International Journal of Women's Health最新文献

Purpose: This study was conducted to analyze the relationship between plasma D-dimer levels and the risk of recurrence after surgical treatment in patients with early-stage cervical cancer (CC).

Methods: In this cohort study, 888 participants with early-stage CC undergoing surgical treatment in Fujian Cancer Hospital between June 2016 and December 2019 were identified. Univariate logistic regression was used to screen confounding factors affecting the recurrence of early CC after surgical treatment. Variables significantly associated with the recurrence of early CC after surgical treatment were confounding factors. Univariate and multivariate logistic regression models were established to explore the association between D-dimer levels and the risk of recurrence of early CC after surgical treatment. ORs and 95% CIs were calculated.

Results: The end of follow-up was when CC recurred or 3 years after surgery. In sum, 80 patients suffered CC recurrence, accounting for 9% of all participants. The risk of recurrence was elevated in CC patients from the elevated group (EG), with an adjusted OR of 2.16 (95% CI 1.28-3.62). The risk of recurrence was increased in the EG in patients with cervical squamous cell carcinoma undergoing surgery in the adjusted model (OR 3.58, 95% CI 1.02-12.89). As for cervical adenocarcinoma patients, the increased risk of recurrence was identified in patients from the EG (OR 1.87, 95% CI 1.01-3.48).

Conclusion: High levels of D-dimer were associated with increased recurrence risk of CC in patients at the early stage of surgical treatment.

Purpose: To evaluate the insulin resistance in patients with menopause who were newly diagnosed with endometrial cancer and its association with disease development.

Methods: The study included 356 patients with menopause who underwent hysteroscopy at Beijing Obstetrics and Gynecology Hospital between September 2013 and July 2018. Data on age, height, weight, menarche and menopausal age, pregnancies, births, and family history of tumors, hypertension, and diabetes were collected. Blood tests provided fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein levels. Pathological testing determined whether patients had endometrial cancer or precancerous lesions. Differences in influencing factors between patients with endometrial cancer or precancerous lesions and those with normal or benign conditions were analyzed using univariate analysis. Quartile grouping of the Metabolic Score for Insulin Resistance (METS-IR) and Triglyceride-Glucose (TyG) index were applied to examine the impact of different insulin resistance on the development of endometrial cancer or precancerous lesions.

Results: Univariate analysis revealed that the proportion of patients with hypertension and diabetes was significantly higher among those with endometrial cancer and precancerous lesions. METS-IR and TyG levels were significantly increased in patients with endometrial cancer and precancerous lesions. The quartile grouping results of METS-IR and TyG suggested that age, BMI, FBG, TG, hypertension, and diabetes prevalence rates increased with an increase in METS-IR or TyG, whereas lipid indicators were negatively correlated and unstable Logistic regression suggested that none of the above influencing factors and METS-IR or TyG were related to the pathological results of the patients.

Conclusion: Patients with endometrial or precancerous lesions showed evidence of insulin resistance compared to others, though this was not directly associated with disease presence. This study provides relevant information for preventing of endometrial cancer in the future. Larger studies are needed to evaluate the role of METS-IR and TyG in endometrial cancer prevention.

Objective: We aimed to explore the abnormal pathology findings in appendix specimens removed based on intraoperative abnormal appearance during elective surgery for benign gynaecological conditions by a minimally invasive gynaecologist, as well as the associated complication rate.

Materials and methods: This retrospective cohort study was conducted in a tertiary referral surgical centre for benign gynaecological conditions between the years 2004-2023. It included patients who underwent appendicectomy by a trained minimally invasive gynaecologist based on observations during surgery for benign gynaecological conditions. Data included demographic, clinical, surgical and pathological information followed by postoperative complication data obtained from electronic medical records and direct communication with surgical colleagues. The primary outcome was the evaluation of the abnormal pathological findings in the appendix. The secondary outcome was the complication rate associated with appendicectomy in these cases.

Results: The study cohort included 34 women who met inclusion criteria and underwent a laparoscopic surgery for endometriosis, chronic pelvic pain or a benign ovarian mass. Indications for appendicectomy included twelve cases (38.2%) with apparent appendiceal immobility (stiffness), fourteen cases (41.2%) with an appendix adherent to ovaries or the pelvic side walls, and seven cases (20.6%) with an abnormal appearance (large, wide, long, coiled, or curved). Pathological findings revealed six cases (17.6%) of acute or chronic appendicitis, four cases (11.8%) of endometriosis, five cases (14.7%) of abnormal pathological conditions, and three cases (8.8%) of cancer (two cases of well-differentiated adenocarcinoma and one case of low-grade appendiceal mucinous cystadenoma). Postoperative complication rate was 5.8% (two cases).

Conclusion: This study supports incorporating appendicectomy by trained gynaecological specialists during gynaecological elective surgery when abnormal findings are encountered. Further research and guidelines in this area can provide even greater clarity and direction for the future of gynaecological surgical practice.

Douglas abscesses (DA) involving the ovaries and/or fallopian tubes and tubo-ovarian abscesses (TOA) constitute a very rare finding in virginal females. Underlying conditions are suspected to play a role in their development; often however, the exact pathomechanism remains hypothetical or unknown. We report the case of a 19-year-old virginal female who was referred to our outpatient clinic for further clarification of a 6-month ongoing secondary amenorrhea. In the course of the investigations, a large Douglas abscess with distinctive bilateral salpingitis was diagnosed as an incidental finding in a basically oligosymptomatic patient. Laparoscopic abscess drainage was performed and appropriate antibiotic therapy administered. Intraoperatively collected specimens revealed Escherichia coli to be the responsible pathogen and detected foreign body giant cell reaction to intestinal contents on histopathological workup. Retrospectively, a small bowel perforation at the level of the jejunojejunostomy after Roux-en-Y gastric bypass with spillage of intestinal contents and positive cultures for Escherichia coli, 6 months prior to her referral, was identified as the triggering event. This case, however unique its pathomechanism may be, demonstrates that a history of intestinal leakage in the context of bowel surgery should be considered a relevant risk factor for the development of DA and TOA in virginal females, even if the primary cause lies several months in the past. It is under these circumstances that the clinical presentation can be atypical and misleading, making it all the more difficult to diagnose. Nonetheless, considering the possibility of this rare condition in light of medical history is crucial.

Background: To construct a risk factor intervention program for perimenopausal patients with coronary heart disease based on the health action process orientation theory, to provide a reference for perimenopausal women to reduce the controllable risk factors of coronary heart disease.

Methods: By reviewing relevant literature, guidelines, and expert consensus, we performed a retrospective analysis of the factors influencing perimenopausal patients with coronary heart disease to engage in risk factor reduction behaviors in the preliminary stage, conducted qualitative interviews on patients' cognition of and motivation for adherence to cardiac rehabilitation, and initially formulated an intervention program for perimenopausal patients with coronary heart disease regarding their risk factors based on the theoretical model of the process of action orientation to health and formed Expert Correspondence Form.

Results: The positive response rate of experts in the 2 rounds of correspondence was 100%, the basis of expert judgment (Ca) was 0.955, the familiarity (Cs) was 0.964, the authority coefficient (Cr) was 0.960, and the Kendall's W coefficients were 0.294 and 0.343, respectively (P<0.05). The final result was a risk factor intervention program for perimenopausal patients consisting of coronary heart disease based on the health action process orientation theory with 3 level 1, 10 level 2, and 42 level 3 entries.

Conclusion: Based on the health action process orientation theory of perimenopausal patients with coronary heart disease risk factor intervention program scientific construction process, the construction of the content around the perimenopausal patients with coronary heart disease characteristics, the development of targeted interventions.

Objective: This study aims to investigate the effects of radiotherapy on ovarian function, endocrine function, and gut microbiota in cervical cancer patients who underwent ovarian transposition, compared to those who did not.

Methods: This study included 100 cervical cancer patients treated from January to June 2024, divided into a control group (50 cases, radical surgery and radiotherapy) and an observation group (50 cases, ovarian transposition surgery plus radiotherapy). Radiotherapy protocols included conventional, intensity-modulated, or conformal radiotherapy, with 6MVX rays delivering 100-200 cGy per session, 5 sessions per week for 6 weeks. In the observation group, the ovarian region was shielded with a lead plate. Outcomes measured included ovarian and endocrine function, quality of life, adverse reactions, and gut microbiota composition. DNA was extracted from fecal samples for 16S rRNA sequencing and bioinformatics analysis, including α- and β-diversity, taxonomic composition, and LEfSe analysis.

Results: Before radiotherapy, no significant differences in serum sex hormone levels were observed between the groups. After radiotherapy, the control group showed greater increases in FSH and LH and a more pronounced decrease in estradiol (E2) levels. Ovarian function preservation was significantly higher in the observation group (28.00% vs 0.00%). The observation group also had a higher Kupperman score 6 months post-surgery (28.01±10.22 vs 21.91±7.38). Adverse reaction rates were comparable. Gut microbiota analysis revealed differences in taxonomic composition, with higher Firmicutes (66.5% vs 65.56%) and Faecalibacterium (7.0% vs 2.7%) in the observation group, while Proteobacteria (4.1% vs 13.9%) and Shigella (2.7% vs 8.5%) were more abundant in the control group. LEfSe analysis identified notable species differences, including higher Peptoniphilus and Actinomyces in the observation group.

Conclusion: Ovarian transposition surgery effectively preserves ovarian function in cervical cancer patients. Changes in gut microbiota during radiotherapy may influence endocrine outcomes, warranting further research.

Purpose: This study aims to examine the risk factors for catheter-associated urinary tract infection (CAUTI) following radical hysterectomy for cervical cancer (CC). Furthermore, the study seeks to develop a visual model that can effectively assist physicians in improving their proficiency in diagnosing, treating, and preventing CAUTIs.

Patients and methods: 48 subjects who developed CAUTI postoperatively were assigned to the infection group. There were 443 cases who did not develop CAUTI, and a 1:1 propensity score matching (PSM) method was employed to match 48 cases for the non-infection group. Univariate logistic and multivariate stepwise regression analyses were used to analyze the risk factors for CAUTI following radical hysterectomy for CC. Subsequently, a nomogram-based model was developed, and its effectiveness was comprehensively assessed.

Results: The incidence rate of CAUTI in 491 patients who underwent radical hysterectomy for CC was 9.76% (48/491). Multivariate stepwise regression analysis revealed that the duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture were the independent risk factors for CAUTI after radical hysterectomy for CC (all β > 0, P < 0.05). A nomogram model incorporating these independent risk factors was constructed, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were generated. The ROC curve exhibited an area under the curve value of 0.9035, 95% CI of 0.8352-0.9718, specificity of 0.8214, sensitivity of 0.8571, accuracy of 0.8429, positive predictive value of 0.8780, and negative predictive value of 0.7931.

Conclusion: The duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture are independent risk factors for CAUTI after radical hysterectomy for CC. This nomogram-based model exhibits numerous advantages, including simplicity, user-friendliness, high diagnostic accuracy, and significant clinical value, which can provide assistance in early clinical diagnosis decision-making.

Introduction: Overactive bladder is a major public health concern that negatively impacts a patient's quality of life, and it is highly prevalent in menopausal women. Acupuncture has been suggested as a viable therapeutic approach. This study aimed to explore the effectiveness of thread-embedding acupuncture in postmenopausal women with overactive bladder.

Methods: This was a single-centre, single-arm, open-label study conducted on 20 postmenopausal women with overactive bladder. Participants received thread-embedding acupuncture treatment once a week for 8 weeks. Patients were evaluated using a bladder diary, overactive bladder symptom score (OABSS), and King's Health Questionnaire (KHQ) at three time points: baseline, end of treatment (week 8), and 4 weeks after treatment completion (week 12).

Results: Nineteen participants completed the study. Average daily micturition frequency decreased significantly after thread-embedding acupuncture treatment (week 8: -2.55 ± 0.37, P=0.001, week 12: -2.69 ± 0.37, P=0.001). Daytime and nighttime micturition frequency and OABSS significantly decreased at week 8 and 12. However, no significant differences were observed in urgency, incontinence, or KHQ. No serious adverse events were reported.

Conclusion: Considering that thread-embedding acupuncture was shown to improve daily quality of life by reducing daytime and nighttime episodes, this pilot study suggests that thread-embedding acupuncture is a feasible alternative for treating overactive bladder.

Purpose: To characterize the burden of uterine fibroids (UF) in individuals experiencing heavy menstrual bleeding (HMB) and moderate-to-severe UF-associated pain in terms of symptoms experienced, impact on work and activities, and pain medication use both on menstrual and non-menstrual days.

Patients and methods: This prospective, real-world, observational study enrolled 350 participants in the USA with a self-reported UF diagnosis, HMB, and moderate-to-severe pain due to UF. Data collection took place from February 9 to July 19, 2021. Over 4 months, participants used an online platform to self-report daily menstrual status, bleeding intensity, UF-associated pain severity, and pain medication use, and to complete weekly work and productivity questionnaires. Results were analyzed descriptively and are reported for the overall population, by pain medication subgroups-defined based on the most potent medication taken-and menstrual versus non-menstrual days/weeks.

Results: The analysis population consisted of 307 participants with ≤5 consecutive missing days of daily survey responses or ≥75% completion rate of the daily surveys. Mean age of participants (standard deviation; SD) was 37.2 (6.3) years. At baseline, 54.1% of participants reported not currently taking medication for treatment of HMB. Over the study period, mean UF-associated pain scores (SD; scale range 0-10) were higher on menstrual days (3.5 [2.7]) than non-menstrual days (1.0 [1.8]), and this was consistent across medication use subgroups. Pain medications were used more frequently on menstrual days than non-menstrual days (22.9% versus 3.7% days of pain medication use, respectively). Participants reported 31.5% work impairment on menstrual weeks versus a 12.7% work impairment on non-menstrual weeks.

Conclusion: In this study, UF-associated pain symptoms coincided with a reduction in individuals' ability to take part in both work and non-work activities and an increase in pain medication use, particularly during menstrual weeks. These results highlight the need for improved diagnosis and pain management strategies in UF.

Purpose: Ovarian mature cystic teratoma (MCT) is the most common ovarian tumor, and only a small fraction undergoes malignant transformation. The most prevalent malignant type of the ovary is squamous cell carcinoma, followed by adenocarcinoma. However, ruptured ovarian mature cystic teratoma with adenocarcinoma transformation is extremely rare.

Case presentation: A 75-year-old postmenopausal woman presented to the emergency room with abdominal pain following a CT examination, the patient was diagnosed with a ruptured ovarian MCT. Subsequently, surgery was performed. Finally, she was diagnosed with adenocarcinoma tumor originating from the MCT of the ovary based on histopathology and immunohistochemistry examination. Following six cycles of chemotherapy with carboplatin and paclitaxel, the patient underwent long-term follow-up, during which no recurrence was observed over 10 months of examinations.

Conclusion: The cases of ruptured cystic teratomas are rare, and ruptured cancerous transformation in MCT is infrequently documented in the literature. Therefore, special attention should be paid when encountering such cases in medical practice, as they can easily be misdiagnosed as benign ovarian tumors.