Epithelial Ovarian Cancer: A Five Year Review.

Ovarian cancer is a malignant disease that affects thousands of patients every year. Currently, we use surgical techniques for early-stage cancer and chemotherapy treatment combinations for advanced stage cancer. Several novel therapies are currently being investigated, with gene therapy and stem cell therapy being the corner stone of this investigation. We conducted a thorough search on PubMed and gathered up-to-date information regarding epithelial ovarian cancer therapies. We present, in the current review, all novel treatments that were investigated in this field over the past five years, with a particular focus on local treatment.

Postpartum Hemorrhage: A Comprehensive Review of Guidelines.

Importance: Postpartum hemorrhage (PPH) is a common complication of childbirth and the leading cause of maternal deaths worldwide, also associated with important secondary sequelae. Objective: The aim of this study was to review and compare the most recently published influential guidelines on evaluation, management, and prevention of this severe, life-threatening obstetric complication. Evidence Acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Network for the Advancement of Patient Blood Management, Hemostasis and Thrombosis in collaboration with the International Federation of Gynecology and Obstetrics, the European Board and College of Obstetrics and Gynecology and the European Society of Anaesthesiology, and the World Health Organization on PPH was carried out. Results: There is a consensus among the reviewed guidelines that once PPH occurs, it is important to identify the underlying cause (4 T's), estimate the blood loss, and immediately initiate a resuscitation protocol with fluid replacement, blood transfusion, and close monitoring of the woman. In case of uterine atony, all the reviewed medical societies recommend uterine massage, bimanual uterine compression, and administration of uterotonics, although minor discrepancies are observed regarding the optimal regimens. If these measures fail, the use of intrauterine balloon tamponade or other surgical interventions is unanimously recommended. There is also agreement regarding the management of PPH due to retained placenta, placenta accreta, obstetric trauma, uterine rupture or inversion, and acute coagulopathy. Massive transfusion protocols are not consistent in the reviewed guidelines. Finally, all guidelines highlight the importance of the active management of the third stage of labor for the prevention of PPH, suggesting several interventions, with the administration of oxytocin being the criterion standard. Conclusions: Postpartum hemorrhage is a significant contributor of maternal morbidity and mortality. Thus, the development of consistent international practice protocols for the effective management and prevention of this major complication seems of paramount importance and will hopefully improve obstetric outcomes and especially maternal mortality rate.

Factors Affecting the Nuclei in Newborn and Children.

It is known that children are more sensitive to the effects of medical treatments and environment than adults. Today there is limited information regarding the differences in genotoxic effects in children. The micronucleus assay is a method that is used to monitor genotoxicity, and it was validated several years before. Today there is international interest for exfoliated buccal cells. Most of the micronuclei studies in children have been performed with the analyses of lymphocytes. However, there is vast interest in using exfoliated cells from the oral cavity. The reason is that other type of cells are acquired non-invasively, this is an important issue in paediatric cohorts. Unfortunately a limitation of measuring micronuclei frequency is that it has been observed to be low in newborns and on the other hand there are a large number of patients and cell sample counts. It has been observed that radiation exposure and environmental pollutants increase the micronuclei frequency in newborn and children. Regarding the medical treatments, there is little data and several studies are needed to optimise the doses. There is the need to observe if there is a relationship between micronuclei in lymphocytes and exfoliated cells and to identify the baseline of the micronuclei levels. Moreover, we evaluate the changes in response to the toxic agents. Prospective cohorts studies will clarify the predictive value of micronuclei for cancer and chronic diseases for both children and adults. Novel molecular technologies will assist in the elucidation of different biological pathways and molecular mechanisms connected with the micronulcei levels in newborn and children.