Women Median Age Research Articles

Burn Hand, Outcome Analysis and Therapeutic Aspects of Burn Treated in Albania.

Background: Even that the entire hand represents 4 percent of the TBSA, The American Burn Association, the Advanced Trauma Life Support, and the Advanced Burn Life Support curricula all recognize the severity of hand burns by classifying these as injuries requiring treatment at a burn qualified center. Hand burns occur commonly both as part of larger burn injuries as well as isolated injuries. Due to damage to the skin and other parts of the hand, burns can lead to open wounds, disability, severe emotional and psychological complications, and economic burden. To further improve the effects of preventive measures, studies are needed to investigate the epidemiology, etiology, and outcomes of burn hand patient population.
 Aim: To give an overview of epidemiologic features and outcome of burn hand patients who admitted in our Service. This current study was performed in University Hospital Center “Mother Teresa” Tirana which is the only tertiary hospital in Albania. 
 Material and methods: In this retrospective study were included all patients who had combustion of the hands solely or hands accompanied with burns to other areas of the body, treated and followed up at our Service during the years 2011-2016.
 Results: Of the 333 included burn patients, 64% were males.The median age of women is 21.8 years, of men is 27.5 years and the median age total patients’ population is 25.9 years. About half of patients belong to the age group 20-60 years (49.5%) and only 10.2% belong to the age above 60 years. In most of the cases (73.6%), the burn of hands is associated with burn of the other anatomical region, mostly forearm.
 Conclusion: The goal of wound management is to have the skin healed by post-burn in two weeks’ time. In many cases, this will occur nonoperatively with good wound care. The surgical treatment is used for less 30% than of patients.Surgical excision of the burn with split-thickness skin grafting should be undertaken as soon as it becomes obvious that wound healing will not be complete by post-burn day 14.The undesirable results of theburn of hands are presented in the 33% of the patients. The contractures were the main unfavorable outcome of the burned hand.

Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

BackgroundCervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting.MethodsWe performed a cross-sectional analysis of data on a sample of women who had received a CCS at the “Operation Stop” cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006–2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05.ResultsDuring the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30–45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82).ConclusionOur analysis supports the design of health systems that facilitates providers’ engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.

Determinants of body mass index by gender in the Dikgale Health and Demographic Surveillance System site, South Africa

ABSTRACTBackground: The study was conducted in the Dikgale Health and Demographic Surveillance System (DHDSS) site where we have observed increasing obesity levels, particularly in women, despite evidence of high physical activity (PA) and a relatively low daily energy intake.Objective: This study aimed to assess the socio-demographic, behavioural and biological determinants of body mass index (BMI) in adult residents permanently residing in the DHDSS.Methods: A cross-sectional study was conducted in which socio-demographic, behavioural and biological characteristics from 1143 participants (aged 40–60 years) were collected using a paper questionnaire and standard anthropometric measures. Human immunodeficiency virus (HIV) testing was performed on all participants except those who indicated that they had tested positive. Chi-square and Mann-Whitney tests were used to analyze categorical and continuous variables, respectively, while hierarchical multivariate regression was used to analyze predictors of BMI.Results: The median age of women and men was 51 (46–56) and 50 (45–55) years, respectively. The prevalence of overweight-obesity was 76% in women and 21% in men. A significant negative association of BMI with HIV and smoking and a significant positive association with socio-economic status (SES) was observed in both sexes. In women, BMI was negatively associated with sleep duration (p = 0.015) and age (p = 0.012), but positively associated with sugar-sweetened beverages (SSBs) (p = 0.08). In men, BMI was negatively associated with alcohol use (p = 0.016) and positively associated with being married (p < 0.001). PA was not associated with BMI in either sexes. Full models explained 9.2% and 20% of the variance in BMI in women and men, respectively.Conclusion: BMI in DHDSS adults is not associated with physical inactivity but is associated wealth, marital status, sleep, smoking, alcohol use, and HIV status. Future studies should explore the contribution of nutrition, stunting, psycho-social and genetic factors to overweight and obesity in DHDSS.

Clinical analysis of hereditary coagulation factor Ⅴ deficiency

Objective: To analyze the clinical characteristics of hereditary coagulation factor Ⅴ deficiency (FⅤD) and to improve the diagnosis and treatment ability of hereditary FⅤD. Methods: A total of 17 patients with hereditary FⅤD admitted to the Department of Hematology, Peking University People's Hospital from February 2013 to January 2018 were selected, and their clinical characteristics, laboratory examination, treatment and prognosis were retrospectively analyzed. Results: There were 9 males and 8 females patients with FⅤD, the median age was 36 (1-72 ) years. The median age of men was 39 (1-72)years, and the median age of women was 33 (8-56)years. There was no significant difference between them (P=0.793). The median prothrombin time(PT) and activated partial thromboplastin time(APTT) values were 21.0(13.0-39.6) s and 54.6(38.2-121.2) s, and the median level of plasma FⅤ was 8.2% (0.9%-39%). Thirteen cases (13/17) were mild, 3 cases (3/17) were moderate, and only 1 case (1/17) was severe according to the FⅤ level. Five cases (5/17) had bleeding, including 3 cases with skin ecchymosis, 1 case with vaginal bleeding, and 1 case with gastrointestinal bleeding. According to the severity of bleeding, 1 case (1/17) had severe bleeding, and the other 4 cases (4/17) were mild bleeding. Conclusions: Patients with hereditary FⅤD either have or do not have bleeding symptoms, with prolonged PT and APTT and decreased plasma of FⅤ activity. There is no need for treatment for those without bleeding symptoms. Fresh frozen plasma is the first choice for patients who have bleeding, and the overall prognosis is good.

Abstract 2648: Prognostic significance of thyroid hormone receptor-alpha-2 (THRα2) expression in triple-negative breast cancer: A TCGA study

Abstract Background: Thyroid hormones promote breast cancer cell proliferation and expression of their cognate nuclear receptors has shown prognostic potential in small cohort studies. Among two isoforms of thyroid hormone receptor alpha (THRα), the alpha1 splice variant (THRα1) promotes thyroid hormone mediated cell proliferation whereas the alpha2 variant (THRα2) opposes it. Hence, THRα2 expression may be a favorable prognostic biomarker in breast cancer. Methods: A publicly available database of breast tumors archived by The Cancer Genome Atlas (TCGA) was employed for this study. We analyzed RNA expression of THRα1 and THRα2 in 106 triple negative breast cancers (TNBCs) and correlated it with tumor stage (I vs II vs III) and nodal involvement (positive vs negative). Tumor grade was not uniformly reported. Univariate Cox proportional hazards regression models were fitted to determine the prognostic impact of THRα1 and THRα2 expression on overall survival (OS) and multivariate models were adjusted for age, tumor stage and radiation treatment. Results: The median age of women was 54 (range 29-90) and 12.3% died. The majority (62.3%) of patients presented with stage II disease; 16.0% were stage III and 17.9% were stage I at diagnosis. There was no significant correlation between THRα1 or THRα2 expression and tumor stage or nodal involvement. Expression of THRα2 was associated with improved OS in both uni- and multi-variate models (Table). Conclusions: In this study, THRα2 expression was independently prognostic for improved OS in TNBC. We previously demonstrated similar results in 158 TNBCs via immunohistochemistry but differentiation between RNA (as opposed to protein) splice variants is more precise. These results support investigation of THRα2 up-regulation or THRα1 inhibition as therapeutic strategies. Table. Prognostic associations of THRα2 expression in TNBCVariableUnivariate HR (95%CI)p valueMultivariate HR (95%CI)p valueLog (THRα2)0.46 (0.26-0.81)&amp;lt;0.010.28 (0.09-0.84)0.02Log (THRα1)0.54 (0.31-0.94)0.031.38 (0.53-3.62)0.51Age (years)0.98 (0.94-1.02)0.370.92 (0.84-1.01)0.10Stage (I vs II vs III vs IV)6.14 (2.19-17.22)&amp;lt;0.0126.03 (4.05-167.14)&amp;lt;0.01Radiation therapy (yes vs no)0.23 (0.04-1.22)0.080.10 (0.02-0.73)0.02 Citation Format: Katarzyna J. Jerzak, Anna Dvorkin-Gheva, Jessica G. Cockburn, Anita Bane, John A. Hassell. Prognostic significance of thyroid hormone receptor-alpha-2 (THRα2) expression in triple-negative breast cancer: A TCGA study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2648.

Malignant peritoneal mesothelioma in patients with endometriosis

AimsFlorid mesothelial hyperplasia is known to result from endometriosis. Well-differentiated papillary mesothelioma and multiloculated peritoneal inclusion cysts have also been described in women with endometriosis. To our knowledge, peritoneal diffuse...

The effect of 12-month dehydroepiandrosterone supplementation on the menstrual pattern, ovarian reserve markers, and safety profile in women with premature ovarian insufficiency.

To evaluate the effect of 12-month DHEA supplementation on menstrual pattern and ovarian reserve markers in women with premature ovarian insufficiency (POI) METHODS: This is a prospective observational study. Women with POI were given DHEA supplements (25mg three times daily) for 12months. Sonographic assessment for ovarian volume and antral follicle count (AFC) and serum measurement for anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), estradiol, testosterone, liver function, and hemoglobin level were performed at baseline and monthly for 13months after the supplementation. Menstrual pattern, ovarian reserve markers, and side-effects were recorded. Between August 2011 and July 2014, 38 women with POI were recruited and 31 completed the study. The median age of women was 36years, and the median baseline FSH and AMH concentrations were 82.2IU/L and 0.01ng/ml, respectively. No women had resumption of regular menstruation after DHEA supplementation. AMH, FSH, and AFC did not change significantly. No serious side effects were reported. Our results do not support any significant improvement in ovarian function by 12-month DHEA supplementation in women with POI.

Abstract GS5-06: A U.S. food and drug administration pooled analysis of outcomes of older women with hormone-receptor positive metastatic breast cancer treated with a CDK4/6 inhibitor as initial endocrine based therapy

Abstract Background: With recent FDA approvals of inhibitors of Cyclin Dependent Kinases 4 and 6 (CDK 4/6) in combination with endocrine therapy for the treatment of postmenopausal women with hormone-receptor positive metastatic breast cancer (MBC), an increasing number of older adults will be treated with this class of agents. An improved understanding of the safety and efficacy of CDK 4/6 inhibitors in this population is important to inform clinical decision making for the treatment of older patients. Methods: Data from two prospective randomized controlled studies (n=1334) of different CDK 4/6 inhibitors in combination with an aromatase inhibitor for the initial treatment of postmenopausal patients with hormone-receptor positive MBC were pooled and analyzed. The effect of age on progression free survival (PFS) was explored using Kaplan Meier (KM) estimates and a Cox-proportional hazard model. Safety analysis included adverse events up to 30 days after last administration of drug based on standardized adverse event datasets. Results: Age was balanced between the two studies, and between treatment arms within each study. The median age of women was 62 (range 23-91). Of the 1334 total patients, 42% were ≥65, and 24% were ≥ 70. For patients ≥70 who were treated with a CDK4/6 inhibitor in combination with an aromatase inhibitor, the estimated PFS was not reached (95% CI: 25.1months, NR) vs an estimated 18 months (95% CI: 13.8, 31.3) for those treated only with an aromatase inhibitor. For patients &amp;lt;70 treated with a CDK4/6 inhibitor, the estimated PFS was 23.5 months (95% CI: 21.4, 25.7) vs an estimated 13.8 months (95% CI: 12.9, 16.5) for those treated only with an aromatase inhibitor. Safety was evaluated in the 778 patients who received at least one dose of CDK4/6 inhibitor. Adverse Events by Age in Patients Treated with a CDK4/6 Inhibitor Patients &amp;lt; 65 yearsPatients≥65 yearsPatients≥70 years N=447N=331N=187 n (%)n (%)n (%)Grade 1-2 Adverse Events437 (98)324 (98)185 (99)Grade 3-4 Adverse Events340 (76)276 (83)159 (85)Serious Adverse Events72 (16)88 (27)50 (27)Adverse Events Leading to Discontinuation35 (8)56 (17)38 (20)Adverse Events leading to dose reduction and/or interruption323 (72)253 (76)147 (79)Selected Adverse Events Neutropenia (all grades)341 (76)256 (77)150 (80)Grade 3-4 neutropenia292 (65)228 (69)134 (72)Infections (all grades)190 (43)165 (50)100 (53)Hepatotoxicty (all grades)79 (18)51 (15)34 (18)Grade 3-4 hepatotoxicity32 (7)16 (5)12 (6)Fatigue (all grades)195 (44)153 (46)89 (48)Grade 3 fatigue11 (2)11 (3)7 (4) Conclusions: This exploratory analysis suggests the use of a CDK4/6 inhibitor in combination with an aromatase inhibitor for the first line treatment of HR+ MBC in older women results in similar efficacy benefit as seen in younger women. Although incidence and severity of Grade 1-4 adverse reactions appeared similar between age groups, greater serious adverse events and discontinuations occurred in patients ≥65. The inclusion of greater numbers of patients ≥70, in clinical trials will further inform clinicians about the safety and efficacy of CDK4/6 inhibitors in older adults. Citation Format: Singh H, Howie LJ, Bloomquist E, Wedam S, Amiri-Kordestani L, Tang S, Sridhara R, Ibrahim A, Goldberg K, McKee A, Beaver JA, Pazdur R. A U.S. food and drug administration pooled analysis of outcomes of older women with hormone-receptor positive metastatic breast cancer treated with a CDK4/6 inhibitor as initial endocrine based therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS5-06.

Ovarian markers and irregular menses among women with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications study.

Women with type 1 diabetes have increased risk of infertility compared to women without diabetes even after adjustment for irregular menses, but aetiologies are incompletely understood. Our aim was to examine the prevalence of abnormalities in ovarian markers consistent with polycystic ovary syndrome in women with type 1 diabetes and associations with irregular menses and diabetes-specific variables. We conducted a secondary analysis of women in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC), a randomized trial and observational follow-up of intensive insulin therapy for type 1 diabetes. We included women with anti-Müllerian hormone (AMH) measurements among women not using oral contraceptives (n=187). Initial AMH and testosterone measures were performed between EDIC years 1 and 4. History of irregular menses was assessed annually. The median age of women was 35 (interquartile ratio 29, 40) years; 133 (35%) had elevated AMH and 62 (17%) reported irregular menses. Twelve per cent of women had relative elevations in total testosterone. In multivariable models, lower insulin dosages were associated with higher AMH concentrations (P=.0027), but not diabetes duration, glycemic control, body mass index or irregular menses. Neither irregular menses nor diabetes-specific variables were associated with testosterone concentrations. Among women with type 1 diabetes in their thirties, abnormalities in ovarian markers are common and not associated with irregular menses and thus may partially account for decreased fecundity in women with type 1 diabetes.

Evaluation of Viral Hepatitis B Treatment in Pointe-Noire in 2016

Prevalence of hepatitis B in Pointe-Noire is 23%. The objective of this study was to evaluate the level of therapeutic management of patients with hepatitis B in Pointe-Noire. Methods: A retrospective, cross-sectional, descriptive and analytical study. Results: 302 patients included: 217 (72%) men and 85 (28%) women of median age 40 years. The viral load was measured in 140 (46%) patients and in 162 (54%), the viral load was not measured. Their distribution according to the viremia was as follows: 0 - 1 log = 1 (0.7%) patients; 1.5 to 2 log = 23 (16%) patients; 2.5 to 3 log = 49 (35%) patients; >3log = 55 (39%) patients. Of the 302 patients included, 36 (11%) patients were treated with antivirals and 253 (83%) patients were not. Conclusion: The number of patients treated for chronic viral hepatitis B was low. Our results show interest for improved preventive and curative management of hepatitis B in Congo in order to reduce the existing high prevalence.

Factores psicosociales y comportamiento agresivo al conducir correlacionados con accidentes de tránsito en conductores salvadoreños

El presente estudio tiene como objetivo analizar si los factores psicosociales y el comportamiento agresivo al conducir están relacionados con los accidentes de tránsito de los conductores. El estudio es de tipo ex post facto, con diseños retrospectivo y transversal, con un muestreo no probabilístico de tipo intencionado. La muestra estuvo conformada por 1.012 conductores del transporte público y privado, de ambos sexos. La técnica fue la encuesta. La media de edad total fue de 34.81 años, con una DT (Desviación Típica) de 11.02. En hombres, la media de edad fue de 34.84 años, con una DT de 11.15; y en las mujeres, de 34.65 años, con una DT de 10.29. Entre las variables sociodemográficas están las siguientes: 152 (15,0 %) son mujeres y 860 (85,0 %) hombres; según los años de experiencia de conducir: los grupos de 1 a 5 años, 341 (33,9 %); de 6 a 15 años, 379 (37,7 %); de más de 16 años, 285 (28,4 %). Los instrumentos utilizados fueron: Escala de bienestar laboral, Escala Magallanes de estrés, Cuestionario de salud general, Escala de ansiedad y depresión, “Inventario de expresión de la ira del conductor” y Driving Log. En los resultados se encontró que existe una correlación importante entre los factores psicosociales y el comportamiento agresivo al conducir con los accidentes de tránsito cometidos.Entorno, octubre 2017, número 64: 9-19

Clinical significance of FDG-PET/CT in assessment of recurrence in breast cancer patients before surgery.

e23215 Background: FDG-PET/CT is widely used for the detection of primary breast cancer and metastasis, although its clinical significance is somewhat restricted to appropriate higher-risk populations. We attempted to apply maximum uptake values (SUVmax) of FDG-PET/CT to assess the malignant potential of breast cancer before surgery. Methods: We retrospectively reviewed 187 consecutive patients with invasive breast cancer and no distant metastasis recruited from 2009 to 2011 in our hospital who underwent PET/CT before surgery, and determined the representative PET imaging features by SUVmax. Correlation of SUVmax with several clinicopathological factors was evaluated by regression analysis. Relapse-free survival (RFS) and overall survival (OS) were compared among these factors and SUVmax using univariate and multivariate Cox analysis, Kaplan-Meier curves, and log-rank tests. Results: All patients were women of median age 60 years. The median follow-up period was 72 months. A logarithmic transformation was applied to SUVmax, which resulted in exclusion of 32 patients with no FDG uptake on PET/CT. Regression analysis revealed that SUVmax significantly correlated with ER (P = 0.0138), HER2 (P = 0.0153), lymph node metastasis (P &lt; 0.0001), and tumor size (P &lt; 0.0001). Multivariate analysis showed that tumor size was a significant independent factor. As regression analysis showed a strong correlation between SUVmax and tumor size &lt; 5 cm (P &lt; 0.0001), the 11 patients with tumor &gt; 5 cm were excluded. Concerning the malignant potential of tumors, RFS was evaluated by univariate analysis whereby the median log SUVmax (0.6) was the only significantly independent factor to predict recurrence (P = 0.045). Patients with log SUVmax &gt; 0.6 showed poor RFS (11 patients with recurrence) compared with log SUVmax &lt; 0.6 (2 patients with recurrence) (P = 0.0064). OS showed no significant correlation. Conclusions: PET/CT is potentially a valuable modality to predict tumor recurrence in patients with breast cancer whose tumor size is &lt; 5 cm and demonstrates uptake before surgery.

Trends in Age at Marriage and the Onset of Fertility Transition in sub‐Saharan Africa

In this chapter the author adopts a comparative approach to examining longterm trends in female age at marriage and fertility in sub-Saharan Africa with a focus on continental countries having at least 1 million inhabitants. The author’s database on nuptiality includes over 360 censuses and national surveys conducted in these 39 countries since the 1960s. The author analyzes the association between changes in age at first union and the onset of fertility transition examining whether there is a typical pattern of association followed by most countries in the region.

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities.

Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect posttreatment cervical disease in HIV-infected women in Kenya. This is a prospective cohort study. At least 6 months following cryotherapy, 517 HIV-infected women were evaluated concurrently with visual inspection with acetic acid (VIA), papanicolaou (Pap) smear, and high-risk human papillomavirus (HR-HPV) testing. Women positive by any test (≥low-grade squamous intraepithelial lesion for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation [and 174 assumed to be truly negative for cervical intraepithelial neoplasia (CIN)2+ after testing negative by all three tests], the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in posttreatment follow-up. The median age of women was 35 years, 68% were WHO stage 1-2, with a median CD4 cell count of 410 cells/μl, and 87% were on combination antiretroviral therapy. At a median of 6.3 months posttreatment, 64% had an abnormal screen by VIA, Pap, and/or HR-HPV. Among women with histological confirmation, 72 (30%) had persistent/recurrent CIN2+. As single tests, Pap correctly classified the most cases (83%) and had the highest specificity [91% (88 and 95%); sensitivity 44% (35 and 53%)], whereas HR-HPV had the highest sensitivity [85% (75 and 96%); specificity 54% (49 and 58%)]. VIA was not sensitive [27% (18 and 36%)] for the detection of posttreatment CIN2+ [specificity 82% (79 and 86%)]. With the goal to minimize the number of false negatives (e.g. not miss CIN2+ posttreatment) in this population that is high-risk due to both prior cervical disease and HIV infection, HR-HPV-based algorithms are recommended.

Disseminated peritoneal leiomyomatosis postmorcellated resection of uterine leiomyomatous tissue

In a retrospective review, we identified six cases of disseminated peritoneal leiomyomatosis (DPL) that occurred after resection for uterine leiomyoma(ta) using a morcellation procedure between 2010 and 2016. DPL occurred in less than 1% of all patients who underwent a prior hysterectomy with morcellation, and DPL never occurred without having underwent such a resection. The median age of women at the time of their original resection of uterine tissue was 38.6 years; the median time interval until resection of DPL after the primary morcellation procedure was 73 months and the median age was 48 years. At the time of DPL resection, a median of 6.5 individual lesions was present per patient, with each lesion having a median size of 1.2 cm in the greatest dimension. The most common peritoneal sites of involvement included the sigmoid colon serosa, right pelvis/pelvic side wall, and anterior abdominal parietal peritoneum. The same parameters are described for previously reported cases of DPL in the literature developing after a morcellated resection of uterine leiomyoma(ta). The use of morcellating hysterectomy specimens with leiomyomata may lead to the development of DPL by seeding, may involve numerous peritoneal sites, and often presents 2 years after the original resection.

Risk Factors and Plasma Glucose Profile of Gestational Diabetes in Omani Women.

We sought to conduct a detailed study on the risk factors of gestational diabetes mellitus (GDM) in Omani women to determine the actual and applicable risk factors and glucose profile in this population. We conducted a cross-sectional case-control study using pregnant women diagnosed with GDM. Pregnant women without GDM were used as a control group. We collected information related to age, family history, prior history of pregnancy complications, age of marriage, age of first pregnancy, fasting glucose level, and oral glucose tolerance test (OGTT) results from three hospitals in Oman through face-to-face interviews and hospital records. The median age of women with GDM was 33 years old (p < 0.050). A significant risk was noted in women with a history of diabetes (p < 0.001), and those with mothers' with a history of GDM. A significant (p < 0.010) relationship with a likelihood ratio of 43.9 was observed between the incidence of GDM in women with five or six pregnancies, a history of > 3 deliveries, height < 155 cm, and pregnancy or marriage at age < 18 years (p < 0.010). The mean difference in random plasma glucose, one-hour OGTT, and two-hour OGTT was significantly higher in GDM cases compared to control. Glucose profile, family history, anthropometric profile, and age of first pregnancy and marriage should be considered while screening for GDM and determining the care needs of Omani women with GDM.

The prevalence of endometrial cancer in pre- and postmenopausal Chinese women.

The incidence of endometrial cancer depends in part on the ethnicity and geographical area in which the woman resides. Menopause status is a well-known risk factor for endometrial cancer and most cases occur after menopause. It is, however, less clear how the menopause status is associated with endometrial cancer including its subtypes in Chinese women. Data on 1,746 women with endometrial cancer including age at diagnosis, age at menopause, and tumor histology from two large obstetrical and gynecological hospitals in China were analyzed. The median age of women at diagnosis was 50 years. Fifty-eight percent of women were diagnosed after menopause. Fifty-six percent of women with type 1 and 69% with type 2 were diagnosed after menopause. In addition, in both pre- and postmenopausal women, there was no difference in the age at diagnosis between type 1 (46 vs 46 y) and type 2 endometrial cancer (53 vs 52 y). Our data demonstrate that although both type 1 and type 2 endometrial cancers are more likely to occur in Chinese women after menopause than before, the total prevalence of endometrial cancer is lower in our study population than in previous reports from white women (80%). The age at diagnosis did not differ between type 1 and type 2 endometrial cancers regardless of the menopause status in our study population. Our results caution clinicians to be more aware of the importance of abnormal uterine bleeding in premenopausal Chinese women.

Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation

BackgroundDiffusion Weighted (DW) Magnetic Resonance Imaging (MRI) has been studed in several cancers including cervical cancer. This study was designed to investigate the association of DW-MRI parameters with baseline clinical features and clinical outcomes (local regional control (LRC), disease free survival (DFS) and disease specific survival (DSS)) in cervical cancer patients treated with definitive chemoradiation.Methods This was a retrospective study approved by an institutional review board that included 66 women with cervical cancer treated with definitive chemoradiation who underwent pre-treatment MRI at our institution between 2012 and 2013. A region of interest (ROI) was manually drawn by one of three radiologists with experience in pelvic imaging on a single axial CT slice encompassing the widest diameter of the cervical tumor while excluding areas of necrosis. The following apparent diffusion coefficient (ADC) values (×10−3 mm2/s) were extracted for each ROI: Minimum - ADCmin, Maximum - ADCmax, Mean - ADCmean, and Standard Deviation of the ADC - ADCdev. Receiver operating characteristic (ROC) curves were built to choose the most accurate cut off value for each ADC value. Correlation between imaging metrics and baseline clinical features were evaluated using the Mann Whitney test. Confirmatory multi-variate Cox modeling was used to test associations with LRC (adjusted by gross tumor volume – GTV), DFS and DSS (both adjusted by FIGO stage). Kaplan Meyer curves were built for DFS and DSS. A p-value < 0.05 was considered significant.Women median age was 52 years (range 23–90). 67 % had FIGO stage I-II disease while 33 % had FIGO stage III-IV disease. Eighty-two percent had squamous cell cancer. Eighty-eight percent received concurrent cisplatin chemotherapy with radiation. Median EQD2 of external beam and brachytherapy was 82.2 Gy (range 74–84).ResultsWomen with disease staged III-IV (FIGO) had significantly higher mean ADCmax values compared with those with stage I-II (1.806 (0.4) vs 1.485 (0.4), p = 0.01). Patients with imaging defined positive nodes also had significantly higher mean (±SD) ADCmax values compared with lymph node negative patients (1.995 (0.3) vs 1.551 (0.5), p = 0.03).With a median follow-up of 32 months (range 5–43) 11 patients (17 %) have developed recurrent disease and 8 (12 %) have died because of cervical cancer. ROC curves based on DSS showed optimal cutoffs for ADCmin (0.488 × 10−3), ADCmean (0.827 × 10−3), ADCmax (1.838 × 10−3) and ADCdev (0.148 × 10−3). ADCmin higher than the cutoff was significantly associated with worse DFS (HR = 3.632–95 % CI: 1.094–12.054; p = 0.035) and DSS (HR = 4.401–95 % CI: 1.048–18.483; p = 0.043).ConclusionPre-treatment ADCmax measured in the primary tumor may be associated with FIGO stage and lymph node status. Pre-treatment ADCmin may be a prognostic factor associated with disease-free survival and disease-specific survival in cervical cancer patients treated with definitive chemoradiation. Prospective validation of these findings is currently ongoing.

Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence

Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population. Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence. The median age of women (n= 33) and men (n= 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p= 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that wastreated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtainedduring the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months. PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy.

Recurrence Rates of Benign Phyllodes Tumors After Surgical Excision and Ultrasonography-Guided Vacuum-Assisted Excision.

The recurrence rates of benign phyllodes tumors diagnosed through surgery and ultrasound-guided vacuum-assisted excision (US-VAE) were evaluated. A total of 146 benign phyllodes tumors diagnosed by surgery (n = 126) or US-VAE (n = 20) in 144 patients who had further follow-up after surgery or US-VAE were included (median follow-up period, 32.3 months; range, 6.7-142.5 months). Comparisons of recurrence rate, interval to recurrence, patient age, initial tumor size, Breast Imaging Reporting and Data System category, or follow-up interval were performed between the surgery and VAE groups and between groups with and without recurrence. Three cases (2.1%, 3/146) had recurrence and all were in the surgery group (2.4%, 3/126). The surgery group demonstrated larger size than the VAE group (median, 25 vs 16 mm; P < 0.001). The median age of women in the surgery group was older than those in the VAE group (39 vs 33 years, P = 0.509). The median age of women with recurrence (n = 3) was older than those without recurrence (n = 143, 49 vs 38 years, P = 0.023). In conclusion, when benign phyllodes tumor is unexpectedly diagnosed at US-VAE, if there is no residual lesion at US, clinical follow-up rather than further surgery might be recommended.