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[Background]: Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Current guidance about its management and prognosis stems from small studies, mostly from high-income countries. The objective of this study was to assess the clinical and genetic characteristics, as well as the impact, of current practice on health outcomes of HoFH patients globally., [Methods]: The HoFH International Clinical Collaborators registry collected data on patients with a clinical, or genetic, or both, diagnosis of HoFH using a retrospective cohort study design. This trial is registered with ClinicalTrials.gov, NCT04815005., [Findings]: Overall, 751 patients from 38 countries were included, with 565 (75%) reporting biallelic pathogenic variants. The median age of diagnosis was 12∙0 years (IQR 5∙5–27∙0) years. Of the 751 patients, 389 (52%) were female and 362 (48%) were male. Race was reported for 527 patients; 338 (64%) patients were White, 121 (23%) were Asian, and 68 (13%) were Black or mixed race. The major manifestations of ASCVD or aortic stenosis were already present in 65 (9%) of patients at diagnosis of HoFH. Globally, pretreatment LDL cholesterol levels were 14∙7 mmol/L (IQR 11∙6–18∙4). Among patients with detailed therapeutic information, 491 (92%) of 534 received statins, 342 (64%) of 534 received ezetimibe, and 243 (39%) of 621 received lipoprotein apheresis. On-treatment LDL cholesterol levels were lower in high-income countries (3∙93 mmol/L, IQR 2∙6–5∙8) versus non-highincome countries (9∙3 mmol/L, 6∙7–12∙7), with greater use of three or more lipid-lowering therapies (LLT; highincome 66% vs non-high-income 24%) and consequently more patients attaining guideline-recommended LDL cholesterol goals (high-income 21% vs non-high-income 3%). A first major adverse cardiovascular event occurred a decade earlier in non-high-income countries, at a median age of 24∙5 years (IQR 17∙0–34∙5) versus 37∙0 years (29∙0–49∙0) in high-income countries (adjusted hazard ratio 1∙64, 95% CI 1∙13–2∙38)., [Interpretation]: Worldwide, patients with HoFH are diagnosed too late, undertreated, and at high premature ASCVD risk. Greater use of multi-LLT regimens is associated with lower LDL cholesterol levels and better outcomes. Significant global disparities exist in treatment regimens, control of LDL cholesterol levels, and cardiovascular event-free survival, which demands a critical re-evaluation of global health policy to reduce inequalities and improve outcomes for all patients with HoFH., Amsterdam University Medical Centers, Location Academic Medical Center; Perelman School of Medicine at the University of Pennsylvania; and European Atherosclerosis Society

The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p

B-cell lymphoblastic lymphoma (LBL) is a highly aggressive malignant proliferation of lymphoblasts of B-origin grouped with acute lymphoblastic leukemia. Multiple studies demonstrated the various sites of involvement in adult LBL. The involvement of the uterus as a site of relapse for such disease is rare. We herein report the case of relapsed B-cell LBL mimicking endometrial sarcoma. The patient is a 56-year-old female patient known to have B-cell LBL on chemotherapy. She presented with abdominal pain and fever. Positron emission tomodensitometry-computed tomography showed the presence of a uterine mass with bilateral iliac lymph node involvement. She underwent surgery with mass removal and pathology showed relapsed B-cell LBL.

Background Breast cancer is the most common cause of the majority of cancer-related deaths in women, among which triple-negative breast cancer is the most aggressive type of breast cancer diagnosed with limited treatment options. Thymoquinone (TQ), the main bioactive constituent of Nigella sativa, has been extensively studied as a potent anticancer molecule against various types of cancers. Honeybee products such as the royal jelly (RJ), the nutritive secretion fed to honeybee queens, exhibit a variety of biological activities besides its anticancer effect. However, the anticancer activity of the combination of TQ and RJ against breast cancer is still unknown. Aim To investigate cytotoxicity of RJ in FHs 74 Int cells and the anticancer effects of TQ, RJ, and their combinations in the MDA-MB-231 cell line. Methods Cells were treated with TQ, RJ, and their combinations for 24 h. Using 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, we determined the half-maximal inhibitory concentration of TQ. Trypan blue and 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays were then performed to assess the cell viability in response to different treatment conditions. Cell death and cycle regulation were investigated using propidium iodide deoxyribonucleic acid staining followed by flow cytometry in response to a single dose of TQ, RJ, and their combination. Immunostaining for cleaved caspase 3 and Ki67 expression was used to determine apoptosis induction and changes in cell proliferation. Results TQ alone inhibited cell viability in a dose-dependent manner at concentrations below and above the half-maximal inhibitory concentration. RJ exhibited relatively nontoxic effects against MDA-MB-231 cells and FHs 74 Int small intestinal cells at concentrations below 5 µg/mL. High doses of RJ (200 µg/mL) had greater toxicity against MDA-MB-231 cells. Interestingly, the inhibition of cell viability was most pronounced in response to 15 µmol/L TQ and 5 µg/mL RJ. A dose of 15 µmol/L TQ caused a significant increase in the PreG1 population, while a more pronounced effect on cell viability inhibition and PreG1 increase was observed in response to TQ and RJ combinations. TQ was the main inducer of caspase 3-dependent apoptosis when applied alone and in combination with RJ. In contrast, no significant regulation of Ki67 expression was observed, indicating that the decrease in cell viability was due to apoptosis induction rather than to inhibition of cell proliferation. Conclusion This study is the first to report enhanced anticancer effects of TQ and RJ combination against MDA-MB-231 breast cancer cells, which could confer an advantage for cancer therapy.

To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age. Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer. Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3 months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16 months from the end of treatment. All babies were delivered vaginally. Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.

Gastric cancer, the fifth most common cancer worldwide, is mainly linked toUsing three different gastric epithelial cell lines, a non-cancerous (HFE-145) and two different subtypes of gastric cancer (AGS and MKN74), we analyzed the modulation of Nrf2 expression over time. After invalidation of Nrf2 by CRISPR-cas9, we assessed its role inWe first demonstrated that the Nrf2 signaling pathway is differentially regulated depending on the infection stage. Rapidly and transiently activated, Nrf2 was downregulated 24 h post-infection in a VacA-dependent manner. We then demonstrated that Nrf2 invalidation leads to increased EMT, which is even exacerbated afterOur work supports the hypothesis that Nrf2 downregulation upon

We present the case of a 30-year-old lady who underwent a core needle biopsy for a BIRADS 4 lesion of her left breast and was diagnosed as having a cellular fibroadenoma. The final diagnosis after excision returned to be a periductal stromal tumor (PST). An extremely rare entity, the PST is actually classified as a subtype of phyllodes tumor, with specific criteria that are only found upon histological examination of the specimen. Care should be taken when considering the diagnosis of fibroadenoma based only on clinical, radiological, and biopsy findings. Any nonclassical, clinical, or radiological findings should prompt a wide excision. Prognosis is generally good when clear margins are obtained and in the absence of malignant heterologous elements.

Introduction/Background* Role of checkpoint inhibitors in ovarian cancer is still unknown and results from ongoing clinical trials are still awaited. We aim in this study to assess the expression of PD-L1 using the Combined Positive Score (CPS) and to evaluate its impact on the overall survival in a cohort of 49 patients diagnosed with high-grade serous ovarian cancer. Methodology Medical charts were reviewed of 49 patients with high-grade serous ovarian cancer operated on at the gynecologic oncology department in Hotel-Dieu de France hospital, Lebanon, between 2015 and January 2020. Immunohistochemical staining was performed for PD-L1 (Agilent Dako, PDL-1 IHC 22C3) and for TP53 (Agilent Biogenex, clone D07, 1:100 dilution) on whole tissue sections from a representative block of formalin-fixed, paraffin-embedded tumor tissue. We looked for correlation between PD-L1 status and overall survival/recurrence. We also looked for correlation between PD-L1 status and TP-53 mutation. Result(s)* 55% of patients presented a positive PD-L1 status. No correlation was found between the PD-L1 status and the stage of the disease. Lymph node status was similar between the two cohorts, positive vs. negative CPS score (p = 0.927). Median follow-up was 36 months (range, 12 – 72 months). Survival rate was similar between the two cohorts, positive vs. negative PD-L1 status (88.9% vs. 72.7% respectively, p = 0.14). No correlation was found between recurrence rate and PD-L1 status (p = 0.184). Also, no correlation was found between PD-L1 status and TP-53 type (wild vs. mutated) (p = 0.154) Conclusion* PD-L1 status does not seem to have a prognostic impact in our series of patients with high-grade serous epithelial ovarian cancer. Also, patients with TP53 mutation do not present increased expression of PD-L1 in comparison to patients with TP53 wild-type.

Introduction/Background* Radiation field planning in patients with locally advanced cervical cancer (LACC) undergoing primary definitive chemoradiotherapy is influenced by lymph node (LN) status. LN assessment by imaging methods has several known limitations including a high false negative rate. The present study aimed to compare the accuracy of LN staging by imaging and surgical staging in LACC patients, and to evaluate their impact on radiation field planning. Methodology A retrospective monocentric study of patients with LACC (International Federation of Gynecology and Obstetrics (FIGO 2018) stage IIA -IVA), undergoing primary definitive platinum-based chemoradiation therapy. Patients were included if LN assessment was available by both methods: surgical (paraaortic/pelvic) and imaging [Thorax/Abdomen Computed Tomography (CT) and/or pelvic Magnetic Resonance Imaging (MRI)]. Result(s)* A total of 58 patients met the inclusion criteria (table 1), 97% (n=56) had a preoperative CT and 88% (n=51) an MRI evaluation. All patients underwent surgical LN staging: 100% paraaortic, and 86% (n=50) additional pelvic lymphadenectomy. Histologically proven LN metastases after surgical LN staging were found in 76% of patients (n=44), 31% (n=18) paraaortic and 76% (n=38) pelvic. As a result of the surgical LN staging, 36% (n=21) of the patients were upstaged (n=11 to FIGO IIIC1 and n=10 to FIGO IIIC2), and 17% (n=10) had treatment modification (extended paraaortic field radiation). LN staging using CT and MRI exhibited a low negative predictive value (29% and 38%, respectively), with a higher positive predictive value (69% and 81%, respectively). Conclusion* In this cohort of LACC patients, paraaortic LN metastases were present in one third of the cases, while CT/MRI imaging underestimated metastatic LN involvement. We thus stress the value of surgical paraaortic LN staging in cases of negative LN imaging, which may lead to treatment modification in about one fifth of patients.

Introduction/Background* Borderline ovarian tumors (BOT) are low malignant potential lesions with a good prognosis that represent around 15% of all epithelial tumors of the ovary. In addition to that, 30% of patients with BOT are less than 40 years old which makes the preservation of fertility a key point in management. Molecular studies in ovarian cancer have shown a correlation between the genetic profile of the tumor and the patient‘s prognosis Methodology We report the case of a 25-year-old patient, G0P0A0, diagnosed with a mucinous borderline right ovarian tumor back in 2005. In 2009, during a routine control ultrasound, another ovarian cyst was identified on the right side. She was operated again of a cystectomy and peritoneal staging and histopathology confirmed the mucinous nature of the tumor. FIGO stage was IA in both cases. The two blocs of tumors underwent a full exome sequencing technique in order to identify possible key mutations. Result(s)* Both tumors had variations of EGFR, FGFR3, BRCA1, STK11, NTKR1 and PIK3CA genes. However, the first tumor also had a KRAS mutation that wasn’t found in the second lesion four years later. KRAS variants have been shown to be present in low grade ovarian cancer and well-differentiated tumors. Conclusion* Borderline tumors often recurs in form of borderline tumor but the genetic profile should not be the same as the primary tumor, as shown in our case report. Loss of KRAS could explain the recurrence of the disease. Seeing that the molecular profile of the tumor is in constant change, a continuity in the spectrum normal-benign-borderline-malignant could be hypothesized.

Organoids represent one of the most important advancements in the field of stem cells during the past decade. They are three-dimensional in vitro culturing models that originate from self-organizing stem cells and can mimic the in vivo structural and functional specificities of body organs. Organoids have been established from multiple adult tissues as well as pluripotent stem cells and have recently become a powerful tool for studying development and diseases in vitro, drug screening, and host–microbe interaction. The use of stem cells—that have self-renewal capacity to proliferate and differentiate into specialized cell types—for organoids culturing represents a major advancement in biomedical research. Indeed, this new technology has a great potential to be used in a multitude of fields, including cancer research, hereditary and infectious diseases. Nevertheless, organoid culturing is still rife with many challenges, not limited to being costly and time consuming, having variable rates of efficiency in generation and maintenance, genetic stability, and clinical applications. In this review, we aim to provide a synopsis of pluripotent stem cell-derived organoids and their use for disease modeling and other clinical applications.

Breast conservation rate is being increasingly used nowadays as a marker of breast cancer care among hospitals. Searching for the ideal technique to predict the feasibility of BCS is ongoing. For this matter, the preoperative MRIs of 169 patients operated with radical or conservative surgery were reviewed. We estimated the tumor volume (TV) and breast volume (BV) on enhanced 3D-MRI and compared the tumor-to-breast volume ratio (TV/BV) in both groups. The mean ratio was 9.5% in the mastectomy group and 1.7% in the BCS group. A tumor-to-breast volume ratio less than 4% seemed to favor the adoption of a conservative option. Our data suggest that preoperative 3D-MRI can orient the surgical approach by assessing the TV/BV ratio, increasing lumpectomy rates with clear margins and good cosmetic outcome.

Aim: To describe the activity in the ‘breast unit’ at the department of radiology during the coronavirus disease 19 lockdown in a university hospital treating coronovirus disease 19 patients in a Middle-Eastern developing country. Materials: This was a retrospective study conducted from March 9 until 11 May 2020, in the breast unit at the department of radiology of a central university hospital in a Middle-Eastern developing country. Data were collected from 205 patients visiting the breast unit during the lockdown period and compared with the activity in the same period in the previous year. Results: Reduction of the breast unit activity was estimated at 73%. In addition, 153 mammograms, 205 ultrasounds, and 16 breast MRIs were done. Indications for mammogram were screening (41.5%), follow-up (22%), clinical symptoms (20%) and breast cancer surveillance (16.5%). MRI was performed mostly for preoperative surgical management. The rate of positive biopsies was 41%. All staff members and patients have accommodated to new adjustments. Conclusion: Activity in the breast unit dropped during the lockdown period. Staff should continue to seek their own and their patient’s safety without diminishing the quality of healthcare.

Objectives HPV associated lesions heavily influence the patients’ psychological health. Merck and coll. developed the HPV Impact profile (HIP) questionnaire to quantify this impact. Previously, while translating this questionnaire to Arabic and validating it in the Lebanese population, we had encountered several issues with its interpretation scheme. This article aims to study the psychometric properties of other proposed schemes found in the literature in order to choose the most adapted one for the Lebanese population. Methods The Arabic versions of the HIP and HADS questionnaires were administered to 118 Lebanese women presenting for an HPV related consultation. The psychometric properties of the initial domains were studied before and after reverse scoring 8 items carrying a positive connotation (‘adapted domains’) and compared to those of two other item distributions created by Santos et al. Results Most of the initial domains presented weak alpha Cronbach coefficients and internal consistency. Reverse scoring 8 items considerably improved the coefficients of 6 of the 7 domains. Both of Santos et al.’s distributions had good coefficients. Nevertheless, by modifying and combining these domains, the ‘Lebanese domains’ were created and showed better outcomes. These new domains had better composite reliability (CR) than the adapted domains, but more modest AVEs. Their discriminant validity (HTMT reports) was also satisfying. Conclusion Merck and coll. ’s item distribution seems flawed; however, reverse scoring the cited items may improve its validity.The adapted domains and the ‘Lebanese domains’ seemed the most suitable for our population. Although the two distributions have their limitations, the ‘Lebanese domains’ were overall superior.

Objectives We aim to compare the outcomes of patients with epithelial ovarian carcinoma treated with neoadjuvant chemotherapy to those with primary debulking surgery. Methods A retrospective case-control study was conducted at a Hotel-Dieu de France University Hospital. We reviewed the clinipathological data of 184 patients who were operated on for an epithelial ovarian cancer and we compared the outcomes of patients who received a neoadjuvant chemotherapy (n=94) with those treated with primary surgery(n=90). Results Patients in both groups had comparable age, menopausal status and comorbidities (p>0.05). Patients receiving neoadjuvant chemotherapy had more serous histology and high-grade lesions (58,1% vs. 41,9% (p=0.003), 58,8% vs. 41,2% (p=0.005), respectively). Bilateral adnexal involvement was more seen in the neoadjuvant group (57,4% vs. 42,6%, p=0.19). Patients receiving neoadjuvant chemotherapy were more likely to present lymph node involvement (61,1% vs. 38,9%, p=0.006). More bowel resection was done in the neoadjuvant group (62,4% vs. 37,6%, p=0.005). Postoperative complications were comparable between the two groups (p=0.441). Interval surgery group received more blood transfusion as primary surgery group (55,7% vs. 44,3%, p=0.004). Survival rate was 41,8% in the interval surgery group vs. 58,2% in the primary surgery group (p=0.000). Recurrence rate 60% in the interval surgery group vs. 40% in the primary surgery group (p=0.025). No difference in the recurrence interval was seen in both groups (p=0.272). Conclusion Patients with ovarian cancer receiving neoadjuvant chemotherapy seem to have more aggressive disease and do not have better outcomes in terms of survival and recurrence in comparison to primary surgery group.

Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one of the first and most specific tools evaluating the psychological impact of the most frequent gynecological lesions linked to HPV. This study aimed to translate the ‘HIP’ questionnaire into Arabic and to study its validity in a sample of Lebanese females. Methods The HIP questionnaire was translated to Arabic following the scheme offered by Beaton et al. It was then administered to a sample of 118 Lebanese women infected with HPV or screened for HPV associated lesions, in parallel with the Hospital anxiety and depression scale (HADS) questionnaire. Results The internal consistency of the HIP questionnaire was weak as alpha Cronbach coefficients of most of the domains were low. Therefore, the study of the composite matrix resulted in the improvement of the internal consistency after elimination of some items. The ‘adapted domains’ were created after inversing the scores of items with positive implications and similar studies were conducted on these domains. Then, the Composite Reliability (CR) and the Average Variance Extracted (AVE) of all the domains were analyzed as well as the Heterotrait-monotrait ratio of correlation. Finally, a statistically significant correlation was found between the total scores of the HIP and professional status and religion. Conclusion The final version of the HIP presents good psychometric properties, allowing its use in clinical trials as well as in clinical practice in order to evaluate the quality of life in women with HPV.

Objectives to determine predictive factors of better survival and delayed recurrence in patients operated on for epithelial ovarian cancer. Methods we reviewed retrospectively all the data of 184 patients receiving complete cytoreductive surgery, whether as primary or interval debulking between January 2005 and ocotber 2019 at Hotel-Dieu de France University Hospital. Results Median age at surgery was 56 years. 41,8% benefited from a primary cytoreductive surgery while 42,9% of patients received their surgery after a neoadjuvant chemotherapy. 74% of patients were in stage III. High-grade serous epithelial ovarian cancer was the most encountered histology (69%). Bowel resection and upper abdominal surgery was needed in 46% and 39,1% of cases, respectively. Survival rate was 66% (122 out of 184 patients). No recurrence was noted in 53,8% of cases and 74,7% of recurrences occurred after 12 months. According to cox regression test, better survival was significantly correlated to younger age ( Conclusion Negative lymph node status, LNR

Objectives to determine the rate, the repartition and to predict the risk factors of lymph node metastasis in patients operated on for epithelial ovarian cancer. Methods we reviewed retrospectively the data of 185 patients diagnosed of epithelial ovarian cancer and operated on between January 2005 and October 2019 at Hotel-Dieu de France University Hospital. Results 88% of patients received a pelvic and paraaortic lymphadenectomy. Node involvement was noted in 56% of cases. 85% of patients presented lymph node metastasis in the pelvic lymph nodes and 83% in the paraaortic nodes. Lymph nodes metastases in both pelvic and paraaortic levels were encountered in 70% of cases. Isolated pelvic or aortic lymph node metastases were seen in 16% and 14% of cases respectively. The median number of removed pelvic and paraaortic lymph nodes was 27 and 30 nodes respectively. In the univariate analysis, the rate of positive lymph nodes was higher in patients with serous histology (65% (serous) vs. 33% (non-serous), p=0.000), high grade (68% vs. 26%, p=0.000), bilateral adnexal involvement (74% vs. 27%, p =0.000) and positive peritoneal cytology (79% vs. 26%, p=0.000). In multivariate logistic regression analysis, the rate was significantly higher in patients with bilateral adnexal involvement, higher grade and positive peritoneal cytology. Conclusion Serous histology, grade 3 tumors, positive peritoneal cytology and bilateral adnexal involvement seem to predictive factors of lymph node involvement in patients with ovarian cancers.

To evaluate the diagnostic value of diffusion-weighted imaging (DWI) in combination with conventional MRI in predicting metastatic axillary lymph nodes (ALN) in breast cancer (BC). We reviewed pathological findings and clinical breast MRI examinations of 169 patients with invasive BC who were evaluated at the Hotel-Dieu de France Hospital in 2009-2015. Morphological parameters and apparent diffusion coefficient (ADC) value were compared with pathological nodal status. Independent t-test/chi-square test and a Pearson correlation analysis were used. With pathological diagnosis as reference, MRI-based interpretations were 87.5% specific and 70.3% sensitive. On conventional MRI, the round shape of lymph nodes (LNs), loss of fatty hilum, irregular margins and hypo-intensity/heterogeneous intensity on T2-weighted sequence were statistically significantly different between metastatic and nonmetastatic groups (P < .001, each). Mean size of metastatic ALN was larger compared with negative ALN (13.9 mm vs. 10.9 mm, P < .001). LNs ≥ 12 mm were associated with higher risk of metastasis (P < .001). ADC value was not significantly different between both groups (P = .862). Conventional MRI using the ALN shape, signal intensity in T2-weighted sequences, loss of fatty hilum, regularity of the margins and size of the LNs can evaluate the axilla with high specificity. ADC value could not be used as a reliable parameter.

Background Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death. Conclusion This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.

Background p53 is a tumor suppressor and key regulator of glycolysis in cancer cells, however highly mutated in tumors. In ovarian cancer, studies concerning p53 mutations focus on the DNA binding domain since the majority of hotspot mutations affects this region. Yet, mutations in other regions such as the proline rich domain may also affect the protein’s expression and activity. The aim of this study is to investigate the effect of various positions of mutations in TP53 gene on glycolysis, apoptosis and transcription of p53 target genes. Methods Mutations frequency and their effect on p53 expression were assessed by PCR-SSCP, sequencing and immunohistochemistry on 30 ovarian cancer biopsies. Six tumors were cultured, as well as SK-OV-3, OVCAR-3 and Igrov-1. SK-OV-3 cells were transfected with 2 TP53 mutants. p53 transcriptional activity was assayed by qPCR, apoptosis by flow cytometry and glycolysis by glucose and lactate measurements, with quantification of glycolytic enzymes expression. Results Our results showed a high frequency of the P72R mutant, associated with p53 overexpression in the ovarian biopsies. However, P72R mutant cells showed similar apoptosis and glycolysis as WT cells. DNA binding domain mutations decreased the transcriptional activity of the protein and increased glucose consumption and lactate production. Conclusion Despite the overexpression of the P72R mutated protein in the biopsies, it showed a similar apoptotic activity and glucose regulation ability as WT p53. Knowing that p53 expression status is used for chemotherapeutic approaches and prognosis in ovarian cancer, the results obtained highlight the importance of locating TP53 mutations. Electronic supplementary material The online version of this article (10.1186/s12935-018-0514-2) contains supplementary material, which is available to authorized users.