Anil K. Sood

Two successful pregnancies after conservative treatment of endometrial cancer and assisted reproduction

OBJECTIVEnTo report successful pregnancies after conservative management of FIGO grade I adenocarcinoma of the endometrium.nnnDESIGNnRetrospective chart review.nnnSETTINGnUniversity-based assisted reproduction and oncology units.nnnPATIENT(S)nOne patient who had two separate pregnancies.nnnINTERVENTION(S)nHigh-dose progestin (megestrol acetate) therapy for adenocarcinoma, followed by assisted reproduction with donor oocyte.nnnMAIN OUTCOME MEASURE(S)nHistologic evaluation of endometrium after megestrol acetate and at completion of childbearing, and successful pregnancies and deliveries.nnnRESULT(S)nThe patient had complete resolution of adenocarcinoma with progestin therapy and successful delivery of two pregnancies after assisted reproduction.nnnCONCLUSION(S)nConservative management of International Federation of Gynecology and Obstetrics grade I adenocarcinoma of the endometrium allows preservation of childbearing.

Second-trimester vaginal bleeding: Correlation of ultrasonographic findings with perinatal outcome

OBJECTIVEnOur purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding.nnnSTUDY DESIGNnA retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded.nnnRESULTSnMultiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0.036), as was history of two or more previous preterm deliveries (6% vs none, p = 0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations.nnnCONCLUSIONnSecond-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.

Chitosan Nanoparticles for miRNA Delivery

RNA interference techniques represent a promising strategy for therapeutic applications. In addition to small interfering RNA-based approaches, which have been widely studied and translated into clinical investigations, microRNA-based approaches are attractive owing to their one hit, multiple targets concept. To overcome challenges with in vivo delivery of microRNAs related to stability, cellular uptake, and specific delivery, our group has developed and characterized chitosan nanoparticles for nucleotide delivery. This platform allows for robust target modulation and antitumor activity following intravenous administration.