Souzana Choussein

GSTM1 polymorphism, GSTT1 polymorphism, and cervical cancer risk: a meta-analysis.

Introduction: A debate exists about whether glutathione S-transferase (GST) polymorphisms (GST mu-1 [GSTM1] null/present genotype and GST theta-1 [GSTT1] null/present genotype) confer additional risk for cervical cancer. This meta-analysis was aimed to examine the associations between the aforementioned polymorphisms and cervical cancer risk. Methods: Thirteen studies were eligible for GSTM1 (1616 cervical cancer cases and 1970 controls), and 12 studies were eligible for GSTT1 (1393 cases and 1766 controls). Pooled odds ratios (OR) were appropriately derived from fixed effects or random effects models. Separate analyses were conducted on Chinese and non-Chinese populations. Metaregression with publication year was also performed. Results: At the overall analysis, the GSTM1 null genotype was associated with increased cervical cancer risk (pooled OR = 1.272; 95% confidence interval [CI], 1.014-1.597, random effects). The association seemed confined to non-Chinese populations (pooled OR = 1.392; 95% CI, 1.003-1.932, random effects) given that the association was not significant in the subset of Chinese studies (pooled OR = 1.080; 95% CI, 0.870-1.340, fixed effects). On the other hand, at the overall analysis, the GSTT1 null genotype was not associated with increased cervical cancer risk (pooled OR = 1.301; 95% CI, 0.948-1.787, random effects). Similarly, no significant associations were detected in either non-Chinese or Chinese populations concerning the GSTT1 null genotype. Conclusions: The GSTM1 null genotype confers additional risk for cervical cancer in non-Chinese populations. The trend concerning GSTT1 has not reached significance.

Cytochrome P450 1A1 gene polymorphisms and endometrial cancer risk: a meta-analysis.

Introduction: This meta-analysis aims to examine whether the genotype status of Msp1, Ile462Val, and Thr461Asn polymorphisms in cytochrome P450 1A1 (CYP1A1) is associated with endometrial cancer risk. Methods: Eligible case-control studies were identified through search in MEDLINE (end of search: August 2010). Pooled odds ratios (ORs) were appropriately derived from fixed-effects or random-effects models. Results: Concerning MspI polymorphism, 8 studies were eligible (1456 cases and 2371 controls); 9 studies were eligible (1889 cases and 3662 controls) for Ile462Val and 6 studies were eligible (1272 cases and 2122 controls) for Thr461Asn. MspI polymorphism was not associated with endometrial cancer risk (for heterozygous TC vs TT carriers: OR = 0.83, 95% confidence interval [CI], 0.59-1.15, random effects; for homozygous CC vs TT carriers: OR = 1.00, 95% CI, 0.55-1.82, fixed effects). Similarly, Ile462Val polymorphism was not associated with endometrial cancer risk (for heterozygous Ile/Val vs Ile/Ile carriers: OR = 1.27, 95% CI, 0.78-2.06, random effects; for homozygous Val/Val vs Ile/Ile carriers: OR = 1.16, 95% CI, 0.48-2.81, fixed effects). Accordingly, Thr461Asn status was not significantly associated with endometrial cancer risk. The same results were reproduced in Caucasians. Conclusions: The 3 examined CYP1A1 genotype polymorphisms do not seem to confer any additional risk for endometrial cancer in Caucasians. Accumulation of further data seems mandatory for future race-specific analyses.

Glutathione-S-transferase gene polymorphisms (GSTM1, GSTT1, GSTP1) and idiopathic male infertility: novel perspectives versus facts.

Glutathione- S -transferase gene polymorphisms (GSTM1, GSTT1, GSTP1) and idiopathic male infertility: novel perspectives versus facts

Mullerian dysgenesis: a critical review of the literature

PurposeTo present an update of the genetic, clinical, diagnostic, and therapeutic aspects of Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome.MethodsStudies were considered eligible if they have evaluated patients with MRKH syndrome. Eligible articles were identified by a search of MEDLINE bibliographical database from 1950 to August 2016. A purely descriptive approach was adopted concerning all outcomes examined by the individual studies.ResultsMRKH syndrome is defined as congenital aplasia of the upper vagina and impairment of uterine development in normal 46XX females. Accounting for 1:4500 women, MRKH is the second most common cause of primary amenorrhea following gonadal dysgenesis. Potential association of MRKH syndrome to specific genes has been the focus of recent research. Null-association results of HOXA genes and Wnt5a, Wnt7a, and Wnt9a have been reported, while point mutations of the WNT4 gene point mutations have been associated with an MRKH-like syndrome characterized by Mullerian duct regression and hyperandrogenism. Ultrasound and Magnetic Resonance Imaging (MRI) are the main techniques to establish an accurate diagnosis of the syndrome. Several non-surgical and surgical procedures have been reported for the creation of a functional neovagina; in general, non-surgical treatment should be the first initially pursued. Along with psychological support, recent developments in assisted reproductive technologies of IVF techniques and the availability of gestational surrogacy, as well as the recent breakthrough of successful uterus transplantation, enable women with MRKH syndrome to attain their own genetic child.Conclusion(s)MRKH syndrome is a medical modality with important social, legal, and ethical projections that require a multi-disciplinary approach.

Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy

STUDY OBJECTIVE To compare the effectiveness and safety of a flexible carbon dioxide (CO2) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system. DESIGN Retrospective cohort study. DESIGN CLASSIFICATION Level II-2 evidence. SETTING Reproductive surgery practice at an academic hospital. PATIENTS Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO2 laser (n = 85) or the ultrasonic scalpel (n = 151). INTERVENTIONS Robot-assisted laparoscopic myomectomy employing either a flexible CO2 laser fiber or a robotic ultrasonic scalpel as the primary energy tool. MEASUREMENTS AND MAIN RESULTS Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups. CONCLUSION Robot-assisted laparoscopic myomectomy with a flexible CO2 laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics.

Follicular development, acquisition of mature oocytes, and pregnancy after 2 weeks of leuprolide acetate administration during the midluteal phase.

OBJECTIVE To present a case of aberrant follicular development, acquisition of mature oocytes, and pregnancy after 2 weeks of leuprolide acetate administration during the midluteal phase. DESIGN Case report. SETTING Department of Obstetrics and Gynecology, Aretaieio University Hospital, Athens, Greece. PATIENT(S) A 37-year-old white woman who was scheduled to undergo ovarian stimulation according to the long luteal phase protocol for IVF and ET because of male factor infertility. INTERVENTION(S) Twenty-first day serum P level was 5.9 ng/dL, and a daily dose of 0.1 mg leuprolide acetate was initiated. Fifteen days later the patient presented for evaluation because of absence of uterine bleeding. Sonographic evaluation revealed the presence of five large follicles. Serum E(2) and P levels at this time were 1,895.0 pg/mL and 0.2 ng/mL, respectively. The patient received recombinant hCG (250 mg), and 36 hours later she underwent oocyte retrieval. Three oocytes were retrieved and fertilized by intracytoplasmic sperm injection. After the transfer of two embryos a singleton pregnancy was achieved, leading to an uneventful delivery. MAIN OUTCOME MEASURE(S) Serum E(2) and P and ultrasound evaluation of ovaries. RESULT(S) She had a singleton pregnancy, and she delivered at 39 weeks of gestation. CONCLUSION(S) The presence of recruitable follicles during the luteal phase of the cycle that responded to endogenous gonadotropins during the flare response before pituitary suppression could be a logical explanation of this observation.

Robotic Assistance Confers Ambidexterity to Laparoscopic Surgeons

STUDY OBJECTIVE To examine whether a robotic surgical platform can complement the fine motor skills of the nondominant hand, compensating for the innate difference in dexterity between surgeons hands, thereby conferring virtual ambidexterity. DESIGN Crossover intervention study (Canadian Task Force classification II-1). SETTING Centers for medical simulation in 2 tertiary care hospitals of Harvard Medical School. PARTICIPANTS Three groups of subjects were included: (1) surgical novices (medical graduates with no robotic/laparoscopic experience); (2) surgeons in training (postgraduate year 3-4 residents and fellows with intermediate robotic and laparoscopic experience); and (3) advanced surgeons (attending surgeons with extensive robotic and laparoscopic experience). INTERVENTIONS Each study group completed 3 dry laboratory exercises based on exercises included in the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Each exercise was completed 4 times: using the dominant and nondominant hands, on a standard laparoscopic FLS box trainer, and in a robotic dry laboratory setup. Participants were randomized to the handedness and setting order in which they tackled the tasks. MEASUREMENTS AND MAIN RESULTS Performance was primarily measured as time to completion, with adjustments based on errors. Means of performance for the dominant versus nondominant hand for each task were calculated and compared using repeated-measures analysis of variance. A total of 36 subjects were enrolled (12 per group). In the laparoscopic setting, the mean overall time to completion of all 3 tasks with the dominant hand differed significantly from that with the nondominant hand (439.4 seconds vs 568.4 seconds; p = .0008). The between-hand performance difference was nullified with the robotic system (374.4 seconds vs 399.7 seconds; p = .48). The evaluation of performance for each individual task also revealed a statistically significant disparate performance between hands for all 3 tasks when the laparoscopic approach was used (p = .003, .02, and .01, respectively); however, no between-hand difference was observed when the tasks were performed robotically. On analysis across the 3 surgeon experience groups, the performance advantage of robotic technology remained significant for the surgical novice and intermediate-level experience groups. CONCLUSION Robot-assisted laparoscopy may eliminate the operative handedness observed in conventional laparoscopy, allowing for virtual ambidexterity. This ergonomic advantage is particularly evident in surgical trainees. Virtual ambidexterity may represent an additional aspect of surgical robotics that facilitates mastery of minimally invasive skills.

Female Fertility Assessment

A fastidious fertility evaluation designed to discern all factors contributing to a couple’s inability to conceive is the quintessential approach to a well-justified, cost-effective treatment plan. The purpose of this review is to outline the steps of female infertility evaluation as well as all evidence-based methods in a reproductive endocrinologist’s armamentarium to perform it. Evaluation should always start with the least invasive approaches for detection of the most common causes of infertility. The most common identifiable causes of female infertility include ovulatory disorders, tubal blockade or other reproductive tract pathology (irregular cervical mucus production, endometriosis, pelvic adhesions), and/or other medical condition interacting with the above (hyperprolactinemia, thyroid disorder). Incessant advancement of Assisted Reproductive Technology techniques renders more and more infertility causes amenable to treatment; a rational use of available approaches in terms of both personalized feasibility and cost-effectiveness should be applied.

Internal versus external tocodynamometry in labor.

n engl j med 362;19 nejm.org may 13, 201