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Chen G, Sun H, Chen Y, Wang L, Song O, Zhang J, Li D, Liu X, Feng L. Perineural Invasion in Cervical Cancer: A Hidden Trail for Metastasis. Diagnostics (Basel) 2024; 14:1517. [PMID: 39061654 PMCID: PMC11275432 DOI: 10.3390/diagnostics14141517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Perineural invasion (PNI), the neoplastic invasion of nerves, is an often overlooked pathological phenomenon in cervical cancer that is associated with poor clinical outcomes. The occurrence of PNI in cervical cancer patients has limited the promotion of Type C1 surgery. Preoperative prediction of the PNI can help identify suitable patients for Type C1 surgery. However, there is a lack of appropriate preoperative diagnostic methods for PNI, and its pathogenesis remains largely unknown. Here, we dissect the neural innervation of the cervix, analyze the molecular mechanisms underlying the occurrence of PNI, and explore suitable preoperative diagnostic methods for PNI to advance the identification and treatment of this ominous cancer phenotype.
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Affiliation(s)
- Guoqiang Chen
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Hao Sun
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Yunxia Chen
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Li Wang
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Ouyi Song
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Jili Zhang
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Dazhi Li
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
| | - Xiaojun Liu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Lixia Feng
- Department of Gynecology, The People’s Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518101, China
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Dall'Asta A, Volpi L, Morganelli G, Ghi T. Added value of intrapartum recording of the maternal heart rate as an adjunct to fetal monitoring using external ultrasound transducer: not only about artifacts. Am J Obstet Gynecol 2024; 231:e47-e50. [PMID: 38453130 DOI: 10.1016/j.ajog.2024.02.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Andrea Dall'Asta
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Lavinia Volpi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giovanni Morganelli
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Tullio Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Malvasi A, Baldini GM, Cicinelli E, Di Naro E, Baldini D, Favilli A, Quellari PT, Sabbatini P, Fioretti B, Malgieri LE, Damiani GR, Dellino M, Trojano G, Tinelli A. Localization of Catecholaminergic Neurofibers in Pregnant Cervix as a Possible Myometrial Pacemaker. Int J Mol Sci 2024; 25:5630. [PMID: 38891818 PMCID: PMC11171499 DOI: 10.3390/ijms25115630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In eutocic labor, the autonomic nervous system is dominated by the parasympathetic system, which ensures optimal blood flow to the uterus and placenta. This study is focused on the detection of the quantitative presence of catecholamine (C) neurofibers in the internal uterine orifice (IUO) and in the lower uterine segment (LUS) of the pregnant uterus, which could play a role in labor and delivery. A total of 102 women were enrolled before their submission to a scheduled cesarean section (CS); patients showed a singleton fetus in a cephalic presentation outside labor. During CS, surgeons sampled two serial consecutive full-thickness sections 5 mm in depth (including the myometrial layer) on the LUS and two randomly selected samples of 5 mm depth from the IUO of the cervix. All histological samples were studied to quantify the distribution of A nerve fibers. The authors demonstrated a significant and notably higher concentration of A fibers in the IUO (46 ± 4.8) than in the LUS (21 ± 2.6), showing that the pregnant cervix has a greater concentration of A neurofibers than the at-term LUS. Pregnant women's mechanosensitive pacemakers can operate normally when the body is in a physiological state, which permits normal uterine contractions and eutocic delivery. The increased frequency of C neurofibers in the cervix may influence the smooth muscle cell bundles' activation, which could cause an aberrant mechano-sensitive pacemaker activation-deactivation cycle. Stressful circumstances (anxiety, tension, fetal head position) cause the sympathetic nervous system to become more active, working through these nerve fibers in the gravid cervix. They might interfere with the mechano-sensitive pacemakers, slowing down the uterine contractions and cervix ripening, which could result in dystocic labor.
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Affiliation(s)
- Antonio Malvasi
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Giorgio Maria Baldini
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Ettore Cicinelli
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Edoardo Di Naro
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | | | - Alessandro Favilli
- Department of Medicine and Surgery, Perugia Medical School, University of Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (A.F.); (P.T.Q.)
| | - Paola Tiziana Quellari
- Department of Medicine and Surgery, Perugia Medical School, University of Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (A.F.); (P.T.Q.)
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
- ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Paola Sabbatini
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
| | | | - Gianluca Raffaello Damiani
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Miriam Dellino
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Giuseppe Trojano
- Department of Maternal and Child, Madonna delle Grazie Hospital ASM, 75100 Matera, Italy;
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Lecce, Italy
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Li R, Tran DN, Lessey BA, Young SL, Kim TH, Jeong JW. Transcriptomic changes in eutopic endometrium and ectopic lesions during endometriosis progression in a mouse model. F&S SCIENCE 2024; 5:182-194. [PMID: 38342342 PMCID: PMC11116064 DOI: 10.1016/j.xfss.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To identify the transcriptomic changes of ectopic lesions and eutopic endometrial tissues during the progression of endometriosis, we performed transcriptomic analysis in the eutopic endometrium and ectopic lesions. DESIGN Laboratory study. SETTING Academic medical center. ANIMALS Four fertile and 4 subfertile Pgrcre/+Rosa26mTmG/+ mice with endometriosis, and 4 sham mice for each group of endometriosis mice as control. These mice underwent either surgery to induce endometriosis or sham surgery. Fertile sham and mice with endometriosis were used 1 month after surgery, whereas subfertile ones were used 3 months after surgery. INTERVENTIONS Early and chronic effects of endometriosis on transcriptomics of ectopic lesions and eutopic endometrium. MAIN OUTCOME MEASURES RNA-sequencing analysis and identification of differentially expressed genes and pathways in the ectopic lesions and eutopic uteri from mice with endometriosis and sham mice at day 3.5 of pregnancy. RESULTS Our mouse model recapitulates the transcriptomic changes of ectopic lesions in humans. RNA-sequencing analysis was performed in ectopic lesions and eutopic uteri from mice with or without endometriosis during the progression of the disease. Estrogen activity, inflammation, angiogenesis, and fibrosis pathways were consistently elevated in all the ectopic lesions compared with eutopic endometrium. Cholesterol/glucose synthesis and stem cell pluripotency pathways were more enhanced in ectopic lesions from subfertile mice compared with their eutopic endometrium. Dysregulation of infiltration of macrophage, dendritic, T and B cells was validated with the use of immunohistochemistry in ectopic lesions. Multiple ligand-receptor pairs between the ectopic and eutopic endometrium were altered compared with the sham endometrium. Suppressed WNT and EGF pathways were only found in the eutopic endometrium from subfertile not fertile mice compared with sham. CONCLUSIONS Our mouse endometriosis model recapitulates the transcriptomics of ectopic lesions in humans. Our transcriptomic analysis during endometriosis progression in our mouse model will help us understand the pathophysiology of endometriosis.
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Affiliation(s)
- Rong Li
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Dinh Nam Tran
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Steven L Young
- Department of Obstetrics, Gynecology and Women's Health, Duke University, Durham, North Carolina
| | - Tae Hoon Kim
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri
| | - Jae-Wook Jeong
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, Missouri.
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Else T, Wong KK, Frey KA, Brooks AF, Viglianti BL, Raffel DM. 3-[ 18F]Fluoro- para-hydroxyphenethylguanidine (3-[ 18F]pHPG) PET-A Novel Imaging Modality for Paraganglioma. J Endocr Soc 2024; 8:bvae049. [PMID: 38617812 PMCID: PMC11010306 DOI: 10.1210/jendso/bvae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 04/16/2024] Open
Abstract
Context Functional positron emission tomography (PET) imaging for the characterization of pheochromocytoma and paraganglioma (PCC/PGL) and for detection of metastases in malignant disease, offers valuable clinical insights that can significantly guide patient treatment. Objective This work aimed to evaluate a novel PET radiotracer, 3-[18F]fluoro-para-hydroxyphenethylguanidine (3-[18F]pHPG), a norepinephrine analogue, for its ability to localize PCC/PGL. Methods 3-[18F]pHPG PET/CT whole-body scans were performed on 16 patients (8 male:8 female; mean age 47.6 ± 17.6 years; range, 19-74 years) with pathologically confirmed or clinically diagnosed PCC/PGL. After intravenous administration of 304 to 475 MBq (8.2-12.8 mCi) of 3-[18F]pHPG, whole-body PET scans were performed at 90 minutes in all patients. 3-[18F]pHPG PET was interpreted for abnormal findings consistent with primary tumor or metastasis, and biodistribution in normal organs recorded. Standardized uptake value (SUV) measurements were obtained for target lesions and physiological organ distributions. Results 3-[18F]pHPG PET showed high radiotracer uptake and trapping in primary tumors, and metastatic tumor lesions that included bone, lymph nodes, and other solid organ sites. Physiological biodistribution was universally present in salivary glands (parotid, submandibular, sublingual), thyroid, heart, liver, adrenals, kidneys, and bladder. Comparison [68Ga]DOTATATE PET/CT was available in 10 patients and in all cases showed concordant distribution. Comparison [123I]meta-iodobenzylguanidine [123I]mIBG planar scintigraphy and SPECT/CT scans were available for 4 patients, with 3-[18F]pHPG showing a greater number of metastatic lesions. Conclusion We found the kinetic profile of 3-[18F]pHPG PET affords high activity retention within benign and metastatic PCC/PGL. Therefore, 3-[18F]pHPG PET imaging provides a novel modality for functional imaging and staging of malignant paraganglioma with advantages of high lesion affinity, whole-body coregistered computed tomography, and rapid same-day imaging.
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Affiliation(s)
- Tobias Else
- Endocrinology, Metabolism, and Diabetes, University of Michigan, Ann Arbor, MI 48109-5674, USA
| | - Ka Kit Wong
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Kirk A Frey
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Allen F Brooks
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Benjamin L Viglianti
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - David M Raffel
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
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Astruc A, Roux L, Robin F, Sall NR, Dion L, Lavoué V, Legendre G, Leveque J, Bessede T, Bertrand M, Odimba Mpoy J, Nzau-Ngoma E, Morandi X, Chedotal A, Le Lous M, Nyangoh Timoh K. Advanced Insights into Human Uterine Innervation: Implications for Endometriosis and Pelvic Pain. J Clin Med 2024; 13:1433. [PMID: 38592287 PMCID: PMC10932059 DOI: 10.3390/jcm13051433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Understanding uterine innervation, an essential aspect of female reproductive biology, has often been overlooked. Nevertheless, the complex architecture of uterine innervation plays a significant role in conditions such as endometriosis. Recently, advances in histological techniques have provided unprecedented details about uterine innervation, highlighting its intricate structure, distribution, and density. The intricate nature of uterine innervation and its influence on pathologies such as endometriosis has garnered increasing attention. (2) Objectives: This review aims to compile, analyze, and summarize the existing research on uterine innervation, and investigate its implications for the pathogenesis of endometriosis and associated pain. (3) Methods: A systematic review was conducted in line with PRISMA guidelines. Using the PubMed database, we searched relevant keywords such as "uterine innervation", "endometriosis", and "pain association". (4) Results: The initial literature search yielded a total of 3300 potential studies. Of these, 45 studies met our inclusion criteria and were included in the final review. The analyzed studies consistently demonstrated that the majority of studies focused on macroscopic dissection of uterine innervation for surgical purposes. Fewer studies focused on micro-innervation for uterine innervation. For endometriosis, few studies focused on neural pain pathways whereas many studies underlined an increase in nerve fiber density within ectopic endometrial tissue. This heightened innervation is suggested as a key contributor to the chronic pain experienced by endometriosis patients. (5) Conclusions: The understanding of uterine innervation, and its alterations in endometriosis, offer promising avenues for research and potential treatment.
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Affiliation(s)
- Audrey Astruc
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- Department of Obstetrics and Gynecology, Angers University Hospital, 49100 Angers, France;
| | - Léa Roux
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
| | - Fabien Robin
- H2P2 Histopathology Laboratory, Rennes 1 University, 35000 Rennes, France;
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, 35000 Rennes, France
- INSERM U1242, Chemistry Oncogenesis Stress Signaling, Rennes 1 University, 35000 Rennes, France
| | - Ndeye Racky Sall
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, IRSET—UMR_S 1085, 35000 Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, IRSET—UMR_S 1085, 35000 Rennes, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, 49100 Angers, France;
| | - Jean Leveque
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
| | - Thomas Bessede
- Urology Department, APHP, Université Paris-Saclay, 94270 Le Kremlin-Bicetre, France;
| | - Martin Bertrand
- Surgery Department, Nîmes University Hospital, University of Montpellier, 30900 Nîmes, France;
| | - Jules Odimba Mpoy
- Department of Obstetrics and Gynecology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo; (J.O.M.); (E.N.-N.)
| | - Emmanuel Nzau-Ngoma
- Department of Obstetrics and Gynecology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo; (J.O.M.); (E.N.-N.)
| | - Xavier Morandi
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Alain Chedotal
- INSERM, CNRS, Institut de la Vision, Sorbonne Université, 75012 Paris, France;
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Krystel Nyangoh Timoh
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
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Malvasi A, Ballini A, Tinelli A, Fioretti B, Vimercati A, Gliozheni E, Baldini GM, Cascardi E, Dellino M, Bonetti M, Cicinelli E, Vitagliano A, Damiani GR. Oxytocin augmentation and neurotransmitters in prolonged delivery: An experimental appraisal. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100273. [PMID: 38274243 PMCID: PMC10809121 DOI: 10.1016/j.eurox.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery and, in particular, the Lower Uterine Segment, cervix, and fundus are all controlled by motor neurofibers. Oxytocin is a neurohormone that acts on receptors located on the membrane of the smooth cells of the myometrium. During the stages of labor and delivery, its binding causes myofibers to contract, which enables the fundus of the uterus to act as a mediator. The aim of this study was to investigate the presence of oxytocinergic fibers in prolonged and non-prolonged dystocic delivery in a cohort of 90 patients, evaluated during the first and second stages of labor. Myometrial tissue samples were collected and evaluated by electron microscopy, in order to quantify differences in neurofibers concentrations between the investigated and control cohorts of patients. The authors of this experiment showed that the concentration of oxytocinergic fibers differs between non-prolonged and prolonged dystocic delivery. In particular, in prolonged dystocic delivery, compared to non-prolonged dystocic delivery, there is a lower amount of oxytocin fiber. The increase in oxytocin appeared to be ineffective in patients who experienced prolonged dystocic delivery, since the dystocic labor ended as a result of the altered presence of oxytocinergic fibers detected in this group of patients.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Ballini
- Department of clinical and experimental medicine, University of Foggia, Foggia, 71122, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris Delli Ponti Hospital, 73020 Scorrano, Italy
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell'Elce di Sotto 8, 06132 Perugia, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Elko Gliozheni
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
- University of Medicine of Tirana, Department of Obstetrics and Gynecology, Tirana, Albania
| | - Giorgio Maria Baldini
- Momo Fertilife, IVF Clinic, Bisceglie, 76011, Italy
- University of Bari Aldo Moro, 70121, Bari, Italy
| | - Eliano Cascardi
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Monica Bonetti
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
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8
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Robin F, Roux L, Zaheer MA, Sulpice L, Dion L, Lavoue V, Landreau J, Morandi X, Nyangoh Timoh K. A reappraisal of the deep uterine vein: a multimodal exploration with implications for pelvic surgery. Surg Radiol Anat 2024; 46:381-390. [PMID: 38493417 DOI: 10.1007/s00276-024-03316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Pelvic gynecological surgeries, whether for malignant or benign conditions, frequently result in functional complications due to injuries to the autonomic nervous system. Recognizing the deep uterine vein (DUV) as an essential anatomical reference can aid in preserving these structures. Despite its significance, the DUV is infrequently studied and lacks comprehensive documentation in Terminologia Anatomica. This research endeavors to elucidate a detailed characterization of the DUV. METHODS We undertook a systematic literature review aligning with the "PRISMA" guidelines, sourcing from PUBMED and EMBASE. Our comprehensive anatomical examination encompassed cadaveric dissections and radio-anatomical evaluations utilizing the Anatomage® Table. RESULTS The literary exploration revealed a consensus on the DUV's description based on both anatomical and surgical observations. It arises from the merger of cervical, vesical, and vaginal veins, coursing through the paracervix in a descending and rearward direction before culminating in the internal iliac vein. The hands-on anatomical study further delineated the DUV's associations throughout its course, highlighting its role in bifurcating the uterus's lateral aspect into two distinct zones: a superior vascular zone housing the uterine artery and ureter and an inferior nervous segment below the DUV representing the autonomic nerve pathway. CONCLUSION A profound understanding of the subperitoneal space anatomy is paramount for pelvic surgeons to mitigate postoperative complications. The DUV's intricate neurovascular interplays underscore its significance as an indispensable surgical guide for safeguarding nerves and the ureter.
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Affiliation(s)
- Fabien Robin
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Léa Roux
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Myra A Zaheer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Laurent Sulpice
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Ludivine Dion
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
| | - Vincent Lavoue
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Julien Landreau
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Xavier Morandi
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Krystel Nyangoh Timoh
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France.
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France.
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France.
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Verrelli L, Merlot B, Chanavaz-Lacheray I, Braund S, D'Ancona G, Kade S, Dennis T, Roman H. Robotic Surgery for Severe Endometriosis: A Preliminary Comparative Study of Cost Estimation. J Minim Invasive Gynecol 2024; 31:95-101.e1. [PMID: 37935331 DOI: 10.1016/j.jmig.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
STUDY OBJECTIVE To compare the postoperative outcomes and the overall expenses between conventional laparoscopy and robotic surgery, in a series of consecutive patients managed for only severe endometriosis in our institute. DESIGN A cohort comparative study. SETTING Center of Excellence in Multidisciplinary Endometriosis Care. PATIENTS A total of 175 symptomatic patients undergoing surgery for only severe endometriosis from March 2021 to August 2022. INTERVENTIONS We treated patients with endometriosis involving the digestive tract such as rectum, sigmoid colon, and ileocecal junction by rectal shaving, discoid resection, or segmental resection (141 surgeries) with or without bladder (23 surgeries), sacral plexus (19 surgeries), and diaphragm involvements (14 surgeries). MEASUREMENTS AND MAIN RESULTS Postoperative outcomes were evaluated in terms of total surgical time (total surgical room occupancy time and total operating time), hospitalization period, postoperative complications, rehospitalization, and second surgical procedures. A statistically higher total surgical room occupancy (203 minutes vs 151 minutes) and operating time (150 minutes vs 105 minutes) were observed in the robotic group (p = .001). No differences in terms of mean hospital stay (p = .06), postoperative complications (p = .91), rehospitalization (p = .48), and secondary surgical treatment (p = .78) were identified. Concerning the cost analysis only for disposable supply, the cost of colorectal resection was totaled at 2604 euros for the laparoscopic conventional approach vs 2957 euros for the robotic approach (+352.6 euros, +14%). The cost of rectal disc excision was 1527 euros for the laparoscopic conventional approach vs 1905.85 euros (+378 euros, +25%). CONCLUSIONS Our study confirms the feasibility of the robotic approach for the treatment of severe endometriosis, with however a higher cost of robotic approach. Next studies should identify specific indications for robotic surgery, where technical advantages provided by the technology are followed by objective improvement of patients' outcomes.
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Affiliation(s)
- Ludovica Verrelli
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sophia Braund
- Expert Center in Multidisciplinary Endometriosis Management, Rouen University Hospital, Rouen, France (Dr. Roman)
| | - Gianmarco D'Ancona
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman); Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Drs. Braund and Roman).
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10
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Giovannetti O, Tomalty D, Velikonja L, Jurkus C, Adams MA. The human cervix: Comprehensive review of innervation and clinical significance. Clin Anat 2023; 36:118-127. [PMID: 36200685 DOI: 10.1002/ca.23960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 12/14/2022]
Abstract
Detailed knowledge regarding the innervation and histology of the human cervix is crucial given the surgical removal of this tissue for conditions such as cervical dysplasia. Recent evidence implicates the cervix in the sexual response, making it pertinent to characterize this region to elucidate its role. Despite this, literature describing the overall innervation of the cervix from anatomical and histological perspectives is lacking. The aim of this review was to consolidate descriptions pertaining to human cervix innervation and discuss possible mechanisms of dysfunction, as an unintended result of cervix removal. A detailed literature search of relevant articles describing human cervix innervation was conducted. 1597 articles were screened based on the keywords searched. Only 16 articles, containing information regarding specific evidence of the innervation of the human cervix, were included and categorized based on parameters of innervation (method, type, location). The published evidence demonstrates that the human cervix has sympathetic, parasympathetic, and sensory innervation, but does not characterize changes after surgical procedures. Despite the gaps in knowledge, it is relevant that associations linking clinical procedures, involving cervical removal and adverse sexual health outcomes, become an important focus for discussions between physicians and patients. Future work is needed to better detail the affected innervation as well as the neural pathway-specific relationship to symptoms of sexual dysfunction.
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Affiliation(s)
- Olivia Giovannetti
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Diane Tomalty
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Leah Velikonja
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Connor Jurkus
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
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Nezhat CH, McGrail K. Exploring fetal pelvic neuroanatomy: a deep dive into understanding nerve pathways, endometriosis, and pain. Fertil Steril 2022; 117:1289-1290. [DOI: 10.1016/j.fertnstert.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
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