Gynecologic and Obstetric Investigation最新文献

Objectives: The objective of this study was to examine the potential of artificial intelligence (AI) in gynecologic oncology decision-making.

Design: A feasibility study was conducted.

Participants: Fictitious case vignettes of patients with gynecologic carcinomas were used.

Setting: The setting was a fictive one.

Methods: Fictitious case vignettes of gynecologic carcinomas were created and evaluated by physicians with varying levels of professional experience, as well as by language models including ChatGPT 4.0, Google Gemini, and Bing Copilot. Treatment approval decisions were based on standardized clinical and laboratory criteria.

Results: Two cases of breast cancer, 1 case of ovarian cancer, 1 case of cervical cancer, and 1 case of endometrial cancer were evaluated. All three language models were able to evaluate all clinical cases and make therapy-relevant suggestions, with ChatGPT providing the most clear and concise recommendations that were in 3 cases totally consistent with physician assessments.

Limitations: This study was limited to a feasibility study based on five fictitious case vignettes.

Conclusions: The study demonstrates that AI models, such as ChatGPT, can to some extent evaluate clinical cases, recognize clinical and/or laboratory abnormalities, and make therapy-related suggestions. Despite high overall agreement, differences were predominantly noted in the more complex cases, rendering human interpretation necessary. The findings underscore the benefits of AI in terms of clarity, time efficiency, and cost-effectiveness. Future research should further explore the application of AI to real patient data and development of hybrid decision models to optimize integration into clinical practice.

Objective: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic ovarian surgery. These recommendations impact many aspects of their lives. The primary objective of this study was to assess the overall quality of life (HRQoL) before and after prophylactic bilateral salpingo-oophorectomy (BSO). Secondary objectives were investigating sexual health (SH) and fatigue severity state.

Design: This was a single-center retrospective observational study.

Setting: Women who underwent surgical treatment of bilateral salpingo-oophorectomy between 2018 and 2024 at "DAI Materno Infantile" of Azienda Ospedaliera Universitaria "Federico II" of Naples were included.

Methods: These patients were tracked down to undergo specific questionnaires, such as "Global Health Status (GHS) and Quality of Life Scale (QOL) (EORTC QLQ-C30)," "EORTC Sexual Health Questionnaire (QLQ-SH22)," and "Fatigue Severity Scale (FSS)," to evaluate their psychological, sexual, and general physical condition impact before the surgery, 3 and 6 months later.

Results: The overall mean QoL score was 88.3 ± 29.8 (mean ± standard deviation), and this score worsened when the surgery was performed at 3 months (p < 0.0001) with a score of 51.7 ± 30.7 and a mean difference (MD) of 36.6 points; instead, at 6 months, the overall mean QoL score was 73.1 ± 24.3 with an MD of 21.4 points. FSS reported a score of 2.7 ± 1.15 vs 4.2 ± 1.59 (p < 0.0001) vs 3.5 ± 1.43 (p < 0.0001), respectively, before and 3-6 months after surgery. EORTC QLQ-SH22 before and after treatment showed statistically significant changes in sexual satisfaction (p < 0.0001).

Conclusion: BSO may impact the quality of life regardless of the hormonal status of patients related to age or menopause, about both the functional evaluation and the psychological and emotional assessment report. The physical change related to the surgical procedure is associated with a mental shift that affects both the physical and sexual energy of our patients in the first 3 months postoperatively, with a slight improvement of these data at 6 months.

Background: Autophagy defect has been detected in premature ovarian insufficiency (POI) patients.

Aim: The aim of this study was to evaluate the efficacy and explore the mechanism of Zigui-Changqi decoction (ZCD) in the treatment of POI.

Materials and methods: Rat model of POI was established to evaluate the efficacy of ZCD on serum hormone levels, ovarian index, and ovarian cell apoptosis. The effect of ZCD on the autophagy of granulosa cell was assessed. Network pharmacology was used to predict potential targets of ZCD against POI.

Results: ZCD attenuated tripterygium glycoside-induced damage to ovarian tissues in rats by improving ovarian index, moderating serum hormone levels, inhibiting ovarian cell apoptosis, and increasing the number of ovarian stromal cells. ZCD moderated the expression of autophagy-related markers, including BECN1, p62, and LC3. Through network pharmacological analysis, the predicted hub genes were EGFR, ERBB2, AKT1, IL6, PTEN, and TP53. After molecular docking and detection of cell expression levels, EGFR, ERBB2, AKT1, and IL6 were inhibited by ZCD, as well as mechanistic target of rapamycin complex 1.

Conclusion: ZCD can ameliorate POI, maybe by moderating autophagy via EGFR/ERBB2/IL6/AKT1 signals.

Objectives: The aim of this study was to investigate the clinical characteristics of women with superficial peritoneal endometriosis (SUP) diagnosed by surgery and not confirmed by histology, compared with histologically proven SUP.

Design: This was a single-center, nested case-control study. Participants/Materials: Patients with a surgical report of SUP (n = 390), comprising a subgroup with histological confirmation of endometriosis (n = 245) and a subgroup without it (n = 145). In addition, we enrolled a control group (n = 390) among nonpregnant patients submitted to a laparoscopy or laparotomy for a benign gynecologic condition without any macroscopic sign of endometriosis.

Setting: The review was conducted in the University hospital.

Methods: Data synthesis, descriptive statistics, chi-square test, and one-way analysis of variance followed by Tukey's test.

Results: All groups had similar age, body mass index, smoking prevalence, serum anti-müllerian hormone levels and menstrual cycle patterns. However, the two SUP subgroups had the same prevalence and intensity of endometriosis symptoms. The SUP/histology-negative subgroup was more likely to have a familial history of endometriosis (14% vs. 1%) or a personal history of primary infertility (29% vs. 19%) or primary dysmenorrhea (50% vs. 33%) compared to the control group (all p <0.01). The intensity scores for dysmenorrhea, deep dyspareunia, and non-cyclic chronic pelvic pain were severer in both SUP subgroups than in the control group (p < 0.05).

Limitations: The participants underwent surgery, so their symptoms may not represent groups with initial or mild disease that responded to medical treatments. Due to the retrospective design, performance bias cannot be ruled out.

Conclusions: Patients with suspected SUP lesions and a negative histology had clinical characteristics resembling those with proven endometriosis. Further characterization with molecular biomarkers is needed to explain why these women are so symptomatic in the absence of histological hallmarks of the disease.

Objectives: The objective of this study was to evaluate the impact of a comprehensive intervention using nursing-sensitive quality indicators on pregnant women with hepatitis B and their newborns.

Design: A randomized controlled monocentric trial was conducted from January 2020 to May 2022. Participants/Materials: 80 pregnant women diagnosed with hepatitis B were randomly assigned to either a control group (n = 40) or an experimental group (n = 40). The experimental group received care-sensitive quality indicators during treatment.

Setting: This study was conducted in the Department of Traditional Chinese Medicine, Nantong Third People's Hospital, affiliated with Nantong Hospital 3 of Nantong University, Jiangsu, China.

Methods: Participants in the experimental group received daily tenofovir from late pregnancy to early postpartum, and newborns received hepatitis B vaccine and immunoglobulin within 24 h of birth. Healthcare personnel underwent 6 months of training on care-sensitive quality indicators. The effectiveness of the intervention was assessed using various indicators such as health education coverage, antiviral medication compliance, follow-up rates, and psychological health.

Results: The results showed that after comprehensive intervention, the coverage rate of health education increased from 82.50% before intervention to 92.50% (p = 0.033), and adherence to antiviral medication improved from 82.50% to 97.50% (p = 0.000). The follow-up rate for hepatitis B mothers also significantly increased from 80.00% to 95.00% (p = 0.001). In addition, the incidence of negative emotions such as anxiety and depression among pregnant women significantly decreased from 57.50% to 30.00% (p = 0.000). These findings demonstrate the effectiveness of comprehensive interventions in improving health education coverage and participation, enhancing adherence to antiviral medication, and effectively reducing the psychological burden of pregnant women. Moreover, after the intervention, the awareness of mother-to-child transmission prevention for hepatitis B significantly increased from 82.36 points before intervention to 94.32 points after intervention (p = 0.000). At the same time, adherence to neonatal immunization increased from 80.00% to 95.00%, and satisfaction with nursing services improved from 90.66 points to 98.64 points (p = 0.000). These results indicate that comprehensive interventions significantly enhance knowledge related to mother-to-child transmission prevention, increase immunization adherence, and improve satisfaction with nursing services.

Limitations: The study's limitations include a small sample size and a single-center location, which may affect the generalizability of the results. Future research should involve more extensive, multicenter studies to validate the findings.

Conclusions: