The use of standardized and reproducible experimental
procedures and outcome measures is critical for judging relative efficacy. Finally, success will hinge on carefully designed clinical trials with well-defined patient selection criteria, gold-standard controls, and objective outcome metrics to assess performance in the early postoperative period.”
“AimTo evaluate the long-term oncological and reproductive outcomes of patients aged 25 years NVP-HSP990 mouse and younger who were treated by fertility-sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT).
MethodsRecords of 42 eligible female patients treated for MOGCT between 1 May 1995 and 31 December 2010 at two centers were analyzed retrospectively. A telephone questionnaire was performed to gather reproductive and menstrual history.
ResultsOne patient was Selleckchem JNJ-26481585 treated without FSCS and two patients were lost to follow-up. The mean age of the remaining 39 patients was 18.43.2 years. Eighteen of the tumors were histologically pure dysgerminomas (PD) and 21 were
non-dysgerminomatous tumors (non-DT). Thirteen patients (33%) presented with stage II-III disease. Optimal cytoreduction was achieved in 34 of the 39 patients (87%). Systematic pelvic and para-aortic lymphadenectomy was performed in 31 of the 39 patients (79.5%). The frequency of lymph node metastasis was 29% (9/31). Twenty-seven patients (69.2%) received ACT. Disease recurred in six (15.3%) patients, all in the non-DT group. Four of six underwent secondary optimal FSCS followed by chemotherapy. Retroperitoneal nodal recurrence was detected in two of these four patients (50%). Four deaths occurred, three due to chemoresistant aggressive disease and one due to secondary acute myelocytic leukemia. The overall survival rates for patients with PD and non-DT were 100% and 81.4%, respectively.
Twenty-three of 27 patients who received ACT continued their regular menses. Sixteen spontaneous pregnancies and one pregnancy by intrauterine insemination were achieved by 21 patients who attempted conception.
ConclusionEither primary or secondary FSCS followed by ACT seems to be a feasible and safe CP-456773 in vitro approach to preserving future fertility and hormonal function in young patients with MOGCT.”
“Purpose of review
To underscore the advantages of hypothermic machine perfusion (HMP) in light of the recent discoveries.
Recent findings
The phase I clinical trial of liver HMP has suggested superiority over static cold storage (SCS) preservation. The liver transplant arena has gained more sophisticated insights into the molecular mechanism and biomechanical understanding behind the benefits of HMP. Its ability to attenuate ischemia-reperfusion injury translates to reduction in ischemia-reperfusion injury with improved early allograft function.