This showed that melatonin may be involved in the modulation of the reproductive neuroendocrine axis in male infertility. Melatonin is believed to be involved in the regulation of circadian rhythm in the fetus.
CONCLUSION
In the event that ROS attack the lipids of the plasma membrane, a process called 'lipid peroxidation' is initiated. In addition to directly scavenging free radicals, melatonin has a high ability to detoxify ROS and indirectly suppress their oxidative effects by enhancing the production of endogenous antioxidants.
Effect of melatonin implants on breeding activity and litter size in UK commercial sheep flocks. The effect of melatonin on the reproductive performance of three sheep breeds in Spain.
INTRODUCTION
This narrative review presents possible mechanisms of pelvic floor disorders in obese women, their symptoms, and the role of bariatric surgery in altering their quality of life.
Role of bariatric surgery in the pelvic floor disorders
Abstract
MINIREVIEW
Studies reporting on the role of bariatric surgery in pelvic floor disorders were included in this review. Weight loss studies have examined its effects and explored the pathophysiological mechanisms of improvement in pelvic floor disorders. Surgically induced weight loss has a beneficial effect on pelvic floor disease symptoms in morbidly obese women.
Cuicchi et al[41] clinically and instrumentally evaluated pelvic floor disorders before and after bariatric surgery in obese women and found that there is a clear correlation between BMI and urinary incontinence. The women were dichotomized as those with pelvic floor disorders (n = 121) and those without pelvic floor disorders (n = 300)[48]. Obesity is associated with increased incidence and severity of pelvic floor disorders in women considering bariatric surgery.
Clinical and instrumental evaluation of pelvic floor disorders before and after bariatric surgery in obese women.
Past, present and future of primary systemic treatment in breast cancer
In the specific case of breast cancer, two dominant theories about the biological behavior of tumors in terms of their mechanisms of metastatic dissemination have dominated the past two centuries, paving the way for two opposing paradigms: Halsted's mechanistic theory and Fisher's systems theory. Therefore, breast cancer must be considered as a systemic disease in order to achieve optimal management outcomes, at least from a conceptual perspective. Systemic adjuvant therapy (hormonal therapy, chemotherapy, immunotherapy, biological therapy against a specific molecular target) used to manage micrometastatic disease after surgery with curative intent has been shown to reduce the risk of recurrence by 0.77 and breast cancer mortality by 0.83[2].
This benefit was achieved, albeit to varying degrees, regardless of axillary lymph node infiltration, hormonal receptor status, histological subtype, level of tumor differentiation, or expression of other predictive response factors (Her -2/.neu). However, for some patients, adjuvant treatment is not the best approach and the use of neoadjuvant chemotherapy (primary or preoperative) is preferable to local treatment of the disease. As a result, neoadjuvant treatment has been transformed from a treatment for patients with locally advanced breast cancer (making surgery more likely in tumors where local treatment with curative intent could not be guaranteed), to the treatment used in initially surgical tumors to allow conservative breast surgery. to make. surgery.
Taking into account that neoadjuvant and adjuvant chemotherapy offer similar benefits in terms of overall and disease-free survival in operable tumors [3], neoadjuvant treatment currently provides a greater knowledge of the in vivo effects of modern treatment options. in tumors prior to surgery.
PRELIMINARY TERMINOLOGICAL CONSIDERATIONS
In light of this historical background, the treatment of most malignancies is complex and requires interdisciplinary teams of physicians who are specialists in different fields working holistically to control them. This should be the case even when the cancer is theoretically committed to this organ (localized breast cancer) and requires local and systemic treatment for its control.
HISTORY OF NEOADJUVANT
CHEMOTHERAPY: THE REASON FOR PRIMARY TREATMENT
In this situation, it was necessary to demonstrate that primary chemotherapy was able to achieve the same effects that adjuvant chemotherapy had already shown in reducing recurrence and overall and disease-free survival[1], as well as in improving the percentage of patients who could undergo conservative surgery. A number of non-randomized studies have examined the ability of neoadjuvant chemotherapy to increase the chances of conservative surgical treatment of breast cancer. Several studies have prospectively analyzed phase 3 trials of the use of adjuvant chemotherapy compared with the same chemotherapy used neoadjuvantly in patients with operable breast cancer, without revealing any difference in overall or disease-free survival and achieving a significant increase in rates of conservative surgery breast cancer.
In the NSABP B-18[8] study, 1523 patients diagnosed with surgical breast cancer (T1-3, N0-1) were randomized to 4 cycles of chemotherapy with adriamycin and cyclophosphamide (60-600 mg/m2) as neoadjuvant . or additional chemotherapy. A clinical response was achieved in 79% of the patients treated with neoadjuvant chemotherapy, with 36% complete clinical responses and 13% complete pathological responses. What's more, 68% conservative surgery was achieved in the neoadjuvant chemotherapy arm compared with 60% in the initial surgery arm, especially in patients with tumors larger than 5 cm in diameter.
The response achieved in patients treated with primary chemotherapy was 49% with 4% complete pathology responses.
CURRENT SITUATION OF PRIMARY THERAPY: CERTAINTIES AND
In addition to allowing the operation of these tumors that were initially inoperable and improving the survival rate of these patients, it was found that primary chemotherapy could play a role in reducing the initial size of the tumors, making it possible to perform conservative surgery in patients with for whom mastectomy was initially decided as a surgical treatment. An increase in ipsilateral local recurrence was observed in patients receiving primary chemotherapy (10.7 vs 7.6) especially in patients under 50 years of age, which was attributed to the fact that they had not been treated with tamoxifen, although this lack of hormonal treatment occurred equal in both treatments. weapons. This means that there is no clear disadvantage for neoadjuvant treatment in terms of loco-regional recurrence, when it allows an increase in the possibilities of conservative treatment, provided that it is followed by the correct hormonal treatment and loco-regional radiotherapy if required [10].
However, these "tailor-made" treatments have shown no advantage in terms of survival or disease-free survival; and (2) the identification of biomarkers that allow us to obtain early information about the antitumor activity of the two treatment options would allow us to make faster decisions when using survival as the underlying variable. Today, this is less important because the initial systemic treatment is very homogeneous from the beginning (with the use of anthracyclines and taxanes) and is mainly based on known biological factors (eg, the use of trastuzumab/lapatinib in patients with Her- 2/ overexpressed. neu), and in addition, we can make accurate local regional staging through sentinel node study before neoadjuvant chemotherapy. The initial staging should use the TNM system, and the "c" prefix is advised in the pre-treatment stage and.
All patients had to undergo a thorough physical examination, at least one bilateral mammography examination, a breast ultrasound analysis and correct systemic staging, especially in case of locally advanced tumors to rule out distant metastases.
LOCOREGIONAL STAGING
The addition of trastuzumab to patients with an overexpression of Her-2/neu has demonstrated a survival benefit both in the context of adjuvant therapy and in advanced disease. Similarly, the use of trastuzumab is recommended in the neoadjuvant treatment of Her-2/neu positive patients, as it increases the chance of complete responses. In both cases the addition of trastuzumab significantly increased the odds of a pathologic complete response (43% and 31.7% compared with 23% and 15.7%, respectively), with no difference in the survival rate or the proportion of patients treated conservatively. surgery.
A meta-analysis was performed comparing the addition of trastuzumab with regimens without it, including 5 studies with 515 patients and the conclusion is similar to the previous one: a significant increase in the chances of achieving a complete pathological response without. Although many studies suggest that the percentage of complete pathological response is greater in triple negative patients than in the rest, it remains unclear whether this provides some kind of benefit in these patients. Some studies go further and separate complete response in the primary tumor and in the axillary lymph node.
Although there is no consensus in the literature regarding complete response, it is currently believed that the achievement of pathologic complete response is a prognostic factor independent of disease-free survival and overall survival in multivariate analysis [7].
FUTURE OF PRIMARY SYSTEMIC THERAPY
Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Timing of sentinel lymph node biopsy in patients receiving neoadjuvant chemotherapy for breast cancer. Trastuzumab combined with neoadjuvant chemotherapy in patients with HER2-positive breast cancer: a systematic review and meta-analysis.
Neoadjuvant chemotherapy in breast cancer response assessment and treatment response prediction using dynamic. Impact of neoadjuvant chemotherapy response with MRI values on changing surgical recommendations in breast cancer. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy.
CT and PET for the assessment of pathological response to neo-adjuvant chemotherapy in breast cancer: a meta-analysis.
Prenatal incarceration of caput succedaneum: A case report
CASE REPORT
DISCUSSION
GENERAL INFORMATION
INSTRUCTIONS TO AUTHORS
SPECIAL STATEMENT
SUBMISSION OF MANUSCRIPTS
Manuscripts should be submitted through the online submission system at: http://www.wjgnet.com/2218-6220office. For assistance, authors who encounter problems with the online submission system can send an email describing the problem to [email protected] or phone.
MANUSCRIPT PREPARATION
Detailed legends should not be included below tables, but rather added to the text where applicable. Brief acknowledgments of persons who made actual contributions to the manuscript and who endorse the data and conclusions should be included.
The format for how to write common units and quantities correctly can be found at: http://www.wjgnet.com/2218-6220/. Standard abbreviations should be defined in the abstract and at the first mention in the text. In general, terms should not be abbreviated unless they are used repeatedly and the abbreviation is useful to the reader.
Certain commonly used abbreviations, such as DNA, RNA, HIV, LD50, PCR, HBV, ECG, WBC, RBC, CT, ESR, CSF, IgG, ELISA, PBS, ATP, EDTA, mAb, can be used directly without further explanation.
MANUSCRIPTS