International Journal of Women's Health最新文献

Objective: The CXCL16/CXCR6 signaling pathway is implicated in macrophage polarization. The correlation between CXCL16 and CXCR6 expressions in decidual tissues from patients with preeclampsia (PE) and macrophage polarization remains unexplored. This study aimed to investigate the correlation between the chemokine axis CXCL16/CXCR6 and macrophage polarization at the maternal-fetal interface in PE.

Methods: In this study, macrophage polarization status in the decidua was assessed using Western blotting (WB), immunohistochemistry (IHC), and immunofluorescence (IF) staining. For quantitative characterization, primary decidual macrophages were isolated and subjected to flow cytometry analysis to further evaluate macrophage polarization. Expression of CXCL16 and CXCR6 in decidual tissues was evaluated by WB and IHC. Additionally, the expressions of CXCL16 and CXCR6 in decidual macrophages were assessed by immunofluorescence double staining.

Results: IHC and WB demonstrated a significant upregulation of CD86 (P < 0.05), alongside a downregulation of CXCL16, CXCR6, and CD206 (P < 0.01) in PE decidual tissues. IF double staining revealed an increased abundance of CD68⁺CD80⁺/CD86⁺ cells in the decidua of patients with PE, while CD68⁺CD163⁺/CD206⁺ and CD68⁺CXCL16⁺/CXCR6⁺ cells was decreased. Flow cytometry analysis of primary decidual macrophages isolated from PE patients confirmed an increase in the proportions of CD68⁺CD80⁺ (P < 0.01) and CD68⁺CD86⁺ (P < 0.0001), and a marked decrease in CD68⁺CD163⁺ (P< 0.001) and CD68⁺CD206⁺ (P < 0.0001). These results indicate dysregulated decidual macrophage polarization in PE, characterized by an M1 bias that may be mediated by impaired CXCL16/CXCR6 signaling at the maternal-fetal interface.

Background: The association between PCOS and the TCM concept of phlegm-damp constitution is well-documented, but their connection via miRNA remains unclear. This study sought to identify key miRNAs implicated in the transition from phlegm-damp constitution to PCOS and to elucidate their associated regulatory networks.

Methods: We conducted miRNA sequencing on granulosa cells from three groups: healthy controls with a neutral constitution (NP), healthy individuals with a phlegm-damp constitution (NB), and PCOS patients (PC). Principal component analysis (PCA) and differential expression analysis were utilized to pinpoint candidate miRNAs, which were subsequently validated using quantitative real-time PCR (qRT-PCR) in larger cohorts. Bioinformatics, including target prediction, protein-protein interaction (PPI) network construction, and pathway analysis, were employed to delineate the regulatory networks involved.

Results: PCA revealed distinct clustering patterns, with NB and PC groups exhibiting closer proximity compared to the NP group. Differential expression analysis identified 24 dysregulated miRNAs in the PC group (20 upregulated, 4 downregulated) and 14 in the NB group (11 upregulated, 3 downregulated), with both groups showing shared enrichment in metabolic, PI3K-Akt, and Ras pathways. Validation confirmed a progressive downregulation of hsa-miR-24-2-5p and hsa-miR-33a-5p across the NP, the NB, and PC groups (P<0.05), whereas hsa-miR-374b-5p exhibited differential expression exclusively between NB and PC groups. Network analysis identified five hub genes (EGFR, MYC, KRAS, CREB1, SMAD4) and nine risk pathways, including MAPK and Wnt signaling pathways. The constructed miRNA-hub gene-pathway network comprised five miRNA-hub gene pairs and thirteen functional modules.

Conclusion: These findings elucidate shared miRNA regulatory mechanisms between phlegm-damp constitution and PCOS, highlighting hsa-miR-24-2-5p and hsa-miR-33a-5p as pivotal mediators in this pathological transition. This provides molecular evidence for the TCM "constitution-disease correlation" theory and identifies potential targets for the prevention and treatment of PCOS.

Background: Adnexal masses in pediatric patients are an uncommon pathology, and treatment often raises the question of whether Gynecologic surgeons (those graduating OBGYN residencies and associated fellowships) or Pediatric and general surgeons (those graduating general surgery or other non-obgyn residencies and fellowships) are better suited to perform the procedure.

Aim: To compare gynecologic surgeons and pediatric surgeons regarding the surgical management of ovarian lesions, whether through laparotomy or laparoscopic procedures.

Methods: We searched all major databases for relative studies.

Results: We found that gynecologic surgeons had lower complication rates (mean 9.5% vs 14.9%) and recurrence rates (mean 10.7% vs 10.8% for laparoscopic) than pediatric surgeons. Additionally, gynecologic surgeons performed more ovarian-sparing surgeries (90% vs 55%) and had fewer laparoscopies converted to laparotomies (mean 8% vs 48%). Hospital stay was shorter with gynecologic surgeons (mean 1.9 days vs 2.1 days). The incidence of accidental tumor spillage was also higher among pediatric and general surgeons than it was with the gynecologic surgeons.

Conclusion: Gynecologic surgeons may be associated with better outcomes compared to pediatric surgeons in the surgical management of pediatric and adolescent female patients with ovarian masses. Limitations include heterogeneity among studies, small number of included studies, and reliance on observational data.

Purpose: To explore the barriers and facilitators to postpartum cardiovascular disease (CVD) risk screening among women with hypertensive disorders of pregnancy (HDP) from both patient and healthcare provider perspectives, with the aim of informing clinical screening strategies, optimizing postpartum care services, and improving maternal health outcomes.

Patients and methods: This study employed purposive sampling and was conducted between February and May 2025 at a tertiary hospital in Suzhou, Jiangsu Province, China. Semi-structured, one-on-one interviews were conducted with 15 women diagnosed with HDP at 3-12 months postpartum. In addition, focus group interviews were held with nine healthcare providers from the obstetrics department and community health centers (CHCs, primary care facilities in China). A content analysis approach was used to analyze the qualitative data.

Results: Three themes and twelve subthemes emerged: (1) Limited perception of CVD risk, poor ability to screen and apply health information, fear-driven avoidance behavior, conflicting role priorities, and economic burden are individual barriers; (2) lack of guidance from healthcare providers, fragmented and unstandardized postpartum care system are system-level barriers; (3) family history of hypertension, emphasis on personal health, strong family support, and positive experience with past interventions are promoting factors that encourage women to get screened.

Conclusion: Postpartum CVD risk screening in women with HDP remains inadequate. Strengthening transitional care, integrating structured screening into postpartum guidelines, expanding insurance coverage, and enhancing digital health and provider training are essential to close clinical gaps and improve long-term cardiovascular outcomes.

Pregnancy-associated Sweet syndrome (PASS), is a diagnostically challenging entity, especially in atypical presentations. Delayed management may result in significant maternal-fetal risks. We describe a 24-year-old woman with PASS presenting like cutaneous dirt-adherent disease, characterized by abrupt-onset facial erythematous plaques with adherent dirt-like crusts. Histopathology revealed superficial dermal edema and dense perivascular neutrophilic infiltrates without vasculitis. Low-dose systemic corticosteroids (prednisone 20mg/day) achieved rapid resolution, underscoring their efficacy and safety in pregnancy. This case explores the potential pathogenesis of PASS and underscores the necessity for awareness among clinicians about PASS, contributing valuable insights into the diagnosis and management of this rare condition in pregnancy.

[This corrects the article DOI: 10.2147/IJWH.S508380.].

Purpose: This study aimed to assess whether different endometrial preparation regimens-natural cycle (NC), hormone replacement therapy (HRT), and gonadotropin-releasing hormone agonist pretreatment followed by HRT (GnRH-a + HRT)-are associated with differences in reproductive and perinatal outcomes among women with diminished ovarian reserve undergoing frozen embryo transfer (FET), and to evaluate whether age (<35 vs ≥35 years) modifies these associations.

Patients and methods: A total of 4629 women with DOR, defined as anti-Müllerian hormone (AMH) <1.2 ng/mL and/or antral follicle count (AFC) <5, undergoing their first autologous FET between 2016 and 2024. Endometrial preparation protocols included natural cycle (NC), hormone replacement therapy (HRT), or gonadotropin-releasing hormone agonist (GnRH-a) pretreatment followed by HRT. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to adjust for baseline differences.

Results: GnRH-a pretreatment before HRT was associated with improved live birth and clinical pregnancy compared with HRT alone, particularly among older women. No significant differences were observed between natural cycle and HRT. Perinatal outcomes among singleton live births were generally comparable across protocols.

Conclusion: GnRH-a pretreatment before HRT may be beneficial for women with diminished ovarian reserve undergoing FET, particularly in those of advanced maternal age.

Background: Distant micrometastasis of breast cancer [M0(i+)] is an emerging metastatic stage that has not yet received widespread attention. This study aimed to compare M0(i+) patients with traditional M0 patients and to evaluate the prognostic value of M0(i+).

Methods: Using data from the SEER database (2018-2022), we identified 283,503 M0 patients and 585 M0(i+) patients. Propensity score matching (PSM) was applied to control for confounding factors in intergroup comparisons. Overall survival (OS) and breast cancer-specific mortality (BCSM) were assessed using the Kaplan-Meier method, Cox regression analysis, the cumulative incidence function (CIF), and the Fine-Gray competing risk model.

Results: After matching, no statistically significant differences were observed between the M0(i+) and M0 groups in either OS or BCSM (OS: HR=0.803, P=0.369; BCSM: HR=1.273, P=0.450). Nevertheless, the M0(i+) group showed a slightly worse survival trend in BCSM, while demonstrating a survival advantage in OS. This advantage may be influenced by the higher proportion of non-cancer-related deaths in this group.

Conclusion: The prognosis of M0(i+) patients is similar to that of M0 patients, supporting the rationale for combining the two stages in the AJCC staging system. Although the differences did not reach statistical significance, M0(i+) may still carry potential adverse prognostic implications. In light of prior literature, further refinement of the M0(i+) classification should be considered, with particular attention to the prognostic role of bone marrow micrometastasis.

Background: Inflammatory proteins play a pivotal role in the pathogenesis of ovarian diseases, although the underlying mechanisms remain poorly understood. The aim of this study is to investigate the association between circulating markers of inflammation and ovarian diseases.

Methods: A two-sample bidirectional Mendelian randomization (MR) approach was employed, utilizing publicly available genetic databases to examine the relationship between 91 circulating inflammatory markers and six ovarian diseases. The primary analysis utilized the inverse variance weighting (IVW) method, with additional sensitivity analyses, including heterogeneity and pleiotropy tests, to assess the robustness of the findings.

Results: Specific inflammatory markers were found to be associated with ovarian diseases and to exhibit causal relationships. Ovarian cysts were linked to CCL4 and other proteins, showing a positive causal relationship with NT-3. Polycystic ovary syndrome (PCOS) was associated with IL-6 and other markers, with a positive causal relationship to IL-17C. Ovarian dysfunction was associated with IL-6 and other markers, while primary ovarian failure was linked to IL-33. Benign ovarian neoplasms were associated with CCL28 and other proteins, showing a positive causal relationship with FGF-19 and negative causal relationships with FGF-5 and NT-3. Malignant ovarian neoplasms were associated with CCL20 and other markers.

Discussion: This study clarifies the causal relationships between circulating inflammatory markers and ovarian diseases, providing a crucial foundation for future translational research and clinical applications.

Objective: To determine the risk of ovarian metastasis and prognosis in patients with neuroendocrine carcinoma of the uterine cervix (NECC).

Methods: A retrospective review was conducted of the clinical and pathological information of patients with stage IA2 to IIA2 cervical cancer who underwent radical hysterectomy between 2008 and 2023. Multivariate Cox proportional hazards regression models were used to identify independent prognostic factors for the 5-year overall survival (OS) and disease-free survival (DFS).

Results: The study included 1351 patients from four Chinese medical institutions. Compared to those with squamous carcinoma or adenocarcinoma, patients with NECC had a significantly higher risk of lymph vascular space invasion (LVSI) and more frequently received adjuvant radiotherapy. The overall rates of fallopian tube and ovarian metastases were low (< 1.0%). Furthermore, the ovary had a higher rate of metastasis than the fallopian tube (P< 0.001). Remarkably, none of the 75 patients with NECC exhibited fallopian tube or ovarian metastasis. The 5-year DFS and OS were significantly shorter in patients with NECC than in those with squamous carcinoma (5-year DFS, 64.7% vs 90.1%, P < 0.001; 5-year OS, 75.7% vs 89.6%, P < 0.001) or adenocarcinoma (5-year DFS, 64.7% vs 83.4%, P < 0.001; 5-year OS, 75.7% vs 88.7%, P=0.004). Multivariate analysis identified NECC as an independent risk factor for decreased 5-year DFS (aHR, 6.274; 95% CI, 3.749-10.499) and 5-year OS (aHR, 5.925; 95% CI, 3.097-11.336). Sensitivity assessments yielded consistent results.

Conclusion: NECC is an independent risk factor associated with a worse prognosis. However, the rates of fallopian tube and ovarian metastases are low in NECC patients, suggesting that ovarian preservation may be a safe and feasible option for these patients. Further validation in broader, diverse populations is warranted to generalize these findings.