Introduction: Oxytocin has long been used for the induction of labor, but it can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labor. We performed this meta-analysis to determine whether discontinuation of oxytocin, once the active phase of induced labor is achieved, affects the second stage of labor and the rate of various maternal and fetal outcomes.
Methods: We searched for randomized controlled trials (RCTs) comparing discontinuing oxytocin after the active stage of labor is established versus continuing to give oxytocin throughout the labor process using databases like PubMed, Embase, the Cochrane Library, and
Results: Pooled analysis of fifteen RCTs included in our review showed that discontinuation of oxytocin, once the active stage of labor is established, did not reduce the primary outcome of incidence of cesarean delivery (RR = 0.91; 95% CI, 0.77-1.07; p = 0.21). The incidence of uterine tachysystole, postpartum hemorrhage, and non-reassuring fetal heart rate was significantly lower in the oxytocin discontinuation group compared to oxytocin continuation. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit admission did not differ among both groups. The duration of the active stage of labor was significantly prolonged in the oxytocin-discontinued group; however, the duration of the second stage of labor and total delivery time remained comparable between the two groups.
Conclusions: Discontinuation of oxytocin during the active phase of labor did not reduce the incidence of cesarean section or neonatal morbidity. We therefore recommend an individualized approach regarding oxytocin discontinuation while factoring in patient-specific factors. New large-scale RCTs focusing on identifying subgroups that might benefit from one approach over the other are required to provide more reliable results.
Objectives: Endometriosis is a chronic gynecological condition characterized by abnormal angiogenesis and cell adhesion processes driven by VEGF-VEGFR-2 signaling. cabergoline, a dopamine agonist, has been shown to inhibit angiogenesis in endometriosis. This study investigates the therapeutic potential of cabergoline in modulating these pathways to mitigate endometriotic lesion progression and improve oocyte quality.
Design: A randomized, placebo-controlled study was conducted, involving two groups of participants: one receiving cabergoline treatment and the other receiving a placebo.
Methods: Eutopic endometrial tissue from women diagnosed with endometriosis was analyzed. VEGFR-2, FAK, PXN, ITGB3, and ITGAV expression levels were measured using qPCR. DNA methylation at the VEGFR-2 promoter was assessed using high-resolution melting analysis to examine epigenetic modifications. Western blot analysis was performed to evaluate the phosphorylation status of tyrosine residue 951 on the VEGFR-2 receptor, which is implicated in cell migration and survival. Oocyte quality was also assessed in both groups.
Results: Cabergoline treatment reduced the expression levels of VEGFR-2, FAK, PXN, ITGB3, and ITGAV, with ITGAV showing a statistically significant decrease (p = 0.0174). Hypomethylation of the VEGFR-2 promoter was observed in the treatment group (p = 0.3566). However, phosphorylation of tyrosine residue 951 on VEGFR-2 significantly increased in the cabergoline-treated group (p = 0.004). Notably, oocyte quality significantly improved in the cabergoline group (p = 0.0318). A strong correlation was found between reduced VEGFR-2 expression (p = 0.0184), decreased promoter methylation (p = 0.0159), and downregulation of PTK2 expression (p = 0.0057), all of which are associated with improved oocyte quality.
Limitations: The sample size was limited, and additional long-term studies are needed to confirm the therapeutic potential of cabergoline in endometriosis treatment.
Conclusions: Cabergoline may enhance oocyte quality by modulating key regulators of the angiogenic pathway. These findings suggest its potential role in the management of endometriosis-related infertility, warranting further clinical investigation.
Objectives: The objective of this study was to explore the lymph node metastasis (LNM) and related risk factors of low-grade endometrioid endometrial carcinomas (EECs) and analyse the efficacy of related risk factors in predicting LNM.
Design: Data from 424 patients with low-grade EEC treated between January 2019 and June 2024 were retrospectively analysed, according to the International Federation of Gynecology and Obstetrics (FIGO) 2009.
Methods: Univariate and multivariate logistic regression analyses were used to examine the factors associated with LNM. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of independent risk factors for LNM.
Results: The rate of LNM was 7.8% (33/424). Histological grade, tumour size, depth of myometrial invasion, cervical stromal invasion, lymphovascular space invasion (LVSI), microcystic, elongated, fragmented (MELF) pattern, carbohydrate antigen 125 (CA125), carbohydrate antigen 199, and human epididymis protein 4 were associated with LNM. However, only LVSI, MELF pattern, depth of myometrial invasion, and CA125 were identified as independent risk factors. The area under the ROC curve for CA125 and depth of myometrial invasion was 0.796 and 0.734, respectively. The optimal cut-off value for CA125 was 31.36 U/mL, with a maximum Youden index of 53.9%. Combining CA125 with depth of myometrial invasion improved diagnostic accuracy compared to either parameter alone.
Limitations: This is a single-center retrospective study.
Conclusions: LNM is more likely with independent risk factors. Combining CA125 and depth of myometrial invasion enhances diagnostic accuracy for LNM. This study provides valuable insights for predicting LNM risk in low-grade EEC patients and guiding stratified management.
.Introduction: The objective of this study was to examine the impact of semaphorin 3F (SEMA3F) on the proliferation, migration and ferroptosis of endometrial stromal cells in patients with endometriosis (EMS).
Methods: This study collected ectopic endometriotic tissues from 30 patients with EMS (EMS group) and eutopic endometrial tissues from 30 patients in the control group who underwent hysterectomy due to uterine fibroids. The ectopic endometriotic tissues were sourced from the cystic walls of ovarian endometriomas in women with EMS. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting were adopted to evaluate SEMA3F expression of endometrial tissues. Endometrial stromal cells (ESCs) were isolated from ectopic endometriotic tissues and divided into the oe-NC group, oe-SEMA3F group, and a blank group (non-transfected). SEMA3F expression in cells was quantified by RT-qPCR and Western blotting. Cell proliferation was quantified with the Cell Counting Kit-8 (CCK-8) assay, and migration and invasion were analyzed via the Transwell method. Ferroptosis markers (Fe2+, malondialdehyde [MDA], glutathione [GSH]) and ferroptosis-related proteins (ACSL4, PTGS2) were evaluated with Western blotting, and inflammatory factors (IL-6, TNF-α) were measured using enzyme-linked immunosorbent assay.
Results: Levels of both mRNA and protein in SEMA3F were lower in the ectopic endometriotic endometrial tissue of EMS patients compared to controls. Overexpression of SEMA3F in ESCs from patients with EMS reduced cellular activity, migration, and invasion. Additionally, Fe2+, MDA, and other ferroptosis markers were significantly reduced, while GSH levels increased. Ferroptosis-related protein expression (ACSL4, PTGS2) was suppressed, and inflammatory factor levels (IL-6, TNF-α) decreased.
Conclusion: SEMA3F may regulate the development of EMS by affecting the proliferation, invasion, migration, as well as ferroptosis of ESCs from patients with EMS.
Objectives: Endometrial preparation provides significant surgical benefits prior to hysteroscopic procedures. However, there is still no consensus on the optimal presurgical protocol. Although there is evidence on rapid preparation, there are currently no studies on rapid endometrial preparation using combined oral contraceptives initiated at a "random" time in the menstrual cycle. The aim of the present trial was to evaluate the use of oral drospirenone/estetrol in random start rapid preparation of endometrium before office hysteroscopic polypectomy.
Design: In this multicenter, prospective, randomized controlled trial, 80 women scheduled for polypectomy were randomly assigned to intervention (n = 40) or control (n = 40) groups.
Participants/materials, setting, methods: The intervention group received oral drospirenone/estetrol (3 mg/14.2 mg/day) for 14 days, starting at any menstrual cycle point (random start). Controls underwent polypectomy on cycle days 8-11 without any prior pharmacological intervention.
Results: Pre- and post-procedure, endometrial thickness was significantly lower in the drospirenone/estetrol group (p < 0.001), and patients showed more hypotrophic/atrophic endometrial patterns (p < 0.001). Operative time, distension medium usage, incomplete resections, and bleeding during polypectomy were significantly lower in the drospirenone/estetrol group (p < 0.001). Endometrial preparation quality, uterine cavity visualization, and procedure satisfaction were higher in the drospirenone/estetrol group (p < 0.001). Furthermore, patients in the drospirenone/estetrol group experienced less pain during (p < 0.001) and after the procedure (p < 0.001), requiring fewer analgesics (p < 0.001) and shorter post-procedure discharge time (p = 0.01) than controls.
Limitations: Limited sample size; possible variability due to different hysteroscopists, caused by the multicenter nature of the study; hysteroscopists were unmasked to treatment allocation; absence of a cost-effectiveness analysis.
Conclusions: Treatment with drospirenone/estetrol could provide rapid, satisfactory and low-cost endometrial preparation before office polypectomy, improving surgical performance and patient compliance.
Introduction: The objective of this study wasto perform a systematic review on artificial intelligence (AI) studies focused on identifying and differentiating pelvic gynecological tumors on ultrasound scans.
Methods: Studies developing or validating AI models for diagnosing gynecological pelvic tumors on ultrasound scans were eligible for inclusion. We systematically searched PubMed, Embase, Web of Science, and Cochrane Central from their database inception until April 30, 2024. To assess the quality of the included studies, we adapted the QUADAS-2 risk of bias tool to address the unique challenges of AI in medical imaging. Using multilevel random-effects models, we performed a meta-analysis to generate summary estimates of the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. To provide a reference point of current diagnostic support tools for ultrasound examiners, we descriptively compared the pooled performance to that of the well-recognized ADNEX model on external validation. Subgroup analyses were performed to explore sources of heterogeneity.
Results: From 9,151 records retrieved, 44 studies were eligible: 40 on ovarian, 3 on endometrial, and 1 on myometrial pathology. Overall, 95% were at high risk of bias - primarily due to inappropriate study inclusion criteria, the absence of a patient-level split of training and testing image sets, and no calibration assessment. For ovarian tumors, the summary AUC for AI models distinguishing benign from malignant tumors was 0.89 (95% CI: 0.85-0.92). In lower risk studies (at least three low-risk domains), the summary AUC dropped to 0.87 (95% CI: 0.83-0.90), with deep learning models outperforming radiomics-based machine learning approaches in this subset. Only five studies included an external validation, and six evaluated calibration performance. In a recent systematic review of external validation studies, the ADNEX model had a pooled AUC of 0.93 (95% CI: 0.91-0.94) in studies at low risk of bias. Studies on endometrial and myometrial pathologies were reported individually.
Conclusion: Although AI models show promising discriminative performances for diagnosing gynecological tumors on ultrasound, most studies have methodological shortcomings that result in a high risk of bias. In addition, the ADNEX model appears to outperform most AI approaches for ovarian tumors. Future research should emphasize robust study designs - ideally large, multicenter, and prospective cohorts that mirror real-world populations - along with external validation, proper calibration, and standardized reporting.
.Background: Close observation is fundamental to both art and medicine, although both disciplines use it in different ways. As doctors need to practice observation of their patients every day, visual arts are increasingly used for the development of observational skills within the medical curriculum. This is particularly useful for students and residents in surgery or in specializations with a surgical component such as gynecology and obstetrics, where close observation of anatomical structures and radiological imaging is essential in providing quality care. Conversely, artists - through close observation - have depicted the world around them for decades. As a result, they might have unintentionally pictured medical abnormalities, before conditions were officially described in the medical world. Several authors have described medical findings in artworks throughout history, such as the visual diagnosis of Erb's palsy.
Objectives: The aim of this paper was to identify and describe depictions of Erb's palsy in art history.
Methods: Authors observed and analyzed several paintings in the Rijksmuseum in the Netherlands on visual medical abnormalities corresponding to obstetrical birth injuries. Additionally, in January 2025 a PubMed search was conducted using the terms "erbs palsy," "birth injuries," "brachial plexus neuropathies," and "art." The paintings of three articles concerning the depiction of Erb's palsy in art were included. A standardized table was constructed in collaboration with medical specialists and used to analyze clinical features of Erb's palsy in the artworks.
Outcome: PubMed search resulted in three different articles concerning the possible diagnosis of Erb's Palsy in a painting of Albrecht Dürer, i.e., Madonna and Child (ca. 1505). In total, five different paintings from the 16th and 17th century were analyzed regarding the presence of clinical features of Erb's palsy. Three paintings matched six out of seven of the clinical criteria, as stated in the standardized table. Two paintings matched five out of seven clinical criteria of Erb's palsy. It should be noted that the art-historical principles of the so-called Renaissance elbow and the technique of "foreshortening" might have contributed to the depiction of incorrect anatomical features, as a result of artistic freedom rather than the depiction of medical abnormalities.
Conclusions: This paper suggests that artists' close observations could possibly have led to depictions of Erb's palsy centuries before the condition was formally described in the medical profession. The findings serve as a reminder that close observation is essential for the work of medical professionals and highlight how art can contribute to training the clinical eye of medical students, residents, and doctors.
.Objectives: The aim of this study was to investigate the ovarian response in different phases of the menstrual cycle in breast cancer women candidates for fertility preservation.
Design: A retrospective study was carried out, including women with breast cancer undergoing oocyte cryopreservation at the Fertility Preservation Unit of the University of Naples Federico II between 2017 and 2023.
Participants/materials, setting, methods: Women who started ovarian stimulation (OS) during the follicular phase (FP) were compared with those who started during the luteal phase (LP). The two study groups were further stratified according to the phase of the menstrual cycle at OS initiation: early (day 1-5, EFP) or late follicular phase (day 6-14, LFP), early (day 15-21, ELP) or late luteal phase (day 22-32, LLP). The primary outcome was oocyte recovery.
Results: A total of 113 women who underwent fertility preservation for breast cancer were included. No differences in oocytes retrieved and ovarian sensitivity were observed when comparing follicular and luteal phases. No differences were observed regarding oocytes retrieved and ovarian sensitivity among the four groups divided according to the menstrual cycle phase. OS was significantly shorter in the early follicular phase (9 days; 8-10) than in the other menstrual phases (LFP: 10 days, 9-11, p < 0.04; ELP: 11, 9-11, p < 0.004; and LLP: 11 days, 10-12, p < 0.001).
Limitations: Our study's limitations are its small sample size and retrospective design.
Conclusions: The phases of the menstrual cycle at which OS was started did not affect oocyte yield and ovarian sensitivity in women with breast cancer undergoing a random-start protocol with letrozole.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：