International Journal of Women's Health最新文献

Background: Fumarate Hydratase (FH)-deficient uterine leiomyomas are a rare type of uterine fibroid associated with somatic or germline mutations in the FH gene. Herein, we report a case of FH-deficient uterine leiomyoma with a double-site mutation of FH in a 41-year-old woman.

Case presentation: The woman was found to have an intrauterine mass during a routine physical examination two years prior. She had no previous medical history or family history of genetic diseases. Ultrasound examination revealed a slightly hypoechoic mass on the posterior wall of the uterus, approximately 4 cm × 4.1 cm in size, suggesting the possibility of a uterine fibroid. The patient opted for regular annual follow-ups and received no specific treatment. However, during the subsequent two years of follow-up, the mass was found to increase in size annually. The patient then came to our hospital and underwent laparoscopic myomectomy. Postoperative pathology indicated that the tumor was negative for FH but positive for 2-succinocysteine (2SC), suggesting a potential diagnosis of FH-deficient leiomyoma. Sanger sequencing analysis demonstrated that the leiomyoma harbored the c.724C>T (p.L242F) mutation in exon 5 and the c.1292C>T (p.T431I) mutation in exon 9 of the FH gene, further confirming the diagnosis of FH-deficient leiomyoma.

Conclusion: We report a rare case of FH-deficient uterine leiomyoma with double mutation sites in the FH gene. Pathological examination and genetic testing are crucial for a definitive diagnosis.

Background: Endometriosis and its associated gynecological diseases such as female infertility and primary ovarian failure (POF), impose a long-term disease burden on women. This study aims to explore the causal relationships between these conditions through a two-sample bidirectional Mendelian randomization (MR) study.

Methods: We utilized large-scale GWAS data and conducted bidirectional MR analyses using methods such as Inverse Variance Weighted (IVW) and MR-Egger to assess the causal relationships between endometriosis and female infertility, POF, amenorrhoea, and oligomenorrhoea.

Results: MR analysis revealed significant causal relationships between endometriosis and female infertility (OR=1.430, 95% CI 1.306-1.567, P<0.01) as well as POF (OR=1.348, 95% CI 1.050-1.731, P=0.019). Reverse MR analysis indicated causal relationships between amenorrhoea (OR=1.076, 95% CI 1.009-1.148, P=0.026) and female infertility (OR=1.340, 95% CI 1.092-1.645, P<0.01) with endometriosis. Sensitivity analyses confirmed the robustness of these findings (heterogeneity: Q_pval>0.05, pleiotropy: pval>0.05).

Conclusion: This study suggested that managing endometriosis may help prevent conditions such as female infertility and POF, and vice versa. Future research is needed to confirm these findings in more diverse populations.

Background & objectives: Growing data on the impact of herd immunity and susceptibility of unvaccinated persons to chronic COVID sequelae requires deeper understanding of vaccine stigma and hesitancy to facilitate population needs. Reproductive-aged women (18-45 years) were at a "vaccine paradox" during COVID-19 - hesitant to receive the vaccine, yet at increased risk for COVID infection. In this study, we sought to: identify demographic predictors, reasons, geographic location of vaccine hesitancy, and COVID-specific attributes that predict future vaccination willingness. We hypothesized that high COVID risk perception and high COVID stress would be predictors of willingness.

Methods: Study Design: Cross-sectional survey of women across the United States. Main Outcomes and Measures: Vaccine hesitancy was defined as responding "No/Not Sure" to the question "Have you received any of the COVID-19 vaccines?" The COVID-Risk scale evaluate perceived COVID Risk, and the COVID-19 Perceived Stress Scale (PSS-10-c) evaluated COVID stress. Open ended questions inquired about participants' vaccine concerns.

Results: Of the 1,037 women who accessed the survey, 948 (91%) consented and completed. Predictors of vaccine hesitancy included younger aged parents (p=0.005), non-white race (p=0.003), and having high school or lower educational attainment (p<0.0001). Using smoking as a proxy measure of "health behavior", we found long-term smokers or quitters were more hesitant than those who never smoked (p=0.03). Geographic analyses showed the most vaccine hesitant women resided in Southeast and Midwest US. Hesitancy reasons included side effects (21%) and fertility/pregnancy concerns (4%). High COVID risk perception (p=0.0004) and high COVID stress (p=0.01) significantly predicted future willingness to get vaccinated.

Conclusions and relevance: This research provides insights for managing the "vaccine paradox" in reproductive age women, and identifying factors that influence COVID-19 vaccine hesitancy and future vaccination willingness. Public health and policy advocates could target messaging around COVID risk and stress in Southeastern and Midwestern regions; as well as address women's concerns around fertility and other side effects.

Objective: The aim of this study is to retrospectively analyze the clinical characteristics of non-puerperal mastitis.

Methods: A retrospective study was undertaken to investigate 724 cases of non-puerperal mastitis in patients hospitalized from April 2004 to December 2021 at the Mammary Gland Department of Shuguang Hospital, which is affiliated with Shanghai University of Traditional Chinese Medicine. Employing statistical methodologies including mean ± standard deviation, median, and one-sample t-test, the study sought to analyze and delineate factors associated with morbidity, such as age, childbirth, lactation, and body mass index (BMI).

Results: The average age of the 724 patients was 33.4 ± 5.5 years. Among them 54.94% were aged 30-39 years, 65.16% were within five years after delivery, and 62.56% were breastfeeding for less than 6 months. The BMI of patients aged 30-39 years was higher than that of the general Chinese population (P < 0.05). There was no significant correlation between smoking, oral contraceptives, trauma, and the incidence of the disease in this group.

Conclusion: Non-puerperal mastitis is more prevalent among women of childbearing age, specifically those aged 30-39 years, who breastfed for less than 6 months within the first five years after childbirth. In this age group, higher BMI is linked to increased morbidity.

Background: Vaginitis is a common disease of the reproductive system in women, causing discomfort in daily life. Many reports indicate that the causes of vaginitis are related to vaginal microecological disturbances. Therefore, treatment strategies to restore microecological balance have shown promising results in both basic research and clinical settings. Recent studies have highlighted the potential adjuvant role of vitamin D in the treatment of vaginitis while illustrating its role in maintaining microecological balance. Therefore, this study focused on the therapeutic effects of vitamin D on vaginitis.

Methods: The study provided a statistical description of 5978 vaginitis patients who visited Shaanxi Provincial People's Hospital, presenting data in absolute numbers (%) and mean ± standard deviation (median quartiles were used for non-normally distributed variables). The chi-square test and analysis of variance were employed to analyze the distribution of vitamin D levels among patients, factors influencing vitamin D levels, and the association between recurrence rates and vitamin D levels.

Results: Vitamin D deficiency (57.74%) or insufficiency (22.20%) is prevalent among patients with vaginitis. Furthermore, vitamin D levels have an impact on the dominant bacterial species in the vagina, as well as catalase, acetylglucosaminidase, and the overall vaginal microecological status. Age and BMI have correlations with vitamin D levels. It is hypothesized that this relationship may be attributed to clinicians utilizing vitamin D as a supplementary treatment.

Conclusion: This study examined the statistical findings of vitamin D-related data from 5978 vaginitis patients, revealing a positive correlation between vitamin D deficiency and vaginitis occurrence. Patients with vitamin D deficiency/severe deficiency showed weakly positive levels of catalase and mostly weakly positive levels of acetylglucosaminidase, and most of these vaginitis are trichomonas vaginalis (TV). Furthermore, older individuals and those with higher BMI were found to be more susceptible to symptoms of vitamin D deficiency.

Background: The impact of androgens on metabolic diseases, cardiovascular diseases (CVD), and long-term mortality in the general female population remains poorly understood. This study, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database managed by the Centers for Disease Control and Prevention, seeks to elucidate the relationship between androgen levels and metabolic syndrome (MS), CVD, and mortality in adult women.

Methods: After excluding ineligible individuals, descriptive analyses were conducted on demographic characteristics, metabolic-related indicators, and disease prevalence, based on the presence of high androgenemia and androgen quartile grouping. Logistic regression models were developed to assess the associations of androgen markers, including total testosterone (TT), Free Androgen Index (FAI), with MS, CVD, and cox regression models were used to explore the relationships with mortality.

Results: Our results show that, even without adjustment for age, age at menarche, marital status, and smoking status, both in patients with hyperandrogenemia and across the general population stratified by quartiles of FAI, higher androgen levels are associated with increased waist circumference, weight, Body Mass Index, fasting insulin, and the monocyte/high-density lipoprotein cholesterol ratio. In adjusted correlational analysis, MS remained positively correlated with FAI, even after controlling for age, tobacco use, and alcohol consumption. As FAI quartiles increased, the correlation strengthened, achieving an odds ratio (OR) of 1.45 (95% CI 1.04 to 2.02, P=0.03) in the highest quartile. This indicates that androgen levels are strongly associated with metabolic syndrome, with FAI proving more sensitive than TT.

Conclusion: The greater sensitivity of FAI may be attributed to its ability to reflect bioavailable testosterone more accurately than TT, underscoring its potential utility in clinical assessments of metabolic risk. This study found no significant correlation between androgen levels and CVD or mortality.

Background: Gestational Trophoblastic Neoplasia (GTN) has a high incidence in Bandung, Indonesia, with a mortality rate between 31% and 51%. The most common type is low-risk GTN with various treatment protocols available. The 8-day Methotrexate (MTX) 50 mg protocol has been implemented at our center; however, due to limitation of government insurance, this study aims to compare its effectiveness against the 1-day Methotrexate (MTX) 300 mg/m² protocol.

Methods: A retrospective cohort study compared two protocols for low-risk GTN treatment at Dr. Hasan Sadikin General Hospital from January 2020 to December 2023: a 1-day Methotrexate (MTX) 300 mg/m² protocol and an 8-day MTX protocol (50 mg MTX IM on days 1, 3, 5, 7 with folinic acid 15 mg orally 24 h after MTX on days 2, 4, 6, 8) and repeat every 2 weeks. Data on patient characteristics, chemotherapy response, side effects, and treatment costs were analyzed.

Results: The 1-day MTX 300 mg/m² protocol achieved similar remission with fewer cycles, milder side effects, and reduced costs compared to the 8-day MTX 50 mg protocol, supporting it as an effective treatment option for low-risk GTN.

Conclusion: The 1-day MTX 300 mg/m² protocol is as an effective treatment option for low-risk GTN compared to the 8-day MTX 50 mg protocol.

Aim: To assess body composition, glucolipid metabolism, and uric acid levels in PCOS (Polycystic Ovary Syndrome) patients to determine their relationship with the risk of endometrial hyperplasia (EH).

Methods: A total of 232 patients were included and divided into groups according to whether they had PCOS and endometrial pathology (Group A: non-PCOS and normal endometrium; Group B: PCOS and normal endometrium; Group C: non-PCOS and EH; Group D: PCOS and EH). Body composition differences between groups and correlations between body composition, glucolipid metabolism, and uric acid levels were analyzed.

Results: In Group D, the patient's PSM (Percent Skeletal Muscle) of Trunk, PBF (Percent Body Fat) of Arm, free mass index, FMI (Fat Mass Index), and appendicular skeletal muscle mass index were significantly higher than in Groups A, B, and C. Waist-hip rate, PBF, PBF of Trunk, PSM of Leg, skeletal muscle mass index and visceral fat level were significantly higher than in Groups A and B. FMI was an independent risk factor for EH in PCOS patients, the AUC for FMI prediction of endometrial hyperplasia in PCOS patients was 0.82. FMI had significant positive correlations with fasting glucose, fasting insulin, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), total cholesterol, triglyceride, low-density lipoprotein, triglyceride/high-density lipoprotein, and uric acid levels. FMI was correlated with HOMA-IR and uric acid at 0.602 and 0.649 respectively in PCOS patients.

Conclusion: Increased FMI and altered glucolipid metabolism as key factors associated with a higher risk of EH in patients with PCOS. Monitoring body composition and metabolic health in PCOS patients could help identify those at greater risk of EH, guiding preventive interventions.

Background: Observational studies have investigated the association between lipid-lowering drugs and breast cancer (BC) and endometrial cancer (EC), but some controversy remains.

Objective: This paper aims to explore the causal relationship between genetic proxies for lipid-lowering drugs and breast and endometrial cancers using drug-target Mendelian randomization (MR).

Methods: Analyses were mainly performed using inverse variance weighted (IVW), heterogeneity and horizontal pleiotropy tests, and sensitivity analysis to assess the robustness of the results and causal relationship.

Results: HMGCR, APOB, and NPC1L1 increased the risk of breast cancer, LPL increased the risk of endometrial cancer, and APOC3 decreased the risk of breast and endometrial cancer. No heterogeneity or horizontal pleiotropy was detected, and nor was there any evidence of an association between other lipid-lowering drugs and breast and endometrial cancer.

Conclusion: Our study demonstrated genetically that HMGCR inhibition, APOB inhibition, and NPC1L1 inhibition decrease the risk of breast cancer, LPL agonist increases the risk of endometrial cancer, and APOC3 inhibition decreases the risk of breast cancer and endometrial cancer, and these findings provide genetic insights into the potential risks of lipid-lowering drug therapy.

Introduction: Ovarian torsion during pregnancy is a rare condition that requires prompt diagnosis and repositioning to preserve ovarian function.

Case report: A 32-year-old woman underwent a successful pregnancy after FET, but was hospitalized for observation because of a threatened abortion. During the 8th week of pregnancy, a transvaginal ultrasound examination was performed due to sudden lower abdominal pain, which displayed an 8.3×5.2cm right ovary and a 4.3×3.6 cm enhanced echogenic mass over the right ovary with striated structures. Consequently, a preliminary diagnosis of ovarian torsion was made, and urgent laparoscopic exploration was conducted. Intraoperatively, the right fallopian tube and right ovary were rotated counterclockwise by 720 degrees. After rotate and reposition the right ovary and fallopian tube, a 3 cm diameter cyst was punctured. After 1 hour of observation, a 2×1×1cm segment of ovarian tissue was excised. Pregnancy was maintained with aggressive postoperative luteal support and anti-infective treatment.

Conclusion: The use of clomiphene citrate during endometrium preparation for frozen-thawed embryo transfer cycles may elevate the risk of ovarian torsion. Laparoscopic ovarian repositioning after ovarian torsion in pregnant women, even those with threatened abortion, is safe when combined with postoperative anti-infective treatment and intensive luteal support.