Research Items (40)
Cervical cancer is one of the leading causes of cancer death in women globally, despite widespread use of cytology/Human Papillomavirus (HPV) screening. Here, we aimed to identify the potential role of miRNA as diagnostic biomarker in the detection of cervical pre‐malignant lesions and cancer. In total, we recruited 582 patients with cervical diseases and 145 control individuals. The expression levels of six miRNAs (miR‐20a, miR‐92a, miR‐141, miR‐183*, miR‐210 and miR‐944) were found to be significantly up‐regulated in cervical cancer and pre‐malignant lesions as compared to normal cervical samples, indicating that they are oncogenic miRNAs. Receiver operating characteristic (ROC) curve analysis showed that these six miRNAs can be used to distinguish patients with cervical pre‐malignant lesions or cancer from normal individuals and had good predictive performance, particularly in cervical lesions. Combined use of these six miRNAs further enhanced the diagnostic accuracy over any single miRNA marker, with an area under the curve (AUC) of 0.998, 0.996 and 0.959, and diagnostic sensitivity of 97.9%, 97.2% and 91.4%, and specificity of 98.6%, 96.6% and 87.6% for low‐grade, high‐grade lesions and cancer, respectively. This six oncogenic miRNA signature may be suitable for use as diagnostic marker for cervical pre‐malignant lesions and cancer in the near future.
Intraperitoneal metastasis is a common occurrence and is usually involved in the poor prognosis of ovarian cancer. Its specific metastatic pattern implies that certain indispensable microenvironmental factors secreted in the peritoneal cavity can direct metastatic ovarian cancer cells to permissive niches for secondary lesion formation. However, the underlying molecular mechanisms are ill defined. Herein, we report that GRO-α and IL-8 are predominately upregulated in culture media derived from either normal or cancerous omenta and are associated with increased ovarian cancer aggressiveness. Methods: OCM was established from culture medium of fresh human omental tissues. Primary and metastatic ovarian cancer cell lines were generated from human tumor tissues and verified by specific antibodies. The functional roles of GRO-α, IL-8, and their specific receptor CXCR2 were examined by neutralizing antibodies, shRNA gene knockdown, CRISPR/Cas9 gene knockout and pharmaceutical CXCR2 inhibitor SB225002. The oncogenic properties of ovarian cancer cells were examined by in vitro and in vivo mouse models. Results: Both GRO-α and IL-8 can activate TAK1/NFκB signaling via the CXCR2 receptor. Intriguingly, TAK1/NFκB signaling activity was higher in metastatic ovarian cancer cells; this higher activity makes them more susceptible to OCM-induced tumor aggressiveness. Treatment of ovarian cancer cells with GRO-α and IL-8 neutralizing antibodies or ablation of CXCR2 by shRNA gene knockdown, CRISPR/Cas9 gene knockout, or CXCR2 inhibitor SB225002 treatment significantly attenuated TAK1/NFκB signaling and decreased in vitro and in vivo oncogenic and metastatic potential, suggesting CXCR2 plays a key role in the GRO-α and IL-8-governed metastatic spreading of ovarian cancer cells in the intraperitoneal cavity. Conclusion: This study highlights the significance of GRO-α and IL-8 as the key chemokines in the peritoneal tumor microenvironment and suggests the utility of targeting their receptor CXCR2 as a potential target-based therapy for peritoneal metastases of ovarian cancer.
Abdominal hysterectomy is a major operation and can significantly impact on a woman’s physical as well as mental wellbeing. Therefore, it is paramount that health care professionals should take all necessary precautions to ensure a successful surgical outcome with minimal morbidity and mortality. Additionally, it is important to allow adequate time for preparation prior to surgery. Each patient should be carefully assessed by both the surgeons and the anaesthesiologists before the operation. Close collaboration with other medical specialists may also be necessary in order to optimize the patient’s pre-existing medical conditions.
Various surgical instruments are required to perform abdominal hysterectomy and surgeons must know the applications and limitations of the instruments. The aim of this chapter is to review the basic surgical instruments that are required for most abdominal hysterectomy and it is not intended to be a comprehensive list of all instruments available.
Human growth factor receptor-bound protein-7 (GRB7) is a pivotal mediator involved in receptor tyrosine kinase signaling and governing diverse cellular processes. Aberrant upregulation of GRB7 is frequently associated with the progression of human cancers. However, the molecular mechanisms leading to the upregulation of GRB7 remain largely unknown. Here, we propose that the epigenetic modification of GRB7 at the post-transcriptional level may be a crucial factor leading to GRB7 upregulation in ovarian cancers. Methods: The upstream miRNA regulators were predicted by in silico analysis. Expression of GRB7 was examined by qPCR, immunoblotting and immunohistochemical analyses, while miR-193a-3p levels were evaluated by qPCR and in situ hybridization in ovarian cancer cell lines and clinical tissue arrays. MS-PCR and pyrosequencing analyses were used to assess the methylation status of miR-193a-3p. Stable overexpression or gene knockdown and Tet-on inducible approaches, in combination with in vitro and in vivo tumorigenic assays, were employed to investigate the functions of GRB7 and miR-193a-3p in ovarian cancer cells. Results: Both miR-193a-3p and its isoform, miR-193b-3p, directly targeted the 3' UTR of GRB7. However, only miR-193a-3p showed a significantly inverse correlation with GRB7-upregulated ovarian cancers. Epigenetic studies revealed that methylation-mediated silencing of miR-193a-3p led to a stepwise decrease in miR-193a-3p expression from low to high-grade ovarian cancers. Intriguingly, miR-193a-3p not only modulated GRB7 but also ERBB4, SOS2 and KRAS in the MAPK/ERK signaling pathway to enhance the oncogenic properties of ovarian cancer cells in vitro and in vivo. Conclusion: These findings suggest that epigenetic silencing of miR-193a-3p by DNA hypermethylation is a dynamic process in ovarian cancer progression, and miR-193a-3p may be explored as a promising miRNA replacement therapy in this disease.
Supplementary Table S1: The list of 78 targets of miR-193a-3p commonly found by three algorithms; miRDB, miRnada and Target Scan. Supplementary Figure S1: A schematic diagram showing the distribution of CpG sites along the first 800 bp of the promoter region of pre-miR-193a-3p. The promoter regions of pre-miR-193a-3p for Methylation-specific PCR (MSP) and pyrosequencing are indicated. Supplementary Figure S2: Schema of miR-193a-3p binding sites in the corresponding 3'UTR sequence of the putative binding site in wild-type ERBB4, SOS2 and KRAS. The capital letters of each genes' 3'UTR represent the seed sequence of the miR-193a-3p binding site. Supplementary Figure S3: A schematic diagram showing miR-193a-3p targets ERBB4, GRB7, KRAS and SOS2 in modulating ERK activity for different oncogenic capacities in ovarian cancer cells.
- Apr 2017
Introduction: The aim of this study was to compare the effect of two educational interventions on the psychosocial well-being of Hong Kong Chinese women who have a positive high-risk human papillomavirus (HPV) test and normal cervical cytology. Methods: Participants were randomised into either leaflet group, in which a written HPV factsheet was provided; or counselling group, in which a didactic HPV presentation in person in addition to the factsheet was provided. Women's psychological conditions were assessed by self-administered questionnaires at pre, post (within one week) and 6 months after the educational interventions. Main outcome measures were psychosocial well-being (cervical cancer worry, anxiety and depression, screening-related anxieties, HPV-related shame) and knowledge of cervical screening and HPV. Results: Data from 121 women (52 in leaflet group; 69 in counselling group) were analysed. There was no significant difference in the psychosocial well-being between the two groups at alltime points. Irrespective of the two educational interventions, cervical cancer worry and anxiety decreased over time. The counselling group had a significantly higher score in knowledge of cervical screening and HPV compared with leaflet group (mean score 4.65 ± 0.19 versus 3.71 ± 0.23, p = 0.002) at post-educational intervention, but there was no significant difference (mean score 4.14 ± 0.22 versus 3.58 ± 0.24, p = 0.084) at 6 months. Discussion: Both educational interventions were comparable in relieving adverse HPV-related psychosocial effects. Combination of counselling and leaflet were more effective than leaflet only in improving women's knowledge on cervical screening and HPV soon after educational interventions but the benefit was not apparent after 6 months.
- Feb 2017
Purpose: To investigate bone marrow changes after chemoradiation (CRT) using intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) and correlate imaging changes with hematological toxicity (HT) in patients with locally advanced cervical cancer. Materials and methods: Thirty-nine patients with newly diagnosed cervical cancer were prospectively recruited for two sequential 3.0T IVIM-MRI studies: before treatment (MRI-1) and 3-4 weeks after standardized CRT (MRI-2). The irradiated pelvic bone marrow was outlined as the regions of interest to derive the true diffusion coefficient (D) and perfusion fraction (f) based on a biexponential model. The apparent coefficient diffusion (ADC) was derived using the monoexponential model. Changes in these parameters between MRI-1 and MRI-2 were calculated as ΔD, Δf, and ΔADC. HT was defined accordingly to NCI-CTCAE (v. 4.03) of grade 3 and above. Statistical analysis was performed using Mann-Whitney U-test. Results: The median age of patients was 54 years old (range 27-83 years old); 14 patients suffered from HT. Early bone marrow changes (3-4 weeks) of ΔD showed a significant difference between HT and non-HT groups (6.4 ± 19.7% vs. -6.4 ± 19.4%, respectively, P = 0.041). However, no significant changes were noted in Δf (3.7 ± 13.3% vs. 1.5 ± 12.5% respectively, P = 0. 592) and ΔADC (5.5 ± 26.3% vs. -3.3 ± 27.0% respectively, P = 0.303) between the HT and non-HT groups. Δf increased insignificantly for both groups. Conclusion: ΔD was the only significant parameter to differentiate early cellular environment changes in bone marrow after CRT, suggestive that ΔD was more sensitive than Δf and ΔADC to reflect the underlying microenvironment injury. Level of evidence: 2. J. Magn. Reson. Imaging 2017.
- Apr 2016
Objective: To estimate the positive predictive value of Pipelle endometrial sampling in detecting the presence of an underlying endometrial polyp. The secondary objective is to examine the histologic features that can predict the presence of endometrial polyps. Study design: This is a retrospective case review study. 195 women who had undergone diagnostic hysteroscopy and/or polypectomy were identified in a University teaching hospital. All patients had a prior polyp diagnosis in the Pipelle endometrial sample. The histology of these samples were compared and analyzed with subsequent DH findings and final hysteroscopic biopsies. Slides were reviewed by 2 gynaecological pathologists. Results: 162 women were premenopausal (mean age 46.1, SD=4.6) and 33 were postmenopausal (mean age 57.2, SD=8.1). The commonest indication for a Pipelle endometrial sampling was abnormal uterine bleeding. Presence of polyp was confirmed by DH in 56.3% (111/195) cases. Of these, 81.1% (90/111) were confirmed histologically. The positive predictive value of detection of polyps in Pipelle endometrial samples for premenopausal and postmenopausal women was 53.7% and 72.7%, respectively (p=.05). The most reliable histologic features that can predict the presence of an underlying polyp was fibrous stroma (p=.01) and focal glandular clustering (p=.03). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was 11.7% (13/111). Conclusion: The positive predictive value of Pipelle endometrial samples in detecting endometrial polyps was 56.3%. It was higher in the postmenopausal women (72.7%) compared to premenopausal women (53.7%). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was consistent with the rate reported in the literature. Using ultrasonography as an adjunct maybe helpful in diagnosing endometrial polyps.
Cancer diagnosed during pregnancy is uncommon, complicating between 0.02% and 0.1% of all pregnancies. Nonetheless, due to increasing age of childbearing, the incidence of cancer during pregnancy is likely to increase due to higher incidence of several age-dependent malignancies. The most common malignancies include breast cancer, cervical cancer, malignant melanoma and lymphoma. One of the key challenges in the management of cancer in pregnancy is treating the women with standard chemotherapy regimen, without compromising the safety of the developing foetus. Exposure of chemotherapy in the first trimester is associated with an increased risk of major birth defects, whereas use in the second and third trimesters is associated with intrauterine growth restriction, low birthweight and stillbirth. In this article, we review available data regarding the use of chemotherapeutic agents in pregnancy, and we summarise the neonatal outcomes, including malformations, perinatal complications and long-term follow-up. In addition, the management plan during pregnancy is also discussed.
Background: A family sense of coherence is central to successfully coping with family stressors and facilitates positive adaptation. Little is known about the implications of family sense of coherence for family adaptation during the transition to parenthood. Objective: The objective of this study was to examine the role of family sense of coherence in family and marital functioning during the perinatal period. Methods: The study used a longitudinal design. A convenience sample of 202 Chinese childbearing couples completed the Medical Outcomes Study Family and Marital Functioning Measures and Family Sense of Coherence Scale during pregnancy, at 6 weeks and at 6 months postpartum. Results: The results showed that the couples experienced a substantial decline in family and marital functioning postpartum and that a strong family sense of coherence was associated with better family and marital functioning in the perinatal period. The levels of family sense of coherence for both mothers and fathers were fairly stable across the perinatal period. Conclusion: The study provides evidence that family sense of coherence plays a significant role in promoting family and marital functioning during the transition to parenthood.
- Oct 2015
Endometriosis is a common gynecologic condition of the premenopausal years. However, postmenopausal endometriosis is rare (2.2%) and thought to be related to high level of circulating estrogen, especially in hormonal replacement therapy. We present a case of a 69-year-old postmenopausal woman, previously healthy and on no regular medication, with diffuse peritoneal endometriosis and bilateral ovarian endometrioma mimicking metastatic ovarian carcinoma on FDG PET/CT. Both ovarian endometrioma had low-grade activity, but more strikingly, there was diffuse FDG-avid peritoneal dissemination and gross ascites. Endometriosis should not be totally disregarded as a differential diagnosis even at postmenopausal status.
- Apr 2015
The purpose of this study was to evaluate the sonographic characteristics of the uterus after apparently uncomplicated second-trimester medical termination of pregnancy and to follow the evolution of these findings until the return of menstruation. Twenty-three women who requested termination of pregnancy at gestational ages between 14 and 20 weeks were recruited. Uterine characteristics were measured by 2- and 3-dimensional transvaginal with or without transabdominal sonography. The uterine anteroposterior diameter, length, and width, endometrial thickness, presence of an endometrial mass, intrauterine vascularity, and endometrial volume were measured within 24 hours, 1, 2, 4, 6, and 8 weeks after termination, and during the postmenstrual phase. The mean uterine anteroposterior diameter, uterine length, uterine width, endometrial thickness, and endometrial volume ± SD deceased gradually from 66.1 ± 9.7 to 40.9 ± 5.3 mm, 131.4 ± 14.7 to 81.3 ± 13.8 mm, 84.6 ± 10.3 to 54.2 ± 7.6 mm, 25.6 ± 8.1 to 4.5 ± 2.6 mm, and 39.4 ± 22.6 to 2.5 ± 2.1 mL, respectively, from within 24 hours after termination to the postmenstrual phase. Endometrial masses were identified in 8 women (34.8%) within 4 weeks after termination, which could persist for up to 8 weeks. However, all endometrial masses resolved after menstruation. Minimal and moderate endometrial vascularity was detectable in up to 21.7% after termination; none was detectable in any women after menstruation. This study provides information on the normal sonographic parameters of the uterus after second-trimester medical termination of pregnancy, which has been lacking in the literature. Also, our findings suggest that all endometrial masses regress with time; therefore, asymptomatic women with an incidental finding of an endometrial mass can be followed without the need for an immediate intervention. © 2015 by the American Institute of Ultrasound in Medicine.
- Dec 2014
Postnatal depression has emerged as a major public health concern, which has deleterious effects on the well-being of the entire family. The aim of this study was to examine the predictive role of prenatal family sense of coherence, stress, social support and family, and marital functioning; the effect that any changes in these factors from pregnancy to postpartum; and partner's depressive symptoms on depressive symptoms at 6months postpartum. This study used a longitudinal design. A convenience sample of 200 childbearing couples in Hong Kong completed assessments of family sense of coherence, stress, social support, family, and marital functioning and depressive symptoms during pregnancy and at 6months postpartum. Multiple regression analyses were employed. The results showed that a low level of family sense of coherence and a high level of depressive symptoms during pregnancy and partner's depressive symptoms were significantly associated with an increase in depressive symptoms for both mothers and fathers at 6months postpartum. A lack of social support was significantly associated with increased risk of depressive symptoms for mothers, but not for fathers. The results suggest that couple-based interventions that foster a sense of family coherence may be helpful in promoting parental well-being. Well-designed trials to test the effects of such interventions are recommended for future research. Copyright © 2014. Published by Elsevier Inc.
Our objective was to review the surgical management, surgical outcomes, and obstetric outcomes of adnexal masses in pregnancy. A retrospective review was performed of pregnant women before 20 weeks of gestation who underwent laparoscopy or laparotomy for management of an adnexal mass during the period of January 2005 to June 2012 at a university-affiliated hospital. Thirty-five pregnant women underwent surgical removal of adnexal masses during the 7.5-year study period: 21 (60.0%) underwent laparoscopic surgery, and 14 (40.0%) underwent laparotomy. The left upper quadrant entry technique was used in 20 women. Conversion to laparotomy was required in 2 women because of extensive pelvic adhesions. The mean gestational age at surgery was 15.2 ± 1.9 weeks. All women had undergone ovarian cystectomy. A malignant mass was found in 3 (8.6%) women. The laparoscopy group had a significantly less blood loss (67.4 ± 55.8 vs 153.6 ± 181.0 mL, P = .048) and shorter mean hospital stay (2.8 ± 1.0 vs 3.8 ± 1.1 days, P = .006) than the laparotomy group. One woman miscarried soon after surgery. There was no significant difference in obstetric outcomes between the laparoscopy and laparotomy groups. Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for the mother and the fetus.
To examine the predictive role of family sense of coherence, social support and stress during pregnancy and their changes from pregnancy to postpartum on family and marital functioning at 6 weeks postpartum. Family sense of coherence plays a significant role in promoting positive family and marital functioning, which is crucial to the child's well-being. However, studies that evaluate the predictive role of family sense of coherence on family and marital functioning during parental transition are limited. The study used a longitudinal design. Chinese childbearing couples (n = 202) completed assessments of family sense of coherence, stress, social support, and family and marital functioning during pregnancy and at 6 weeks postpartum between January 2011-May 2012. Mothers with a stronger family sense of coherence, greater social support and less stress during pregnancy experienced less decline in family and marital functioning at 6 weeks postpartum, while fathers with a higher prenatal family sense of coherence and family and marital functioning also experienced less such decline. Couple-based interventions should be initiated early during pregnancy by strengthening family sense of coherence and social support to promote positive family functioning.
Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. A 47-year-old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen. The mass was resected laparoscopically and histologic examination showed a benign Mullerian cyst of the uterus. Diagnosis of Mullerian cyst of the uterus can be challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible sonographically. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 2013.
Gestational trophoblastic neoplasia (GTN) is highly chemosensitive and has a high cure rate. Since the introduction of chemotherapy, reliable measurement of human chorionic gonadotropin (hCG) levels, and individualised risk-based therapy into the management of GTN, almost all low-risk and more than 80 % of high-risk GTN cases are curable. However, approximately 25 % of high-risk GTN developed resistance to chemotherapy or relapsed after completion of initial therapy, which often necessitate salvage combination chemotherapy. On the other end of the spectrum, a proportion of patients with gestational trophoblastic disease (GTD) have persistently low levels of hCG, without clinical or radiological evidence of disease, a condition called quiescent GTD. Recently, measurement of hyperglycosylated hCG has been proposed for the management of patients with quiescent GTD. Although representing a small proportion of GTD cases, the management of patients with chemoresistant and quiescent GTD often poses challenges to medical practitioners.
J Obstet Gynaecol Can 2014;36(2):106 U ne femme de 71 ans présentait des saignements postménopausiques, une dysurie, des difficultés mictionnelles et une masse faisant saillie à partir de l'orifice. L'examen physique a révélé la présence d'une tuméfaction non réductible en forme de beigne au niveau du méat urétral, le tout s'accompagnant de saignements de contact, ce qui était compatible avec la présence d'un prolapsus urétral (Figure). La cystoscopie a révélé la présence d'une muqueuse engorgée au niveau du méat urétral. Une réduction manuelle du prolapsus a été menée à la suite de l'injection intralésionnelle de 1 500 UI d'hyaluronidase et de lignocaïne à 2 %, ce qui constituait le mode de traitement privilégié au sein de notre établissement 1. Trois semaines plus tard, la patiente a subi l'excision de la muqueuse urétrale en prolapsus sous anesthésie générale, en raison de la présence de symptômes récurrents. L'examen histopathologique des tissus excisés a révélé la présence d'une thrombose et d'une urétrite glandulaire. Bien que le prolapsus urétral soit un trouble peu courant qui se manifeste habituellement chez les filles prépubertaires et chez les filles d'origine africaine 2 , sa présence a occasionnellement été signalée chez des femmes postménopausées 1,3,4. La patiente a consenti à la publication de cette image. RÉFÉRENCES 1. Ho KL, Chu SM, Tam PC. Reduction of strangulated urethral prolapse using local anaesthesia with hyaluronidase.
- Dec 2013
Objective: Quality of life has emerged as an important health outcome in the care of perinatal families. This study was designed to examine the changes in quality of life among Chinese couples during the transition to parenthood. Methods: A longitudinal design was used. Participants comprised a convenience sample of 203 Chinese-childbearing couples attending the antenatal clinics, who completed data collection during pregnancy and at six weeks and six months postpartum. At each point, couples completed the Medical Outcomes Study Short Form 12-Item Health Survey. Results: The results showed that women experienced substantial changes in their quality of life during pregnancy and postpartum, whereas the changes in their partners' quality of life were less noteworthy. Women had a poorer quality of life than their partners during the early postpartum period. The mental health component of women's quality of life was closely related to their partners' across the perinatal period. Conclusions: The findings of the present study highlight the need for more attention to a couple's quality of life during the transition to parenthood. Couple-based and culturally relevant interventions should be developed to assist both parents to cope with the new challenges and demands of parenthood, and thus achieve a better quality of life.
- Sep 2013
A family sense of coherence is important to successful family adaptation during parental transition. The purpose of this study was to examine the relationships between family sense of coherence, stress, family and marital functioning, and depressive symptoms among Chinese childbearing couples. A cross-sectional design was used. Two hundred and twenty-four Chinese childbearing couples were recruited at the antenatal clinic between January and May 2011. Data were collected using the Family Sense of Competence Scale, Social Readjustment Rating Scale, Medical Outcome Study Family and Marital Functioning Measures, and General Health Questionnaire. Path analysis was employed. Family sense of coherence had a direct impact on family and marital functioning and depressive symptoms among both couples. Family sense of coherence also mediated the effect of stress on family and marital functioning and depressive symptoms among the pregnant women. The study provides evidence that family sense of coherence plays a significant role in promoting family functioning and reducing depressive symptoms during the transition to parenthood. Knowledge of the impact of family sense of coherence in parental transition can better equip healthcare professionals for developing couple-based and culturally sensitive care to assist childbearing couples to cope with the stress and demands of the parental role, thereby promoting positive family functioning and well-being.
- May 2013
Background: Medical abortion in women with the scar of a classical caesarean section (CS) and a large uterine leiomyoma is rarely attempted; it carries the risk of uterine rupture and haemorrhage. Case: A 34-year-old multiparous woman with prior classical CS and a 14 × 10 × 9 cm leiomyoma arising from the uterine isthmus had an induced abortion at 14 weeks' gestation. Mechanical cervical priming with Dilapan(®)-S followed by vaginal misoprostol administration resulted in the uncomplicated expulsion of the uterine contents. Conclusions: An early second trimester medical abortion with misoprostol was successfully performed in a woman with prior classical CS and a large uterine leiomyoma.
Objective: The fetal fibronectin test is advocated to facilitate the management of women presenting with threatened preterm labour, but is underutilised in Hong Kong. This study aimed to provide experience with this test and evaluate its utility in a local setting. Design: Prospective cohort study. Setting: A university-affiliated hospital in Hong Kong. Patients: Women presenting with symptoms of preterm labour were recruited from 1 January 2011 to 30 June 2012. Main outcome measures: The sensitivity, specificity, positive predictive value, and negative predictive value of the fetal fibronectin test to predict delivery within 24 hours, 48 hours, 7 days, and 14 days. Results: A total of 22 women were recruited; 12 (55%) of whom had a negative fetal fibronectin test, none of whom delivered within 7 days; six received corticosteroids and tocolysis, one of whom delivered within 14 days. The 10 remaining women had a positive fetal fibronectin test. Five of whom delivered within 7 days and two within 14 days; all of them had received corticosteroids and tocolysis. For predicting delivery within 7 days, the sensitivity and negative predictive value of the test were both 100%. Conclusions: Our study demonstrated the high negative predictive value of the fetal fibronectin test in our local setting, which suggests that it should be utilised more readily in women presenting with threatened preterm labour.
OBJECTIVE. To evaluate the prevalence of dysmenorrhoea, its impact, and management approaches in Hong Kong university students, and to compare between medical and non-medical students for any potential differences in coping strategies. DESIGN. Cross-sectional questionnaire survey. SETTING. The University of Hong Kong, Hong Kong. PARTICIPANTS. A total of 240 undergraduate (128 medical and 112 non-medical) students. MAIN OUTCOME MEASURES. Data on the presence and severity of dysmenorrhoea, its impact on daily life, management approaches, specific strategies, and their self-perceived effectiveness were obtained and analysed. RESULTS. In these subjects, the prevalence of dysmenorrhoea was 80% (95% confidence interval, 75-85%) with a mean (standard deviation) pain score of 5.0 (1.7). The most common impacts on daily life included reduced ability to concentrate and/or disturbance with study (75%) and changes in normal physical activity (60%). Only 6% sought medical advice, while 70% practised self-management. Pain scores and pain affecting normal physical activities were important predictive factors for self-management and for management based on pharmacological or non-pharmacological means. The commonest specific strategies used were a warm beverage (62%), paracetamol (57%), and sleeping (45%), while the most effective strategies were non-steroidal anti-inflammatory drugs (100%), traditional Chinese medicine (93%), and dietary/nutritional supplements (92%). Regarding the comparison of medical and non-medical students, the former used fewer pharmacological strategies among the various management approaches investigated. CONCLUSION. With data showing dysmenorrhoea as a very common condition having a significant impact in the Hong Kong community, primary care doctors should reassure young women with dysmenorrhoea that it is a common experience in the same age-group. Health education on the existence of effective treatment from medical practitioners could help women whose dysmenorrhoea was not controlled by self-management.
- Dec 2012
Purpose: The purpose of this study was to examine the relationships between family sense of coherence, social support, stress, quality of life and depressive symptoms among Chinese pregnant women. Methods: A cross-sectional design was used. A convenience sample of 267 Chinese pregnant women was recruited at the antenatal clinic and completed the Family Sense of Coherence Scale, Medical Outcomes Study Social Support Survey, Social Readjustment Rating Scale, Medical Outcome Study Short Form 12-Item Health Survey and General Health Questionnaire. Path analysis was employed. Results: Family sense of coherence and social support had a direct impact on the mental health component of quality of life and depressive symptoms during pregnancy. Family sense of coherence also mediated the effect of stress on quality of life and depressive symptoms. Conclusions: The study provides evidence that family sense of coherence and social support play a significant role in promoting quality of life and reducing depressive symptoms during the transition to motherhood. Culturally competent healthcare should be developed to strengthen women's family sense of coherence and foster social support to combat the stress of new motherhood, thereby promoting quality of life during that period of their lives.
- Nov 2012
A 36-year-old, gravida 7 para 2, presented at 5 weeks of amenorrhoea for vaginal bleeding and abdominal pain. She had two previous tubal ectopic pregnancies managed 11 and 12 years previously by medical therapy and laparoscopic salpingectomy, respectively, two cesarean deliveries and two surgical abortions. Abdominal and pelvic examination was unremarkable. Transvaginal sonography (TVS) showed no evidence of intrauterine or ectopic pregnancy. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
- Mar 2012
To compare the use of vaginoscopic vs traditional hysteroscopy in evaluation of the endometrial cavity. Prospective, randomized, single blinded, clinical trial (Canadian Task Force classification I). University-affiliated hospital in Hong Kong. Ninety women scheduled to undergo diagnostic hysteroscopy without anesthesia. Women were randomized to undergo either vaginoscopic hysteroscopy using the H Pipelle for endometrial sampling (n = 45) or traditional hysteroscopy using the standard Pipelle (n = 45). Both procedures were performed without anesthesia and using a rigid 4.5-mm hysteroscope. Main outcome measures analyzed were pain scores using a 10-point visual analog scale during hysteroscopy, endometrial biopsy, and overall pain score of the procedure, success and duration of each procedure, and adequacy of the endometrial sample obtained. The success rates for vaginoscopic and traditional hysteroscopy were 93.33% and 100%, respectively (p = .24). There was no significant difference in the mean pain score and procedure duration between the 2 hysteroscopic approaches. Endometrial sampling using the H Pipelle was significantly quicker by about 45 seconds compared with use of the standard Pipelle (mean [SD] duration, 1.46 [0.72] min vs 2.20 [1.19] min, respectively; p = .001), with similar biopsy adequacy. Most women (95.5% in both approaches) found the procedure acceptable. There were no intraoperative or postoperative complications. Vaginoscopic and traditional hysteroscopic approaches are similar in safety, feasibility, and associated pain. Although the time needed to obtain an endometrial sample using the H Pipelle was quicker than with the standard Pipelle, there is no difference in overall procedure duration.
- Feb 2012
Molar pregnancy found in a cesarean scar is exceedingly rare. It can be challenging to manage and can have potentially catastrophic consequences. A 34-year-old multigravid woman presented with persistent symptoms of pregnancy after a surgical termination of pregnancy. Cesarean scar molar pregnancy was suspected on ultrasonography, and suction evacuation was performed under ultrasound guidance. This was followed by bimanual compression, oxytocin, and uterine artery embolization to reduce bleeding. A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy.
The aim of the study was to evaluate the psychometric properties of the Chinese version of Medical Outcomes Study Family and Marital Functioning Measures (C-MOS-FMFM) in Hong Kong Chinese childbearing families. A cross-sectional survey was conducted using a convenience sample of 128 childbearing couples recruited from antenatal clinics. The C-MOS-FMFM demonstrated good internal consistency (Cronbach's alpha = 0.79) and test-retest reliability (intraclass correlation coefficient = 0.74). Significant correlations with Medical Outcomes Study-Social Support Survey (r = 0.38, P < 0.01) and Trait Anxiety Inventory (r = -0.48, P < 0.01) supported construct validity. Factor analysis identified one factor corresponding to family functioning and two factors corresponding to marital functioning. The C-MOS-FMFM has satisfactory psychometric properties. It has the potential to be used as a clinical and research instrument for measuring family and marital functioning in the Chinese population.
Family sense of coherence is central to successful coping with family stressors and facilitates positive adaptation. Little is known about the implications of family sense of coherence for family adaptation during the transition to parenthood in Chinese society. The aims of this study were to translate the Family Sense of Coherence Scale-Short Form (FSOC-S) into Chinese FSOC-S (C-FSOC-S) and to evaluate the psychometric properties. In Phase 1, the FSOC-S was translated into Chinese using the translation/back-translation technique and was reviewed by an expert panel for cultural equivalence. In Phase 2, a cross-sectional survey was conducted using a convenience sample of 128 Chinese childbearing couples recruited from the antenatal clinics. Participants completed the C-FSOC-S, Sense of Coherence Scale, Medical Outcomes Study Family and Marital Functioning Measures, and State-Trait Anxiety Inventory. The C-FSOC-S showed good internal consistency (Cronbach's α = .83) and test-retest reliability (intraclass correlation coefficient = .75). Significant correlations with Sense of Coherence Scale (r = .55, p < .01), Medical Outcomes Study Family and Marital Functioning Measures (r = .71, p < .01), and State-Trait Anxiety Inventory (r = -.50, p < .01) indicated good construct validity. Exploratory factor analysis revealed a single-factor structure of the C-FSOC-S. The C-FSOC-S has satisfactory psychometric properties and has the potential to be used as a clinical and research instrument for measuring family sense of coherence in Chinese childbearing families.
- Aug 2011
To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period. Retrospective review. Setting. University-affiliated hospital. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Medical records were reviewed. Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications. 143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surgery in the second trimester of pregnancy (16, 11.1%), presence of large pelvic mass (9, 6.2%), previous transverse rectus abdominis myocutaneous flap for breast reconstruction (3, 2.0%), previous periumbilical hernia repair (1, 0.6%) and previous laparoscopic umbilical wound dehiscence (1, 0.6%). In women with previous abdominal surgery, the overall incidence of adhesions between omentum and/or bowel to the anterior abdominal wall in the umbilical region was 58.4%. Twelve (8.3%) patients required conversion to laparotomy. One patient had subcutaneous surgical emphysema over the left upper quadrant entry site. The left upper quadrant approach is an effective, safe and easy technique for peritoneal cavity access in women undergoing laparoscopic gynecologic surgery and should be considered in women with risk factors of periumbilical adhesions and in the presence of a large pelvic mass.
- Feb 2011
An accessory ovary is a rare congenital anomaly of the female reproductive tract. This report illustrates a case of a cyst arising from an accessory ovary complicated by torsion. A 39-year-old nulliparous woman presented with lower abdominal pain and was found on physical examination to have an 8-cm mass anterior to the uterus. Ultrasonography of the pelvis showed a 9.3×6.7 cm cystic lesion with a solid component anterior to the uterus suggestive of a left ovarian cyst. Laparoscopy was performed for presumed ovarian torsion. Torsion of a tumor arising from an accessory ovary was found intraoperatively. Patients suspected to have ovarian torsion should have emergency surgery for diagnosis and attempted ovarian preservation. Physicians should consider complications of paraovarian anomalies in the differential diagnosis.