Objective: This study evaluates the predictive value of the systemic immune-inflammatory index (SII) in locally advanced cervical cancer treated with chemoradiotherapy and aims to develop a nomogram based on inflammatory and clinical-pathological factors to predict survival. Materials and methods: We retrospectively analyzed 421 stage IIB–IVA cervical cancer patients treated with chemoradiotherapy between 2012 and 2021. We analyzed the association between SII, other factors with overall survival (OS) and progression-free survival (PFS). And combined the variables to create a nomogram. Results: Using SII cutoff value of 957, a high SII (>957) was associated with larger tumor size (P < 0.001), BMI (P = 0.005), FIGO stage (P = 0.008), ECOG performance status (P = 0.001) and lymph node metastasis (P = 0.003). Univariate Cox regression analysis indicated that higher SII was associated with worse PFS and OS. In the training cohort, multivariate analysis identified factors affecting OS, including SII ≥ 957 (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.02–2.66), larger tumor size (HR: 1.71, 95% CI: 1.08–2.7), poor ECOG (HR: 2.31, 95% CI: 1.29–4.12), and metastatic lymph nodes (HR: 1.91, 95% CI: 1.1–3.33). A high SII was also linked to poorer survival outcomes in the validation cohort and correlated with shorter PFS in both cohorts. The nomogram, including SII, accurately predicted 3- and 5-year survival rates with good discriminatory ability (concordance probability, 0.7), which was consistent across validation cohorts. Conclusion: Elevated SII was linked to poorer OS and PFS, which can help clinicians better assess and predict survival for these patients.
OBJECTIVE:A higher oocyte yield is generally associated with improved outcomes in assisted reproductive technology (ART). Vitrification enables the accumulation of oocytes, zygotes, or embryos across multiple cycles, offering a potential strategy to enhance success in women with diminished ovarian reserve (DOR), who typically produce few oocytes per stimulation cycle. Among accumulation approaches, vitrified zygote banking remains understudied regarding its clinical efficacy and cost-effectiveness. This study aimed to evaluate clinical pregnancy rates, live birth rates, and treatment costs associated with vitrified zygote banking in women with DOR. MATERIALS AND METHODS:This retrospective cohort study included 122 women with DOR (POSEIDON Groups 3 and 4) who underwent controlled ovarian stimulation (COS) and embryo transfer (ET) using banked vitrified two-pronuclear (2 PN) zygotes between June 2019 and December 2022. Primary outcomes were clinical pregnancy and live birth rates; secondary outcomes included treatment costs per patient and per transfer cycle. Outcomes were also compared by maternal age and against a historical cohort from the same institution. RESULTS:The overall clinical pregnancy rate per embryo transfer cycle was 22.3%, and the live birth rate was 14.5%. Women aged <40 years achieved significantly higher live birth (24.1% vs. 8.3%, p = 0.027) and implantation rates (16.8% vs. 7.5%, p = 0.019) compared to those aged ≥40 years, while clinical pregnancy rates were comparable between age groups. Zygote banking was associated with higher treatment costs per patient and per transfer cycle than a simulated fresh transfer model (all p < 0.05). The estimated cost per live birth was lower in women aged <40 years (NT$891,154) than in those aged ≥40 years (NT$2,814,143). Patients achieving live birth incurred higher mean treatment costs than those without live birth, although this difference did not reach statistical significance (p = 0.056). Compared to a historical fresh transfer cohort, clinical pregnancy and live birth outcomes with zygote banking were comparable in women aged <40 years, with a higher clinical pregnancy rate observed in those aged ≥40 years (p = 0.018). CONCLUSIONS:Vitrified zygote banking yielded clinical pregnancy and live birth outcomes comparable to conventional fresh embryo transfer, though differences in study design limit direct comparison. While associated with higher treatment costs, zygote banking may provide additional flexibility in embryo selection and transfer timing. Further prospective studies are needed to validate its clinical and economic utility.
OBJECTIVE:The role of lymph node (LN) involvement on recurrence patterns and survival in patients with advanced epithelial ovarian cancer (EOC) remains unclear. This study investigates the treatment failure patterns and clinical outcomes in EOC patients with initial LN involvement. MATERIALS AND METHODS:We conducted a retrospective cohort study. Patients with stage IIIC/IV EOC who received standard therapy including cytoreductive surgery with lymphadenectomy and platinum-based adjuvant chemotherapy at our hospital between 2008 and 2018, achieved a complete response, were included. RESULT:Among 310 women with advanced EOC, 130 met the inclusion criteria. Of these, 77 had pathologically confirmed initial LN involvement (LN-positive group), of whom 51 (66.2 %) experienced recurrence. The remaining 53 patients were in the LN-negative group, with 29 (54.7 %) experiencing recurrence. Patients of the LN- positive group were more likely to experience treatment failure in retroperitoneal lymph node (RPLN) compared to those in the LN-negative group (28.6 % [22/77] vs. 11.3 % [6/53], p = 0.02). Out of 22 patients in the LN-positive group with RPLN recurrence, 10 experienced isolated retroperitoneal lymph node (iRPLN) recurrence, while none in the LN-negative group developed such recurrence. The rates of isolated LN-positive (iIP) recurrence and isolated distant recurrence were similar between the two groups. Isolated RPLN recurrence was not associated with better overall survival (OS) compared to iIP recurrence. The 5-year OS rate was 45.5 % for patients with iRPLN recurrence and 46.7 % for patients with iIP recurrence. In the LN-positive group, patients with >5 positive lymph nodes had a higher overall recurrence rate compared to those with ≤5 nodes (82.8 % vs. 55.6 %, p= 0.02), a significantly higher rate of RPLN recurrence (41.4 % vs. 20.0 %, p= 0.046), and poorer OS (p= 0.047). A similar trend was observed in patients with a lymph node ratio (LNR) ≥ 10 %, who showed a higher rate of RPLN recurrence (35.6 % vs. 17.2 %, p= 0.09) and reduced OS (p= 0.07), though these differences did not reach statistical significance. CONCLUSION:This study highlights the significant impact of initial LN involvement on recurrence patterns in patients with advanced EOC. Patients in the LN-positive group were more likely to experience recurrence in the RPLN and had a higher frequency of isolated RPLN recurrence. Isolated RPLN recurrence was not associated with better OS compared to iIP recurrence. The presence of more than five positive LNs was associated with higher recurrence rates, including a significantly higher rate of retroperitoneal recurrence, and poorer OS compared to patients with fewer positive LNs.
OBJECTIVE:Chronic vulvar irritation and pruritus are among the most common reasons for gynecologic consultation. These symptoms often persist or recur, posing a significant therapeutic challenge. This preliminary study aimed to evaluate the effectiveness and cosmetic outcomes of a novel surgical technique we developed. MATERIALS AND METHODS:We developed a novel surgical technique, wide excision with clitovulvopexy, as a treatment for chronic vulvar pruritus. This technique, not previously described in the English literature, involves the complete excision of all diseased vulvar skin, including the clitoral prepuce and labia minora. The impact on sexual function and sensation was assessed. Cosmetic outcomes were evaluated by patients using a four-point satisfaction scale: very satisfied (score 4), moderately satisfied (score 3), minimally satisfied (score 2), and unsatisfied (score 1). RESULTS:The median operative time was 30 min, with minimal blood loss in all cases. No intraoperative or postoperative complications were observed. Vulvar irritation and pruritus resolved completely in all patients, with no recurrence during the follow-up period. Among the nine patients, three reported an improvement in sexual function, while five maintained their preoperative levels without deterioration. Sensation was well preserved in all patients. Eight out of nine patients (88.9%) reported being very or moderately satisfied with their cosmetic outcomes. CONCLUSION:The findings of this preliminary study are highly promising. Wide excision with clitovulvopexy appears to be a safe and effective surgical option for treating chronic vulvar pruritus, providing excellent symptom relief and satisfactory cosmetic results in an outpatient setting.
Objective: Bartter syndrome (BS) is a general term for a group of rare genetic disorders in which the defective kidneys have impaired ability to reabsorb salt, resulting in salt wasting, hypokalemia, and metabolic alkalosis. Prenatal diagnosis of antenatal BS is challenging because of the absence of structural anomalies in the fetus. We here report four cases of antenatal BS identified in utero by fetal exome analysis. Case report: A total of four cases of antenatal BS were detected. All cases presented with idiopathic polyhydramnios, with no evidence of anomalies in the fetuses and placentae on serial ultrasounds, and excluding maternal diabetes. Polyhydramnios occurred at 23–24 weeks gestation, and the amniotic fluid volume continued to increase through the gestation in all cases. Premature rupture of membranes occurred at 26 weeks after amniocentesis in the first case and the pregnancy was terminated. In the second case, the pregnancy continued to near term after five amnioreductions performed at 25, 27, 29, 31 and 34 weeks respectively. Preterm labor occurred at 27 weeks in the third case, and the infant died at life of day 2. In the fourth case, the pregnancy continued to 30 weeks despite two amnioreductions done at 27 and 29 weeks, and the infant survived. Variants were detected in three genes, including SLC12A1, KCNJ1 and BSND, corresponding to type 1, type 2, and type 4A. Conclusion: Early-onset polyhydramnios without evidence of congenital anomalies should raise the clinical suspicion of BS. Prenatal genetic testing should be the option to confirm the diagnosis. Serial amnioreduction is recommended for the management to prevent perinatal complications.
Adverse outcomes after motor-vehicle crashes are the leading cause of death among individuals aged 5–29 years. The objective was to assess the risks of maternal and fetal complications associated with traffic accidents during pregnancy. This systematic review and meta-analysis included searches in PubMed, MEDLINE, EMBASE, LILACS, SciELO, Scopus, and COCHRANE databases up to February 2024, focusing on observational cohort studies. Article selection was performed independently by two authors. Fixed and random-effects meta-analyses with odds ratios (OR) were conducted. Analyses were performed using R software. The study was registered with PROSPERO (CRD42024508710). A total of 6147 articles were identified, with 1519 duplicates. From the 4628 articles reviewed, 108 were selected for full-text review, and finally, seven studies were included in the systematic review, with six included in the meta-analysis. The combined effect sizes for evaluated outcomes were as follows: maternal mortality [OR = 1.66, 95% CI 0.78–3.53], placental abruption [OR = 2.43, 95% CI 1.12–5.29], premature rupture of membranes [OR = 1.05, 95% CI 0.98–1.13], preterm birth [OR = 2.02, 95% CI 0.63–6.44], and cesarean delivery [OR = 1.12, 95% CI 0.92–1.36]. In conclusion, motor-vehicle crashes during pregnancy may increase the risk of maternal mortality, premature rupture of membranes, preterm birth, cesarean delivery, and placental abruption. However, statistical significance was observed only for placental abruption. These findings highlight the importance of understanding country-specific statistics to develop tailored protocols aimed at improving prehospital and hospital care for this vulnerable population.
Objectives: To present a rare prenatal case of incomplete trisomy 15 rescue with hypermethylation in the Prader–Willi critical region and to emphasize the diagnostic challenges associated with discordant results among NIPT, chromosomal microarray, and karyotype, highlighting the critical role of methylation analysis in confirming the diagnosis. Case report: Our patient of 41-yea-old underwent NIPT showed trisomy 15 but low risk in PWS and Angelman syndrome. Subsequent karyotyping and CGH array provided discordant results possibly due to incomplete trisomy rescue. To clarify the diagnosis, MLPA was performed to confirm the hypermethylation of the Prader–Willi critical region, presenting as atypical PWS. Conclusion: This case highlights the importance of MLPA test in the diagnosis workflow of atypical PWS caused by incomplete trisomy rescue. Early recognizing of atypical PWS is important due to its variable prognosis reported by current literatures.
Objective: Intravenous leiomyomatosis is a rare disease that occurs in premenopausal women. We examined the clinical characteristics, diagnosis, and therapeutic approaches of intravenous leiomyomatosis in postmenopausal women. Materials and methods: The clinical records of 20 menopausal patients with intravenous leiomyomatosis who were admitted to Peking Union Medical College Hospital between January 2014 and September 2021 were retrospectively analyzed. Results: The mean patient age was 54.95 years (±standard deviation: ±5.2). Ten patients had a history of uterine leiomyomas before menopause. Nine patients had lesions in the pelvic cavity, and 11 had lesions in the microvasculature or heart, including in the iliac vein, inferior vena cava, right heart, and pulmonary artery. All 20 patients were treated by surgical excision, and 19 underwent one-stage surgery. All patients underwent histopathological examination, and nine underwent immunohistochemical analysis; seven were positive for cluster of differentiation 31/34 and four were positive for estrogen receptor or progesterone receptor. Six patients without a history of ovariectomy had a median serum estradiol level of 30.80 pg/mL before surgery, which significantly decreased to 14.5 pg/mL after surgery. The postoperative follow-up duration was 10–108 months (mean: 45 months). Nineteen patients completed the study, and one was lost to follow-up. At the last follow-up, 19 patients had no evidence of recurrence. Conclusion: The incidence of intravenous leiomyomatosis is low in postmenopausal women, although it is commonly misdiagnosed. Most patients have a history of uterine fibroids before menopause. Intravenous leiomyomatosis is treated via surgical resection, and it has a low postoperative recurrence rate.
OBJECTIVE:Patients with variations exhibiting abnormal phenotypes or no significant clinical signs offer crucial insights into our genome's complexities. To help determine the pathogenicity of 13q21.1q21.32 deletion, we reported four patients in a family carrying this variation. CASE REPORT:Our study identified a family of four patients harboring a deletion of approximately 10.884 Mb spanning 13q21.1 to q21.32, despite exhibiting no apparent phenotypic manifestations. CONCLUSION:This finding, alongside evidences from existing research, suggests that the deletion of 13q21.1q21.32 is a likely benign copy number variation (CNV). The findings can be used as a reference for genetic counseling in cases of similar abnormalities encountered during future prenatal diagnosis.
OBJECTIVE:To investigate the etiologies, management, and outcomes of postpartum hemorrhage (PPH) cases referred from local clinic, and to analyze the potential causes of poor prognosis and find out possible preventive measure. MATERIALS AND METHODS:This is a retrospective cohort study conducted at a tertiary referral center in Taipei, Taiwan, from January 2011 to February 2025. Medical records of primary PPH cases referred from local clinics were reviewed, excluding cases of amniotic fluid embolism and secondary PPH. A total of 159 patients were categorized into eight etiologic groups: birth canal laceration, uterine rupture, vessel injury during cesarean section, placenta accreta spectrum, placenta previa, uterine inversion, uterine atony, and retained placental tissue. Clinical characteristics, management approaches, and outcomes were analyzed. RESULTS:Among the 159 enrolled cases, birth canal laceration was the most common cause (59.1%) with 27.7% of cases admitted to ICU. The overall hysterectomy rate was 4.4%, and the mortality rate was 1.3%. Intrauterine laceration, placenta accreta spectrum, and vascular injury during cesarean section showed the highest rates of receiving exploratory laparotomy and hysterectomy. Four patients experienced out-of-hospital cardiac arrest (OHCA); two died despite having ACLS and hysterectomy, and one survivor developed hypoxic-ischemic encephalopathy. CONCLUSION:PPH remains a major cause of maternal morbidity and mortality. Birth canal laceration was the most frequent cause of referred PPH, whereas placenta previa, placenta accrete spectrum, and uterine rupture were strongly associated with poor maternal outcomes. OHCA with 50% mortality rate, highlights the crucial need of preventing maternal cardiac arrest before arrival at referral centers. For placenta previa or accreta spectrum, planned transfer before delivery is preferable than emergency transfer. Early recognition, timely fluid resuscitation or blood transfusion, slow down bleeding speed, and rapid referral are essential. Therefore, regular training in immediate PPH management and referral protocols may shorten transfer delays and reduce adverse outcomes.
