Predicting recurrence in adult granulosa cell tumors: the role of Ki67, p53, and TERT mutations

PURPOSE

Adult granulosa cell tumors (aGCTs) are a rare type of ovarian malignancy. While most aGCTs have an indolent course, up to 25% experience recurrence. Identifying markers for disease recurrence is crucial for optimal management.

METHODS

Our study consisted of a total of 55 patients, comprising primary non-recurrent aGCTs (n = 30), aGCT recurrences without corresponding primary tumors (n = 19), and primary aGCTs which later recurred along with their matched recurrences (n = 6). Immunohistochemical analysis was conducted for CD73, Ki67, and p53, along with TERT mutation analysis on selected tissue samples.

RESULTS

Immunohistochemical analysis revealed higher Ki67 proliferation index in recurrent aGCTs compared to non-recurrent cases. Mutational p53 staining was only present in recurrent cases. CD73 expression did not differ significantly between primary non-recurrent and recurrent aGCTs. A notably increased occurrence of TERT promoter mutations was identified in recurrent aGCTs (14/25, 56%) in contrast to primary non-recurrent instances (8/27, 29.6%) (p = 0.05). In primary non-recurrent aGCTs with identified TERT mutations, the C250T locus was impacted in 2 cases, while the C228T locus was affected in 6 cases. Recurrent aGCT cases predominantly exhibited TERT C228T mutation in 13 out of 14 patients. Among the six pairs of primary and recurrent aGCTs studied, four pairs displayed TERT mutations in both primary and recurrence samples. Moreover, cases with TERT mutations exhibited a higher Ki67 index.

CONCLUSION

Identifying patients with high Ki67 and mutational p53 together with TERT mutations may help predict potential recurrence in aGCT cases.

Correlation of dyslipidemia characterized by abnormal cholesterol in first trimester with early pregnancy loss: a retrospective study

PURPOSE

Dyslipidemia has been linked to adverse pregnancy outcomes in observational studies. This study aimed to explore how variations in lipid levels during the first trimester might influence early pregnancy loss (EPL).

METHODS

Blood samples from pregnant women were analyzed to examine the relationship between EPL and lipid metabolism using logistic regression and restricted cubic splines (RCS). Sensitivity analysis was conducted to verify the robustness of the results.

RESULTS

Elevated low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels at most times of 4-9 weeks of gestation were associated with a higher risk of EPL, regardless of whether the control group was successful pregnancy or live birth. Specifically, taking the successful pregnancy group as a control example, increased EPL risks were observed in the highest quartile of plasma TC at 4 weeks (OR = 2.18, 95%: 1.14-4.21) and 7 weeks (OR = 4.30, 95%: 1.87-9.93) of pregnancy. Significant EPL risks were also noted in the third (Q3) and fourth (Q4) quartiles of LDL-C at 4 weeks (Q3, OR = 2.98, 95%: 1.47-6.08; Q4, OR = 2.66, 95%: 1.27-5.55) and 7 weeks (Q3, OR = 3.12, 95%: 1.44-6.73; Q4, OR = 5.17, 95%: 2.14-12.49). High TC levels (> 3.25-3.78 mmol/L) and high LDL-C levels (> 1.92-2.04 mmol/L) were linked to an increased risk of EPL compared to lower levels of TC (≤ 2.91-3.05 mmol/L) and LDL-C (≤ 1.64-1.75 mmol/L).RCS analysis further confirmed this finding that plasma TC and LDL-C levels at 4 and 7 weeks of gestation may have a linear relationship with the risk of EPL. By the way, triglyceride levels at 6 and 8 weeks of gestation were associated with a higher risk of EPL, whereas high-density lipoprotein cholesterol (HDL-C) levels at 5 and 9 weeks of gestation have a completely opposite relationship with EPL risk.

CONCLUSIONS

Elevated cholesterol levels during the first trimester are associated with an increased risk of early pregnancy loss, emphasizing the need for lipid monitoring during pregnancy and even before pregnancy.

Immunohistochemical examination of PNAd, α4β1 integrin and MUC-2 expressions in the secretary phase endometrium of women diagnosed with recurrent implantation failure

OBJECTIVE

Successful embryo implantation is contingent upon the intricate interaction between the endometrium and the blastocyst. Recurrent implantation failure (RIF) signifies the clinical challenge of failing pregnancy post-transfer of high-quality embryos, fresh or frozen, in at least three in vitro fertilization (IVF) cycles, often in women under 40 years. Recent studies identify impaired blastocyst maternal tissue communication among recurrent implantation failure causes. Despite successful embryo transfer in vitro fertilization cycles, endometrial factors persist in women with recurrent implantation failure history, underscoring implantation's complexity. The implantation window, during which the endometrium becomes receptive to the blastocyst, involves the expression of key molecules that facilitate the implantation process. When the literature was examined, it was observed that comparative immunohistochemical studies on key molecules such as α4β1 integrin, MUC-2 and PNAd, which are thought to play a critical role in the endometrium before and during implantation, were limited. In this study, we aimed to investigate, through immunohistochemical and histological analyses, the roles of adhesion molecules in the secretory phase endometrium of patients diagnosed with RIF.

DESIGN

Twenty-one patients diagnosed with recurrent implantation failure and 21 patients with a history of previous pregnancy at the Gynecology and Obstetrics Clinic of Balcalı Hospital, Faculty of Medicine, Çukurova University were clinically evaluated between days 19-21 of the menstrual cycle and included in the study. Endometrial biopsies, prepared for light and electron microscopy, received Hematoxylin and Eosin staining and anti-α4β1 integrin, anti-MUC-2, and anti-PNAd antibodies for immunohistochemistry. Blood samples were collected on the 2nd and 3rd days of the menstrual cycle to assess serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and thyroid-stimulating hormone (TSH).

RESULTS

While FSH, LH, and E2 levels showed no significant difference, TSH was elevated in the recurrent implantation failure group. Structural differences in the endometrium included increased microvilli cells and reduced pinopod counts in infertile women compared to controls. In women with recurrent implantation failure MUC-2 expression were found to be elevated in the endometrial surface epithelium, while PNAd expression was reduced compared to the control group.

CONCLUSION

These findings suggest structural and molecular disparities during the endometrial receptivity window in recurrent implantation failure women may underlie infertility by hindering blastocyst adherence. Molecular studies are needed to elucidate the pathophysiology of the biomarkers whose presence in the endometrium we examined immunohistochemically and to discover new molecules.

CAPSULE

Changing expressions of adhesion molecules (PNAd, α4β1 and MUC-2) under the influence of steroid hormones, remodeling of intercellular connections and stromal epithelial communication play an important role in endometrial receptivity.

Toll-like receptor 4 inhibition by pyridostigmine is associated with a reduction in hypertension and inflammation in rat models of preeclampsia

BACKGROUND

Preeclampsia (PE) is marked by hypertension and detrimental sterile inflammatory response. Despite the reported anti-inflammatory effect of pyridostigmine bromide (PYR) in different models, its anti-inflammatory mechanism in PE is unclear. This study assessed whether such an anti-inflammatory effect involves inhibition of placental Toll-like receptor 4 (TLR4) signaling.

METHODS

Placental TLR4 expression and its signaling were assessed respectively in PE women and Sprague-Dawley rats with reduced uterine perfusion pressure (RUPP) induced on gestational day14 (GD14). RUPP and lipopolysaccharides (LPS, 5 μg/kg)-induced PE rats were treated with a selective TLR4 signaling inhibitor (TAK-242, 2.5 mg/kg/day). The effect of PYR (20 mg/kg/day) on TLR4 expression and signaling was also assessed in RUPP or LPS-infused rats. On GD19, rats' mean arterial pressure (MAP) and samples were collected and processed. At the cellular level, the effect of acetylcholine (ACh), the indirect by-product of PYR activity, on LPS-stimulated HTR-8/SVneo cells was assessed.

RESULTS

Both PE women and RUPP rats had increased (P  < 0.05) placental TLR4 expression and elevated (P  < 0.05) MAP. Selective inhibition of TLR4 signaling with TAK-242 blunted (P < 0.05) RUPP-elevated MAP. Activation of TLR4 induced PE-like symptoms in dams, which were prevented by TAK-242. PYR reduced (P < 0.05) MAP and downregulated placental TLR4 expression and TLR4/TRAF6/NF-κB signaling-mediated inflammation in RUPP and in response to TLR4 selective activation. ACh inhibited the same signaling pathway in LPS-stimulated HTR-8 in vitro.

CONCLUSION

Our data support that PYR attenuates placental TLR4 expression and inhibits TLR4/TRAF6/NF-κB signaling pathway-mediated inflammation in RUPP, clarifying the anti-inflammatory mechanisms of PYR in the PE rat model.

Dietary fat intake with risk of gestational diabetes mellitus and preeclampsia: a systematic review and meta-analysis of prospective cohort studies

CONTEXT

Gestational diabetes mellitus (GDM) and preeclampsia (PE) are commonly observed medical complications in pregnancy. Dietary total fat and fatty acids associated with GDM and PE risk have been examined in several epidemiological studies. In some instances, systematic reviews and meta-analyses might provide more accurate dietary recommendations.

OBJECTIVES

This systematic review and dose-response meta-analysis was conducted to investigate the association between dietary total fat and fatty acids and the risk of GDM and PE.

DATA SOURCES

Research on dietary fat intake and the risk of GDM and PE was conducted through systematic searches of the PubMed, Scopus, and Web of Science databases for articles published up to August 19, 2023. An investigation of associations between dietary intake of total fat and fatty acids and the risk of GDM and PE was performed using prospective cohort study designs.

RESULTS

Twenty-one prospective cohort studies were considered eligible. Findings indicated that higher intakes of total fat (relative risk [RR], 1.08; 95% confidence interval [CI], 1.02-1.14), animal fat (RR, 1.56; 95%CI, 1.34-1.89), vegetable fat (RR, 1.23; 95%CI, 1.05-1.45), dietary cholesterol (RR, 1.48; 95%CI, 1.10-2.00), and omega-3 fatty acid (RR, 1.11; 95%CI, 1.02-1.20) are associated with a greater risk of GDM. However, no significant association was found between dietary total fat and fatty acids and the risk of PE. Dose-response meta-analyses suggested every 10% increment in total energy intake from total fat, 5% from animal fat, 5% from vegetable fat, and 100 mg from cholesterol was related to 15%, 12%, 7%, 14%, and 20% higher GDM risk, respectively.

CONCLUSIONS

Overall, total fat, animal fat, vegetable fat, dietary cholesterol, and omega-3 fatty acid consumption are associated with a small but statistically significant increase in GDM risk.

PROTOCOL REGISTRATION

PROSPERO (CRD42023466844).

Voltage-Gated Calcium Channels and the Parity-Dependent Differential Uterine Response to Oxytocin in Rats

The experience of pregnancy affects uterine function well beyond delivery. We previously demonstrated that the response to oxytocin is more robust in the uteri of proven breeder rats. This study investigates the contribution of T-type calcium channels (TTCCs) and L-type calcium channels (LTCCs) to the distinct response of virgin (V) and proven breeder (PB) rat uteri to oxytocin. Dose-inhibition responses to mibefradil (TTCC inhibitor) and verapamil (LTCC inhibitor) were conducted on isolated V and PB uterine strips. These experiments were followed by dose-response curves to oxytocin (10-10 to 10-5 M) in the presence of 10 µM of each inhibitor. Area-under-the-curve (AUC), amplitude, frequency, and duration of contractions were measured. V uteri generally showed a greater dependence on VGCCs, especially TTCCs. However, PB uteri exhibited a stronger frequency response to oxytocin. Blocking TTCCs had a more pronounced impact on the differential oxytocin response, particularly affecting the frequency component of contractions. The stronger frequency response in PB uteri may be due to a higher concentration of TTCCs in their myometrial pacemaker cells. This study provides supporting evidence that pregnancy induces lasting changes in uterine calcium handling. Our findings suggest that TTCCs play a more important role than LTCC in the parity-dependent differential response to oxytocin. The impact of ORAI and TRP channels still needs to be evaluated, to gain a more comprehensive understanding of the relative impact of voltage-gated calcium channels vs. storage-operated calcium entry channels on this phenomenon.

XRCC1 Polymorphisms p.Arg194Trp, p.Arg280His, and p.Arg399Gln, Polycyclic Aromatic Hydrocarbons, and Infertility: A Case-Control and In Silico Study

XRCC1 is involved in repair of single-strand breaks generated by mutagenic exposure. Polymorphisms within XRCC1 affect its ability to efficiently repair DNA damage. Polycyclic aromatic hydrocarbons or PAHs are genotoxic compounds which form bulky DNA adducts that are linked with infertility. Few reports suggest combined role of XRCC1 polymorphisms and PAHs in infertility. Present study investigates association of three XRCC1 polymorphisms (p.Arg194Trp, p.Arg280His, p.Arg399Gln) with male and female infertility in a North-West Indian population using case-control approach. Additionally, in silico approach has been used to predict whether XRCC1 polymorphisms effect interaction of XRCC1 with different PAHs. For case-control study, XRCC1 polymorphisms were screened in peripheral blood samples of age- and gender-matched 201 infertile cases (♂-100, ♀-101) and 201 fertile controls (♂-100, ♀-101) using PCR-RFLP method. For in silico study, AutoDock v4.2.6 was used for molecular docking of B[a]P, BPDE-I, ( ±)-anti-BPDE, DB[a,l]P, 1-N, 2-N, 1-OHP, 2-OHF with XRCC1 and assess effect of XRCC1 polymorphisms on their interaction. In case-control study, statistical analysis showed association of XRCC1 p.Arg280His GA genotype (p = 0.027), A allele (p = 0.019) with reduced risk of male infertility. XRCC1 p.Arg399Gln AA genotype (p = 0.021), A allele (p = 0.014) were associated with reduced risk for female primary infertility. XRCC1 p.Arg194Trp T allele was associated with increased risk for female infertility (p = 0.035). In silico analysis showed XRCC1-PAH interaction with non-significant effect of XRCC1 polymorphisms on predicted binding. Therefore, present study concludes that XRCC1 polymorphism-modified risk for male and female infertility in North-West Indians without significant effect on predicted XRCC1-PAH interactions. This is the first report on XRCC1 in female infertility.

Long-Term Postoperative Recurrence Rates and Fertility Outcomes After Endometrioma CO2-Laser Vaporization: A Five-Year Follow-Up Experience

STUDY OBJECTIVE

Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has shown encouraging data on ovarian reserve preservation, postoperative pregnancy rates, and recurrence. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery.

DESIGN

Retrospective study.

SETTING

Italian tertiary center from October 2023 to February 2024.

PATIENTS

We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis, or any findings of malignancy at histology were exclusion criteria.

INTERVENTION

Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-ups.

MEASUREMENTS AND MAIN RESULTS

Seventy-eight patients were included. The mean age was 33.2 ± 4.6 years, the basal anti-Müllerian hormone was 2.7 ± 1.9 ng/mL, and the median diameter of the endometriomas was 4 (3-5) cm. The median duration of follow-up was 72.5 months (67-84.5). After surgery, 65.5% (n = 36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously, and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7 ± 18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% confidence interval 82.10%-95.62%).

CONCLUSION

CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term postoperative recurrence rate comparable with that described in literature for the cystectomy.

Increased gallbladder emptying and reduced GLP-1 response in pregnancy with and without gestational diabetes mellitus

AIM

Gestational diabetes mellitus (GDM) has been associated with reduced postprandial glucagon-like peptide 1 (GLP-1) responses. As pregnancy induces changes in gallbladder motility and bile acids stimulate GLP-1 secretion, we investigated postprandial gallbladder emptying and GLP-1 responses in women with GDM.

METHODS

Women with and without GDM underwent two 240-min mixed meal tests; one during third trimester of pregnancy and one 3-6 months postpartum. We evaluated ultrasonography-assessed gallbladder emptying, plasma concentrations of glucometabolic hormones including GLP-1, paracetamol absorption (proxy for gastric emptying) and circulating factors known to affect gallbladder dynamics.

RESULTS

Fifteen women with GDM and 15 pregnant women with normal glucose tolerance (NGT) (baseline median age 31 (interquartile range 29;33) versus 32 (28;33) years, body mass index (BMI) 27.2 (24.7;30.7) versus 28.4 (26.2;31.0) kg/m2, HbA1c 30 (29;32) versus 30 (28;31) mmol/mol) were included. No differences in postprandial gallbladder emptying or GLP-1 responses were observed between women with and without GDM, neither during pregnancy nor postpartum. Pregnancy increased fasting gallbladder volumes by 69 (30;122)% and 103 (59;156)% and postprandial gallbladder emptying by 77 (28;236)% and 99 (37;190)% compared with postpartum in women with and without GDM, respectively. Postprandial GLP-1 responses were reduced by 60 (3;82)% and 81 (11;90)% during pregnancy compared with postpartum in women with and without GDM, respectively.

CONCLUSION

Pregnancy-induced changes in gallbladder motility seem to play no or a limited role in previously reported GDM-associated reduced postprandial GLP-1 responses as gallbladder emptying was greater and postprandial GLP-1 response was lower in pregnancy than postpartum regardless of GDM status.

Stringent Regulations of Oocyte Donation Among Jewish Women in Israel: Characteristics and Outcomes of the National Oocyte Donation Program in One Central IVF Unit

On September 5, 2010, the Israeli Parliament passed a law that allows Israeli female residents to donate their oocytes to infertile Israeli female residents. This law includes unique restrictions that do not exist in other countries. Our aim was to characterize Israeli oocyte donors and recipients and the outcomes of the oocyte donation program as regulated by national law. This retrospective study included 26 financially compensated volunteer donors (mean age 29 ± 3.52 years) and 69 recipients (mean age 44.6 ± 3.53 years) who underwent 30 intracytoplasmic sperm injection cycles and 166 embryo transfers (ETs) in our unit between March 2016 and November 2020. Stringent legal caveats unique to Israel (e.g., Jewish/Moslem donor only to Jewish/Moslem recipient, only unmarried donor, eggs in one cycle restricted to ≤ 3 recipients, donated sperm only from non-Jewish donors, and more) were meticulously applied. Sociodemographic characterizations of donors and recipients were reviewed, and pregnancy and obstetric outcomes were determined. Variables that were significant in achieving live births among the recipients were examined. Twenty-five donors and all 69 recipients were Jewish, and most were unmarried and childless. The main indication for seeking egg donation was age ≥ 40 years/perimenopause (80%). One-half of the recipients used donor sperm and one-half used partner sperm. The pregnancy, clinical pregnancy, live birth, and miscarriage rates were 28.6%, 19.2%, 18.2%, and 2.8%. The live birth rate was negatively associated with multiple ETs. Maternal complications included hypertensive disorders of pregnancy (18.2%), gestational diabetes mellitus (32.3%), and caesarean sections (78.8%). There were no adverse neonatal outcomes. In conclusion, few young women are interested in donating oocytes in Israel. Pregnancy and live birth rates are lower than published values in other egg donation programs.

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation

BACKGROUND

Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines.

METHODS

This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence.

RESULTS

In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p < 0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p < 0.01).

CONCLUSION

ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

Peripheral GABAA receptors - Physiological relevance and therapeutic implications

The role of γ- aminobutyric acid (GABA) and GABAA receptors is not only essential for neurotransmission in the central nervous system (CNS), but they are also involved in communication in various peripheral tissues such as the pancreas, liver, kidney, gastrointestinal tract, trachea, immune cells and blood vessels. GABAA receptors located outside the CNS ("peripheral GABAA receptors") enable both neuronal and non-neuronal GABA-ergic signaling in various physiological processes and are generally thought to have similar properties to the extrasynaptic receptors in the CNS. By activating these peripheral receptors, GABA and various GABAA receptor modulators, including drugs such as benzodiazepines and general anesthetics, may contribute to or otherwise affect the maintenance of general body homeostasis. However, the existing data in the literature on the role of non-neuronal GABA-ergic signaling in insulin secretion, glucose metabolism, renal function, intestinal motility, airway tone, immune response and blood pressure regulation are far from complete. In fact, they mainly focus on the identification of components for the local synthesis and utilization of GABA and on the expression repertoire of GABAA receptor subunits rather than on subunit composition, activation effects and (sub)cellular localization. A deeper understanding of how modulation of peripheral GABAA receptors can have significant therapeutic effects on a range of pathological conditions such as multiple sclerosis, diabetes, irritable bowel syndrome, asthma or hypertension could contribute to the development of more specific pharmacological strategies that would provide an alternative or complement to existing therapies. Selective GABAA receptor modulators with improved peripheral efficacy and reduced central side effects would therefore be highly desirable first-in-class drug candidates. This review updates recent advances unraveling the molecular components and cellular determinants of the GABA signaling machinery in peripheral organs, tissues and cells of both, humans and experimental animals.

IGF2BP1 promotes endometriosis by enhancing m6A modification stability of HMGB1

BACKGROUND

Endometriosis is a chronic inflammatory condition afflicting women of reproductive age. Our study aims to clarify the function and mechanism of insulin-like growth factor 2 mRNA-binding protein 1 (IGF2BP1) and high mobility group box 1 protein (HMGB1) in endometriosis.

METHODS

HMGB1 and various N6-methyladenosine (m6A) reader protein levels were assessed in normal, eutopic, and ectopic endometrial tissue, and a correlation analysis was conducted. The impact of IGF2BP1 knockdown on endometriosis was assessed both in vivo in rat models and in vitro in ectopic endometrial stromal cells (eESCs) using methods such as immunoblotting and mRNA quantification. The binding of IGF2BP1 to HMGB1 mRNA in eESCs was assessed using RIP-PCR. Following transfection with sh-IGF2BP1 and oe-HMGB1, the expression of IGF2BP1 and HMGB1, as well as cell proliferation, invasion, and migration abilities, were measured in eESCs.

RESULTS

In ectopic endometrial tissue, IGF2BP1 and HMGB1 were elevated and positively correlated. Inhibition of IGF2BP1 reduced eESC proliferation, migration, invasion, and glucose intake. Meanwhile, HMGB1, PKM2, and HK2 expression were depressed. In vivo, results were consistent with in vitro. Additionally, in vivo experiments confirmed that inhibition of IGF2BP1 resulted in reduced ectopic endometrial lesion spherical volume, weight, and interstitial lesions. IGF2BP1 bound to HMGB1 mRNA and enhanced its stability by m6A modification. Conversely, when IGF2BP1 was knocked down and HMGB1 was overexpressed, the results were opposite to those observed previously.

CONCLUSION

IGF2BP1 promotes endometriosis progression by enhancing m6A modification stability of HMGB1. This study provides a theoretical basis for identifying therapeutic targets for endometriosis.

Probiotic supplement for the treatment of polycystic ovarian syndrome

Polycystic Ovarian Syndrome is one of the major prevalent causes of infertility reported worldwide nearly 6-26 %, especially in girls hitting puberty and women at their childbearing age. The main clinical manifestations include irregular menstrual cycle, small cysts on one or both ovaries, chronic oligo-anovulation, and hirsutism. The etiological criteria are very complex and related to many factors like obesity, insulin sensitivity, inflammation, hyperandrogenism, diabetes mellitus type II, cardiovascular diseases, and dysbiosis of gut microbiota. The given review focuses on managing PCOS through probiotics by analyzing the effects on the symptoms of the disease. The probiotics effective in treating PCOS belong to Bifidobacterium, Lactobacilli, Clostridium, Enterococcus, and other Lactic acid bacteria. Its significance in PCOS is mainly due to the antagonizing of the growth of pathogenic microorganisms, increasing intestinal mucus layer production, reducing intestinal permeability, and modulating the gastrointestinal immune system. Also, their interaction with certain hormones such as insulin, androgen, and estrogen through short-chain fatty acids influences fertility. More research is necessary to validate these results. Probiotic supplements could be a viable option for treating PCOS in adults.

The impact of body mass index on surgical complications in minimally invasive hysterectomy for uterine fibroids

RESEARCH QUESTION

We aimed to assess the impact of Body Mass Index (BMI) on 30-day postoperative complications in patients undergoing minimally invasive hysterectomy (MIH) for fibroids.

DESIGN

Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2012-2020), we analyzed major and minor 30-day postoperative complications, stratified by BMI, in patients with uterine fibroids who underwent MIH. Complications were stratified according to the Clavien-Dindo classification.

RESULTS

Among 61,192 patients, overall complication rates ranged from 6.3 % to 8.1 %, with the highest rates in obesity class 3. Significant differences were observed in minor complication rates across BMI groups, though major complication rates did not significantly vary. Higher BMI classes correlated with longer operative times, with mean durations ranging from 127.1 min in the lowest BMI group to 158.1 min in the highest BMI group (p < 0.001). In multivariable regression, higher BMI was associated with increased odds of minor complications [

CONCLUSION

After adjusting for confounding factors, overweight, obesity class 2 and 3 are associated with a decreased risk of major complications compared to normal BMI. In contrast, BMI categories were not associated with any- or minor complications. Higher BMI classes were associated with longer operative times.

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Key Words

• Minimally invasive hysterectomy (MIH)
• Myoma
• Obesity paradox
• Postoperative complications
• Uterine fibroids
• body mass index (BMI)

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MESH Headings

• Humans
• Female
• Leiomyoma/surgery
• Body Mass Index
• Hysterectomy/adverse effects
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Middle Aged
• Adult
• Uterine Neoplasms/surgery
• Obesity/complications
• Minimally Invasive Surgical Procedures/adverse effects
• Minimally Invasive Surgical Procedures/statistics & numerical data
• Operative Time
• Retrospective Studies

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Affiliation(s)

Michal Axelrod Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; The School of Medicine, Tel Aviv University, Israel.
Kacey M Hamilton Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States
Rebecca J Schneyer Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States
Gabriel Levin Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Quebec, Canada
Yotam Weiss The School of Medicine, Tel Aviv University, Israel; Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Israel
Matthew T Siedhoff Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States
Kelly N Wright Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States
Raanan Meyer Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; The School of Medicine, Tel Aviv University, Israel; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, United States; The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel

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Differential Expression of Granulysin, MHC Class I-Related Chain A, and Perforin in Serum and Peritoneal Fluid: Immune Dysregulation in Endometriosis-Related Infertility

INTRODUCTION

Endometriosis is a chronic inflammatory disease characterized by endometrial-like tissue outside the uterus. Molecules linked to natural killer (NK) and cytotoxic T cells, including granulysin (GNLY), MHC class I-related chain A (MICA), and perforin (PRF1) support immune surveillance, though their roles in endometriosis remain unclear. This study investigates the association of these molecules with clinical parameters in infertile women with endometriosis.

METHODS

Eighty-seven infertile women undergoing diagnostic laparoscopy were included: 44 with endometriosis and 43 with benign gynecologic disorders. Serum and peritoneal molecules were measured using ELISA. Statistical analyses compared groups and correlated immune markers with clinical parameters.

RESULTS

Endometriosis patients displayed significantly higher PRF1 levels in serum (p = .038) and peritoneal fluid (p = .002), particularly in late-stage disease. Serum and peritoneal PRF1 levels correlated positively with the rASRM adhesion scores. Elevated serum PRF1 was observed in ovarian endometrioma (p = .021). Peritoneal MICA was higher in late-stage endometriosis (p = .013). Serum MICA was elevated in the follicular phase compared to the luteal phase (p = .008).

CONCLUSION

Elevated PRF1 and MICA levels were associated with endometriosis severity, indicating their potential as biomarkers. Future studies should validate this finding and explore its therapeutic role in endometriosis.

Dysmenorrhea, Premenstrual Syndrome, and Lifestyle Habits in Young University Students in Spain: A Cross-Sectional Study

BACKGROUND

Menstruation is a physiological process that may be accompanied by pain, headache, edema, emotional changes, and other symptoms, all of which affect quality of life. Although the results of some studies indicate lifestyle habits can affect the menstrual cycle and associated symptoms, few have investigated this issue, and even fewer have explored the impact of these symptoms on quality of life, in Spanish women.

PURPOSE

The objectives of this study were to determine the prevalence of dysmenorrhea and premenstrual syndrome (PMS) among students at a Spanish university, assess the impact of these conditions on quality of life, and analyze the relationship among lifestyle habits, dysmenorrhea, and PMS.

METHODS

A cross-sectional study was carried out on 743 women enrolled at the University of Extremadura in the 2021-2022 academic year. Data related to the menstrual cycle, pain, and PMS-related physical and emotional symptoms were collected. Quality of life related to menstruation was evaluated using the CVM-22 scale. Lifestyle data collected included adherence to a Mediterranean diet (PREDIMED [Prevención con Dieta Mediterránea] questionnaire), level of physical activity (International Physical Activity Questionnaire), and alcohol and tobacco consumption (Alcohol, Smoking, and Substance Involvement Screening Test Version 3). Also, other clinical data were recorded.

RESULTS

In terms of the sample, the median age was 21 (19-23) years, the prevalence of dysmenorrhea was 57.9%, 92.7% reported premenstrual physical symptoms, and 55.6% reported experiencing premenstrual emotional changes. Having a low level of adherence to a Mediterranean diet was associated with the presence of dysmenorrhea, with an adjusted odds ratio (aOR) of 1.47 (95% CI [1.06, 2.03]). Having a low level of physical activity was strongly associated with the presence of premenstrual physical symptoms, with an aOR of 5.89 (95% CI [1.71, 20.26]). Also, an association was found between tobacco use and premenstrual emotional changes, with an aOR of 2.02 (95% CI [1.25, 3.25]). Furthermore, dysmenorrhea and PMS were both associated with a low quality of life, with pain and emotional changes being the most significantly associated factors, with ORs of 16.25 (95% CI [10.36, 25.47]) and 26.73 (95% CI [16.46, 43.40]), respectively.

CONCLUSIONS

Similar to previous studies, the findings of this study indicate a high prevalence of dysmenorrhea and PMS among young university students in western Spain, with both of these symptoms impacting quality of life significantly and negatively. In addition, lifestyle habits, diet, physical activity, and tobacco use seem to influence the occurrence of these symptoms. Promoting lifestyle changes may be an effective strategy to reduce the incidence of dysmenorrhea and PMS and improve the quality of life of young women.

MR imaging for preoperative characterization of pelvic adhesions: role in diagnosis and surgical planning

Pelvic adhesions are nonanatomic connections between organs and normal peritoneal surfaces that develop secondary to a maladaptive inflammatory response to tissue insults. Comprised of fibrous tissue, adhesions can result in the distortion of operative dissection planes, which can complicate the establishment of abdominal access in patients undergoing surgery, prolong the length of surgery, and increase the risk of injury to bowel and other structures if involved by extensive adhesive disease. This can adversely impact patient outcomes by increasing the risk of surgical complications including bleeding, infection, and prolonging postoperative length of stay. Literature on the characterization of adhesions with imaging is limited and a systematic framework for evaluating adhesive disease on cross-sectional imaging of the pelvis does not currently exist. In this review, we discuss the MR imaging features of pelvic adhesions, highlighting unique teaching cases in which surgical exploration was significantly complicated by the presence of adhesive disease. We will also review the correlation between MR imaging and intraoperative findings in these cases. A proposed standardized framework for the detection and characterization of adhesions on pelvic MRI will be reviewed with multiple imaging examples. Identification and characterization of pelvic adhesive disease on preoperative imaging provides radiologists with an opportunity to inform the referring clinician of their presence, potentially improving outcomes and the quality of patient care.

Elevated estradiol in a prepubertal female: within-laboratory systematic and practical interference screening

Analytical errors related to endogenous or exogenous substances are a cause of unnecessary investigation, intervention, and patient concern especially in immunoassay platforms. In this report, we systematically screened for estradiol interference using a practical algorithm. For extended research in interference screening, repeated estradiol measurements for control and case samples were carried out for method comparison (three immunoassay platforms and one liquid chromatography-mass spectrometry (LC-MS/MS) measurement), dilution test, polyethylene glycol (PEG) precipitation, and heterophile antibody blocking tube. When serial dilutions were applied to the sample, a deviation from linearity was observed when compared to the control sample. With PEG precipitation, the recovery rate of 63%. While the patient's serum estradiol value was 389.02 pmol/L using the Siemens Atellica immunoassay method, the same sample was <36.7 pmol/L in the Abbott immunoassay method and 34.9 pmol/L in the Roche immunoassay platform. Applying the LC-MS/MS method, the patient had a serum estradiol of 3.33 pmol/L. Immunoassays are susceptible to interferences that can cause high estimates due to cross-reactivity. Therefore, LC-MS/MS may be more suitable than immunoassays for preventing misdiagnosis and inappropriate treatments, especially for children.

Noninferiority of single-incision laparoscopy vs conventional laparoscopy in salpingectomy or salpingotomy for ectopic pregnancy: a meta-analysis

OBJECTIVE

Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports.

DATA SOURCES

This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy.

STUDY ELIGIBILITY CRITERIA

This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies.

METHODS

Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the I2 and P values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis.

RESULTS

Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=-0.57; P<.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=-0.08; P=.19), intraoperative complications (odds ratio=1.17; P=.8), postoperative complications (odds ratio=1.02; P=.96), conversion to laparotomy (odds ratio=1.40; P=.59), bowel injury (odds ratio=1.42; P=.8), and postoperative fever (odds ratio=0.52; P=.42).

CONCLUSION

The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.

Randomized, controlled, proof-of-concept trial of gefapixant for endometriosis-related pain

OBJECTIVE

To evaluate the P2X3 receptor antagonist, gefapixant, for treating moderate-to-severe endometriosis-related pain.

DESIGN

Randomized, double-blind, phase 2, and proof-of-concept trial.

SUBJECTS

Premenopausal women age 18-49 years with moderate-to-severe endometriosis-related pain who were not using hormonal treatment.

INTERVENTION(S)

Gefapixant (45-mg twice daily) or placebo over two menstrual cycles.

MAIN OUTCOME MEASURE(S)

Participants rated peak pelvic pain severity daily on a 0 (no pain) - 10 (extremely severe pain) scale. The primary endpoint was change from baseline in average daily peak pelvic pain severity during treatment cycle 2.

RESULT(S)

All 187 participants randomized (gefapixant, N = 94; placebo, N = 93) took ≥1 dose of investigational treatment and all but six in each treatment group completed the trial. The model-based least-squares mean reduction from baseline in average daily peak pelvic pain severity during treatment cycle 2 was -2.2 for gefapixant and -1.7 for placebo (difference, -0.5; 95% confidence interval, -1.01 to 0.03). In secondary analyses, the difference between gefapixant and placebo in peak pelvic pain severity reduction from baseline on menstrual days was -0.6 (95% confidence interval, -1.18 to -0.06) and -0.5 (95% confidence interval, -1.04 to 0.03) on nonmenstrual days. Taste-related adverse events were reported in 31.9% of participants for gefapixant vs. 4.3% for placebo. Pharmacokinetic assessments at months 1 and 2 clinic visits indicated that of the 94 participants in the gefapixant group, 39 had detectable levels of gefapixant in the blood for both assessments although 38 had no detectable levels for ≥1 assessment.

CONCLUSION(S)

Gefapixant (45-mg twice daily) was not shown to be superior to placebo in reducing endometriosis-related pain, although the results directionally favored gefapixant. This trial result should be considered inconclusive given possible issues with treatment compliance.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03654326.

Evaluation of the recently established Dutch nationwide Archipelago of Ovarian Cancer Research biobank

Fundamental and translational research in ovarian cancer aims to enhance understanding of disease mechanisms and improve treatment and survival outcomes. To support this, we established the Dutch multicenter, interdisciplinary Archipelago of Ovarian Cancer Research (AOCR) infrastructure, which includes a nationwide biobank. In this study, we share our experiences in establishing the infrastructure, offer guidance for similar initiatives, and evaluate the AOCR patient cohort. Key challenges included obtaining Data Protection Impact Assessment (DPIA) clearance, drafting the consortium agreement, and securing ethical approval from all hospitals. Over three years, 1093 patients were enrolled across 17 hospitals, resulting in the collection of 1339 tissue samples and 2280 blood samples. Of the 523 patients with currently available clinical and pathological data, 74 % (n = 387) had primary ovarian cancer. Among these patients, 73.4 % was diagnosed with high-grade serous ovarian carcinoma, and 80.9 % presented with advanced-stage disease. Surgery was performed on 93 % of patients with primary ovarian cancer, and chemotherapy was administered to 90.4 % of these patients. In conclusion, the AOCR biobank has established a robust foundation for future fundamental and translational ovarian cancer research. This manuscript provides valuable insights and guidance for developing future research infrastructures and biobanks, and contains detailed information about the AOCR patient cohort to date.

Investigating the prevalence and associated factors of elevated liver enzymes and dyslipidemia during pregnancy

Liver dysfunctions during pregnancy can either be pregnancy-specific or preexisting in acute or chronic form. Data on the prevalence of abnormal liver functions and dyslipidemia during pregnancy in Bangladesh are scarce since these tests are not typically done in routine prenatal screening. This study aims to investigate the prevalence of elevated liver enzymes and dyslipidemia and associated risk factors in a cohort of pregnant women in Bangladesh. This cross-sectional study included 194 pregnant women participants from different trimesters. A standardized questionnaire was used to collect baseline, demographic, and lifestyle data. Blood samples were collected from each participant to measure biochemical parameters such as liver enzymes (ALT and GGT), lipid profile (TC, TG, HDL-C, and LDL-C), glucose, and creatinine levels in the serum. Logistic regression analysis was applied to identify factors associated with liver dysfunction and lipid profile abnormalities. The average age of the participants was 25 ± 5 years. Overall, the prevalence of preeclampsia was 12.4%. Among participants, 27% had increased ALT levels, most in their third trimester, while 11.8% had elevated GGT levels, mostly in early pregnancy. 83.8% of the study subjects had general dyslipidemia, with the highest prevalence in the second trimester and 5.2% had mixed dyslipidemia. Several factors were significantly associated with ALT elevation, such as preeclampsia, elevated blood pressure, low HDL-C levels, high parity number, having a higher number of children, hypertensive disorders during pregnancy and inadequate knowledge about pregnancy diet. On the other hand, advanced maternal age, high gravidity, and mixed dyslipidemia were associated with elevated GGT levels. Conversely, age, hypertensive disorders during pregnancy, preeclampsia, and diabetes were associated with dyslipidemia. In conclusion, elevated levels of liver enzymes and an abnormal lipid profile are common among pregnant women in Bangladesh. Various factors are linked to abnormal liver enzymes and dyslipidemia in these participants. Monitoring liver function and lipid levels, along with proper prenatal care, can help reduce the risk of maternal and neonatal mortality.

Best Practice & Research clinical obstetrics & gynaecology

Screening for fetal genetic disorders is a focus of prenatal care. Cell free DNA (cfDNA) screening for aneuploidies became available in 2011. Initially available only to high-risk individuals, this test is now standard of care in many settings. cfDNA screening has expanded to include sex chromosomal aneuploidies, copy number variants, and rare autosomal trisomies. However, the positive predictive value for rarer conditions is significantly lower, the number of conditions tested for is small, and abnormal results may occur due to maternal genetic findings. The field is changing quickly, and national recommendations for the use of cfDNA in screening for fetal and maternal diseases varies internationally. Research on the performance of screening for many different genetic disorders using cfDNA is ongoing, and suggests that this methodology may allow for testing of a much greater number of genetic conditions. Additionally, improved understanding of the cfDNA molecules themselves may provide additional insights: both high and low fetal fractions may suggest adverse pregnancy outcomes, and characteristics of the fragments themselves may help distinguish tissue of origin.

The role of magnetic resonance imaging in the rare pathologies of the vulva

Pathologies of the vulva encompass a wide range of mesenchymal and epithelial benign and malignant lesions. Suspicion is raised by non-specific symptoms or clinical findings detected during routine gynecological examinations, and histopathology is essential for the diagnosis. The role of imaging has often been limited, but it can be essential in guiding treatment and, in some cases, in helping differential diagnosis. In particular, magnetic resonance imaging (MRI) can play a central role in identifying the extent of disease and planning surgical treatment. To this aim, rigorous image acquisition, correct disease evaluation in the context of vulvar anatomy and understanding of the possible differential diagnosis are essential. The aim of this article is to review the role of MRI in the evaluation of rare vulvar pathologies, focusing on different sites of origin, imaging characteristics, and local extent.

Long-Term Reassurance with Negative High-Risk Human Papillomavirus (HR-HPV) and Clear Margins After Large Loop Excision of the Transformation Zone (LLETZ)

BACKGROUND/OBJECTIVE

Women treated with large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2-3 (CIN2-3) remain at risk of CIN2-3 and cervical cancer for many years. We assessed the roles of high-risk human papillomavirus (HR-HPV) post-LLETZ, surgical margins, and LLETZ characteristics on the long-term risk of CIN2-3.

METHODS

A retrospective observational study was performed using data for 432 women with a histological diagnosis of CIN2-3 treated by LLETZ between 1996 and 2020 and followed-up until October 2021 at Hospital Bellvitge in Barcelona, Spain. Age, surgical margins, 6-month HR-HPV status, excision type, and cone volume/dimensions were analyzed in association with the risk of persistent/recurrent CIN2-3. The cumulative probability of persistent/recurrent CIN2-3 was calculated using the Kaplan-Meier and Cox models.

RESULTS

Persistent/recurrent CIN2-3 was detected in 7.4%, with over 90% found within 5 years post-LLETZ. Predictors of persistent/recurrent CIN2-3 were HR-HPV (HR = 7.36, 95% CI = 3.55-15.26), involved margins (HR = 3.94, 95% CI = 1.68-9.25), uncertain margins (HR = 4.42, 95% CI = 1.55-12.55), and age ≥ 35 years (HR = 2.92, 95% CI = 1.19-7.13). Type 3 excision (p = 0.035) and cone length (p = 0.010) correlated with clear margins. The negative predictive value (NPV) of both negative HR-HPV and clear margins post-LLETZ was 98.7%.

CONCLUSIONS

The combination of negative HR-HPV and clear margins post-LLETZ provides stronger reassurance against the risk of persistent/recurrent CIN2-3 than do LLETZ characteristics. However, larger excisions in older women likely reduce the risk of involved margins. Close surveillance, including repeat HR-HPV testing in the first 5 years post-LLETZ, is crucial.

Understanding the Associations of Urogenital Microbiomes With Fertility and In Vitro Fertilization

Infertility, defined as the inability to establish a clinical pregnancy after a year of regular, unprotected sexual intercourse, impacts 8%-12% of couples worldwide. Many of these couples turn to in vitro fertilization (IVF) to build their families. The success rate of IVF procedures is variable, with estimates of up to 40% of embryo transfers being unsuccessful. Herein we review the existing literature on the role of the female and male urogenital microbiomes and genital inflammation on fertility and IVF outcomes. We discuss the microbiome across the female reproductive tract (FRT) and identify associations with female infertility, female genital tract inflammation, and success of IVF procedures. We also discuss the male urogenital microbiome and the associations between microbial taxa, genital inflammation, and male fertility parameters. Finally, we consider microbial transfer within couples and the impact this may have on fertility and the success of IVF procedures.

A positive association between postpartum electrohysterography parameters and blood loss after vaginal delivery: A prospective study

INTRODUCTION

The postpartum period can be complicated by hemorrhage, frequently caused by uterine atony. Electrohysterography, allowing continuous monitoring of uterine activity, may be a promising alternative for early detection of uterine atony, and thereby contribute to the prevention of postpartum hemorrhage. Associations between electrohysterographic parameters postpartum and total blood loss were studied.

METHODS

In this prospective explorative study, women were included with a vaginal delivery between 36+0 and 42+0 weeks of gestation. Linear regression analysis was used to describe the association between electrohysterographic parameters (i.e. area under the contraction curve (AUC) total (in arbitrary units), AUC from baseline (in arbitrary units), maximum amplitude (in arbitrary units) and baseline tone (in arbitrary units)) and total blood loss (in mL) during the first 30 min postpartum.

RESULTS

In total, 25 women were included for analysis, of whom three had postpartum hemorrhage. A moderate positive linear correlation was found between the logarithmically transformed total blood loss and the AUC total (r = 0.44, p = 0.03), AUC from baseline (r = 0.43, p = 0.03) and baseline tone (r = 0.43, p = 0.03). There was no significant linear correlation between the logarithmically transformed total blood loss and maximum amplitude. Explorative analysis revealed a significantly higher AUC total, AUC from baseline and baseline tone in women with postpartum hemorrhage compared to women without postpartum hemorrhage. (p = 0.02, p = 0.02 and p = 0.03, respectively).

DISCUSSION

There is a moderate positive correlation between the logarithmically transformed total blood loss and the AUC total, AUC from baseline and baseline tone. Also, these parameters were all significantly higher in women with postpartum hemorrhage compared to women without postpartum hemorrhage.

Platelet-rich plasma and plasma rich in growth factors in extra-oral wound care

This narrative review evaluates the existing literature on the clinical efficacy and safety of platelet-rich plasma (PRP) and plasma rich in growth factors (PRGFs) in extra-oral wound care, considering their potential benefits and drawbacks. The review specifically focuses on the impact of these treatments on patients' quality of life, pain management, treatment costs, recurrence rates, and potential complications. Given the extensive literature and diverse range of extra-oral wound types in which these autologous platelet concentrates have been applied, this narrative review focuses on the most frequently described wound types, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, surgical wounds, and burns. The use of PRP has been reported in various medical specialties, with a low risk of adverse events. While there is a growing interest in the use of PRGF with promising results, the available literature on this topic is still limited. Only a few studies evaluated patients' perception of the treatment and the relationship between treatment costs and clinical outcomes. Data on recurrence rates and complications also vary across studies. In conclusion, PRP and PRGF show promise as alternatives or as adjunctive therapies to conventional treatments for various extra-oral wounds and ulcers, leading to reduced wound size and accelerated healing time but should be considered on a case-by-case basis, taking into account the type and severity of the wound.

Reproductive performance and obstetric outcomes after hysteroscopic septum resection

PURPOSE

The aim of this retrospective cohort study was to investigate the effects of hysteroscopic uterine septum resection on the clinical pregnancy rate (CPR), live birth rate (LBR) and miscarriage rate.

MATERIALS AND METHOD(S)

Hospital records of consecutive patients who underwent hysteroscopic uterine septum resection between February 2021 and December 2022 were reviewed. They were telephoned and interviewed about their reproductive performance after surgery, and pregnancy outcomes, if achieved.

RESULTS AND CONCLUSIONS

Sixty-nine eligible patients were enrolled. Forty-one (59.4%) of these patients were referred to our clinic for otherwise unexplained infertility of at least 1 year and 28 (40.6%) for pregnancy loss. During the follow-up period, 32 patients conceived. The overall CPR was 46.4%, the LBR per woman was 36.2%, the LBR per pregnancy was 78.1% and the miscarriage rate was 12.5%. The LBRs per pregnancy were 83.3% and 71.4% in the infertility and miscarriage subgroups, respectively. The miscarriage rates per pregnancy were 0% and 28.6% in the infertility and miscarriage subgroups, respectively. Three of 6 patients whose uterine septum was incomplete but prominent became pregnant (CPR: 50.0%), and all pregnancies resulted in live birth (LBR per pregnancy:100%, LBR per woman:50%). Two patients with complete uterine septum didn't achieve pregnancy. Hysteroscopic uterine septum resection may improve the CPR, LBR and miscarriage rates in subfertile population with and without previous pregnancy loss.

Hepatic Rupture in HELLP Syndrome: Report of Two Patients and a Review of Peripartum Surgical Care and Transfusion

Herein, we report the cases of two patients with hemolysis, elevated liver enzymes, and low platelets syndrome who underwent emergent Cesarean sections that were complicated by massive hemorrhage due to undiagnosed hepatic rupture. Intraoperative General Surgery team intervention, early activation of massive transfusion protocol, hemostatic resuscitation, and transfer to ICU resulted in the survival of both patients.

Effect of nutritional interventions on the psychological symptoms of premenstrual syndrome in women of reproductive age: a systematic review of randomized controlled trials

CONTEXT

Premenstrual syndrome (PMS) affects approximately 48% of women of reproductive age worldwide. It can lead to functional impairment, lower quality of life, and decreased work productivity. Despite the availability of medical treatment options, women are seeking alternative interventions because of concerns of harmful side effects and limited evidence of efficacy associated with pharmacological treatments. To date, high-quality research investigating the effects of dietary and nutrient intervention on PMS is limited.

OBJECTIVE

This systematic review investigated the effect of nutritional interventions on the psychological symptoms of PMS.

DATA SOURCES

Five electronic databases were searched for randomized controlled trials (RCTs) published in English from inception to October 2022. Trials eligible for inclusion were nutritional intervention studies involving women of reproductive age that measured PMS-associated psychological outcomes.

DATA EXTRACTION

Articles were selected using prespecified inclusion criteria. Data screening and extraction and risk-of-bias assessments were conducted by 3 independent reviewers using article screening software and the Cochrane Risk of Bias 2 tool.

DATA ANALYSIS

Thirty-two articles reporting on 31 RCTs involving 3254 participants, ranging in age from 15 to 50 years were included and narratively reviewed. Only 1 of the included studies had a low risk of bias. Treatment with vitamin B6, calcium, and zinc consistently had significant positive effects on the psychological symptoms of PMS. There was insufficient evidence to support the effects of vitamin B1, vitamin D, whole-grain carbohydrates, soy isoflavones, dietary fatty acids, magnesium, multivitamin supplementation, or PMS-specific diets.

CONCLUSIONS

There is some evidence to support the use of nutritional interventions for improving psychological symptoms of PMS. However, more research using consistent protocols, procedures to minimize risk of bias, intention-to-treat analysis, and clearer reporting is required to provide conclusive nutritional recommendations for improving PMS-related psychological outcomes.

PROSPERO REGISTRATION NO

CRD42022369999.

Ultrasound-based ADNEX model for differentiating between benign, borderline, and malignant epithelial ovarian tumours

BACKGROUND

The purpose of this study was to evaluate the ability of the International Ovarian Tumor Analysis-Assessment of Different NEoplasias in the adneXa (IOTA-ADNEX) model to distinguish among benign, borderline, and malignant epithelial ovarian tumours (BeEOTs, BEOTs, and MEOTs, respectively).

METHODS

The study included 813 patients with BeEOTs, BEOTs, and MEOTs who underwent ultrasound examinations and pelvic operations. Comparisons were made between the clinical information and ultrasonographic features of the three patient groups, and the histopathological diagnosis was the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of the ADNEX model were calculated.

RESULTS

This was a single-centre retrospective study. Of the 813 patients, 257 (31.6%) had BeEOTs, 114 (14.0%) had BEOTs, and 442 (54.4%) had MEOTs. For a cut-off value of 10% to identify the overall risk for ovarian cancer (OC), the sensitivity and specificity were 99.1% and 73.2%, respectively. According to the receiver operating characteristicscurves, the AUC was 0.987 (95% CI: 0.981-0.993) for BeEOTs compared with MEOTs, 0.820 (95% CI: 0.768-0.872) for BeEOTs compared with BEOTs, 0.912 (95% CI: 0.876-0.948) for BeEOTs compared with stage I OC, and 0.995 (95% CI: 0.992-0.998) for BeEOTs compared with stages II-IV OC. The AUC was 0.614 (95% CI: 0.519-0.709) for BEOTs compared with stage I OC, 0.903 (95% CI: 0.869-0.937) for BEOTs compared with stages II-IV OC, and 0.851 (95% CI: 0.800-0.902) for stage I OC compared with stages II-IV OC.

CONCLUSIONS

The IOTA-ADNEX model demonstrated good diagnostic performance for the three categories of EOTs and may have the potential to be popularised in assisting radiologists in the assessment of adnexal masses in the future.

Oral citrulline supplementation in pregnancies with preeclampsia: a multicenter, randomized, double-blind clinical trial

BACKGROUND

Preeclampsia (PE) contributes to maternal and fetal mortality and morbidity. Supplementation with L-arginine, the precursor of nitric oxide, has not proven effective, possibly due to extensive arginine catabolism in the splanchnic bed. Citrulline is converted by the kidney to L-arginine. Citrulline, therefore, could be a more effective nitric oxide donor in the treatment of PE.

OBJECTIVES

The study aimed to determine whether oral L-citrulline supplementation would prolong the delay between diagnosis and delivery in preeclamptic females.

METHODS

A total of 115 females with monofetal preeclamptic pregnancy were enrolled before 36 weeks of gestation in a multicenter randomized, double-blind trial: 58 received oral L-citrulline supplementation, and 57 received placebo. The duration of pregnancy, neonatal and maternal outcomes, and soluble fms-like tyrosine kinase 1/placental growth factor ratio, an index of placental dysfunction, were monitored.

RESULTS

Gestational age at inclusion was similar in both groups. The duration of pregnancy between inclusion and delivery was unaltered (hazard ratio: 0.90; 95% confidence interval: 0.62, 1.31). Neither neonatal weight nor pregnancy outcome differed between groups. Liver enzymes were higher on the day of delivery in the treated, compared to the placebo group (65.1 compared with 33.2 UI and 70.4 compared with 33.7 UI for alanine aminotransferase and aspartate aminotransferase, respectively, (estimate: 5.92; 95% confidence interval: 1.09, 10.74). Systolic blood pressure (BP) was higher at delivery in the citrulline group compared with the control group (P = 0.015), whereas the diastolic BP showed no difference. We did not find any difference in neonatal outcomes nor soluble fms-like tyrosine kinase 1/placental growth factor ratio.

CONCLUSIONS

The current trial found no benefit of oral L-citrulline supplementation to females with PE regarding either the duration of pregnancy, fetal growth, or maternal and neonatal outcomes. Systolic BP and liver enzymes levels were found to increase at delivery in the treated group. L-citrulline oral supplementation does not seem to be a promising candidate as a therapeutic intervention in pregnancies with PE. This trial was registered at CITRUPE as NCT02801695.

Re-embarking in ART while still breastfeeding: an unresolved question

Infertile women may request to embark on a new course of Assisted Reproductive Technologies (ART) in pursuit of a second child while still breastfeeding their first child. Breastfeeding is a time of profound hormonal changes that may interfere with ovarian physiology and uterine receptivity. Prolactin and oxytocin can mediate a plethora of potential detrimental effects. However, robust evidence to advise in favor or against ART during breastfeeding is lacking. In this narrative review, we reviewed the literature with the intent to shed light on this neglected issue. Possible adverse effects on ART success emerged for ovulatory mechanisms, folliculogenesis, uterine contractions, uterine peristalsis, and early embryo development. A negative impact of exogeneous hormones on infant health might be considered only for stimulation cycles. Overall, most concerns can be claimed for the clinical setting of ovarian stimulation, followed by the one of embryo transfer in a natural cycle and, finally, by the embryo transfer in a hormone replacement treatment preparation. However, in general, it seems wise to wait for breastfeeding to be discontinue before re-embarking on IVF, also considering that a too short interpregnancy interval may be deleterious to pregnancy outcomes. On the other hand, one must also recognize that available evidence is insufficient to deny access to treatments for women requesting earlier access. These women must be informed regarding the non-fully reassuring evidence.

Analyzing the performance of ChatGPT in answering inquiries about cervical cancer

OBJECTIVE

To analyze the knowledge of ChatGPT about cervical cancer (CC).

METHODS

Official websites of professional health institutes, and websites created by patients and charities underwent strict screening. Using CC-related keywords, common inquiries by the public and comments about CC were searched in social media applications with these data, a list of frequently asked questions (FAQs) was prepared. When preparing question about CC, the European Society of Gynecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO), and European Society of Pathology (ESP) guidelines were used. The answers given by ChatGPT were scored according to the Global Quality Score (GQS).

RESULTS

When all ChatGPT answers to FAQs about CC were evaluated with regard to GQS, 68 ChatGPT answers were classified as score 5, and none of ChatGPT answers for FAQs were scored as 2 or 1. Moreover, ChatGPT answered 33 of 53 (62.3%) CC-related questions based on ESGO, ESTRO, and ESP guidelines with completely accurate and satisfactory responses (GQS 5). In addition, eight answers (15.1%), seven answers (13.2%), four answers (7.5%), and one answer (1.9%) were categorized as GQS 4, GQS 3, GQS 2, and GQS 1, respectively. The reproducibility rate of ChatGPT answers about CC-related FAQs and responses about those guideline-based questions was 93.2% and 88.7%, respectively.

CONCLUSION

ChatGPT had an accurate and satisfactory response rate for FAQs about CC with regards to GQS. However, the accuracy and quality of ChatGPT answers significantly decreased for questions based on guidelines.

Postnatal Outcome After Ultrasound Findings of an Abnormal Fetal Gallbladder: A Systematic Review and Meta-Analysis

OBJECTIVE

To describe postnatal outcome following the prenatal diagnosis of an abnormal fetal gallbladder.

METHODS

We conducted a systematic review of studies from January 1980 to January 2023 that described FGB abnormalities, which included agenesis or non-visualisation, abnormal content presence of sludge, abnormal shape or size and abnormal position, and postnatal outcome to determine the association with pathology.

RESULTS

In 51 studies, 842 fetuses had abnormal FGB. Non-visualisation of the FGB was the most common diagnosis (521 fetuses, mean gestational age 21.6 weeks, range 14-29). The FGB was subsequently visualised prenatally in 128 out of 521 cases (24.6%; 95% CI, 20.9%-28.3%). Of the 393 cases with persistent FGB non-visualisation (75.4%; 95% CI, 71.7-79.1), 48 cases (12.2%; 95% CI, 9.0-15.5) underwent termination of pregnancy (TOP) with FGB agenesis confirmed in 16 out of 26 fetuses that had a postmortem examination (61.5%; 95% CI, 42.8-80.2). After excluding cases with missing outcomes (n = 121), postnatal ultrasound was performed in 82.4% of cases with persistent non-visualised FGB (224/272; 95% CI, 77.8%-86.9%). The gallbladder was not visualised in 63.4% (142/224; 95% CI, 57.1-69.7), confirming GB agenesis. This was an isolated finding in 41.1% of cases (92/224; 95% CI, 34.6-47.5). Of 272 known outcomes, biliary atresia, cystic fibrosis, and structural or chromosomal abnormalities were diagnosed in 8.5% (n = 23), 12.5% (n = 34), 18.0% (n = 49) and 6.3% (n = 17) cases, respectively. The sensitivity (true positive rate) of ultrasound for GB agenesis in fetuses with persistently non-visualised FGB was 58.1% (158/272; 95% CI, 52.2%-64.0%). Fetal gallbladder stones/sludge were described in 100 fetuses mainly in the third trimester of pregnancy (mean gestational age 33.8 weeks). Resolution of postnatally followed up cases occurred in around one-third of the cases (37.3%) within 1 month after birth. There was a low reported association with severe conditions (2%).

CONCLUSIONS

This systematic review and meta-analysis found that when the fetal gallbladder was absent in mid-trimester, it was visualised in subsequent fetal ultrasound examinations in around 25% of cases. If persistently absent on prenatal ultrasound, the confirmed rate of GB agenesis was around 50%, with the neonates having biliary atresia, cystic fibrosis, or structural abnormalities. Because of the association with severe conditions, if persistent FGB agenesis is suspected, prenatal diagnosis should be offered. FGB abnormalities such as stones/sludge tended to resolve by 1 year of age with around half of all cases resolving by 1 month postnatal.

The Effects of Cosmic Radiation Exposure on Pregnancy During a Probable Manned Mission to Mars

Space missions have revealed certain disincentive factors of this unique environment, such as microgravity, cosmic radiation, etc., as the aerospace industry has made substantial progress in exploring deep space and its impacts on human body. Galactic cosmic radiation (GCR), a form of ionizing radiation, is one of those environmental factors that has potential health implications and, as a result, may limit the duration - and possibly the occurrence - of deep-space missions. High doses of cosmic radiation exposure during spaceflight, particularly during exploration class missions, may have teratogenic effects on a developing fetus, if an unintended pregnancy occurs shortly before or during the flight. This study aimed to discuss whether the cumulative dosage for a pregnant woman during a probable manned mission to Mars may exceed the terrestrial teratogenic radiation limit. A variety of studies, technical documents, and publications that provided flight duration data and the absorbed cosmic radiation dosage equivalents between Earth and Mars were analyzed. A literature-based hypothetical model of a pregnancy simulation over a 6-month spaceflight was also designed to estimate the cumulative absorbed GCR dose. The estimated dose rates ranged from 90 to 324 mSv. Assuming that a pregnant crew member is exposed to this dosage range, the total teratogenic dose equivalent to the embryo/fetus appear to be significantly higher than that of the National Council on Radiation Protection (NCRP)'s and United States Nuclear Regulatory Commission (USNRC)'s recommendations, which state a maximum radiation dose of 5 mSv for the duration of the pregnancy, and thus such an exceeded dose may likely result in teratogenesis. Current protective strategies may not be sufficient to protect the human genome from the detrimental effects of cosmic radiation, and they need be improved for long-term interplanetary travels during human colonization of Mars.

The value of multiparametric MRI-based habitat imaging for differentiating uterine sarcomas from atypical leiomyomas: a multicentre study

PURPOSE

To explore the feasibility of multiparametric MRI-based habitat imaging for distinguishing uterine sarcoma (US) from atypical leiomyoma (ALM).

METHODS

This retrospective study included the clinical and preoperative MRI data of 69 patients with US and 225 patients with ALM from three hospitals. At both the individual and cohort levels, the K-means and Gaussian mixture model (GMM) algorithms were utilized to perform habitat imaging on MR images, respectively. Specifically, T2-weighted images (T2WI) and contrast-enhanced T1-weighted images (CE-T1WI) were clustered to generate structural habitats, while apparent diffusion coefficient (ADC) maps and CE-T1WI were clustered to create functional habitats. Parameters of each habitat subregion were extracted to construct distinct habitat models. The integrated models were constructed by combining habitat and clinical independent predictors. Model performance was assessed using the area under the curve (AUC).

RESULTS

Abnormal vaginal bleeding, lactate dehydrogenase (LDH), and white blood cell (WBC) counts can serve as clinical independent predictors of US. The GMM-based functional habitat model at the cohort level had the highest mean AUC (0.766) in both the training and validation cohorts, followed by the GMM-based structural habitat model at the cohort level (AUC = 0.760). Within the integrated models, the K-means functional habitat model based on the cohort level achieved the highest mean AUC (0.905) in both the training and validation cohorts.

CONCLUSION

Habitat imaging based on multiparametric MRI has the potential to distinguish US from ALM. The combination of clinical independent predictors with the habitat models can effectively improve the performance.

The vaginal route for minimally invasive surgery: a practical guide for general surgeons

INTRODUCTION

Vaginal approaches have become routine in the field of gynecologic surgery, whereas in general surgery vaginal wall transection is an infrequent practice typically reserved for extensive tumor resections. Approximately two decades ago, natural orifice transluminal endoscopic surgery (NOTES) revolutionized conventional boundaries by accessing the peritoneal cavity transorally, transrectally, or transvaginally, enabling general surgery without visible scars. Although transvaginal approaches have been successfully used for various abdominal procedures by general surgeons, a gap remains in comprehensive training to fully exploit the potential of this route.

MATERIAL AND METHODS

PubMed, Google Scholar, and Scopus databases were searched to retrieve relevant articles illustrating how general surgeons can adeptly manage vaginal approaches.

RESULTS

The article presents a practical framework for general surgeons to execute a complete vaginal approach, addressing the management of vaginal specimen extraction and vaginal cuff closure, even in the absence of an experienced gynecologist.

CONCLUSION

The evolution of abdominal surgery is moving towards less invasive techniques, emphasizing the importance of understanding the nuances and challenges associated with the vaginal route. This approach is linked to minimal oncological, sexual, and infective complications, and to the absence of pregnancy-related complications. Such knowledge becomes increasingly crucial, particularly with the renewed demand for transvaginal access in robot-assisted NOTES procedures.

Assessment of tissue factor pathway inhibitor 2 (TFPI2) as a novel serum marker for malignant tumors of the ovary before and after treatment: A case-control study

AIM

Tissue factor pathway inhibitor 2 (TFPI2) is a preoperative biomarker that was developed to discriminate ovarian benign tumors from cancer and is covered by health insurance in Japan. The purpose of this study was to evaluate how the TFPI2 changes after treatment.

METHODS

Serum levels of TFPI2 (cut off 191 pg/mL) and CA125 (cut off 35 U/mL) before and after primary debulking surgery in patients with ovarian malignant tumors were evaluated among recurrent and nonrecurrent cases, respectively.

RESULTS

A total of 46 cases were analyzed, including 11 borderline tumors, 13 clear cell carcinomas, 15 serous carcinomas, 4 endometrioid carcinomas, and 3 mucinous carcinomas. Among 37 patients without recurrence, the preoperative mean levels of TFPI2 (235.3 pg/mL, range: 78.3-607.7) and CA125 (1125.5 U/mL, range: 6.2-6272.0) were higher than the cutoff values. The mean minimum level of TFPI2 decreased to below the cutoff (150.2 pg/mL, range 56.4-471.1) at 3 months or more after primary debulking surgeries. The postoperative TFPI2 level exceeded the cutoff in 11 out of 37 patients without recurrence (29.7%); however, the postoperative TFPI2 level decreased in 8 patients. The mean maximum levels of TFPI2 and CA125 in 9 patients after recurrence were 492.6 pg/mL and 727.4 U/mL, respectively. Moreover, the mean TFPI2 level was higher than the preoperative one (421.5 pg/mL), different from CA125 (2903.8 U/mL).

CONCLUSIONS

Our results suggest the clinical validity of TFPI2 as a serum tumor marker for postoperative recurrence screening among malignant ovarian tumors.

Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024: part 4-trauma, burn, obstetrics, acute pancreatitis/liver failure, and others

Disseminated intravascular coagulation (DIC) is a complex condition with diverse etiologies. While its association with sepsis has been widely studied, less focus has been given to DIC arising from other critical conditions, such as trauma, burns, acute pancreatitis, and obstetric complications. The 2024 Clinical Practice Guidelines, developed by the Japanese Society on Thrombosis and Hemostasis (JSTH), aim to fill this gap and offer comprehensive recommendations for managing DIC across various conditions. This study, Part 4 of the guideline series, addresses DIC management in trauma, burns, obstetric complications, acute pancreatitis/liver failure, viral infections, and autoimmune diseases. For trauma-associated DIC, early administration of fresh-frozen plasma (FFP), coagulation factor concentrates such as fibrinogen and prothrombin complex concentrates, and tranexamic acid is recommended. The guidelines also highlight DIC in obstetrics, which is associated with massive bleeding, and recommend the administration of fibrinogen concentrate, antithrombin concentrate, and tranexamic acid. Through a systematic review of the current evidence, the guidelines provide stratified recommendations aimed at improving clinical outcomes in DIC management beyond sepsis, thereby serving as a valuable resource for healthcare providers globally.

Gestational diabetes mellitus and polycystic ovary syndrome, a position statement from EGOI-PCOS

Gestational diabetes mellitus is a worldwide health issue in pregnancy, posing a threat to both mother and child. One of the major risk factors for the development of gestational diabetes mellitus is polycystic ovary syndrome, primarily due to the biochemical hyperandrogenism and metabolic issues, commonly observed in these patients. In recent years, the Expert Group on Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS) has sought to better understand the pathogenesis behind polycystic ovary syndrome, in order to accurately diagnose and treat patients according to their individual needs. Through the scope of polycystic ovary syndrome, this position paper examines the characteristics of both conditions, and underlying biological mechanisms, before moving on to common treatment strategies to avoid or treat gestational diabetes mellitus in women with polycystic ovary syndrome.

Prevalence and sociodemographic distribution of endometriosis symptoms and indicators in Denmark

INTRODUCTION

Endometriosis is characterized by a range of non-specific symptoms which may contribute to the significant delay in diagnosis. Knowledge about the distribution of endometriosis symptoms across different geographical regions as well as other sociodemographic factors could add knowledge and guide initiatives to reduce this underdiagnosis. This study aims to explore how the prevalence of endometriosis symptoms and indicators are linked to the different sociodemographic factors.

STUDY DESIGN

The study used data from the CYKLUS-survey; a women's health survey sent to 63,199 Danish women aged 16 to 51 in 2023. Self-reported information on endometriosis symptoms and indicators was linked to Danish register data on sociodemographic factors. Age-standardized prevalence of six endometriosis symptoms and indicators were estimated for each of the nine different regions of residence and for the whole country. In addition, logistic regression analysis was used to estimate the association between sociodemographic factors and the six endometriosis symptoms and indicators.

RESULTS

11,407 women were included in the study. Age-standardized prevalence of symptoms showed little variation across Danish regions. However, younger age, lower socioeconomic status, and non-Danish origin were found to be associated with higher prevalences, and higher education was found to be associated with lower prevalences.

CONCLUSION

No major regional differences in endometriosis symptoms and indicators were found. However, associations were found between several sociodemographic factors and endometriosis symptoms and indicators, suggesting disparities in the burden of symptoms. These findings call for further investigation into factors causing these disparities in Denmark.

Postoperative abdominopelvic adhesion and umbilical wound validation after single-port laparoscopy or two-port laparoscopy for gynecological surgery: a comparison with conventional laparoscopy

PURPOSE

The emergence of minimally invasive surgery has led to the development of laparoscopic surgery to reduce the number of ports. Although the incision for the umbilical port is sufficiently large, thus reducing the number of ports used during laparoscopic surgery, postoperative complications involving incisions at port sites have been reported. Thus, we analyzed postoperative intraperitoneal outcomes after laparoscopy by reviewing operation records and photographs of consecutive surgeries.

METHODS

A total of 134 patients were enrolled in the clinical study to analyze their intraperitoneal outcomes. The patients were divided into groups, which were compared and analyzed on the basis of the number of ports used intraoperatively. The clinical characteristics of the patients were obtained from their medical records, and their operation records, including those of their consecutive operations, were analyzed.

RESULTS

Patients who underwent single-port laparoscopy were included in Group 1, patients who underwent two-port laparoscopy were included in Group 2, and patients who underwent three-port laparoscopy or four-port laparoscopy were included in Group 3. Correlation analysis of the number of ports used during surgery revealed that the white blood cell count before and after surgery and the intraperitoneal umbilical adhesion score were negatively correlated. The incidence of intraperitoneal umbilical adhesions increased as the number of ports used during laparoscopy decreased.

CONCLUSIONS

Because the incidence of postoperative intraperitoneal umbilical adhesion increases as the size of the umbilical wound increases, such as after single-port laparoscopy, surgical umbilical wounds should be cautiously repaired after single-port laparoscopic surgery.

Vascular health and exercise in females throughout the lifespan: Exploring puberty, pregnancy and menopause

This narrative review highlights the impact of exercise on vascular health in females over the lifespan with an emphasis on puberty, pregnancy and menopause. These events encompass substantial changes in sex hormone levels, particularly oestrogens and progesterone. They are also accompanied by distinct adaptations of the central, peripheral and cerebral vasculature. Regular exercise is an effective mechanism to reduce vascular risk in females of all ages, especially for those at higher risk for vascular disorders. However, there are large variabilities in the vascular adaptations to exercise in females that may be related to circulating sex hormone levels. In addition, exogenous hormones, such as oral contraceptives taken after puberty or hormonal replacement therapy taken to mitigate symptoms of menopause, may interact with exercise-induced changes in vascular function. We highlight how more research is needed to understand the optimal exercise interventions to promote vascular health in females across the lifespan, especially during times of hormonal transition.

C3AR1 as a target for preeclampsia: from bioinformatics and network pharmacology to experimental validation

BACKGROUND

Preeclampsia, characterized by hypertension and proteinuria during pregnancy, poses significant risks to both mother and fetus. The complement system's aberrant activation, notably the C3AR1, is important to the pathogenesis of preeclampsia, although the precise mechanisms are not fully understood.

MATERIALS AND METHODS

Utilizing the Comparative Toxicogenomics Database (CTD) and Molecular Signatures Database (MSigDB), we identified complement system targets associated with preeclampsia and environmental pollutants. Expression validation was conducted through the Gene Expression Omnibus (GEO) database. Molecular docking predicted interactions between BPA, PFOS, and C3AR1. Immunohistochemical staining of 80 placental tissues (40 early-onset preeclampsia and 40 healthy controls) confirmed C3AR1 expression and its clinical correlation. Integrated bioinformatics analyses revealed C3AR1's role in preeclampsia's molecular mechanisms. Functional verification was assessed by knocking down C3AR1 in HTR-8/Svneo cells, including cell proliferation, invasion, and apoptosis.

RESULTS

Network pharmacology established connections between pollutants and preeclampsia, with C3AR1 as a key target. Molecular docking confirmed BPA and PFOS binding to C3AR1. Reduced C3AR1 in preeclamptic placentas correlated with maternal blood pressure, and showed high diagnostic potential (AUC = 0.95). C3AR1's involvement in preeclampsia was linked to Jak-STAT, TGF-β, and HIF-1 pathways, and associated with NK cell and M1 macrophage activity. C3AR1 knockdown in HTR-8/Svneo cells decreased proliferation and invasion, and increased apoptosis.

CONCLUSION

C3AR1 expression is diminished in preeclampsia placental tissues, correlating with disease severity, suggesting its potential as a biomarker. It is crucial for cellular functions and inflammation, with future studies aiming to leverage this for novel preeclampsia treatments.

CLINICAL TRIAL

Not applicable.

Perioperative Pain Management in Patients With Cancer-Related Pain: A Narrative Review

The number of cancer patients, cancer survivors, and cancer surgeries is expected to continue to grow and anesthesiologists will benefit from having a framework on how to approach treating perioperative pain in the oncologic population. This article presents general considerations for formulating a perioperative pain management plan including cancer-specific contraindications for epidurals and nerve blocks, common procedures for pain after thoracic and abdominal surgeries, and alternative pain management techniques.

Low-dose aspirin for the prevention of preeclampsia in women with polycystic ovary syndrome: a retrospective cohort study

BACKGROUND

The objective of this study was to investigate the efficacy of low-dose aspirin (LDA) in preventing preeclampsia among pregnant women with polycystic ovary syndrome (PCOS), given the increased susceptibility of this population to preeclampsia development.

METHODS

A retrospective cohort study was conducted on pregnant women with PCOS who delivered between January 1, 2018 and February 10, 2024 at our institution. Clinical characteristics and obstetric data were extracted from medical records. Propensity score matching (PSM) was employed to analyze the association between LDA use and PE incidence.

RESULTS

The study cohort comprised 1522 pregnant women with PCOS. Among 395 pregnant women identified as high-risk for preeclampsia, 98 were administered LDA for preeclampsia prevention, while 297 did not receive LDA. Following PSM, no statistically significant difference was observed in preeclampsia risk between the LDA and non-LDA groups. Additionally, maternal and neonatal outcomes were comparable between the two groups.

CONCLUSIONS

This cohort analysis did not provide sufficient evidence to support the efficacy of LDA in preventing preeclampsia among PCOS patients at high risk for preeclampsia.