LIM/58 - Laboratório de Ginecologia Estrutural e Molecular

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O Laboratório de Ginecologia Estrutural e Molecular é ligado ao Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).

Linhas de pesquisa: repercussões bioquímicas, metabólicas e clínicas das diversas modalidades terapêuticas no climatério; abordagem translacional da síndrome dos ovários policísticos; estudo das alterações endometriais na saúde reprodutiva feminina; aspectos moleculares e terapêuticos do câncer genital e mamário; marcadores bioquímicos, imunológicos e moleculares e sua relação com a endometriose peritoneal, de ovário e profunda.

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Scopus: 53


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article 0 Citação(ões) na Scopus
Skin-sparing mastectomy for the treatment of breast cancer
Background: Skin-sparing mastectomy (SSM) is a surgical technique that aims to maximize skin preservation, facilitate breast reconstruction, and improve cosmetic outcomes. Despite its use in clinical practice, the benefits and harms related to SSM are not well established. Objectives: To assess the effectiveness and safety of skin-sparing mastectomy for the treatment of breast cancer. Search methods: We searched Cochrane Breast Cancer's Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP), and on 9 August 2019. Selection criteria: Randomized controlled trials (RCTs), quasi-randomized or non-randomized studies (cohort and case-control) comparing SSM to conventional mastectomy for treating ductal carcinoma in situ (DCIS) or invasive breast cancer. Data collection and analysis: We used standard methodological procedures expected by Cochrane. The primary outcome was overall survival. Secondary outcomes were local recurrence free-survival, adverse events (including overall complications, breast reconstruction loss, skin necrosis, infection and hemorrhage), cosmetic results, and quality of life. We performed a descriptive analysis and meta-analysis of the data. Main results: We found no RCTs or quasi-RCTs. We included two prospective cohort studies and twelve retrospective cohort studies. These studies included 12,211 participants involving 12,283 surgeries (3183 SSM and 9100 conventional mastectomies). It was not possible to perform a meta-analysis for overall survival and local recurrence free-survival due to clinical heterogeneity across studies and a lack of data to calculate hazard ratios (HR). Based on one study, the evidence suggests that SSM may not reduce overall survival for participants with DCIS tumors (HR 0.41, 95% CI 0.17 to 1.02; P = 0.06; 399 participants; very low-certainty evidence) or for participants with invasive carcinoma (HR 0.81, 95% CI 0.48 to 1.38; P = 0.44; 907 participants; very low-certainty evidence). For local recurrence-free survival, meta-analysis was not possible, due to high risk of bias in nine of the ten studies that measured this outcome. Informal visual examination of effect sizes from nine studies suggested the size of the HR may be similar between groups. Based on one study that adjusted for confounders, SSM may not reduce local recurrence-free survival (HR 0.82, 95% CI 0.47 to 1.42; P = 0.48; 5690 participants; very low-certainty evidence). The effect of SSM on overall complications is unclear (RR 1.55, 95% CI 0.97 to 2.46; P = 0.07, I2 = 88%; 4 studies, 677 participants; very low-certainty evidence). Skin-sparing mastectomy may not reduce the risk of breast reconstruction loss (RR 1.79, 95% CI 0.31 to 10.35; P = 0.52; 3 studies, 475 participants; very low-certainty evidence), skin necrosis (RR 1.15, 95% CI 0.62 to 2.12; P = 0.22, I2 = 33%; 4 studies, 677 participants; very low-certainty evidence), local infection (RR 2.04, 95% CI 0.03 to 142.71; P = 0.74, I2 = 88%; 2 studies, 371 participants; very low-certainty evidence), nor hemorrhage (RR 1.23, 95% CI 0.47 to 3.27; P = 0.67, I2 = 0%; 4 studies, 677 participants; very low-certainty evidence). We downgraded the certainty of the evidence due to the risk of bias, imprecision, and inconsistency among the studies. There were no data available on the following outcomes: systemic surgical complications, local complications, explantation of implant/expander, hematoma, seroma, rehospitalization, skin necrosis with revisional surgery, and capsular contracture of the implant. It was not possible to perform a meta-analysis for cosmetic and quality of life outcomes due to a lack of data. One study performed an evaluation of aesthetic outcome after SSM: 77.7% of participants with immediate breast reconstruction had an overall aesthetic result of excellent or good versus 87% of participants with delayed breast reconstruction. Authors' conclusions: Based on very low-certainty evidence from observational studies, it was not possible to draw definitive conclusions on the effectiveness and safety of SSM for breast cancer treatment. The decision for this technique of breast surgery for treatment of DCIS or invasive breast cancer must be individualized and shared between the physician and the patient while considering the potential risks and benefits of available surgical options.
Menopause symptoms and eating habits of postmenopause women in times of the SARS-CoV-2 pandemic
(2022) NASCIMENTO, Monique G.; BAYER, Luiza; OLIVEIRA, Bruna; NOLL, Priscilla R. E. Silva; NOLL, Matias; SIMES, Ricardo dos Santos; BARACAT, Edmund Chada; SORPRESO, Isabel C. Esposito; JUNIOR, Jose M.
Social Media as Health Education Strategy for Women in The Menopause and Postmenopauseal Transitions and Medical Students
(2022) PORTELLA, Caio Fabio S.; FRANCISQUETTI, Camila C.; MACHADO, Mariana; SANTOS, Nayara S. Sousa; HASHIMOTO, Adriana S.; BURCH, Caroline da Silva; SILVA, Igor de Azevedo da; SIMES, Ricardo dos Santos; NOLL, Priscilla R. E. Silva; BARACAT, Edmund Chada; SOARES JUNIOR, Jose M.; SORPRESO, Isabel C. Esposito
A Overview Of Systematic Reviews In Medicinal Plants And Herbal Formulations For The Treatment Of Climacteric Symptoms: A Lack Of Research On Southern Hemispheric Plants
(2022) PORTELLA, Caio Fabio S.; SILVA, Igor de Azevedo da; SIMES, Ricardo dos Santos; BARACAT, Edmund Chada; SOARES JUNIOR, Jose M.; SORPRESO, Isabel C. Esposito
(2023) ATTIA, Nadera Mansouri; FRANZOI, Marco; MCHALE, Melissa P.; GARGIULO, Antonio R.; ABRAO, Mauricio S.; VIDALI, Andrea
article 0 Citação(ões) na Scopus
AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery
(2023) LATTHE, Pallavi; MARQUINI, Gisele Vissoci; ACHTARI, Chahin; HADDAD, Jorge; PANZA, Joseph; JANKOWSKI, Christopher. J.; HEISLER, Christine. A.; REAGAN, Krista; HICKMAN, Lisa. C.
article 1 Citação(ões) na Scopus
Follitropin delta combined with menotropin in patients at risk for poor ovarian response during in vitro fertilization cycles: a prospective controlled clinical study
(2024) DUARTE-FILHO, Oscar Barbosa; MIYADAHIRA, Eduardo Hideki; MATSUMOTO, Larissa; YAMAKAMI, Lucas Yugo Shiguehara; TOMIOKA, Renato Bussadori; PODGAEC, Sergio
Background The maximum daily dose of follitropin delta for ovarian stimulation in the first in vitro fertilization cycle is 12 mu g (180 IU), according to the algorithm developed by the manufacturer, and based on patient's ovarian reserve and weight. This study aimed to assess whether 150 IU of menotropin combined with follitropin delta improves the response to stimulation in women with serum antimullerian hormone levels less than 2.1 ng/mL.Methods This study involved a prospective intervention group of 44 women who received 12 mu g of follitropin delta combined with 150 IU of menotropin from the beginning of stimulation and a retrospective control group of 297 women who received 12 mu g of follitropin delta alone during the phase 3 study of this drug. The inclusion and exclusion criteria and other treatment and follow-up protocols in the two groups were similar. The pituitary suppression was achieved by administering a gonadotropin-releasing hormone (GnRH) antagonist. Ovulation triggering with human chorionic gonadotropin or GnRH agonist and the option of transferring fresh embryos or using freeze-all strategy were made according to the risk of developing ovarian hyperstimulation syndrome.Results Women who received follitropin delta combined with menotropin had higher estradiol levels on trigger day (2150 pg/mL vs. 1373 pg/mL, p < 0.001), more blastocysts (3.1 vs. 2.4, p = 0.003) and more top-quality blastocysts (1.8 vs. 1.3, p = 0.017). No difference was observed in pregnancy, implantation, miscarriage, and live birth rates after the first embryo transfer. The incidence of ovarian hyperstimulation syndrome did not differ between the groups. However, preventive measures for the syndrome were more frequent in the group using both drugs than in the control group (13.6% vs. 0.6%, p < 0.001).Conclusions In women with serum antimullerian hormone levels less than 2.1 ng/mL, the administration of 150 IU of menotropin combined with 12 mu g of follitropin delta improved the ovarian response, making it a valid therapeutic option in situations where ovulation triggering with a GnRH agonist and freeze-all embryos strategy can be used routinely.
article 0 Citação(ões) na Scopus
Association of early cleavage, morula compaction and blastocysts ploidy of IVF embryos cultured in a time-lapse system and biopsied for genetic test for aneuploidy
IVF embryos have historically been evaluated by morphological characteristics. The time-lapse system (TLS) has become a promising tool, providing an uninterrupted evaluation of morphological and dynamic parameters of embryo development. Furthermore, TLS sheds light on unknown phenomena such as direct cleavage and incomplete morula compaction. We retrospectively analyzed the morphology (Gardner Score) and morphokinetics (KIDScore) of 835 blastocysts grown in a TLS incubator (Embryoscope+), which were biopsied for preimplantation genetic testing for aneuploidy (PGT-A). Only the embryos that reached the blastocyst stage were included in this study and time-lapse videos were retrospectively reanalysed. According to the pattern of initial cleavages and morula compaction, the embryos were classified as: normal (NC) or abnormal (AC) cleavage, and fully (FCM) or partially compacted (PCM) morulae. No difference was found in early cleavage types or morula compaction patterns between female age groups (< 38, 38-40 and > 40 yo). Most of NC embryos resulted in FCM (congruent to 60%), while no embryos with AC resulted in FCM. Aneuploidy rate of AC-PCM group did not differ from that of NC-FCM group in women < 38 yo, but aneuploidy was significantly higher in AC-PCM compared to NC-FCM of women > 40 yo. However, the quality of embryos was lower in AC-PCM blastocysts in women of all age ranges. Morphological and morphokinetic scores declined with increasing age, in the NC-PCM and AC-PCM groups, compared to the NC-FCM. Similar aneuploidy rates among NC-FCM and AC-PCM groups support the hypothesis that PCM in anomalous-cleaved embryos can represent a potential correction mechanism, even though lower morphological/morphokinetic scores are seen on AC-PCM. Therefore, both morphological and morphokinetic assessment should consider these embryonic development phenomena.
article 0 Citação(ões) na Scopus
Oral probiotics and vaginal microbiome in post-menopause women: an opinion for the improvement of natural therapies in gynecology
(2024) SILVA, Virginia Franco; REFINETTI, Paulo; VICARIOTTO, Franco; BARACAT, Edmund Chada; SOARES JUNIOR, Jose Maria
article 0 Citação(ões) na Scopus
Association of intrauterine synechiae with pituitary gonadotrophin pulse patterns: A pilot study
(2023) GIANFALDONI, Arlete; ROA, Cristiane; SIMOES, Ricardo dos Santos; BARACAT, Maria Candida P.; FONSECA, Angela Maggio da; BAGNOLI, Vicente Renato; SOPRESO, Isabel Cristina Esposito; RIVAS, Fernando Wladimir Silva; MONTELEONE, Pedro; BARACAT, Edmund C.; JR, Jose Maria Soares
BackgroundIntrauterine synechiae (IS) is an acquired uterine condition that occurs when scar tissues (adhesions) form within the uterus and/or cervix, causing menstrual disturbance. However, approximately 50% of patients with IS are refractory to treatment. Therefore, other endocrine disturbances, such as gonadotropin disturbance, may affect treatment success.Study aimTo analyze gonadotropin levels in women with and without IS.MethodsTen women with refractory IS experiencing amenorrhea since at least 6 months and nine with normal menstrual cycles (control group) were included in this study. Blood sample were collected every 10 minutes during a 4-h period. The serial ultrasound was performed in both groups for evaluating the cycle phase. Blood was collected when the follicles size was between 5-10 mm. Serum LH, FSH, progesterone and estradiol concentrations were measured. To detect LH and FSH pulses, the technique proposed by Santen and Bardin was adopted; therefore, one pulse was defined as a 20% increase in the concentrations as to the preceding point, followed by an important decrease.ResultsNo differences were observed between the study groups at baseline. Estradiol levels were lower in the IS group than in the control group, but the difference was not statistically significant. During the first hour of monitoring, cumulative FSH pulsatile frequency of IS group was lower than one of control.ConclusionOur data suggest that the estradiol levels of IS participants are lower than those of women with normal menstrual cycle. The role of this finding in the physiology of uterine synechiae requires further investigation.