Background The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. Methods We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. Results The range of gestational age at delivery in our study was 12–21 weeks in 61 cases, 22–36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9–47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. Conclusion The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.
Background: The prognosis of small cell neuroendocrine carcinoma of the uterine cervix (SCNECC) is extremely poor due to the aggressive natural history. Since it is a rare cancer, there are few studies describing its molecular biology. Small cell lung cancer (SCLC) accounts for 95% of small cell carcinomas, therefore, clinically the chemotherapy regimens used for SCNECC have been based on regimens used for SCLC. This study aims to detect therapeutic targets for SCNECC by taking clues from the molecular biological commonalities between SCNECC and SCLC. Methods: We analyzed protein expression of cancer tissue-originated spheroids from lung and cervical cancers using isobaric tags for relative and absolute quantitation (iTRAQ). In vitro, protein expression levels of VRK1 in SCNECC cell lines (TC-YIK and HCSC-1), SCLC cell lines (SBC3 and OS2RA) and cell lines of mucinous adenocarcinoma and squamous cell carcinoma of the uterine cervix (HeLa and ME180) were assessed by western blotting (WB), and the change of cell proliferation induced by siRNA/shRNA-mediated VRK1 knockdown was assessed by WST-8 assay. In vivo, in mice xenograft models of SCNEC, the change of tumor size due to downregulation of VRK1 by shRNA were assessed. Furthermore, to explore the possible role of VRK1 in small carcinoma, pathway enrichment and ontology analysis between VRK1-high and -low-SCLC was performed by Gene Set Enrichment Analysis (GSEA), and it was compared with RNA-seq results of between shRNA-mediated VRK1 knockdown and control SCNECC cell lines. Results: iTRAQ showed that SCNECC and SCLC revealed similar protein expression profiles, rather than organ of origin-specific patterns. In addition, higher expression of VRK1 was detected in small cell carcinomas compared to the others. (SCLC/mucinous adenocarcinoma of the lung=2.86, SCNECC/mucinous adenocarcinoma of the cervix=2.56, SCNECC/squamous cell carcinoma of the cervix=2.17). WB showed that all SCNECC and SCLC cell lines expressed more highly VRK1 than other cervical cancer cell lines. In vitro, siRNA/shRNA-mediated VRK1 knockdown significantly suppressed the cell proliferation of SCNECC and SCLC (-29.0±0.3% in SBC-3 and -33.1±6.7% in TC-YIK, p<0.05, other cell lines were comparable). In vivo, the downregulation of VRK1 significantly suppressed tumor size in mice xenograft models of SCNEC (1726±442mm3 vs 544±233mm3 in TC-YIK, p<0.05, HCSC-1 was comparable). GSEA showed that VRK1 might participate in DNA repair to affect the biological process of SCLC, and the genes contained in this gene set was also detected in RNA-seq of SCNEC, suggesting involvement with VRK1. Conclusion: These findings suggest that VRK1 is involved in the proliferation of SCNECC in relation to DNA repair pathways. Our ongoing research is investigating the functional relationship between VRK1 and genes related to DNA repair and its effect on proliferation of SCNECC in vitro. Citation Format: Mariya Kobayashi, Satoshi Nakagawa, Yuji Kamei, Tatsuo Masuda, Mamoru Kakuda, Kosuke Hiramatsu, Ai Miyoshi, Tomomi Takata, Toshihiro Kimura, Eiji Kobayashi, Yutaka Ueda, Tadashi Kimura. Knockdown of VRK1 inhibits the proliferation of small cell neuroendocrine carcinoma of the uterine cervix [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 327.
Peritoneal inclusion cysts (PICs) often develop in post-operative patients. Since the incidence of adhesions is lower with laparoscopic surgery than with open surgery, PICs are less likely to occur in the former. Although post-operative adhesions or PICs rarely develop after laparoscopic surgery (such as total laparoscopic hysterectomy: TLH), we encountered two cases of giant PICs with abdominal pain after TLH. In Case 1, strong adhesion was already present when TLH was performed. Therefore, this case may have been predisposed to the development of adhesions in the abdominal cavity. However, no adhesions were observed during TLH in case 2, and there were no risk factors, such as pre-operative adhesions and endometriosis. Therefore, adhesions and PICs may develop even after TLH, and approaches need to be considered for their prevention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.