Salpingectomy

We carried out a retrospective chart review to identify patients with advanced or recurrent HGSOC treated at the University of Iowa Hospitals and Clinics. We identified 253 such patients and determined that there were 193 with available flash-frozen tumor tissues stored in the Department of Obstetrics and Gynecology Gynecologic Oncology Bank (IRB, ID#200209010) that is part of the Women’s Health Tissue Repository (WHTR, IRB, ID#200910784)^{24 (link)}. All tissues archived in the Gynecologic Oncology Bank were originally obtained from adult patients under informed consent in accordance with University of Iowa IRB guidelines. Both genomic DNA (gDNA) and total cellular RNA were purified from the identified tumors (Fig. 1).Figure 1

Distribution of controls and samples. (A) Normal fallopian tube controls retrieved from patients at the University of Iowa. (B) University of Iowa Hospitals and Clinics patients diagnosed with high grade serous ovarian cancer (HGSOC). (C) Normal fallopian tubes and HGSOC samples in the cancer genome atlas, TCGA, database.

A separate approval was given by the University of Iowa Institutional Review Board (IRB, ID#201202714) to collect 20 normal fallopian tube samples to be used as controls in coordination with the University of Iowa Tissue Procurement Core Facility. Again, all tissues were obtained from adult patients under informed consent in accordance with University of Iowa IRB guidelines. Samples came from the junction of the ampullary and fimbriated end of fallopian tubes of patients who were scheduled to undergo salpingectomy for benign indications. No patient indicating a personal or family history of cancer was included.
Genomic DNAs (gDNAs) were purified from frozen tumor tissues using the DNeasy Blood and Tissue Kit according to manufacturer’s (QIAGEN) recommendations. Yield and purity were assessed on a NanoDrop Model 2000 spectrophotometer and used a 260 nm/280 nm absorbance ratio of ~1.8 with minimal to no degradation as shown through horizontal agarose gel electrophoresis. Among the initial purifications, 97 gDNAs met our quality control standard which included minimal visible degradation (Fig. 1B). These samples were then bisulfite-converted using the EZ-96 Deep-Well Format DNA Methylation Kit (ZYMO Research) following the Illumina Infinium® Methylation Assay alternate incubation instructions. Similarly, gDNAs from the control fallopian tube tissues were purified and subjected to the quality control standard. Twelve of the original twenty tissues yielded material meeting our standard (Fig. 1A).

We initially screened 1106 patients with COPD who underwent preoperative consultations with respiratory physicians and were registered in our institutional, prospectively collected PPC database between March 2014 and January 2015 [14 (link)]. We excluded 64 patients with bronchial asthma, determined by Shin SH and Im Y based on the patients’ medical history with further confirmation by Park HY. Thereafter, we further excluded 623 patients owing to the reasons described in Figure 1. Finally, 419 patients with COPD who had undergone an elective abdominal surgery (upper abdominal surgery, n = 177; lower abdominal surgery, n = 132; and perineal surgery, n = 110) under isolated general anesthesia were included in this study. Upper abdominal surgery included pancreatectomy, gastrectomy, hepatectomy, cholecystectomy, small bowel resection, and abdominal aortic surgery. Lower abdominal surgery included colectomy, adrenalectomy, nephrectomy, and cystectomy. Perineal surgery included prostatectomy, endourological surgery, ureterostomy, ureteroureterostomy, oophorectomy, salpingo-oophorectomy, salpingectomy, hysterectomy, and uterine myomectomy. All patients underwent a lung expansion maneuver with incentive spirometry during the preoperative and postoperative periods [15 (link)]. Deep inspiration, active coughing, and sputum expectoration were encouraged during the postoperative period.
All preoperative and postoperative data (including the presence or type of PPCs) were already collected by respiratory physicians in the aforementioned PPC database before the start of this study. PPCs were defined as a composite of respiratory failure, pleural effusion, atelectasis, respiratory infection, pneumothorax, and bronchospasm within seven days postoperatively based on previously published articles [13 (link),16 (link)]. In particular, bronchiectasis was assessed by reviewing chest radiographs or high-resolution chest computed tomography scans [17 (link)]. Bronchodilator use was defined as the use of an inhaled short- or long-acting bronchodilator during the perioperative period. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was calculated based on age, blood oxygen saturation, recent respiratory infection, anemia, surgical incision, and surgical duration [16 (link)].
Intraoperative anesthetic variables collected for this study from electronic medical records included intubation difficulty, anesthetic agent use, mechanical ventilation parameters, hemodynamics, fluid therapy use, blood loss, core temperature, airway humidification, vasoactive drug use, and neuromuscular blockade and its reversal. Furthermore, postoperative outcome variables collected from electronic medical records included prolonged mechanical ventilation >24 h, reintubation, length of hospital stay, and postoperative 30- or 90-day mortality. Our institutional review board approved this retrospective study (SMC 2018-11-092, Chairperson Prof. Lee Suk-Koo) and waived the requirement for written informed consent.

A retrospective study was conducted to collect 1828 cases of benign hysterectomy from 01/01/2015 to 31/12/2021 from the electronic case database of the Department of Obstetrics and Gynecology of the No. 1 People's Hospital of Xiangyang City, Hubei University of Medicine (a large general hospital in Xiangyang City, Hubei Province, China). Case searches were performed using the following ICD-9-CM procedure codes: abdominal hysterectomy (AH) (68.3), total laparoscopic hysterectomy (TLH) (68.4), or vaginal hysterectomy (VH) (68.5). AH requires an incision of the abdominal wall, separation of the bladder, and treatment of blood vessels and ligaments before a hysterectomy. TLH used a four-hole method of abdominal distension, a puncture cannula, and an insertion scope to remove the uterus under laparoscopy. VH is the removal of the uterus through the vagina, with the incision located at the top of the vaginal vault, leaving no wound in the abdomen. This study was approved by the Ethics Committee of Xiangyang No. 1 People's Hospital, Hubei University of Medicine (2022KY058). In accordance with the Declaration of Helsinki, all patients provided written or oral informed consent prior to enrollment.
Case inclusion criteria included a clinical diagnosis of benign uterine diseases, the main surgical approaches of AH, TLH, or VH, the absence of surgical contraindications, normal cognition, and the completeness of clinical records. Excluded criteria included female patients with ICD-9-CM diagnosis codes for primary or secondary malignant diseases (140–208), complicated by important organ dysfunction, comorbid mental illness, severe respiratory diseases, missing clinical data, non-cooperation, or involuntary participation in this study. We subclassified subtotal AH, TLH, and VH according to the type of adjoint surgery performed at the time of hysterectomy, specifically bilateral salpingectomy (BS) and bilateral salpingo-oophorectomy (BSO). Clinical data such as operative bleeding, duration of surgery, length of hospital stays, surgery cost, and uterine volume were also collected.
Statistical analyses were performed using SPSS 22.0; P < 0.05 was considered statistically significant.