Can probiotics enhance fertility outcome? Capacity of probiotics as a single intervention to improve the feminine genital tract microbiota in non-symptomatic reproductive-aged women.

Modifications in vaginal and endometrial microbiome and microbiota have been associated with fewer implantation rates and poorest pregnancy outcomes. Therefore, its study has emerged as a new biomarker in reproductive medicine. Despite the numerous papers published on probiotic use for vaginal dysbiosis and their actual wide empiric use especially for infertile patients, there is still no clear answer to justify their recommendation. The impact of probiotics on the vaginal or endometrial microbiota has often been investigated under a symptomatic altered vaginal microbial ecosystem, such as bacterial vaginosis. However 50% of women with bacterial vaginosis are asymptomatic. Actual clinical practice guidelines clearly recommend the use of specific antimicrobial agents for the management of symptomatic vaginal infections. Assuming this should be the management as well for an infertile population, what should be the treatment for the 50% non-symptomatic women presenting unfavorable vaginal/endometrial microbiota? The aim of this review is to assess the capacity of probiotics as a single intervention to alter the feminine genital tract microbiota in non-symptomatic reproductive-aged women.

Making a Subjective Notion Computer-Interpretable: The Case of the Tumour-Volume to Breast-Volume Ratio for the Surgical Decision of Breast Cancer.

Clinical practice guidelines (CPGs) often include ambiguous criteria making their translation as computer-interpretable guidelines a difficult task. In breast cancer management, whether to perform a breast conservative surgery (BCS) or not is one example. Most international CPGs recommend to perform a BCS when the tumour volume / breast volume ratio allows for good cosmetic results, which cannot be directly translated into a computable format. We propose to compute an estimate of the ratio using the maximum size of the tumour to compute the tumour volume and the bra size to compute the breast volume. In addition, we take into account the location of the tumour according to quadrants and unions of quadrants. The model has been tested on a retrospective sample of 34 clinical decisions of a breast cancer unit in a Parisian university hospital (France). Concordance was found in 91.2% of the cases, with good sensibility and specificity. This finding could set a new pathway to advance on the development of actionable decision criteria to be used in a future clinical decision support system for breast cancer management.

Preliminary Qualitative and Quantitative Evaluation of DESIREE, a Decision Support Platform for the Management of Primary Breast Cancer Patients.

The DESIREE project has developed a platform offering several complementary therapeutic decision support systems (DSSs) to improve care quality for breast cancer patients. A first assessment of the system was carried out in close-to-real tumor boards (TBs). Fourteen TB sessions were organized corresponding to a total of 125 exploitable decisions previously made without the system and re-played with the system after a washout period in three pilot sites. Results show an overestimation of declared compliance with guidelines when not using the system as compared to measured compliance with the recommendations issued from the guideline-based DSS of DESIREE. After using the system, measured compliance rate of decisions with guidelines was significantly improved from 74.4% to 89.6%. Most of the changes in decisions when using the guideline-based DSS were associated with non-compliant decisions that became compliant. Qualitative analysis and interviews showed that despite maturity issues, clinicians found DESIREE DSSs innovative and promising.

Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos / MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases

Introducción. El adenocarcinoma endometrioide del endometrio (AEE) es un tumor generalmente de buen pronóstico. Recientemente se ha descrito el patrón MELF (del inglés microcystic, elongated, and fragmented) de infiltración miometrial que se asocia a invasión linfovascular y a metástasis ganglionares. Se revisan 70 casos de AEE para establecer la presencia de MELF y correlacionar su presencia con otros factores pronósticos. Material y métodos. Se han revisado las histerectomías practicadas por AEE en un periodo de 5 años en busca del patrón MELF de infiltración miometrial. Su presencia se ha correlacionado con otras variables como el grado histológico, el nivel de infiltración miometrial, las metástasis ganglionares pélvicas y/o paraaórticas, los implantes peritoneales y la evolución. Resultados. En 17 (24%) casos se observó el patrón MELF. Aunque era más frecuente en tumores de bajo grado, estaba presente en 4 casos de grado3. En 9 (53%) casos la infiltración miometrial era profunda. Cinco casos mostraron metástasis ganglionares pélvicas y 3 aórticas. Una de las pacientes falleció, otra mostró recidiva vulvar y otra, metástasis pulmonares. Conclusión. El patrón MELF puede encontrarse en adenocarcinomas de alto grado y se correlaciona con otros hallazgos morfológicos de mal pronóstico como la infiltración miometrial profunda y la afectación de ganglios linfáticos pélvicos. Su presencia no parece influir en la evolución (AU)

Introduction. Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. Material and methods. Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. Results. In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. Conclusion. MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival (AU)

[MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases]. / Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos.

INTRODUCTION: Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. MATERIAL AND METHODS: Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. RESULTS: In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. CONCLUSION: MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.

Utility and Actual Use of European and Spanish Guidelines on the Management of Endometrial Cancer Among Gynecologic Oncologists in Spain.

OBJECTIVE: The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines. MATERIALS AND METHODS: An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology-registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program. RESULTS: One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P < 0.001), appropriate nodal staging in intermediate-risk cases (96 [95%] vs 39 [88.6%], respectively; P = 0.004), appropriate treatment in advanced-stage cases (63 [67.7%] vs 13 [40.6%], respectively; P < 0.001), and surgical treatment of relapses (87 [93.5%] vs 18 [56.3%], respectively; P = 0.004) but nonsignificant in the rate of complete paraaortic lymphadenectomy performance (82 [81.2%] vs 28 [63.6%], respectively; P = 0.056). Similar results have been observed when comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers. CONCLUSIONS: This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.

Diagnosis and laparoscopic management of a rudimentary horn pregnancy: Role of three-dimensional ultrasound.

Rudimentary horn pregnancy occurs in 1 in 76,000-150,000 pregnancies and causes uterine rupture in about 80% of cases. The use of three-dimensional transvaginal ultrasound seems to be useful for its early detection. We present a case of an 8-week pregnancy in a rudimentary horn, managed by laparoscopic excision. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:112-115, 2017.