International Journal of Women's Health最新文献

On December 28, 2016, a 35-year-old female patient presenting with chest pain and a brief fainting spell was admitted to a hospital in Guangzhou and promptly received thrombectomy and catheter-directed thrombolysis. She had experienced two episodes of explosive thrombosis, with the second occurring in May 2020, triggered by pregnancy. Her diagnoses included polycystic ovary syndrome (PCOS), hereditary Protein C (PC) deficiency resulting from a heterozygous mutation deletion of 572_574 in exon 7, recurrent spontaneous abortion (RSA), as well as PCOS-associated insulin resistance and chronic endometritis. Our regimen comprises dydrogesterone for cycle regulation, rivaroxaban for PC deficiency-related thrombophilia, and metformin, amoxicillin, and omeprazole to manage PCOS-associated insulin resistance and chronic endometritis, with the aim of mitigating their contribution to impaired endometrial receptivity. Following our targeted and persistent treatment, the patient gave birth to a healthy baby in April 2023. It is rare for RSA to be caused by PCOS complicated by hereditary PC deficiency, and there are no international treatment guidelines for such cases. This report adds to the existing body of knowledge regarding the treatment of PCOS complicated by hereditary PC deficiency. For RSA patients, a comprehensive approach considering all contributing factors and individual circumstances is essential. Multi-disciplinary treatment (MDT) is crucial. Moreover, there are currently no international, evidence-based guidelines for the use of combined oral contraceptives (COCs) in PCOS complicated by hereditary thrombophilia, highlighting the urgent need for multicenter clinical studies to establish appropriate management strategies.

Background: Preeclampsia is a complex hypertensive disorder of pregnancy, significantly impacting maternal and fetal health worldwide. Despite extensive research, its pathogenesis, involving inflammatory, immune, microbiological, and metabolic factors, requires comprehensive elucidation.

Methods: This study applied Mendelian randomization (MR) to investigate causal relationships between multi-omics traits and the risk of preeclampsia. The genome-wide association studies (GWAS) datasets used consisted of immune cells (N = 3757), inflammatory factors (N = 14,824), gut microbiota (N = 7738), circulating metabolites (N1 = 7824, N2 = 8299), plasma proteins (N = 3301), and preeclampsia (7212 cases, 194,266 controls). The inverse variance-weighted method was used in the main analysis, and the weighted median, weighted mode, and MR Egger regression were used in sensitivity analyses.

Results: Our analysis identified 81 potential causal factors for preeclampsia. Among the most novel and clinically significant findings were several druggable plasma proteins, including Astacin-like metalloendopeptidase (ASTL) and Baculoviral IAP repeat-containing protein 3 (BIRC3), which exhibited strong causal evidence. Furthermore, we identified specific gut microbiota genera, notably Bifidobacterium, as potential protective factors. We also validated the causal roles of key metabolic disturbances, like cysteine and guanidinoacetate, and dysfunctions in specific immune cell populations, particularly regulatory T and B cells.

Conclusion: These findings highlight the intricate interplay of immune, inflammatory, microbiological, metabolic, and protein factors in preeclampsia, suggesting novel diagnostic and therapeutic targets. Further research is warranted to explore these associations in detail.

Background: Osteoporosis (OP) and knee osteoarthritis (KOA) are common comorbidities in postmenopausal women, yet the relationship between OP and localized bone mineral density (BMD) around the knee remains unclear. This study investigated the effect of concomitant OP on periarticular BMD and its associations with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), radiographic severity, and hip-knee-ankle (HKA) angle in postmenopausal women with KOA.

Methods: In this cross-sectional study, 117 postmenopausal women were classified into a KOA combined with OP group (n=59) and a KOA-only group (n=58) based on dual-energy X-ray absorptiometry (DXA) T-scores. All participants underwent dual-energy computed tomography (DECT) to quantify BMD around the distal femur, proximal tibia, and patella; weight-bearing radiographs to assess Kellgren-Lawrence (K&L) grade and HKA angle; and the WOMAC questionnaire to evaluate pain and joint function.

Results: Patients with KOA combined with OP demonstrated significantly lower knee BMD than those with KOA alone (P < 0.001). This reduction in BMD was more pronounced with increasing OP severity. Notably, even after adjusting for pain levels, BMD remained significantly lower in the KOA combined with OP group (P < 0.05). Furthermore, medial knee BMD in the KOA combined with OP group exhibited an inverted U-shaped relationship with K&L grade, peaking at grade III before declining. In contrast, BMD increased progressively with K&L grade in the KOA group. A significant inverse correlation was also observed between the HKA angle and medial knee BMD in the KOA combined with OP group, suggesting greater bone loss with increasing valgus deformity.

Conclusion: Postmenopausal women with KOA combined with OP have markedly lower periarticular BMD, associated with more severe pain, distinctive radiographic changes, and poorer alignment. These findings highlight the need for active bone preservation and OP management in KOA patients to alleviate symptoms and potentially slow disease progression.

Background: Oxidative stress has been implicated in the pathogenesis of various malignancies, including gynecological cancers (GC). This study aimed to evaluate the association between oxidative balance score (OBS) and GC prevalence using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018.

Methods: A total of 7816 adult female participants were included, of whom 195 reported a history of GC (cervical, endometrial, or ovarian). OBS was computed from 20 components: 15 antioxidants and five pro-oxidants from dietary and lifestyle sources. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for GC according to the OBS tertiles and per-unit increases, adjusting for covariates.

Results: Higher total OBS was associated with significantly lower odds of GC (adjusted OR per unit increase = 0.92; 95% CI: 0.86-0.97). Participants in the highest OBS tertile had 34% lower odds of developing GC than those in the lowest tertile. This association was more pronounced among women aged ≥60 years, non-smokers, and those with normal body mass index (BMI).

Conclusion: Greater antioxidant exposure, as reflected by higher OBS, was inversely associated with GC risk. These findings support dietary and lifestyle interventions aimed at improving oxidative balance.

Background: Scar endometriosis is a rare manifestation of extrapelvic endometriosis, characterized by the presence of endometrial tissue within a cesarean section scar. It typically manifests as cyclical pain and swelling at the site of the surgical incision and is often subject to misdiagnosis.

Case presentation: This report examines a case involving a 30-year-old Somali woman with a history of multiple childbirths, presenting with a painful nodule at the location of a previous lower segment cesarean section (LSCS) scar. Her symptoms were cyclical, worsening during menstruation. Ultrasonographic evaluation revealed an endometriotic lesion, and histological examination following surgical excision confirmed the diagnosis. The patient had an uneventful recovery post-surgery.

Conclusion: It is important for clinicians to contemplate scar endometriosis in women presenting with a painful mass near a surgical scar that fluctuates with the menstrual cycle. Early identification and comprehensive surgical removal are crucial for effective management.

Background: Previous studies have reported the correlation between single galectin levels and gynecologic cancers. The present study used the Mendelian randomization (MR) technique to evaluate the causal relationship between galectin levels and gynecologic cancers.

Methods: Data on galectin levels (3394 individuals of the Gal-3 dataset, 3301 individuals of Gal-1, Gal-2, Gal-4, Gal-7, Gal-8, Gal-9, and Gal-10 datasets) and gynecologic cancers were obtained from the IEU Open genome-wide association study (GWAS) project, Ovarian Cancer Association Consortium (OCAC) and FinnGen consortium. Two-sample MR was performed to determine the causal relationship between galectin levels and gynecologic cancers. Meanwhile, a bi-directional MR analysis was also conducted to examine the direction of the causal relations. The results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Gal-3 (OR=1.001, 95% CI: 1.000-1.001) and Gal-8 (OR=1.001, 95% CI: 1.000-1.002) may indicate small effects on cervical cancer. Gal-1 was suggested as risk factors for ovarian cancer (OR=1.108, 95% CI: 1.033-1.188), high grade serous ovarian cancer (OR=1.106, 95% CI: 1.019-1.202), and invasive mucinous ovarian cancer (OR=1.279, 95% CI: 1.041-1.573). Gal-9 showed modest effect in ovarian cancer (OR=1.070, 95% CI: 1.000-1.144), but significantly associated with an elevated risk of mucinous ovarian cancer (OR=1.242, 95% CI: 1.015-1.520). Gal-10 was suggested as a protective factor against ovarian cancer (OR=0.929, 95% CI: 0.867-0.994) and clear cell ovarian cancer (OR=0.803, 95% CI: 0.653-0.987). Gal-2 (OR=0.779, 95% CI: 0.654-0.929) and Gal-4 (OR=0.786, 95% CI: 0.639-0.966) were found as protective factors for malignant neoplasm of corpus uteri. Gal-2 (OR=0.921, 95% CI: 0.851-0.997) and Gal-10 (OR=0.892, 95% CI: 0.815-0.977) were suggested as protective factors against endometrial cancer (endometrioid histology). Similarly, higher Gal-4 was also associated with decreased risk of endometrial cancer (OR=0.902, 95% CI: 0.840-0.969) and endometrial cancer (endometrioid histology) (OR=0.846, 95% CI: 0.778-0.920).

Conclusion: The study explored potential causal relationships between galectin levels and gynecologic cancers. While some associations were modest, the consistent directionality across sensitivity analyses and the biological plausibility of galectins in tumor immunology suggest that these proteins warrant further investigation as potential biomarkers and therapeutic targets. Future research should validate these findings in clinical cohorts and explore underlying mechanisms.

Purpose: Cardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time-specifically, whether it is persistent and affects multiple body sites-influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).

Patients and methods: This prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.

Results: At baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00-1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03-1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00-1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.

Conclusion: Among postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.

Background: Teratomas usually occur in the gonads. The retroperitoneum is the least common location, which accounts for approximately 4% of primary retroperitoneal tumors and 26% of retroperitoneal teratomas are malignant. Retroperitoneal teratomas occur mainly in childhood, and with a low incidence in adults. Due to its nonspecific clinical and imaging features, the disease is difficult to distinguish from cystadenoma and other diseases, making accurate diagnosis a persistent clinical challenge.

Case presentation: Here, we present a 65-year-old female patient who was admitted to the hospital due to intermittent right upper abdominal pain for half a month. Preoperative abdominal computed tomography imaging revealed a large mass in the left abdominal cavity, which showed mild enhancement. However, the imaging findings were non-diagnostic, and the nature of the mass could not be determined. Postoperative pathological examination revealed a retroperitoneal mature cystic teratoma. Through close follow-up, the patient achieved a favorable prognosis, and had no local recurrence or distant metastasis 6 years after surgery.

Conclusion: This case highlights the importance of considering teratoma in the differential diagnosis of retroperitoneal tumor and emphasizes the importance of complete surgical resection for the patient's prognosis, which are critical to preventing misdiagnosis as malignancy and optimizing patient outcomes.

Objective: The aim of this study was to analyze the risk factors of urinary tract infection in ovarian cancer patients after cytoreductive surgery(CRS) and construct a nomogram model.

Methods: A retrospective study was conducted on 349 ovarian cancer patients (all undergoing CRS) admitted to Meizhou people's hospital from August 2021 to August 2024. The patients were randomly assigned into modeling group and validation group in a 7:3 ratio (According to the random number table method). The modeling group was assigned into infected group and non infected group based on whether the patient developed urinary tract infection after CRS. Logistic regression was used to analyze influencing factors, and R software (R version 3.6.3 software and the rms package) was used to construct nomogram models. P<0.05 indicates a statistically significant difference.

Results: A total of 86 out of 349 patients developed infections, with an incidence rate of 24.64%. Among 244 patients in the modeling group, 61 cases developed infections, with an incidence rate of 25.00%. Logistic regression analysis showed that age, diabetes, tumor staging, number of catheter insertions, catheter retention time and postoperative hypoproteinemia were the risk factors for urinary tract infection after CRS in ovarian cancer patients (P<0.05). The area under the curve(AUC) of the modeling group was 0.950, and the H-L test showed χ²=6.912, P=0.697. The AUC of the validation group was 0.970, and the H-L test showed χ²=6.756, P=0.642. Decision curve analysis (DCA) curve indicated that the clinical value was higher when the probability was between 0.08 and 0.90.

Conclusion: The nomogram predicting the risk of postoperative UTI based on the identified risk factors demonstrated good discrimination and calibration. However, this model is still preliminary and requires external, multicenter validation before it can be applied in clinical practice.

The incidence of colorectal cancer (CRC) is rising among adults under 50. Similarly, the incidence of rare anal squamous cell carcinoma (ASCC) is also steadily increasing, especially among women. The consequences of chemoradiotherapy on sexual health vary but are very common. For example, sexual dysfunction affects up to 85% of ASCC survivors, according to a recent systematic review. Because of its impact on quality of life, addressing sexual issues-especially in women who had active sexual lives before cancer-should not be underappreciated in managing CRC and ASCC survivors. A potential strategy may involve combining the benefits of hyaluronic acid for vulvovaginal hydration with an ingredient that supports long-term regeneration of the dermal and submucosal extracellular matrix, including collagen, elastin fibrils, and glycosaminoglycans. This report describes the case and evolution over time of the iatrogenic menopause symptoms, with special attention to dyspareunia and sexual well-being, of a 42-year-old woman with severe iatrogenic sexual dysfunction following chemoradiotherapy for ASCC. The woman successfully underwent six sessions of infiltrative treatment via intradermal vulvar and submucosal vaginal injections with a combination of hyaluronic acid and Polynucleotides High Purification Technology (PN HPT) using a CE-marked Class III medical device, for dermal and submucosal regeneration over approximately four months.