Classification of high-grade endometrium carcinomas using molecular and immunohistochemical methods.

OBJECTIVES: As a result of the integration of molecular changes into the histological classification of cancers, which increases diagnostic repeatability, the differences between the groups become more prominent and targeted therapies gain significance. The most comprehensive molecular study regarding endometrial carcinomas (EC) is The Cancer Genome Atlas (TCGA) project. According to TCGA, endometrial carcinomas are classified into four molecular prognostic subgroups: copy-number-low/p53-wild-type (p53wt), DNA polymerase epsilon (POLE)-mutated/ultramutated (POLEmt), microsatellite-instability/hypermutated (MSI), and copy-number-high/p53-mutated (p53mt). In this study, we aim to apply the molecular classification to our high-grade endometrial cancer patients, and particularly, to identify our overtreated patients. MATERIAL AND METHODS: Ninety-seven patients diagnosed with high-grade EC in Selcuk University, Faculty of Medicine between 2009-2018 were retrospectively evaluated and classified into four subgroups. Primary outcomes of overall and progression-free survival were evaluated for clinical, pathological, and molecular features. Further, all molecular groups were divided into endometroid and non-endometrioid groups, and disease-free survival (DFS) and overall survival (OS) were investigated across groups. RESULTS: According to molecular classification, 23 patients (23.7%) were assigned to the MSI group, 21 (21.6%) to the POLEmt group, 40 (41.2%) to the p53mt group, and 13 (13.4%) to the p53wt group. Patients' DFS (p = 0.001) and OS rates (p = 0.001) were significantly different according to their molecular classification. The results of our analyses determined that, in the molecular classification of high-grade ECs, the p53mt group had the poorest prognosis and the POLEmt group had the best prognosis. Tumor size, myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastasis, cervical invasion, ovarian invasion and stage showed statistically significant differences based on molecular classification (p < 0.05). CONCLUSIONS: The use of molecular classification in the clinical practice will allow more accurate prognostic prediction and more appropriate treatment planning, particularly as high-grade ECs constitute a heterogenous group with poor prognosis.

The struggle against endometrial cancer: ten years of experience of a tertiary center.

OBJECTIVES: We aimed to investigate the clinical and pathological factors of our patients who were diagnosed with endometrial cancer in terms of prognosis. With this study, we present our 10 years of surgical experience in endometrial carcinoma cases. MATERIAL AND METHODS: Four hundred twelve patients with endometrial carcinoma who applied to our center between 2010-2019 and that we followed up were evaluated retrospectively. RESULTS: Most of the tumors were low-grade endometrioid malignancies. Non-endometrioid types accounted for 12.1% of cases. Lymph node dissection was performed in 395 of 412 patients (95.9%). 66 (16.01%) of the 412 patients died during the follow-up period in the study sample. Higher OS and DFS rates were associated with endometrioid histological types, FIGO stage, absence of lymphovascular space invasion, lower grade and less than 50% myometrial invasion (p < 0.05). 5-year OS at stage 1, 2, 3, 4 was found as 88.9 ± 2.2%, 65.5 ± 10.8%, 49.4 ± 0.79% and 23.7 ± 0.97% respectively. 5-year DFS at stage 1, 2, 3, 4 was found as 84.1 ± 2.6%, 65.5 ± 10.8%, 47.7 ± 0.78% and 23.7 ± 0.97% respectively. In univariate analysis, Age, tumor histology, FIGO stage, histological grade, LVSI, positive peritoneal cytology, cervical involvement, myometrial invasion and not receiving adjuvant therapy were defined as prognostic factors. CONCLUSIONS: Age, grade, FIGO stage, myometrial invasion, histological type, LVSI involvement, cervical involvemet, positive peritoneal cytology and not receiving adjuvant therapy are important prognostic factors for progression-free survival and overall survival in patients diagnosed with endometrial cancer.

Is striae gravidarum a sign of spontaneous premature birth?

BACKGROUND: This study aimed to investigate the association of striae gravidarum (SG) and preterm delivery. MATERIAL AND METHODS: This prospective cross-sectional study was performed between November 2018 and February 2019. In addition to demographic variables, SG score of the abdomen, presence of striae on breasts, arms, hips, and thighs were recorded. Davey's scoring system was used to define the severity of SG in the abdomen by the same investigators. Patients with cervical dilatation of 6 cm or more were included in the preterm labor group. RESULTS: A total of 292 women were included in the study. Of these, 176 (60.3%) had no SG, 20 (6.8%) had mild SG, and 96 (32.9%) had severe SG. Davey's score was lower in the group of patients with preterm birth than in the term birth groups (p = .002). SG in the breasts was more common in the preterm labor group than in the term birth group (p = .007). Also, the presence of SG in the legs was less common in the preterm labor group than in the term birth group (p < .001). In a logistic regression model, stria in the breasts revealed most significant in preterm delivery. CONCLUSIONS: No difference was found in the pregnancy length in gestational weeks among groups of different SG severity. The Davey's score and the presence of striae in the legs and breasts were found different between the preterm and term birth groups, and the term birth subgroups.

Can ultrasound predict the delivery time of patients with previous cesarean section in the 37th gestational week? A prospective cross-sectional study.

BACKGROUND: The aim was to investigate factors that predict when patients with previous cesarean section will undergo cesarean section (CS) using ultrasonography in the 37th gestational week. MATERIAL AND METHODS: In this prospective cross-sectional study, a total of 166 patients with previous CS who presented to the hospital for routine checks at the 370/7th gestational week were included in the study. Uterine-related, fetus-related, and patient-related factors that affect labor time were analyzed by the same physician at admission, and the patients were then divided into two groups as those having CS at early term (370/7 to 386/7 weeks of gestation) and full-term (390/7 to 406/7 weeks of gestation). Ninety-four patients underwent CS at full-term and 72 patients underwent CS at the early term in the study. RESULTS: There was no significant difference for age (years), parity, weight gain, previous cesarean number, cervical length, myometrial thickness, estimated fetal weight, and full lower uterine segment thickness between the groups (p>.05). In the full-term group, 58% had a history of vaginal birth, whereas, in the early-term group, 42% had a history of vaginal birth (p < .05). Vaginal birth history was found to be independently associated with reaching full-term (respectively, OR: 2.876, 95% CI: [1.227-6.738]; p = .015) in all patients. Two different regression models were created to predict different CS times after the 37th week of pregnancy. Weight gain was found to be independently associated with CS time within the first seven days after admission (OR: 1.267, 95% CI: [1.003-1.599]; p = .047). Vaginal birth history and estimated fetal weight were found to be independently associated with CS time in the 8th day and further after admission (OR: 0.244, 95% CI: [0.089-0.675]; p = .007 and OR: 1.002, 95% CI: [1.000-1.003]; p = .047). CONCLUSION: Vaginal birth history can be useful to predict reaching full-term in patients with previous CS. Determination of such risk factors is important in terms of reducing the frequency of emergency cesarean delivery.

Serum sclerostin level and its relation to subclinical atherosclerosis in the polycystic ovary syndrome phenotypes: A prospective controlled study

Objective: We aim to study the relationship between atherosclerosis and serum sclerostin levels in different phenotypes of polycystic ovary syndrome (PCOS). Materials and Methods: A total of 134 women with PCOS and 33 age-matched controls participated in this study. Women with PCOS were further divided into subgroups based on their PCOS phenotypes: phenotype A (n=35), phenotype B (n=33), phenotype C (n=31), and phenotype D (n=35). Metabolic parameters, hormonal parameters, carotid intima-media thickness (CIMT), and sclerostin levels were compared among the PCOS phenotypes. Results: Statistically significant differences occurred among groups regarding follicle-stimulating hormone, luteinizing hormone, estradiol, total cholesterol, low-density lipoprotein, Ferriman-Gallwey score, total testosterone, and free androgen index. The mean CIMT was statistically higher in all PCOS phenotypes than in controls. In subgroup comparison, phenotypes A and B had a higher body mass index (BMI) adjusted CIMT than other phenotypes, respectively (p=0.005). Serum sclerostin levels were higher in PCOS patients than in controls. A concentration of ≥6.297 ng/mL showed a sensitivity of 56% and a specificity of 69.7% to predict PCOS. The BMI-adjusted sclerostin level was significantly higher in phenotype C (20.3±0.7 ng/mL) than in other phenotypes. Conclusion: Patients with phenotypes A and B seem to have an increased risk for atherosclerosis. Although sclerostin was higher in PCOS patients, we could not demonstrate the relation between sclerostin and atherosclerosis in different PCOS phenotypes.

YouTube as a source of information on gonadotropin self-injections.

OBJECTIVE: To investigate the comprehensiveness, quality, and reliability of YouTube videos that target teaching patients gonadotropin self-injections. STUDY DESIGN: Videos demonstrating gonadotropin self-injections were searched using the keywords "Gonal-f injection," "Puregon injection," "Menapur injection," "Merional injection," "Fostimon injection," and "Menagon injection," on December 20th, 2020. The videos were divided into two categories as including "useful information" and "misleading information" by two physicians. A 5-point global quality scale (GQS) and 5-point modified DISCERN scale were used for the assessments of quality and reliability, respectively. RESULTS: Among 110 videos, 90 (81.8%) were found to include useful information and 20 (18.2%) were found to give misleading information. The kappa statistic for inter-observer agreement was 0.817 (p < 0.001). Useful videos were the most comprehensive and had the highest reliability and quality scores. We found that all videos uploaded by universities or professional organizations included useful information. However, there was no significant difference between useful and misleading videos regarding audience interaction analysis parameters (p > 0.05). On the other hand, mean reliability, GQS, and comprehensiveness scores were higher in the useful information group than in the other group. As the subgroup analysis was performed by source, patient opinion videos had lower reliability, comprehensiveness, and GQS scores than videos created by other sources (p < 0.001). CONCLUSION: Our analysis revealed that there were a significant number of English-language YouTube videos, with high quality, rich content, and reliability that could be sources of information on the accurate technique of gonadotropin self-injections. However, some misleading information videos may lead to negative outcomes. Therefore, physicians should ensure that online sources are comprehensive and reliable for the use of their patients with infertility. Also, YouTube health videos should be checked for both reliability and ethical standards.

Effect of re-approximation of the rectus muscles on diastasis recti abdominis at cesarean section - a prospective cross-sectional study.

OBJECTIVES: Caesarean section (CS) is one of the most frequently performed surgical procedures in the world and Turkey. In this study, we aimed to investigate the relationship between re-approximation of the rectus muscles during CS and the severity of diastasis recti abdominis in the first postoperative month. To investigate the relationship between re-approximation of the rectus muscles during CS and the severity of diastasis recti abdominis in the first postoperative month. MATERIAL AND METHODS: The study was designed as a prospective cross-sectional study. Patients were divided into two groups: parietal peritoneum closure only (Group 1), and closure of the parietal peritoneum and re-approximation of rectus muscle (Group 2). The distance between the rectus muscles and the thickest rectus muscle thickness were measured one month after CS from three anatomic regions using superficial ultrasonography by the same blinded physician. The anatomic regions were described as xiphoid, 3 cm above the umbilicus, and 2 cm below the umbilicus. The relation of the measurements between the groups was evaluated. RESULTS: There was a total of 128 patients, 64 in Group 1 and 64 in Group 2. There were no statistical differences between the groups in terms of the distance between rectus muscles and the thickness of rectus muscle at the described anatomic regions (p > 0.05). CONCLUSION: Re-approximation of rectus muscles has no effect on the prevention of diastasis recti, which is an important cosmetic problem.

The influence of vaginal progesterone on Uterine Artery Pulsatility Index.

OBJECTIVES: Uterine artery Doppler is frequently used in the first trimester and it is one of the more effective measurement methods in the prediction of preeclampsia and intrauterine growth restriction (IUGR). Progesterone is a hormone that is used quite frequently in various indications in obstetrics and gynecologic practice. We aimed to investigate the influence of progesterone on the uterine artery Doppler pulsatility index (PI) at 11-14 gestational weeks. MATERIAL AND METHODS: This study is a retrospective case-control study conducted in Selcuk University Faculty of Medicine between January and December 2019. Uterine artery Doppler PI values of patients using progesterone were compared with PI values of patients not using progesterone. Uterine artery PI was measured two times, left and right. Then the mean PI was calculated. All measurements were made by two operators and by the same ultrasonography machine RESULTS: A total of 288 patients, 140 patients using progesterone and 148 patients not using progesterone were included in the study. Demographic characteristics were similar between the groups (p > 0.05). There were no significant differences between the groups in the right and left uterine artery PI values. There was no significant difference for average uterine artery PI between the groups (p < 0.05). CONCLUSIONS: Progesterone has no significant influence on uterine artery PI. However, more prospective studies in which all potential confounding factors are considered including serum progesterone levels are needed for this subject.

Effect of Closure of Anterior Abdominal Wall Layers on Early Postoperative Findings at Cesarean Section: A Prospective Cross-sectional Study.

OBJECTIVE: To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. METHODS: The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and during mobilization), analgesia requirement, and return of bowel motility. RESULTS: The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. CONCLUSION: In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominis muscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens?

OBJECTIVE: Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography. MATERIALS AND METHODS: Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1 month, 3 months, and 6 months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement. RESULTS: Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5 mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5 mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60-0.75). CONCLUSION: IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.

The relationship between KRAS LCS6 polymorphism and endometrium cancer.

The aim of this study was to investigate the relationship between KRAS LCS6 mutation and endometrial cancer (EC). The study included 105 patients who had hysterectomy for benign reasons and 99 EC patients. The patients with Type 1 EC were classified according to histological properties, cancer stage, grade, tumour dimension, myometrial invasion (MMI), lymphovascular invasion (LVI), cytology, and number of positive lymph nodes. KRAS LCS6 mutation was examined in blood samples taken from all patients in both groups. No statistically significant difference was determined between the EC patients and the control group in demographic features. Weight and the Body Mass Index (BMI) values were higher in EC group (p < .001). While the incidence of this polymorphism is 5.8% throughout the world, the polymorphism rate was found to be 16.2% in the EC group and 12.4% in the control group, with no statistically significant difference determined (p > .05). Despite the higher rate of LCS6 polymorphism incidence in EC patients in this study conducted on a relatively large sample, there was not found to be a statistically significant difference in comparison with the control group. In addition, the presence of LCS6 polymorphism was not determined to have an effect on EC histopathological characteristics.Impact statementWhat is already known on this subject? Endometrial cancer (EC) is a genital system cancer which is one of the most widespread gynecological cancers seen in the USA and other developed countries, In EC, the most frequently seen gene mutations are PTEN tumour suppressor gene, KRAS, ß1 catenin, BCL-2, CTNNB and P53 mutations. KRAS LCS6(let-7 miRNA binding region polymorphism) polymorphism has a worldwide incidence of 5.8% (Chin et al. 2008).There are studies shown that KRAS LCS6 polymorphism has an effect on developing EC (Lee et al. 2014), ovarian cancer(Ratner et al. 2010)and endometriosis in women (Grechukhina et al. 2012).What do the results of this study add? In our study, LCS6 located on KRAS 3'-UTR was found at the rate of 16.2% in Type 1 EC patients. This increase is noticeable when it is considered that the incidence of this polymorphism is 5.8% in the general population. The results of the current study supports the preliminary findings of Lee et al.What are the implications of these findings for clinical practice and/or further research? These new genetic markers could help to develop gene-targeted therapies, identify genetic basis of the disease and the factors that could affect the EC prognosis.

Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study.

INTRODUCTION: Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG. MATERIALS AND METHODS: A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses. RESULTS: Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCT. CONCLUSIONS: PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.

Systemic inflammatory response markers in preeclampsia.

PURPOSE: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity. MATERIALS AND METHODS: This is a retrospective case-control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers. RESULTS: There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305). CONCLUSIONS: MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.

The effect of increased number of cesarean on maternal and fetal outcomes.

OBJECTIVES: The aim of this study was to evaluate the effects of multiple cesarean deliveries (CDs) on maternal-fetal mor-bidity and mortality rates. MATERIAL AND METHODS: This retrospective study included a total of 1,506 patients who underwent multiple CDs between January 2006 and May 2014. The patients were divided into two groups. One group consisted of patients with four or more CDs (n = 444) and a control group of patients with three CDs (n=1,062). Both groups were analyzed for demographics, complications from multiple cesarean deliveries and perinatal outcomes. RESULTS: The mean age was higher in the study group (p < 0.001). Dense adhesion (p < 0.001), demand for tubal ligation (p < 0.001), the requirement of pelvic drainage (p < 0.001), duration of hospitalization (p < 0.001) and the requirement for blood transfusion (p=0.03) was also significantly higher in the study group. Hemoglobin levels (p = 0.002) were signifi-cantly higher in the control group on the second postoperative day. Regarding perinatal morbidity; umbilical artery pH results (p = 0.003) were significantly lower in the study group. There was no significant difference in the maternal and fetal mortality rates between both groups. CONCLUSIONS: According to our study results, an increase in the number of cesarean sections increases maternal and fetal morbidity rates significantly. Therefore, we recommend decreasing the rate of primary cesarean deliveries by encouraging vaginal birth after CD. We also advocate the use of permanent contraceptive methods in patients with a high number of CD's. Further large-scale prospective results are required to establish a definitive conclusion.