Evaluation of goserelin effectiveness based on assessment of inflammatory cytokines and symptoms in uterine leiomyoma

Feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) panhysterectomy: a polycentric retrospective study

OBJECTIVES

To investigate the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) panhysterectomy.

METHODS

A retrospective analysis was conducted on the data of 75 patients who underwent panhysterectomy for hysteromyoma in the Department of Obstetrics and Gynecology of Tongxiang Maternal and Child Health Hospital; Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University and Department of Gynecology, The First Affiliated Hospital of USTC from June 2019 to June 2020. According to the operation mode, the patients were divided into two groups: the traditional multi-port laparoscopic surgery (MPLS) group (n = 45) and the Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) group (n = 30). The operation duration, intraoperative blood loss, postoperative exsufflation time, postoperative activity time, hospital stay, treatment cost, 6 h activities of daily living (ADL) score after the operation, cosmetic score, visual analog score, and complications were observed in the two groups.

RESULTS

Perioperative period related indicators: Compared with the MPLS group, the total treatment cost and cosmetic score of the V-NOTES group were significantly better than those of the MPLS group, but the operation duration was longer, and the HB decreased more significantly (P < 0.05). However, there was no significant difference in intraoperative blood loss, postoperative exsufflation time, postoperative activity time, 6 h ADL score after the operation, and hospital stay between the two groups (P > 0.05). Postoperative pain: The VAS score 1 h, 6 h, 12 h, and 24 h after the operation was lower in the V-NOTES group than in the MPLS group (P < 0.05). Postoperative complications: The complication rate of the V-NOTES group was significantly lower than that of the MPLS group (P < 0.05).

CONCLUSIONS

In treating panhysterectomy patients, both V-NOTES and MPLS can achieve satisfactory efficacy and prognosis, and both have advantages and disadvantages. Specifically, the V-NOTES surgery has significant advantages such as a lower treatment cost, lower incidence of postoperative complications, less pain, and more beautiful wounds.

Relation of Endocan Serum Levels with Patient Characteristics and Morphological Features of Uterine Fibroids: A Case-Control Study

OBJECTIVES

This study aimed to compare the serum endocan levels of patients with uterine fibroids and the healthy control group.

DESIGN

A case-control study was designed. Participants/Materials: The study group includes women diagnosed with uterine fibroids, and the control group includes healthy women.

SETTING

The study was conducted at a tertiary education and research hospital with 130 women (uterine fibroid group, n = 65; control group, n = 65).

METHODS

Serum endocan levels were determined in the study and control groups using the ELISA method. The number of uterine fibroids was identified, and the volume of uterine fibroids was calculated with ellipsoid formula by ultrasonography. The primary outcome parameter was serum endocan levels in patients with uterine fibroids and healthy control groups. Second, it is aimed to determine the distribution of the serum endocan level of patients according to uterine fibroid number, volume, and clinical presentation.

RESULTS

The mean serum endocan level of patient with uterine fibroid was 145.18 ± 169.86 (median: 94.10; Q25-Q75%: 54.50-116.50) pg/mL; it was 88.94 ± 54.21 (median: 76.9; Q25-Q75%: 64.20-152.65) pg/mL in the control group (p = 0.016). According to ROC analysis, cutoff value of the endocan level for uterine fibroid was determined as ≥133.1 pg/mL. For the cutoff value of 133.1 pg/mL, sensitivity was 36.92%, specificity was 89.23%, positive predictive value was 77.40%, and negative predictive value was 58.60%. Above this cutoff value, a 4.8-fold increased significant risk (OR) for uterine fibroid was detected.

LIMITATIONS

The major limitation of the study is the lack of histopathological examination.

CONCLUSION

Serum endocan levels were found to be higher in women with uterine fibroids compared to the control group, so endocan may be considered as a significant serum marker.

Role of inflammation and immune response in the pathogenesis of uterine fibroids: Including their negative impact on reproductive outcomes

Uterine fibroids (UFs), the most common tumors in women of reproductive age, are characterized by sex steroid-dependent growth and excessive deposition of extracellular matrix (ECM) surrounding UF smooth muscle cells. Women with symptomatic UFs experience heavy menstrual bleeding and consequent iron-deficiency anemia. They also have a risk of recurrent pregnancy loss, preterm birth, and cesarean delivery, indicating that UFs can negatively affect reproductive outcomes. Various types of immune cells, including innate and adaptive cells, are observed in UFs; however, the impact of these cells on the pathophysiology of UFs remains unclear. Inflammation may play important roles in the growth of UFs, and expression levels of proinflammatory and inflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-10, TNF-α, and TGF-β, are upregulated in UFs. These cytokines play important roles in the interaction between growth factors and ECM that is regulated by the sex steroids estrogen and progesterone. Furthermore, proinflammatory mediators are upregulated in females with UFs, with higher expression levels in the endometrium with submucosal and intramural UFs than in the endometrium without UFs, indicating that these proinflammatory cytokines may impair endometrial receptivity, leading to implantation failure in in vitro fertilization programs. Hormonal treatments using gonadotropin releasing hormone analogs and the selective progesterone receptor modulator ulipristal acetate significantly shrink UFs and improve UF-related symptoms. These compounds can regulate local inflammation in UFs and adjacent myometrium. Controlling and improving local inflammation caused by UFs may represent a novel therapeutic strategy for UFs and potentially improve reproductive outcomes in women with symptomatic UFs.

Current and Emerging Treatment Options for Uterine Fibroids

Uterine fibroids are the most common benign neoplasm of the female reproductive tract in reproductive age women. Their prevalence is age dependent and can be detected in up to 80% of women by the age of 50 years. Patients affected by uterine fibroids may experience a significant physical, emotional, social, and financial toll as well as losses in their quality of life. Unfortunately, curative hysterectomy abolishes future pregnancy potential, while uterine-sparing surgical and radiologic alternatives are variously associated with reduced long-term reproductive function and/or high tumor recurrence rates. Recently, pharmacological treatment against uterine fibroids have been widely considered by patients to limit uterine fibroid-associated symptoms such as heavy menstrual bleeding. This hormonal therapy seemed effective through blocking the stimulatory effects of gonadal steroid hormones on uterine fibroid growth. However, they are contraindicated in women actively pursuing pregnancy and otherwise effective only during use, which is limited because of long-term safety and other concerns. Accordingly, there is an urgent unmet need for safe, durable, and fertility-compatible non-surgical treatment options for uterine fibroids. In this review article, we cover the current pharmacological treatments for uterine fibroids including their comparable efficacy and side effects as well as emerging safe natural compounds with promising anti-uterine fibroid effects.

GnRH agonists and antagonists in therapy of symptomatic uterine fibroids - current roles and future perspectives

INTRODUCTION

Uterine fibroids are the most common noncancerous tumors in women of childbearing age. This review was developed to evaluate the current role of gonadotropin-releasing hormone (GnRH) agonists and antagonists in the therapy of symptomatic uterine fibroids.

AREAS COVERED

There is a great need for alternative methods for surgical treatment of uterine fibroids. Hormonal therapy remains the first-line treatment option for most patients. GnRH analogs (agonists and antagonists) modulate the pulsatile release of GnRH. This review summarizes the available literature concerning pharmacologic principles underlying the mechanism of action of GnRH and its analogs, as well as individual therapeutic applications to which these drugs have been applied.

EXPERT OPINION

In many cases, it is possible to try to treat uterine fibroids pharmacologically. Both groups of GnRH analogs are used in therapy, agonists instead as a preparation for surgery, and antagonists as a drug for long-term use. It is essential to develop this path further and look for at least long-term-release systems or new methods of administering these drugs. It is also important from the patient's perspective to search for possible drugs that may have an additive effect of decreasing side effects when combined with GnRH analogs.

Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment

Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common tumors in women worldwide. To date, no long-term or noninvasive treatment option exists for hormone-dependent uterine fibroids, due to the limited knowledge about the molecular mechanisms underlying the initiation and development of uterine fibroids. This paper comprehensively summarizes the recent research advances on uterine fibroids, focusing on risk factors, development origin, pathogenetic mechanisms, and treatment options. Additionally, we describe the current treatment interventions for uterine fibroids. Finally, future perspectives on uterine fibroids studies are summarized. Deeper mechanistic insights into tumor etiology and the complexity of uterine fibroids can contribute to the progress of newer targeted therapies.

Intelligent Noise Reduction Algorithm to Evaluate the Correlation between Human Fat Deposits and Uterine Fibroids under Ultrasound Imaging

This study aimed to realize the automatic diagnosis of fatty degeneration of uterine fibroids. In this study, the traditional nonlocal means (NLM) algorithm was improved by changing the Euclidean distance and introducing a cosine function and applied to the ultrasonic imaging intelligent diagnosis of patients with fatty degeneration of uterine fibroids. Then, the noise reduction effect of the improved NLM algorithm was evaluated based on several indicators, such as peak signal-to-noise ratio (PSNR), mean square error (MSE), contrast-to-noise ratio (CNR), figure of merit (FOM), and structural similarity (SSIM). The accuracy, sensitivity, specificity, and F1 score were adopted to evaluate the improved NLM algorithm for diagnosing fatty degeneration of uterine fibroids, and the Perona-Malik (PM) algorithm and NLM algorithm were used for comparative analysis. The results showed that after the ultrasound images of patients with uterine fibroids were denoised using the improved NLM algorithm, the PSNR, MSE, CNR, FOM, and SSIM were obviously better than the same indicators of the image processed with the PM algorithm and the NLM algorithm, and the differences were statistically significant (P < 0.05). The diagnosis results of patients with fatty degeneration of uterine fibroids found that there was only one patient with missed diagnosis after the ultrasound image was processed with NLM algorithm, and there was no statistical difference between the improved NLM algorithm and the assisted diagnosis accuracy of the pathological examination results (P > 0.05). The average noise reduction time of the PM algorithm, NLM algorithm, and the improved NLM algorithm was 16.38 ± 4.33 s, 18.01 ± 5.14 s, and 23.81 ± 4.62 s, respectively. The diagnosis rate before improvement was 75.0%, the diagnosis accuracy rate for PM was 79.69%, and that after improvement was 85.94%. In summary, the improved NLM algorithm showed a good noise reduction effect on ultrasound images of patients with uterine fibroids, could improve the diagnosis accuracy of fatty degeneration of uterine fibroids, and could assist clinicians in the ultrasound imaging diagnosis of patients with uterine fibroids.

Evaluation of online counselling services based on Turkish web-based pharmacy care setting: A retrospective observational study

AIMS OF THE STUDY

To determine the types of online pharmacy care services provided by the clinical pharmacists regarding identification of medication-related problems, provision of counselling services for health and disease conditions alongside medications' counselling for patients seeking online consultation about health, medication and lifestyle concerns based on Turkish web-based pharmacy care setting(WPCS).

METHODS

A retrospective, descriptive cohort study carried out on patients during their online visiting of Turkish WPCS seeking consultation for diverse kinds of concerns from September 2015 to March 2016. Patients' health and medication data were gathered for assessment of health-, medication- and lifestyle-related concerns. Descriptive analysis and Chi square test were used to analyse study data. Study outcomes included personalised online pharmacy care services regarding identification of medication-related problems, counselling services for health and disease conditions and medications' counselling alongside associations with counselling-related concerns by the WPCS.

RESULTS

A total of 350 participants enrolled in this study and the majority of them were women (62.6%). Dermatological and gynaecological conditions represented the majority of disease conditions (51.4%, 44.6%), respectively. Within 1 year, 63.7% of the study participants visited the Turkish WPCS more than three times. Medication- and health-related concerns were reported by 90.8% and 68.3% of the study participants, respectively. Medication side effects (44.1%) and an inappropriate medication timing (31.4%) were the major medication-related problems identified. A total of 477 different counselling services regarding health conditions and 990 counselling regarding medications were provided by the clinical pharmacist through the Turkish WPCS.

CONCLUSION

The WPCS could be considered as an additional option for the clinical pharmacist to provide care services regarding identification of medication-related problems, provision of counselling about health and disease conditions alongside different medication counselling to improve health conditions and proper pharmacotherapy management.