The relationship of the Fas 670 A/G gene polymorphism with cardiovascular risk factors in polycystic ovary syndrome (PCOS) patients

Aims.?Apoptosis has been shown in cardiac cells under divergent physiological and pathological conditions. Apoptosis plays a key role in the pathogenesis of cardiac diseases. We aimed to evaluate the relation between Fas 670 A/G gene polymorphism in polycystic ovary syndrome (PCOS) patients carrying a potential risk for developing cardiovascular disease (CVD).

Materials and methods.?Ninety-one patients with PCOS and 100 cases of healthy control people were included in this study. PCOS was defined by the Rotterdam PCOS consensus criteria. The evaluation of genotype for Fas 670 A/G gene polymorphism was performed by using PCR-RFLP method.

Results.?The evaluation of Fas genotype and gene allele frequency did not show statistically significant difference between patient and control groups. Both in PCOS patients and control groups, there were no statistically significant differences among A/A, A/G, and G/G.

Conclusions.?We found no relation between the cardiovascular risk factors and Fas 670 A/G gene polymorphism in women with PCOS and healthy subjects. Our results in risk factors of CVD can probably be explained by the fact that metabolic parameters and endothelial systems of the patients may not be affected yet in this short period of time.     

A single nucleotide A>G polymorphism at position -670 in the Fas gene promoter: relationship to preterm premature rupture of fetal membranes in multifetal pregnancies

OBJECTIVE: The relationship between a polymorphism at position -670 in the Fas gene (TNFRSF6) and preterm premature rupture of membranes (PPROM) in multifetal pregnancies was examined. METHODS: Buccal swabs from 119 mother-infant sets were analyzed for an adenine (A) to guanine (G) substitution at position -670 in the TNFRSF6 promoter. Pregnancy outcome data were subsequently obtained. Analysis was by Fisher exact test. RESULTS: Maternal allele G homozygosity (TNFRSF6*G) was observed in 42.4% of 33 PPROM pregnancies as opposed to 19.5% of 77 with no spontaneous preterm birth (P = .01). Similarly, TNFRSF6*G homozygosity was present in 37.5% of 32 first-born neonates from PPROM pregnancies as opposed to 18.7% of 75 uncomplicated pregnancies (P = .04). PPROM occurred in 8 of 14 (57.1%) pregnancies in which mother and all neonates were TNFRSF6*G homozygotes as opposed to 25 of 105 (23.8%) cases in which uniform TNFRSF6*G homozygosity was not observed (P = .02). CONCLUSIONS: A genetic variant in the Fas gene is associated with an increased rate of PPROM in multifetal pregnancies.     

Fas gene promoter -670 polymorphism (A/G) is associated with cervical carcinogenesis

OBJECTIVE: To investigate the biological significance of single nucleotide polymorphism (SNP) at Fas gene promoter in cervical carcinogenesis. METHODS: SNP at -670 of Fas gene promoter (A/G) together with human papillomavirus (HPV) types were examined in a total of 279 cervical smear samples and 8 human cervical squamous carcinoma cell lines using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) techniques. RESULTS: 49 patients with high-grade squamous intraepithelial lesion (HSIL) had higher frequency of high-risk HPV and GA + GG genotype than 167 with low-grade SIL (LSIL) and 63 controls. G allele frequency was also higher in HSIL than in LSIL and controls. There was an increased OR (6.00; CI, 1.32-27.37; P = 0.021) for GA + GG genotype in HSIL cases compared to controls among 96 patients with high-risk HPV. 7 of 8 cervical carcinoma cell lines also showed GA or GG genotype. CONCLUSION: Fas gene promoter -670 polymorphism (A/G) may be closely associated with cervical carcinogenesis in a Japanese population.     

Pelvic exenteration without external urinary or fecal diversion in gynecological cancer patients

In 1993, the authors introduced an orthotopic bladder replacement technique in the treatment of gynecological cancer patients. In this series, they report their long-term experience with orthotopic urinary reconstruction in case of primary- and radiotherapy-treated recurrent gynecological malignancies. Between 1993 and 2003, in 29 patients orthotopic ileocecal ascending colon reservoirs (Budapest pouch) were created. Twenty-one of the 29 patients received radiotherapy prior to their operation. In 12 out of these 29 cases, the fecal stream was reconstructed with the use of low rectal anastomosis. Two patients (6.9%) died in the perioperative period. Orthotopic reconstruction of the lower urinary system was successful in 77% of the cases. Success rate was 68% in the irradiated cohort of patients. All orthotopic bladder replacement patients voided voluntarily at the time of their follow-up, without the need of self-catheterization, and 23.5% of them complained of some degree of daytime incontinence and 47% of nighttime incontinence. Low rectal anastomosis reconstruction of the fecal stream was successful in all but one case. Our present experience demonstrated that anterior and total supralevator pelvic exenteration in patients with gynecological malignancies is feasible with orthotopic reconstruction of the lower urinary tract.     

The polycystic ovary syndrome and gynecological cancer risk

Abstract

This review updates the knowledge regarding the association between the polycystic ovary syndrome (PCOS) and the risk of gynecological cancer. We performed a literature review of clinical and epidemiological studies concerning PCOS and the risk of breast, endometrial and ovarian cancer after selecting information by quality of scientific methodology. It was found that evidence does not support a link between PCOS and breast cancer risk. There is an increased risk of endometrial cancer, while data concerning ovarian cancer are contradictory. Regarding PCOS and its association to cervical, fallopian tube, and vulvar cancer, the quality of evidence is heterogeneous. In conclusion, women with PCOS should be screened for endometrial cancer and more research is warranted to determine in this population the true risk of developing other gynecological cancers such as breast and ovarian.     

134例乳腺癌患者妇科并发症临床病理分析

目的 观察乳腺癌患者妇科并发症的临床病理特征，判断其与服用三苯氧胺（TAM）的关系。方法 对90例术后服用TAM的乳腺癌患者（TAM组）及另外44例同时期无TAM服药史的乳腺癌患者（对照组）进行回顾性分析。结果两组患者的就诊原因有明显的差异，TAM组B超检查发现异常占68．9％，对照组中阴道淋漓出血或月经改变的比率明显增加为31.8％，具有统计学意义（P〈0．05）。TAM组子宫内膜息肉的发生率为25．6％，明显高于对照组9．1％（P〈0．05）；TAM组子宫内膜增生的发生率为30．0％，明显高于对照组13．6％（P〈0．05）。TAM组及对照组出现子宫内膜癌的情况为1：3例。TAM组子宫肌瘤／腺肌症的发生率为66．2％，明显高于对照组44．1％（P〈0．05）。两组患者的宫颈及卵巢病理改变无明显差异，其中宫颈的病理改变以慢性宫颈炎为主（82．8％），卵巢的病理改变以功能性卵巢囊肿为主（34．2％）。服用TAM时间的长短与某些妇科异常情况出现的频率相关，如随着TAM服药时间的延长，子宫内膜息肉与宫颈息肉的发生率明显升高，具有统计学意义（P〈0．05）；而服用TAM时间的长短与肌瘤的发生、肌瘤变性无明显关系（P〉O．05）。134例乳腺癌患者妇科手术治疗以全子宫＋双附件切除术为主，TAM组为68．9％，对照组为61．4％，上环治疗分别占10．0％与2．3％。结论 乳腺癌患者服用TAM后子宫内膜病变与子宫肌瘤／腺肌症的发生增多，前者与服药时间长短有关。对所有乳腺癌患者应进行规律的妇科TVB监测或官腔镜检查，并接受有效的低刨治疗。     

Assessing economics of treatments for gynecological cancer where clinical effectiveness meets value for money

During the last 10 years, the management of gynecological cancer has been undergoing a great deal of change. This is due to a drive to reduce ineffective treatment and associated morbidity while at the same time maximizing the benefits of currently available treatment. The foundation for this approach has been high-quality clinical trials which have been performed in increasing numbers. These trials can provide strong evidence that treatments are equivalent or that a new drug adds superiority to previous treatment. The access that women have to the most effective forms of treatment often depends on the availability of healthcare resources and their affordability within the healthcare system. Healthcare decision makers increasingly require not just clinical effectiveness of treatments but also cost-effectiveness to be demonstrated. While health economic methods have been applied to many forms of cancer treatment and screening, there have been very few rigorous economic studies performed in gynecological cancer. This article discusses how economic analysis can be incorporated into clinical trials and how it can provide the sort of value for money determination that payers of healthcare are now requiring. Economic analysis may add a little to the cost of trials, but in the end, it may increase access to treatment by convincing decision makers of cost-effectiveness.     

Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies—result of a long-term follow-up

The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.     

妇科门诊患者子宫颈癌认知度和筛查状况分析

目的了解妇科门诊患者宫颈癌认知程度和宫颈癌筛查状况及二者的关系。方法选取2010年2月至2011年5月就诊于北京大学人民医院妇科门诊的患者1800例,进行问卷调查及统计学分析。结果①入组患者平均年龄（38.3±10.8）岁,其中有工作者1100例,无工作者700例;北京城镇居民1345例,非北京城镇居民455例。②完成认知程度问卷调查者共1729例,有工作者认知程度10分、5分和0分者分别为613例（58.4%）、216例（20.6%）和221例（21.0%）,无工作者分别为60例（8.8%）、112例（16.5%）和507例（74.7%）,有工作者认知水平高于无工作者（P〈0.05）;北京城镇居民认知程度10分、5分和0分者分别为560例（42.9%）、289例（22.1%）和456例（34.9%）,非北京城镇居民分别为113例（26.7%）、39例（9.2%）和272例（64.2%）,北京城镇居民认知水平高于非北京城镇居民（P〈0.05）。③完成筛查状况问卷调查者共1630例。有工作者距末次检查时间为1年、1～3年、〉3年和未筛查者分别为280例（28.0%）、472例（47.2%）、221例（22.1%）和27例（2.7%）,无工作者分别为71例（11.3%）、176例（27.9%）、280例（44.4%）和103例（16.3%）,有工作者筛查水平高于无工作者（P〈0.05）;北京城镇居民距末次检查时间1年、1～3年、〉3年和未筛查者分别为320例（24.6%）、610例（46.9%）、270例（20.8%）和100例（7.7%）,非北京城镇居民分别为31例（9.4%）、38例（11.5%）、231例（70.0%）和30例（9.1%）,北京居民筛查水平高于非北京城镇居民（P〈0.05）。结论妇科门诊有工作患者宫颈癌认知水平高于无工作者,北京城镇居民高于非北京城镇居民。门诊患者宫颈癌的整体筛查率较低,有工作者优于无工作者,北京城镇居民优于非北京城镇居民。应广泛开展宫颈癌相关知识和筛查的宣教,提高广大妇女主动参加筛查的自觉性。     

Attitudes to radical gynecological oncology surgery in the elderly: a pilot study

Abstract. Nordin AJ, Dixon S, Chinn DJ, Moloney I, Naik R, de Barros Lopes A, Monaghan JM. Attitudes to radical gynecological oncology surgery in the elderly: a pilot study.
Does age-related inequality of cancer care reflect patient preference or physician prejudice? We hypothesize no difference between elderly and younger patients' desire for optimal surgery and disease cure, and psychological adaptation to cancer. A newly developed questionnaire to assess attitudes to radical gynecological surgery in the elderly (ARGOSE) and a battery of established instruments were administered to 54 gynecological cancer patients (32 aged 65 + years; and 22 aged < 65 years) by structured interview. Disease diagnosis differed between cohorts ( P = 0.007), but treatment modalities were similar ( P = 0.46). There was no difference between cohorts in desire for optimal surgery and disease cure. Trends suggest the young consider a patient's age is less important than do the elderly, but the elderly may oppose age-related economic rationing of treatment more than the young. Furthermore, elderly individuals tend to perceive their seniors too elderly for treatment, but not themselves. The elderly believe more strongly that doctors should make management decisions. Perceptions of change in body image after cancer treatment did not differ between cohorts. The influence of age in determining attitudes is complex. A larger study with increased power is indicated to examine trends revealed in this pilot study.     

Investigation of resistin 420 and 62 gene polymorphism in patients with endometrial cancer

Objective

We aimed to assess resistin gene polymorphisms, namely 420C > G and 62G > A and their effect on the risk of endometrial cancer (EC).

Hyperbaric oxygen therapy for delayed radiation injuries in gynecological cancers

Delayed radiation-induced injuries are difficult to treat. The treatment of delayed radiation injuries with hyperbaric oxygen therapy (HBOT) is reported in small case series and case reports. This study reports the experience of a single institution with HBOT in delayed radiation injuries in patients with gynecological cancers. At least 20 sessions of 100% oxygen inhalation at 2.4 Atmospheric Absolutes (ATA) for 90 min in a hyperbaric chamber were carried out. Of the 14 patients included in the study, 10 patients have healed or showed improvement of more than 50%, resulting in a success rate of 71%. Mean follow-up was 31.6 months (range 6-70 months). The adverse events were acceptable. HBOT should be considered for patients with delayed radiation injuries, not responding to other treatments.     

The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer

The objective of this study was to determine whether, after accounting for illness and demographic variables, spiritual involvement and beliefs and positive and negative spiritual coping could account for any of the variation in anxiety and depression among women within 1 year's diagnosis of gynecological cancer (GC). One hundred patients from outpatient GC clinics at two Melbourne-based hospitals completed a brief structured interview and self-report measures of anxiety, depression, spirituality, and spiritual coping. Using two sequential regression analyses, we found that younger women with more advanced disease, who used more negative spiritual coping, had a greater tendency towards depression and that the use of negative spiritual coping was associated with greater anxiety scores. Although not statistically significant, patients with lower levels of generalized spirituality also tended to be more depressed. The site of disease and phase of treatment were not predictive of either anxiety or depression. We conclude that spirituality and spiritual coping are important to women with GC and that health professionals in the area should consider these issues.