Yakir Segev

Dynamic Nanoparticle-Based Flexible Sensors: Diagnosis of Ovarian Carcinoma from Exhaled Breath

Flexible sensors based on molecularly modified gold nanoparticles (GNPs) were integrated into a dynamic cross-reactive diagnostic sensing array. Each bending state of the GNP-based flexible sensor gives unique nanoparticle spatial organization, altering the interaction between GNP ligands and volatile organic compounds (VOCs), which increases the amount of data obtainable from each sensor. Individual dynamic flexible sensor could selectively detect parts per billion (ppb) level VOCs that are linked with ovarian cancers in exhaled breath and discriminate them from environmental VOCs that exist in exhaled breath samples, but do not relate to ovarian cancer per se. Strain-related response successfully discriminated between exhaled breath collected from control subjects and those with ovarian cancer, with data from a single sensor being sufficient to obtain 82% accuracy, irrespective of important confounding factors, such as tobacco consumption and comorbidities. The approach raises the hope of achieving an extremely simple, inexpensive, portable, and noninvasive diagnostic procedure for cancer and other diseases.

The effect of statins on risk and survival of gynecological malignancies

PURPOSE The use of statins has been associated with reduced risk of malignancies in a variety of organ sites. This study was aimed at studying the effects of statins on gynecological cancers. METHODS The Cancer in The Ovary and Uterus Study (CITOUS) is a case-control study of newly diagnosed cases of gynecological malignancies and age/sex/clinic/ethnic-group matched population controls. Use of statins prior to and following diagnosis was assessed in a subset of 424 cases of ovarian and endometrial cancers and 341 controls, enrolled in Clalit Health Services (CHS), using pharmacy records. RESULTS The use of statins for more than one year prior to diagnosis was associated with a significantly reduced risk of ovarian cancer (OR=0.56, 95% CI: 0.33-0.94) and of endometrial cancer (OR=0.59, 95% CI: 0.40-0.87). The association with endometrial cancer, but not with ovarian cancer (OR=0.54, 0.26-1.13), remained statistically significant after adjustment for fruit and vegetable consumption, sports activity, family history of endometrial and colorectal cancer, ethnicity, BMI, duration of breast feeding, age at 1st pregnancy and use of menopausal hormones (RR=0.48, 0.26-0.89). Women who used statins only after diagnosis of cancer had a significantly better survival of both ovarian cancer (Log rank test, p=0.021, age adjusted HR=0.47, 0.26-0.85) and endometrial cancer (p=0.06, age adjusted HR=0.45, 0.23-0.87). CONCLUSION The use of statins for more than one year before diagnosis was associated with a reduction in the risk of endometrial cancer and possibly ovarian cancer. A significantly improved survival of cases of both malignancies was noticed when statins were taken only after diagnosis.

Low-grade serous ovarian cancer: A review

Epithelial ovarian cancers can be divided into the more common, aggressive type II cancers and the less common, slow-growing type I cancers. Under this model, serous ovarian carcinomas can be subdivided into high-grade (type II) and low-grade (type I) tumours. The two-tier system for grading serous ovarian carcinomas is superior to more detailed grading systems in terms of predicting survival. Low-grade serous carcinomas typically present in young women and have a relatively good prognosis, despite being resistant to chemotherapy. Low-grade serous cancers have a high prevalence of KRAS and BRAF mutations, but a low prevalence of TP53 mutations (which are characteristic of high-grade serous cancers). Among women with low-grade serous ovarian cancer, the presence of a KRAS/BRAF mutation is a favorable prognostic factor. Studies of the mitogen-activated protein kinase (MAPK) inhibitor in low-grade serous ovarian cancer suggest that identifying MAPK mutations might eventually be useful in guiding treatment.

Assisted Reproductive Technologies: Medical Safety Issues in the Older Woman

Abstract Previous study has shown that in the United States, most maternal deaths and severe obstetric complications due to chronic disease are potentially preventable through improved medical care before conception. Many women who need assisted reproductive technology (ART) because of infertility are older than the average pregnant woman. Risks for such chronic diseases as obesity, diabetes mellitus, chronic hypertension, cardiovascular disease (CVD), and malignancy greatly increase with maternal age. Chronic illness increases the risk of the in vitro fertilization (IVF) procedure and is also associated with increased obstetric risk and even death. The objective of this review is to outline the potential risks for older women who undergo ART procedures and pregnancy and to characterize guidelines for evaluation before enrollment in ART programs. A PubMed search revealed that very few studies have related to pre-ART medical evaluation. Therefore, we suggest a pre-ART medical assessment, comparable to the recommendations of the American Heart Association before noncompetitive physical activity and the American Society of Anesthesiologists before elective surgery. This assessment should include a thorough medical questionnaire and medical examination. Further evaluation and treatment should follow to ensure the safety of ART procedures and of ensuing pregnancies.

Risk Factors for Ovarian Cancers with and without Microsatellite Instability

Objective The objective of this study was to evaluate the association between microsatellite instability (MSI) status and (1) ovarian cancer risk factors and (2) the distribution of the specific histologic subtypes in a population-based sample of epithelial ovarian cancers. Methods Participants were drawn from 3 population-based studies of primary epithelial ovarian cancer. Tumor DNA was analyzed using 5 standardized microsatellite markers to assess MSI status. Patients were divided into 3 groups (MSI-high, MSI-low, and MSI-stable) according to National Cancer Institute criteria. We compared the prevalence of specific known risk and protective factors among the 3 subgroups, including body mass index, smoking history, parity, BRCA1 and BRCA2 mutation status, past oral contraceptive use, and tubal ligation. Similarly, we compared the distribution of the histologic subtypes among the 3 subgroups. Results A total of 917 ovarian cancer patients were included. One hundred twenty-seven (13.8%) cancers were MSI-high. Subgroup analyses according to smoking, body mass index, parity, past oral contraceptive use, and past tubal ligation did not reveal any statistically significant differences among the groups. Among the 29 patients with BRCA1 mutations, 20.7% had MSI-high cancers compared with 5.9% among 17 BRCA2-mutation patients. The proportions of different ovarian cancer histologic findings among the various MSI subgroups were similar. Conclusions The prevalence of risk and protective factors among ovarian cancer patients is similar for cancers with and without MSI. The distributions of MSI do not differ significantly among ovarian cancers with different histologic findings. Ovarian cancer patients with BRCA1 mutations had a 21% rate of MSI-high tumors, compared with 6% among patients with BRCA2 mutations, but this difference was not statistically significant.

Laparoscopic removal of an intrauterine device following colon perforation.

Intestinal perforation by a migrating intrauterine device is a serious complication and may be corrected by using a laparoscopic approach.

Are women with pelvic organ prolapse at a higher risk of developing hernias

Introduction and hypothesisPelvic organ prolapse and hernia are common disorders which share several pathopysiological and epidemiological features. We therefore aimed to assess whether women with advanced pelvic organ prolapse have a higher prevalence of hernia.MethodsWe reviewed charts of women undergoing surgery for advanced pelvic organ prolapse and compared them to age-matched controls with mild or no prolapse.ResultsWe identified 60 patients who underwent surgery for advanced pelvic organ prolapse and 60 controls. The total prevalence of hernias was significantly higher among patients with pelvic organ prolapse (31.6% vs. 5%, p = 0.0002), attributed to hiatal (16.6% vs. 1.6%, p = 0.004) and inguinal (15% vs. 3.3%, p = 0.04) hernias.ConclusionsPatients with advanced pelvic organ prolapse have a higher prevalence of hiatal and inguinal hernias. This finding may be explained by similar pathophysiological mechanisms shared by both disorders.

Is there a place for adjuvant therapy in IVF

Objectives. To review studies of adjuvant therapies for in vitro fertilization (IVF), and to establish the role of adjuvant therapy for women with repeated failure to conceive with IVF. Design. Review of the literature. Articles were identified through a PubMed, Medline, EMBASE, Cochrane library, and the national research Register literature search according to preset criteria followed by a cross-reference of published data. Main Outcome Measure(s). Clinical pregnancies and live births. Result(s). Most adjuvant therapies for IVF are empirical, and prescribed without a clear diagnosis of whether the failure to conceive is due to a maternal or fetal factor. Although some randomized controlled trials are available, the results are conflicting. Conclusion(s). No adjuvant therapy has been shown to be definitively advantageous. At present the diagnosis of IVF failure is not specific enough to indicate a certain adjuvant therapy. Hence, some unconfirmed therapies might be highly efficacious for subgroups with particular characteristics. The use of endometrial biopsy with a pipelle is promising, but like other therapies, requires additional testing. Chromosomal aberrations present a confounding factor for maternal adjuvant therapies that are difficult to exclude. Target Audience: Obstetricians & Gynecologist, Family Physicians. Learning Objectives: After completion of this educational activity, the reader will be able to interpret the proven scientifically significant studies of the various forms of adjuvant therapy in IVF. Assess shortcomings in many of the different types of adjuvant therapy and interpret potential dangers in some forms of adjuvant therapy.

Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms

To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction.

Symptomatic pelvic hematoma following transvaginal reconstructive pelvic surgery: incidence, clinical presentation, risk factors, and outcome

OBJECTIVE To assess the incidence, clinical presentation, risk factors and outcome of symptomatic pelvic hematomas following transvaginal pelvic reconstructive surgery. MATERIALS AND METHODS We reviewed the medical records of all women undergoing transvaginal reconstructive pelvic surgery in our institution between January 2006 and July 2009. RESULTS 462 patients underwent pelvic reconstructive surgery, of whom 28 (6%) presented with symptomatic pelvic hematomas. All cases occurred after transvaginal hysterectomy, 25 (90%) presented with fever, 20 (71%) with pelvic pain and 5 (20%) with urinary retention. All hematomas were diagnosed by ultrasound. They were located at the vaginal cuff in 18 (64%), anterior vaginal wall in six (21%) and posterior vaginal wall in four patients (14%), and had a mean volume of 590 ± 140 cm(3). Laboratory data included leukocytosis (71%), thrombocytosis (57%) and elevated liver enzymes (18%). Nine patients (33%) required ultrasound-guided drainage of the hematoma, which resulted in marked clinical improvement. Surgical outcome was not affected by the presence of pelvic hematoma. CONCLUSIONS A postoperative symptomatic pelvic hematoma is not rare and is closely related to transvaginal hysterectomy. Its clinical presentation includes fever, pelvic pain, leukocytosis, thrombocytosis and occasionally liver dysfunction. Surgical outcome is generally unaffected.