Gynecologic and Obstetric Investigation最新文献

Background: Stress urinary incontinence (SUI) commonly affects women's quality of life. The widespread recommendation of using non-absorbable meshes has delayed a more definitive surgical solution. Newer, less invasive biomaterial treatments show promise.

Objective: Our aim was to describe and evaluate a new urethral suspension technique called "shore-up," performed with APTOS® resorbable tensor threads on an outpatient procedure.

Design: A pilot study was conducted.

Participants: 32 SUI women, unresponsive to conservative treatment, participated in the study.

Settings: The study was conducted at the HM IMI Clinic, Toledo, Spain.

Method: Patients completed validated incontinence questionnaires (Sandvik and ISCQ SF) before and at 1, 2, 6, and 12 months post-procedure. A blinded analysis of results was conducted.

Results: Women with SUI of different degrees: mild (3/32), moderate (19/32), severe (8/32), and very severe (2/32) showed a significant improvement (p < 0.05) in scores on both tests. After 12 months, a success rate of 72% (23/32) without SUI was observed, 16% with mild (5/32) and 12% with moderate SUI (4/32). None of them required hospitalization or post-surgical assistance, and the most frequent complications were extrusion of the final thread end through the vagina in 33% (9/32), transient dyspareunia in 6% (4/31), and early suture dehiscence in 6% (2/32).

Conclusion: The shore-up technique is a promising, minimally invasive option for managing SUI, offering high efficacy, safety, and patient satisfaction.

Limitations: This is a small study, and further research is recommended to confirm these findings (ethic code 23.02.2155-GHM).

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.

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.

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.

Objectives: Several studies explored the role of maternal systemic inflammation indices during pregnancy. Different conditions, such as gestational hypertension, preeclampsia, and gestational diabetes, are associated with abnormal systemic inflammation indices. However, there is a lack of research on the impact of systemic inflammation indices on fetal growth in physiological pregnancies. The objective of this study was to explore the potential associations between birth weight, length, and head circumference with a group of systemic inflammatory indices, namely, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), the mean platelet volume-to-lymphocyte ratio (MPVLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).

Design: Full-term, physiological pregnancies admitted to a tertiary center from November 2019 until February 2021 were included in a prospective observational study. We excluded pregnancies affected by gestational or pregestational diabetes, chronic hypertension, gestational hypertension, pre-eclampsia/eclampsia, fetal growth restriction, preterm delivery or premature rupture of membranes, multiple pregnancies, and malformed fetuses. Sociodemographic characteristics, clinical data, and complete blood count were recorded.

Materials and methods: Continuous variables were reported as either the means and standard deviation or median and interquartile ranges according to their distribution, as assessed by the Shapiro-Wilk normality test. Categorical variables were reported as percentages. To measure the linear association between continuous variables, the Pearson correlation test was used if variables had a normal distribution. Otherwise, Spearman's rank correlation test was calculated. To obtain an inflammatory latent score, a principal component analysis (PCA) was performed on NLR, PLR, MPVLR, MLR, SII, and SIRI.

Results: Overall, 264 pregnant women came to our observation before the delivery. After the exclusion criteria, 199 pregnant were included. The Spearman's rank correlation test showed a high correlation among the indices. Then, a PCA was performed to a composite indicator of inflammatory score. The first principal component was selected, with a proportion of explained variance equal to 73.11%. The contributions of variables suggested excluding from the score the MLR index. From the linear regression models, results denoted that the inflammatory score negatively affects the birth weight (β = -42.60, 95% CI -76.91, -8.28) and the head circumference (β = -0.14, 95% CI -0.24, -0.04); however, the effect of the score on the birth length is not statistically significant at 5% (β = -0.12, 95% CI -0.27, 0.02).

Limitations: This research's main limitation is the lack of data about the indirect inflammatory markers during the first and

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 the study was to report the first cases of surgical staging for apparently early-stage endometrial cancer performed using the Versius® next-generation robotic surgical system (Cambridge Medical Robots [CMR] Surgical, Cambridge, UK).

Design: The study used a prospective case series. Participants/Materials: Women who underwent surgical staging, including total hysterectomy, bilateral adnexectomy, and sentinel lymph node (SLN) biopsy, for apparently early-stage endometrial cancer using the Versius® next-generation robotic surgical system (CMR Surgical, Cambridge, UK) were included.

Setting: The study was conducted at a Gynecologic Oncology Referral Center.

Methods: We prospectively recorded data of all consecutive women who underwent the investigated surgical procedure.

Results: Fourteen endometrial cancer patients were treated between March and August 2024 at the Azienda Ospedaliera Universitaria Integrata of Verona. The mean age was 69.4 ± 8.7 years, and the average body mass index was 27.2 ± 4.8. SLN biopsy was performed on all patients: 5 patients had unilateral and 9 bilateral successful SLN detection; 6 women underwent systematic pelvic lymphadenectomy in the unmapped areas. The median operative time was 122 (min-max, 77-185) minutes, and the median hysterectomy time was 34 (min-max, 18-68) minutes. None of the surgical procedures required conversion to conventional laparoscopic or open surgery for technical reasons, and no intraoperative complications were recorded. No readmissions, reoperations, or deaths were observed during the follow-up (median 102 days, min-max 39-249).

Limitations: The limitations of the study are the first experience in a limited study population and the use of methylene blue for SLN mapping.

Conclusions: Our preliminary results with the Versius® platform appear encouraging regarding surgical time, blood loss, rate of completion of the robotic procedures, and complications risk. Further studies will confirm the indications, feasibility, and safety of the Versius® surgical robot system for treating apparently early-stage endometrial cancer.