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Background and Objectives@#Obstructive sleep apnea (OSA) is an obstructive airflow disorder that occurs in the upper respiratory tract during sleep and is therefore associated with the occurrence of cardiovascular diseases. By examining the Lund-Mackay (L-M) scores and maxillary sinus mucosal conditions according to the severity of sleep breathing disorder (SBD), we tried to find out the association between SBD and sinus mucosal change.Subjects and Method Of the 189 patients who underwent sinus CT with a polysomnography test, 175 patients were enrolled in our study. We investigated the average L-M score and L-M score of five or higher, and the ratio of maxillary sinus mucosal thickness (MSMT) of 2 mm or higher. @*Results@#The average L-M score of study population was 0.98 points and the L-M score of five or more was found in 14 patients (8%). The MSMT of 2 mm or more was found in 25.5% of the study group. The average L-M scores for the different groups, namely, the simple snoring group, the mild OSA, the moderate OSA, and the severe OSA were 1.31 points, 0.77 points, 0.91 points, and 1.08 points, respectively. There was no significant difference (p=0.736) among them, and there was no correlation between the apnea-hypopnea index score and the L-M score (r=-0.052, p=0.499). There was no significant difference between OSA severity and MSMT (p=0.490). @*Conclusion@#There was no significant difference between the L-M score and MSMT depending on the severity of SBD. Therefore, it is believed that SBD will have little effect on the sinus mucosa.
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Purpose@#High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard management for relapsed or high-risk non-Hodgkin’s lymphoma (NHL). We reported the busulfan, melphalan, and etoposide (BuME) conditioning regimen was effective in patients with relapsed or high-risk NHL. Moreover, the busulfan, cyclophosphamide, and etoposide (BuCE) conditioning regimen has been used widely in ASCT for NHL. Therefore, based on these encouraging results, this randomized phase II multicenter trial compared the outcomes of BuME and BuCE as conditioning therapies for ASCT in patients with NHL. @*Materials and Methods@#Patients were randomly assigned to receive either BuME (n=36) or BuCE (n=39). The BuME regimen was comprised of busulfan (3.2 mg/kg/day, intravenously) administered on days –7, –6, and –5, etoposide (400 mg/m2 intravenously) on days –5 and –4, and melphalan (50 mg/m2/day intravenously) on days –3 and –2. The BuCE regimen was comprised of busulfan (3.2 mg/kg/day intravenously) on days –7, –6, and –5, etoposide (400 mg/m2/day intravenously) on days –5 and –4, and cyclophosphamide (50 mg/kg/day intravenously) on days –3 and –2. The primary endpoint was 2-year progression-free survival (PFS). @*Results@#Seventy-five patients were enrolled. Eleven patients (30.5%) in the BuME group and 13 patients (33.3%) in the BuCE group had disease progression or died. The 2-year PFS rate was 65.4% in the BuME group and 60.6% in the BuCE group (p=0.746). There were no non-relapse mortalities within 100 days after transplantation. @*Conclusion@#There were no significant differences in PFS between the two groups. Therefore, busulfan-based conditioning regimens, BuME and BuCE, may be important treatment substitutes for the BCNU-containing regimens.
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Background/Aims@#We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). @*Methods@#We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. @*Results@#The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. @*Conclusions@#Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.
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Coronavirus disease 2019 (COVID-19) is associated with a systemic inflammatory response that activates coagulation in symptomatic patients. In addition, a rare form of thrombosis has been reported in people who received the COVID-19 vaccine, most of whom were women younger than 50 years of age. Considering that hormonal contraceptive methods widely used by women of childbearing age increase the risk of thrombosis, the development of guidelines for the use of hormonal contraceptives in the era of the COVID-19 pandemic is necessary. In this context, the Korean Society of Contraception and Reproductive Health provides guidelines for issues regarding contraception and reproductive health during the pandemic.
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Background and Objectives@#It is important to identify variations of paranasal sinuses during sinus surgery. The Onodi cell (OC), a variant of the paranasal sinuses, is the most posterior ethmoid cell with a close relationship with the optic nerve (ON). The purpose of this study is to evaluate the prevalence of OCs and analyze the relationship of OCs with ON in Koreans.Subjects and Method This retrospective study utilized CT images of 526 slides from 263 Korean adults. The prevalence of the OCs and the degree of indentation of the ON within the OC was determined using binary logistic regression analysis. @*Results@#The OCs were observed in 37.3% of 263 subjects and in 27.6% of 526 slides. The OCs are found more frequently in males than in females (p=0.01), and also more frequently in the right side than in the left side (p=0.001). Binary logistic regression analysis revealed that the ON protrusion in female was 0.339 times lower than in male and 1.052 times higher with the increased age. The ON protrusion within the OC in the postsellar type was 10.214 times higher than that in the presellar. @*Conclusion@#The OCs were observed in 37.3% of the Koreans. The protrusion of the ON within the OCs increased in male and in the postsellar type of the sphenoid sinus.
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In recent years, the demand for fertility preservation for both oncologic and nononcologic reasons, as well as for personal reasons, has increased dramatically.Current Concepts: Currently, embryo and oocyte cryopreservation after ovarian stimulation are the mainstays of fertility preservation treatment in women. Embryo cryopreservation is an established and the most successful method of fertility preservation when sufficient time (approximately 2 weeks) is available to perform ovarian stimulation. Recent advances in freezing techniques (vitrification) have significantly improved the outcomes from oocyte cryopreservation that are comparable with those from embryo cryopreservation.Discussion and Conclusion: This review focuses on the indications for the two techniques of fertility preservation and their results. For women to receive timely opportunities to preserve fertility, it is necessary to raise awareness among all medical departments and the public.
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Background@#Nilotinib is a tyrosine kinase inhibitor approved by the Ministry of Food and Drug Safety for frontline and 2nd line treatment of Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML). This study aimed to confirm the safety and efficacy of nilotinib in routine clinical practice within South Korea. @*Methods@#An open-label, multicenter, single-arm, 12-week observational post-marketing surveillance (PMS) study was conducted on 669 Korean adult patients with Ph + CML from December 24, 2010, to December 23, 2016. The patients received nilotinib treatment in routine clinical practice settings. Safety was evaluated by all types of adverse events (AEs) during the study period, and efficacy was evaluated by the complete hematological response (CHR) and cytogenetic response. @*Results@#During the study period, AEs occurred in 61.3% (410 patients, 973 events), adverse drug reactions (ADRs) in 40.5% (271/669 patients, 559 events), serious AEs in 4.5% (30 patients, 37 events), and serious ADRs in 0.7% (5 patients, 8 events). Furthermore, unexpected AEs occurred at a rate of 6.9% (46 patients, 55 events) and unexpected ADRs at 1.2% (8 patients, 8 events). As for the efficacy results, CHR was achieved in 89.5% (442/494 patients), and minor cytogenetic response or major cytogenetic response was achieved in 85.8% (139/162 patients). @*Conclusion@#This PMS study shows consistent results in terms of safety and efficacy compared with previous studies. Nilotinib was well tolerated and efficacious in adult Korean patients with Ph + CML in routine clinical practice settings.
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The delayed rupture of the flexor tendons is a rare complication of malunited distal radius fractures after nonoperative management. The known cause of a flexor tendon rupture is attrition between the palmarly displaced ulnar head and the involved tendons. Sharp bony spurs on the volar side of the malunited distal radius can also cause flexor tendon rupture. About 30 cases have been reported in literature. There were only four case reports about the delayed rupture of the 2nd, 3rd, 4th, and 5th flexor tendons. In this case, we experienced flexor digitorum superficialis and flexor digitorum profundus tendon ruptures of the index, middle, ring, and little fingers, after 8 months following the malunion of a distal radius fracture. At two years follow-up after tendon graft and corrective osteotomy, the range of motion and motor weakness of the 2nd, 3rd, 4th, and 5th fingers improved.
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The coronavirus disease 2019 (COVID-19) pandemic has impacted the medical, social, and reproductive health of millions of people since its outbreak. The causative virus transmits, reproduces, and manifests through the respiratory tract. COVID-19 can invade any system of the body, including the cardiovascular and endocrine systems, through a secondary immune response. In particular, because the fatality rate is high in those over the age of 50 years, special attention is required during the medical care of this population. However, considering the benefit of therapy and the risk of COVID-19, high-quality evidence regarding individualized management in relation to hormone therapy is still insufficient in the field of gynecology. Furthermore, this review aims to serve as a reference for clinical application by analyzing and summarizing the results of studies reported to date regarding female hormone therapy in the context of the COVID-19 pandemic.
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Background@#Most head and neck infections originate from odontogenic causes; therefore, it is important to determine the severity of odontogenic infections. Since severe infection can cause sepsis, a systemic examination should be performed when evaluating a patient with odontogenic infection. C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT), and presepsin (PSEP) can be used to evaluate the severity of inflammatory status and sepsis in patients in the early stages of visiting the emergency room. Moreover, sepsis can be diagnosed based on the systemic inflammatory response syndrome (SIRS) classification. In relation to PSEP, significant study results on sepsis have been reported in other organ infections. However, there has been no progress in odontogenic infection; therefore, this study aimed to determine the diagnostic value of sepsis derived from odontogenic infection. @*Methods@#This study was conducted from March 2021 to October 2021 on 43 patients admitted to the Department of Oral and Maxillofacial Surgery, Dankook University Hospital, in the emergency room for odontogenic infection. All patients underwent vital sign assessment and diagnostic tests (CRP, WBC, PCT, PSEP) in the emergency room. Sepsis was classified according to the SIRS criteria, and CRP, WBC, PCT, and PSEP levels were measured. The Statistical Package for the Social Sciences was used for statistical analyses. @*Results@#The results of this study showed a moderately positive correlation between CRP and PCT, CRP and PSEP, and CT and PSEP levels. In addition, PCT and PSEP levels showed a positive correlation with sepsis. The odds ratios of sepsis and PCT and sepsis and PSEP were statistically significant. The optimal cut-off values obtained through the receiver operating characteristic curve were 0.24 and 671.5 for PCT and PSEP, respectively. Finally, there were positive correlations between CRP level and length of stay, WBC and Flynn scores, PCT level and Flynn scores, PCT level and length of stay, and PSEP level and length of stay. @*Conclusion@#WBC and CRP and PCT levels have been used in the past to determine the severity of infection and sepsis in patients with odontogenic infection, but PSEP was also found to have diagnostic value in this study. According to this study, a PSEP level of 671.5 pg/ml or higher for odontogenic infection can be considered an abnormal level.
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Purpose@#This study evaluated the efficacy of adjuvant chemotherapy (AC) in patients with resected ampulla of Vater (AoV) carcinoma. @*Materials and Methods@#Data from 646 patients who underwent surgical resection at Asan Medical Center between 2000 and 2017 were retrospectively reviewed. @*Results@#The median age of the patients was 62 years, and 54.2% were male. Patients were classified into AC group (n=165, 25.5%) and no AC group (n=481, 74.5%). With a median follow-up duration of 88 months, in patients with stage I, II, III, median recurrence-free survival (RFS) was not reached, 44 months, and 15 months, respectively, and the median overall survival (OS) were not reached, 88 months and 35 months, respectively. Despite no statistical significance, RFS and OS were better in stage II patients with AC than in those without AC (median RFS, 151 months vs. 38 months; p=0.156 and median OS, 153 months vs. 74 months; p=0.299). In multivariate analysis for RFS and OS, TNM stage, R1 resection status, presence of lymphovascular invasion, and perineural invasion remained significant factors, whereas AC (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.54 to 1.00; p=0.052) was marginally related with RFS. After propensity score matching in only stage II/III patients, RFS and OS with AC were numerically longer than those without AC (HR, 0.80; 95% CI, 0.60 to 1.06; p=0.116 and HR, 0.77; 95% CI, 0.56 to 1.06; p=0.111). @*Conclusion@#AC with fluoropyrimidine did not improve survival of patients with resected AoV carcinoma. However, multivariate analysis with prognostic factors showed a marginally significant survival benefit with AC.
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Background and Objectives@#It is necessary to understand the variations of the paranasal sinuses (PNS) and other anatomical structures during an endoscopic sinus surgery (ESS). The purpose of this study was to investigate any association between the degree of frontal sinus (FS) pneumatization and the development of the PNS structures. Subjects and Method We analyzed 311 PNS computed tomography (CT) scans (622 sinuses, including the left and right sides). We classified FS into type I (aplasia), type II (hypoplasia), and type III (control). We assessed and compared the middle turbinate pneumatization (MTP), superior turbinate pneumatization (STP), agger nasi cell (ANC), infraorbital cell (IOC), optic nerve (ON) type, and vidian nerve (VN) type with the pneumatization of the FS. We further studied for any association between the degree of pneumatization of the FS, maxillary sinus (MS), and sphenoid sinus (SS) and the lateral lamella length (LLL). @*Results@#MTP, ANC, and IOC rates according to the FS types were not significant (p>0.05). Both type II and III showed more frequent occurrences of STP than type I (p=0.005). The ON type III and IV were significantly frequent in the FS type III (p0.05). In the FS type II and III, the LLL was significantly greater than in type I (p<0.001). @*Conclusion@#Increased FS pneumatization shows greater indentation of ON and VN into the SS, as well as increased LLL. During ESS, it is important to recognize the possibility of structural damage of ON, VN, and LLL according to FS pneumatization.
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Background@#Most of the maxillofacial infections are bacterial infections, and there is a possibility that systemic infections occur by maxillofacial infections. The aim of this study was to investigate the diagnostic value of procalcitonin in patients with odontogenic bacterial infections of the maxillofacial region. @*Methods@#We enrolled sixty patients, who were admitted with odontogenic maxillofacial infection from September 2018 to March 2020. White blood cell counts, C-reactive protein, and procalcitonin concentrations were evaluated. Sixty patients were classified into two groups, sepsis and non-sepsis groups, based on systemic inflammatory response syndrome. A Student t test was performed to statistically analyze the difference in inflammatory markers between sepsis and non-sepsis groups. @*Results@#The mean procalcitonin values on admission were 7.24 ng/mL (range, 0.09–37.15 ng/mL) and 0.40 ng/mL (range, 0.02–4.94 ng/mL) in the sepsis group and non-sepsis group, respectively. The procalcitonin values between the two groups showed a significant difference (P < 0.05). The area under the curve of procalcitonin was 0.927 (P < 0.001), and the cutoff value of procalcitonin that maximizes the area under the curve was calculated to be 0.87 ng/ mL. @*Conclusions@#According to our study, routine laboratory tests have insufficient accuracy in diagnosing sepsis syndrome. Therefore, it is strongly recommended to perform the procalcitonin test in patients with maxillofacial infection in addition to the conventional laboratory tests to diagnose the systemic inflammatory condition of the patients.
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Background@#This study was to evaluate the bone formation ability of demineralized dentin matrix (DDM) combined with platelet-rich fibrinogen (PRF) and DDM combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) to improve the osteoinductive ability of DDM. @*Methods@#After four bone defects with a diameter of 8mm were created in the calvarium of each rabbit, DDM was grafted into the first defect (experimental groups 1), a combination of DDM and PRF was grafted into the second defect (experimental groups 2), and DDM with absorbed rhBMP-2 was grafted into the third defect (experimental groups 3). The fourth defect was used as the control group. Twelve healthy male rabbits (New Zealand, white rabbits) weighing around 3.0–4.0 kg were used. Among 12 rabbits, 3 rabbits were sacrificed immediately after surgery and at 2, 4, and 8 weeks after surgery, respectively. Histopathologic analysis and histomorphometric analysis were conducted to evaluate bone formation in each group. @*Results@#The PRF/DDM group did not show a significantly higher degree of new bone formation in calvarial bone defects than the DDM group at 2, 4, and 8 weeks postoperatively in histopathological findings and histomorphometric results. On the other side, the rhBMP-2/DDM group showed higher degrees of new bone formation and calcification, and the lamellae of bone matrix, which are observed in mature bone tissue, were more distinctly visible in the rhBMP-2/DDM group. Moreover, the rhBMP-2/DDM group showed a significantly higher amount of new bone formation, compared to the DDM group at 4 and 8 weeks postoperatively (P<0.05) in histomorphometric results. @*Conclusion@#The DDM has great potential as a carrier for the maintenance and sustained release of rhBMP-2, which has been recently receiving wide attention as a type of signaling molecules to promote bone formation.
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Objectives@#This study compared serum anti-Mullerian hormone (AMH) levels in endometriotic cysts (ECs) with those in non-ECs and analyzed changes thereof after single-port laparoscopic (SPL) ovarian cyst enucleation using vasopressin injection. @*Methods@#In total, 180 patients (EC group, n = 112; non-EC group, n = 68) who underwent SPL ovarian cyst enucleation were retrospectively reviewed. Their AMH levels were checked preoperatively, on postoperative day 10 (POD10), and on postoperative month 3 (POM3). Changes in AMH levels were analyzed according to tumor type and vasopressin use. @*Results@#The median initial and postoperative serum AMH levels in the EC group were significantly lower than those in the nonEC group (preoperation: 2.0 vs 3.8 ng/mL, P < 0.001; POD10: 1.0 vs 3.2 ng/mL, P < 0.001; POM3: 1.2 vs 3.6 ng/mL, P < 0.001). The postoperative decrease in AMH levels was higher in the EC group than the non-EC group on POD10 (0.8 vs 0.5 ng/mL, P = 0.011) but not on POM3 (0.7 vs 0.5 ng/mL, P = 0.164). Vasopressin injection during EC enucleation had no significant effect on the decrease in AMH levels on POD10 (vasopressin group vs non-vasopressin group: 1.0 vs 0.8 ng/mL, P = 0.253) and POM3 (vasopressin group vs nonvasopressin group: 1.4 vs 1.1 ng/mL, P = 0.242). @*Conclusions@#AMH levels were lower at baseline and had higher decreasing rates after SPL surgery in the EC group relative to the nonEC group. Vasopressin injection might not protect the ovary from the postoperative decrease in AMH levels.
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Purpose@#Intraoperative cardiac arrest (IOCA) is rare, unpredictable, and may result in a poor outcome. The features of IOCA during cancer surgery and factors related to survival following an IOCA were examined. @*Methods@#This was a retrospective study of patients who had cancer surgery under general anesthesia between March 2009 and March 2021 (n = 84,615) to determine the number of patients who had an IOCA. Patients’ clinical information, cause of IOCA, hypoxemia during anesthesia, and the duration of hypotension and CPR were analyzed. @*Results@#A total of 22 cases of IOCA occurred during cancer surgery (overall incidence: 2.6 per 10,000 surgeries). Return of spontaneous circulation was achieved in 17 patients, but only 13 survived until discharge. There were statistically significant differences between the deceased and the survival cancer patient groups in; (1) duration of hypoxemia (survival group: 5 minutes, range: 2-18 minutes; deceased group: 60 minutes, range, 22.5-120 minutes; p = 0.019); (2) duration of hypotension (survival group: 35 minutes, range, 15-55 minutes; deceased group 160 minutes, range, 140-185 minutes; p = 0.007); and (3) total duration of CPR (survival group: 3 minutes, range: 1-15 minutes; deceased group: 40 minutes, range: 19-149 minutes; p = 0.005). @*Conclusion@#The duration of hypoxemia and hypotension prior to the onset of IOCA, as well as the duration of CPR were associated with the prognosis of IOCA, highlighting the need to reduce multiorgan damage caused by hypoxemia and hypotension during surgery in high-risk patients.
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Background/Aims@#Several prediction models for evaluating the prognosis of nonmetastatic resected pancreatic ductal adenocarcinoma (PDAC) have been developed, and their performances were reported to be superior to that of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. We developed a prediction model to evaluate the prognosis of resected PDAC and externally validated it with data from a nationwide Korean database. @*Methods@#Data from the Surveillance, Epidemiology and End Results (SEER) database were utilized for model development, and data from the Korea Tumor Registry System-Biliary Pancreas (KOTUS-BP) database were used for external validation. Potential candidate variables for model development were age, sex, histologic differentiation, tumor location, adjuvant chemotherapy, and the AJCC 8th staging system T and N stages. For external validation, the concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC) were evaluated. @*Results@#Between 2004 and 2016, data from 9,624 patients were utilized for model development, and data from 3,282 patients were used for external validation. In the multivariate Cox proportional hazard model, age, sex, tumor location, T and N stages, histologic differentiation, and adjuvant chemotherapy were independent prognostic factors for resected PDAC. After an exhaustive search and 10-fold cross validation, the best model was finally developed, which included all prognostic variables. The C-index, 1-year, 2-year, 3-year, and 5-year time-dependent AUCs were 0.628, 0.650, 0.665, 0.675, and 0.686, respectively. @*Conclusions@#The survival prediction model for resected PDAC could provide quantitative survival probabilities with reliable performance. External validation studies with other nationwide databases are needed to evaluate the performance of this model.
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Theca lutein cysts are rare, benign lesions responsible for gross cystic enlargement of both ovaries during pregnancy. This condition is also termed hyperreactio luteinalis. Elevated human chorionic gonadotropin (hCG) levels or states of hCG hypersensitivity seem to promote these changes, which in up to 30% of patients produce clinical signs of hyperandrogenism. Given the self-limiting course of theca lutein cysts, which are subject to spontaneous postpartum resolution, conservative treatment is the mainstay of patient management. Described herein is a rare case of theca lutein cysts with maternal virilization that failed to regress by 9 months after childbirth. Surgical intervention was eventually undertaken, necessitated by adnexal torsion.
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Red ginseng (RG) exerts anti-inflammatory, anti-proliferative, and immunomodulatory effects on endometriosis through the regulation of microRNA (miRNA) expression. It may also ameliorate endometriosis by affecting the expression of multiple miRNAs simultaneously, rather than acting on a single miRNA at a given time. Since studies on the overall effects of RG on endometriosis via the regulation of miRNA expression are lacking, the current study aimed to explore the global effect of RG on miRNA expression in a mouse model of endometriosis. Methods: To establish the mouse model, the uterine horn of donor mice was implanted into the lateral side of the recipients’ peritoneum, followed by vehicle or RG treatment for 8 weeks. Results: To confirm the effects of RG on the established mouse model, the size of the implanted uterus was measured; it was found to be lower in mice from the RG group than in mice from the control group. miRNA expression profiles in the implanted uterus of the mouse model of endometriosis after vehicle or RG administration were analyzed using microarray technology. Thereafter, seven candidate miRNAs and 125 candidate genes (miRNA targets) were identified through a bioinformatics analysis. Conclusion: The present findings suggest that RG regulates the expression of multiple miRNAs and mRNAs, thereby alleviating endometriosis in a mouse model of the disease.
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Advances in anticancer treatments have resulted in increasing survival rates among cancer patients. Accordingly, the quality of life after treatment, particularly the preservation of fertility, has gradually emerged as an essential consideration. Cryopreservation of embryos or unfertilized oocytes has been considered as the standard method of fertility preservation among young women facing gonadotoxic chemotherapy. Other methods, including ovarian suppression and ovarian tissue cryopreservation, have been considered experimental. Recent large-scale randomized controlled trials have demonstrated that temporary ovarian suppression using gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy is beneficial for preventing chemotherapy-induced premature ovarian insufficiency in breast cancer patients. It should also be emphasized that GnRHa use during chemotherapy does not replace established fertility preservation methods. All young women facing gonadotoxic chemotherapy should be counseled about and offered various options for fertility preservation, including both GnRHa use and cryopreservation of embryos, oocytes, and/or ovarian tissue.