Background: This study aimed to evaluate the anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) against robot-assisted sacrocolpopexy (RASC) for the treatment of primary advanced apical prolapse. Methods: We conducted a retrospective cohort study of all robot-assisted pelvic organ prolapse surgeries for primary advanced apical prolapse (stage ≥II) between January 2011 and May 2021 at an academic tertiary hospital. Surgical outcomes and pelvic organ function were evaluated using the Pelvic Organ Prolapse Quantitative (POP-Q) stage and validated questionnaires (POPDI-6) during preoperative and postoperative 12-month follow-up evaluations. All data were obtained from electronic medical records. Results: A total of 2368 women underwent surgery for apical prolapse repair, and 18 women underwent either RASH (n = 11) or RASC (n = 7). Compared to the RASC group, the RASH group was significantly younger, premenopausal, and less parous. Preoperative prolapse stage, operative time, estimated blood loss, and hospitalization length was comparable between the groups. No intraoperative complications were observed. All women had a median follow-up duration of 24 months (range: 12-108 months). During the 12-month follow-up period, women in the RASH group reported higher satisfaction with the surgery than those in the RASC group (100% vs. 71.4%, p = 0.137). The mesh exposure rate was significantly higher in the RASC group (3/7, 42.9%) than in the RASH group (0/11, 0%) (p = 0.043), which was found at 12 to 36 months postoperatively and was successfully managed with vaginal estrogen cream. In the RASH group, one woman required reoperation with anterior colporrhaphy for recurrent anterior prolapse at 60 months postoperatively. The apical success rate was 100% at one year postoperatively, without apical recurrence in either group during the follow-up period. Conclusion: RASH represents an effective and feasible option for the surgical treatment of advanced primary apical prolapse in women who desire uterine preservation and have a significantly lower risk of mesh erosion than RASC.

The influences of time of storage of platelet-rich plasma (PRP), temperature of storage of PRP, platelet number in PRP, mean platelet volume in whole blood, sex, age, hemoglobin concentration, and different forms of PRP storage on platelet aggregation (PAG) tests, performed with epinephrine, collagen, arachidonate, and ristocetin by a four-channel aggregation profiler (Platelet Aggregation Profiler, Model PAP-4, Bio/Data Corporation, Hatboro, PA 19040, U.S.A.), were evaluated in four groups of subjects (52 men, 22 women, age range 20-85 years, hemoglobin concentration range 8.4-16.8 g/dl). The PRP was stored with or without packed cells, at room temperature or at 4 degrees C, for 0-6 h. The ideal platelet number of PRP for performing the PAG test fell between 150 and 500 x 10(9)/l. If the number was less than 150 x 10(9)/l, the result of PAG should be meaningless. No significant change was noted for up to 6 h when the PRP was stored either at room temperature or at 4 degrees C. Hemoglobin concentration and mean platelet volume did not affect the PAG. However, there was significant but weak correlation (p = 0.0125, r = 0.3696) between age and PAG when using arachidonic acid as the agonist. Men had significantly increased PAG when collagen and ristocetin were used as the agonists. The PRP was stored best at room temperature, without packed cells. In conclusion, to obtain the best result from a PAG test, the PRP should be kept without packed cells at room temperature for no longer than 6 h, and the platelet number should fall between 150 and 500 x 10(9)/l.

Ovarian clear cell carcinoma (OCCC), a chemoresistant ovarian cancer, shows a modest response to anti–programmed death-1/programmed death ligand-1 (PD-1/PD-L1) therapies. The effects of anti-PD-1/PD-L1 therapies rely on cytotoxic T-cell response, which is triggered by antigen presentation mediated by major histocompatibility complex (MHC) class I. The loss of MHC class I with simultaneous PD-L1 expression has been noted in several cancer types; however, these findings and their prognostic value have rarely been evaluated in OCCC. We collected data from 76 patients with OCCC for clinicopathologic analysis. Loss of MHC class I expression was seen in 44.7% of the cases including 39.3% to 47.4% of the PD-L1+ cases and was associated with fewer CD8+ tumor-infiltrating lymphocytes (TILs). PD-L1 positivity was associated with a higher number of CD8+ TILs. Cox proportional hazard models showed that high (≥50/mm2) CD8+ TILs was associated with shorter disease-specific survival (hazard ratio [HR]=3.447, 95% confidence interval [CI]: 1.222-9.720, P=0.019) and overall survival (HR=3.053, 95% CI: 1.105-8.43, P=0.031). PD-L1 positivity using Combined Positive Score was associated with shorter progression-free survival (HR=3.246, 95% CI: 1.435-7.339, P=0.005), disease-specific survival (HR=4.124, 95% CI: 1.403-12.116, P=0.010), and overall survival (HR=4.489, 95% CI: 1.553-12.972, P=0.006). Loss of MHC class I may contribute to immune evasion and resistance to anti-PD-1/PD-L1 therapies in OCCC, and CD8+ TILs and PD-L1 positivity using Combined Positive Score may have a negative prognostic value.

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