Journal of Obstetrics and Gynaecology最新文献

Background: Endometrial polyps (EPs) are a localised hyperproliferative disorder of the endometrium, and its pathogenesis remains unclear. Progesterone resistance may influence the recurrence rate of progesterone-treated EPs. Expression of the Hippo-YAP1 signalling pathway has been studied in various diseases. However, few studies have explored their expression in EPs and association with progesterone resistance. Prolactin (PRL), a molecular marker of endometrial mesenchymal cell metaplasia, indirectly reflects progesterone action in vivo. This study aimed to explore the role of Hippo-YAP1 signalling pathway in EPs.

Methods: Endometrial tissue specimens obtained by surgical resection from 35 patients with a normal endometrium and 35 with EPs were collected between July 2023 and July 2024. Immunohistochemically, the expressions of mammalian STE20-like kinase 1 (MST1), Yes-associated protein 1 (YAP1), progesterone receptor (PR) and PRL in the normal endometrium and EPs tissues were detected.

Results: Compared to normal endometrial tissues, the expression of MST1 was relatively low in EPs (p < .05), while the total and nuclear expression of YAP1 was relatively high in EPs (p < .0001). The expression of PR in EPs tissues was significantly lower than that in normal endometrial tissues (p < .05), and the expression level of PRL was lower than that of normal endometrium in EPs tissues (p < .001).

Conclusions: EPs have progesterone resistance, and the Hippo-YAP1 signalling pathway may be involved in the development and progression of EPs by acting on the progesterone resistance mechanism.

Background: The systemic immune-inflammation index (SII) has been a marker and prognostic indicator of several diseases. However, its utility in pregnancy is unknown. Herein, we reviewed the evidence on the ability of SII to predict gestational diabetes mellitus (GDM) and preeclampsia (PE).

Methods: A systematic search of PubMed, Embase, Scopus and Web of Science was conducted for studies comparing SII between GDM/PE and non-GDM/non-PE groups. Studies reporting diagnostic accuracy data were also included. The last date of the search was 5 November 2024. Risk of bias was assessed using Newcastle Ottawa Scale. Random-effect meta-analysis was conducted comparing values of SII between GDM/PE and non-GDM/non-PE groups.

Results: Nine studies were eligible. Four studies reported data on GDM and five on PE. Most studies measured SII in the first trimester. The pooled analysis showed no statistically significant difference in the SII values between PE and non-PE groups (MD: 13.07, 95% confidence interval (CI): -117.21, 143.35, I² = 78%). Meta-analysis of four studies comparing data of GDM and non-GDM groups showed that SII was significantly higher in GDM females (MD: 210.32, 95% CI: 57.3, 363.34, I² = 94%). The sensitivity of SII to predict PE varied from 40 to 77.5% while specificity varied from 53.8 to 67.5%. For studies on GDM, the sensitivity and specificity values varied from 66 to 80.2% and 34.4 to 65%, respectively.

Conclusions: SII values are significantly higher in GDM compared to non-GDM females. However, SII values did not correlate with PE. SII may have potential in predicting GDM which needs to be explored by further studies.

Background: With the gradual legalisation of recreational cannabis, associated health effects have received widespread attention, but their association with female infertility remains unclear. The aim of this study was to explore the association between cannabis use and infertility among females of childbearing age in the United States.

Methods: Data were obtained from the National Health and Nutrition Examination Survey 2013-2018; 1694 female participants aged 18-45 years were included. The association between cannabis use and female infertility was analysed by logistic regression analysis. All data were weighted before analysis.

Results: After adjusting for all covariates, former cannabis users demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.04, 95% confidence interval: 1.21-3.43, P = 0.012), whereas current cannabis users exhibited no significant difference in infertility odds relative to never-users. In subgroup analysis, former users aged 18-35 years exhibited higher odds of infertility than never-users (odds ratio: 2.37, 95% confidence interval: 1.11-5.04, P = 0.027); but former cannabis users aged 36-45 years demonstrated no significant difference in infertility odds compared with never-users. Among former cannabis users aged 18-35 years, those with sustained abstinence exceeding 3 years demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.94, 95% confidence interval: 1.29-6.71, P = 0.005). In contrast, individuals with shorter abstinence durations (<3 years) showed no significant difference in infertility odds relative to never-users.

Conclusions: Among females of childbearing age, the odds of infertility was not elevated among current cannabis users compared with never-users, while the odds of infertility was elevated among former users. This relationship between cannabis use and female fertility is more often reflected in the distant term (>3 years of cessation), and this adverse association is more pronounced among females in the most active reproductive years (18-35).

Background: The aetiology and pathogenesis of adenomyosis remain unclear. This study utilised untargeted metabolomics to explore the aberrant amino acid metabolism in adenomyosis. Among the studied metabolites, hydroxyproline is known to promote the proliferation and invasion of tumour cells. Due to detection limitations, hydroxyproline levels were inferred via the expression of prolyl 4-hydroxylase subunit alpha 1 (P4HA1), a crucial enzyme that catalyses the conversion of proline to hydroxyproline.

Methods: Endometrial metabolomic analysis was performed using gas chromatography-mass spectrometry (GC-MS) in 15 and 20 patients with and without adenomyosis. The expression levels of P4HA1 mRNA and protein were detected using quantitative PCR (qPCR), western blotting, and immunohistochemistry. In vitro, Cell Counting Kit-8, and 5-Ethynyl-2'-deoxyuridine (EdU) assays were used to investigate the effect of hydroxyproline on the proliferation of human endometrial stromal cells (hESCs). Additionally, a wound-healing assay was conducted to examine the effect of hydroxyproline on hESCs migration.

Results: In total, 22 differentially expressed metabolites were identified in the adenomyosis group compared to the control group. qPCR results demonstrated that P4HA1 mRNA expression levels were significantly higher in the adenomyosis group than in the control group (p < 0.01), which was further validated at the protein level by western blotting and immunohistochemistry. In vitro, functional assays revealed that hydroxyproline promoted hESCs proliferation and migration in a dose-dependent manner. EdU assays showed a significant increase in the number of EdU-positive hESCs in the 5 mM hydroxyproline treatment group than that in the control group (p < 0.01). Additionally, wound healing assays demonstrated enhanced migration of hESCs after treatment with 5 mM hydroxyproline (p = 0.002).

Conclusion: Hydroxyproline levels were significantly elevated in the endometrial tissues of patients with adenomyosis. Furthermore, hydroxyproline promotes the proliferation and migration of hESCs. These findings provide new insights into the pathogenesis of adenomyosis and suggest potential therapeutic strategies.

Background: Epithelioid and placental site trophoblastic tumours are rare gestational malignancies which have little detailed information on their population incidence or risk related to maternal age.

Methods: We performed a retrospective UK national population-based study examining all of the cases registered between 2000 and 2020 using the databases at the UK's two gestational trophoblastic treatment centres at Charing Cross Hospital in London and Weston Park Hospital in Sheffield. The data obtained was compared with the contemporary UK birth and pregnancy statistics.

Results: Over the 21-year study period, there were 132 cases of ETT or PSST. PSTT comprised 57% of the cases, 30% were ETT and 13% had mixed pathology. The combined incidence of ETT and PSTT was 1:118,736 relative to live births and 1:150,872 compared to total viable conceptions. For women aged under 20 the incidence relative to live births was 1:412,488, increasing to 1:188,292 for women 30-34 years, and 1:1,426 for women aged 45 and above. The median interval from the antecedent pregnancy to the time of diagnosis was 15 months (0-288) for the PSTT patients compared to 24 months (0-336) for patients with a diagnosis of ETT.

Conclusions: ETT and PSTT are both rare diagnoses with little detailed information on their demographics. The data in this study indicates a wide range in the interval from the antecedent pregnancy to diagnosis and confirms a close relationship between increasing incidence and rising maternal age.

Background: This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

Methods: Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

Results: B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

Conclusions: miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

Male foetuses have historically been perceived as more active than females, and foetal movement has been observed to be greater in male foetuses in late pregnancy. Nonstress tests (NSTs), a common form of antepartum assessment, rely on movement in their interpretation. To see if this difference could influence their interpretation, NSTs of patients undergoing clinically indicated testing at 36 weeks' gestation were evaluated. In this cross-sectional observational study, tests were compared between male and female foetuses for maternal indicators of foetal movement and heart rate characteristics including baseline, variability, and number of accelerations. Among 287 foetuses analysed, recordings of foetal movement and heart rate characteristics were similar between the two groups. The results suggest no difference in movement or NST parameters between males and females, and foetal sex should not affect NST interpretation.