional studies had longer times from presentation to publication compared with their counterparts.ConclusionsA high percentage of plenary presentations at the Society of Gynecologic Oncologists annual meeting resulted in subsequent publication. Multi-institutional studies and randomized clinical trials were more likely to be published.     

Single-Port Access Laparoscopic-Assisted Vaginal Hysterectomy: A Novel Method with a Wound Retractor and a Glove

Study ObjectiveTo present our initial experience with single port–access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) by use of a wound retractor and a glove.DesignContinuing, prospective study (Canadian Task Force classification II-3).SettingUniversity teaching, research hospital, and a tertiary care center.PatientsWe performed the SPA-LAVH in 24 patients from May 6, 2008, through October 8, 2008.InterventionsAll cases of SPA-LAVH were performed by a single surgeon (T. J. K.).Measurements and Main ResultsWe analyzed the data to determine the outcome of SPA-LAVH and compared the initial 10 cases (group A) and the latter 14 cases (group B) to consider the learning curve. Median and range are used to describe non-normal data. A total of 24 consecutive patients have undergone SPA-LAVH, for benign gynecologic conditions, including 16 uterine myomas and 8 cases of adenomyosis, regardless of body mass index or previous abdominal or pelvic surgery. All cases but 3 were performed exclusively through a single port. The median operative time, weight of the uterus, and estimated blood loss were 119 minutes (range 90 to 255 minutes), 347 g (range 225 to 732 g), and 400 mL (range 100 to 1000 mL), respectively. The decline in hemoglobin from before surgery to postoperative day 1 was from 0.7 to 4.3 g/dL, with a median of 2.05 g/dL. The median hospital stay (postoperative day) was 3 days (range 3 to 7). When we compared the operative outcomes between the 2 groups, there was a tendency toward a decreased operative time in group B, although the difference was not significant. However, there was a significant decrease in the estimated blood loss and hospital stay in group B (p = .00, = .04, respectively).ConclusionThe SPA-LAVH was safe and effective, and the procedure could be learned over a short period of time. Additional experience and continued investigation are warranted. Journal of Minimally Invasive Gynecology     

Genetic polymorphisms in the Fas and FasL genes are associated with epithelial ovarian cancer risk and clinical outcomes

AimIn this study, we evaluated whether functional polymorphisms within the Fas and FasL genes were associated with the risk of developing epithelial ovarian cancer (EOC) and survival of patients with EOC.MethodsA case–control study was performed in 342 EOC patients and 344 control women. The genotypes of three promoter region polymorphisms (Fas ? 1377G/A, ? 670A/G and FasL ? 844T/C) were determined using ligase detection reaction-polymerase chain reaction (LDR-PCR). The clinical outcomes in 202 EOC patients were compared across genotypes.ResultsThe genotype frequencies of the FasL ? 844 T/C polymorphism were significantly different between the case and control groups (P = 0.034). Compared to the T/T and T/C genotypes, the C/C genotype significantly increased the risk of developing EOC (OR = 1.46, 95% CI = 1.08–1.99). The survival analysis showed that the Fas ? 1377G/A and ? 670A/G polymorphisms were related to prognosis in EOC patients. Compared with patients with the G/G genotype of the ? 1377G/A polymorphism, patients carrying the A allele had a shorter PFS and OS, as determined by univariate and multivariate analysis (HR = 1.81, 95% CI = 1.26–2.62 and HR = 1.86, 95% CI = 1.15–3.00, respectively). Similarly, Kaplan–Meier and Cox proportional hazard model analyses indicated that patients carrying the G allele of Fas ? 670A/G polymorphisms had shorter PFS and OS than those carrying the AA genotype (HR = 1.67, 95% CI = 1.15–2.42 and HR = 1.80, 95% CI = 1.10–2.94, respectively).ConclusionsFunctional polymorphisms in the Fas and FasL genes may be involved in epithelial ovarian cancer development and progression in northern Chinese women.     

Woman and Partner-Perceived Partner Responses Predict Pain and Sexual Satisfaction in Provoked Vestibulodynia (PVD) Couples

IntroductionProvoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that results in significant sexual dysfunction, psychological distress, and reduced quality of life. Although some intra-individual psychological factors have been associated with PVD, studies to date have neglected the interpersonal context of this condition.AimWe examined whether partner responses to women's pain experience—from the perspective of both the woman and her partner—are associated with pain intensity, sexual function, and sexual satisfaction.MethodsOne hundred ninety-one couples (M age for women = 33.28, standard deviation [SD] = 12.07, M age for men = 35.79, SD = 12.44) in which the woman suffered from PVD completed the spouse response scale of the Multidimensional Pain Inventory, assessing perceptions of partners' responses to the pain. Women with PVD also completed measures of pain, sexual function, sexual satisfaction, depression, and dyadic adjustment.Main Outcome MeasuresDependent measures were women's responses to: (i) a horizontal analog scale assessing the intensity of their pain during intercourse; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction Scale.ResultsControlling for depression, higher solicitous partner responses were associated with higher levels of women's vulvovaginal pain intensity. This association was significant for partner-perceived responses (β = 0.29, P < 0.001) and for woman-perceived partner responses (β = 0.16, P = 0.04). After controlling for sexual function and dyadic adjustment, woman-perceived greater solicitous partner responses (β = 0.16, P = 0.02) predicted greater sexual satisfaction. Partner-perceived responses did not predict women's sexual satisfaction. Partner responses were not associated with women's sexual function.ConclusionsFindings support the integration of dyadic processes in the conceptualization and treatment of PVD by suggesting that partner responses to pain affect pain intensity and sexual satisfaction in affected women. Rosen NO, Bergeron S, Leclerc B, Lambert B, and Steben M. Woman and partner-perceived partner responses predict pain and sexual satisfaction in provoked vestibulodynia (PVD) couples.     

Do Romantic Partners' Responses to Entry Dyspareunia Affect Women's Experience of Pain? The Roles of Catastrophizing and Self-Efficacy

IntroductionEntry dyspareunia is a sexual health concern which affects about 21% of women in the general population. Characterized by pain provoked during vaginal penetration, introital dyspareunia has been shown by controlled studies to have a negative impact on the psychological well-being, sexual function, sexual satisfaction, and quality of life of afflicted women. Many cognitive and affective variables may influence the experience of pain and associated psychosexual problems. However, the role of the partner's cognitive responses has been studied very little.AimThe aim of the present study was to examine the associations between partners' catastrophizing and their perceptions of women's self-efficacy at managing pain on one side and women's pain intensity, sexual function, and sexual satisfaction on the other.MethodsOne hundred seventy-nine heterosexual couples (mean age for women = 31, SD = 10.0; mean age for men = 33, SD = 10.6) in which the woman suffered from entry dyspareunia participated in the study. Both partners completed quantitative measures. Women completed the Pain Catastrophizing Scale and the Painful Intercourse Self-Efficacy Scale. Men completed the significant-other versions of these measures.Main Outcome MeasuresDependent measures were women's responses to (i) the Pain Numeric Visual Analog Scale; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction scale.ResultsControlled for women's pain catastrophizing and self-efficacy, results indicate that higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing are associated with decreased pain intensity in women with entry dyspareunia, although only partner catastrophizing contributed unique variance. Partner-perceived self-efficacy and catastrophizing were not significantly associated with sexual function or satisfaction in women.ConclusionsThe findings suggest that partners' cognitive responses may influence the experience of entry dyspareunia for women, pointing toward the importance of considering the partner when treating this sexual health problem. Lemieux AJ, Bergeron S, Steben M, and Lambert B. Do romantic partners' responses to entry dyspareunia affect women's experience of pain? The roles of catastrophizing and self-efficacy. J Sex Med 2013;10:2274–2284.     

Pregnancy on long term follow up in endometriosis patients with evidence of altered peritoneal fluid oxidative stress status

ObjectiveThe aim is to assess whether women with endometriosis, idiopathic infertility, and tubal ligation have different levels of reactive oxygen species (ROS), total antioxidant capacity (TAC), and ROS–TAC score in their peritoneal fluid, and to assess whether the ROS–TAC score is a better predictor of endometriosis and pregnancy than the ROS and TAC scores alone.Materials and methodsPeritoneal fluid from 108 women: 60 with endometriosis, 38 with tubal ligation/reanastomosis and 10 with unexplained infertility was obtained. ROS was measured by the chemiluminescence assay using luminol as the probe and TAC was measured using the colorimetric assay. We compared the three groups on their ROS, TAC, and ROS–TAC scores using Kruskal–Wallis test, and compared the ability of ROS, TAC and the ROS–TAC scores to predict endometriosis vs. idiopathic and tubal, and pregnancy using the DeLong non-parametric method of comparing two dependent ROC curves.ResultsEndometriosis patients had significantly higher ROS values compared with tubal ligation/reanastomosis patients (P = 0.005). Peritoneal fluid TAC levels were not different across the three groups. Significantly lower ROS–TAC score [indicative of higher oxidative stress (OS)] was observed in endometriosis and unexplained infertility patients compared to tubal ligation/reanastomosis patients (overall P = 0.003). There is no evidence that the ROS–TAC score (AUC = 0.71, 95%; CI = 0.60, 0.81) is significantly better at predicting endometriosis diagnosis than either TAC alone (AUC = 0.73, 95%; CI = 0.63, 0.82) or ROS alone (AUC = 0.73, 95%; CI = 0.63, 0.83). Fifty-four patients with endometriosis attempted to become pregnant. Those that became pregnant (20%, 11/54) had significantly lower levels of ROS values (P = 0.001), higher levels of TAC (P = 0.021), and higher ROS–TAC scores (P = 0.002) than endometriosis patients who did not get pregnant.ConclusionEndometriosis patients with lower peritoneal fluid ROS and higher TAC levels were more likely to get pregnant.