International Journal of Women's Health最新文献

Gynecological cancers pose great health threats to women, in which ovarian cancer (OC), cervical cancer (CC) and endometrial cancer (EC) are most common. Conventional treatment modalities for gynecological cancers, such as surgery, chemotherapy and radiotherapy, are usually affected by multiple factors like drug resistance and recurrence. Organoids, a three-dimensional culture system derived from stem cells, have been demonstrated to recapitulate the biological structure and function of human organs and gradually used in the treatment of various cancer types, including gynecological cancers. The organoids established from gynecological cancers have patient tumor-dependent morphology and disease characteristics while retaining the tumor's marker expression and genomic profiling, and present heterogeneous inter- and intra-patient drug responses, offering novel insights into drug response of the individual patients. This review provides an overview of recent advancements in the development and application of organoids from gynecological cancers, promoting the understanding of the mechanism underlying tumorigenesis, drug screening prediction and personalized treatment application in gynecological cancers.

Purpose: This study aims to evaluate the feasibility of using immune checkpoint-related gene polymorphisms and serum levels of PD-1, PD-L1 and CTLA4 in predicting chemotherapy resistance in patients with cervical cancer.

Methods: Seven candidate SNPs in PDCD1, CD274 and CTLA4 were genotyped in 1032 cervical cancer patients (537 non-responders and 495 responders based on their responses to chemotherapy), and the serum level of PD-1, PD-L1 and CTLA4 was detected by ELISA.

Results: The frequencies of minor allele A of PDCD1- rs2227982, CD274-rs2890658 and CTLA4-rs3087243 were significantly higher in non-responders than that in responders (p ≤ 0.0001). Moreover, the genotype AA of the three SNPs was associated with a 2.24, 3.78 and 2.71-fold increase in susceptibility to platinum resistance, respectively (p ≤ 0.0001). In addition, all of the three SNPs were associated with the risk of cisplatin resistance in both patients with squamous cell carcinoma and adenocarcinoma under different genetic models (p <0.05). The serum concentrations of PD-L1 and CTLA4 in the non-responder group were significantly higher than those in the responder group (p < 0.0001). Moreover, the PD-L1 and CTLA4 levels of carriers with mutant genotypes of CD274-rs2890658 and CTLA4-rs3087243 were significantly higher than those of with wild-type, and the serum levels of homozygous mutant carriers were even higher (p < 0.0001).

Conclusion: The PDCD1- rs2227982, CD274-rs2890658 and CTLA4- rs3087243 polymorphisms and high serum levels of PD-L1 and CTLA4 may predict chemotherapy resistance in cervical cancer patients.

Human papillomavirus (HPV) is a leading cause of cervical cancer among women worldwide. Although HPV vaccination is proven to be safe and effective, global coverage remains suboptimal, with substantial disparities between high-income and lower-middle-income countries. Recent evidence indicates that HPV vaccine uptake in upper-middle-income countries is considerably higher than in lower-middle-income countries, reflecting persistent inequities in vaccine access. Pharmacists, as accessible and trusted healthcare professionals, have been increasingly recognized for their potential roles in supporting HPV vaccination through education, counseling, and vaccine administration. This scoping review, conducted in accordance with the PRISMA-ScR framework, aimed to explore how pharmacists influence HPV vaccine uptake among women by identifying their roles, assessing their impact on vaccination-related outcomes, and examining implementation challenges. A comprehensive search of PubMed and Scopus databases was performed. A total of 24 studies were included in this review. The majority of studies originated from high-income countries, particularly the United States, where pharmacists are authorized to provide immunization services. Nine studies reported pharmacist-led interventions such as public education, individualized counseling on the importance of vaccination for parents/caregivers, outreach messaging, and vaccine administration, which demonstrated improvements in awareness, vaccination intent, and HPV uptake. The remaining studies assessed pharmacists' knowledge, attitudes, readiness, and perceived barriers related to the provision of immunization services, including limited training, unclear legal authority, and workload constraints. Overall, this review underscores the important contribution of pharmacists in HPV vaccination delivery. When adequately supported by education, infrastructure, and policy, pharmacists can serve as key partners in expanding equitable access to HPV vaccination and advancing cervical cancer prevention.

Aim: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with high incidence. It has been reported that patients with PCOS are at great risk of developing endometrial cancer (EC). Our study was aimed to analyze the shared gene signatures and biological mechanism between PCOS and EC.

Methods: The datasets of PCOS and EC were downloaded from Gene Expression Omnibus (GEO) database, weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI) network, functional enrichment analysis, miRNA and transcription factor prediction were applied to select key genes and pathways. In addition, Mendelian randomization (MR) was performed to analyze the association of PCOS with EC.

Results: Through WGCNA and PPI network, 8 key genes namely, IL-10, CXCL8, IFNG, MMP9, PECAM1, CYBB, MYD88 and IRF4 were identified. Function enrichment analysis indicated that type I interferon signaling pathway was the most important common pathways for PCOS and EC. Furthermore, a causal effect was found between EC and PCOS (Inverse variance weighted, p < 0.05) after bidirectional MR analysis.

Conclusion: This study, for the first time, systematically investigated the potential association between PCOS and EC through an integrative approach combining bioinformatics analysis and MR analysis. Type I interferon signaling pathway played key regulatory effect in PCOS and EC. Eight genes, such as MMP9, PECAM1 and CYBB, may be key markers linking PCOS and EC.

Objective: The purpose of this study was to explore theoretical models and frameworks used to guide research studies that explain factors influencing participation in breast cancer screening (BCS).

Methods: This study was conducted according to the framework developed by Arksey and O'Malley and reported in line with the PRISMA-ScR guidelines. A comprehensive search was performed across six databases: PubMed, Embase, CNKI, Scopus, EBSCO, and the Cochrane Library. Two researchers independently screened titles and abstracts. Data extraction and cross-checking were conducted on included studies, with a third researcher facilitating consensus in cases of disagreement. Extracted information included author, publication year, country, research methods, sample size, age, theoretical framework, and outcomes. A pre-designed form ensured consistency and accuracy in data extraction.

Results: A total of 70 studies were included. The studies were primarily cross-sectional (66/70, 94.29%), with the largest geographical locations being the United States (16/70, 22.86%), Iran (15/70, 21.43%), and China (9/70, 12.86%). The review identified 13 models, with Health Belief Model being the most commonly used (21/70, 30.0%), followed by Andersen's Behavioral Model (11/70, 15.71%) and Theory of Planned Behavior (8/70, 11.43%). The Health Belief Model emerged as the most empirically supported framework across all studies, particularly effective in identifying economic barriers and trust issues within healthcare systems among low-income and low-health literacy populations. This model has also been incorporated into more comprehensive frameworks, demonstrating strong predictive power and practical applicability with additional variables. All models offer distinct strengths, but their predictive power largely depends on research contexts and target populations. These variations may result in an incomplete or unreliable understanding of factors influencing BCS behavior.

Conclusion: The findings provide a comprehensive summary of the models and frameworks employed to investigate factors influencing BCS over the past decade. These insights have significant implications for designing targeted healthcare interventions and informing policy changes to enhance global BCS participation and reduce disparities. Future refinements of these models are expected to improve their applicability and effectiveness across diverse populations and settings.

Purpose: MicroRNAs can epigenetically regulate numerous cancer-related genes and are recognized as key players in cancer biology. To explore the intrinsic mechanisms by which miR-6844 regulates the functions of BC cells and assess its potential as a prognostic biomarker for BC clinical outcomes.

Methods: A total of 130 BC patients were enrolled as the research subjects. Real-time fluorescence quantitative PCR was used to detect miR-6844 levels in cancer tissues and adjacent non-cancerous tissues. Kaplan-Meier survival curve was employed to analyze the 5-year survival status of BC patients. Multivariate Cox regression analysis was conducted to identify the influencing factors for mortality in BC patients. CCK-8 and Transwell assays were utilized to measure the proliferation, migration, and invasion of MCF-7 and MDA-MB-231 cells.

Results: miR-6844 is markedly upregulated in BC tissues and cell lines. The expression of miR-6844 is closely correlated with the TNM stage and lymph node metastasis in BC patients. Elevated levels of miR-6844 are correlated with diminished overall survival rates. Functional investigations reveal that miR-6844 enhances BC cell proliferation, migration, and invasion while exerting a negative regulatory effect on the expression of the Methylthioadenosine phosphorylase (MTAP). Conversely, silencing miR-6844 markedly inhibits the progression of BC cells, an effect that can be counteracted by concurrent inhibition of MTAP expression.

Conclusion: miR-6844 exhibits elevated expression levels in BC and is correlated with adverse prognostic outcomes. This microRNA promotes BC progression by targeting and negatively regulating MTAP.

Background: The atypical hemolytic uremic syndrome (aHUS) presents diagnostic and therapeutic challenges due to overlapping features with other conditions like Preeclampsia/HELLP syndrome and thrombotic thrombocytopenic purpura (TTP). Pregnancy-associated aHUS is rare but carries a high risk of end-stage renal disease without prompt intervention.

Case presentation: A 41-year-old female developed severe abdominal pain, acute kidney injury, and microangiopathic hemolysis following a surgical abortion five days ago. Laboratory findings revealed thrombocytopenia, schistocytes, elevated lactate dehydrogenase, and creatinine. Fragmented red blood cells were observed in the peripheral blood smear. Infection and complement dysregulation were suspected triggers. Despite normal complement levels, aHUS was diagnosed. Continuous renal replacement therapy stabilized renal function, but eculizumab was declined due to cost constraints.

Discussion: This case highlights aHUS triggered by early miscarriage and postoperative infection, supporting the "multiple-hit" hypothesis. Diagnostic challenges include distinguishing aHUS from other TMAs, particularly with normal complement levels. Early plasmapheresis and eculizumab are recommended, though economic barriers may limit treatment options. Therapeutic plasma exchange demonstrated efficacy in renal recovery despite the absence of targeted therapy.

Conclusion: This report expands the clinical spectrum of aHUS to include early pregnancy loss as a potential trigger. It underscores the importance of rapid diagnosis, multidisciplinary management, and the need for accessible therapies in resource-limited settings. Further research is needed to optimize diagnostic criteria and treatment protocols for abortion-associated aHUS.

Purpose: The association between reproductive lifespan and all-cause and cardiovascular mortality in women aged ≥65 years remains unclear. We examined this association in a nationally representative sample of older US women using NHANES data.

Patients and methods: The study included postmenopausal women aged 65 years and older from the NHANES database as our study cohort. Throughout the analyses, NHANES sampling weights were applied to account for the complex survey design, and multiple imputation were used to deal with missing values. Multivariable Cox regression, restricted cubic splines, Kaplan-Meier survival curves, and subgroup analyses were used to estimate the associations between reproductive lifespan and both all-cause and cardiovascular mortality. Additionally, sensitivity analyses were performed to verify the robustness of the results.

Results: Among 4514 participants followed for a median of 101 months, all-cause mortality occurred in 1843 (38.67%) and cardiovascular mortality in 512 (10.74%). A linear relationship was observed between reproductive lifespan and all-cause mortality; in the fully adjusted model, for each additional year of reproductive lifespan, the risk of all-cause mortality decreased by 1% (HR = 0.99, 95% CI 0.98-0.99, p < 0.001). Conversely, the relationship between reproductive lifespan and cardiovascular mortality followed an L-shaped curve. Further threshold-effect analysis identified an inflection point at 36 years: for reproductive lifespan < 36 years, each additional year conferred a 2% reduction in cardiovascular mortality risk (HR = 0.98, 95% CI 0.95-1.00, p = 0.033), whereas the protective effect plateaued when reproductive lifespan ≥ 36 years.

Conclusion: Short reproductive lifespan may be associated with an increased risk of all-cause and cardiovascular mortality. Greater attention should be given to women with a short reproductive lifespan.

Purpose: Preoperative diagnosis of uterine leiomyosarcoma (ULMS) can be difficult due to its ability to mimic benign leiomyomas (LM). The current study aimed to investigate the influence of preoperative clinical characteristics and hematologic parameters on preoperative diagnosis and to design a scoring system.

Patients and methods: We conducted a retrospective analysis of 288 patients with uterine tumors treated at the First Affiliated Hospital of Wenzhou Medical University between January 2006 and April 2022, including 64 with ULMS and 224 with LM. Preoperative clinical and laboratory variables were compared between groups. Logistic regression analysis was employed to identify predictors of ULMS, with receiver operating characteristic (ROC) curves used to evaluate diagnostic performance.

Results: Multivariate analysis identified four independent risk factors for ULMS: older age (>48 years), larger tumor size (>9.7 cm), elevated systemic immune-inflammation index (SII > 500), and higher controlling nutritional status score (CONUT ≥ 3) (all P<0.001). A preoperative scoring system was developed by assigning one point for each risk factor, yielding a total possible score of 0-4 points. A score ≥ 2 points demonstrated significant utility in differentiating ULMS from LM (AUC = 0.823, sensitivity 64.1%, specificity 85.3%).

Conclusion: This single-center retrospective study demonstrates that the integration of age, tumor size, SII, and CONUT score shows promising utility for preoperative differentiation between ULMS and LM. The constructed scoring system may provide valuable auxiliary support for identifying occult ULMS preoperatively. However, given the study's limitations, including its retrospective design and sample size, external validation through large-scale, multicenter prospective studies is necessary before clinical implementation.

Background: Pelvic organ prolapse (POP) is a global problem that severely affects a woman's quality of life. This study aimed to investigate the association between weight change during pregnancy and post-pregnancy POP.

Methods: This study retrospectively enrolled 640 participants from Tianjin Central Hospital of Gynecology Obstetrics (institution 1, n = 363 cases) in northern China and First People's Hospital of Wanzhou District, Chongqing (institution 2, n = 277 cases) in southwestern China. The participants were grouped into POP-Q I-II (n = 288), POP-Q III-IV (n = 132), and non-POP groups (control group, n = 220). Pre-pregnancy body mass index (BMI), weight gain during pregnancy, and weight retention at 6 months postpartum were compared among the three groups after eliminating confounding factors.

Results: No statistically significant differences were detected in the pre-pregnancy BMI in the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared to the control group (P > 0.05). Significant statistical differences (P < 0.05) were observed in weight gain during pregnancy (≥14 kg) in the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared with the control group. Significant statistical differences (P < 0.05) were observed in weight retention (≥5 kg) at 6 months postpartum among the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared to the control group.

Conclusion: Weight change during the perinatal period is the risk factor of postpartum POP. Specifically, a pre-pregnancy BMI < 23 kg/m² did not increase the risk of POP, whereas gestational weight gain ≥14 kg and weight retention ≥5 kg at 6 months postpartum significantly increased the risk of postpartum POP. Weight management programs during and after pregnancy may help reduce the risk of POP.