Gynecologic and Obstetric Investigation最新文献

Objectives: Retained products of conception (RPOC) can occur after delivery, abortion, or uterine evacuation, presenting diagnostic challenges. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound (TVS) endometrial thickness measurements for identifying RPOC and propose tailored hysteroscopic management strategies.

Design: This is a retrospective cohort study.

Participants and setting: A total of 226 women with suspected RPOC underwent hysteroscopy between 2018 and 2021 at the Galilee Medical Center.

Methods: Endometrial thickness was measured by TVS, and diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated.

Results: The mean endometrial thickness was 1.6 cm (0.7-6 cm). The overall PPV for RPOC was 79.2%, with a false-positive rate of 20.7%. A cut-off of 1.49 cm yielded a sensitivity of 69.8%, specificity of 59.6%, PPV of 86.8%, and NPV of 34.1%. Women with thickness >1.49 cm had a threefold increased likelihood of RPOC. Stratifying by endometrial thickness showed PPVs of 54.5% (<10 mm), 76.5% (10-20 mm), and 98.0% (>20 mm).

Limitations: Retrospective design may introduce selection bias, and findings require validation in larger, prospective studies.

Conclusions: An endometrial thickness above 1.49 cm significantly increases the likelihood of RPOC confirmation. RPOC can occur in asymptomatic women with associated risk factors. TVS endometrial thickness measurements are effective for diagnosing and managing these cases, and stratification further enhances diagnostic accuracy.

Objectives: This research aimed to unveil the value of human epididymal protein 4 (HE4), carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) in the early diagnosis of cervical cancer.

Design: This was a clinical study.

Participants: Sixty patients with cervical cancer stage IA-IIA (early stage cervical cancer group), 60 patients with cervical intraepithelial neoplasia (CIN) (disease control group), and 60 healthy women who had passed the physical examination (healthy control group) were selected.

Setting: The review was conducted in a Jiaxing First Hospital.

Methods: Sixty patients with cervical cancer stage IA-IIA (early stage cervical cancer group), 60 patients with CIN (disease control group), and 60 healthy women who had passed the physical examination (healthy control group) were selected. The expression levels of serum HE4, CEA, and AFP in the three groups were detected, and the correlation between the levels of serum HE4, CEA, and AFP and the clinicopathological characteristics of patients with early stage cervical cancer were analyzed, and the receiver operating characteristic (ROC) curves were plotted to identify the value of the single and triple tests of serum HE4, CEA, and AFP for the early stage diagnosis of cervical cancer.

Results: The levels of serum HE4, CEA, and AFP in the early stage cervical cancer group were higher than those in the disease control and the healthy control groups (p < 0.05). The levels of serum HE4, CEA, and AFP were related to the FIGO stage as well as the histological grading of patients with early stage cervical cancer (p < 0.05). The results of the ROC curves revealed that the AUC areas of HE4, CEA, and AFP for single as well as triple diagnosis of patients with early stage cervical cancer were 0.725, 0.679, 0.663, and 0.811, respectively, and the AUC of the three combined tests was markedly higher than that of HE4, CEA, AFP single test (p < 0.05).

Limitations: There is a lack of larger sample sizes to test whether the combined HE4, CEA, and AFP detection has sufficient validity at the individual level and there are not enough serum samples in this study to perform circulating HPV-DNA detection and compare it with the levels of serum markers.

Conclusion: The combination of HE4, CEA, and AFP has good clinical reference value analysis in the auxiliary diagnosis of early stage cervical cancer, and it is worthy of further validation and popularization.

Introduction: Bacterial vaginosis (BV) is a risk factor for preterm delivery. Yet, previous studies have found BV treatment ineffective in preventing preterm delivery in unselected population. This study aimed to evaluate the effectiveness of BV screening and treatment in reducing the rate of preterm deliveries before 37 weeks in high-risk women.

Materials and methods: Embase, PubMed, Ovid-Medline, and Web of Science were searched. Randomized controlled trials that evaluated antibiotic treatment for BV versus no treatment/placebo were included. The primary outcome was the rate of preterm delivery and/or late miscarriages in pregnant women with a history of preterm delivery. The pooled relative risks (with 95% CI) were estimated. The Cochrane's Q test of heterogeneity, and I2 were used to assess heterogeneity. In total, 4,701 papers were retrieved of which seven met inclusion criteria and were analyzed.

Results: Among the participating women, 738 were at high risk for preterm delivery and included in the analysis. Among them, 397 and 341 women received active or placebo treatment, respectively. The included studies had a low risk of bias. In six out of seven studies, the risk factor for preterm delivery was a previous preterm delivery. One study (N = 16) was excluded from the analysis since no group had preterm deliveries. Treatment for BV in high-risk women reduced the rate of preterm deliveries (pooled relative risk with 95% CI, 0.65 [0.44-0.98]). The protective effect of BV treatment was statistically significant in women treated with clindamycin, and when treatment was started after 20 gestational weeks.

Conclusion: Screening for and treatment of BV may be effective in preventing preterm delivery in high-risk pregnant women. Randomized clinical trials are needed to confirm the findings of this study.

Background: Endometriosis-related infertility and its treatment with assisted reproductive technologies (ART) have been broadly researched. Yet, underlying mechanisms of infertility, particularly in the absence of tubal dysfunction, remain unclear. While the impact of inflammatory milieu on the ovary and/or endometrium has been indicated as a contributing factor, recent evidence from euploid transfers and donor cycles questions the extent of these effects. Moreover, the frequent coexistence of other confounders, such as adenomyosis, further complicates the clinical picture, making it difficult to isolate the specific impact of endometriosis on ART outcomes.

Objectives: The aim of the study was to evaluate the influence of endometriosis on various aspects of ART, including oocyte competence, ART success, and whether surgical or medical treatments improve these.

Methods: We primarily focused on recent high-quality sources, including systematic reviews, large-scale observational studies, and meta-analyses, to provide a robust and reliable synthesis of the available evidence.

Outcome: While oocyte yield can decrease in the presence of an endometrioma or history of endometrioma excision, oocyte quality, early embryo development indicators, aneuploidy rates, and clinical outcomes of endometriosis patients do not differ from other infertility diagnoses in ART setting. Surgical treatments and hormonal suppression before ART do not seem to improve outcomes. Ovarian stimulation for ART does not exacerbate endometriosis symptoms.

Conclusions and outlook: Endometriosis, despite its high prevalence among infertile patients, does not inherently impair ART success, except in cases where ovarian reserve is compromised due to ovarian disease or its surgical treatment. The causal link between endometriosis and infertility remains an enigma, and future studies should continue to explore this association with other confounding factors.

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder in women. At present, the pathogenesis has not been clarified, and the clinical application of drugs and lifestyle intervention may not prevent disease progression. This study aimed to investigate how circ_0043314 regulates ovarian granulosa cell biological functions to provide a theoretical basis for the treatment of patients with PCOS. MicroRNA (miR)-146b-3p/Apelin 13 axis was used to investigate the mechanism by which circ_0043314 regulated ovarian granulosa cell proliferation and apoptosis in PCOS via miR-146b-3p/Apelin 13 axis. Participants/Materials, Methods: Ovarian tissues (cortical tissues) from 35 PCOS patients and 35 normal controls, as well as HEK293T and human ovarian granulosa cell line (KGN, COV434), were included in this study. We examined the expression levels of circ_0043314, miR-146b-3p, and Apelin 13 in PCOS tissues. Ovarian granulosa cells were transfected with corresponding plasmids to clarify the influence of circ_0043314, miR-146b-3p, or Apelin 13 on proliferation and apoptosis of ovarian granulosa cells through MTT and flow cytometry assays. Moreover, the relationships among circ_0043314, miR-146b-3p, and Apelin 13 were analyzed through dual-luciferase and RNA immunoprecipitation assays.

Results: Circ_0043314 and Apelin 13 were highly expressed and miR-146b-3p was lowly expressed in ovarian tissues of PCOS compared with non-PCOS controls. Downregulation of circ_0043314 or upregulation of miR-146b-3p hindered ovarian granulosa cell proliferation and advanced its apoptosis. Downregulation of miR-146b-3p reversed the impacts of downregulation of circ_0043314, and overexpression of Apelin 13 counteracted the influences of upregulation of miR-146b-3p in ovarian granulosa cells. Mechanically, circ_0043314 could bind to miR-146b-3p, and miR-146b-3p directly targeted and modulated Apelin 13 expression.

Limitations: This study was limited by the lack of animal experiments.

Conclusion: Our data demonstrated that circ_0043314 enhances ovarian granulosa cell proliferation and suppresses its apoptosis via miR-146b-3p/Apelin 13 axis.

Objectives: The objective of the study was to conduct a cost-minimization analysis of laparoscopic sacrocolpo(recto)pexy (LSCP) using either synthetic glue or sutures alone for mesh fixation.

Design: A cost-minimization study comparing two single-center consecutive cohorts (n = 20 each), evaluating differences in consumables and operating room costs for LSCP, performed either with sutures alone or synthetic glue for mesh fixation (January 2021 to December 2021).

Participants: All patients underwent LSCP using the same standardized technique performed by one of two gynecologic surgeons experienced in LSCP (≥50 procedures per year), both proficient in using sutures or glue for LSCP, to minimize any learning curve bias.

Methods: Consumables costs associated with mesh fixation were prospectively recorded. Additional patient data were extracted from the electronic medical record. Statistical analysis was performed using GraphPad Prism. The chi-square test or t test were applied as appropriate, with a significance level set at p < 0.05.

Results: In the sutures-only group, consumables costs were EUR 194.54 ± 38.76, compared to EUR 298.16 ± 31.59 in the glue group (p < 0.0001; 95% CI [81.80, 125.4]). The mean procedure time was significantly shorter in the glue group (34.6 ± 6.2 min vs. 51.3 ± 12.7 min; p < 0.0001; 95% CI [-23.19, -10.21]), reducing operating room maintenance costs by 32% (EUR 477.22 ± 85.63 vs. EUR 707.22 ± 175.14). Based on the consumables and operating room maintenance costs (EUR 826.35 per hour) and time usage, the sutures-only method cost EUR 901.76 ± 171.97 compared to EUR 775.37 ± 86.62 for the glue group. In our setting, this translates to a cost saving of EUR 126.39 per patient (-14%) when using glue (p < 0.0001; 95% CI [-214.6, -38.19]).

Limitations: The numbers above are specific to our setting. Our findings are also specific to laparoscopic approaches and cannot be directly applied to robotic sacrocolpopexy as suturing times and operating room maintenance costs would differ significantly.

Conclusions: Using synthetic glue for mesh fixation increases consumables costs but reduces procedure time, resulting in overall cost savings that favor glue-based mesh fixation. These findings align with previous studies demonstrating reduced operation times with the use of glue. Our study is the first to formally assess and compare the costs of both techniques. We believe the overall cost saving is widely generalizable. To calculate the local impact, one can use the proportional differences reported here and substitute local consumables and operating room costs.

Introduction: This study evaluated the efficacy and safety of early amniotomy, performed before the active phase of labor, versus late amniotomy, conducted during the active phase.

Methods: Six data sources were screened until April 2024 for relevant randomized controlled trials (RCTs). Outcomes were pooled using risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) in fixed or random-effects models.

Results: Sixteen RCTs involving 3,378 patients were included. Four RCTs had a low risk of bias, and 12 had some concerns. There was no significant difference in cesarean section rates (RR = 1.00, 95% CI [0.79, 1.27], p = 0.99) or normal vaginal delivery (RR = 1.01, 95% CI [0.93, 1.10], p = 0.81) between early and late amniotomy. However, early amniotomy reduced time-to-delivery by 2.42 h (95% CI: -3.06, -1.54, p < 0.0001) but increased the risk of chorioamnionitis (RR = 1.46, 95% CI [1.06, 2.01], p = 0.02). There was no difference in other maternal or neonatal outcomes, including endometritis, maternal fever, postpartum hemorrhage, cord prolapse, uterine hyperstimulation, APGAR score, neonatal sepsis, neonatal intensive care unit admission, or meconium-stained amniotic fluid.

Conclusion: Early amniotomy significantly reduced time-to-delivery without increasing cesarean section rates but was associated with a higher risk of chorioamnionitis. Further research is needed to determine the optimal induction of labor protocol.

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.

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.