The Onco Fertility Journal (Onco Fertil J)

Ethical concerns in fertility preservation in the young Nalini Mahajan The Onco Fertility Journal 2018 1(2):59-60

Breast cancer and Fertility Part 2- Pregnancy Associated Breast Cancer Nalini Mahajan The Onco Fertility Journal 2018 1(2):61-70 Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy or within the first postpartum year. The increasing incidence follows the increase in age at first childbirth. Diagnostic delay due to physiological breast changes of pregnancy leads to the tumor being diagnosed at a more advanced stage. Since the termination of pregnancy does not alter the course of disease, patients can be offered BC management during pregnancy with a good outcome. Chemotherapy (CT) can be given safely during the second and third trimester of pregnancy. In the first trimester, the option of surgery is available while during puerperium, radiotherapy can be safely administered in addition to CT. Prognosis is related to the stage and grade of the tumor. Neonatal outcomes are reassuring. This article gives an overview of the diagnosis, management, and prognosis of PABC.

Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan Yasushi Takai The Onco Fertility Journal 2018 1(2):71-73 Fertility preservation (FP)/oncofertility is a crucial facet of cancer supportive care. The publication of FP guidelines is becoming increasingly prevalent in Japan. However, the viability of the guidelines is predicted on a well-developed FP network comprising of cancer hospitals, assisted reproductive technology (ART) hospitals/clinics, and oncofertility center, and the quality of the FP network in Japan varies greatly based on the region. Oncofertility care availability is influenced by the sustainability of each network and public financial support which may be facilitated by oncofertility registry system which recently launched in Japan.

Comparison of ovarian reserve and response to gonadotropin stimulation in fertile and infertile Indian women based on ovarian reserve markers, anti-Mullerian hormone and antral follicle count Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):74-80 Background: Poor ovarian response to gonadotropin (GT) stimulation during assisted reproductive technology cycles is often encountered in infertile women and is considered to be a cause of their infertility. Poor ovarian response is mostly a result of a low ovarian reserve (OR), implying that there may be an earlier depletion of the oocyte pool in infertile women. Aim of the Study: To evaluate whether infertile Indian women below the age of 35 years have an earlier depletion of their OR and a lower ovarian response to GT in comparison to age-matched fertile controls. Materials and Methodology: A total of 146 women undergoing in vitro fertilization-intracytoplasmic sperm injection at our fertility center between March 2017 and August 2017 were prospectively enrolled in this study. Anti-Mullerian hormone and antral follicle count (AMH and AFC) assessment was done for women enrolled in the study in the early follicular phase. Flexible GnRH antagonist protocol was followed. Age, AMH, AFC, body mass index, and response to ovarian stimulation (OS) were compared between the fertile and infertile groups. We also sought to determine which among these had the best prediction for ovarian response to controlled OS. Statistical Analysis: Chi-square test was used for comparisons between study groups with respect to percentages. P < 0.05 was considered to be statistically significant. Results: When adjusted for the differences in the demographic variables, we found no difference in the AMH (P = 0.298) and AFC (P = 0.302) between the fertile and infertile women. In addition, there was no difference in the ovarian response; the mean number of oocytes retrieved was 15.8 ± 7.5 in the fertile group and 14.3 ± 7.5 in the infertile group (P = 0.510). AMH had the strongest correlation with the number of oocytes retrieved (r = 2.11) in comparison to AFC (r = 0.08) and age (r = −0.45) Conclusion: There is no difference in OR and response in fertile and infertile Indian having similar demographics and basal characteristics.

Intrauterine autologous platelet-rich plasma therapy to improve implantation rates in patients undergoing frozen embryo transfer: A pilot study Anju Madhavan, Padmaja Naidu, Kum Kum Rani, Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):81-85 Background: Successful implantation is a well-orchestrated event requiring the presence of a healthy embryo, a receptive endometrium, appropriate embryo endometrial cross-talk, and adequate maternal immune protection. Despite advances in assisted reproductive technology, there are insignificant improvements in the implantation and pregnancy rates. Intrauterine infusion of platelet-rich plasma (PRP) might improve implantation rates through its paracrine effects by recruiting growth factors and cytokines that favor decidualization and implantation. Objectives: The objective of the study is to study whether intrauterine PRP improves implantation rates in patients undergoing frozen embryo transfer (FET). Subjects and Methods: In this retrospective study, we collected data of patients who underwent FET in Mother and Child Hospital for 11 months from January 2018 to November 2018. We screened data of 98 patients who had at least one previous failed FET and underwent subsequent FET. The patients were divided into a study and control group. The study group received Intrauterine PRP before FET, while the control group did not. All patients underwent the same hormone replacement therapy regimen for endometrial preparation. Main Outcome Measure: The main outcomes studied were the implantation rates and clinical pregnancy rates (CPR) after embryo transfer. Results: Patient demographics such as mean age, body mass index, and anti-mullerian hormone of both groups were comparable. Overall, the CPR was 42.8% in the control group and 47.6% in the intervention group, and the difference was not statistically significant. Conclusion: Intrauterine PRP does not increase the implantation rates/CPR significantly in patients who have had one previous FET failure.

Strategies for fertility preservation in young patients with cancer Devika Gunasheela, Jyothi Menon, N Ashwin The Onco Fertility Journal 2018 1(2):86-88 Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.

Fertility preservation in testicular seminoma Madhuri Patil, Priyanka Reddy The Onco Fertility Journal 2018 1(2):89-95 Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1% of all cancers in men. Germ cell tumors (GCTs) account for 95% of testicular cancers. Two broad categories of testicular tumors have been described, one pure seminoma (no nonseminomatous elements present) and the other is nonseminomatous GCTs. It is one the most curable neoplasm with 5 years survival rate of 98%–99% when diagnosed at an early stage. We present here one such case of metastatic seminoma, where the semen was cryopreserved for fertility preservation. Although the sample was oligoasthenospermic, a successful pregnancy and live birth was obtained with intrauterine insemination of the frozen sample in an controlled ovarian stimulation cycle. Testicular tumors can impair fertility after treatment in majority of patients. Fertility preservation methods such as semen freezing, sperm freezing using epididymal or testicular sperm extraction (TESE) or testicular tissue freezing provides hope for those who wish to father a child latter.

Fertility preservation in a premenarcheal female with sickle cell anemia Sonu Balhara Ahlawat, Sarabpreet Singh The Onco Fertility Journal 2018 1(2):96-98 The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.

A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen Sankar Kumar Das, Priyanka Roy The Onco Fertility Journal 2018 1(2):99-102 Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.

Beware of bleomycin toxicity: Fertility preservation for dysgerminoma Ashraf M Ali, Paapa Dasari The Onco Fertility Journal 2018 1(2):103-106 An 18-year-old female who underwent fertility preservation surgery for dysgerminoma Stage IIa received adjuvant chemotherapy and bleomycin, etoposide and cisplatin of four cycles. She presented with cough and breathlessness after 45 days of the last cycle of chemotherapy. She was tachypneic and had decreased SpO2 and was managed by supportive therapy. Her X-ray chest revealed bilateral ground-glass nodular opacity and computed tomography thorax showed evidence of pulmonary fibrosis in the form of intra- and inter-lobular septal fibrosis with surrounding ground-glass opacity. She ultimately died after 5 days of admission due to respiratory failure. Her body weight was 37 kg and she received standard dose of bleomycin and the cumulative dose was 360 U. Bleomycin dose recommendation is not per kg bodyweight, and the complication of pulmonary fibrosis could have been prevented if the dosage schedule as per bodyweight (0.25–0.5 U/kg) is advocated.

Squamous cell carcinoma around a dental implant: A case report and literature review

Publication date: Available online 22 February 2019

Source: Oral Oncology

Author(s): Eve Malthiéry, Marie De Boutray, Charlotte Koren, Jean-Pierre Albouy, Jacques-Henri Torres, Marie-Alix Fauroux

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Strategy for treatment of stage IV human epidermal growth factor 2-positive gastric cancer: a case report

The prognosis of stage IV gastric cancer and human epidermal growth factor 2 (HER2)-positive gastric cancer is poor, although new drugs and regimens have been developed. We report a case of a patient with stag...

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2018 Reviewer Acknowledgement List

Publication date: Available online 21 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s):

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An algorithm for management of dentofacial deformity resulting from juvenile idiopathic arthritis: Results of a multinational consensus conference

Publication date: Available online 21 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Cory M. Resnick, Paula Frid, Sven Erik Norholt, Peter Stoustrup, Zachary S. Peacock, Leonard B. Kaban, Thomas Klit Pedersen, Shelly Abramowicz, Temporomandibular Joint Juvenile Arthritis Working group (TMJaw)

ABSTRACT

Purpose

Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joints (TMJ) and may cause dentofacial deformity and dysfunction. The adverse effects of JIA on dentofacial growth, morphology and function may be due to erosion of the existing mandibular condyle(s), the inhibitory effect of the arthritis on the growing mandible, or both. No algorithm exists for management of JIA-induced skeletal and dental abnormalities; treatment varies widely.

Methods

Based on available literature and expert opinion obtained by a consensus conference held by the TMJaw group, a multidisciplinary and multi-national clinical and research network dedicated to diagnosis and management of TMJ arthritis caused by JIA, we present an algorithm to be used as a conceptual framework for management of dentofacial deformity resulting from JIA.

Results

An algorithm for management of dentofacial deformity resulting from JIA is presented and exemplified by 5 clinical cases.

Conclusion

A standardized algorithm will improve clinical decision making and facilitate outcomes research by allowing valid comparisons between published research studies. We emphasize the importance of multidisciplinary evaluation, management and long-term follow-up.

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Is SPECT/CT Superior to SPECT in Assessing Unilateral Condylar Hyperplasia?

Publication date: Available online 21 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Pingan Liu, Jun Shi

Abstract

Purpose

Single-photon emission computed tomography (SPECT) imaging with technetium-99m-disphosphates plays an important role in assessing unilateral condylar hyperplasia. The aim of the study was to evaluate whether quantification methods of single-photon emission computed tomography/computed tomography (SPECT/CT) based on precise region of interest (ROI) drawings made under the guide of CT images are more accurate than conventional SPECT methods in the assessment of unilateral condylar hyperplasia (UCH) growth.

Methods

This study is a nonblinded, retrospective case series. Patients with UCH who had undergone SPECT/CT scans were enrolled. CT images were used to guide the ROI drawings around the anatomical contour of the affected and contralateral condyles in SPECT/CT while conventional SPECT used fixed ROIs. Both the mean and maximum values within the ROIs were recorded to compute the percentile ratios. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were calculated separately for SPECT-based methods (SPECTaver, SPECTmax) and SPECT/CT methods (SPECTCTaver, SPECTCTmax). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve of each method was calculated and compared pairwise.

Results

Fifty-six patients total, including 30 patients with progressive and 26 patients with nonprogressive mandibular asymmetry, were evaluated. SPECTmax had the highest sensitivity of 83.3%, followed by SPECTCTmax, SPECTaver, and SPECTCTaver. Alternatively, SPECTaver, SPECTCTmax, and SPECTmax had similar specificities, PPVs and NPVs. Nonetheless, SPECTCTaver had the lowest specificity, PPV and NPV among all methods. ROC analysis also showed similar diagnostic performances between SPECTaver, SPECTmax and SPECTCTmax (P>0.05) and poorer diagnostic performance of SPECTCTaver compared to the other three methods (P<0.05).

Conclusions

The method of using ROIs drawn around the contour of the condyle from SPECT/CT does not show improved accuracy over conventional SPECT-fixed ROI methods in assessing unilateral condylar hyperplasia.

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Residential crowding and asthma in preschool children, a cross-sectional study

Publication date: Available online 21 February 2019

Source: Allergologia et Immunopathologia

Author(s): S. Kutzora, L. Puerto Valencia, A. Weber, J. Huß, L. Hendrowarsito, U. Nennstiel-Ratzel, C. Herr, S. Heinze

Abstract

Background

Asthma is the most common chronic disease in children, and associations with crowding have been reported. The aim of this study was to explore possible associations of crowding with asthma in children.

Methods

Seven cross-sectional surveys with preschool children were conducted within the framework of the health monitoring units in Bavaria, Germany, from 2004 to 2014. Residential crowding was defined as habitation of more than one person per room or less than 20 m² living space per person. Logistic regression models examined temporal changes in crowding, applying the first survey as reference. The relationship between crowding and physician-diagnosed asthma, asthma defined by the International Study of Asthma and Allergies in Childhood (ISAAC) and asthma symptoms were analyzed.

Results

Analyzing temporal changes of crowding rates did not reveal any differences over the years. However, the stratified descriptive analysis indicated a crowding increase in time in urban households where parents had a low education level (47.9% in 2004/05, 55.8% in 2014/15). No association was found between crowding and the variables "physician-diagnosed asthma" in 2014/15, "asthma defined by ISAAC" in 2014/15, or "wheezing" in 2014/15. A positive association with cough was identified in 2014/15 after adjusting for confounders (aOR = 1.42 [95% CI: 1.20–1.69]).

Conclusions

In general, residential crowding did not change from 2004 to 2014; however, there seems to be a small upsurge for children with low-educated parents, living in urban areas over the years. A statistically significant association between crowding and cough was only found in the survey from 2014/15.

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