Treatment Of Female Patients Research Articles

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors

BackgroundLong-term results and factors affecting outcomes of vacuum bell therapy for pectus excavatum are relatively unknown. MethodsWe conducted a retrospective study on patients (<18y) treated with vacuum bell therapy between May 2008 and October 2021. Primary outcome was treatment success; secondary outcomes were analysis of daily time spent on treatment, treatment duration, complications, long-term follow-up, treatment for patients awaiting a Nuss procedure, treatment for female patients, and factors affecting outcomes. ResultsOf 259 patients treated with vacuum bell therapy, 18.9% (n = 49/259) were still being treated, 17.4% (n = 45/259) were lost to follow-up and 63.7% (n = 165/259) completed treatment, with a 52.1% (n = 86/165) success rate. Median follow-up was 64.0 months (interquartile range 48.0–87.0). More time spent daily on vacuum bell therapy, total treatment duration, and overnight use led to a higher success rate (P = 0.002, P < 0.001, P < 0.001 resp.). Complications (22.8%, n = 59/259) were minor, recurrence occurred in 2.3% (n = 2/86) of patients. Of the patients treated while awaiting a Nuss procedure, 26.7% (n = 4/15) no longer required the Nuss procedure. Breast growth made 39.3% (n = 11/28) of female patients quit treatment. Deeper deformities (P = 0.02, P = 0.009), flexible chest wall (P = 0.007) and symptomatic pectus excavatum (P = 0.02) resulted in lower success rates. ConclusionsVacuum bell therapy is successful in up to 52.1% of patients. Overnight vacuum bell use and treatment while awaiting a Nuss procedure should be encouraged. Older patients with a stiff chest wall can be successfully treated with prolonged treatment. For female patients watchful waiting or early treatment, to prevent challenges during breast growth, is preferred. Level of evidenceLevel II.

Efficacy of transcutaneous electrical nerve stimulation combined with mirabegron therapy compared with mirabegron monotherapy for overactive bladder: a prospective randomized controlled study.

The objective was to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) combined with mirabegron therapy compared with mirabegron monotherapy in the treatment of female patients with overactive bladder (OAB). In this randomized controlled study, 100 female outpatients with OAB were screened. Among these patients, 86 who met the inclusion criteria were randomly divided into the TENS combined with mirabegron treatment group and mirabegron monotherapy treatment group, with 43 patients in each group. The voiding diary, Overactive Bladder Symptom Score (OABSS), Overactive Bladder Questionnaire Symptom Bother Score (OAB-q SBS), total health-related quality of life (OAB-q HRQoL), and treatment satisfaction-visual analog scale (TS-VAS) score before and after treatment were recorded to evaluate the efficacy of OAB treatment. Seventy-nine of the 86 patients (40 in the TENS plus mirabegron group and 39 in the mirabegron monotherapy group) completed 12 weeks of treatment. TENS combined with mirabegron therapy was superior to mirabegron monotherapy in improving the primary endpoints, including the daily number of micturition episodes and the daily MVV/micturition and secondary endpoints, including the daily number of urgency episodes, the OABSS, the OAB-q SBS, the HRQoL score and TS-VAS score. There were no statistically significant differences in urgency urinary incontinence and nocturia between the groups. Some minor adverse effects were observed, including muscle pain, local paresthesia and constipation. The combination of TENS and mirabegron was more effective than mirabegron alone in the treatment of female patients with OAB. ChiCTR2400080528 (31.01.2024, retrospectively registered).

Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence.

Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.

Efficacy of combined phytotherapy (NefroBest® and UroBest®) in female patients with urolithiasis and preoperative drainage of upper urinary tract before ureteroscopy

Introduction. In most cases, double-J stent placement is the initial method of drainage in patients with urolithiasis. Until ureteroscopic intervention, most patients report «stent-related symptoms» that reduce the quality of life.Objective. To improve the results of treatment in female patients with urinary stone disease (USD) and preoperative drainage of the upper urinary tract using double-J stent by assessing the effect of the NefroBest® and UroBest® complexes on the prevention of the development of «stent-related symptoms» and inflammatory processes.Materials &amp; methods. The study group included 90 female patients with USD, who were performed ureteroscopic interventions with preoperative stent placement from March to September 2023 in the Yudin City Clinical Hospital. Patients were divided into two groups: the main group 1 (n = 30) — patients who received phytotherapy with NefroBest® (30 days) and UroBest® (7 days) complexes after placement of an internal ureteral stent; the control group 2 (n = 60) — patients who did not receive specific therapy postoperatively.Results. According to the USSQ, in group 1 the median score due to urinary symptoms was 22 points, and in group 2 — 28 points (p = 0.001), when assessing symptoms associated with pain — 12 and 18 points (p &lt; 0.001), general health — 17 points both and work performance — 9 and 11 points, respectively. Among patients in group 1, stonefree rate was observed in 90.0%, and among patients in group 2 — in 93.3%. In group 1, antibacterial therapy in the postoperative period was in 37.0% of patients, and in group 2 – among 53.0%.Conclusion. The co-use of the NefroBest® and UroBest® complexes in female patients with USD and preoperative drainage of the upper urinary tract using double-J stent can reduce the severity of symptoms associated with urination and pain, and postoperatively resulted in a lower incidence of infectious-inflammatory complications.

Возможности коррекции гормонального статуса, репродуктивной функции и нейровегетативных расстройств у пациенток с преждевременной недостаточностью яичников

Background: nowadays reproductive health condition tends to worsen. One of the problems is a decrease in the ovarian reserve, manifested in the form of premature ovarian insufficiency (POI), which initiates the infertility problem on the one hand, and the issue of premature menopause with all its accompanying socio-psychological aspects on the other Aim: to study the therapeutic possibilities of the bovine epiphyseal cartilage polypeptide in POI and anovulation in female patients aged 30–45 years old. Patients and Methods: the study included 40 female patients aged 30–45 years with a BMI of 18.5–29.9 kg/m2 and POI signs, determined by the following indicators: follicle-stimulating hormone (FSH) concentration ≥12 IU/L; anti-müllerian hormone (AMH) 0.2–1.2 ng/mL; antral follicle count (AFC) ≤5 during ultrasound on the 7th±2 day of the menstrual cycle; decreased serum estradiol concentration and anovulation lasting 1 to 5 years or with failed IVF. The female cohort was randomized into 2 groups of 20 persons: for two menstrual cycles, the main group received a drug for menopausal hormone therapy (MHT) containing 2 mg of estradiol and 10 mg of didrogesterone (per os 1 tablet daily in a cyclic regimen from day 1 to day 28) and the bovine epiphyseal cartilage polypeptide (lyophilizate for the preparation of a solution for intramuscular administration, 10 mg intramuscularly daily for 10 days from the 5th to the 14th day of the cycle). The control group received only MHT in the same regimen for two menstrual cycles. During the study, the changes of endometrial thickness and follicle growth, ovulation markers (corpus luteum), FSH, estradiol and AMH concentrations, the number of female patients with a normalized menstrual cycle and spontaneous conception were evaluated in both groups Results: in the main group there was a statistically significant (p&lt;0.05) decrease in FSH and luteinizing hormone (LH) levels relative to the baseline, an increase in estradiol concentration, an increase in the AFC and endometrial thickness, whereas the similar indicator changes were statistically insignificant in the control group. Besides, complete relief of neurovegetative symptoms was noted in the main group, and restoration of the ovulatory cycle was observed in 6 (30%) cases. There were no adverse events or complications during the drug regimen. Conclusion: the results obtained indicated the efficacy of the bovine epiphyseal cartilage polypeptide in the treatment of female patients with POI and anovulation and allowed to recommend the developed treatment regimen for practical use. KEYWORDS: premature ovarian insufficiency, follicle-stimulating hormone, anti-müllerian hormone, infertility, anovulation, menopausal disorders FOR CITATION: Khardikov A.V., Netyaga O.A. Correction of hormonal status, reproductive function and neurovegetative disorders in female patients with primary ovarian insufficiency. Russian Journal of Woman and Child Health. 2024;7(2):116–122 (in Russ.). DOI: 10.32364/2618- 8430-2024-7-2-5.

Analysis of Urinary Conditions and Effects of Pelvic Floor Muscle Electrical Stimulation Combined with Biofeedback Therapy in Women with Stress Urinary Incontinence

Objective: To analyze the urinary conditions and assess the effects of pelvic floor muscle electrical stimulation combined with biofeedback treatment in female patients with stress urinary incontinence. Methods: 80 patients with stress urinary incontinence admitted to Haimen District Traditional Chinese Medicine Hospital from March 2023 to September 2023 were included as the research subjects. Following the principle of random grouping, they were divided into an observation group and a control group. Patients in the control group received single pelvic floor muscle electrical stimulation treatment, while patients in the observation group underwent pelvic floor muscle electrical stimulation combined with biofeedback. The treatment effects, pelvic floor muscle strength, quality of life, and any adverse reactions in both groups were analyzed. Results: The total effective rate of patients undergoing combined treatment was significantly higher (P &lt; 0.05) compared to the control group with a single treatment. While there was no significant difference in the pelvic floor muscle data between the observation and control groups before treatment, after treatment, the data in the observation group showed a significant increase (P &lt; 0.05). Before treatment, there was no statistical difference in quality of life data between the two groups (P &gt; 0.05), but after treatment, the quality of life score in the observation group was significantly higher (P &lt; 0.05). No adverse reactions were reported in either group during the treatment process. Conclusion: Pelvic floor muscle electrical stimulation combined with biofeedback can effectively improve urinary leakage in patients with stress urinary incontinence, demonstrating a relatively ideal clinical effect. Furthermore, this combined treatment can enhance pelvic floor muscle condition, improve quality of life, and effectively safeguard the physical and mental health of female patients.

Indicators of quality of life, anxiety-depressive symptoms and severity of dysmenorrhea in adolescent girls with peritoneal endometriosis during conservative therapy for a year

Introduction. Delayed diagnosis and treatment of endometriosis lead to impaired quality of life and pain chronification in young female patients.Aim. To study indicators of quality of life, anxiety, depression and pain syndrome in adolescents with peritoneal endometriosis (PE) over a one-year period of conservative therapy.Materials and methods. A total of 45 girls aged 13 to 17 years with a confirmed diagnosis of PE were enrolled in a prospective longitudinal study. Pain syndrome (VAS, McGill Pain Questionnaire), anxiety-depressive symptoms (Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI)), quality of life indicators (SF-36) were assessed before and after one year of treatment in female patients (dienogest administered continuously, NSAIDs and drotaverine for immediate pain relief only).Results. One year of therapy resulted in a significant decrease in the severity of dysmenorrhea and chronic pelvic pain, gastrointestinal symptoms and dysuria, daily activity and productivity impairment (p &lt; 0.001) in girls with PE. In addition, the study demonstrated decreased indicators of anxiety and depressive disorders (BDI depression, HADS anxiety and depression, STAI reactive and personal anxiety (p &lt; 0.001)) and an improvement in quality-of-life indicators (physical and psychological component, average index (p &lt; 0.001)). There was a declining trend in blood hormone and inflammation test results within the reference range during treatment. The estradiol level has been shown to be a risk factor for high levels of affective disorder symptoms in adolescents with PE: STAI reactive anxiety (p = 0.046), HADS anxiety and depression (p = 0.044 and 0.033, respectively).Conclusion. The one-year therapy of PE in adolescents (dienogest administered continuously, a combination of NSAIDs and drotaverine in pain syndrome only) was associated with significantly improved quality of life, decreased severity of anxietydepressive disorders and pain, which confirms the need to start therapy when symptoms of the disease begin to show them-selves in adolescence.

Real-world experience of OnabotulinumtoxinA treatment in female patients with chronic migraine: a qualitative study using in-depth interviews

Background Chronic migraine (CM) causes great disability and affects an individual’s quality of life. OnabotulinumtoxinA (OBT-A, Botox®) was the first prophylactic treatment specifically indicated for CM. The aim of this study was to describe the experiences of women with CM treated with OBT-A. Materials and Methods The study design is a qualitative descriptive study. A purposeful sampling of 30 women (mean age, 42.7; standard deviation, 10.6) who had received at least two administrations of OBT-A for CM (PREEMPT protocol) was performed. Data collection included in-depth interviews and researchers’ field notes. A thematic analysis was carried out according to qualitative research guidelines. Results Five themes were identified: (a) A long way to go before Botox®, (b) First time hearing about the treatment and its expectations, (c) The administration of Botox®, (d) Treatment effects, and (e) Follow-up. Patients described a long history of treatment failures prior to the start of OBT-A treatment. Information about this migraine treatment came from the neurologist; following the information, patients had high expectations, including unrealistic expectations regarding the onset and duration of effect. They acknowledged fear of the injections and some discomfort due to the procedure. With treatment, participants reported better migraine control and an improvement in their quality of life. Follow-up had some barriers, such as delayed appointments for subsequent doses, but also strengths, such as effectiveness and few side effects. Conclusions Qualitative research offers insight into how patients with CM experience treatment with OBT-A. Our results highlight some relevant aspects that should be considered when providing OBT-A treatment.

The Effects of Extracorporeal Magnetic Innervation in the Treatment of Women with Urinary Incontinence: A Systematic Review.

The aim of this study is to identify and critically evaluate literature regarding the clinical efficacy of extracorporeal magnetic innervation (ExMI) in the treatment of female patients with urinary incontinence (UI). An analysis was carried out using the following electronic databases: Medline, PubMed, ScienceDirect, and the Cochrane Library (data published between 2008 and 2023). Searches of the above databases were conducted in April 2023. Only randomized clinical studies (RCTs) in English studies were eligible for the study. Randomized controlled trials were included in the review and evaluated with the Downs and Black checklist. Eleven studies met the inclusion criteria. Among these, two studies examined the use of ExMI and PMFT (pelvic floor muscle training) and three studies compared active ExMI versus sham ExMI. Four studies evaluated solely ExMI, and moreover, there was no control group in two of these studies. One study compared the effects of Kegel exercises with ExMI, while another study compared electrostimulation with ExMI. The reviewed studies exhibited significant differences in interventions, populations, and outcome measures. Extracorporeal magnetic stimulation has shown promise as an effective treatment for female urinary incontinence. Whether used alone or as a component of combination therapy, ExMI has the potential to enhance patients' quality of life (QoL) without significant safety concerns.

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)

The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD42-06 EFFECTS OF INTRAVESICAL BOTULINUM TOXIN TYPE-A INJECTION LOCATION ON SYMPTOM SCORES AND SEXUAL FUNCTIONS IN FEMALE PATIENTS WITH A DIAGNOSIS OF REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS: A RANDOMIZED, PROSPECTIVE STUDY Murat Karaburun, Eralp Kubilay, Derya Gökmen, Mehmet İlker Gökçe, Evren Süer, and Ömer Gülpınar Murat KaraburunMurat Karaburun More articles by this author , Eralp KubilayEralp Kubilay More articles by this author , Derya GökmenDerya Gökmen More articles by this author , Mehmet İlker GökçeMehmet İlker Gökçe More articles by this author , Evren SüerEvren Süer More articles by this author , and Ömer GülpınarÖmer Gülpınar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine the effect of Intravesical Botulinum Toxin type-A (BTX-A) treatment with trigon included and trigone sparing on symptoms and sexual function in female patients diagnosed with Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) who did not benefit from conventional treatments. METHODS: Patients with BPS/IC who were treated with hydrodistension+BTX-A were enrolled in the study between January 2020 and April 2022. Using the stratified randomization technique, patients were randomly randomized to one of two groups: hydrodistension+trigone sparing injection (Group-1) or hydrodistension+trigone-included injection (Group-2). The study comprised a total of 27 patients. The patients were evaluated with VAS, ICSI, ICPI, FSFI questionnaires, and 3-day voiding diaries, voiding tests, and residual urine tests (uroflowmetry and residue determination) in the preoperative period and in the postoperative first and third months. RESULTS: The study comprised a total of 27 patients, 14 from Group-1 with a mean age of 40,9 (±9,25) and 13 from Group-2 with a mean age of 41.7 (±10.3). Preoperative VAS, ICSI, ICPI, and FSFI scores for 27 patients were 8.95±1.39; 16.21±2.94; 14.38±2.27 and 15.92±3.73, respectively. VAS, ICSI, ICPI, and FSFI scores were 3.47±2.94; 7.14±3.97; 6.47±3.95 and 22.41±5.02 at the first postoperative month, respectively. It was 2.69±3.18; 5.79±5.08; 5.79±4.95 and 24.41±6.06 in the third month postoperatively. Treatment led to statistically significant improvements in all four variables (p<0.001). While significant improvement was observed with treatment in both groups, no difference was found between the two groups in terms of treatment results (p: 0.89; p: 0.341; p: 0.488 and p: 0.706, respectively). In total, two patients had urinary tract infection in the postoperative period and one patient had retention, but there was no difference between the two groups in terms of adverse effects (p>0.05). CONCLUSIONS: Intravesical BTX-A treatment is an effective and safe treatment in female patients with BPS/IC unresponsive to conventional treatments. The treatment also contributes positively to sexual functions. The inclusion of trigone in the injections makes no difference to the treatment response. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1113 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Murat Karaburun More articles by this author Eralp Kubilay More articles by this author Derya Gökmen More articles by this author Mehmet İlker Gökçe More articles by this author Evren Süer More articles by this author Ömer Gülpınar More articles by this author Expand All Advertisement PDF downloadLoading ...

Association between progression-free survival and overall survival in women receiving first-line treatment for metastatic breast cancer: evidence from the ESME real-world database

BackgroundOverall survival (OS) is the gold standard endpoint to assess treatment efficacy in cancer clinical trials. In metastatic breast cancer (mBC), progression-free survival (PFS) is commonly used as an intermediate endpoint. Evidence remains scarce regarding the degree of association between PFS and OS. Our study aimed to describe the individual-level association between real-world PFS (rwPFS) and OS according to first-line treatment in female patients with mBC managed in real-world setting for each BC subtype (defined by status for both hormone-receptor [HR] expression and HER2 protein expression/gene amplification).MethodsWe extracted data from the ESME mBC database (NCT03275311) which gathers deidentified data from consecutive patients managed in 18 French Comprehensive Cancer Centers. Adult women diagnosed with mBC between 2008 and 2017 were included. Endpoints (PFS, OS) were described using the Kaplan–Meier method. Individual-level associations between rwPFS and OS were estimated using the Spearman’s correlation coefficient. Analyses were conducted by tumor subtype.Results20,033 women were eligible. Median age was 60.0 years. Median follow-up duration was 62.3 months. Median rwPFS ranged from 6.0 months (95% CI 5.8–6.2) for HR-/HER2 − subtype to 13.3 months (36% CI 12.7–14.3) for HR + /HER2 + subtype. Correlation coefficients were highly variable across subtypes and first-line (L1) treatments. Among patients with HR − /HER2 − mBC, correlation coefficients ranged from 0.73 to 0.81, suggesting a strong rwPFS/OS association. For HR + /HER2 + mBC patients, the individual-level associations were weak to strong with coefficients ranging from 0.33 to 0.43 for monotherapy and from 0.67 to 0.78 for combined therapies.ConclusionsOur study provides comprehensive information on individual-level association between rwPFS and OS for L1 treatments in mBC women managed in real-life practice. Our results could be used as a basis for future research dedicated to surrogate endpoint candidates.

EXPERIENCE OF USING ENHANCED POSTOPERATIVE RECOVERY PROGRAM IN THE TREATMENT OF PELVIOPERITONITIS

Purpose: This article describes the experience of using the Enhanced Recovery After Surgery (ERAS) program in the treatment of female patients with pelvioperitonitis in a gynecological in-patient department. Materials and Methods: We examined 60 female patients who were divided into the main and comparison groups. The groups were comparable in terms of age, marital status, education, and place of residence. In addition to the standard approaches in the treatment of pelvioperitonitis, 30 patients of the main group were treated using some elements of the concept of enhanced recovery, such as detailed preoperative counseling about future treatment, non-use of premedication, control of hypothermia during and after surgery, prevention of dyspeptic disorders in postoperative period, avoiding narcotic analgesics, early enteral nutrition and mobilization. In the comparison group, which also included 30 patients, the treatment of pelvioperitonitis was carried out in strict accordance with the standard scheme - surgery, balanced infusion therapy, symptomatic treatment. Results: At the same time, the pain level by the visual analogue scale (VAS) averaged 6.11 ± 0.34 after 2, 4 and 8 hours in women from the comparison group. Vomiting was registered in 3 (10.0%) patients from the main group on the day 1 of the postoperative period. Whereas 7 (23.3%) patients from the comparison group had vomiting on the day 1 of the postoperative period. The absence of active motility and passage of flatus, an increase in hypoproteinemia, hypoalbuminemia, and an increase in the level of leukocytosis in both groups showed the severity of the systemic inflammatory response. However, by the end of the day 2 of the postoperative period, the improvement in biochemical parameters was registered as a sign of a positive change in the patients’ general condition. LII decreased by 1.5 times by the day 5 in the comparison group; but in the main group it decreased by 2.3 times. First active peristaltic noises were auscultated and first passage of flatus were noted on average after 20.33 ± 1.02 hours in the main group, but in the comparison group - after 40.28 ± 0.81 hours. In addition to that, the need for pharmacological intestinal stimulation was 2.5 times higher in patients from the comparison group than in patients from the main group. Postoperative purulent inflammation of the wound was registered in 9 (30.0%) women from the control group. However, only 2 (6.7%) women from the main group had one of the above mentioned disorders. The absolute risk reduction is 15% and NNT = 7. The average hospital stay for patients from the main group was 6.15 ± 0.25 days, and 8.64 ± 0.38 days for women from the comparison group. Conclusion: The results obtained during the study prove the effectiveness of the concept of enhanced recovery in the treatment of pelvioperitonitis.

Diagnosis and Therapy of Female Urinary Incontinence. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/091, January 2022): Part 1 with Recommendations on Diagnostics and Conservative and Medical Treatment.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.

Acupuncture treatment in female patient diagnosed with hypothyroidism after COVID-19 infection

Acupuncture treatment in female patient diagnosed with hypothyroidism after COVID-19 infection

Evaluating the Role of Adjuvant Radiation Therapy in Node-Positive Male Breast Cancer Patients Using the NCDB

<h3>Purpose/Objective(s)</h3> The survival benefit associated with adjuvant external beam radiation therapy (EBRT), following mastectomy and breast conserving surgery, in the treatment of female patients with lymph node-positive (LN+) breast cancer is well established. Treatment of LN+ male breast cancer is largely extrapolated from randomized clinical trials and meta-analyses including females only. This study retrospectively examines the impact of adjuvant EBRT, after either mastectomy or breast conserving surgery, in LN+ male breast cancer patients using data from the National Cancer Database (NCDB). We hypothesize that a survival benefit will also be seen in LN+ male breast cancer patients receiving adjuvant EBRT. <h3>Materials/Methods</h3> The NCDB was queried for male patients with a diagnosis of invasive breast cancer who were pathologically node positive from 2004 to 2017. Patients were excluded if they had metastatic disease at time of diagnosis or pathologically node negative disease. We included males irrespective of type of surgery performed, including mastectomy, lumpectomy, sentinel lymph node biopsy, and/or axillary lymph node dissection. Cohorts were separated based upon treatment with or without EBRT. Cox regression was used for multivariate survival analyses taking into account patient's insurance, Charlson-Deyo-Comorbidity score, hormone receptor status, age at diagnosis, number of LNs involved, and if adjuvant chemotherapy and/or hormone therapy were delivered. <h3>Results</h3> A total of 7,558 men were identified, with 3,852 (51%) having received EBRT (cohort 1a) and 3,706 who did not receive EBRT (cohort 1b). See the table below for some of the patient characteristics. Numbers listed in the table represent the total number of patients with percentages of each cohort in parenthesis. Five-year overall survival was 72.3% for those who received EBRT in comparison to 64.6% for those who did not receive EBRT. When using multi-variate survival analysis, the hazard ratio for cohort 1b as compared to cohort 1a was 1.30 (p <0.01), signifying that those who did not receive EBRT were 30% more likely to die in comparison to those who did receive EBRT. <h3>Conclusion</h3> There appears to be an overall survival benefit associated with adjuvant EBRT in LN+ male breast cancer patients, despite those patients presenting with higher stage. Consideration for adjuvant radiation therapy in LN+ male breast cancer patients should be discussed.

Sex-Specific Association between Antioxidant Defense System and Therapeutic Response to Risperidone in Schizophrenia: A Prospective Longitudinal Study.

There are various differences in response to different antipsychotics and antioxidant defense systems (ADS) by sex. Previous studies have shown that several ADS enzymes are closely related to the treatment response of patients with antipsychotics-naïve first-episode (ANFE) schizophrenia. Therefore, the main goal of this study was to assess the sex difference in the relationship between changes in ADS enzyme activities and risperidone response. The plasma activities of glutathione peroxidase (GPx), catalase (CAT), superoxide dismutase (SOD), and total antioxidant status (TAS) were measured in 218 patients and 125 healthy controls. Patients were treated with risperidone for 3 months, and we measured PANSS for psychopathological symptoms and ADS biomarkers at baseline and at the end of 3 months of treatment. We compared sex-specific group differences between 50 non-responders and 168 responders at baseline and at the end of the three months of treatment. We found that female patients responded better to risperidone treatment than male patients. At baseline and 3-month follow-up, there were no significant sex differences in TAS levels and three ADS enzyme activities. Interestingly, only in female patients, after 12 weeks of risperidone treatment, the GPx activity of responders was higher than that of non-responders. These results indicate that after treatment with risperidone, changes in GPx activity were associated with treatment response, suggesting that changes in GPx may be a predictor of response to risperidone treatment in female patients with ANFE schizophrenia.

Evaluation of factors related to morphological masseter muscle changes after preoperative orthodontic treatment in female patients with skeletal class III dentofacial deformities

BackgroundThe purpose of the current study was to investigate factors related to morphological changes in the masseter muscle after preoperative orthodontic treatment in patients with skeletal class III dentofacial deformities for analysis of muscle changes and malocclusions.MethodsTwenty female patients with dentofacial deformities were included in the study. Computed tomography was performed before and after preoperative orthodontic treatment, and the lengths, widths, and cross-sectional areas of the masseter muscles were measured. Changes in these parameters were evaluated, and factors related to changes in masseter muscle area after preoperative orthodontic treatment were analyzed.ResultsThe lengths, widths, and areas of masseter muscles were significantly smaller after preoperative orthodontic treatment. Smaller masseter muscle area was significantly associated with changes in overbite and pretreatment values of SNA angle.ConclusionsAtrophy of the masseter muscle during preoperative orthodontic treatment was greater in patients with increased open bite due to improved dental compensation in patients with skeletal class III dentofacial deformities with maxillary retraction.

An Update on Demand and Pattern of Root Canal Treatments in a Clinical Setting in Lagos, Nigeria

There have been a growing number of patients demanding root canal treatment to save their teeth. This study aimed to determine the pattern of demand and treatment need for root canal treatments at a tertiary healthcare facility in Lagos, Nigeria and update the dental literature with the demand and pattern of root canal treatments as seen in Nigeria. This was a retrospective study. Data from 8239 patients treated at restorative dental clinic, Lagos State University Teaching Hospital from 2011 through 2014, were reviewed. Data were analyzed using IBM SPSS Version 26. Association between categorical variables was assessed using Chi square test. Significance level was set at p&lt;0.05. Nine hundred (900) patients age 18 to 79 years (Mean ± SD 38.95±9.4) of which 542 (60.2%) were male and 358 (39.8%) female received root canal treatment involving 1256 teeth. More male patients demanded for root canal treatment but treatment need was greater in female patients and increased with age. Demand for root canal treatment was more prevalent in those &lt; 40 years of age. Central incisors were the most frequently root filled teeth in the maxilla and this was statistically significant (p=0.002). In the mandible, first molars were the most frequently root filled teeth however, this was not statistically significant (p=0.093). Findings in this study corroborate those of several other studies in Nigeria. However, unlike other Nigerian studies, this study noted a greater need for root canal treatment in female patients compared to male patients.