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Objective: To present a case of successful pregnancy after undergoing vaginal radical trachelectomy (VRT) and pelvic lymph node dissection (PLND) for early-stage cervical cancer. Case report: A 37-year-old female patient has been diagnosed with stage IB1 cervical cancer and underwent VRT and PLND. Two years after the surgery, the patient successfully conceived and delivered a healthy baby through a cesarean section. Conclusion: This case report demonstrates that pregnancy after VRT and PLND for stage IB1 cervical cancer is possible and can result in a successful outcome. This report provides valuable information for patients and physicians who are considering these surgical options.

Purpose: To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M). Methods: The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed. Results: The age of the participants was 39.3 ± 6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5 ± 2.2 cm and 1.7 ± 1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5 cm in diameter. The mean weight of the myomas was 281.1 ± 183.1 g. The operation time was 97.6 ± 40.2 min, and the intraoperative blood loss was 99.3 ± 115.2 mL. There were 3 (1%) cases of excessive blood loss (more than 500 mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3 ± 32.2 min vs. 141.2 ± 54 min, p

Objective: The pandemic Coronavirus Disease 2019 (COVID-19) is a global public health crisis. Many maternity units worldwide are currently establishing the management protocols for these patients. Case report: We report the first critically ill pregnant woman with COVID-19-induced respiratory failure undergoing emergent caesarean delivery at 32 weeks of gestation, in the setting of a positive pressure operating room (OR) with negative pressure anteroom in Taiwan. Conclusion: Multidisciplinary planning and collaboration are necessary to achieve satisfactory clinical outcomes in pregnancies with critical COVID-19 pneumonia. The combinations of comprehensive evaluation, timely treatment as well as establishment of rigorous protocol and safe environment for the emergent delivery are important.

Objective: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a paraneoplastic syndrome associated with ovarian teratomas. Anti-NMDAR encephalitis patients typically present with prominent psychiatric symptoms, seizures, and involuntary movements; further, they rapidly progress to unresponsiveness with central hypoventilation and dysautonomia. Case report: This paper presents two anti-NMDAR encephalitis cases with ovarian teratomas and reviews 13 anti-NMDAR encephalitis clinical case reports in Taiwan, of which six involved ovarian tumors, five being mature teratomas. Patients presented with acute onset of psychiatric symptoms and subsequently developed coma within a few days. Anti-NMDAR encephalitis usually occurs in young women and is often associated with ovarian tumors, specifically teratomas. Ovarian cystectomy or oophorectomy was performed, which markedly improved cognitive function. Conclusion: Paraneoplastic neurological conditions associated with ovarian teratomas represent a fascinating disease process. Identifying the gynecological cause of a neurological condition, particularly in young women, followed by prompt treatment can remarkably improve clinical conditions and, thus, be lifesaving. Keywords: Anti-N-Methyl-d-aspartate receptor (anti-NMDAR) encephalitis, Autoimmune encephalitis, Ovarian teratoma, Paraneoplastic syndrome, Psychosis

Background: The full breastfeeding may lead to insufficient milk intake of newborns and increase the rate of body weight loss (BWL). Severe BWL was generally believed as a cause of significant hyperbilirubinemia in newborn babies. The study aimed to investigate the effect if early supplemental feeding in newborns with birth weight loss at the first 3 days after birth could decrease the rate of hyperbilirubinemia 72 h of birth.Methods: A total of 395 neonates with gestational age >37 weeks and birth body weight >2500g were prospectively collected between 2016 and 2018. We analyzed 280 neonates with BWL rate reaching the predictive value (4.5%, 7.5%, and 8% on the first, second, third day after birth, respectively) for subsequent hyperbilirubinemia after 72 hours after birth. The enrolled cases were divided into four subgroups as interventional consecutive milk supplement for 0, 1, 2, and 3 days after birth for further analysisResults: For newborns with BWL reaching the predictive value on the first day after birth, the serum bilirubin levels were lower in the experimental group than those in the non-involved control group (p < 0.05). For newborns with three consecutive days of interventional milk supplementation, the serum bilirubin levels at the 72 h after birth showed the lowest levels compared with the other sub-groups with two consecutive days and one consecutive day of interventional milk supplementation (p < 0.05). Moreover, there was a significantly decreasing trend in the consecutive days of interventional milk supplementation (p < 0.05).Conclusion: Newborns with BWL over 4.5% on the first day after birth receiving early intervention milk supplementation could significantly reduce serum bilirubin levels at the72 h after birth. The more days of consecutive milk supplementation after birth may lead to the lower the 72 h serum bilirubin levels. It is recommended to early and consecutive milk supplementation after birth to be an effective way in reducing serum bilirubin levels.

Objective: To report a single surgeon's experience with 109 laparoendoscopic single-site myomectomy (LESS-M) using conventional laparoscopic instruments and a homemade glove port system. Materials and methods: A total of 109 consecutive women who underwent LESS-M between March 2011 and April 2015 were reviewed. Results: The mean age and body mass index were 38.3 ± 6.5 years and 22.1 ± 3.0 kg/m2. The mean diameter of the largest myoma and the mean number of myomas were 8.1 ± 2.4 cm and 1.6 ± 0.7. The mean weight of the myomas was 223.2 ± 159.7 g. The most common type of myoma was intramural (61%), followed by subserosal (23%), submucosal (9%), and intraligamental (7%). The most common site of the myomas was anterior (39%), followed by posterior (38%), lateral (15%), and fundal (9%). The mean operative time and estimated blood loss were 138.5 ± 43.8 min and 104.9 ± 270.1 mL. Two patients (1.8%) required intraoperative transfusion. The mean hospital stay was 2.5 ± 0.6days. There were no conversions to laparotomy, but three patients(2.8%) were converted to two-port laparoscopic myomectomy. No patient experienced any major complication, including bowel, ureter, bladder injuries, or incisional hernia. Six women became pregnant after the operation, and five of these patients delivered their babies at full term by cesarean section. One patient delivered her baby at a gestational age at 32 weeks due to idiopathic polyhydramnios by cesarean section. One patient had the second pregnancy and delivery after LESS-M. Fourteen patients (12.8%) had small recurrent myomas that did not require treatment. Conclusion: LESS-M is a feasible alternative for patients with symptomatic myomas, and this technique can provide cosmetic advantages compared to conventional laparoscopic surgery.

Objective: Radical trachelectomy (RT) is an alternative treatment for preserving fertility in patients with cervical cancer. Because women with operable cervical cancer opting for fertility preservation are scarce, few cases have been reported in Taiwan. Here we report our cases series. Materials and Methods: We retrospectively evaluated seven patients who underwent vaginal RT and three patients who underwent abdominal RT in a single medical institute for a median follow-up period of 5 years. Results: The oncological outcome was highly satisfactory. All patients survived and are currently disease-free, except for two who had recurrence and received additional concurrent chemoradiation therapy. Other complications included urinary tract infection, cervical stenosis, and unilateral hydronephrosis. All complications were manageable with little long-term effects. However, no pregnancy was observed during the 5-year follow-up period. Conclusion: RT is considered a complicated surgical procedure among gynecological operations. Here we review the literature and describe several factors associated with higher pregnancy rates.

Objective: To investigate the possible causes of iatrogenic parasitic myoma and methods to prevent its occurrence. Case report: A 27-year-old nulliparous unmarried patient underwent laparoscopic myomectomy with morcellation for a submucosal myoma at the National Taiwan University Hospital (Taipei, Taiwan). Seven years later, an asymptomatic pelvic tumor was noted during a regular annual follow up. Two pelvic tumors were detected and excised by laparoscopic surgery. The masses were confirmed by histopathology to be cellular leiomyomas. Conclusion: In the past 7 years, the incidence of iatrogenic parasitic myomas has increased because of the increased use of minimally invasive surgery using a morcellator. Forty-one cases of iatrogenic parasitic myoma were reviewed from 23 published studies. Parasitic myoma frequently occurs in the dependent part of the abdominal cavity, which suggests seeding of myometrial tissues during morcellation. In situ morcellation and vigorous irrigation with concomitant changes in position may decrease the incidence of retained myoma tissue in the abdomen during surgery.

Objectives: To assess the learning curve and safety of laparoendoscopic single-site (LESS) surgery of gynecological surgeries. Materials and methods: Sixty-three women who underwent LESS surgery by a single experienced laparoscopic surgeon from February 2011 to August 2011 were included. Commercialized single-incision laparoscopic surgery homemade ports were used, along with conventional straight instruments. The learning curve has been defined as the additional surgical time with respect to surgical order of LESS surgery, which has been estimated using a smooth function in a linear model with generalized least squares, with some adjustments made due to influencing factors of the operations. Results: All women completed LESS surgeries without the need for ancillary ports, except for two laparotomy conversions due to incidental ovarian malignancy. Three women, one with a gastrointestinal stromal tumor, one with laparoscopic myomectomy, and one who had been receiving simultaneous hysteroscopic myomectomy, were excluded. Of the 58 women included, 39 underwent adnexal surgeries and 19 underwent hysterectomies. Complications occurred with one woman who required a blood transfusion during the procedure. Surgical time was longer in bilateral cystectomy compared with unilateral cystectomy and unilateral/bilateral salpingo-oophorectomy (110.6 ± 51.1 minutes vs. 73.0 ± 26.3 minutes and 66.3 ± 26.9 minutes; p

Objective: To evaluate the outcome of myoma enucleation by morcellation while it is attached to the uterus (in situ morcellation) in laparoscopic myomectomy. Materials and Methods: A total of 82 patients diagnosed with myoma or adenomyosis in 2007 were enrolled. The patients were divided into three groups according to the myoma weight. The operative time, myoma weight, blood loss, duration of hospital stay, and complication experienced were recorded for analysis. Results: The mean myoma weight was 265 ± 240 g and the mean operative time was 93 ± 30 minutes. The patients were divided into three groups: group A with myomas less than 150 g; group B with myomas 150-349 g; and group C with myomas greater than 350 g. The mean myoma weights were 73 ± 34 g, 214 ± 52 g, and 571 ± 218 g for groups A, B, and C, respectively; the mean operative times were 79 ± 17 minutes, 84 ± 22 minutes, and 121 ± 32 minutes, respectively. The operative time increased with myoma weight. Two patients (8%) in group C had excessive intraoperative hemorrhage and one (4%) required a blood transfusion. There was no conversion to laparotomy. Conclusion: In situ morcellation was an efficient and safe procedure for removal of large uterine myoma during laparoscopic myomectomy.

The role of laparoscopic surgery in the management of gynecological cancers continues to expand. For early-stage cervical cancer, laparoscopically assisted radical vaginal hysterectomy is feasible, and radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy has emerged as a safe option for women who desire fertility preservation. In the treatment of early-stage endometrial cancer, the surgical staging of laparoscopic hysterectomy, peritoneal washings and pelvic lymph node dissection is effective and safe when compared with the same surgery performed via laparotomy. In ovarian malignancies, laparoscopic surgery has been incorporated to manage early-stage cancers.

Objective: With improvements in immunosuppression and surgical techniques, more women are undergoing kidney transplantation (KT) for management of end-stage renal disease. Location of the transplanted pelvic kidney and transplanted ureter must be taken into consideration when performing pelvic surgery. We demonstrate that laparoscopically assisted vaginal hysterectomy (LAVH) can be successfully performed in patients who had previously undergone KT. Materials and Methods: We prospectively enrolled four patients requiring operation for symptomatic adenomyosis after KT. LAVH was performed in these cases after initial uterine artery ligation during laparoscopy. Results: The median age of the patients was 44 years (range, 40–46 years) and the extirpated uterine weight was 195 g (range, 160–380 g). Intraoperatively, the median operation time was 147.5 minutes (range, 105–175 minutes) and the blood loss was 50 mL (range, 50–100 mL). There was mild pelvic adhesion in two cases. The postoperative recovery was good in all patients with oral intake, flatus passage, and ambulation within 1 day after operation. The median intramuscular meperidine requirements were 25 mg (range, 0–100 mg) and the hospital stay was 4 days (range, 3–8 days). There were no major complications in these cases except one with mild postoperative fever. Conclusion: LAVH may be a safe and effective treatment for treating patients with adenomyosis after KT.

Squamous cell carcinoma (SCC) arising from a mature cystic teratoma of the ovary is rare and only reported sporadically. Clinical information on the disease is limited. This study assesses the clinical characteristics, treatment, outcome and prognostic factors of reported cases. Methods: Two hundred and twenty cases from 1976 through to 2005 in MEDLINE were analyzed for patient age, clinical and laboratory data, extent of disease, tumor markers, treatment and survival rates. Only the 188 cases with surgical staging were included in the survival analysis. Results: The disease occurred most often in elderly women (mean, 55.0 ± 14.4 years) and cysts were large (mean, 13.7 ± 5.7 cm). Abdominal pain (71.6%) was the most common symptom. Preoperative serum SCC antigen level had a high positive rate (81.3%). Overall 5-year survival rate for all stages was 48.4%. For Stage I, the 5-year survival rate was 75.7%; stage II, 33.8%; stage III, 20.6%; and stage IV, 0% (p < 0.0001). Univariate analysis revealed that tumor stage, patient age, tumor size, preoperative SCC antigen and CA125 levels, and optimal debulking were significant prognostic factors. Further investigation into treatments for all stages revealed that postoperative adjuvant chemotherapy may produce a better survival rate for both stage III and stage IV cases. However, postoperative radiotherapy did not show a similar effect. Multivariate analysis indicated that stage and optimal debulking were significant factors that influenced survival. Conclusion: A mature cystic teratoma should be treated as early as possible. Tumor stage and optimal debulking are critical to survival. Unlike SCCs of the uterine cervix, postoperative adjuvant chemotherapy may produce a better result than adjuvant radiotherapy for advanced-stage cases.

Objective: Uterine leiomyomas rarely cause pseudo-Meigs' syndrome. We describe a case of pseudo-Meigs' syndrome during pregnancy. Case Report: A 35-year-old woman (gravida 0, para 0) experienced rapid abdominal distension over a period of 1 week in the first trimester. She had had an adnexal mass of 7 × 6 cm for 5 years but continued to have regular menstrual cycles. Serial imaging showed slow progressive enlargement of the adnexal mass but serum CA-125 levels remained normal. Ultrasonography showed a large solid mass that was 25 × 20 × 20 cm in size, with a uterine gestational sac and massive ascites. Both ovaries appeared normal and a small amount of pleural effusion was detected. CA-125 levels increased to 558.11 kU/L and exploratory laparotomy was performed. During surgery, the solid mass was found to be a pedunculated leiomyoma originating from the uterine fundus, with 3,200 mL of clear yellowish ascites. Myomectomy was performed and microscopic examination showed a leiomyoma with degenerative changes. The patient received regular prenatal examinations in outpatient clinics after discharge; a healthy female baby was delivered at term. Conclusion: Pseudo-Meigs' syndrome was diagnosed when hydrothorax and ascites occurred with a pelvic mass other than ovarian fibroma. Pregnancy may aggravate the syndrome.

Objective: Ectopic pregnancy embedded in a previous cesarean section scar is rare. We report two cases of cesarean section scar pregnancy managed with conservative treatment. Case Reports: The first patient was a 39-year-old woman who presented with vaginal spotting and delayed menstruation. She had undergone two previous cesarean sections and was found to be at 5 weeks' gestation. The second patient was a 38-year-old woman with one previous cesarean section. She presented with vaginal bleeding and abdominal fullness and was found to be at 7 weeks' gestation. In both cases, cesarean section scar pregnancies were diagnosed by transvaginal sonography. Intragestational sac injection of methotrexate (MTX) 50 mg was administered under transabdominal sonographic guidance, followed by multiple doses of intramuscular MTX. Serum β-human chorionic gonadotropin levels declined gradually and reabsorption of the gestational sacs was confirmed by sonography. Conclusion: Early detection of cesarean section scar pregnancy allowed the choice of several conservative treatment options. Intragestational sac injection of MTX followed by systemic MTX was effective in terminating the ectopic pregnancy, even after a fetal heartbeat was detected.

Transdermal nicotine patches (TNPs), administering nicotine into the bloodstream through skin, have been widely used as nicotine replacement therapy, and exposure to nicotine can be detected by measurement of plasma cotinine concentration. In animal studies, nicotine treatment could increase the number of endothelial progenitor cells (EPCs), but the effect of TNPs on circulating EPCs and their activity in humans remained unclear. This study aimed to explore the influence of TNPs on circulating EPCs with surface markers of CD34, CD133, and/or KDR, and colony‐forming function plus migration activity of early EPCs derived from cultured peripheral blood mononuclear cells before and after TNP treatments in young healthy nonsmokers. In parallel, pulse wave analysis (PWA) was applied to evaluate the vascular effect of TNP treatments. Twenty‐one participants (25.8 ± 3.6 years old, 10 males) used TNP (nicotine: 4.2 mg/day) for 7 consecutive days. During the treatment, the CD34+ EPCs progressively increased in number. In addition, the number of EPCs positive for CD34/KDR, CD133, and CD34/CD133 were also increased on day 7 of the treatment. Furthermore, the early EPC colony‐forming function and migration activity were increased with the plasma cotinine level positively correlating with change in colony‐forming unit number. PWA analyses on day 7, compared with pretreatment, did not show significant change except diastolic pressure time index, which was prolonged and implied potential vascular benefit. In conclusion, 7‐day TNP treatments could be a practical strategy to enhance angiogenesis of circulating EPCs to alleviate tissue ischemia without any hemodynamic concern. [ABSTRACT FROM AUTHOR]

This research explores the role of microRNA in senescence of human endothelial progenitor cells (EPCs) induced by replication. Hsa‐miR‐134‐5p was found up‐regulated in senescent EPCs where overexpression improved angiogenic activity. Hsa‐miR‐134‐5p, which targeted transforming growth factor β‐activated kinase 1‐binding protein 1 (TAB1) gene, down‐regulated TAB1 protein, and inhibited phosphorylation of p38 mitogen‐activated protein kinase (p38) in hsa‐miR‐134‐5p‐overexpressed senescent EPCs. Treatment with siRNA specific to TAB1 (TAB1si) down‐regulated TAB1 protein and subsequently inhibited p38 activation in senescent EPCs. Treatment with TAB1si and p38 inhibitor, respectively, showed angiogenic improvement. In parallel, transforming growth factor Beta 1 (TGF‐β1) was down‐regulated in hsa‐miR‐134‐5p‐overexpressed senescent EPCs and addition of TGF‐β1 suppressed the angiogenic improvement. Analysis of peripheral blood mononuclear cells (PBMCs) disclosed expression levels of hsa‐miR‐134‐5p altered in adult life, reaching a peak before 65 years, and then falling in advanced age. Calculation of the Framingham risk score showed the score inversely correlates with the hsa‐miR‐134‐5p expression level. In summary, hsa‐miR‐134‐5p is involved in the regulation of senescence‐related change of angiogenic activity via TAB1‐p38 signalling and via TGF‐β1 reduction. Hsa‐miR‐134‐5p has a potential cellular rejuvenation effect in human senescent EPCs. Detection of human PBMC‐derived hsa‐miR‐134‐5p predicts cardiovascular risk. [ABSTRACT FROM AUTHOR]

This study explores the impact of senescence on autocrine C‐C motif chemokine ligand 5 (CCL5) in human endothelial progenitor cell (EPCs), addressing the poorly understood decline in number and function of EPCs during ageing. We examined the effects of replication‐induced senescence on CCL5/CCL5 receptor (CCR5) signalling and angiogenic activity of EPCs in vitro and in vivo. We also explored microRNAs controlling CCL5 secretion in senescent EPCs, its impact on EPC angiogenic activity, and validated our findings in humans. CCL5 secretion and CCR5 levels in senescent EPCs were reduced, leading to attenuated angiogenic activity. CCL5 enhanced EPC proliferation via the CCR5/AKT/P70S6K axis and increased vascular endothelial growth factor (VEGF) secretion. Up‐regulation of miR‐409 in senescent EPCs resulted in decreased CCL5 secretion, inhibiting the angiogenic activity, though these negative effects were counteracted by the addition of CCL5 and VEGF. In a mouse hind limb ischemia model, CCL5 improved the angiogenic activity of senescent EPCs. Analysis involving 62 healthy donors revealed a negative association between CCL5 levels, age and Framingham Risk Score. These findings propose CCL5 as a potential biomarker for detection of EPC senescence and cardiovascular risk assessment, suggesting its therapeutic potential for age‐related cardiovascular disorders. [ABSTRACT FROM AUTHOR]

Background Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. Methods and findings We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, [less than or equal to]25 kg/m.sup.2 [lean]; high, >25 kg/m.sup.2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, Conclusions In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome., Author(s): Shih-Chieh Chien 1,2,3, Chanchal Chandramouli 4,5, Chi-In Lo 1,2, Chao-Feng Lin 2,3, Kuo-Tzu Sung 1,2,3, Wen-Hung Huang 3, Yau-Huei Lai 2,6, Chun-Ho Yun 2,7, Cheng-Huang Su 2,3, Hung-I Yeh [...]