Genetic variations in vascular endothelial growth factor but not in angiotensin I-converting enzyme genes are associated with endometriosis in Estonian women

Objective

To determine plausible associations between endometriosis and vascular endothelial growth factor gene (VEGF −2578 A/C, −1154 G/A, −634 G/C and 936 C/T), also angiotensin I-converting enzyme gene (ACE −240 A/T and 2350 A/G) single nucleotide polymorphisms (SNPs), as well as their respective haplotypes.

Study design

PCR-based restriction fragment length polymorphism analysis was used to detect SNPs in VEGF and ACE genes in 150 Estonian women with endometriosis and 199 control subjects.

Results

The CC genotype of the VEGF −2578 A/C SNP was correlated with a decreased risk of endometriosis (OR = 0.40, 95% CI 0.20-0.78). Other VEGF and ACE SNPs and haplotypes were not associated with endometriosis.

Conclusion

This case-control study demonstrated that the VEGF −2578 A/C SNP may influence susceptibility to endometriosis in the Estonian population, while associations between endometriosis and other VEGF and ACE SNPs, as well as the respective haplotypes are unlikely.     

First trimester ultrasound estimation of gestational age in pregnancies conceived after in vitro fertilization

Objective

To evaluate BPD as an alternative to CRL for the estimation of gestation age in late first trimester pregnancies (between 9th and 13th gestational weeks), and to construct a first trimester reference chart of fetal BPD growth.

Study design

A prospective study that compared the gestational age estimated by BPD and CRL with the IVF gestational age in 167 first trimester pregnancies (127 singletons, 40 twins).

Results

Both BPD and CRL correlated well with the IVF gestational age (GA) from 9th to 13th gestation weeks. When comparing the difference of the GA (in days) estimated from the two respective ultrasound parameters versus the GA based on IVF (oocyte retrieval day +14 days), BPD estimations had a significantly lower mean difference than CRL (0.013 vs. 0.746; p < 0.01), as well as a lower standard deviation (2.414 vs. 3.008; p < 0.05). In addition, the 95% limits of agreement between the BPD estimated GA and IVF GA were also smaller than CRL estimated GA versus IVF GA (−4.719 to 4.745 vs. −5.149 to 6.641).

Conclusion

Biparietal diameter shares similar accuracy with crown rump length in late first trimester ultrasound estimation, with additional advantages of lower random measurement errors.     

Endothelial nitric oxide synthase gene polymorphisms (−786T>C, 4a4b, 894G>T) and haplotypes in Korean patients with recurrent spontaneous abortion

Objective

To investigate the association of three common polymorphisms (−786T>C, 4a4b, 894G>T) of the endothelial nitric oxide synthase (eNOS) gene with idiopathic recurrent spontaneous abortion (RSA).

Study design

In a prospective case-control study, 340 patients with unexplained recurrent spontaneous abortion and 115 controls with at least one live birth and no history of pregnancy loss were enrolled. Polymerase chain reaction and restriction fragment length polymorphism analysis were performed to identify the genotypes.

Results

The recurrent spontaneous abortion patients exhibited a significantly higher frequency of the eNOS 894GT + TT genotype (Odds ratio (OR), 2.39; 95% confidence interval (CI), 1.25-4.58; p = 0.008) compared to the control group; no significant differences in the −786T>C and 4a4b genotype frequencies were observed. The eNOS 894GT genotype (OR, 1.94; 95% CI, 1.00-3.75; p = 0.056) was marginally different between recurrent spontaneous abortion and control groups. The frequency of the −786T-4b-894T haplotype (p = 0.001) was significantly higher in the idiopathic RSA group than in the control group.

Conclusion

The eNOS 894GT + TT genotype and the −786T-4b-894T haplotype are significantly associated with idiopathic recurrent spontaneous abortion in Korean women.     

Use of fetal colon thickness for auxiliary term dating of pregnancy

Objective

To verify whether fetal colon thickness can be used as a marker for estimating, independent of biometrics and fetal weight percentile, the gestational age (GA) of fetuses between 37 and 40 weeks.

Methods

The study group was 1296 fetuses aged between 33 and 40 weeks. The correlation between GA and colon thickness was assessed by the Pearson correlation test. For term fetuses (≥ 37 weeks), comparisons among the mean colon thickness for different weight percentiles at each GA (in weeks) were made with an analysis of variance test.

Results

A significant relationship was observed between GA and colon thickness (P < 0.001, r² = 0.6). For term fetuses, significant differences were observed among the mean colon thickness values for different weight percentiles at 38 and 39 weeks. Of the 157 term fetuses for which biometrics would have underestimated GA by 2 weeks or more, 126 (80.3%) had a colon thickness equal to, or greater than, 14 mm. This colon thickness was also observed in 52 (70.3%) of term fetuses weighing less than the 10th percentile (n = 74).

Conclusion

The present study suggested that colon thickness might be a good marker for 37 weeks of gestation, and might identify term fetuses for which biometrics has underestimated the GA.     

Association of GSTP1 −313A/G polymorphisms and endometriosis risk: a meta-analysis of case–control studies

Objectives

In view of the controversies surrounding the association of glutathione S-transferases (GST) P1 with endometriosis, a meta-analysis of GSTP1 −313A/G polymorphism with endometriosis risk was performed.

Study design

The relevant studies were identified through a search of PubMed, Excerpta Medica Database (Embase), Elsevier Science Direct and Chinese Biomedical Literature Database (CBM) until March 2013. The association between GSTP1 −313A/G polymorphism and endometriosis risk was pooled by odds ratios (ORs) together with their 95% confidence intervals (95% CIs).

Results

A total of eight case–control studies were eventually identified. We found that GSTP1-313A/G polymorphism was not associated with endometriosis risk in the overall population (A vs. G: OR = 1.02, 95% CI = 0.97–1.07, P = 0.511; AA vs. GG: OR = 1.02, 95% CI = 0.98–1.06, P = 0.359; GA vs. GG: OR = 1.03, 95% CI = 0.98–1.08, P = 0.299; AA vs. GA/GG: OR = 1.01, 95% CI = 0.96–1.07, P = 0.621; AA/GA vs. GG: OR = 1.00, 95% CI = 0.97–1.03, P = 0.972). In the sub-group analysis based on ethnicity, a significant association was found in Caucasians under the recessive model (AA vs. GA/GG: OR = 1.28, 95% CI = 1.08–1.53, P = 0.006).

Conclusions

GSTP1 −313A/G polymorphism may not be associated with endometriosis risk, while the observed increase in risk of endometriosis may be due to small-study bias. Considering the limited sample size and ethnicity included in our meta-analysis, an updated meta-analysis will be urgently needed when further larger and well-designed studies are published.     

Association between endometriosis and polymorphisms in insulin-like growth factors (IGFs) and IGF-I receptor genes in Korean women

Objectives

To evaluate the relationship between endometriosis and polymorphisms in insulin-like growth factors (IGFs) and IGF-I receptor genes.

Study design

In a case-control study, 128 women with endometriosis and 108 control women were recruited at the Department of Obstetrics and Gynecology in Seoul National University Hospital. Determinations of −969(CA) block, −603A>T, and −553T>C single nucleotide polymorphism (SNP)s in the IGF-I gene, c.517C>T, c.540G>T and 820G>A SNPs in the IGF-II gene, and c.3129G>A SNP in the IGF-I receptor gene were performed to evaluate the prevalence of IGFs and IGF-I receptor genotypes or alleles.

Results

Among studied SNPs, the IGF-II 820G>A polymorphism was associated with endometriosis. Women with endometriosis were observed 1.99 times more frequently in the GG genotype of the IGF-II 820G>A polymorphism compared with non-GG genotype (95% confidence level: 1.18-3.35). The similar finding was observed only in early stage endometriosis (stages I and II).

Conclusions

The IGF-II 820G>A polymorphism is a genetic factor which may be associated with the development of endometriosis in Korean women.     

Uterine leiomyosarcomas: tumor size, mitotic index, and biomarkers Ki67, and Bcl-2 identify two groups with different prognosis

Objectives

This study aimed to assess the feasibility of a lifestyle intervention for promoting physical activity (PA) and diet quality during adjuvant chemotherapy for ovarian cancer.

Methods

Patients were enrolled post-operatively and received PA and nutrition counseling, at every chemotherapy visit for six cycles. Quality of life (QoL) was measured with the Functional Assessment of Cancer Therapy (FACT-G), PA with the Leisure Score Index (LSI), dietary intake with 3-day food records, and symptom severity/distress by the Memorial Symptom Assessment Scale (MSAS). Pedometer step count was collected during chemotherapy cycles.

Results

Recruitment was 73% with 27 patients enrolled. Mean [95% confidence interval] change in minutes of PA from cycle #3 to following cycle #6 was 61 min [− 3, 120] p = 0.063, and from baseline to after cycle #6 was 73 min [− 10, 15]; p = 0.082. Mean change in total fruit and vegetable consumption between baseline and during chemotherapy was 0.56 [− 0.09, 0.64]; p = 0.090. FACT-G increased from 75.4 at baseline to 77.6 during chemotherapy and 83.9 following chemotherapy (p = 0.001 for change from baseline to post-chemotherapy). Mean total MSAS score was 20.6 at baseline, 26.6 at cycle #3 and decreased to 17.0 following chemotherapy (p = 0.01 comparison of cycle #3 and following chemotherapy). Increased moderate to strenuous PA was correlated with higher physical well-being during chemotherapy (r = 0.48, p = 0.037).

Conclusions

Lifestyle counseling during adjuvant chemotherapy for ovarian cancer is feasible and may improve PA and diet quality. Randomized controlled trials examining the effects of lifestyle counseling on quality of life and treatment outcomes in ovarian cancer patients are warranted.     

Quality of life and survival in advanced cervical cancer: a Gynecologic Oncology Group study

Purpose

To determine associations between pretreatment health-related quality of life subscales with progression-free (PFS) and overall survival (OS) in advanced and recurrent cervical cancer.

Patients and Methods

Patients included those participating in Gynecologic Oncology Group advanced or recurrent cervical cancer phase III treatment trials who completed the Functional Assessment of Cancer Therapy for patients with cervical cancer (FACT-Cx) and a single-item pain scale at study entry. The FACT-Cx includes five domains: physical (PWB), emotional (EWB), social (SWB), functional well being (FWB), and cervix cancer subscale (CCS). A high quality of life (QoL) score reflects better QoL. After stratifying by protocol and adjusting for patient and disease characteristics, a Cox proportional hazards model was fitted for each subscale as a continuous variable. If statistically significant, (p < 0.05), an analysis on mean item scores (MIS) was performed.

Results

Nine-hundred-ninety-one patients were enrolled from 1997 to 2007. The majority (87%) had recurrent disease. After adjustment for covariates and predictors, only the PWB domain (better physical QoL) was associated with improved OS [HR 0.96 95% CI 0.95-0.98; p < 0.001]. When classifying patients based on the MIS of each subscale, the patients with the lowest risk of death were likely to report less compromised QoL (MIS > 3) for PWB [HR 0.44 (0.33-0.58) P < 0.001], FWB [0.49 (0.38-0.62) P < 0.001], and CCS [0.48 (0.38-0.61) P < 0.001].

Conclusion

The pretreatment patient-reported PWB as measured by the PWB subscale of the FACT-Cx, is significantly associated with survival in advanced cervical cancer trials, even after controlling for known prognostic factors.     

Circulating ghrelin levels and the polycystic ovary syndrome: correlation with the clinical, hormonal and metabolic features

Objectives

Dysregulation of ghrelin levels may lead to physiological problems including obesity and polycystic ovary syndrome (PCOS). The aim of the study was to compare ghrelin levels in women with and without PCOS.

Study design

Serum ghrelin levels (pre- and post-prandial) were compared between 30 Saudi women suffering from PCOS and 30 healthy controls. The relationship between circulating ghrelin levels and other hormones was investigated. Anthropometric measurements were made for all subjects. Biochemical and hormonal investigations included plasma glucose, insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17β-estradiol (E2), progesterone, testosterone and sex hormone binding globulin (SHGB), and serum ghrelin levels. The data were statistically analyzed using independent T-test and ANOVA. Correlation studies were performed between ghrelin levels and other variables.

Results

No differences were observed in the levels of ghrelin during fasting and the postprandial period in the PCOS (p = 0.487) and control groups (p = 0.378). A significant inverse correlation was observed in ghrelin levels (fasting and postprandial) levels and BMI (PCOS: r = −0.529; p = 0.009, controls: r = −0.670; p = 0.005); PCOS: r = −0.421; p = 0.007, controls: r = −0.491; p = 0.004 respectively). No correlations between ghrelin levels and other parameters were observed.

Conclusion

The findings of the study suggest that circulating plasma ghrelin levels were found to be normal and were inversely related to BMI in women with PCOS. No relationship between circulating ghrelin levels and the abnormal hormonal pattern of the PCOS were observed.     

Clinico-pathologic comparison of type II endometrial cancers based on tamoxifen exposure

Objective

To compare clinico-pathologic variables and protein expression of potential regulatory components in patients who develop type II endometrial cancer with and without antecedent tamoxifen.

Methods

Clinico-pathologic variables were compared for all surgically staged patients (2000-2008) with grade 3 endometrioid, papillary serous, clear cell, and carcinosarcoma of the uterus based on tamoxifen exposure [Tam (+) vs. Tam (−)]. Overall survival was analyzed using a multivariable Cox regression model and Kaplan-Meier estimates. Protein expression of ERα, PR, mTOR, p-mTOR, IGF-1R, EGFR, VEGF and HER-2/neu was compared by immunohistochemistry using a semiquantitative scoring system.

Results

Of 115 patients with high grade endometrial cancers, 15 received tamoxifen. These patients were older at diagnosis than Tam (−) patients. A higher percentage of Tam (+) patients had carcinosarcoma compared to Tam (−) patients (60% vs. 30%, P = 0.038). Overall survival for Tam (+) patients was shorter than Tam (−) patients (16.6 vs. 32.2 months, P = 0.004). The hazard ratio for death for Tam (+) patients was 2.53 (P = 0.014), controlling for age and stage. Intensity and extent of staining were similar for ERα, PR, VEGF, EGFR, p-mTOR and HER-2/neu. The average expression score for IGF-1R and mTOR in the Tam (+) group was significantly higher than the Tam (−) group: 10.3 vs 7.0, P = 0.001 and 6.0 vs 3.1, P = 0.029, respectively.

Conclusion

There are differences in the biology of type II endometrial cancers that develop in women with prior tamoxifen exposure. Tamoxifen associated cancers show higher expression of IGF-1R and mTOR, which should be further investigated.     

Contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women

Objective

To determine the contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women.

Study design

One thousand and ninety-four women with adnexal mass were included. Patients were divided into three groups according to clinical complaints: asymptomatic (group A), patients with symptoms non-suspicious of ovarian cancer (group B) and patients with symptoms suspicious of ovarian cancer (group C). All patients underwent transvaginal power Doppler ultrasound prior to surgery. Any mass in which the echo architecture at B-mode ultrasound was not highly suggestive of benign histology was categorized as questionable. In these cases power Doppler was performed as the second step. Definitive histological diagnosis was used as the standard reference. Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (−LR) were calculated for B-mode diagnosis and B-mode plus Doppler in each group.

Results

In group A, B-mode was significantly more sensitive (98.1%) than Doppler ultrasound (91.3%) (p < 0.01). In group B Doppler ultrasound (97.0%) was more specific than B-mode ultrasound (92.2%) (p < 0.001). In group C Doppler ultrasound (84.0%) was more specific than B-mode ultrasound (68.0%) (p < 0.001). Positive LR was significantly higher after Doppler evaluation in all groups (30.5 vs 12.8 in group A, 33.2 vs 12.8 in group B and 6.0 vs 3.1 in group C).

Conclusions

The diagnostic performance of B-mode and power Doppler ultrasound is different depending on patients’ complaints.     

Vascular endothelial growth factor gene polymorphisms and endometriosis risk: a meta-analysis

Purpose

The vascular endothelial growth factor (VEGF) gene polymorphism has been reported to be associated with endometriosis risk. The purpose of the present study was to perform a comprehensive meta-analysis to explore whether VEGF gene polymorphisms confer risk to endometriosis.

Methods

By searching PubMed and EMBASE databases, a total of 11 studies were identified. Crude odds ratio (OR) and their corresponding 95% confidence intervals (CI) for VEGF gene polymorphisms and endometriosis risk were calculated.

Result

An association of VEGF gene +936TC polymorphism with endometriosis was found (Fixed-effect model: TT?+?TC vs. CC: OR 1.184, 95% CI 1.027?C1.366, P?=?0.020; TC vs. CC: OR 1.187, 95% CI 1.024?C1.375, P?=?0.023. Random-effcet model: TT?+?TC vs. CC: OR 1.203, 95% CI 1.003?C1.443, P?=?0.046; TC vs. CC: OR 1.188, 95% CI 1.021?C1.382, P?=?0.026). No association between VEGF genes ?460CT, +405CG, ?2578AC, ?1154GA polymorphisms and endometriosis was observed.

Conclusion

Our results indicate that VEGF +936TC gene polymorphism is a risk factor for endometriosis, and not ?460CT, +405CG, ?2578AC, ?1154GA.     

Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma?

Objective

Prior studies have shown that age ≥ 70 years is associated with more aggressive non-endometrioid histology and worse survival in endometrial cancer. The purpose of this study is to assess if age is an independent poor prognostic factor in endometrioid histologies.

Methods

Under an IRB-approved protocol, we identified patients with surgical stage I to II endometrioid endometrial adenocarcinoma from 1995 to 2008 at two institutions. Patients were divided into two groups based on age at diagnosis: Group A (age 50-69 years) and Group B (age ≥ 70 years). All patients underwent hysterectomy, bilateral salpingoophorectomy, +/−pelvic/aortic lymphadenectomy and adjuvant therapy. Prognostic factors were evaluated by univariate and multivariate analyses.

Results

We identified 338 patients with stage IA to IIB endometrioid endometrial adenocarcinoma. The median age in Group A was 59 years (range 50-69) and Group B was 75 years (range 70-92). Patients in Group B were more likely to have hypertension (51% vs. 68%, p = 0.006) and coronary artery disease (9% vs. 18%, p = 0.03). There were no differences in progression-free or disease-specific survival, however, Group B had a worse overall survival (OS) (50.1 vs. 62.6 months, p = 0.03). On univariate analysis, age (p = 0.04), grade (p = 0.006), and coronary artery disease (p = 0.01) were associated with worse OS. After adjusting for grade and coronary artery disease, age was no longer a significant variable for OS (p = 0.17).

Conclusions

After adjusting for other poor prognostic factors, age ≥ 70 years alone may not be a significant variable affecting overall survival in patients with early stage endometrioid endometrial adenocarcinoma.     

Accuracy of sonographic fetal weight estimation of fetuses with a birth weight of 1500 g or less

Objective

To compare 35 commonly used formulae for small and average sized fetuses on their accuracy in estimating the birth weight in fetuses of 1500 g or less.

Study design

For this retrospective study a database search was performed for all singleton pregnancies without structural or chromosomal defects and with a birth weight of 1500 g or less where the last ultrasound examination was performed within seven days before delivery. Percentage error and absolute percentage error were calculated based on 35 different weight estimation formulae. Multiple regression analysis was used to determine the significant contributors to the absolute percentage error.

Results

One hundred and ninety-three cases fulfilled the inclusion criteria. The median birth weight was 990 g. The percentage error ranged between −15.2% (underestimation with the Merz I formula) and 37.4% (overestimation with the Jordaan formula) and the respective standard deviations between 10.5% (Mielke I) and 54.0% (Schillinger), respectively. The absolute percentage error was between 8.5% and 37.6%. The most accurate weight estimation was achieved with the formula from Mielke (percentage error 1.8% and absolute percentage error 8.5%). Multiple regression analysis showed that significant contributors to the percentage error of the Mielke formula were biparietal diameter (OR = −0.206, p = 0.045), occipitofrontal diameter (OR = 0.765, p < 0.0001), abdominal circumference (OR = −2.953, p < 0.0001), femur length (OR = −0.903, p < 0.0001), head to abdomen ratio (OR = −1.080, p < 0.0001) and fetal weight (OR = 2.847, p < 0.0001).

Conclusion

When estimating fetal weight in fetuses weighing 1500 g or less, one has to be aware of the great differences in accuracy among the formulae.     

Comparison of the acute alterations in serum bone turnover markers and bone mineral density among women with surgical menopause

Objective

To determine the effect of a sudden decrease in estrogen levels via bilateral oophorectomy on serum turnover markers and to examine their correlation with bone mineral density (BMD).

Study design

This study included 51 women who had regular menses preoperatively and underwent bilateral oophorectomy for benign reasons. These women did not have any systemic disease or drug use that would influence bone metabolism. For each woman, spine and femur BMD were measured preoperatively and sixth months after surgery. Serum C-terminal telopeptide (CTX) and bone alkaline phosphatase (BAP) were measured preoperatively and at the first and sixth months after surgery. Correlations between bone turnover markers and BMD were pre- and post-operatively analyzed.

Results

The mean serum CTX and BAP concentrations at the first and sixth postoperative months were significantly higher compared to the preoperative measurements (p = 0.001). Spine BMD values at the sixth postoperative month was significantly lower compared to preoperative period (p = 0.0001). There was a significant negative correlation between spine BMD values and BAP levels both in the preoperative period and at the sixth postoperative month (r = −0.407, p = 0.001), whereas a significant positive correlation between serum CTX and BAP was noted at this time periods (r = 0.615, p < 0.001).

Conclusions

The results of this study showed that serum BAP and CTX levels rapidly increase in women after bilateral oophorectomy. Therefore, these markers (especially BAP) could be useful in the evaluation of osteoporosis risk in the early period of surgical menopause.     

Luteinizing hormone β-subunit gene (LHβ) polymorphism in infertility and endometriosis-associated infertility

Objective

To establish the frequency of LHβ G1502A polymorphism in infertile women with endometriosis, infertile women without endometriosis and a control group.

Study design

Case-control study including 110 infertile women with endometriosis, 84 infertile women without endometriosis and a control group consisting 209 healthy fertile women recruited from the ABC School of Medicine. The LHβ G1502A polymorphism was studied by RPLP-PCR (restriction fragment length polymorphism-polymerase chain reaction).

Results

Genotypes GG, GA and AA of the LHβ G1502A polymorphism presented frequencies of 54.6%, 31.8% and 13.6%, respectively, in the women with endometriosis (p = 0.0398); of 52.4%, 38.1% and 9.5% (p = 0.0123), respectively, in the infertile women without endometriosis; and of 68.9%, 21.5% and 9.6%, respectively, in the control group. In patients with minimal/mild endometriosis and moderate/severe endometriosis, the GG, GA and AA genotype frequencies were, respectively, 47.3%, 36.4% and 16.3% (p = 0.0118); and 61.8%, 27.3% and 10.9% (p = 0.5975). Considering the alleles, allele G was present in 70.5% of the patients with endometriosis, 71.4%% of the infertile women without endometriosis and in 79.7% of the controls, whereas allele A was present in 29.5%, 28.6% and 20.3%, respectively, in the infertile women with endometriosis (p = 0.0121), infertile women without endometriosis (p = 0.0409) and controls. Alleles G and A presented frequencies of 65.5% and 34.5% and 75.5% and 24.5%, respectively, in minimal/mild endometriosis (p = 0.0026) and moderate/severe endometriosis (p = 0.4062).

Conclusion

The data suggest that LHβ G1502A polymorphism may be involved in the predisposition to infertility and minimal/mild endometriosis-associated infertility, although endometriosis might be only a coincidental finding along with infertility.     

Interaction between preoperative CA-125 level and survival benefit of neoadjuvant chemotherapy in advanced epithelial ovarian cancer

Objective

This study aims to determine whether neoadjuvant chemotherapy (NAC) has survival benefit in selected patients with advanced epithelial ovarian cancer (EOC) who have high risk of suboptimal cytoreduction which is represented by high serum CA-125 level.

Methods

We retrospectively reviewed records of 314 patients with EOC including 94 patients who received NAC. After stratification by preoperative CA-125 levels, the progression-free survival (PFS) was compared between the NAC group and the primary debulking surgery (PDS) group.

Results

The NAC group had more FIGO stage IV disease (P < 0.001) and higher CA-125 levels (P < 0.001). Although suboptimal resection rate was higher in the PDS group (50% vs. 18%, P < 0.001), however, NAC was not associated with increased PFS in multivariate Cox analysis (P = 0.334). Nevertheless, after stratification according to CA-125 levels, NAC showed survival benefit in the subgroup with high CA-125 levels (> 2000 U/ml; HR 0.62, P = 0.037).

Conclusion

Our preliminary data suggests the possible interaction between CA-125 levels and survival benefit of NAC. The randomized trial data about NAC should be stratified by the reproducible and relevant criteria such as preoperative serum CA-125 level to elucidate true survival benefit of NAC in ovarian cancer.     

High prevalence of vitamin D deficiency in Pakistani mothers and their newborns

Objective

To determine the prevalence of vitamin D deficiency in Pakistani parturients and their newborns and to assess the correlation between maternal and newborn serum levels of the vitamin D metabolite 25-hydroxy vitamin D3.

Methods

A prospective study of parturients presenting to the labor suite with a singleton pregnancy. Maternal and cord blood were collected for estimation of serum 25-hydroxy vitamin D3.

Results

In total, 89% of the gravidae were deficient in vitamin D (serum 25-hydroxy vitamin D3 < 30 ng/mL). There was a positive correlation between maternal and cord blood 25-hydroxy vitamin D3 levels(r = 0.68; P < 0.001). Inverse correlations were noted between cord blood 25-hydroxy vitamin D3 and a longer duration of gestation (r = − 0.33; P = 0.003) and with the newborn's birth weight (r = − 0.23; P = 0.048). Maternal 25-hydroxy vitamin D3 levels were inversely correlated with maternal mean arterial pressure (r = 0.029; P < 0.020).

Conclusion

There was a high prevalence of vitamin D deficiency in the Pakistani parturients and their newborns. There was a correlation between higher maternal vitamin D levels and lower blood pressure in the mothers.     

Length of the endometrial cavity and intrauterine contraceptive device expulsion

Objective

To evaluate the correlation between endometrial cavity length and expulsion rate in acceptors of the TCu380A intrauterine device (IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS).

Methods

The study included 235 nulligravida and parous women who received a TCu380A IUD or LNG-IUS and who were observed for up to 1 year. The length of the uterine cavity was measured by uterine sounding and ultrasonography.

Results

The endometrial cavity was shorter than 3.2 cm in 2 LNG-IUS users and at least 3.2 cm long in 87 LNG-IUS users, with expulsions occurring in 0 (0.0%) and 2 (2.3%) of these women, respectively (P > 0.999). Among the TCu380A IUD users, the endometrial cavity was shorter than 3.6 cm in 63 women and at least 3.6 cm long in 83 women, with expulsions occurring in 3 (4.8%) and 5 (6.0%) of these women, respectively (P > 0.999). The mean length of the endometrial cavity—evaluated via ultrasonography—among the 10 women whose devices were expelled was 3.9 ± 0.3 cm, compared with 3.9 ± 0.0 cm in those who retained their devices (P = 0.799).

Conclusion

The present results do not support the hypothesis of an association between uterine length and risk of intrauterine contraceptive expulsion.     

Disparities in treatment and survival between African American and White women with vaginal cancer

Objective

The study aims to compare the difference in treatment and survival between White (W) and African American (AA) patients with vaginal cancer (VC).

Methods

Patients with a diagnosis of invasive vaginal cancer were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007 and were divided into White (W) and African American (AA) subgroups. Student's t test, Kaplan-Meier survival methods, and Cox regression proportional hazards were performed.

Results

A total of 2675 patients met the inclusion criteria, with histologic distribution of squamous cell carcinoma (SCC; 2190, 82%) and adenocarcinoma (AC; 485, 18%); 2294 (85.8%) were W, and 381 (14.2%) were AA. Median age was 69 for W and 65 for AA (p < 0.001). SCC and AC were equally distributed between W and AA. Advanced stage disease (FIGO III and IV) was more prominent in AA compared with W (30.4% vs. 23.1%, p = 0.019). Radiation therapy was utilized equally in both racial groups; however, surgical treatment alone or combined with radiation therapy was more frequent in W compared with AA (27.7% vs. 17.5%, p < 0.001).The 5-year survival was 45% in W and 38.6% in AA (p = 0.008). In multivariate analysis, AA had significantly poorer survival compared with Whites when controlling for age, histology, stage, grade and treatment modality (HR 1.2, 95% CI 1.1-1.4, p = 0.007).

Conclusions

African American women with vaginal cancer were more likely to present, at a younger age, advanced stage and less likely to receive surgical treatment. Our data suggests that AA race is an independent predictor of poor survival in vaginal cancer.