Long-term outcome after transvaginal mesh repair of pelvic organ prolapse

Introduction and hypothesis

The aim of this study was to report long-term subjective and objective outcomes after the transvaginal mesh (TVM) procedure in long-term. Possible late-onset complications were of particular interest.

Methods

This was a retrospective analysis of TVM performed using Prolift? transvaginal mesh measuring subjective outcome using validated questionnaires. Objective outcome was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system using two definitions: POP-Q stage?≤?1, and vaginal wall prolapse at or above the hymen or vaginal apex not descending below the upper third of the vagina. Complications were reported with the Prosthesis/Graft Complication Classification Code designed by the International Continence Society/International Urogynecological Association (ICS/IUGA).

Results

Of 195 patients, 161 (82.6 %) participated this study after a median of 7 years. The scores in questionnaires evaluating urinary (UI) or anal incontinence and constipation or pelvic floor symptoms were low, indicating favorable surgical outcomes. Altogether, 80.1 % of patients were satisfied with the procedure. Anatomical cure was 56.4 % and 69.3 % depending on the definition used. Reoperation due to POP in any compartment was performed in 16.2 % of patients. Mesh exposure rate was 23 %, most of these being asymptomatic and of late onset.

Conclusions

Outcome of the TVM procedure was satisfactory. Anatomical cure was inferior to subjective cure. Mesh exposure rate was high; most exposures observed in the long-term were of late onset and were asymptomatic.

     

The plant lignans matairesinol and secoisolariciresinol administered to Min mice do not protect against intestinal tumor formation

The lignans matairesinol (MAT) and secoisolariciresinol (SECO) were fed to Min mice at 0.02% (w/w) in diet to study their effects on intestinal tumor development. The mean number (67 vs. 51, P=0.052) and size (1.4 vs. 1.2 mm, P=0.011) of tumors in the MAT group was elevated when compared with the control group. Tumor formation of the SECO group did not differ from the control group. Intake of MAT increased the level of both MAT and enterolactone in the plasma while SECO feeding increased SECO, enterodiol, and enterolactone (P=0.001). These results showed that MAT or SECO do not prevent intestinal carcinogenesis in Min mice and that MAT may have adverse effects.     

Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy

Introduction and Hypothesis

Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n?=?107) and total (n?=?105) abdominal hysterectomy.

Methods

Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times.

Results

In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess.

Conclusions

Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years.

Clinical trial registration

ClinicalTrials.gov (www.clinicaltrials.gov): NCT02166749.

     

Transmission of high-risk human papillomavirus (HPV) between parents and infant: a prospective study of HPV in families in Finland

The Finnish HPV Family Study is a prospective cohort study assessing the dynamics of human papillomavirus (HPV) transmission between parents and infant. Serial genital and oral scrapings from 76 families, including mother, father, and infant, and semen samples were collected over 2 years of follow-up, analyzed by nested PCR, and confirmed by hybridization with 12 high-risk (HR) HPV types. The most common HPV profile was HR HPV in all family members (29%), followed by HPV-positive mother-infant pairs (26%). HPV-positive father-infant pairs were less frequent (11%), and in six (8%) families, only the infant was HR HPV positive. The prevalence of genital HR HPV in the parents ranged from 13 to 25%, and that of oral HPV ranged from 8 to 34%. In the infants, HPV DNA was detected in 15% of the genital and 10% of the oral samples at birth, reaching peaks of 18 and 21%, respectively, at 6 months, and declining to 10% at 24 months. Persistent HPV in the mother was a risk factor for oral HPV in the infant (odds ratio [OR], 5.69; 95% confidence interval [95% CI], 1.5 to 21.3), while oral HPV in the mother at 6 months was a risk factor for genital HR HPV (OR, 6.38; 95% CI, 1.15 to 35.32). No such independent risk could be attributed to subclinical HPV in the father. Persistent maternal cervical HPV and subclinical oral HPV affect the risk of infant HPV. The age of 6 months is a critical point for the infant to acquire or be free of HR HPV DNA.     

Clinical Value of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Response Evaluation after Primary Treatment of Advanced Epithelial Ovarian Cancer

Aims

To prospectively evaluate the use of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) in the definition of the treatment response after primary treatment of advanced epithelial ovarian cancer (EOC).

Home care from the perspective of older clients and their professional carers

The aim of this cross-sectional study was to explore and compare the views of older home care Cs and their professional carers in relation to the care given. The data were collected with a postal questionnaire distributed to 200 Cs (≥65 years) and 570 Ps (Ps), with a total response rate of 63%. The differences in responses between Cs and Ps were analyzed using cross-tabulations, the Pearson χ²-test and Fisher's exact test. The Cs’ and the staff's perceptions of Cs’ own resources were very similar. The collaboration between the Cs and the staff was experienced as being confidential. However, their views differed when separate issues of the collaborative relationship were queried. The staff saw the coordination of care in a positive light. The results showed that information transfer between staff, Cs and close relatives still needs to be developed. The evaluation of home care interventions was also quite weak.     

Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up

Study ObjectiveTo report the subjective and objective outcomes and patient satisfaction with the outside-in transobturator tape (TOT) procedure during long-term follow-up.DesignClinical follow-up study (Canadian Task Force classification II-2).SettingUniversity hospital.PatientsOne hundred ninety-one women who underwent the TOT procedure. Of these, 66% had stress urinary incontinence and 34% had mixed urinary incontinence, and 45% underwent concomitant surgery.InterventionsPatients underwent surgery between May 2003 and December 2004 using the TOT procedure. After a mean follow-up of 6.5 years, postal questionnaires and an invitation for a follow-up visit to the outpatient clinic were sent to the patients. Objective cure was defined as a negative result of a stress test and no repeat operation because of stress urinary incontinence during follow-up. Subjective outcome was evaluated using the following validated questionnaires: UISS (Urinary Incontinence Severity Score), DIS (Detrussor Instability Score), VAS (visual analog scale, 0–100), short versions of the IIQ-7 (Incontinence Impact Questionnaire-7) and UDI-6 (Urogenital Distress Inventory-6), and the EQ-5D and EQ-5D VAS. Patient satisfaction was evaluated using a self-tailored questionnaire.Measurements and Main ResultsOf 191 patients, 139 (73%) were evaluated after a mean follow-up of 6.5 years. Objective and subjective cure rates were 89% and 83%, respectively. Of the patients with genuine stress urinary incontinence, 92% were completely or quite satisfied with the surgery, and 76% of the patients with mixed urinary incontinence were satisfied (p < .001). Patients with body mass index >30 had significantly higher scores on the IIQ-7, UDI-6 (p < .01 for both), VAS (p < .001), UISS (p < .01), and DIS (p < .001), thus indicating a less favorable outcome of the procedure.ConclusionA high objective cure rate persisted after a mean follow-up of 6.5 years. Caution is advised when the TOT procedure is planned in patients with mixed urinary incontinence or severe obesity.     

Toll-like receptor 2 mediates microglia/brain macrophage MT1-MMP expression and glioma expansion

Background

Glioblastomas are the most aggressive primary brain tumors in humans. Microglia/brain macrophage accumulation in and around the tumor correlates with malignancy and poor clinical prognosis of these tumors. We have previously shown that microglia promote glioma expansion through upregulation of membrane type 1 matrix metalloprotease (MT1-MMP). This upregulation depends on signaling via the Toll-like receptor (TLR) adaptor molecule myeloid differentiation primary response gene 88 (MyD88).

Methods

Using in vitro, ex vivo, and in vivo techniques, we identified TLR2 as the main TLR controlling microglial MT1-MMP expression and promoting microglia-assisted glioma expansion.

Results

The implantation of mouse GL261 glioma cells into TLR2 knockout mice resulted in significantly smaller tumors, reduced MT1-MMP expression, and enhanced survival rates compared with wild-type control mice. Tumor expansion studied in organotypic brain slices depended on both parenchymal TLR2 expression and the presence of microglia. Glioma-derived soluble factors and synthetic TLR2 specific ligands induced MT1-MMP expression in microglia from wild-type mice, but no such change in MT1-MMP gene expression was observed in microglia from TLR2 knockout mice. We also found evidence that TLR1 and TLR6 cofunction with TLR2 as heterodimers in regulating MT1-MMP expression in vitro.

Conclusions

Our results thus show that activation of TLR2 along with TLRs 1 and/or 6 converts microglia into a glioma supportive phenotype.