Molecular Classification of Endometrial Cancer and Its Impact on Therapy Selection.

Endometrial cancer (EC) accounts for 90% of uterine cancer cases. It is considered not only one of the most common gynecological malignancies but also one of the most frequent cancers among women overall. Nowadays, the differentiation of EC subtypes is based on immunohistochemistry and molecular techniques. It is considered that patients' prognosis and the implementation of the appropriate treatment depend on the cancer subtype. Patients with pathogenic variants in POLE have the most favorable outcome, while those with abnormal p53 protein have the poorest. Therefore, in patients with POLE mutation, the de-escalation of postoperative treatment may be considered, and patients with abnormal p53 protein should be subjected to intensive adjuvant therapy. Patients with a DNA mismatch repair (dMMR) deficiency are classified in the intermediate prognosis group as EC patients without a specific molecular profile. Immunotherapy has been recognized as an effective treatment method in patients with advanced or recurrent EC with a mismatch deficiency. Thus, different adjuvant therapy approaches, including targeted therapy and immunotherapy, are being proposed depending on the EC subtype, and international guidelines, such as those published by ESMO and ESGO/ESTRO/ESP, include recommendations for performing the molecular classification of all EC cases. The decision about adjuvant therapy selection has to be based not only on clinical data and histological type and stage of cancer, but, following international recommendations, has to include EC molecular subtyping. This review describes how molecular classification could support more optimal therapeutic management in endometrial cancer patients.

Factors conditioning pain control and reduction in post-cesarean section parturients: a cross-sectional study.

BACKGROUND: Pain experienced by women in the perinatal period constitutes a complex and multifaceted phenomenon. The aim of the study was to assess conditions of pain locus of control and pain reduction in post-cesarean section parturients. MATERIALS AND METHODS: A cross-sectional quantitative study with convenience sampling was performed among 175 hospitalized post-cesarean section women in hospitals in Eastern Poland in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. A self-design questionnaire regarding general information and obstetrics/gynaecology medical interview, The Pain Coping Strategies Questionnaire (CSQ) and The Beliefs about Pain Control Questionnaire (BPCQ) were used. The inclusion criteria were as follows (1) age of ⩾18 years old; (2) cesarean section (CS); (3) period from the 13th hour to the end of the 72nd hour after the procedure; and (4) informed consent. The data was analyzed with IBM SPSS Statistics. RESULTS: Internal locus of control (M = 14.02) was provided the highest value by the parturients and followed by chance events (M = 12.61) and doctors' power (M = 12.18). Dominant coping with pain strategies in the post-cesarean parturients were coping self-statements (M = 19.06), praying or hoping (M = 18.86). The parturients assessed their pain coping (M = 3.31) strategies along with pain reduction (M = 3.35) at the moderate level. Higher pain control was correlated with cognitive pain coping strategies (ß = 0.305; t = 4.632; p < 0.001), internal pain control ß = 0.191; t = 2.894; p = 0.004), cesarean section planning (ß = -0.240; t = -3.496; p = 0.001) and past medical history of CS (ß = 0.240; t = 3.481; p = 0.001). The skill of reduction of pain was positively associated with cognitive pain coping strategies (ß = 0.266; t = 3.665; p < 0.001) and being in subsequent pregnancy (ß = 0.147; t = 2.022; p = 0.045). Catastrophizing and hoping were related to lower competences of coping with pain (B = - 0.033, SE = 0.012, ß = - 0.206, T = -2.861). CONCLUSIONS: The study allowed for identification and better comprehension of factors conditioning pain control and pain reduction in parturients after the cesarean section. Furthermore, a stronger belief that pain can be dealt with is found in the parturients characterized by cognitive pain coping strategies and internal pain locus of control. The skill of reduction of pain is related to cognitive coping strategy and procreation status.

Synchronously occurring endometrioid carcinomas of the uterine corpus and uterine cervix preceded by different precancerous lesions: A case study and a literature review.

The incidence of two synchronous carcinomas originating from the uterine corpus and uterine cervix, both endometrioid subtypes, is exceedingly rare. Herein, we presented synchronous early stage G1 adenocarcinoma of the uterine corpus with cervical G2 endometrioid adenocarcinoma. Although both neoplasms displayed the same histological subtype, they differed significantly according to the histological grading or clinical stage of the disease. Finally, it is worth emphasizing that both tumors were preceded by different precancerous lesions, atypical endometrial hyperplasia (AEH) and foci of endometriosis localized within the uterine cervix. Although AEH is a well-known precancerous condition of endometrioid carcinoma, the mechanisms resulting in the malignant transformation of endometriosis foci to the cervical endometrioid carcinoma are still a matter of controversy. We briefly summarized the impact of different precancerous lesions on the development of synchronous female genital tract neoplasms with the same histotype.

Ureteric injury after laparoscopic hysterectomy: a report of 3 cases and brief literature review.

OBJECTIVES: The application of minimally invasive laparoscopic techniques in gynecologic surgery gained popularity due to quicker recovery, shorter hospital stays as well as lower risk of complications. Ureteric injuries at laparoscopic hysterectomies are incidental and occur in less than 1% of cases. They can be identified intra-operatively but most of them are undetected. In most cases, the symptoms of an injury are non-specifically manifested after several days or even months following surgery. MATERIAL AND METHODS: We described different clinical symptoms suggesting ureteric injury based on 3 laparoscopic hysterectomies. Methods of diagnosis and repair techniques were also presented. CONCLUSIONS: All complications following laparoscopic hysterectomy should be analyzed meticulously and ureteral injury must be considered as one of the possible causes of abnormal patient recovery.

Doctoral programmes in the nursing discipline: a scoping review.

BACKGROUND: This study aimed to map and summarise the state of the research regarding doctoral programs in nursing, as well as the issues debated in the context of nursing doctoral education. A Scoping Review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension scoping reviews statement (PRISMA-ScR) was conducted. Three electronic bibliographic data bases were searched: Cumulative Index to Nursing and Allied Health Literature Complete, Medline (on EBSCO Host) and SCOPUS to identify empirical studies published between January 2009 and December 2019. The review process was based on framework identified by Arksey and O'Malley and further revised by Levac and colleagues. Analysis was performed with the use of the Donabedian framework regarding the structure of the doctorate programmes, the process, and the outcomes. RESULTS: The review included 41 articles, mostly originating in the United States (n=26) and Europe (n=8), mainly by collecting the perceptions of students and faculty members with descriptive studies. The following issues were investigated at the (a) structure level: Prerequisite for doctoral candidates, Qualifications of faculty members, Mission of doctoral programs; (b) process level: Doctoral programs contents, Doctoral programs resources and quality, Mentoring and supervision, Doing doctorate abroad; and (c) outcome level: Academic performance outcomes in doctoral programs, Doctoral graduates' competences, Doctoral students/graduates' satisfaction, Doctoral graduates' challenges. CONCLUSIONS: Doctoral programs have mainly been investigated to date with descriptive studies, suggesting more robust research investigating the effectiveness of strategies to prepare future scientists in the nursing discipline. Doctorates are different across countries, and there is no visible cooperation of scholars internationally; their structure and processes have been reported to be stable over the years, thus not following the research development in nursing, discipline and practice expectations. Moreover, no clear framework of outcomes in the short- and long-term have been established to date to measure the quality and effectiveness of doctorate education. National and global strategies might establish common structure, process and outcome frameworks, as well as promote robust studies that are capable of assessing the effectiveness of this field of education.

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter-Description of Two Clinical Cases with Review of Literature.

Urinary tract pathologies are the most common congenital abnormalities. Duplex colleting system occurs at different stages of completion and is usually asymptomatic. Ureteral ectopia is an associated anomaly which may manifest as continuous incontinence. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life.

Uterovesical fistula caused by cervical pessary placed for the prevention of preterm delivery - case report.

Uterovesical fistulas are the rarest of all urogenital fistulas, mostly occurring as a complication of cesarean section. We present a case of a 32-year-old woman, who noticed continuous vaginal urine leakage starting immediately after a vaginal delivery. The shortening of the uterine cervix was reported at 26th week of gestation, and a cervical pessary was placed. Shortly after delivery, the patient noticed the loss of urinary continence control, and she was diagnosed with urinary incontinence and hematuria. The office diagnostic hysteroscopy revealed uterovesical fistula. The correction procedure by transabdominal approach was performed by the team of gynecological and urological surgeons. One year of follow-up, the patient reports no symptoms related to lower urinary tract dysfunction. Based on the literature search, we believe that his is the first study of a uterovesical fistula followed by the use of a cervical pessary for the prevention of preterm delivery. Our case is a clear reminder that symptoms of urinary incontinence after vaginal delivery should be carefully managed.

Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation.

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years' follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician.

[Indications for hospitalization of young girls and adolescent girls--clinical work-up in the selected cases]. / Wskazania ginekologiczne do hospitalizacji dziewczynek i mlodych kobiet--postepowanie w wybranych przypadkach klinicznych.

OBJECTIVE: The aim of the study was to analyze the clinical reasons for hospitalization due to gynecological causes of adolescent girls and young women. METHODS: We reviewed clinical data on reasons for hospitalization, treatment methods, and histopathological diagnosis in adolescent girls and young women hospitalized at the Second Department of Gynecology Medical University of Lublin, between January 2003 and December 2012. Methods of conservative or surgical treatment, as well as their clinical effectiveness, have been discussed. RESULTS: Over the analyzed period of time, we identified 334 patients at the age between 8 and 20 years, which accounted for 1.61% of all hospitalized women during that time. Rating these patients by age, we found the following: 1 patient < 9 years old, 2 patients aged 10-11 years, 38 patients aged 12-14 years, 128 patients aged 15-17 years and 165 patients aged 17-19 years old. The main clinical reasons for hospitalization of adolescents and young women due to gynecological causes were: ovarian cysts (138 cases; 41.3%), menstrual disorders (46 cases; 13.7%), pregnancy complications (35 cases; 10.5%), and congenital Müllerian anomalies (33 cases; 9.9%). The remaining patients (24.6%) were admitted due to suspicion of ovarian cyst (22 cases; 6.6%), cervical erosion (15 cases; 4.5%), juvenile metrorrhagia (15 cases; 4.5%), and vulvar diseases (8 cases; 2.4%). CONCLUSIONS: Adolescent girls and young women are rarely admitted to gynecological departments. Nevertheless, they present a clinical challenge. Proper diagnosis using advanced visualization methods, along with modern pharmacotherapy accounts for the final therapeutic success.

Both the middle and distal sections of the urethra may be regarded as optimal targets for 'outside-in' transobturator tape placement.

PURPOSE: To investigate whether the position of the tape under the urethra may influence 'outside-in' transobturator sling (TOT) outcome. METHODS: The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment. RESULTS: Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40-70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results. CONCLUSIONS: The highest failure rate for 'outside-in' TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.

Most of the patients with suburethral sling failure have tapes located outside the high-pressure zone of the urethra.

OBJECTIVES: The high-pressure zone of the urethra (HPZ), which is crucial for the continence mechanism, extends between the point of the maximum urethral closure pressure and the urethral knee, and has been calculated to lie between 53% and 72% of the functional urethral length. According to recent studies the best results of suburethral slings are achieved when tapes are positioned under this zone. The aim of the study was to determine the location of tapes relative to the urethral length in patients seeking help due to recurrent stress urinary incontinence (SUI) following sling procedures. MATERIAL AND METHODS: The study group comprised 61 patients suffering from recurrent SUI following suburethral slings performed from 6 months to 5 years earlier Forty-nine (80.3%) women were initially treated with a transobturator sling and 12 (19.7%) with a retropubic procedure. Twenty patients had the original sling performed at our department whereas, the other 41 in other institutions. The position of the tapes was determined at the sagittal plane by 3-D transvaginal ultrasound using a linear transducer The length of the urethra was measured from the bladder neck to the external urethral meatus following the urethral lumen, taking into account its curve. The position of the tapes relative to the percentage of the urethral length was calculated assuming the bladder neck as the proximal end of the urethra. The reference point was set at the midpoint on the tape. RESULTS: Only 13 (21.3%) patients had tapes positioned at 50%-75% of the urethral length. In 45 (73.8%) of women examined the tapes were found under proximal half of the urethra and in 3 (4.9%) distally to the 75% of the urethral length. CONCLUSIONS: In most patients in whom slings procedures proved unsuccessful the tapes are located under the proximal half of the urethra, that is outside the HPZ The position of a.tape outside the HPZ may be considered as a cause of suburethral sling failure.

PARP-1 activity in normal and cancerous human endometrium and its relationship with quantity of abasic sites (AP).

OBJECTIVES: Poly (ADP-ribose) polymerase (PARP-1) is involved in the processes of DNA repair contributing to the maintenance of genomic stability. Recent data suggest that polymerase is involved in the development of endometrial adenocarcinomas and more advanced tumors displaying lowest enzyme protein expression. Data on PARP-1 activity regarding carcinogenesis in human endometrium are scarce. That was the reason why the authors of the present work wished to investigate the enzyme activity in human uterine hormone-dependent cancer and to compare the results with those obtained for normal endometrial tissue. The next aim was to check whether enzyme activity in normal and cancerous endometrium depends on the number of AP sites, which are widely known as oxidative stress DNA damage markers and PARP-1 activity stimulators. MATERIAL AND METHODS: Universal Colorimetric PARP Assay Kit was used to estimate the enzyme activity in units/ mg protein. Apurinic sites/105 base pairs (bp) were measured by Oxidative DNA Damage Kit Quantitative. Results were calculated for 47 endometrial samples and 15 uterine adenocarcinomas specimens. Finally the PARP-1 activity was analyzed for histological and some clinical features of neoplasms. RESULTS AND CONCLUSIONS: 1. no differences in PARP-1 activity were found in non-cancerous types of human endometrium; 2. mean enzyme activity was lower in sporadic endometrial cancers than in noncancerous endometrial specimens (2.89 +/- 0.55 vs 6.39 +/- 0.06; p < 0.005); 3. mean PARP-1 activity in lower grade neoplasms was higher than in G3 tumors and was lower in adenocarcinomas displaying deep uterine wall infiltration; 4. there was no relationship between PARP-1 activity and AP level.

[Tethered vagina syndrome after classical anterior colporrhaphy]. / Zespól zbliznowacialej pochwy jako powiklanie po klasycznej plastyce pochwy.

We presented etiology symptomatology and diagnosis of the tethered vagina syndrome. Detailed information concerning pharmacological and surgical treatment was given. Surgical method of vaginal anatomy restoration using Martius flap technique was described in patients with tethered vagina syndrome after classical anterior colporrhaphy. We paid special attention to a particular type of genital fibrosis such as labial fusion in girls.

Clinical effectiveness of Strassman operation in the treatment of bicornuate uterus.

OBJECTIVE: To evaluate the impact of conventional metroplasty on the reproductive outcome of symmetric uterine anomalies and to determine the complications of this procedure. MATERIAL AND METHODS: A prospective clinical analysis of 13 consecutive women who underwent classical abdominal metroplasty according to Strassman technique in II Dept Obstet & Gynecol in Lublin from April 2001 till January 2008. RESULTS: The fetal survival rate increased from 0% before surgery to 80% after the operation. No intraoperative and postoperative complications were observed as well as no uterine rupture and other intrapartum complications were noticed. CONCLUSIONS: Conventional transabdominal metroplasty seems to be a safe and efficient procedure in women with symmetric uterine anomalies--class IV AFS. Even in the era of operative hysteroscopy, transabdominal metroplasty remains the only approach in cases of bicornuate uterus.

[Anatomical and functional effect of laparoscopic Vecchietti operation]. / Efekt anatomiczny i czynnosciowy laparoskopowej operacji sposobem Vecchiettiego.

OBJECTIVE: To evaluate surgical: anatomical and functional effect of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. METHODS: Retrospective analysis of 10 patients operated in the II-nd Department of Gynecology Medical University of Lublin, Poland. The length of vagina and macroscopic evaluation of it structure was assessed in each case. Sexually active women for more than 6 months answered the BISF-W questionnaire (Brief Index of Sexual Functioning for Women). The results were analyzed comparing health age-matched controls. RESULTS: The mean age of operated women was 22.8-4.5 year whereas in the control group 22.9 +/- 3.3 year. In two operated patients the small areas of granulation were found in the vagina: in one woman on the side wall of vagina in the other in the apex. The mean length of neo-vagina was 8 +/- 2.1 cm, whereas in the control group 10 +/- 1.0 cm. The difference was statistically significant (U Mann-Whitney test, p = 0.013). BISF-W scores were comparable in both groups. CONCLUSION: The laparoscopic Vecchietti operation allows to create shorter vagina in comparison to health women but the sexual life of this patients is as satisfying as the normal controls.

[DNA adducts in human female genital organs]. / Addukty DNA w narzadach plciowych kobiety.

DNA adducts, one of genetic damages markers, precede and finally can lead to oncogenic mutations. They appear in genome as a result of DNA bases damages caused by various and numerous environmental factors eg. ultraviolet light, ionic radiation, toxins and also endogenic substances, for example estrogens. It is believed that the creation of DNA adducts is a necessary but insufficient process for the neoplastic transformation of the cell. The following review presents concise knowledge about the DNA adducts creation and their sequels served in healthy and cancerous tissues of the female genital organs, on the base of the available data.