Gynecologic and Obstetric Investigation最新文献

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.

Background: Vitamin D deficiency during pregnancy has been linked to adverse maternal-fetal outcomes. However, it remains unclear whether standard supplementation mitigates risks equally in patients with differing baseline 25-hydroxyvitamin D [25(OH)D₃] levels.

Objectives: The objective of this study was to determine whether differences exist in obstetric outcomes and pregnancy-related disorders among patients with different levels of 25(OH)D₃ in the first trimester who receive standard supplementation.

Design: This retrospective comparative cohort study involves pregnant women aged 16-50 years who received prenatal care at a semiprivate hospital in Northeastern México between January 2022 and December 2024.

Participants/materials, setting, methods: Participants were grouped based on first-trimester serum 25(OH)D₃ levels (≥30 ng/mL vs. <30 ng/mL), all receiving standard 25(OH)D₃ supplementation (4,000 IU/day). For comparisons between groups, we performed independent samples t-tests or Mann-Whitney U tests for quantitative variables and chi-square tests for qualitative variables. A multivariate logistic regression analysis was conducted to identify predictors of adverse obstetric outcomes.

Results: A total of 303 women (mean [standard deviation] age 29.3 [5.4] years) were analyzed, divided almost equally between first-trimester 25(OH)D₃ deficient group (n = 151) and the sufficient group (n = 152), with similar baseline characteristics. Although insufficient 25(OH)D₃ women reached sufficiency during the second and third trimesters, sufficient women maintained significantly higher serum 25(OH)D₃ levels throughout pregnancy (p < 0.001) and had lower rates of preeclampsia (1.3% vs. 10.6%, p < 0.001), gestational diabetes (8.6% vs. 24.5%, p < 0.001), preterm labor (0% vs. 5.3%, p = 0.003), urinary tract infections (4.6% vs. 14.6%, p = 0.003), and bacterial vaginosis (3.9% vs. 13.2%, p = 0.004). Logistic regression confirmed first-trimester 25(OH)D₃ sufficiency as independently protective against adverse outcomes (OR = 0.21, 95% CI: 0.10-0.43, p < 0.001).

Conclusions: First-trimester 25(OH)D₃ sufficiency was associated with reduced risk of obstetric complications, compared with women with insufficiency, even when the last achieved sufficiency in the second and third trimester. These findings highlight the importance of early screening and support the need for personalized supplementation strategies before conception to optimize maternal-fetal outcomes.

Background: The nature and functions of the innermost layer of the myometrium, which is located immediately below the endometrium, coined the "junctional zone" (JZ), continue to be the subject of debate. The role and significance of the JZ have attracted little attention beyond its relation to the diagnosis of adenomyosis.

Objectives: This review was conducted to update our current understanding of the role of the JZ as a specific uterine region.

Methods: This is a comprehensive review of literature that was published in PubMed and MEDLINE platforms till April 2025 and that addresses the uterine JZ, excluding articles concerned with uterine adenomyosis.

Outcome: It is not possible to reconcile JZ appearance on imaging with embryological or functional correlates. There are clear histological and immunohistological differences between the inner and outer myometrium, but the change is gradual with no demarcation of the transition. Whether the JZ has a different origin remains controversial because of the lack of supportive embryological evidence. There is evidence that JZ appearance on MRI is hormonally dependent, but it is not always recognizable and is often indistinct before puberty and after menopause. JZ seems to increase in thickness in the secretory and menstrual phases.

Conclusion: While increased thickness is often considered a sign of adenomyosis, considerable uncertainty remains. We have not been able to identify studies that related features of the JZ per se to clinical outcomes. This supports the need for caution when interpreting the relevance of the JZ.

Background: In the field of polycystic ovary syndrome (PCOS), metformin and myo-inositol are frequently employed to treat the endocrine-metabolic aspects of the condition. Accordingly, myo-inositol is sometimes considered as a nutraceutical alternative for metformin. Both compounds have undergone repurposing efforts to identify new applications; however, the mechanisms of both these compounds differ considerably, as does their potential in conditions outside of PCOS.

Objectives: This paper discusses contrasts both molecules in terms of mechanism, possible adverse effects, and novel indications, with an aim of detangling the unique properties of each molecule.

Methods: A narrative review was conducted independently by the authors using the search platforms PubMed, Google Scholar, and Web of Science between August and November 2024.

Conclusions and outlook: Myo-inositol has a more acceptable safety profile than metformin, which is known to be associated with gastrointestinal adverse effects and, in rare cases, lactic acidosis. Myo-inositol is a naturally present molecule in physiological conditions, which underlines its importance in a variety of biological functions, as opposed to the strict pharmacological action of metformin. Both myo-inositol and metformin have been investigated in several pathological fields, particularly in gynecology where they may improve pregnancy outcomes and fertility care. The safety profile of these molecules seems quite different since data, even if incomplete, sustain high tolerance of myo-inositol, while the safety of metformin use during pregnancy is still controversial. However, further study is required to fully understand the potential of each of these molecules, specifically within the fields of mental health and oncology.

Objective: The aims of this study were to investigate influence of placental position and type on occurrence of placenta accreta spectrum (PAS) and to analyze their correlation with adverse perinatal outcomes.

Methods: This retrospective study included 270 pregnant women who delivered at the Affiliated Hospital of Guangdong Medical University and Huizhou Central People's Hospital between January 2021 and December 2023. Placental position, type, and related imaging features were assessed using magnetic resonance imaging (MRI) and compared with PAS and perinatal outcomes. Logistic regression was used to analyze the associations between placental position, type, and PAS, as well as adverse outcomes.

Results: There were significant differences between the PAS group and the non-PAS group in terms of pregnancy history, cesarean section history, delivery history, history of placenta previa, antepartum hemorrhage, and intraoperative blood loss. Lateral wall/fundus placenta location (OR = 4.984, 95% CI: 1.376-18.050, p = 0.014) and complete placenta previa (OR = 3.160, 95% CI: 1.321-7.558, p = 0.010) were significantly associated with the occurrence of PAS.

Conclusion: Placental location and the type of placenta previa were significantly associated with the occurrence of PAS and adverse perinatal outcomes. In future clinical management, particular attention should be paid to placental location and type, especially in cases of lateral wall/fundus placenta and severe placenta previa. Individualized monitoring and intervention strategies should be implemented to improve both PAS-related and overall perinatal outcomes.