Journal of Obstetrics and Gynaecology最新文献

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel minimal invasive technique which employs the vaginal orifice for surgical access, after which endoscopic instruments are introduced, thus obviating the need for any external skin incisions. This approach has gained traction as it is associated with reduced morbidity, improved cosmesis, lower pain scores and decreased length of hospital stay, with no increase in adverse events, when compared with conventional laparoscopic surgery. Initially limited to hysterectomy and adnexectomy, its role has now expanded to include indications such as urogynaecology, oncology and fertility. Clinicians wishing to implement vNOTES need to undergo appropriate training and appreciate judicious governance. Further randomised controlled trials will allow us to better understand if this newer technique will offer well-evidenced preferable outcomes and become the preferred surgical approach.

Background: To investigate the mechanism and prognostic value of LINC01094 in cervical cancer (CC).

Methods: This study included 113 patients with CC. Their cervical tumour tissues and tumour-free cervical tissues were collected, with patient follow-up for a five-year prognostic period. Reverse transcription-quantitative PCR (RT-qPCR) was used to identify LINC01094 and measure miR-1266-5p expression, Kaplan-Meier curves were used to predict patient survival, and multivariate Cox regression analysis revealed the factors affecting CC prognosis. A dual luciferase reporter (DLR) assay was performed to verify the targeting relationship of reciprocal genes. The Cell Counting Kit-8 (CCK8) assay was used to measure cell proliferation, and the Transwell recorded cell migration and invasion.

Results: Lower LINC01094 expression and higher level of miR-1266-5p expression were detected in-tumour tissues than in the tumour-free cervical tissues, with a negative correlation. Low LINC01094 expression, International Federation of Gynaecology and Obstetrics (FIGO) stage, and lymph node metastasis were identified as risk factors for CC prognosis, LINC01094 downregulation predicted higher patient mortality. The DLR assay identified miR-1266-5p as a possible target gene of LINC01094. Additional experiments revealed miR-1266-5p downregulation and decreased cell proliferation, migration and invasion of CC cells transfected with oe-LINC01094. These effects were restored after co-transfection with miR-mimic.

Conclusions: Low LINC01094 expression in patient with CC is a risk factor for prognosis. Overexpression of LINC01094 targeting miR-1266-5p prevents the progression of CC neoplasm.

Background: The relationship between dietary antioxidants and pelvic inflammatory disease (PID) remains poorly understood. This study aimed to investigate this association in US women using both observational data and Mendelian randomisation (MR) to assess causality.

Methods: We conducted a cross-sectional analysis of 4,003 women aged ≥20 from the National Health and Nutrition Examination Survey (2013-2018). The Composite Dietary Antioxidant Index (CDAI) was calculated from six dietary antioxidants. PID was self-reported. Multivariable logistic regression was used to assess the association between the CDAI and PID, with subgroup analyses to test robustness. Subsequently, a two-sample MR analysis using the inverse-variance weighted (IVW) method was performed to evaluate a potential causal link.

Results: The prevalence of PID was 5.6% (224/4,003). In the fully adjusted logistic regression model, a higher CDAI was associated with lower odds of PID (Odds Ratio [OR] 0.95, 95% Confidence Interval [CI] 0.92-0.99). Among individual components, higher zinc intake was also inversely associated with PID (OR 0.96, 95% CI 0.93-0.99, P = 0.037). The inverse association between the CDAI and PID was consistent across all subgroups. However, the MR analysis did not find a significant causal relationship between antioxidant levels and PID risk.

Conclusions: A higher dietary antioxidant intake, as measured by the CDAI, is associated with a lower prevalence of PID in US women. However, our MR findings do not support a causal role for individual antioxidants in the development of PID. Further longitudinal studies are warranted to enhance our understanding of the interactions between antioxidants and PID.

Prospective parallel genetic testing of both germline and tumour DNA in ovarian cancer patients (OC) is the recommended model in several different countries across the globe and the UK. The high (∼67%) chance of identifying germline PVs in patients with tumour PVs has led to a discourse surrounding the need for consent for tumour genetic testing in OC. We discussed with OC patients during focus group workshops, physicians, and charity representatives about consent options for tumour testing in OC patients: verbal consent prior to testing (Option 1) and reflex testing (Option 2). Most patients (97%; 33/34) did not feel that consent was required and were happy with reflex testing (Option 2). Physician consensus was that reflex testing was preferred and most charity representatives (4/5; 80%) agreed. All groups wanted an opt-out option and a patient information sheet about tumour testing. This can inform new recommendations in the UK and foster further discussions regarding consent for OC tumour testing.

Background: We investigated the relationship between immune cells and endometrial cancer by conducting a two-sample bidirectional Mendelian randomisation (MR) analysis.

Methods: MR uses genetic variation as an instrumental variable to study the causal effects of exposure on observed data outcomes. We conducted a dual-sample MR analysis to investigate the causal relationship between 731 immune cell phenotypes and endometrial cancer (EC). The weighted-median method and inverse variance weighted method MR were mainly used, and the p-value was corrected with the Benjamini-Hochberg procedure.

Results: The forward MR analysis revealed a causal relationship between EC and eight immune-cell phenotypes. The reverse MR analysis identified two immune-cell phenotypes with a potential causal effect on EC, with additional subtype-specific associations observed for endometrioid and non-endometrioid histology.

Conclusion: Our study demonstrated a causal relationship between immune cells and EC, thereby providing guidance for the development of future immunoregulatory therapeutic strategies.

Background: To investigate the occurrence of the persistent left superior vena cava (PLSVC) anomaly and evaluate its postpartum outcomes.

Methods: This retrospective analysis included 425 pregnant women carrying singleton foetuses diagnosed with PLSVC. Comprehensive data on maternal characteristics and postpartum outcomes were collected.

Results: Among the cohort, 307 foetuses (72.2%) were diagnosed with isolated PLSVC, while 118 (27.8%) presented with PLSVC in conjunction with other structural and/or chromosomal abnormalities. The cardiovascular system exhibited the highest incidence of malformations, followed by single umbilical artery (SUA), and abnormalities of the digestive and urinary systems. Foetuses with PLSVC and additional abnormalities had poorer outcomes. The most common cardiovascular abnormality was right heart enlargement, followed by ventricular septal defect (VSD) and either coarctation of the aorta (COA) or interrupted aortic arch (IAA).

Conclusions: Upon diagnosing PLSVC in a foetus, a thorough structural examination is essential. Particular attention should be paid to evaluating the cardiovascular system and identifying the presence of SUA. If associated malformations are detected, continuous monitoring of the right heart, ventricles, and aortic arch is advised to screen for complications such as right heart enlargement, VSD, COA, or IAA.

Background: The objective of this study was to explore the factors that influence overall survival in obese patients with endometrial cancer (EC).

Methods: The retrospective study included patients with EC who were treated between 2000 and April 2013. Subjects were divided into the following groups based on body mass index (BMI): non-obese (<24.0 kg/m²), overweight (24.0-28.0 kg/m²) and obese (>28.0 kg/m²). Survival data were estimated using Kaplan-Meier's curves and compared using log-rank statistics.

Results: A total of 280 cases were enrolled, including 22.5% in non-obese group, 42.9% in overweight group and 34.6% in obese group. Among different BMI groups, obese EC patients with diabetes have a lower survival rate (p = .041), and obese EC patients with menopause have a lower survival rate (p = .021). The survival rate of overweight EC patients was significantly reduced if vascular thrombus and lymph node metastasis were found during operation (p < .001).

Conclusions: Our data suggest that the association of obese EC patients with menstrual status, diabetes and intraoperative vasculature embolus and lymph node metastasis significantly affects postoperative survival. In all subjects, the relevant factors were independent prognostic factors in patients with obese.

Background: Maternal obesity is a growing global health concern, yet its impact on maternal haemodynamic throughout pregnancy remains underexplored. We investigated haemodynamic adaptations across gestation in women with high body mass index (BMI) (≥35 kg/m²) and results were compared to low-risk controls (BMI 18.5-24.9 kg/m²).

Methods: This prospective observational study used non-invasive cardiac output monitoring (NICOM; Baxter Healthcare, Deerfield, IL) to assess maternal haemodynamic parameters, including cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), systolic blood pressure (sBP) and mean arterial pressure (MAP) in pregnant women with high BMI. Assessments were carried out across five gestational windows (11-19 + 6, 20-27 + 6, 28-33 + 6, 34-37 + 6 and ≥38 weeks). Results were compared to low-risk healthy controls (BMI 18.5-24.9 kg/m²).

Results: A total of 329 women were recruited, including 125 with high BMI and 189 controls. Across all gestational windows, women with high BMI consistently demonstrated significantly higher CO and SV. Compared to controls, median CO was high among women with high BMI, at 11-19 + 6 weeks [8.8 L/min (IQR 7.2-9.9) versus 6.7 L/min (5.8-7.6); p < .001]; median SV was 104.2 mL (93.7-124.9) versus 81.9 mL (74.3-94.0) (p < .001). This trend persisted at later gestations. In contrast, median TPR was significantly lower in the high BMI group; at 28-33 + 6 weeks, 847 dyn·s·cm^-5 (unit of measurement of TPR: dynes·seconds per centimetre to the fifth power) (783-937) versus 1083 (924-1161) in the controls (p < .001). Despite reduced TPR, sBP and MAP were higher in women with high BMI throughout pregnancy. Heart rate (HR) and diastolic blood pressure (dBP) did not differ significantly between groups at any gestational window.

Conclusions: Pregnant women with high BMI have a distinctive haemodynamic profile characterised by high CO with a compensatory reduction in TPR. Further research is required to assess the risk of placental mediated diseases in that group.