Cervical cancer is the most common gynaecological malignancy worldwide threatening women's health, especially in developing countries. 1,2 Radical hysterectomy is the recommended surgical option for women with early-stage cervical cancer, with a 5-year disease-free survival rate exceeding 90% in some studies. 3,4 Radical hysterectomy has become a landmark surgical method for patients with early-stage cervical cancer, but the long-term prognosis of different surgical approaches remains uncertain.The first randomised, open-label, non-inferiority study, the Laparoscopic Approach to Cervical Cancer (LACC) trial, 5 stopped enrolling new patients in advance due to their unexpected findings that women with early-stage cervical cancer treated by minimally invasive radical hysterectomy had a nearly four times higher risk of cancer recurrence and cancer-specific death compared with those
Background Cyclosporine is widely used for immunosuppressive treatment of various systematic and local autoimmune diseases. Breastfeeding is conventionally contraindicated when treating with cyclosporine due to its excretion into breast milk, which may cause immune suppression of exposed infants and affect infants` growth. A few cases have tested cyclosporine levels in random breast milk samples and concluded the infants exposed to safe cyclosporine levels during breastfeeding. Since infants do not maintain a fixed feeding schedule, we monitored cyclosporine levels in breast milk at different times of the day to assess the safety of breast milk for infants throughout the day. Case presentation A 32-year-old dichorionic twin-pregnancy woman had nephrotic syndrome with renal biopsy confirmed type V lupus nephritis for over five years. She was treated only with prednisone 10 mg a day before pregnancy and during early pregnancy. Cyclosporine was added in her regimen from 22 weeks gestation and was adjusted to 225 mg a day from 28 weeks gestation. After parturition, she partially breastfed her twin infants while being treated with cyclosporine 3 mg/kg a day as well as prednisone and hydroxychloroquine sulfate. The cyclosporine level in maternal blood was determined, and several breast milk samples were collected for consecutive 48 h beginning on the ninth day after parturition. The concentration of cyclosporine in breast milk was measured and ranged from 0.443 to 5.307 mcg/L. Both infants grew and developed normally at the three-month follow-up, with no adverse effects observed. The study was conducted at West China Second University Hospital of Sichuan University, started in September 2021, with the consent of the participant and the approval of the ethics committee. Conclusion In this case, cyclosporine levels in breast milk were low at all times of the day. The growth and development of both infants were normal at three months postpartum. Thus, breastfeeding may still be an option for mothers with nephrotic syndrome who are treated with cyclosporine.
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