Predicting lower limb lymphedema after cervical cancer surgery using artificial neural network and decision tree models.

PURPOSE: This study aimed to develop and validate accessible artificial neural network and decision tree models to predict the risk of lower limb lymphedema after cervical cancer surgery. METHODS: We selected 759 patients who underwent cervical cancer surgery at the Hunan Cancer Hospital from January 2010 to January 2020, collecting demographic, behavioral, clinicopathological, and disease-related data. The artificial neural network and decision tree techniques were used to construct prediction models for lower limb lymphedema after cervical cancer surgery. Then, the models' predictive efficacies were evaluated to select the optimal model using several methods, such as the area under the receiver operating characteristic curve and accuracy, sensitivity, and specificity tests. RESULTS: In the training set, the artificial neural network and decision tree model accuracies for predicting lower limb lymphedema after cervical cancer surgery were 99.80% and 88.14%, and the sensitivities 99.50% and 74.01%, respectively; the specificities were 100% and 95.20%, respectively. The area under the receiver operating characteristic curve was 1.00 for the artificial neural network and 0.92 for the decision tree model. In the test set, the artificial neural network and decision tree models' accuracies were 86.70% and 82.02%, and the sensitivities 65.70% and 67.11%, respectively; the specificities were 96.00% and 89.47%, respectively. CONCLUSION: Both models had good predictive efficacy for lower limb lymphedema after cervical cancer surgery. However, the predictive performance and stability were superior in the artificial neural network model than in the decision tree model.

Ferroptosis contributes to the progression of female-specific neoplasms, from breast cancer to gynecological malignancies in a manner regulated by non-coding RNAs: Mechanistic implications.

Ferroptosis, a recently identified type of non-apoptotic cell death, triggers the elimination of cells in the presence of lipid peroxidation and in an iron-dependent manner. Indeed, ferroptosis-stimulating factors have the ability of suppressing antioxidant capacity, leading to the accumulation of reactive oxygen species (ROS) and the subsequent oxidative death of the cells. Ferroptosis is involved in the pathophysiological basis of different maladies, such as multiple cancers, among which female-oriented malignancies have attracted much attention in recent years. In this context, it has also been unveiled that non-coding RNA transcripts, including microRNAs, long non-coding RNAs, and circular RNAs have regulatory interconnections with the ferroptotic flux, which controls the pathogenic development of diseases. Furthermore, the potential of employing these RNA transcripts as therapeutic targets during the onset of female-specific neoplasms to modulate ferroptosis has become a research hotspot; however, the molecular mechanisms and functional alterations of ferroptosis still require further investigation. The current review comprehensively highlights ferroptosis and its association with non-coding RNAs with a focus on how this crosstalk affects the pathogenesis of female-oriented malignancies, from breast cancer to ovarian, cervical, and endometrial neoplasms, suggesting novel therapeutic targets to decelerate and even block the expansion and development of these tumors.

An Intramyocardial Mass Mimicking ST-Segment Elevation Myocardial Infarct at Presentation.

ST-segment elevation on the electrocardiogram typically indicates acute myocardial infarction but can mimic ST-segment elevation myocardial infarction in various conditions. We present a case of a patient with an intramyocardial mass and anterior ST-segment elevation without significant myocardial biomarker elevation. Multimodality imaging was crucial in revealing cardiac metastasis as the attributable cause.

Combining multimodal diffusion-weighted imaging and morphological parameters for detecting lymph node metastasis in cervical cancer.

BACKGROUND: Accurate detection of lymph node metastasis (LNM) is crucial for determining the tumor stage, selecting optimal treatment, and estimating the prognosis for cervical cancer. This study aimed to assess the diagnostic efficacy of multimodal diffusion-weighted imaging (DWI) and morphological parameters alone or in combination, for detecting LNM in cervical cancer. METHODS: In this prospective study, we enrolled consecutive cervical cancer patients who received multimodal DWI (conventional DWI, intravoxel incoherent motion DWI, and diffusion kurtosis imaging) before treatment from June 2022 to June 2023. The largest lymph node (LN) observed on each side on imaging was matched with that detected on pathology to improve the accuracy of LN matching. Comparison of the diffusion and morphological parameters of LNs and the primary tumor between the positive and negative LN groups. A combined diagnostic model was constructed using multivariate logistic regression, and the diagnostic performance was evaluated using receiver operating characteristic curves. RESULTS: A total of 93 cervical cancer patients were enrolled: 35 with LNM (48 positive LNs were collected), and 58 without LNM (116 negative LNs were collected). The area under the curve (AUC) values for the apparent diffusion coefficient, diffusion coefficient, mean diffusivity, mean kurtosis, long-axis diameter, short-axis diameter of LNs, and the largest primary tumor diameter were 0.716, 0.720, 0.716, 0.723, 0.726, 0.798, and 0.744, respectively. Independent risk factors included the diffusion coefficient, mean kurtosis, short-axis diameter of LNs, and the largest primary tumor diameter. The AUC value of the combined model based on the independent risk factors was 0.920, superior to the AUC values of all the parameters mentioned above. CONCLUSION: Combining multimodal DWI and morphological parameters improved the diagnostic efficacy for detecting cervical cancer LNM than using either alone.

Efficacy and safety of 3-dimensional printing noncoplanar template (3D-PNCT)-assisted high-dose-rate interstitial brachytherapy (HDR-ISBT) for reirradiation of recurrent cervical cancer: a prospective cohort.

OBJECTIVE: This study aimed to investigate the efficacy and safety of 3-dimensional printing noncoplanar template (3D-PNCT)-assisted computed tomography (CT)-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for reirradiation of pelvic recurrent cervical carcinoma after external beam radiotherapy. METHODS: From January 2019 to August 2023, 45 eligible patients were enrolled in this prospective cohort. All patients underwent 3D-PNCT-assisted CT-guided HDR-ISBT with a prescribed dose of 4-7 Gy/fraction to the high-risk clinical target volume (HR-CTV) over 3-8 fractions, either for curative or palliative purposes. The primary endpoints were local progression-free survival (LPFS) and tumor response rate (TRR). The secondary outcome measures included overall survival (OS), toxicities, and symptom resolution. RESULTS: Forty-five patients received 261 fractions of 3D-PNCT-assisted HDR-ISBT. Twenty-nine patients had isolated pelvic recurrence, and 16 patients had simultaneous extra-pelvic or distant recurrences. The TRR was 66.7%. The 2- and 5-year LPFS rates were 30.0% and 25.7%, respectively. The median OS was 23.2 months, and 2- and 5-year OS rates were 49.5% and 34.0%, respectively. The multivariate analysis indicated that squamous cell carcinoma, radical surgery, recurrence-free interval≥12 months, tumor diameter, pelvic recurrence type, and HR-CTV D90≥45 Gy were independent factors influencing LPFS (all p<0.05). D100≥21 Gy, V100≥83%, and V150≥45% were associated with better LPFS (all p<0.05). Tumor diameter and metastasis were independent predictive factors for OS (all p<0.05). The pain relief rate was 66.7% (10/15). Grade 3-4 toxicities occurred in 20.0% of patients. CONCLUSION: 3D-PNCT-assisted HDR-ISBT for reirradiation of recurrent cervical cancer proved to be an effective and safe alternative to radical surgery.

Type-specific human papillomavirus prevalence in women referred for colposcopy in Tehran.

Background and Objectives: Although several studies have been achieved on the frequency of the HPV types among women with cervical cancer in Iran, HPV-positive samples were in some cases directed to specific-primer genotyping of HPV 16 and 18. Therefore, the other HPV types are underestimated. Several studies have also reported a greater prevalence of HPV 16 in cervical cancer in Iran than in the world. To clarify these subjects, the distribution of HPV types in women referred for colposcopy in Tehran was investigated. Materials and Methods: In this cross-sectional study, a total of 148 cervical samples from women with normal, atypical squamous cells of undetermined significance, cervical intraepithelial neoplasia I-III, and invasive cervical cancer histopathology were included. HPV was detected by PCR assay and all HPV-positive specimens were subjected to direct nucleotide sequencing. Results: Our results demonstrated that the total prevalence of HPV was 92.5%. The five most common HPV types were HPV 16 (49.3%), 18 (14.8%), 6 (7.4%), 31 (4.1%), and 11 (2.7%). About the histopathological stage, HPV 16 and 18 were dominant in all studied groups. In cervical cancer, HPV 16 and 18 were detected in 60% and 20% of cases, respectively. Conclusion: HPV 16 and 18 were the most common in cervical cancer in Iran.

The implications of hormone treatment for cancer risk, screening and treatment in transgender individuals.

There is evidence that gender-affirming hormone treatment (GAHT) for transgender individuals modulates their risk for specific malignancies including breast and prostate cancer, and meningiomas. However, there is insufficient data to make precise risk estimates accounting for age and inherited cancer risk. As such, screening recommendations remain broad. Even less evidence exists for best practice in the management of active or historical cancers in the transgender population. Guidance is therefore mainly extrapolated from cisgender populations but with considerations of the significant benefits of GAHT in the face of any hormonal risk. Clinical experience, the multidisciplinary team and shared decision making with the patient are vital in providing person-centred care, while further research is acquired.

Multiparametric mri-based radiomics nomogram for predicting lymph-vascular space invasion in cervical cancer.

PURPOSE: To develop and validate a multiparametric magnetic resonance imaging (mpMRI)-based radiomics model for predicting lymph-vascular space invasion (LVSI) of cervical cancer (CC). METHODS: The data of 177 CC patients were retrospectively collected and randomly divided into the training cohort (n=123) and testing cohort (n = 54). All patients received preoperative MRI. Feature selection and radiomics model construction were performed using max-relevance and min-redundancy (mRMR) and the least absolute shrinkage and selection operator (LASSO) on the training cohort. The models were established based on the extracted features. The optimal model was selected and combined with clinical independent risk factors to establish the radiomics fusion model and the nomogram. The diagnostic performance of the model was assessed by the area under the curve. RESULTS: Feature selection extracted the thirteen most important features for model construction. These radiomics features and one clinical characteristic were selected showed favorable discrimination between LVSI and non-LVSI groups. The AUCs of the radiomics nomogram and the mpMRI radiomics model were 0.838 and 0.835 in the training cohort, and 0.837 and 0.817 in the testing cohort. CONCLUSION: The nomogram model based on mpMRI radiomics has high diagnostic performance for preoperative prediction of LVSI in patients with CC.

Rationale and design of the Self-TI Study protocol: a cross-sectional human papillomavirus self-testing pilot study among transgender adults in England.

INTRODUCTION: Persistent infection with high-risk human papillomavirus (HPV) is the causal agent of several cancers including cervical, anal and oropharyngeal cancer. Transgender men and transmasculine non-binary (TMNB) people with a cervix are much less likely to undergo cervical cancer screening than cisgender women. Transgender women and transfeminine non-binary (TWNB) people assigned male at birth may be at increased risk of HPV. Both TMNB and TWNB people face many barriers to HPV testing including medical mistrust due to stigma and discrimination. METHODS AND ANALYSIS: The Self-TI Study (Self-TI) is a pilot study designed to measure acceptability and feasibility of HPV self-testing among transgender and non-binary people in England. TMNB people aged 25-65 years, with at least 1 year of testosterone, and TWNB people, aged 18 years and over, are eligible to participate. Participants self-collect up to four samples: an oral rinse, a first void urine sample, a vaginal swab (if applicable) and an anal swab. TMNB participants are asked to have an additional clinician-collected cervical swab taken following their routine Cervical Screening Programme sample. TWNB people are asked to take a self-collection kit to perform additional self-collection at home and mail the samples back to the clinic. Acceptability is assessed by a self-administered online survey and feasibility is measured as the proportion of samples returned in the clinic and from home. ETHICS AND DISSEMINATION: Self-TI received ethical approval from the Research Ethics Committee of Wales 4 and ethical review panel within the Division of Cancer Epidemiology and Genetics at the US National Cancer Institute. Self-TI was coproduced by members of the transgender and non-binary community, who served as authors, collaborators and members of the patient and public involvement (PPI) group. Results of this study will be shared with the community prior to being published in peer-reviewed journals and the PPI group will help to design the results dissemination strategy. The evidence generated from this pilot study could be used to inform a larger, international study of HPV self-testing in the transgender and non-binary community. TRIAL REGISTRATION NUMBER: NCT05883111.

Cervical cancer screening by cytology and the burden of epithelial abnormalities in low resource settings: a tertiary-center 42-year study.

BACKGROUND: Cytological screening remains a high-impact practice, particularly in low-resource settings, for preventing cervical cancer. The examination of screening practices over time and the prevalence of epithelial abnormalities have not been investigated in longitudinal studies in one of the largest countries in the Middle East and Africa. METHODS: Routine healthcare data, between March 1981 and December 2022, were extracted from the database of the Early Cancer Detection Unit in a tertiary referral university hospital in the Greater Cairo Region, Egypt. Cervical smears were obtained using a standardized technique and sent to the cytopathology laboratory for conventional cytology examination by expert pathologists. The anonymous data were analyzed to determine the temporal trend of the number of women screened each year and the prevalence of epithelial abnormalities. RESULTS: Data included the results of satisfactory smears from 95120 women. The mean age (SD) of the women at the time of screening was 38.5 (10.5). None of the included women received an HPV vaccine. Abnormal epithelial cells were reported in 5174 women (5.44%). Of these epithelial abnormalities, the majority were low-grade squamous intraepithelial lesions in 4144 women (4.36%). Other abnormalities included atypical squamous cells in 378 women (0.40%), high-grade squamous intraepithelial lesions in 226 women (0.24%), atypical glandular cells not otherwise specified in 184 women (0.19%), adenocarcinoma in 165 women (0.17%), squamous cell carcinoma in 70 women (0.07%), and atypical glandular cells favoring neoplasms in 7 women (0.01%). Women who were at an early age at first intercourse, those who opted for routine cervical cytology screening, and those who were older at screening were more likely to have epithelial abnormalities. The yearly number of screened women was positively associated with the detection of low-grade squamous intraepithelial lesions (correlation coefficient [95% CI] = 0.84 [0.72, 0.91]) and negatively associated with the detection of squamous cell carcinoma (correlation coefficient [95% CI] = -0.55 [-0.73, -0.29]). CONCLUSIONS: The small number of annually screened Egyptian women and the temporal trend in epithelial abnormalities critically demonstrate the need for establishing and scaling up a structured population-based program to achieve the goal of eliminating cervical cancer.

BD SurePath Direct to Slide (DTS) cervical cytology: Migrating the benefits of liquid-based cytology to low-resource settings.

OBJECTIVES: The benefits of liquid-based cytology (LBC) in routine cervical cancer screening are often associated with the availability of instrumented platforms and economic considerations. A low-cost alternative to LBC in low-volume settings remains an unmet need. METHODS: A multisite evaluation of the BD SurePath (SurePath) LBC Direct to Slide (DTS) method was conducted. The DTS preparations were evaluated across 3 sites. Cytology features for DTS preparation included predetermined thresholds for total cellularity, cell distribution, cellular preservation, and stain quality. Rare event detection was evaluated using SiHa cells spiked into pools from negative cytology specimens. Concordance between Bethesda classification results was evaluated for SurePath LBC and DTS methods using routinely collected SurePath specimens in a split-sample study design. RESULTS: The DTS specimens met criteria for total cellularity, cell distribution, cellular preservation, and stain quality in more than 98% of all cases. Rare event detection was observed with an average detection of 5 SiHa cells per 2 mL of specimen. Concordant cervical cytology classifications were observed between SurePath LBC and DTS methods. CONCLUSIONS: The results demonstrate that the DTS process is suitable for routine cervical cytology evaluation. The procedure is reproducible and detected abnormal cervical cells in concordance with standard SurePath LBC preparation.

[Artificial Intelligence: accuracy for the diagnosis of precancerous lesions of the cervix]. / Inteligencia Artificial: precisión diagnóstica de lesiones preneoplásicas de cérvix uterino.

INTRODUCTION: To compare the diagnostic sensitivity of artificial intelligence (AI) assisted videocolposcopy with standard videocolposcopy performed by specialist colposcopists. METHODS: A descriptive retrospective cross-sectional study, 782 anonymized medical records from the Computerized System for Screening (SITAM) of women who underwent videocolposcopy with AI and colposcopy with common videocolposcopy performed by specialists, with their corresponding biopsies (gold standard) were analyzed. The relationship between the results of IA videocolposcopy and regular videocolposcopy and the results of biopsies was evaluated. The overall accuracy of each diagnostic procedure was calculated. The sensitivity and concordance of the results of AI videocolposcopy with the gold standard (biopsy) were determined. RESULTS: A total of 395 patient records of patients with IA videocolposcopy and 387 with regular videocolposcopy were analyzed. The accuracy of results was 80% (IC 95%: 75-83%) in IA videocolposcopy and 65% (IC 95%: 60-69%) in regular videocolposcopy (p<0.001). Videocolposcopy results with IA and common colposcopy were significantly correlated with biopsy results, rs=0.75 vs. rs=0.57 respectively (p<0.001). The sensitivity of videocolposcopy with AI was 96% (95% CI: 94-98%), and 93% (95% CI: 89-95%) for regular colposcopy. The overall agreement of colposcopic impressions classified by videocolposcopy with AI and disease was higher than that of colposcopic interpretation by colposcopists (90% vs. 83%, Kappa 0.59 vs. 0.47, p<0.001). CONCLUSION: The high diagnostic accuracy of AI videocolposcopy allows obtaining highly sensitive studies that help in the early detection of precursor lesions of cervical neoplasia.

Introducción: Objetivo: comparar sensibilidad diagnóstica de videocolposcopia con inteligencia artificial (IA) auxiliar, con la videocolposcopia común realizada por colposcopistas. Métodos: Estudio descriptivo de corte transversal retrospectivo, en 782 historias clínicas anonimizadas del Sistema Informático para el Tamizaje (SITAM), de mujeres a las cuales se les efectuaron videocolposcopia con IA y colposcopías con videocolposcopio común realizadas por especialistas, con sus biopsias (gold standard). Se evaluó la relación entre los resultados de videocolposcopia con IA y videocolposcopia común con resultados de las biopsias. Se calculó precisión global de cada procedimiento diagnóstico. Se determinó sensibilidad y concordancia de los resultados de la videocolposcopia con IA, con el gold standard. Resultados: Se analizaron 395 historias clínicas de pacientes con videocolposcopia con IA y 387 con videocolposcopia común. La precisión diagnóstica de resultados fue 80% (IC 95%: 75-83%) en videocolposcopias con IA y 65% (IC 95%: 60-69%) en videocolposcopia común (p<0.001). Los resultados de videocolposcopia con IA y colposcopia común se correlacionaron significativamente con los resultados de las biopsias, rs=0.75 vs. r s=0.57 respectivamente (p<0.001). La sensibilidad de videocolposcopia con IA fue 96% (IC 95%: 94-98%), y 93% (IC 95%: 89-95%) en colposcopías comunes. La concordancia general de las impresiones colposcópicas clasificadas por videocolposcopia con IA y enfermedad fue mayor que la de la interpretación colposcópica de los colposcopistas (90% frente a 83%, Kappa 0.59 frente a 0.47, p<0.001). Conclusión: La alta precisión diagnóstica de videocolposcopia con IA permite aumentar la sensibilidad del estudio y mejorar la detección precoz de lesiones precursoras de neoplasias cervicouterinas.

Primary human papillomavirus testing by clinician- versus self-collection: Awareness and acceptance among cervical cancer screening-eligible women.

OBJECTIVES: Primary human papillomavirus (HPV) testing by clinician-collection is endorsed by U.S. guideline organizations for cervical cancer screening, but uptake remains low and insights into patients' understanding are limited. This study aims to primarily address patient awareness of primary HPV screening by clinician-collection and acceptance of primary HPV screening by clinician- and self-collection, and secondarily assess factors associated with awareness and acceptance. SETTING: Primary care practices affiliated with an academic medical center. METHODS: A cross-sectional survey study of screening-eligible women aged 30-65 years was conducted to assess awareness and acceptability of primary HPV screening. We analyzed bivariate associations of respondent characteristics with awareness of primary HPV screening by clinician-collection, willingness to have clinician- or self-collected primary HPV testing, and reasons for self-collection preference. RESULTS: Respondents (n = 351; response rate = 23.4%) reported cervical cancer screening adherence of 82.8% but awareness of clinician-collected primary HPV as an option was low (18.9%) and only associated with HPV testing with recent screening (p = 0.003). After reviewing a description of primary HPV screening, willingness for clinician-collected (81.8%) or home self-collected (76.1%) HPV testing was high, if recommended by a provider. Acceptability of clinician-collected HPV testing was associated with higher income (p = 0.009) and for self-collection was associated with higher income (p = 0.002) and higher education (p = 0.02). Higher education was associated with reporting self-collection as easier than clinic-collection (p = 0.02). Women expected self-collection to be more convenient (94%), less embarrassing (85%), easier (85%), and less painful (81%) than clinician-collection. CONCLUSIONS: Educational interventions are needed to address low awareness about the current clinician-collected primary HPV screening option and to prepare for anticipated federal licensure of self-collection kits. Informing women about self-collection allows them to recognize benefits which could address screening barriers.

Variables that impact HPV test accuracy during vaginal self collection workflow for cervical cancer screening.

Vaginal self collection (SC) is safe and effective for human papillomavirus (HPV) testing and can increase cervical cancer screening coverage for underserved women. To better understand the impact of SC methodology on HPV test outcomes, empirical testing was conducted using different swab collection workflows. Deposition of the collection swab into resuspension buffer resulted in a 2.4-cycle reduction in threshold detection of human beta-hemoglobin during PCR when compared to "swirl-and-toss". In addition, reducing the swab resuspension volume from 10 mL to 3 mL resulted in a 2.6-cycle reduction in threshold detection of human beta-globin. A systematic literature search (01/01/2020 to 08/02/2023) of Ovid Medline and Embase, followed by data extraction and analysis, was conducted to further assess the impact of resuspension volume on performance following SC. HPV test performance for SC, relative to clinician collection (CC), was calculated for detection of cervical pre-cancer. Data were stratified by the resuspension volume ratio of SC to CC being either ≥ 1.0 or < 1.0. SC with a volume ratio of ≥ 1.0 and < 1.0 had a relative ≥ CIN2 sensitivity of 92.0 % (95 % CI: 88.0, 96.0) and 97.0 % (95 % CI: 94.0, 100), respectively. Taken together, these results suggest that SC conditions can be modified to optimize sample recovery and performance, as part of cervical cancer screening.

Risk factors for the development of cervical cancer: analysis of the evidence.

Introduction: Cervical cancer (CC) is the fourth most prevalent female cancer globally. Understanding its epidemiology is crucial for devising practical strategies suited to geographic and social contexts to attain the global eradication of CC. Hence, this study examined the latest evidence of risk factors contributing to CC development. Methods: An independent literature search was conducted on PubMed using MESH terms. The primary sources were meta-analyses published from 2010 to 2023, which detail updated evidence on risk factors associated with CC. Additionally, the quality of the evidence was evaluated using the GRADE system and recommendations were made accordingly. Results: The main risk factors related to the cause of CC include co-infections with other sexually transmitted infections, genetic markers, cervicovaginal microbiota, nutritional factors, comorbidities that affect the immune response, smoking, and the use of hormonal contraceptives with a quality evidence based on the GRADE scale moderate. Conclusions: Since the necessary cause for CC is persistent cervicovaginal HPV, all the risk factors implicated in the causality of CC act as non-independent cofactors that increase the risk of CC. Thus, changes in public policies aimed at addressing these risk factors are highly recommended and can substantially decrease the risk of CC.

A rare case of Blastic plasmacytoid dendritic cell neoplasm with gynecologic presentation.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy characterized by the proliferation of plasmacytoid dendritic cells with a blast-like appearance. It usually presents in elderly people, and clinical manifestations include nodular blue-violet skin lesions, bone marrow infiltration and, less frequently, extramedullary involvement. Gynecological manifestation (breast mass and exocervical lesion) is an unusual and rare presentation. Herein, we report the case of a 51-year-old woman patient who presented with a history of a rapidly growing and bleeding breast mass, along with a decline in general health. Notably, the disease had multifocal involvement, affecting the breast, uterine cervix, and cervical lymphadenopathy. Biopsies were performed on the breast mass and cervical lesion. Histopathological examination showed a diffuse lymphoid proliferation. The neoplastic cells show immunoreactivity for CD45 and CD56. The myelogram showed a 50 % excess of blasts with a heterogeneous appearance with the presence of cells that could suggest dendritic plasmacytoid cells. Bone marrow immunophenotyping showed the presence of blast-like cells that were positive for CD4, CD56, CD123, which supported the diagnosis of BPDCN. Despite initiating chemotherapy, the patient's condition rapidly deteriorated, highlighting the aggressive nature of BDCP. This case underscores the importance of early detection and the need for further research to improve outcomes for this rare condition.

Female sexual function in long-term cervical cancer survivors compared with healthy women and women affected by benign gynecological disorders.

OBJECTIVE: To compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases. STUDY DESIGN: From January 1, 2010 to January 31, 2019, a case-control study was conducted to compare the female sexual function of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a routine gynecological examination (n=46) or for a benign gynecological disorder (symptomatic, n=113; asymptomatic, n=26). We prospectively assessed the female sexual function using the Female Sexual Function Index (FSFI). For the contrastive analysis hypothesis, we employed R statistical software. RESULTS: Cervical cancer survivors reported lower sexual activity rates than controls, in general, did (47.12% vs. 88.65%, p=0.0001), and, particularly, compared with healthy and symptomatic controls (47.12% vs. 82.61%, p=0.003; 47.12% vs. 87.61%, p=0.0001, respectively). Sixty and fifty-eight hundredths percent of the cervical cancer survivors experienced female sexual dysfunction, mainly due to hypoactive sexual desire (93.27%). Female sexual dysfunction was diagnosed in 64.32% of the controls, with sexual arousal disorders being the most common diagnosis (44.86%). Compared with controls, cervical cancer survivors exhibited considerably lower FSFI total scores and in sexual desire and lubrication domains (p <0.000; p <0.0001; p=0.023). CONCLUSIONS: Cervical cancer survivors had worse female sexual function and less sexual activity than controls did, although scores in both groups were in range of FSD. Rates of female sexual dysfunction were similar across cervical cancer survivors and controls, with hypoactive sexual desire and sexual arousal disorders as the most common diagnoses, respectively.

Perspectivas comunitarias e institucionales acerca del cáncer cervicouterino en indígenas del Amazonas colombiano / Community and Institutional Perspectives on Cervical Cancer in Indigenous People of the Colombian Amazon / Perspectivas comunitárias e institucionais sobre o câncer de colo de útero em indígenas da Amazônia colombiana

Introducción: la información en cáncer en poblaciones indígenas colombianas es escasa; de ahí que el objetivo de este estudio sea conocer las perspectivas comunitarias y de los prestadores de servicios de salud acerca del cáncer de cuello uterino (CaCU) en mujeres indígenas del Amazonas colombiano. Materiales y métodos: estudio cualitativo, derivado de una investigación de métodos mixtos de triangula-ción convergente. Se realizaron 40 entrevistas semiestructuradas que incluían profesionales de la salud y actores clave comunitarios representados en curacas, médicos tradicionales o chamanes, parteras, pro-motores de salud, auxiliares de salud pública, líderes y lideresas, abuelos, abuelas y mujeres indígenas en general. Para el análisis se utilizó la técnica de análisis de contenido. Resultados: emergieron cuatro categorías:1) concepciones y factores de riesgo alrededor del cáncer en general y el CaCU, 2) prácticas de cuidado y de atención occidentales y ancestrales para el CaCU, 3) dificultades socioculturales y del sistema de salud para la prevención y atención del CaCU y 4) recomendaciones para el fortalecimiento de la de prevención del CaCU. Conclusión: los participantes reconocen la citología cervicouterina como una forma de prevenir el cáncer y aunque los participantes mencionaron algunos aspectos culturales y personales que podrían constituirse en una barrera para la prevención y control del CaCU, se hizo hinca-pié en los problemas estructurales del sistema de salud, la falta de integración cultural y las dificultades de acceso al tamizaje, diagnóstico y tratamiento.

Introduction: Information on cancer in Colombian indigenous populations is scarce, the objective of this study was to know the community and health care providers' perspectives on cervical cancer (CaCU) in indigenous women of the Colombian Amazon. Materials and methods: Qualitative study, derived from a mixed methods research of convergent triangulation, 40 semi-structured interviews were conducted, including health professionals and key community actors represented by curacas, traditional doctors or shamans, midwives, health promoters, public health assistants, leaders, grandfathers, grandmothers, and indigenous women in general. The content analysis technique was used for the analysis. Results:Four categories emerged: (a) conceptions and risk factors surrounding cancer in general and CaCU; (b) western and ancestral care and attention practices for CaCU; (c) sociocultural and health system diffi-culties for the prevention and attention of CaCU, and (d) recommendations for strengthening CaCU pre-vention. Conclusion: Participants recognize cervical cytology as a way to prevent cancer and although participants mentioned some cultural and personal aspects that could constitute a barrier to cervical cancer prevention and control, the greatest emphasis was given to structural problems of the health system, lack of cultural integration and difficulties of access to screening, diagnosis and treatment.

Introdução: a informação sobre o câncer nas populações indígenas colombianas são escassas, o objetivo deste estudo foi conhecer as perspectivas da comunidade e dos prestadores de serviços de saúde sobre o câncer do colo do útero (CaCU), em mulheres indígenas da Amazônia colombiana. Materiais e méto-dos: estudo qualitativo, derivado de uma investigação de métodos mistos de triangulação convergente. Foram realizadas 40 entrevistas semiestruturadas que incluíram profissionais de saúde e principais atores comunitários representados em curacas, médicos tradicionais ou xamãs, parteiras, promotores de saúde, assistentes de saúde pública, lideranças, avôs, avós e mulheres indígenas em geral. Para a análise foi uti-lizada a técnica de análise de conteúdo. Resultados: emergiram quatro categorias, a) concepções e fatores de risco em torno do câncer em geral e do CaCU; b) cuidados e práticas de cuidado ocidentais e ancestrais para CaCU; c) dificuldades socioculturais e do sistema de saúde para a prevenção e cuidado do CaCU, e d) recomendações para fortalecer a prevenção de CaCU. Conclusão: as participantes reconhecem a citolo-gia cervical como forma de prevenção do câncer e embora as participantes tenham mencionado alguns aspectos culturais e pessoais que poderiam constituir uma barreira para a prevenção e controle do câncer do colo do útero, a maior ênfase foi dada aos problemas estruturais do sistema de saúde, a falta de integra-ção cultural e as dificuldades de acesso ao rastreio, ao diagnóstico e ao tratamento

Comprehensive analysis of autophagy associated genes and immune infiltrates in cervical cancer.

Objectives: Cervical cancer (CC) is the most common gynecological malignant tumor and the fourth leading cause of cancer-related death in women. The progression of CC is significantly affected by autophagy. Our objective was to use bioinformatics analysis to explore the expression, prognostic significance, and immune infiltration of autophagy-related genes in CC. Materials and Methods: We identified a set of autophagy-related differentially expressed genes (ARDEGs) from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. ARDEGs were further validated by The Human Protein Atlas (HPA), GSE52903, and GSE39001 dataset. Hub genes were found by the STRING network and Cytoscape. We performed Gene Set Enrichment Analysis (GSEA), Gene ontology analysis (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and immune infiltration analysis to further understand the functions of the hub genes. Kaplan-Meier (K-M) and receiver operating characteristic (ROC) were used to check the hub genes. Results: A total of 10 up-regulated (CXCR4, BAX, SPHK1, EIF2AK2, TBK1, TNFSF10, ITGB4, CDKN2A, IL24, and BIRC5) and 19 down-regulated (PINK1, ATG16L2, ATG4D, IKBKE, MLST8, MAPK3, ERBB2, ULK3, TP53INP2, MTMR14, BNIP3, FOS, CCL2, FAS, CAPNS1, HSPB8, PTK6, FKBP1B , and DNAJB1) ARDEGs were identified. The ARDEGs were enriched in cell growth, apoptosis, human papillomavirus infection, and cytokine-mediated. Then, we found that low expression of MAPK3 was associated with poor prognosis in CC patients and was significantly enriched in immune pathways. In addition, the expression of MAPK3 was significantly positively correlated with the infiltration levels of macrophages, B cells, mast cell activation, and cancer-associated fibroblasts. Furthermore, MAPK3 was positively correlated with LGALS9, and negatively correlated with CTLA4 and CD40. Conclusion: Our results show that MAPK3 can be used as a new prognostic biomarker to predict the prognosis of patients with CC.