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대한산부인과학회> Obstetrics & Gynecology Science> Sentinel lymph node biopsy in high-risk endometrial cancer: performance, outcomes, and future avenues

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Sentinel lymph node biopsy in high-risk endometrial cancer: performance, outcomes, and future avenues

Yoo-na Kim , Young Tae Kim
  • : 대한산부인과학회
  • : Obstetrics & Gynecology Science 65권5호
  • : 연속간행물
  • : 2022년 09월
  • : 395-405(11pages)
Obstetrics & Gynecology Science

DOI


목차

Introduction
Methods
Results
Conclusion
Conflict of interest
Ethical approval
Patient consent
Funding information
References

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초록 보기

Endometrial cancer is the second most common gynecological malignancy worldwide, with an overall favorable prognosis. However, a subgroup of patients has a high risk of recurrence and poor prognosis. This review summarizes recently published articles that examined sentinel lymph node (SLN) biopsy in patients with high-risk endometrial cancer. We focused on the performance and outcomes of SLN biopsy, and examined potential methods for improving the management of this high-risk subset. Few studies have examined the long-term outcomes of SLN in patients with high-risk endometrial cancer. Thus, we reviewed recently published retrospective studies that have adopted statistical techniques, such as inverse probability weighting or propensity score matching, to examine the outcome of SLN biopsy compared to conventional lymphadenectomy. Potential avenues for future research to fine-tune decision making for this patient subgroup were also discussed.

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간행물정보

  • : 의약학분야  > 산부인과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2287-8572
  • : 2287-8580
  • : 학술지
  • : 연속간행물
  • : 1958-2022
  • : 11148


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1COVID-19 and vaccination during pregnancy: a systematic analysis using Korea National Health Insurance claims data

저자 : Ki Hoon Ahn , Hae-in Kim , Kwang-sig Lee , Ju Sun Heo , Ho-yeon Kim , Geum-joon Cho , Soon-cheol Hong , Min-Jeong Oh , Hae-joong Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 487-501 (15 pages)

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Objective
This study systematically analyzed coronavirus disease 2019 (COVID-19) and vaccination details during pregnancy by using the national health insurance claims data.
Methods
Population-based retrospective cohort data of 12,399,065 women aged 15-49 years were obtained from the Korea National Health Insurance Service claims database between 2019 and 2021. Univariate analysis was performed to compare the obstetric outcomes of pregnant women (ICD-10 O00-O94) and their newborns (ICD-10 P00-P96) with and without COVID-19. Univariate analysis was also performed to compare the age and obstetric outcomes of pregnant women receiving different types of vaccines.
Results
The percentage of pregnant women with COVID-19 during pregnancy was 0.11%. Some obstetric outcomes of pregnant women with COVID-19, including the rates of preterm birth or cesarean delivery, were significantly better than those of pregnant women without COVID-19. The rate of miscarriage was higher in pregnant women with COVID-19 than without COVID-19. However, the outcomes of newborns of women with and without COVID-19 were not significantly different. Regarding vaccination type, obstetric outcomes of pregnant women appeared to be worse with the viral vector vaccine than with the mRNA vaccine.
Conclusion
To the best of our knowledge, this is the first study to systematically analyze COVID-19 and vaccination details during pregnancy using the national health insurance claims data in Korea. The obstetric outcomes in pregnant women with and without COVID-19 and their newborns were similar.

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2Improving body image and sexual life among postpartum women: a single-blind-randomized controlled trial to evaluate a social network-based cognitive-behavioral intervention

저자 : Erfaneh Talebi , Mohammad Heidari , Forouzan Elyasi , Shayesteh Jahanfar , Zohreh Shahhosseini

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 502-512 (11 pages)

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Objective
To determine the effect of a social network-based cognitive-behavioral intervention on postpartum body image and sexual life of primiparous women.
Methods
In this single-blind randomized controlled trial, 82 postpartum women were allocated into two intervention and control groups (allocation ratio, 1:1) using permuted block randomization. Primary outcome was change in body image scores between the groups over time. Secondary outcomes were genital self-image, sexual quality of life, and sexual satisfaction. The intervention group participated in eight (2 weeks) 60-minute sessions through WhatsApp (WhatsApp Inc., Mountain View, CA, USA). Data were collected at recruitment, post-intervention, and 1-month of follow-up.
Results
Cognitive-behavioral intervention had a medium effect on improving body image in postpartum women (partial eta squared, 0.33; P<0.001). The results showed significant differences between the two groups regarding sexual quality of life and sexual satisfaction at 1-month follow-up.
Conclusion
The results of this study can be used to develop psychological interventions targeting body image in postpartum women.

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3Preoperative modified frailty index to predict surgical complications in endometrial cancer patients

저자 : Aroontorn Pichatechaiyoot , Sarayut Thannil , Sathana Boonyapipat , Rakchai Buhachat

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 513-521 (9 pages)

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Objective
To assess the predictive value of the preoperative modified frailty index (mFI) for postoperative complications in endometrial carcinoma, evaluate risk factors associated with complications, and compare the predictive properties of the mFI with the American Society of Anesthesiologists (ASA) physical status classification.
Methods
A total of 364 patients with endometrial cancer who underwent primary surgery between January 2009 and December 2016 were examined. The prognostic value of mFI in predicting severe postoperative complications, assessed according to the Clavien-Dindo classification, was analyzed and compared with ASA status. The risk factors for adverse outcomes were determined using multivariate analysis.
Results
The 30-day postoperative surgical- or medical-related complication rate was 26.6%. The rates of postoperative complications were 1.3%, 8.8%, 12.2%, and 60.0% for mFI scores of 0, 1, 2, and ≥3, respectively (P<0.001). The odds ratios for predicting postoperative complications in patients with mFI scores of 1, 2, and ≥3 were 7.38, 10.59, and 114.75, respectively. In the multivariate analysis, the significant predictive factors for postoperative complications were mFI ≥1, body mass index (BMI) ≥30 kg/㎡, and non-endometrioid cell type. At cut-off points of mFI ≥1 and ASA ≥2, both tools had similar sensitivities but mFI was more specific (sensitivities 92.9% vs. 100%; specificity 45.5% vs. 19.4%).
Conclusion
mFI provides a satisfactory predictive value for postoperative complications. Patients with an mFI score ≥1, a BMI ≥30 kg/㎡, and a non-endometrioid subtype, are at risk of postoperative complications and should receive comprehensive preoperative and postoperative management.

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4Laparoscopic systemic restaging surgery for women with unexpected uterine malignancy

저자 : Eun Bi Kim , Hyeon Myeong Hong , Won Moo Lee , Joong Sub Choi , Jaeman Bae , Un Suk Jung , Jeong Min Eom , Jihyun Keum

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 522-530 (9 pages)

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Objective
We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer.
Methods
This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy.
Results
The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/㎡ (range, 20.75-31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence.
Conclusion
Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.

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5Triphenyl phosphate activates estrogen receptor α/NF-κB/cyclin D1 signaling to stimulate cell cycle progression in human Ishikawa endometrial cancer cells

저자 : Hyun Young Kwon , Seung Bin Park , Myoungseok Han , Jung-woo Park , Yongmin Lee , Sang Jun Han , Youngmin Kwon , Yeon Jean Cho

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 531-541 (11 pages)

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Objective
Triphenyl phosphate (TPHP) is one of the most commonly used organophosphorus flame retardants that may accumulate in the environment. However, its effects on human reproductive organs have not been well studied. We aimed to investigate the in vitro effects of TPHP in human Ishikawa endometrial cancer cells to elucidate how TPHP exposure disrupts intracellular signaling and cell proliferation in reproductive tissues.
Methods
Human Ishikawa endometrial cancer cells were exposed to TPHP.
Results
Exposure to TPHP elevated the levels of estrogen receptor (ER) α and progesterone receptor-B and reduced ER β in human Ishikawa endometrial cancer cells. TPHP stimulated phosphoinositide 3-kinase/protein kinase B and mitogen-activated protein kinase/ extracellular signal-regulated kinases 1/2 kinase signaling, which may contribute to the activation of ER function and induce nuclear translocation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in human Ishikawa endometrial cancer cells. Activated ER and NF-κB stimulate the expression of cyclin D1/cyclin-dependent kinase (CDK) 4/CDK6, indicating cell cycle progression and proliferation.
Conclusion
This report may provide new information on the molecular mechanisms underlying how TPHP exposure dysregulates the cellular physiology of the human endometrium.

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6Surgical outcomes of laparoscopic trachelectomy following supracervical hysterectomy: a multicenter study

저자 : Ayman Shehata Dawood , Heba Fouad Harras , Hossam Ramadan Moussa , Ahmed Saber Soliman

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 542-551 (10 pages)

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Objective
To evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy.
Methods
This multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded.
Results
The median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22-28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy result revealed stump carcinoma in three cases (7.5%) that were excluded. The median operative time was 210 minutes (range, 170-220). The median blood loss was 270 mL (range, 220-320). Additionally, histopathological examinations revealed that chronic non-specific cervicitis was present in 54.05% of trachelectomy specimens. There were no significant differences between symptomatic and asymptomatic patients regarding operative outcomes, except adhesions, which were more significantly increased in symptomatic patients (P=0.015). Minimal complications, both operative and postoperative, were related to the procedure.
Conclusion
Although the operative time was long and adhesions were common during laparoscopic trachelectomy, the procedure was feasible and safe, with minimal complications.

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7The effect of diluted ropivacaine in distending fluid on cramping pain after hysteroscopic surgeries: a randomized clinical trial study

저자 : Kobra Tahermanesh , Abolfazl Mehdizadeh Kashi , Marziyeh Ajdary , Samaneh Rokhgireh , Masood Mohseni , Shahla Chaichian , Maryam Ahmadi

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 6호 발행 연도 : 2022 페이지 : pp. 552-559 (8 pages)

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Objective
The effect of ropivacaine on postoperative hysteroscopy has not yet been evaluated; this study investigated the effect of diluted ropivacaine in distending media during hysteroscopy on postoperative cramping pain.
Methods
This double-blind randomized clinical trial was conducted on 60 women who underwent hysteroscopy at a tertiary hospital. Normal saline was used as the distending fluid in both groups. The intervention group received 10 mL of 2% ropivacaine in only one bottle of 1,000 mL normal saline as a distending fluid, while the control group received 10 mL of normal saline in 1,000 mL normal saline during hysteroscopy. Patients' pain scores were evaluated before hysteroscopy and at 2, 6, 12, 24, and 48 hours after hysteroscopy.
Results
Based on the results, the pain measured by visual analog scale (VAS) score was significant at 6 and 12 hours after the intervention was significantly lower than that in the ropivacaine group (3.03±1.57 vs. 4±1.49, P=0.02 at 6 hours and 1.28±1.36 vs. 2.4±1.43, P=0.003 at 12 hours). There were no significant differences in the VAS scores at 2, 24, and 48 hours after the intervention between the two groups.
Conclusion
Ropivacaine in the distending fluid during hysteroscopy is associated with a significant reduction in pain within a few hours after hysteroscopy with no remarkable adverse effects.

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1Prenatal maternal alcohol exposure: diagnosis and prevention of fetal alcohol syndrome

저자 : Young Min Hur , Jiwon Choi , Sunwha Park , Sarah Soyeon Oh , Young Ju Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 385-394 (10 pages)

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Fetal alcohol syndrome (FAS) is a developmental and congenital disorder characterized by neurocognitive impairment, structural defects, and growth restriction due to prenatal alcohol exposure. The estimated global prevalence of alcohol use during pregnancy is 9.8%, and the estimated prevalence of FAS in the general population is 14.6 per 10,000 people. In Korea, the estimated prevalence of alcohol use during pregnancy is 16%, and the prevalence of FAS is 18-51 per 10,000 women, which is higher than the global prevalence. Women's alcohol consumption rates have increased, especially in women of childbearing age. This could increase the incidence of FAS, leading to higher medical expenses and burden on society. Alcohol is the single most important teratogen that causes FAS, and there is no safe trimester to drink alcohol and no known safe amount of alcohol consumption during pregnancy. Thus, physicians should assess women's drinking patterns in detail and provide education on FAS to women by understanding its pathophysiology. Moreover, the prevention of FAS requires long-term care with a multidisciplinary approach.

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2Sentinel lymph node biopsy in high-risk endometrial cancer: performance, outcomes, and future avenues

저자 : Yoo-na Kim , Young Tae Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 395-405 (11 pages)

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Endometrial cancer is the second most common gynecological malignancy worldwide, with an overall favorable prognosis. However, a subgroup of patients has a high risk of recurrence and poor prognosis. This review summarizes recently published articles that examined sentinel lymph node (SLN) biopsy in patients with high-risk endometrial cancer. We focused on the performance and outcomes of SLN biopsy, and examined potential methods for improving the management of this high-risk subset. Few studies have examined the long-term outcomes of SLN in patients with high-risk endometrial cancer. Thus, we reviewed recently published retrospective studies that have adopted statistical techniques, such as inverse probability weighting or propensity score matching, to examine the outcome of SLN biopsy compared to conventional lymphadenectomy. Potential avenues for future research to fine-tune decision making for this patient subgroup were also discussed.

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3Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials

저자 : Ahmed Abu-zaid , Saeed Baradwan , Ehab Badghish , Rayan Alsghan , Ahmed Ghazi , Bayan Albouq , Khalid Khadawardi , Nora F Alnaim , Latifa F Alnaim , Meshael Fodaneel , Fatimah Shakir Abualsaud , Mohammed Ziad J

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 406-419 (14 pages)

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To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy and safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy for benign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed for risk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervals in a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two and three studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirement for postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantly reduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobin level was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequency of self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhea rate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolic events, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivity analyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions, prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative blood loss and related morbidities.

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4Ritodrine in external cephalic version: is it effective and safe?

저자 : Sin Ae Kim , Eun-hwan Cha , Kyoung-chul Chun , Young Ah Kim , Jae-whoan Koh , Jung Yeol Han , Jong Hee Hwang

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 420-429 (10 pages)

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Objective
The external cephalic version (ECV) has been shown to lower the likelihood of cesarean section requirements among pregnant women with breech presentations. In the current study, we investigated the effectiveness and safety of ritodrine as a tocolytic for ECV.
Methods
A total of 407 pregnant women with breech presentations, who had no contraindications for ECV, were enrolled in this study. Multivariable logistic regression analyses were used to assess the impact of ritodrine use on the safety and efficacy of ECV.
Results
The overall success rate was 67.6%, and ritodrine use was associated with significantly higher odds of successful ECV after adjusting for confounders. Moreover, using ritodrine did not increase the risk of adverse effects, including temporary changes in fetal heart rate, need for elective or emergency cesarean section due to fetal distress during ECV, low Apgar scores, and perinatal mortality.
Conclusion
Our results suggest that using ritodrine as a tocolytic during ECV may increase the likelihood of ECV success and may not increase adverse perinatal outcomes.

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Objective
To determine the value of endometrial thickness (ET) and Doppler indices of uterine artery (UtA) as sonographic markers in predicting endometrial cancer (EC) among postmenopausal bleeding (PMB) women in low-resource settings as Vietnam.
Methods
This cross-sectional study was conducted at the Hue University Hospital and Hue Central Hospital between June 2016 and June 2019. The study enrolled all women who complained of PMB and were followed by transvaginal Doppler ultrasound. Their definitive histopathological examination was the gold standard for comparison.
Results
The UtA Doppler indices, including resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV), were significantly lower in the malignant group than in the benign group. The threshold values of the UtA, RI ≤0.73 and PI ≤1.42, were found with an area under receiver operating characteristic curve (AUC) of 0.85-0.88, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Unlike PSV, the diagnostic value was the lowest, with an AUC of 0.72. ET was a good predictor for the diagnosis of EC, with an AUC of 0.89. In women with PMB, when using the cutoff value of EC more than 12.5 mm, the sensitivity and specificity were 93.8% and 77.8%, respectively. In addition, the higher the stage of EC, the lower the RI and PI and the greater the EC.
Conclusion
ET, and RI, PI, and PSV of the UtA could help in differentiating malignant from benign endometrial changes. Pulsed ultrasonic Doppler velocimetry seems to play a role in predicting the higher stages of EC. Further studies are needed to confirm these findings.

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6The effect of a support program on the burden of spouses caring for their partners with breast cancer: a randomized controlled trial

저자 : Seyedeh-zeynab Hosseinnejad , Forouzan Elyasi , Seyed-nouraddin Mousavinasab , Zohreh Shahhosseini

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 441-450 (10 pages)

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Objective
This study aimed to determine the effect of a support program on burden of spouses caring for their partners with breast cancer.
Methods
This randomized controlled trial was conducted among spouses of women with breast cancer undergoing chemotherapy at a referral chemotherapy center in Iran. They were assigned to intervention (n=40) and control (n=40) groups using permuted block randomization. Three small group sessions lasted 45-60 minutes, followed by three telephone-based sessions, lasting 15-20 minutes (twice a week). The intervention sessions included defining stress management strategies in different situations: strengthening creativity, optimism, and management in planning, and defining the role of the caregiver. Primary outcome was care burden, and secondary outcomes were spouses' stress, satisfaction with intervention, and partners' quality of life (QOL). The caregiver burden inventory, depression anxiety stress questionnaire, World Health Organization QOL brief version, and client satisfaction questionnaire were completed before and after the intervention and at a 6-week follow-up.
Results
Thirty-eight participants in each group with a mean age of 44.24±9.01 years completed the study. Repeated measures analysis of variance showed a significant difference in the care burden (P<0.05; effect size, 0.70), stress (P<0.05; effect size, 0.64), and women's QOL (P<0.05; effect size, 0.67) before and after the intervention.
Conclusion
The results of this study can be used to develop interventions, targeting the care burden and stress of spouses of women with breast cancer undergoing chemotherapy.

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7Predictive value of 'Smartscopy' for the detection of preinvasive cervical lesions during the COVID-19 pandemic: a diagnostic study

저자 : Thamawoot Phoblap , Amornrat Temtanakitpaisan , Apiwat Aue-angkul , Pilaiwan Kleebkaow , Bandit Chumworathayi , Sanguanchoke Luanratanakorn , Yuwadee Itarat

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 451-458 (8 pages)

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Objective
To evaluate the performance of “Smartscopy” in diagnosing preinvasive cervical lesions among patients with abnormal cervical cancer screening results obtained during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
This diagnostic study enrolled non-pregnant women with abnormal cervical cancer screening results obtained at the colposcopy clinic at Srinagarind Hospital (Khon Kaen, Thailand) between September 2020 and March 2021. Two colposcopists independently evaluated the uterine cervix using a smartphone and colposcopy. Cervical biopsies and endocervical curettage were performed in accordance with standard procedures. The diagnostic performance of a smartphone in detecting low-grade squamous intraepithelial lesions or worse plus (LSIL+) and high-grade squamous intraepithelial lesions plus (HSIL+) was assessed.
Results
In total, 247 patients were included. There was high agreement between the two colposcopists (κ=0.88; 95% confidence interval [CI], 0.82-0.93). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the smartphone to detect LSIL+ were 96.6% (95% CI, 91.6-99.1), 12.9% (95% CI, 8.06-19.2), 46.2% (95% CI, 39.7-52.4), 83.3% (95% CI, 62.6-95.3), and 0.49% (95% CI, 0.43-0.55), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of smartscopy in diagnosing HSIL+ were 67.6% (95% CI, 55.2- 78.5), 85.4% (95% CI, 79.9-90.0), 60.5% (95% CI, 48.6-71.6), 88.9% (95% CI, 83.7-92.9), and 81.0% (95% CI, 0.75-0.85), respectively.
Conclusion
Smartscopy demonstrated a remarkable correlation with colposcopy and a high diagnostic performance value for the detection of preinvasive cervical lesions. Therefore, smartscopy may be an alternative tool for detecting abnormal cervical lesions in low to medium medical resource settings. Smartscopy may be applied in telemedicine during the COVID-19 pandemic.

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8Clinical outcomes of immunohistochemistry of the p53 staining pattern in high-grade serous ovarian carcinoma

저자 : Panarat Orachum , Amornrat Temtanakitpaisan , Pilaiwan Kleebkaow , Bandit Chumworathayi , Sanguanchoke Luanratanakorn , Apiwat Aue-angkul , Yuwadee Itarat

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 459-467 (9 pages)

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Objective
To investigate the prevalence of p53 mutations and associated factors between immunohistochemistry (IHC) and p53 staining patterns among patients with high-grade serous ovarian carcinoma (HGSOC).
Methods
This study is a retrospective review. A total of 62 patients with HGSOC underwent surgery at Srinagarind Hospital between January 2016 and December 2020. Histological examination was performed based on a combination of morphology and IHC staining with p53. The p53 immunostaining pattern was interpreted as a missense mutation, nonsense mutation, or a wild-type pattern. Missense (p53 overexpression pattern) and nonsense (null expression p53 pattern) mutations were considered p53 mutations. A wild-type pattern was defined as a p53 non-mutation.
Results
p53 mutations were identified in 93.6% of the patients. Subgroup analysis of the p53 mutation group between the p53 overexpression pattern and the p53 null expression pattern in terms of clinicopathological characteristics and initial treatment was performed. Patients with the p53 overexpression pattern had significantly more omental metastases than those with the p53 null expression pattern (87.8% vs. 64.7%, P=0.042). There were no statistically significant differences in median progression-free survival (PFS) (9 vs. 10 months, P=0.813) or median overall survival (OS) (12 vs. 17 months, P=0.526) between the two groups.
Conclusion
The prevalence of p53 mutations in HGSOC patients in this study was 93.6%. Omental metastasis is a significant pathological factor in predicting overexpression p53 pattern in HGSC. However, IHC analysis of the p53 staining pattern did not affect OS or PFS among patients with HGSOC.

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9Body fat distribution and insulin resistance among Korean middle-aged women: a Korean National Health and Nutrition Examination Survey

저자 : Sae Mi Lee , Ki-jin Ryu , Serhim Son , Yeon Ju Lee , Hyuntae Park , Tak Kim

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 468-476 (9 pages)

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Objective
To evaluate menopause-related changes in body fat distribution and their relationship with insulin resistance in middleaged Korean women.
Methods
We analyzed women aged 40-60 years using data from the National Health and Nutrition Examination Survey conducted from 2008 to 2011. Body fat was measured using dual-energy X-ray absorptiometry. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).
Results
Among 3,468 participants, menopausal women (n=1,489) had a higher body mass index (BMI) and higher trunk, arm, and head fat percentages than premenopausal women (n=1,979). However, no significant difference was found in the leg fat percentage according to menopausal status. Multivariable regression analysis for HOMA-IR showed that trunk fat percentage, BMI, and waist circumference positively correlated with insulin resistance and leg fat percentage negatively correlated after adjusting for several confounding factors, whereas menopausal status was not associated with HOMA-IR.
Conclusion
Middle-aged women not only have different body weights and BMI but also have different body fat distributions according to menopausal status. Each fat percentage change in the trunk and leg is differently associated with metabolic health, particularly insulin resistance. To evaluate the metabolic health of middle-aged women, BMI is generally noted; however, body fat distribution, which can be easily assessed using dual-energy X-ray absorptiometry, should also be considered.

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10Vaginal vault drainage as an effective and feasible alternative in laparoscopic hysterectomy

저자 : Soohyun Oh , Seung Joo Chon , Seung Ho Lee , Jin Woo Shin

발행기관 : 대한산부인과학회 간행물 : Obstetrics & Gynecology Science 65권 5호 발행 연도 : 2022 페이지 : pp. 477-482 (6 pages)

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Objective
Infected pelvic hematoma is a serious complication of hysterectomies. Pelvic drainage can help reduce complications. In this study, we evaluated the efficacy and safety of vaginal vault drainage in patients who underwent laparoscopic hysterectomy for benign gynecological diseases.
Methods
Patients who underwent laparoscopic hysterectomy and pelvic drain insertion for benign gynecological diseases between January 2008 and December 2015 were enrolled retrospectively in the study. They were grouped according to drain insertion sites, that is, through the abdomen (group 1) and vaginal vault (group 2). The postoperative outcomes were compared between the two groups.
Results
A total of 504 women were included. No significant differences were observed in the prevalence of postoperative fever, readmission, and reoperation between the two groups.
Conclusion
Given the discomfort associated with holding and removing the abdominal drain, inserting a closed pelvic gravity drain through the vaginal vault appears to be a feasible alternative to an abdominal drain.

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