Gynecologic and Obstetric Investigation最新文献

Objectives: We aimed to determine the prevalence of female infertility in 204 countries and territories from 1990 to 2019.

Design: We evaluated the female infertility global burden between 1990 and 2019 in this systematic study.

Materials: The Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool) and sociodemographic index (SDI) (http://ghdx.healthdata.org/data-type/estimate) provided data on the annual prevalence numbers, age-standardized prevalence rates (ASR), and disability-adjusted life-years (DALYs) of female infertility in 204 countries and territories from 1990 to 2019 for various age groups.

Setting: Female infertility has a devastating impact on the physical and mental health of individuals and national fertility. However, most of the previous studies on this subject were conducted on rather small sample sizes and have certain limitations.

Methods: We examined female infertility in terms of prevalence, ASR, and DALYs across different age groups in 204 countries and territories from 1990 to 2019 using data from the Global Health Data Exchange query tool.

Results: From 1990 to 2019, ASR and DALYs for female infertility increased globally. At the SDI quintile level, middle-SDI and high-middle-SDI countries exhibited a faster increase in the ASR of female infertility. In 2019, with the highest female infertility rate recorded among those between the ages of 30-34 years and the lowest among those between the ages of 45-49 years. In 2019, high-income North America recorded the highest proportion of primary infertility, while East Asia recorded the lowest proportion.

Limitations: First, the global burden of disease (GBD) database lacks data for some countries and regions. Second, data access and quality differ across locations. Third, the causes of infertility are not comprehensive, and data on Klinefelter in GBD 2019 in relation to primary infertility were absent.

Conclusion: Globally, the prevalence of DALYs and age-standardized female infertility rates increased from 1990 to 2019.

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.

Introduction: Primary dysmenorrhea (PD) is one of the most common gynecological pathologies in women. The aim was to determine the differences in coping with PD in women who practice high-intensity sport, compared to women who are less physically active.

Methods: This was a cross-sectional observational study. A total of 476 women were recruited and administered a Google Form multiple-choice questionnaire divided into six sections. The following scales were used: Numerical Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Menstruation-related Quality of Life Questionnaire (MQOL-22), Tampa Scale for Kinesiophobia (TSK), and Borg scale.

Results: The 389 participants meeting the inclusion criteria were divided into three groups according to their score in Borg test: high-intensity physical activity group (n = 178), moderate-intensity physical activity group (n = 101), and low-intensity physical activity group (n = 110) for those scoring under 4. ANOVA analysis showed statistical significance only for PCS (p = 0.024). Tukey group per group comparison determined differences between high-intensity physical activity group and low-intensity physical activity group regarding PCS (p = 0.018). Spearman correlation analysis showed a high relation between PCS and NPRS (r = 0.664) and between MQOL-22 and NPRS (r = -0.562).

Conclusion: The intensity of the exercise training does not influence PD-related pain perception nor kinesiophobia. High-intensity exercise reduces catastrophizing when compared with sedentary or low-intensity exercise. Level of catastrophizing is highly related with perceived pain and quality of life in menstruation in these PD patients.

Introduction: Mature cystic teratomas (MCTs) are the most common neoplasm of the ovary, occurring in 10-20% of women during their lifetimes. MCTs may rarely undergo malignant transformation, of which squamous cell carcinoma is the most common histopathology. This rare malignancy is poorly understood; therefore, medical and surgical treatment have yet to be optimized to produce the best outcomes for patients diagnosed with squamous cell carcinoma in MCT (SCC-MCT). We aimed to characterize the clinicopathologic features, surgical treatment, adjuvant treatment, and prognosis of SCC-MCT.

Methods: A systematic literature search was performed using MEDLINE through Ovid and PubMed for relevant articles on malignant transformation of squamous cell carcinoma in MCT of the ovary. 155 studies were identified, yielding clinical information on 654 unique patients. Univariate and multivariate analyses were performed to assess factors influencing overall survival (OS). Disease-free survival and OS of cases with follow-up were assessed by the Kaplan-Meier life table analysis. Survival rates were assessed with the log-rank test.

Results: We found that SCC-MCT generally presented in postmenopausal patients with tumor sizes greater than 10 cm. Patients diagnosed with FIGO stage I disease had better survival than later stage disease, and higher FIGO stage was independently associated with worse OS. Longer OS was associated with younger age at diagnosis, low preoperative levels of SCC Ag and CA-125, and treatment with lymphadenectomy. Chemotherapy or radiotherapy were not associated with improved survival.

Conclusion: The prognosis of SCC-MCT is dependent on a variety of factors including age, serum tumor marker levels, and surgical treatment. Prognosis regardless of adjuvant treatment modality chosen for late-stage malignancy is generally poor. Future research focusing on collecting patient outcome data from international centers is needed to better guide treatment choices.

Background: Bowel endometriosis is one of the more severe manifestations of deep endometriosis; it may cause pain and intestinal symptoms. The noninvasive diagnosis of bowel endometriosis is of crucial importance in planning the management of patients affected by this condition.

Objectives: This review aims to describe how transvaginal ultrasonography (TVS) is performed in patients with suspicion of rectosigmoid endometriosis, the diagnostic performance, and the strengths and limitations of this technique.

Methods: To identify relevant literature, a literature search was performed across the PubMed and Google Scholar databases up to July 2024.

Outcome: Numerous meta-analyses have demonstrated that TVS has high diagnostic accuracy in diagnosing rectosigmoid endometriosis. Rectosigmoid nodules can present with different morphological characteristics, but they are typically described as irregular, hypoechoic nodules located in the anterior wall of the rectosigmoid colon. The presence of "soft markers," such as a negative sliding sign and kissing ovaries, can further reinforce the diagnosis of this condition. Posterolateral parametrial involvement often coexists with large rectal nodules. Introducing water contrast into the rectosigmoid does not improve the performance of TVS in diagnosing rectosigmoid endometriosis.

Conclusions and outlook: TVS should be the first-line investigation in women suspected of having rectosigmoid endometriosis. The widespread use of TVS for the diagnosis of intestinal endometriosis can reduce diagnostic delays and facilitate the treatment of patients affected by this condition.

Objective: The objective of this meta-analysis was to conduct a comprehensive assessment of the therapeutic effectiveness and safety profile of the combination of immune checkpoint inhibitors (ICIs) with either chemotherapy or tyrosine kinase inhibitors (TKIs) in the treatment of advanced-stage endometrial cancer (EC).

Methods: This meta-analysis conducted a thorough literature search across PubMed, Cochrane Library, Embase, and Web of Science databases from their earliest records up to November 18, 2023, identifying qualified randomized controlled trials (RCTs), cohort studies, and single-arm trials for inclusion in the analysis. The meta-analysis were performed to quantify and analyzed the evidence from the existing literature, focusing on outcomes including the objective response rate (ORR), disease control rate (DCR), duration of response, overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

Results: A total of 13 studies were included. In terms of ICI combined with chemotherapy, the single-arm trials showed that ICI combined with chemotherapy was effective in improving the ORR, but the overall rate of AE was higher. The results based on RCT suggested that ICI combined with chemotherapy resulted in a longer PFS of 12-24 months and OS of 18 months compared to the control group in advanced EC. In terms of ICI combined with TKI, the pooled ORR was 39.0%, the pooled DCR was 79.9%, the pooled OS rate was 50.4%, and the pooled overall AE rate was 95.8%, the pooled grade ≥3 AE rate was 73.8%, the pooled median progression-free survival was 6.126 months, and pooled OS was 15.099 months in advanced EC.

Conclusions: The integrative therapeutic approach combining ICIs with chemotherapy or TKIs demonstrates notable clinical efficacy in advanced EC, which can prolong the survival and help disease control. Nevertheless, it is imperative for clinicians to be vigilant regarding the potential for adverse reactions to emerge. In addition, more RCTs are needed to solidify this study's efficacy and safety further.

Objective: In recent years, several studies have proposed an association between endometriosis and various cardiovascular diseases. Our study evaluated the association between endometriosis and atherosclerosis in patients under 35 years of age using a large population database.

Design: This was a cross-sectional retrospective population-based study.

Participants/materials, setting, methods: We used the data of more than eight million hospitalized women under 35 years of age who were registered in one of the hospitals participating in the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP NIS) during the study period of 2007-2014. The prevalence of endometriosis, atherosclerosis, and related conditions was estimated, and logistic regression model was used to examine the association.

Results: In the period of study of 8,061,754 patients, we noted an upward pattern for the prevalence of atherosclerosis and a downward trend for endometriosis. Adjusting the analysis for sociodemographic characteristics and comorbidities, the probability of being diagnosed with atherosclerosis was 42% higher in patients with endometriosis (odds ratio [OR] = 1.421; 95% confidence interval [CI]: 1.058-1.910); 35% higher in patients with anxiety (OR = 1.352; 95% CI: 1.249-1.464); and three times higher in women with both endometriosis and anxiety (OR = 3.075; 95% CI: 1.969-4.803) compared to women without those conditions.

Limitations: In HCUP NIS databases, some information such as the severity of disease, laboratory findings, or medical treatment is not available.

Conclusion: The strong association between endometriosis and atherosclerosis suggests that they may share a similar mechanism possibly endothelial dysfunction related to chronic inflammation. Further studies on the potential role of psychological conditions, such as anxiety, on systemic inflammatory diseases are also deemed timely and important.

Objectives: The high incidence of invasive cervical cancer among those who have not undergone cancer screening is a serious problem. This study aimed to investigate the utility of human papillomavirus (HPV) test results from self-collected urine and vaginal samples as screening tools.

Design: The study was conducted in two steps. First, the appropriate storage container, temperature, and time until urine HPV assay performance were verified. Second, the results of spot urine testing under those conditions and of gynecologist-collected cervical and self-collected vaginal samples were compared to verify the feasibility of using the BD Onclarity® HPV assay for individuals with abnormal cervical cytology.

Participants/materials, setting, methods: The participants were 121 women with abnormal cervical cytology. Self-collected urine and vaginal samples, along with gynecologist-collected cervical samples, were tested for HPV using the BD Onclarity® HPV assay. The optimal conditions for urine sample storage were identified by comparing the HPV detection rates under various conditions.

Results: Urine stored in a BD Probe Tec™ (QxUPT) for less than 72 h at room temperature was found to have the highest HPV positivity rate. Under these conditions, the detection rates of HPV in urine, cervical, and vaginal samples were examined. HPV type 16 was detected in 41.7% of the cervical samples, type 18 in 10%, and types 31 and 52 in 12.6% each. The concordance rate for HPV testing between clinician-collected cervical and urine samples was 63.9% (kappa: 0.34; 95% CI: 0.21-0.47), and that between clinician-collected cervical and self-collected vaginal samples was 77.8% (kappa: 0.68; 95% CI: 0.53-0.83), indicating good concordance. In a population with an HPV-related lesion/tumor prevalence of approximately 70%, the sensitivity of HPV testing was 82.7% for the cervix, 46.4% for urine, and 75.7% for vaginal samples.

Limitations: The primary limitation is the lower detection rate of HPV in spot urine samples than in other sample types, indicating room for methodological improvement. The study's findings are based on a specific population, which may limit generalizability.

Conclusions: We investigated the optimal self-collected urine-to-testing time and temperature. Self-collected vaginal and urine HPV tests show moderate-high concordance with clinician-collected cervical HPV tests, suggesting their potential utility for women who do not undergo regular cancer screening. However, the sensitivity was not high in spot urine. Therefore, further large-scale studies are needed to verify these findings and optimize testing methods to encourage broader participation in cancer screening programs.