Validation of two risk assessment models for venous thromboembolism in patients undergoing gynecologic surgery.

BACKGROUND: According to published guidelines, gynecologic surgical patients should be stratified into different risk level groups to receive prophylaxis for venous thromboembolism (VTE), but the applicability of available risk assessment models (RAMs) in common gynecologic surgical patients remained to be confirmed. We aimed to validate the use of the Caprini RAM and gynecologic Caprini (G-Caprini) RAM for assessing postoperative VTE risk in gynecologic surgical patients. METHODS: The database of a randomized controlled trial (RCT) was used to select patients who underwent gynecologic surgeries for benignant and malignant diseases in five institutions in China between 2011 and 2018. The Caprini RAM version recommended by the American College of Chest Physicians (ACCP) was adopted. Participants were divided into four risk levels based on the Caprini and G-Caprini scores. For each risk level group, the incidence of VTE was calculated. The correlation between VET incidence and risk levels was assessed by Spearman's rank correlation coefficient (RS) value. RESULTS: As a result, 800 patients in the data base were analyzed with an overall VTE incidence of 5.8%. Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 0%, 4.3%, 44.4%, and 51.4%, respectively, and the VTE incidence was 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 0.500 (P=0.667). G-Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 7.8%, 28.0%, 32.0%, and 32.3%, respectively, and the VTE incidence was 0.0%, 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 1.000 (P<0.01). CONCLUSIONS: The G-Caprini RAM was as suitable as the Caprini RAM for VTE risk assessment in gynecologic surgical patients. The gynecologic model has the advantages of ease of use and more accurate identification of low-risk groups.

Different combination strategies for prophylaxis of venous thromboembolism in patients: A prospective multicenter randomized controlled study.

The aim was to evaluate the efficacy and safety of different combination strategies for prophylaxis of venous thromboembolism (VTE) after gynecologic surgery in patients at different levels of risk. This was a prospective multicenter randomized controlled study, in which 625 women who would undergo pelvic surgery for gynecologic diseases were stratified into three risk groups and then randomized into four groups to receive graduated compression stockings (GCS) alone (group A), GCS + low molecular weight heparin (LMWH) (group B), GCS + intermittent pneumatic compression (IPC) (group C), and GCS + IPC + LMWH (group C), respectively. The overall incidence of DVT was 5.1%. Group A had the highest incidence of DVT (8.8%), followed by group C (5.2%), group B (3.8%), and group D (2.6%). There was a significant difference in the incidence of DVT between groups A and D. The incidence of DVT was significantly lower in LMWH-treated patients (group B + group D) than in non-LMWH-treated patients (group A + group C). In conclusion, combination prophylaxis, especially LMWH-containing strategies, is better than monoprophylaxis in reducing VTE after gynecologic surgery. Risk-stratified prophylactic strategies should be implemented in patients undergoing gynecologic surgery, with LMWH-containing strategies being recommended for high-risk and very-high-risk patients.

Aberrant expression profile of translationally controlled tumor protein and tumor-suppressive microRNAs in cervical cancer.

PURPOSE: Invasive and recurrent cervical cancer accounts for major mortality among women. The activity of biomarkers in cervical cancer varies with different pathological stages. The purpose of the present study was to evaluate the expression of 2 biomarkers in cervical cancer and their possible contribution to novel therapeutic strategies. METHODS: In this study, we assessed the expression of translationally controlled tumor protein (TCTP) using immunohistochemistry and Western blot analysis. The expression pattern of miR-143 was also evaluated using Northern blot analysis. RESULTS: HeLa cells and mice were used for tumor induction. A group of mice injected with HeLa cells and incubated for 6 weeks developed initial tumor, while a different group of mice injected with HeLa cells and incubated for about 10 weeks developed advanced stage cervical cancer. Histological analysis revealed higher proliferation of cells resulting in complex forms of tumor in advanced cervical cancer, whereas cell clustering was not found to be initiated in the initial stage. The results of immunohistochemistry and Western blot analysis indicated less variation in the expression of TCTP, but significant difference was observed in advanced stage. Expression of Bax apoptotic protein was higher in the initial stage of the tumor than in the advanced cervical cancer. Similar pattern of marginal downregulation of miR-143 was observed between control and initial tumor stages, but striking reduction in miR-143 expression was observed in advanced stages of tumor development. CONCLUSION: The results of this study reveal a new aspect of altered expression of biomarkers in different pathological stages that could help identify novel therapeutic strategies for cervical cancer treatment.

Expression of glucose transporter protein 1 and p63 in serous ovarian tumor.

AIM: It has been shown that glycolytic metabolism is increased in malignant cells. Cancer cell growth is an energy-related process supported by an increased glucose metabolism. In addition, p63, a known homolog of p53, is expressed predominantly in basal cell and squamous cell carcinomas. The purpose of this study was to evaluate the expression of glucose transporter protein 1 (GLUT1) and p63 in patients with serous ovarian tumor (benign, borderline and malignant) and study their close relationship with the malignant transformation of serous ovarian tumors. METHODS: Two hundred formalin-fixed, paraffin-embedded sections were immunostained with rabbit anti-GLUT1 polyclonal antibody and mouse anti-p63 monoclonal antibody using the streptavidin-biotin method. The samples were as follows: 40 normal ovarian tissues, 40 serous cystadenomas, 40 borderline serous cystadenomas and 80 serous cystadenocarcinomas were stained. RESULT: Normal ovarian tissues showed completely negative staining for GLUT1 and p63. However, from benign serious cystadenomas, borderline cystadenomas to cystadenocarcinomas, the expression of GLUT1 and p63 grew stronger (P < 0.05). Moreover, the intensity staining of GLUT1 maintained a significant association with the expression of p63 (P < 0.05). In χ²-test analysis, expression of borderline cystadenomas and cystadenocarcinomas, intraperitoneal implants, ascites, lymph node status and International Federation of Gynecology and Obstetrics (FIGO) stage and GLUT1 expression levels have an appalling significance (P < 0.05), while FIGO stage, intraperitoneal implants and lymph node status except patient age and ascites have a statistical significance with the expression of p63 levels (P < 0.05). CONCLUSION: Our findings show a progressive increase in the expression of GLUT1 and p63 from the benign serous cystadenomas, borderline cystadenomas to cystadenocarcinomas. Overexpression of GLUT1 and p63 are associated with the histology FIGO stage and metastasis of the tumors. These data suggested that the expression of GLUT1 and p63 may be closely related to the malignant transformation of serous ovarian tumors. However, the relative importance of GLUT1 and p63 in ovarian serous tumor development and tumorigenesis remains mostly unclear and awaits further investigation.

Investigation on delivery analgesia effect of combined spinal epidural anesthesia plus Doula and safety of mother and baby.

OBJECTIVE: To explore the effect of patient-controlled lumbar epidural combined anesthesia with Doula for labor analgesia with ropivacaine and sufentanil, and its influence on the progress of labor, and outcomes of mother and infant. MATERIALS AND METHODS: Two hundred parturients that requested labor analgesia were randomly selected by patient-controlled lumbar epidural combined anesthesia with Doula as the observation group, meanwhile another 200 parturients were selected as the control group without any analgesic measurements. Labor pain score, labor duration, blood gas analysis results, the incidence of cesarean section, neonatal asphyxia, and postpartum hemorrhage were compared between the two groups. RESULTS: Compared with the control group, labor analgesic effect was remarkable, the cesarean section rate was significantly reduced in observation group, and the difference was statistically significant (p < 0.05), but with respect to the duration of labor, maternal, postpartum hemorrhage, and neonatal asphyxia, there was no statistical significance between the two groups (p > 0.5). In the observation group regarding maternal and neonatal blood gas analysis results, PO2 was higher and PCO2 was lower than those in the control group. The differences were statistically significant (p < 0.05). CONCLUSION: Labor analgesia by patient-controlled lumbar epidural combined anesthesia accompanied with Doula with ropivacaine and sufentanil is effective, safe, reliable, has no adverse effects, and reduces cesarean section rate.