Assessment of human papilloma viral load of archival cervical intraepithelial neoplasia by real-time polymerase chain reaction in a Turkish population

The purpose of this study was to determine the existence, and viral load of human papilloma virus (HPV) subtypes 16 and 18 in paraffinized cervical intraepithelial neoplasia (CIN) samples by real-time polymerase chain reaction (RT-PCR). Overall 94 women were included. Of these patients 47 (50%) had CIN I, 27 (28.8%) had CIN II, and 20 (21.2%) had CIN III. HPV positivity for these three groups were 4.2%, 14.8% and 45%, respectively. HPV positivity in CIN III patients was significantly higher than CIN I (OR = 18.41, 95% CI 3.00-145.73; p < 0.001), and CIN II patients (OR = 4.70, 95% CI 1.00-23.76; p = 0.05). The difference between CIN I and II was not significant (p = 0.18). Viral loads were 10(2), and 10(4) copy/ml for two CIN I patients; 10(2), 10(3), and 10(5) for three CIN II patients; and 10(2), 10(3), 10(4), 10(4), 10(5), 10(5), and 10(6) copy/ml for eight patients with CIN III. Viral load of the remaining one patient could not be assessed. No significant variance was noted among the groups with respect to viral load (p = 0.73). RT-PCR had important advantages of detecting, typing, and quantifying at the same time. Although HPV positivity was increased significantly by the degree of lesions, this relation was not observed for viral load.     

子痫前期患者胎盘组织中LIF和CD105的表达及意义

目的探讨子痫前期患者胎盘组织中白血病抑制因子(LIF)和CD105的表达及其意义。方法采用免疫组织化学的方法,对20例正常孕妇(对照组)和45例子痫前期患者(其中轻度子痫前期患者25例,重度子痫前期患者20例)的胎盘组织中LIF和CD105表达水平进行检测,并分析两者的相关性。结果与对照组比较,子痫前期组胎盘组织中LIF的表达明显降低(P<0.01);而轻度子痫前期组与重度子痫前期组比较无明显差异(P>0.05)。子痫前期组CD105表达较对照组明显升高(P<0.01);重度子痫前期组较轻度子痫前期组明显升高(P<0.01)。对照组及子痫前期组胎盘组织中的LIF与CD105的表达均呈负相关(P<0.01)。结论子痫前期患者胎盘组织中LIF表达减弱,而CD105表达增强,两者呈负相关,可能共同参与了子痫前期的病理生理过程。     

Molecular Biomarkers of Prognosis in Advanced Renal Cell Carcinoma Patients Treated With Pazopanib Plus Interferon Alpha (INF-2A) in a Phase I/II Study by the Spanish Oncology Genitourinary Group

IntroductionThe therapeutic repertoire available for advanced renal cell carcinoma (RCC), including tyrosine kinase inhibitors (TKIs) and immunotherapy, required for molecular biomarkers for response.Patients and MethodsThis was a phase I to II trial on the combination of pazopanib with interferon-alpha (INF-2A) as first-line treatment for advanced RCC. The primary endpoint was recommended phase II dose (RP2D) and efficacy in terms of objective response rate (ORR, RECIST 1.1 criteria). Secondary endpoints included safety and a translational study of molecular biomarkers in serum and exosomes from peripheral blood samples at three-time points: baseline, 8 weeks of treatment, and progression of the disease.ResultsBetween July 2011 and July 2017, 53 eligible patients were treated and followed up (I, n = 20; II, n = 33). Pazopanib 800 mg + INF-2A 3 MIUs showed a manageable safety profile; therefore, it was selected for dose expansion. Overall, grade 3/4 toxicities were reported in 24 (72.7%) patients. The ORR was 27.2%. The 12-month OS rate was 83.6% (median not reached), and after 30.9 months of follow-up, 24 (72.7%) patients were still alive. CCL2, IL8, TNF-α, and PD-L1 were significantly overexpressed after treatment initiation, while TGF-β1 and CCL5 were significantly decreased. TNF-α, endoglin, and PD-L1 expression are correlated with the response after treatment initiation.ConclusionThe trial did not reach its pre-specified target ORR. However, OS was longer than expected with pazopanib monotherapy. Changes in the molecular profile suggest a crucial role of vascular remodeling and inflammatory-mediated immune cell infiltration in optimal response to pazopanib plus INF-2A.     

All-advanced life support vs tiered-response ambulance systems*

In this discussion, two principal types of ambulance deployment systems were compared and contrasted: 1) the multipurpose, sole-provider all-advanced life support (all-ALS) ambulance system in which all ambulance-related services (emergent and nonemergent) for a city or region are provided by one fleet of ambulances, each of which is staffed by ALS providers (paramedics); and 2) the tiered ambulance system (tiered) in which some 911 ambulances are staffed by paramedics and others are staffed by basic emergency medical technicians (EMT-Bs) who provide basic life support (BLS) care. When managed with advanced system status management (SSM) techniques, the multipurpose, sole-provider all-ALS ambulance system can significantly reduce response intervals while simultaneously providing both fiscal and operational efficiencies. It can also be used to readily integrate and expand the scope of services for the ambulance provider service, such as interfacility transfers, thus increasing revenues. On the other hand, in large urban centers, the tiered ambulance system can be used to reduce response intervals to critical calls, primarily through the use of sophisticated dispatch triage protocols. This approach requires fewer paramedics in the system and appears, in some systems, to also provide medical care advantages in terms of skills utilization for individual ALS providers as well as a more concentrated focus for medical supervision. Therefore, both of these deployment systems can offer certain advantages depending on local emergency medical services (EMS) system needs as well as the local philosophy of health care delivery. Applicability must therefore be considered in terms of local service demands and other factors that affect the EMS system, including catchment population, statutory and jurisdictional issues, available funding, accessibility of receiving facilities, and medical quality concerns. PREHOSPITAL EMERGENCY CARE 2000;4:1-6     

卵巢冠囊肿临床术式分析

目的探讨卵巢冠囊肿的临床治疗情况。方法回顾性分析我院住院治疗的273例卵巢冠囊肿患者的治疗情况,并比较各种疗法的效果及恢复情况等。结果卵巢冠囊肿腹腔镜手术组的手术时间、术后排气时间、术后住院时间均明显短于开腹手术组（P〈0.05）,术中出血量也明显少于开腹组（P〈0.05）。结论腹腔镜治疗卵巢冠囊肿损伤小、恢复快,可作为临床首选的一种理想术式。     

Progress with oocyte cryopreservation

PURPOSE OF REVIEW: This article reviews human oocyte cryopreservation, one of the most stimulating challenges of assisted reproduction technology. Since the first steps in assisted reproduction technology, researchers have pursued this goal, to greatly improve the management of infertility treatments. This present review depicts the present state of research and clinical applications of this methodology. RECENT FINDINGS: Recent literature focuses on the possible mechanisms of oocyte damage caused by temperature and cryoprotectant injury and forecasts possible technological solutions. Several papers illustrate encouraging results in the increasing clinical application of this procedure. SUMMARY: Findings give support to several indications of human female gamete cryostorage. Oocyte cryopreservation might replace embryo freezing. Egg freezing offers an alternative to women at risk of losing their reproductive function, caused by antineoplastic treatments, endometriosis, ovarian surgery or genetic premature ovarian failure. In addition, oocyte storage may contribute to an increase in in-vitro fertilization flexibility. Despite the early disappointing results, recent technical modifications have improved the clinical efficiency greatly, with the birth of several healthy children.     

Computed tomography diagnosis of a primary aortoduodenal fistula in a patient with a partially thrombosed abdominal aortic aneurysm

Primary aortoenteric fistula is a rare but fatal cause of gastrointestinal bleeding and requires urgent intervention. A high index of clinical suspicion in conjunction with imaging is required because a favorable outcome relies on prompt diagnosis. The primary forms of aortoduodenal fistulas are nearly always associated with abdominal aortic aneurysm, mostly atherosclerotic. Technological advances in imaging, particularly computed tomography (CT), play a pivotal role in the preoperative detection of these fistulas. We report the case of a 76-year-old man who was diagnosed with a large abdominal aortic aneurysm with associated contained rupture and suggestion of an aortoduodenal fistula on CT. This case demonstrated the effectiveness, ease, and low cost of the preoperative evaluation and documentation of a primary aortoduodenal fistula using CT scans.     

Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology

Objectives

The objective of this review is to discuss alternatives to commonly used methods of soft tissue reconstruction in patients with gynecologic malignancies, and in particular alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps.

Methods

A review of the literature was performed on soft tissue reconstruction in patients with gynecologic malignancies.

Results

Soft tissue reconstruction is often necessary to achieve successful wound healing, minimize complications, and to restore anatomic form and function. Commonly used methods such as skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are effective, but many scenarios exist where they may be suboptimal or unavailable for use. Situations faced by the gynecologic oncologist where this may be the case include patients in whom prior treatments and/or tumor involvement have affected the vascular supply and tissues of commonly used options, those with disease recurrence who have previously undergone tumor extirpation and reconstruction, and patients undergoing radical surgery where commonly used options alone are inadequate. Under these circumstances, there are several alternative options, and an understanding of the full spectrum of reconstructive techniques is essential.

Conclusions

Many clinical scenarios exist where commonly used options for soft tissue reconstruction are suboptimal or unavailable. Current evidence supports use of alternative methods of reconstruction in these situations. However, further larger scale and comparative studies are needed to refine surgical decision-making.