Gynecologic and Obstetric Investigation最新文献

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries.

Design: This was a retrospective cohort study.

Participants/materials, setting, methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery.

Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient's age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004).

Limitations: This is a retrospective study, thus the choice of anesthesia may be biased.

Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.

Background: There is a paucity of studies on the association between polycystic ovary syndrome (PCOS) and endometriosis and the occurrence of venous thromboembolism (VTE).

Objective: Our study aimed to evaluate the association between PCOS, endometriosis, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Methods: This was a retrospective study of prospectively collected data using the Healthcare Cost and Utilization Project databases. We examined the association between PCOS and endometriosis with DVT and PE from a cohort of 12,814,970 female patients, aged 18-49 years, who were hospitalized between 2007 and 2014.

Results: We observed increasing trends, with a relative increase of 140% (from 0.27% to 0.65%) for PCOS, 16% (from 0.43% to 0.50%) for DVT, and 39% (from 0.23% to 0.32%) for PE, whereas we observed a decline by 34% for endometriosis (from 0.85% to 0.56%). The unadjusted analysis showed an association between PCOS and VTE, which remained significant after adjustment for sociodemographic characteristics and comorbidities (OR = 2.16; 95% CI: 2.00-2.33 and OR = 2.44; 95% CI: 2.23-2.67 for DVT and PE, respectively). The association between endometriosis and VTE was age-dependent, with an increased risk of VTE among women 18-24 years whereas this risk was decreased among those 35 years and older.

Conclusion: Our study indicates an association between PCOS and VTE and an age-dependent association between endometriosis and VTE.

Background: Accessory and cavitated uterine masses (ACUM) are rare Mullerian anomalies, defined as an isolated accessory cavitated mass lined with endometrial epithelium.

Objectives: This article explores ACUM lesions from two aspects and integrates a case report of a successful laparoscopic-assisted intervention for ACUM in a 24-year-old woman with refractory dysmenorrhea with a review of current literature on laparoscopic surgical techniques. Unique to this case was the process of undergoing targeted genetic sequencing via the Find ITTM Panel Version 3.4 on the ACUM, looking for mutations in KRAS, PIK3CA, and FGFR2. A process that was inspired by recent reports that indicate that even normal endometrium can harbor cancer-associated mutations.

Methods: A comprehensive search of Ovid MEDLINE and Embase was performed. Studies were selected if they explored laparoscopic surgery's impact on ACUM patients' outcomes related to fertility, menorrhagia, or dysmenorrhea. Risk of bias assessment was performed using the JBI Critical Appraisal Checklist.

Outcome: From 160 articles identified, 25 full-text articles were analyzed with a total of 75 unique patients discussed. Dysmenorrhea was present in 100% of cases (n = 75/75), and laparoscopic resection improved patient symptoms in 84% (n = 63/75) of cases. The mass excised in the case was positive for somatic missense mutations in RET (R813W) and HRAS (G12S) genes, identified at low variant allele frequencies.

Conclusions and outlook: These results demonstrated that laparoscopic surgical approaches are effective and frequently the first surgical approach chosen for the treatment of ACUM, but that techniques to treat these conditions are not standardized. This case is the first to demonstrate mutations in ACUM, suggesting a potential role for cancer-associated somatic mutations in their genesis. Future developments in this area may include sending more of these samples for genetic analysis, improving our understanding of how these lesions are formed, while also working to standardize how they are removed.

Objective: The aim of this study was to explore the mechanism of methyltransferase-like 14 (METTL14) on human endometriotic stromal cell (ESC; HEM15A) proliferation, migration, and invasion to provide novel therapy for endometriosis (EMs).

Design: Normal human endometrial stromal cells (HESCs) and HEM15A cells were selected. Corresponding controlled experiments were performed to analyze whether overexpression of METTL14, N6-methyladenosine (m6A) methylated ZEB1 mRNA, upregulation of ZEB1, and activating the mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) can affect the proliferation, migration, and invasion of HEM15A cells. Materials, Setting, and Methods: HEM15A and HESCs were cultured in vitro. HEM15A cells were treated with oe-METTL14 and oe-zinc finger E-box-binding protein 1 (ZEB1) plasmids, 3-deazaadenosine (3-DAA) and the MEK/ERK pathway inhibitor isoprenaline (ISO). After identifying HEM15A and HESCs, METTL14, ZEB1, p-ERK1/2/ERK1/2, and p-MEK/MEK levels, and cell proliferation, migration, and invasion were assessed. The modification sites of ZEB1 and m6A were predicted using SRAMP database, with an m6A modification level assessed by MeRIP. The binding of YT521-B homology domain 2 (YTHDF2) to ZEB1 messenger RNA (mRNA), and ZEB1 stability and mRNA level were tested.

Results: Compared with HESCs, METTL14 level in HEM15A was significantly reduced. METTL14 overexpression in HEM15A prominently increased its proliferation, migration, and invasion. METTL14 overexpression notably elevated m6A-methylated ZEB1 mRNA level and reduced the stability and expression of ZEB1 mRNA. Further m6A modification inhibition increased ZEB1 mRNA stability and mRNA and protein levels and decreased ZEB1 m6A modification level. ZEB1 upregulation partially reversed METTL14 overexpression-inhibited HEM15A proliferation, migration, and invasion. METTL14 inhibited the MEK/ERK signaling activation by regulating ZEB1, and the MEK/ERK signaling activation partly averted METTL14-suppressed proliferation, migration, and invasion.

Limitations: The effects of METTL14 on other growth aspects of HEM15A cells and the relation between ZEB1 and m6A require further investigation.

Conclusions: METTL14 lowered ZEB1 expression by regulating ZEB1 m6A modification levels, thereby inhibiting the activation of the MEK/ERK pathway and ESC proliferation, migration, and invasion.

Objective: The objective of this randomized controlled trial was to compare the effect of bowel preparation using only oral polyethylene glycol electrolyte (PEG) solution versus oral PEG solution combined with mechanical sodium phosphate (NaP) enema on the surgical field visualization in patients undergoing robot-assisted laparoscopic gynecologic procedures.

Methods: Participants were randomized to either a single oral PEG solution or an oral PEG solution combined by mechanical NaP enema. The intraoperative visualization of the surgical field, the ease of manipulation of the bowels, and overall difficulty level of the surgery were evaluated by the surgeon using a self-administered questionnaire. After the surgery, the patients completed a survey assessing postoperative gastrointestinal discomfort.

Results: A total of 114 women were enrolled and randomized to oral PEG solution-only group (n = 48), and oral PEG plus mechanical NaP enema group (n = 66). Forty-two women in oral PEG-only group and 59 oral PEG plus NaP enema group completed the study. There was no difference in intraoperative visualization or overall difficulty of the operation between the two groups, and bowel manipulation was easier in the oral PEG-only group. Also, there was no difference in operating time between the groups. The patients' level of gastrointestinal discomfort after the surgery was not significantly different between the two groups.

Conclusion: Routine use of mechanical NaP enema before robot-assisted laparoscopic gynecologic surgery is not recommended, because it has no additional benefit regarding intraoperative visualization or the surgical level of difficulty over oral bowel preparation methods.

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: Endometriosis (EM) is a chronic disease severely impacting reproductive health, with its exact cause still unclear. In-depth understanding of the etiology and pathogenesis of EM from the perspective of genetics and exploring individualized treatment strategies can improve the health and quality of life of patients.

Design: This study combined genetic data analysis with experimental validation to provide novel biomarkers and drug targets for the diagnosis and treatment of EM.

Participants/materials, setting, and methods: Whole blood cis-expression quantitative trait loci (eQTL) data were used as exposure data, and data from the FinnGen database EM1-2 and EM3-4 were used as outcomes. Summary-data-based Mendelian randomization (SMR) methods were used to select genes with causal relationship to the disease. These genes were validated through bioinformatics analysis and real-time quantitative polymerase chain reaction (RT-qPCR) analysis of clinical samples, and potential diagnostic and drug targets were screened through colocalization and molecular docking.

Results: Through SMR analysis, seven genes were selected as potential diagnostic markers of EM, namely Eukaryotic Elongation Factor, Selenocysteine-TRNA-Specific (EEFSEC), INO80 complex subunit E (INO80E), RAP1 GTPase-activating protein (RAP1GAP), Lipid Droplet-Associated Hydrolase (LDAH), Ring Finger And SPRY Domain Containing 1 (RSPRY1), HLA Complex Group 22 (Non-Protein Coding) (HCG22), and Adenosine Kinase (ADK). Colocalization analysis showed that EEFSEC, HCG22, INO80E, and RSPRY1 could be used as potential drug targets.

Limitations: SMR is limited by dependence on publicly available summary data, potential confounding biases in genetic variant-phenotype associations, the presence of underlying horizontal pleiotropy, and issues related to insufficient statistical power. Colocalization analysis cannot assess undiscovered genetic variants. The in vitro experiments in this study utilized clinical samples but were validated only at the expression level. The accuracy of molecular docking analysis largely depends on the quality of protein structures and ligands.

Conclusions: The study identifies potential diagnostic markers and drug targets for EM from a genetic perspective, providing new directions for drug development and precision medicine for EM treatment.

Objectives: The objective of this study was to examine the potential of artificial intelligence (AI) in gynecologic oncology decision-making.

Design: A feasibility study was conducted.

Participants: Fictitious case vignettes of patients with gynecologic carcinomas were used.

Setting: The setting was a fictive one.

Methods: Fictitious case vignettes of gynecologic carcinomas were created and evaluated by physicians with varying levels of professional experience, as well as by language models including ChatGPT 4.0, Google Gemini, and Bing Copilot. Treatment approval decisions were based on standardized clinical and laboratory criteria.

Results: Two cases of breast cancer, 1 case of ovarian cancer, 1 case of cervical cancer, and 1 case of endometrial cancer were evaluated. All three language models were able to evaluate all clinical cases and make therapy-relevant suggestions, with ChatGPT providing the most clear and concise recommendations that were in 3 cases totally consistent with physician assessments.

Limitations: This study was limited to a feasibility study based on five fictitious case vignettes.

Conclusions: The study demonstrates that AI models, such as ChatGPT, can to some extent evaluate clinical cases, recognize clinical and/or laboratory abnormalities, and make therapy-related suggestions. Despite high overall agreement, differences were predominantly noted in the more complex cases, rendering human interpretation necessary. The findings underscore the benefits of AI in terms of clarity, time efficiency, and cost-effectiveness. Future research should further explore the application of AI to real patient data and development of hybrid decision models to optimize integration into clinical practice.

Objective: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic ovarian surgery. These recommendations impact many aspects of their lives. The primary objective of this study was to assess the overall quality of life (HRQoL) before and after prophylactic bilateral salpingo-oophorectomy (BSO). Secondary objectives were investigating sexual health (SH) and fatigue severity state.

Design: This was a single-center retrospective observational study.

Setting: Women who underwent surgical treatment of bilateral salpingo-oophorectomy between 2018 and 2024 at "DAI Materno Infantile" of Azienda Ospedaliera Universitaria "Federico II" of Naples were included.

Methods: These patients were tracked down to undergo specific questionnaires, such as "Global Health Status (GHS) and Quality of Life Scale (QOL) (EORTC QLQ-C30)," "EORTC Sexual Health Questionnaire (QLQ-SH22)," and "Fatigue Severity Scale (FSS)," to evaluate their psychological, sexual, and general physical condition impact before the surgery, 3 and 6 months later.

Results: The overall mean QoL score was 88.3 ± 29.8 (mean ± standard deviation), and this score worsened when the surgery was performed at 3 months (p < 0.0001) with a score of 51.7 ± 30.7 and a mean difference (MD) of 36.6 points; instead, at 6 months, the overall mean QoL score was 73.1 ± 24.3 with an MD of 21.4 points. FSS reported a score of 2.7 ± 1.15 vs 4.2 ± 1.59 (p < 0.0001) vs 3.5 ± 1.43 (p < 0.0001), respectively, before and 3-6 months after surgery. EORTC QLQ-SH22 before and after treatment showed statistically significant changes in sexual satisfaction (p < 0.0001).

Conclusion: BSO may impact the quality of life regardless of the hormonal status of patients related to age or menopause, about both the functional evaluation and the psychological and emotional assessment report. The physical change related to the surgical procedure is associated with a mental shift that affects both the physical and sexual energy of our patients in the first 3 months postoperatively, with a slight improvement of these data at 6 months.