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Frontiers in Oncology 2022The impact of obesity on the surgical outcomes in patients after primary ovarian cancer surgery is unclear. We aimed at conducting a meta-analysis to evaluate the...
BACKGROUND
The impact of obesity on the surgical outcomes in patients after primary ovarian cancer surgery is unclear. We aimed at conducting a meta-analysis to evaluate the associations between obesity and major surgical outcomes in ovarian cancer patients.
METHOD
Embase, PubMed and Web of Science databases were searched for eligible studies. Study-specific relative risks (RR) were pooled using fixed effect model when little evidence of heterogeneity was detected, otherwise random effect model was employed.
RESULTS
Twelve eligible studies were identified. The pooled incidence rates of all complications were 38% (95% CI: 29%, 47%) for obese patients and 27% (95% CI: 18%, 36%) for non-obese patients. Compared with the non-obese patients, there was a significantly increased risk of all complications in obese patients after ovarian cancer surgery, with a pooled RR of 1.75 (95% CI: 1.26, 2.43). For advanced (stages III-IV) ovarian cancer, the pooled RR of all complications was 1.55 (95% CI: 1.07, 2.24). Obese patients after ovarian cancer surgery were at higher risks of wound complication (pooled RR: 7.06, 95% CI: 3.23, 15.40) and infection (pooled RR: 1.94, 95% CI: 1.47, 2.55) compared with non-obese patients. Such increased risk was not observed for other major complications, namely, venous thromboembolism, ileus and organ failure. Hospital stay days between obese patients and non-obese patients were similar (Standardized Mean Difference: -0.28, 95% CI: -0.75, 0.19). The rates of optimal debulking (pooled RR: 0.96, 95% CI: 0.90, 1.03), readmission/return to operation room (pooled RR: 1.20, 95% CI: 0.56, 2.57) and 30-day mortality (pooled RR: 0.95, 95% CI: 0.54, 1.66) were also comparable between obese patients and non-obese patients.
CONCLUSION
Obesity is associated with an increased risk of postoperative complications, especially wound complications and infection after primary ovarian cancer surgery. Obesity may not affect their optimal debulking rates and 30-day mortality in patients undergoing ovarian cancer surgery. Besides, to improve surgical outcomes, an advanced minimally invasive robotic approach seems to be feasible for the treatment of obese patients with ovarian cancer.
PubMed: 35223523
DOI: 10.3389/fonc.2022.841306 -
Immunity, Inflammation and Disease Jan 2024The current study aims to evaluate the impact of COVID-19 infection and vaccination on ovarian reserve by detecting the anti-Mullerian hormone (AMH) level. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The current study aims to evaluate the impact of COVID-19 infection and vaccination on ovarian reserve by detecting the anti-Mullerian hormone (AMH) level.
METHOD
PubMed, Embase, Web of Science, and Scopus has been searched for studies assessing the effect of COVID-19 infection and/or vaccination on AMH levels up to February 27, 2023. Based on PRISMA 2020 statement criteria, a systematic review and meta-analysis of included studies were performed. The studies' quality was assessed by the National Institute of Health (NIH) quality assessment tool. The standardized mean difference (MD) of the AMH level was used and the quantitative values of each study were pooled separately by using a random effect model.
RESULTS
Out of 246 studies screened, 18 were included in the systematic review and 14 in the meta-analysis. Included studies were published between 2021 and 2022 and were conducted in different countries, including the USA (n = 3), China (n = 2), Russia (n = 2), Turkey (n = 5), Israel (n = 3), Czech (n = 2), and Spain (n = 1). Eight studies investigated the effect of SARS-CoV-2 infection on AMH levels, and ten studies investigated the possible effect of COVID-19 vaccination on AMH levels. The pooled analysis showed a statistically significant decrease in AMH levels after COVID-19 infection (SMD: -0.24; 95% CI: -0.36 to -0.11; I2 = 0%; p = .0003). Vaccination analysis showed a nonstatistically significant change in AMH levels after COVID-19 vaccination (SMD: -0.11; 95% CI: -0.25 to 0.04; I2 = 35%; p = .14).
CONCLUSION
COVID-19 infection can result in ovarian reserve injury by reducing the AMH level but getting vaccinated against COVID-19 has no impact on the AMH level.
Topics: Humans; Anti-Mullerian Hormone; COVID-19; COVID-19 Vaccines; SARS-CoV-2; Vaccination; Transforming Growth Factor beta
PubMed: 38270314
DOI: 10.1002/iid3.1136 -
European Journal of Cancer Prevention :... May 2018Hereditary breast and ovarian cancer is an inherited syndrome associated with BRCA1/2 germline defects. The identified mutations are classified as missense, large...
Hereditary breast and ovarian cancer is an inherited syndrome associated with BRCA1/2 germline defects. The identified mutations are classified as missense, large deletion, insertion, nonsense and splice-site variants with a deleterious impact on BRCA1/2 function. Part of these forms the well-documented truncating mutations, and missense variants represent a clinical dilemma as the pathogenic role is yet to be clearly shown. In this systematic review, we collected these missense variations with a documented deleterious function. We focused on English language articles from MEDLINE. This study included all BRCA1/2 germline missense mutations identified in breast and ovarian cancer patients. The method of this study followed the 'PRISMA statement for reporting systematic reviews and meta-analyses'. A total of 61 BRCA1/2 germline and pathogenic missense mutations were identified: 70.5% affected BRCA1 and 29.5% BRCA2, respectively. In BRCA1, the majority of mutations were located in the BRCA C-terminus (48.8%), leading to a disruption of function. Conversely, no specific associations were verified between mutations and the BRCA2 gene. The European population was the most affected by BRCA1 and the Asian population by BRCA2 mutant patterns. The identification of novel BRCA1/2 missense mutations requires specific genetic tests to assess pathogenicity. With this systematic review, we are, to the best of our knowledge, the first to collect the overall amount of data on these pathogenic mutants with the aim of improving the management of carriers and their kindred.
Topics: BRCA1 Protein; BRCA2 Protein; Biomarkers, Tumor; Genetic Predisposition to Disease; Germ-Line Mutation; Humans; Mutation, Missense; Neoplasms; Prospective Studies
PubMed: 28277317
DOI: 10.1097/CEJ.0000000000000337 -
International Journal of Gynecological... Mar 2022Appropriate diagnosis and treatment of gynecological cancers in people living with human immunodeficiency virus (HIV) remains a clinical challenge given rapid changes in... (Review)
Review
Appropriate diagnosis and treatment of gynecological cancers in people living with human immunodeficiency virus (HIV) remains a clinical challenge given rapid changes in both HIV and cancer management and a lack of prospective clinical trial data inclusive of the HIV population. A semi-systematic literature review was performed to identify published studies addressing risk factors, screening, treatment efficacy, treatment toxicity, and prognosis for people living with HIV diagnosed with gynecological malignancies, with a focus on radiotherapy and cervical cancer, given the relative paucity of literature on uterine, ovarian, and vulvovaginal cancers in people living with HIV. People living with HIV are more likely to be co-infected with human papilloma virus and more likely to develop human papilloma virus-associated malignancies. People living with HIV are less likely to receive cancer treatment compared with HIV-uninfected cancer patients, even after adjusting for differences in clinical features and sociodemographic variables. The literature on cervical cancer outcomes is mixed, with some studies demonstrating that people living with HIV have inferior treatment tolerability, response rates, and survival following chemoradiotherapy, and others showing no difference in these outcomes, particularly in patients receiving antiretroviral therapy. Importantly, even in the series showing inferior outcomes in people living with HIV, there were long-term survivors after administration of curative therapy. Consistent with published cancer management guidelines, people living with HIV diagnosed with gynecological cancers should be treated with standard cancer therapy. Co-management with the patient's HIV specialist is critical to avoid overlapping toxicities and provide optimal supportive care. The morbidity and mortality caused by gynecologic cancers in this population can be mitigated by early diagnosis, appropriate treatment delivery including inclusion of people with HIV in cancer clinical trials, and diligent HIV management.
Topics: Female; HIV; HIV Infections; Humans; Mass Screening; Risk Factors; Uterine Cervical Neoplasms
PubMed: 35256433
DOI: 10.1136/ijgc-2021-002533 -
The Cochrane Database of Systematic... Jul 2015Assisted reproduction techniques (ART), such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), can help subfertile couples to create a family.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Assisted reproduction techniques (ART), such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), can help subfertile couples to create a family. It is necessary to induce multiple follicles, which is achieved by follicle stimulating hormone (FSH) injections. Current treatment regimens prescribe daily injections of FSH (urinary FSH either with or without luteinizing hormone (LH) injections or recombinant FSH (rFSH)).Recombinant DNA technologies have produced a new recombinant molecule which is a long-acting FSH, named corifollitropin alfa (Elonva) or FSH-CTP. A single dose of long-acting FSH is able to keep the circulating FSH level above the threshold necessary to support multi-follicular growth for an entire week. The optimal dose of long-acting FSH is still being determined. A single injection of long-acting FSH can replace seven daily FSH injections during the first week of controlled ovarian stimulation (COS) and can make assisted reproduction more patient friendly.
OBJECTIVES
To compare the effectiveness of long-acting FSH versus daily FSH in terms of pregnancy and safety outcomes in women undergoing IVF or ICSI treatment cycles.
SEARCH METHODS
We searched the following electronic databases, trial registers and websites from inception to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialized Register, MEDLINE, EMBASE, PsycINFO, CINAHL, electronic trial registers for ongoing and registered trials, citation indexes, conference abstracts in the ISI Web of Knowledge, LILACS, Clinical Study Results (for clinical trial results of marketed pharmaceuticals), PubMed and OpenSIGLE. We also carried out handsearches.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) comparing long-acting FSH versus daily FSH in women who were part of a couple with subfertility and undertaking IVF or ICSI treatment cycles with a GnRH antagonist or agonist protocol.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, data extraction and assessment of risk of bias. We contacted trial authors in cases of missing data. We calculated risk ratios for each outcome, and our primary outcomes were live birth rate and ovarian hyperstimulation syndrome (OHSS) rate. Our secondary outcomes were ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, miscarriage rate, any other adverse event (including ectopic pregnancy, congenital malformations, drug side effects and infection) and patient satisfaction with the treatment. Trials reported all outcomes, except patient satisfaction with the treatment.
MAIN RESULTS
We included six RCTs with a total of 3753 participants and we graded the quality of the included studies as moderate. All studies included women with an indication for COS as part of an IVF/ICSI cycle with age ranging from 18 to 41 years. A comparison of long-acting FSH versus daily FSH did not show evidence of difference in effect on overall live birth rate (Risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.07; 2363 participants, eight studies; I² statistic = 44%) or OHSS (RR 1.00, 95% CI 0.74 to 1.37; 3753 participants, nine studies; I² statistic = 0%). We compared subgroups by dose of long-acting FSH. There was evidence of reduced live birth rate in women who received lower doses (60 to 120 μg) of long-acting FSH compared to daily FSH (RR 0.70, 95% CI 0.52 to 0.93; 645 participants, three studies; I² statistic = 0%). There was no evidence a difference between the groups in live births in the medium dose (150 to 180 μg) subgroup (RR 1.03, 95% CI 0.90 to 1.18; 1685 participants, four studies; I² statistic = 6%). There was no evidence of a difference between the groups in the clinical pregnancy rate (any dose), ongoing pregnancy rate (any dose), multiple pregnancy rate (any dose), miscarriage rate (low or medium dose), ectopic pregnancy rate (any dose), congenital malformation rate, congenital malformation rate; major or minor (low or medium dose).
AUTHORS' CONCLUSIONS
The use of a medium dose (150 to 180 μg) of long-acting FSH is a safe treatment option and equally effective compared to daily FSH in women with unexplained subfertility. There was evidence of reduced live birth rate in women receiving a low dose (60 to 120 μg) of long-acting FSH compared to daily FSH. Further research is needed to determine whether long-acting FSH is safe and effective for use in hyper- or poor responders and in women with all causes of subfertility.
Topics: Adult; Delayed-Action Preparations; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Hormones; Humans; Live Birth; Luteinizing Hormone; Ovulation Induction; Pregnancy; Randomized Controlled Trials as Topic; Recombinant Proteins; Sperm Injections, Intracytoplasmic
PubMed: 26171903
DOI: 10.1002/14651858.CD009577.pub3 -
Revista Brasileira de Ginecologia E... Dec 2021To analyze the clinical and obstetric aspects of pregnant women with COVID-19.
OBJECTIVE
To analyze the clinical and obstetric aspects of pregnant women with COVID-19.
METHODS
A systematic literature review in the , , SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: ; ; ; , . Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies.
RESULTS
We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death.
CONCLUSION
Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.
Topics: Adult; COVID-19; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnant Women; Premature Birth; SARS-CoV-2
PubMed: 34933389
DOI: 10.1055/s-0041-1733913 -
Romanian Journal of Morphology and... 2019Primary ovarian hydatid disease (HD) is a rare entity, produced by the larval stage of Echinococcus granulosus. HD commonly involves liver, lung, abdomen cavity, spleen...
Primary ovarian hydatid disease (HD) is a rare entity, produced by the larval stage of Echinococcus granulosus. HD commonly involves liver, lung, abdomen cavity, spleen and is unusually identified in pelvic organs. Based on our knowledge, the paper reviews 27 literature reports of ovarian HD, diagnosed during the last 20 years, providing a valuable database. Patients' ages ranged between 12-76 years, the gross appearance was that of 40-330 mm diameter hydatid cysts (HCs), 66.66% of them being primary. According to these reports, ovarian HD has non-specific clinical manifestations, such as abdominal or pelvic pain, nausea, dysmenorrhea or amenorrhea. The diagnosis may be achieved by abdominal ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), serological exams, such as eosinophilia (in 10-30% of patients) or indirect hemagglutination and immunoglobulin (IgG) antibodies detection. Ovarian HC microscopic pattern is characterized by three layers: pericyst or adventitia (host origin), germinal layer (endocyst), and laminated membrane (ectocyst). The immunoreaction triggered by parasites is initially rich in macrophages and neutrophils, followed by eosinophils and lymphocytes, with numerous cluster of differentiation 8 (CD8)-positive T-cells in active lesions and progressive forms. Concomitant ovarian diseases are relatively rare, being represented by borderline tumors (n=2 cases), mucinous cystadenoma (n=1 case), hemorrhagic cyst (n=1 case), and serous adenocarcinoma (n=1 case). In conclusion, the ovarian location of HD should be considered in any differential diagnosis of a cystic lesion, while it does not exclude synchronous ovarian tumors. These cases reinforce the necessity of better measures of prophylaxis and screening of HD in endemic areas.
Topics: Adolescent; Adult; Aged; Child; Echinococcosis; Female; Humans; Immunohistochemistry; Middle Aged; Ovarian Cysts; Young Adult
PubMed: 31912083
DOI: No ID Found -
Diagnostics (Basel, Switzerland) Mar 2023(1) Background: Among new anti-angiogenesis agents being developed and ever-changing guidelines indications, the question of the benefits/safety ratio remains unclear.... (Review)
Review
(1) Background: Among new anti-angiogenesis agents being developed and ever-changing guidelines indications, the question of the benefits/safety ratio remains unclear. (2) Methods: We performed a systematic review combined with a meta-analysis of 23 randomized controlled trials (12,081 patients), evaluating overall survival (OS), progression free survival (PFS) and toxicity (grade ≥ 3 toxic effects, type, and number of all adverse effects. (3) Results: The analysis showed improvement of pooled-PFS (HR, 0.71; 95% CI, 0.64-0.78; I = 77%; < 0.00001) in first-line (HR, 0.85; 95% CI, 0.78-0.93; = 0.0003) or recurrent cancer (HR, 0.62; 95% CI, 0.56-0.70; < 0.00001) and regardless of the type of anti-angiogenesis drug used (Vascular endothelial growth factor (VEGF) inhibitors, VEGF-receptors (VEGF-R) inhibitors or angiopoietin inhibitors). Improved OS was also observed (HR, 0.95; 95% CI, 0.90-0.99; = 0.03). OS benefits were only observed in recurrent neoplasms, both platinum-sensitive and platinum-resistant neoplasms. Grade ≥ 3 adverse effects were increased across all trials. Anti-angiogenetic therapy increased the risk of hypertension, infection, thromboembolic/hemorrhagic events, and gastro-intestinal perforations but not the risk of wound-related issues, anemia or posterior leukoencephalopathy syndrome. (4) Conclusions: Although angiogenesis inhibitors improve PFS, there are little-to-no OS benefits. Given the high risk of severe adverse reactions, a careful selection of patients is required for obtaining the best results possible.
PubMed: 36980348
DOI: 10.3390/diagnostics13061040 -
Infectious Diseases in Obstetrics and... 2015HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV... (Review)
Review
BACKGROUND
HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women.
MATERIALS AND METHODS
A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner.
RESULTS AND DISCUSSION
Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.
Topics: Adult; Female; Fertilization in Vitro; HIV Infections; Humans; Pregnancy; Pregnancy Complications, Infectious
PubMed: 26778910
DOI: 10.1155/2015/517208 -
Human Reproduction Update Nov 2018Estrogens are known to orchestrate reproductive events and to regulate the immune system during infections and following tissue damage. Recent findings suggest that, in...
BACKGROUND
Estrogens are known to orchestrate reproductive events and to regulate the immune system during infections and following tissue damage. Recent findings suggest that, in the absence of any danger signal, estrogens trigger the physiological expansion and functional specialization of macrophages, which are immune cells that populate the female reproductive tract (FRT) and are increasingly being recognized to participate in tissue homeostasis beyond their immune activity against infections. Although estrogens are the only female gonadal hormones that directly target macrophages, a comprehensive view of this endocrine-immune communication and its involvement in the FRT is still missing.
OBJECTIVE AND RATIONALE
Recent accomplishments encourage a revision of the literature on the ability of macrophages to respond to estrogens and induce tissue-specific functions required for reproductive events, with the aim to envision macrophages as key players in FRT homeostasis and mediators of the regenerative and trophic actions of estrogens.
SEARCH METHODS
We conducted a systematic search using PubMed and Ovid for human, animal (rodents) and cellular studies published until 2018 on estrogen action in macrophages and the activity of these cells in the FRT.
OUTCOMES
Our search identified the remarkable ability of macrophages to activate biochemical processes in response to estrogens in cell culture experiments. The distribution at specific locations, interaction with selected cells and acquisition of distinct phenotypes of macrophages in the FRT, as well as the cyclic renewal of these properties at each ovarian cycle, demonstrate the involvement of these cells in the homeostasis of reproductive events. Moreover, current evidence suggests an association between estrogen-macrophage signaling and the generation of a tolerant and regenerative environment in the FRT, although a causative link is still missing.
WIDER IMPLICATIONS
Dysregulation of the functions and estrogen responsiveness of FRT macrophages may be involved in infertility and estrogen- and macrophage-dependent gynecological diseases, such as ovarian cancer and endometriosis. Thus, more research is needed on the physiology and pharmacological control of this endocrine-immune interplay.
Topics: Animals; Endometriosis; Estrogens; Female; Genitalia, Female; Homeostasis; Humans; Infertility; Macrophages; Menstrual Cycle; Ovarian Neoplasms; Reproduction; Signal Transduction
PubMed: 30256960
DOI: 10.1093/humupd/dmy026