Fertility-preserving treatment and pregnancy outcomes in the early stage of endometrial carcinoma.

OBJECTIVE: This study aimed to review the available literature on fertility-preserving treatment and pregnancy outcomes in patients with early-stage endometrial carcinoma who desired to preserve their fertility. DATA SOURCES: The PubMed database (1992-2012) was searched for the words "conservative "OR" fertility sparing "OR" fertility preserving" AND "endometrial neoplasms" (MeSH). All relevant articles in English and the relevant references were collected. STUDY SELECTION: Data from published articles about fertility-preserving treatment of endometrial cancer, including the response and recurrence rate of conservative treatment, strategies of infertility treatment, pregnancy, and obstetric outcomes, were selected. Data were mainly extracted from 41 studies, which are listed in the reference section of this review. RESULTS: Hormone therapy was the most common method used for early-stage endometrial carcinoma in patients who wished to preserve fertility. Sixty percent of the patients became pregnant after remission of the carcinoma. The percentage of patients who conceived in the assisted reproductive technology group was higher than that of the natural pregnancy group (80.0% vs. 43.2%, P < 0.01). A higher rate of preterm labor and multiple pregnancies was observed in the assisted reproductive technology group than that in the natural pregnancy group. The majority of pregnancies (71.4%) in the assisted reproductive technology group were achieved by in vitro fertilization-embryo transfer. The clinical pregnancy rate of transfer cycles in patients with endometrial carcinoma was 34.1%. CONCLUSIONS: Assisted reproductive technology is a good option in well-selected patients with early-stage endometrial carcinoma who have completed conservative treatment. In vitro fertilization-embryo transfer offers an opportunity to achieve an immediate pregnancy.

[Clinical application of protein-to-creatinine ratio in spot urine samples for preeclampsia].

OBJECTIVE: To evaluate the clinical application of protein-to-creatinine ratio (P/Cr) in spot urine samples so as to check whether it can replace urine protein excretion in 24 h collections for the diagnosis and screening of preeclampsia. METHODS: The investigators selected 100 cases of pregnant women with preeclampsia and 36 cases of normal pregnant women examined at Sir Run Run Shaw Hospital over the last two years. The correlations between P/Cr in first morning urine samples and urinary protein excretion in 24 h collections were analyzed. The cutoff values of P/Cr in first morning urine samples for screening preeclampsia of 0.3 g and 5 g in urinary protein excretion in 24 h collections were determined by a receiver operating characteristics (ROC) curve. RESULTS: A highly significant correlation existed between P/Cr in first morning urine samples and urinary protein excretion in 24 h collections. By the ROC curve analysis, the P/Cr of 0.34 g/g and 2.08 g/g in first morning urine samples represented the most appropriate threshold for detecting the urinary protein excretion of 0.3 g and 5 g in 24 h collections. CONCLUSION: The P/Cr in spot urine samples can replace urinary protein excretion in 24 h collections. It is a simple and reliable tool of diagnosis and follow-up for preeclampsia.

[Clinical curative effects of preoperative neoadjuvant chemotherapy on cervical cancer: analysis of 62 patients].

OBJECTIVE: To explore the clinical curative effects of preoperative neoadjuvant chemotherapy (NACT) on locally advanced cervical cancer. METHODS: A total of 62 patients of stage Ib2-IIb cervical cancer received neoadjuvant chemotherapy of paclitaxel plus cisplatin for 2 - 3 courses. The clinical curative effects were evaluated according to the changes of lesion size, intraoperative conditions and postoperative pathological reactions. RESULTS: The overall response rate was 90.32% (56/62) and the complete response rate 30.65% (19/62). The tumor volumes decreased after NACT. The differences were significant (P < 0.05). After NACT, 56 patients undergoing radical hysterectomy recovered smoothly. The surgical resection rate was 90.32%. Chemotherapeutic reactions of cancerous tissue and a large number of infiltrated lymphocytes were seen in 50 cases. Lymph nodes were positive in 3 cases. There were parametrial invasion (n = 2) and vascular tumor emboli (n = 2). CONCLUSION: Preoperative neoadjuvant chemotherapy is efficacious in cervical cancer. The parametrium becomes softer and the tumor staging decreases.

[A pilot study on relationship of periodontal status, serum level of interleukin-1beta and delivery outcomes in pregnant women].

OBJECTIVE: To evaluate the associations between periodontal conditions, serum level of interleukin-1beta (IL-1beta) and delivery outcomes in pregnant women with a diagnosis of threatened premature labor(TPL). METHODS: Eighty systemically healthy pregnant women were enrolled in the study. The case group was composed of 40 pregnant women hospitalized with the diagnosis of TPL (TPL group) and the control group was composed of 40 normal pregnant women (Non-TPL group). Periodontal examinations included assessments of plaque index (PLI), clinical attachment loss (CAL), probing depth (PD), bleeding index (BI) and the percent of periodontitis sites (PD >3 mm, CAL > or =2 mm). The serum level of IL-1beta was determined using commercially available enzyme-linked immunoassays. RESULTS: (1) Fourteen of forty subjects of TPL group delivered premature labor infants (TPL-TB group), and twenty-six subjects delivered natural labor infants (TPL-PB group). No infants were delivered as premature labor infants in non-TPL group. There were significant differences in gestational age at delivery, birth weight, PLI, percentage of periodontitis sites and IL-1beta levels between the non-TPL group and TPL group or between the TPL-TB group and TPL-PB group (P < 0.05). (Significant negative correlation were observed between the gestational age at delivery and percentage of periodontitis sites as well as serum IL-1beta levels (P < 0.05). And significant positive correlation were observed between percentage of periodontitis site and serum IL-1beta levels (P < 0.05). CONCLUSION: Periodontal inflammation might be one of the pathogenesis of preterm birth.

[Associations between periodontal status and delivery outcomes in pregnant women with a diagnosis of threatened premature labor].

OBJECTIVE: To evaluate the association between periodontal conditions and delivery outcomes in pregnant women with a diagnosis of threatened premature labor (TPL). METHODS: Eighty systemically healthy pregnant women were enrolled in the study. Forty of these were pregnant women hospitalized with the diagnosis of TPL, and 40 normal pregnant women served. TPL was control clarified as TPL-PB (14 women) and TPL-TB (26 women) based on the delivery outcomes. No infants were delivered as PB in the control with non-TPL. Periodontal examinations included assessments of plaque index (PLI), clinical attachment loss (CAL), probing depth (PD), bleeding index (BI) and the percentage of periodontitis sites (PD > 3 mm, CAL >or= 2 mm). The serum level of TNF-alpha was determined using commercially available enzyme-linked immunoassays (ELISA). RESULTS: The mean PLI (0.94 +/- 0.05), percentage of periodontitis sites (2.93%) and TNF-alpha levels [14.81 ng/L (13.40 - 15.64 ng/L)] were significantly higher in the TPL group than in the non-TPL group [0.59 +/- 0.03, 1.32% and 11.47 ng/L (10.82 - 12.86) ng/L] (P < 0.001). The mean PLI (0.96 +/- 0.06), BI (2.99 +/- 0.14), percentage of periodontitis sites (3.61%) and TNF-alpha levels [18.35 ng/L (15.47 - 31.94) ng/L] were significantly higher in the TPL-PB group than in the TPL-TB group [0.66 +/- 0.04, 2.76 +/- 0.12, 2.25% and 13.70 ng/L (12.64 - 14.80 ng/L)]. Significant negative correlations were observed between the gestational age at delivery and percentage of periodontitis sites as well as serum TNF-alpha levels (P < 0.05). And significant positive correlations were observed between percentage of periodontitis site and serum TNF-alpha levels (P < 0.05). CONCLUSIONS: Periodontal inflammation might be involved in the pathogenesis of preterm birth.

[Analysis of periodontal status in pregnant women with a diagnosis of threatened premature labor].

PURPOSE: To evaluate the associations between periodontal conditions and delivery outcomes in pregnant women with a diagnosis of threatened premature labor (TPL). METHODS: Eighty systemically healthy pregnant women were enrolled in the study. The case group was composed of 40 pregnant women hospitalized with the diagnosis of TPL and the control group was composed of 40 normal pregnant women. Periodontal examinations included assessments of plaque index (PLI), clinical attachment loss (CAL), probing depth (PD), bleeding index (BI) and the percentage of periodontitis sites (PD > 3 mm, CAL > or = 2mm). The serum level of IL-6 was determined using commercially available enzyme-linked immunoassays (ELISA). The data were analyzed with SPSS11.0 software package for chi2 test, Student's t test and Pearson correlation analysis. RESULTS: 40 subjects were clarified as TPL and 14 as TPL-PB. 26 TPL women subsequently delivered TB infants. No infants were delivered as PB in 40 subjects clarified as non-TPL. There were no significant differences in the mean ages and gestational age at examination between the non-TPL and TPL groups or between the TPL-TB, and TPL-PB groups. There were significant differences in gestational age at delivery and birth weight between the non-TPL and TPL groups or between the TPL-TB, and TPL-PB groups (P < 0.05). The mean PLI, percentage of periodontitis sites and IL-6 levels were significantly higher in the TPL group than those of the non-TPL group. The mean PLI, BI, and percentage of periodontitis sites were significantly higher in the TPL-PB group than those of the TPL-TB group. Significant negative correlations were observed between the gestational age at delivery and percentage of periodontitis sites as well as BI (P < 0.05). CONCLUSION: Periodontal inflammation might be involved in the pathogenesis of preterm birth.