Perinatal Outcomes and Long-term Health in Offspring of Teenage Mothers

Study ObjectiveTo evaluate whether extremely young maternal age (≤17 years) is associated with an increased risk of adverse perinatal outcome and an increased risk for long-term pediatric morbidity in offspring.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA retrospective population-based cohort study, in which all singleton deliveries of women, between the years 1991 and 2014 were compared. Parturients were classified into 3 groups according to age at delivery: 17 years or younger, 18-20 years, and 21-35 years (the comparison group). The incidence of long-term hospitalizations of offspring because of cardiovascular, endocrine, hematological, and respiratory morbidity were evaluated in the 3 maternal age groups. Kaplan–Meier survival curves were used to compare the cumulative morbidity incidence. Multiple regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes, and long-term offspring morbidities (using survival analysis) while controlling for multiple potential confounders.ResultsOf 213,177 deliveries that met the inclusion criteria, 90.1% (n = 192,185) occurred in mothers aged 21-35 years, 8.7% (n = 18,645) in mothers 18-20 years old, and 2347 were in mothers aged 17 years or younger (1.1%). Using multivariable logistic regression models, low birth weight and preterm delivery were significantly associated with young maternal age. The incidence of long-term morbidities of the offspring did not differ between the groups, in either the Kaplan–Meier analysis or the multivariable survival analysis.     

Aggressive characteristics of cervical cancer in young women in Taiwan

Objective

To compare the characteristics and prognosis of cervical cancer in young women (under 30 years) with those of older women (over 30 years).

Methods

A retrospective study of 2443 patients diagnosed with FIGO stage IA-IIA cervical cancer who underwent surgical procedures between January 1983 and December 2007.

Results

Thirty patients (1.2%) were 30 years or younger. The proportion of non-squamous cell carcinoma was higher in patients 30 years or younger compared with in patients over 30 years (14/30, 46.7% vs 10/30, 33.3%; P = 0.001). A higher rate of parametrial involvement was found in the younger group of patients compared with those over 30 years (10/30, 33.3% vs 289/2413, 12.0%; P = 0.001). Patients under 30 years had a higher rate of distant metastases compared with older patients (60% vs 49.7%; P = 0.036).

Conclusions

Non-squamous histology, parametrial involvement, a higher rate of distant metastases, and poorer prognosis are more common in women aged 30 or younger with cervical cancer than in older women with the disease.     

Benefits and risks of low molecular weight heparin use on reproductive outcomes: A retrospective cohort study

ObjectiveLow molecular weight heparin (LMWH) has been given to reproductive-age women with various indications. This study aims to assess the benefits and risks of such use.Materials and methodsWe retrospectively reviewed data (n = 204) between Jan 2016 and May 2019. Logistic regression analysis was conducted to evaluate the correlation between indications and reproductive outcomes.ResultsLMWH use had higher odds of live birth in women less than 30 years of age (OR: 4.98; 95% CI = 1.13–21.98; p = 0.034) and with protein S deficiency (OR: 3.90; 95% CI = 1.77–8.59; p = 0.001). For the subgroup of recurrent pregnant loss, LMWH use was only advantageous to women with protein S deficiency (OR: 2.45; 95%:1.01–5.97; p = 0.048). Risks such as preterm delivery, small-for-gestational-age, placental abruption, antepartum/postpartum hemorrhage were not significantly increased among subgroups. Women treated with LMWH and who had successful live births (n = 171) had a slightly increased risk of postpartum hemorrhage compared to controls (n = 8058) during this period in our institution (2.9% vs 1.2%, p < 0.001).ConclusionLMWH administration produces a higher chance of live-birth to women younger than 30 years of age or with protein S deficiency. However, risk of postpartum hemorrhage is increased.     

Comparisons of survivals and toxicities between young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy

ObjectiveTo compare the survivals and toxicities of young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy (CCRT).Materials and methodsPatients with cervical cancer treated with radiotherapy or CCRT between January 2010 and December 2015 in our institute were reviewed. A dose of 50.4 Gy in 28 fractions was delivered to the pelvis with intensity modulated radiation therapy. In addition, a dose of 30–36 Gy in 5–7 fractions was prescribed to point A with brachytherapy. Weekly cisplatin was the first-line regimen of concurrent chemotherapy. Comparisons were made between patients in the young group (<60 years) and those in the elderly group (≥70 years) with multivariate analysis and propensity score matching.ResultsThere were 991 patients in the young group and 70 patients in the elderly group. The median follow-up period was 30.2 months. In multivariate analysis, age was an independent factor of overall survival (OS, hazard ratio, HR 1.99, p = 0.014), but it was not significant in predicting disease-free survival (DFS, HR 1.41, p = 0.179) and cancer-specific survival (CSS, HR 1.38, p = 0.332). After propensity score matching, 64 pairs of patients were selected. The 3-year OS, DFS, and CSS rates in the young and elderly groups were 86.5% and 73.9% (p = 0.280), 74.6% and 75.4% (p = 0.744), and 87.9% and 81.7% (p = 0.967), respectively. Significant differences between the young and elderly groups were observed in grade 3 and above chronic toxicities (2.9% and 8.6%, p = 0.027) and grade 3 and above chronic gastrointestinal toxicities (2.4% and 8.6%, p = 0.009).ConclusionAfter definitive radiotherapy or CCRT, the DFS and CSS of elderly patients with cervical cancer were similar to those in young patients. Elderly patients experienced more chronic toxicities than did young patients.     

Validation of multi-gene panel next-generation sequencing for the detection of BRCA mutation in formalin-fixed,paraffin-embedded epithelial ovarian cancer tissues

ObjectiveThe therapeutic effect of poly (ADP-ribose) polymerase (PARP) inhibitors in patients with epithelial ovarian cancer (EOC) with somatic BRCA mutations is consistent with that observed in patients with germline BRCA mutations, indicating the importance of detecting both germline and somatic BRCA mutations concurrently. We compared the efficacy of multi-gene panel next generation sequencing (NGS) in EOC patients’ formalin-fixed, paraffin-embedded (FFPE) tissue to that of conventional Sanger sequencing in blood samples.Materials and methodsThis study included 48 patients with EOC, and both blood Sanger sequencing and FFPE tissue NGS were conducted in all of them. Clinical and pathological data were reviewed, including age at diagnosis, histology, and stage. Blood Sanger sequencing was performed using peripheral blood leukocytes. The target regions of 90 cancer-related genes were identified using FFPE tissue.ResultsThe median age of patients was 56.1 years, with serous carcinoma (n = 40, 83.3%) and stage III (n = 37, 77.1%) being the most common histology and International Federation of Gynecology and Obstetrics (FIGO) stage, respectively. FFPE tissue NGS identified ten pathogenic variants, including all eight pathogenic variants identified by blood Sanger sequencing and two additional pathogenic variants. Furthermore, FFPE tissue NGS identified 19 variants of uncertain significance (VUS), including all ten VUS identified by blood Sanger sequencing and nine additional VUS.ConclusionThe FFPE tissue multi-gene panel NGS had 100% sensitivity for detecting BRCA germline mutations and could detect additional somatic mutations. Furthermore, performing FFPE tissue multi-gene panel NGS followed by blood Sanger sequencing sequentially may help differentiate germline from somatic BRCA mutations for genetic counseling.     

Endometriosis-associated epithelial ovarian cancer is a more complicated disease than we suspected before

ObjectiveEndometriosis-associated epithelial ovarian cancer (EOC) often includes clear cell carcinoma and endometrioid-type carcinoma. Due to the low incidence of primary mucinous EOC and absence of association between endometriosis and primary mucinous EOC, we present an unusual endometriosis-associated mixed mucinous and endometrioid adenocarcinoma arising from the same ovary.Case reportA 54-year-old woman had an abdominal palpable mass for months. Medical and surgical history, as well as preoperative surveys was unremarkable, except of presence of a pelvic mass. She underwent an exploration laparotomy, and a 22-cm right ovarian tumor was found. Grossly, right ovarian tumor containing brownish cloudy cystic fluid 2450 ml and an apparent 4 × 4 × 2 cm-sized papillary growth. Microscopically, a confluent glandular and infiltrative pattern presented endometrioid adenocarcinoma, and cells with intracytoplasmic mucin and stratified elongated epithelial cells presented mucinous adenocarcinoma. Surgico-pathological stage was FIGO IIIA due to tumor invading to the peritoneum above the pelvis. Postoperatively, the dose-dense chemotherapy was applied with uneventful outcome.ConclusionThis is a rare case, composed with mixed mucinous and endometrioid adenocarcinoma of the same ovary, suggesting that careful pathological diagnosis of endometriosis-associated EOC is needed.     

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Might Predict Pediatric Ovarian Torsion: A Single-Institution Experience and Review of the Literature

Study ObjectiveTo determine clinical and laboratory characteristics of ovarian torsion (OT; n = 28) compared with a non-OT control (OC; n = 64) group.DesignRetrospective single-center review performed between January 2006 and December 2016.SettingAcademic department of pediatric surgery.Participants and InterventionsPostoperative diagnosis of pediatric ovarian pathology (International Classification of Diseases, 10th Revision code N83) in 88 patients who underwent 92 surgeries for suspected OT, aged from 3 days to 17.8 years.Main Outcome MeasuresPredictive value for OT according to biometric, procedural, and laboratory parameters at the time of admission.ResultsCompared with OC, OT in patients aged older than 1 year was associated with elevated values regarding white blood cell count, neutrophils, neutrophil to lymphocyte ratio (NLR; all P < .001), platelet to lymphocyte ratio (PLR; P = .003), platelets (P = .011), and a trend toward raised C-reactive protein (P = .054), whereas lymphocytes and lymphocyte to C-reactive protein ratio (both P < .001) were decreased. Using receiver operating characteristic analysis for differentiating OC from OT, besides lymphocytes and NLR (both area under the curve > 0.9), PLR elicited strongest discriminatory accuracy (area under the curve = 0.946 ± 0.037; P < .001; sensitivity 82%; specificity 90%). At binary logistic regression analysis PLR (P = .018) was independently predictive of OT. OT was suspected on ultrasound imaging in 15/18 (83%), showed a right-sided dominance in 13/18 (72%), and was associated with younger age (P = .003). No differences regarding laboratory or procedural parameters in patients aged younger than 1 year were discerned.ConclusionBlood count indices such as PLR, NLR, and lymphocyte to C-reactive protein ratio might be helpful in identification of inflammatory processes as induced by ischemia in OT. Together with ultrasound and clinical features, these parameters constitute potential predictors of OT in girls aged older than 1 year.     

The influence of age on prognosis in carcinoma of the cervix

Summary. Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB—IV treated between 1970–1984 inclusive, 11% (43 patients) were aged ≤35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970–1972 to 18% for 1982–1984. In women aged ≤35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients ( P >0·1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival ( P >0·1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.     

Brain metastasis from ovarian carcinoma: Analysis of eight cases from a single radiotherapy center

ObjectiveBrain metastasis from epithelial ovarian carcinoma (EOC) is rarely seen having rate of 1–3% with very poor prognosis. Studies on brain metastatic EOC is limited with low number of participants. An increasing trend in EOC related to brain metastasis has been reported recently confronting managing clinicians with new challenges. Therefore, more information on this issue is needed. We aimed to analyze a single radiotherapy center experience on EOC related brain metastases.Materials and methodsData of all patients treated between January 1998 and December 2016 at a radiation center of a university hospital were reviewed retrospectively. Clinicopathological characteristics, treatment details and outcome were analyzed.ResultsWe identified only ten cases with EOC related brain metastasis in our department during 18-year period. Two patients were excluded because of data unavailability and therefore our study was performed among 8 patients. The median time between EOC diagnosis and detection of brain metastasis was 19.8 months. Brain metastasis was multiple in majority (75%). Extracranial metastasis at the time of brain metastasis was 62.5%. All patients died in the follow-up. The median survival time after the diagnosis of brain metastasis was 4.5 months. The median overall survival (OS) after the diagnosis of EOC was 28.9 months. The interval between the initial diagnosis and brain metastasis was negatively correlated with survival after brain metastasis (B-OS) occurred as time interval (p = 0.047). Presence of extracranial metastasis at time of occurrence of brain metastasis and application of multimodal treatment after brain metastasis were positively correlated with B-OS time (p = 0.007, p = 0.046, respectively).ConclusionPrognosis of brain metastasis from EOC remains poor. The factors associated with better B-OS were the longer time between initial diagnosis and brain metastasis, absence of extracranial disease at time of brain metastasis, and application of the multimodal treatment.     

Evaluation of the Effect of Closure Technique on Incidence of Incisional Hernia after Single-Port Laparoscopy in Gynecologic Oncology Surgery

Study ObjectiveTo evaluate incidence and risk factors for incisional hernia in women undergoing single-port laparoscopy (SPL) for gynecologic oncology indications with a standardized fascia closure (SC) technique vs historical controls (HC).DesignRetrospective cohort study.SettingSingle academic institution.PatientsWomen who underwent SPL from June 1, 2017, to December 31, 2019, for gynecologic oncology indications with SC were compared with HC who underwent SPL from January 1, 2009, to December 31, 2015.InterventionsData were collected for patient demographics, postoperative outcomes, and incisional hernia development. Univariate analysis and multivariable regression models were built for predictors of incisional hernia.Measurements and Main ResultsOf 1163 patients, 242 (20.8%) patients had SC, and 921 (79.2%) patients were HC. SC cohort had lower rates of diabetes vs HC (10.3% vs 15.3%; p = .049) but no differences in hypertension (36.8% vs 43.0% p = .081) and obesity (42.6% vs 36.9%, p = .11). A total of 1123 (96.6%) patients did not undergo conversion to multiport laparoscopy or laparotomy, of whom 7.2% (n = 81) of patients developed an incisional hernia; there was no difference in incisional hernia development for SC with SPL (n = 237) vHC with SPL (n = 886) (9.7% vs 6.5%, p = .095). On multivariable analysis, increased body mass index (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03–1.09, p < .001) and diabetes (OR 2.41; CI 1.34–4.32, p = .003) were associated with incisional hernia, but age (OR 1.00; CI .98–1.02, p = .92), length of surgery (OR 1.00; CI 1.00–1.01, p = .62), and hypertension (OR .89; CI .52–1.53, p = .68) were not. Patients with prior abdominal surgeries (OR 1.92; CI 1.14–3.26, p = .015) and hand-assist surgery (OR 3.17; CI 1.48–6.80, p = .003) were significantly associated with incisional hernia.ConclusionImplementation of an SC protocol did not decrease the rate of incisional hernia vs HC during SPL. Risk of incisional hernia must be considered for SPL planning in patients with complex medical comorbidities and prior abdominal surgery.     

Low serum T3 levels are associated with false-positive results when using the risk of ovarian malignancy algorithm (ROMA) in women with benign ovarian disease

ObjectiveWe investigated factors that could cause false-positive results when using the risk of ovarian malignancy algorithm (ROMA) for assessing ovarian cancer risk.Materials and methodsROMA scores were calculated from patients followed surgery to remove a pelvic mass. We compared a false-positive group with a true-negative group of ROMA scores.ResultsWe analyzed 324 patients using medical records. There were 22 with an epithelial ovarian cancer (EOC), 15 with a borderline ovarian tumor, and 287 with benign disease. Twenty-nine (10.1%) of the patients with benign disease showed high-risk ROMA score (false positive) and 13/37 (35%) patients with EOC, or borderline ovarian tumor showed low ROMA scores (false negatives). The median serum triiodothyronine (T3) level of the false-positive ROMA group in patients with benign disease was lower than in the true-negative ROMA group (p < 0.001) and the estimated glomerular filtration rate (eGFR) was also lower (p = 0.001) in the false-positive ROMA group. Median serum T3 levels in the true-positive ROMA group among patients with EOC, or borderline ovarian tumor were lower than in the false-negative ROMA group (p = 0.043).ConclusionMedian serum T3 level and eGFR in the false-positive ROMA group in patients with benign ovarian disease were lower than in the true-negative group.     

Bleeding-related outcomes of low-risk total placenta previa are equivalent to those of partial/marginal placenta previa

ObjectiveTo clarify whether “low-risk total PP” patients bleed more than partial/marginal PP patients.Materials and methodsThe retrospective cohort study was performed involving patients with PP between April 2006 and December 2018. The placental position was determined by ultrasound. From medical charts, the backgrounds as well as obstetric and neonatal outcomes of PP patients were retrieved.ResultsThis study included 349 patients with PP, which was classified into three types according to the distance between the placenta and internal ostium: total (n = 174), partial (n = 52), and marginal (n = 123) PP. In total PP patients, three factors (prior CS, anterior placenta, and placental lacunae on ultrasound) significantly increased blood loss at CS, the need for hysterectomy, homologous transfusion (≥10 U), and ICU admission. No significant difference was observed in bleeding-related poor outcomes (rate of blood loss ≥2000 mL, amount of homologous transfusion, need for hysterectomy, and ICU admission) between total PP patients without all three factors: “low-risk total PP patients” and partial/marginal PP patients (19.8 vs. 17.1%; p = 0.604, 3.7 vs. 1.1%; p = 0.330, 1.2 vs. 1.1%; p = 1.000, and 1.2 vs. 1.1%; p = 1.000, respectively).ConclusionPrior CS, anterior placenta, and placental lacunae on ultrasound were risk factors for a bleeding-related poor outcome in total PP patients. Total PP patients without these three factors showed the same bleeding-related poor outcome as partial/marginal PP patients.     

Comparison of early-stage primary serous fallopian tube carcinomas and equivalent stage serous epithelial ovarian carcinomas

ObjectiveTo investigate the outcome of patients with early-stage primary fallopian tube carcinomas (PFTC) and those of patients with equivalent-stage serous epithelial ovarian carcinomas (SEOC).Materials and methodsA balanced and matched, case–control comparison was conducted in a university-based tertiary hospital database between 1978 and 2007. All PFTC and SEOC patients were treated with complete staging surgery followed by multiagent chemotherapy. One SEOC control was matched for each PFTC patient in a very uniform manner (characteristics and treatment). Disease-free survival (DFS) and overall survival (OS) were then compared using Kaplan-Meier analysis.ResultsTwenty-six paired patients were analyzed. Patients with PFTC were significantly older than the SEOC patients (58 years vs. 51 years, p = 0.001). In terms of recurrence, PFTC patients frequently had an extra-abdominal metastasis (3/4, 75%), in contrast to the SEOC patients, who did not (1/5, 20%). The 5-year DFS rate was similar in both groups (85% vs. 81%, p = 0.05), contributing to a similar OS rate (89% vs. 85%, p = 0.50). The median DFS and OS of patients with PFTC and SEOC were also similar without a statistically significant difference (125 months vs. 109 months, and 125 months vs. 122 months, respectively).ConclusionOur study demonstrated that the survival outcome of International Federation of Gynecology and Obstetrics (FIGO) I/II PFTC patients was similar to that of FIGO I/II SEOC patients, and both groups had a >80% 5-year DFS rate after complete staging surgery, followed by multiagent chemotherapy. This finding is worthy of being investigated.     

Factors affecting serum concentration of dabigatran in Asian patients with non-valvular atrial fibrillation

Background/purposeDabigatran is effective in preventing ischemic stroke and systemic embolism in patients with atrial fibrillation. Although the therapeutic window for dabigatran is wide, its pharmacokinetic properties can differ between specific populations. This study aimed to establish a real-life plasma dabigatran concentration database and investigate potential factors affecting this concentration in Asians.MethodsPatients under dabigatran therapy were recruited. Plasma dabigatran concentration was determined in trough and peak blood samples by using ultra-high performance liquid chromatography with tandem mass spectrometry analysis. Factors affecting the dabigatran concentration were investigated.ResultsA total of 46 patients (33 male, 71.7%) were prospectively enrolled. Most of them were receiving a low dose regimen (110 mg twice daily, n = 38, 82.6%). The trough and peak concentrations were significantly correlated (p < 0.001), and the trough concentration was higher in patients aged ≥75 years, body weight ≤60 kg, creatinine clearance (CrCl) ≤50 mL/min, CHA₂DS₂-VASc score >3 points, and HAS-BLED score ≥3 points. Multiple linear regression analysis identified body weight and serum creatinine as key factors predicting trough concentration (p = 0.003 and 0.005, respectively). Importantly, drug adherence was the only independent factor associated with low trough concentration, defined as the lowest 20th percentile in our study cohort (n = 10, hazard ratio = 9.07; 95% CI, 1.12 to 73.22; p = 0.004).ConclusionDabigatran monitoring may be considered for patients at risk of overexposure, especially those with low body weight and renal insufficiency, and also for detecting those with extremely low drug concentration.     

Impact de la prise en charge thérapeutique sur la survie chez les femmes très âgées avec cancer de l’endomètre

ObjectivesWe aimed to determine whether patients characteristics, clinicopathologic features and survival rates were worse in elderly women with endometrial cancer.Patients and methodsThe study cohort consisted of consecutive women undergoing surgery for endometrial cancer in our institution from January 2000 to October 2011. Patients were divided by age into two groups: patients aged 65 to 79 and those aged 80 or older. Clinical data included comorbidities, BMI (kg/m²), surgical procedures, surgical International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade, relevant prognostic factors, occurrence of perioperative complications, adjuvant therapies, overall survival and long term disease specific mortality.ResultsAs expected, elderly women had more major comorbidities and were less likely to undergo optimal surgery, FIGO stages, histological grades. The 5-year disease specific survival was significantly poorer for the older group compared to younger women 64.5% 95%CI [54.3–73.8] vs 83.49% 95%CI [74.7–90.2] P = 0.008. Cancer-specific mortality was also higher in the elderly: 100% vs 41.17% (P = 0.005).Discussion and conclusionOldest patients with newly diagnosed endometrial cancer were found to have worse overall survival and higher cancer-specific mortality than younger patients because of less aggressive care. Clinical efforts must be managed toward the oldest patients with an early stage of endometrial cancer to maximize the therapeutic ratio, in particular surgical.     

The influence of age on prognosis in carcinoma of the cervix

Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB-IV treated between 1970-1984 inclusive, 11% (43 patients) were aged less than or equal to 35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970-1972 to 18% for 1982-1984. In women aged less than or equal to 35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients (P greater than 0.1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival (P greater than 0.1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.     

Pretreatment maximum standardized uptake value in 18F-fluorodeoxyglucose positron emission tomography-computed tomography as a prognostic factor for ovarian clear cell carcinoma and low-grade serous carcinoma

ObjectiveThe maximum standardized uptake value (SUVmax) derived by positron emission tomography-computed tomography (PET/CT) can be an index of biological tumor aggressiveness, which is assessed using noninvasive tools before the treatment of epithelial ovarian cancer (EOC). This study aimed to evaluate the prognostic value of the pretreatment SUVmax in patients with EOC.Materials and methodsWe reviewed the data of patients with EOC who underwent pretreatment 18F-FDG PET/CT between June 2006 and September 2016. The relationships between pretreatment SUVmax and histological subtypes of EOC were determined. Moreover, progression-free survival (PFS) and overall survival (OS) were evaluated according to the pretreatment SUVmax. Risk factors associated with progression or death were also analyzed.ResultsOf 148 patients, 66 (44.6%), 11 (7.4%), 34 (23.0%), 19 (12.8%), 15 (10.1%), and three (2.0%) were diagnosed with high-grade serous carcinoma (HGSC), low-grade serous carcinoma (LGSC), clear cell carcinoma (CCC), endometrioid carcinoma, mucinous carcinoma, and others, respectively. The median SUVmax was marginally lower in LGSC (6.80 vs. 10.5; P = 0.059) and significantly lower in CCC (5.92 vs. 10.5; P = 0.001) than in HGSC. A high pretreatment SUVmax (≥9.30) was a prognostic factor for OS in patients with LGSC (P = 0.046). Furthermore, multivariate analysis revealed that a high SUVmax (≥5.85) was an independent prognostic factor for OS (P = 0.046) in patients with CCC. However, a high SUVmax (≥7.77) was a poor predictor of PFS and OS in patients with EOC (P = 0.156 and P = 0.158, respectively).ConclusionOur findings suggest that the pretreatment SUVmax is not only an independent predictor of survival in patients with CCC but also a significant predictor of survival in patients with LGSC.     

Association of resolvin level in pregnant women with preeclampsia and metabolic syndrome

ObjectivePreeclampsia (PE) and Metabolic syndrome (MetS) are multifactorial conditions and are major causes of maternal and neonatal morbidity and mortality worldwide. Both conditions are pro-inflammatory and can be causative factor for vascular damage. Anti-inflammatory mediators such as Resolvin also called resolution-phase interaction products may help to reduce the effect. Therefore, this study aimed to measure the serum Resolvin level in mild pre-eclamptic women with and without metabolic syndrome.Material and methodsA total of 293 pregnant females were recruited in this case control study. They were grouped as: Group A [pre-eclamptic patients with MetS (n = 140)] and Group B [pre-eclamptic patients without MetS (n = 153)]. Preeclampsia was diagnosed according to the ACOG criteria and metabolic syndrome according the NCEP-ATP III guidelines. Anthropometric data, lipid profile, Resolvin, VEGFR and PlGF levels were tested as per manufacturer's guidelines. Data was analyzed by using SPSS version 23. In all instances, a p value of <0.05 was considered significant.ResultsAll females were aged matched so no difference was observed in any group. Blood pressure and triglyceride levels were significantly higher in Group A; whereas VEGFR and PlGF were lower as compared to Group B. Higher Resolvin levels were observed in Group A subjects as compared to Group B [105.19 ± 42.29 pg/ml; 46.74 ± 20.16 pg/ml; p < 0.01 respectively]. Resolvin levels were found to have a weak correlation with BMI (r = 0.264; p = 0.11), while a positive strong correlation with systolic BP (r = 0.722; p < 0.001), diastolic BP (r = 0.664; p < 0.001) and a negative correlation with VEGFR (r = −0.639; p < 0.01) and PlGF (r = −0.523; p < 0.01).ConclusionHigher resolvin levels were observed in PE subjects with metabolic syndrome and showed a significant strong positive correlation with blood pressure. Further longitudinal studies are required to identify the causal link.     

Prevalence of and Risk Factors for Emergency Department Visits After Outpatient Gynecologic Surgery

Study ObjectiveTo identify the prevalence of and risk factors for emergency department (ED) visits within 30 days of outpatient gynecologic surgery.DesignRetrospective cohort study.SettingTertiary academic medical institution.PatientsAdult patients who underwent outpatient surgery (≤1 midnight in the hospital) between January 2018 and September 2019 (N = 2373).InterventionsScheduled outpatient gynecologic surgery for a benign indication.Measurements and Main ResultsA total of 109 patients (5%) visited the ED within 30 days of surgery. Patients who visited the ED were significantly younger (median age 37 years vs 42 years, p = .02) and had a higher prevalence of abdominal surgical history (67% vs 56%, p = .02) and cardiopulmonary comorbidities (53% vs 40%, p = .007). They were more likely to have undergone a hysterectomy (26% vs 20%) and less likely to have undergone prolapse surgery (4% vs 12%, p = .05). Pain related to the surgical site (42% of ED visits), nausea and/or vomiting (14%), and fever (12%) were the most common surgery-related reasons for ED visits. Medical issues not directly related to surgery accounted for 31% of ED visits. A total of 36% of ED visits resulted in admission. When adjusted for age, insurance status, American Society of Anesthesiologists class, chronic pain and cardiopulmonary comorbidities, abdominal surgical history, primary procedure performed, and surgical route, the following factors were associated with significantly increased risk of visiting the ED: decreasing age (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1–1.3, p <.001), history of abdominal surgery (aOR 1.7, 95% CI 1.1–2.6, p = .017), cardiopulmonary comorbidities (aOR 1.9, 95% CI 1.2–3.0, p = .003), undergoing hysterectomy (aOR 2.0, 95% CI 1.1–3.8, p = .032), and a vulvovaginal surgical route as opposed to abdominal surgical route (aOR 2.4, 95% CI 1.2–5.1, p = .015).ConclusionED visits after outpatient gynecologic surgery were uncommon, although approximately one-third of visits resulted in admission. Strategies that target our identified risk factors of younger patient age and cardiopulmonary comorbidities may help reduce the ED burden generated by patients undergoing gynecologic surgery.