Journal of Obstetrics and Gynaecology最新文献

Background: The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol.

Methods: We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate.

Results: Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, I² = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, I² = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, I² = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, I² = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, I² = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I² = 0%).

Conclusions: Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.

Background: This study aim to compare the proportion of pessary users reporting satisfaction with ultra-low dose oestriol and Lactobacillus vaginal tablets and vaginal moisturiser.

Methods: A randomised-controlled trial enrolled patients who were able to take care, insert, and remove a pessary themselves and did not use any local oestrogen or vaginal moisturiser for 3 months at a tertiary centre. Participants were randomised to receive either vaginal moisturisers or ultra-low-dose oestriol and Lactobacillus vaginal tablets for 2 months. A single-blinded evaluator assessed outcomes. The oestriol group received one vaginal tablet daily for 6 days followed by two tablets weekly for 8 weeks. The moisturiser group received one application every 3 days for 8 weeks. The primary outcome was the proportion of patients reporting high satisfaction, defined as 'very much improved' or 'much improved', using the Thai version of the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes were subjective and objective outcomes of vaginal health. Sixty patients were randomised, of whom one did not complete treatment.

Results: The majority of enrolled participants were postmenopausal women with a mean age of 65.54 years, mean BMI of 25.13 kg/m², and advanced-stage POP. The average duration of pessary use was 12-15 months. Patient satisfaction was not significantly different between the oestriol and moisturiser groups at 4 or 8 weeks (93.10% vs. 96.67%, P = 0.61 and 89.66% vs. 93.33%, P = 0.67, respectively). There were no serious adverse events.

Conclusions: Vaginal moisturisers and ultra-low-dose oestriol and Lactobacillus acidophilus vaginal tablets provided high satisfaction in pessary users. Both preparations were comparable in both subjective and objective outcomes.

Background: Vaginal preparation before transvaginal gynecological surgeries improves the success rate. However, there is no consensus on which agent is superior for transvaginal repair of vesicovaginal fistula (VVF). We aimed to compare irritation symptoms and antimicrobial function between sterile normal saline (SS) and 1% povidone-iodine (PI) for vaginal preparation in surgical repair of VVF.

Methods: This randomised, controlled trial was conducted on patients with VVF underwent transvaginal repair. Preoperative vaginal irrigation was randomly performed with either SS or 1% PI. The patients' self-reported symptoms questionnaires, including numerical rating scale (NRS) of pain, Indevus urgency severity scale (IUSS), and vaginal symptoms, tissue edoema degree and pathogenic microbiology were recorded.

Results: The study included 30 patients in the SS group and 31 patients in the PI group. After twice irrigations before surgery, compared with the PI group, the SS group had a similar count of bacterial species but a higher bacterial load (p = .079 and p = .033). The NRS of pain and IUSS in the SS group were lower than those in the PI group (p < .001). The SS group had less severe vaginal symptoms (p < .001) and tissue edoema (p < .001) than the PI group. The successful repair rates were 86.7% in the SS group and 83.9% in the PI group (p = .758). Patients with more severe urinary and vaginal symptoms had lower successful repair rates (92.3% vs. 72.7%, p = .047).

Conclusions: SS is an effective vaginal preparation liquid for transvaginal repair of VVF with less irritation symptoms and acceptable antimicrobial function.

Background: This study aimed to examine the alterations in apoptosis and autophagy in placental tissues from normal pregnancies compared to those affected by preeclampsia (PE) and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We analysed the expression of autophagy-associated proteins, Beclin-1 and BCL-2, in human placental tissues and assessed their variations in placentas from pregnancies complicated by PE and HELLP syndrome by immunohistochemical (IHC) and in silico analyses.

Methods: An experimental case-control study was performed, involving 40 pregnant women complicated with preeclampsia, 25 pregnant women with HELLP syndrome, and 40 healthy pregnant women. The placental sections were stained with BCL-2 and Beclin-1 immunostains and subjected to IHC examination. The results of the IHC staining were assessed using semi-quantitative analysis. In silico analyses were performed using STRING and Cytoscape software to construct protein interaction networks for BCL-2 and Beclin-1 in PE and HELLP syndrome, followed by Gene Ontology analysis of common interactors to identify significant biological pathways.

Results: Both BCL-2 expression was significantly decreased (p < 0.001 and p < 0.0001, respectively) and Beclin-1 staining was significantly increased (p < 0.0001 and p < 0.0001, respectively) in the PE group and HELLP group compared to the control group. The changes in BCL-2 and Beclin-1 expression between PE and the HELLP group were also statistically significant. BCL2 expression was notably lower (p < 0.0001), and Beclin-1 staining was significantly higher (p < 0.05) in the HELLP group compared to the PE group. In PE, BCL-2 interactors were enriched in apoptosis, cytokine production, and cell proliferation pathways, while Beclin-1 interactors were linked to autophagy and phosphatidylinositol-mediated signalling. In HELLP, BCL-2 interactors were involved in inflammatory response regulation, whereas Beclin-1 interactors were associated with vascular endothelial growth factor (VEGF) signalling and immune regulation.

Conclusions: The differential expression patterns of BCL-2 and Beclin-1 between the PE and HELLP groups suggest that these proteins play distinct roles in the pathophysiology of these conditions.

Background: A growing body of evidence indicates that the systemic immune-inflammation index (SII) is associated with the prognosis of cervical cancer (CC). However, its prognostic value remains controversial. This study aimed to comprehensively evaluate the performance of SII in predicting the prognosis of CC.

Methods: Studies on the prognostic potential of SII in CC were acquired from PubMed, Embase, Web of Science, and the Cochrane Library from database inception to July 4, 2024. Outcome measures included progression-free survival (PFS), overall survival (OS), relapse-free survival (RFS), and complete response (CR), which were expressed as hazard ratio (HR) and 95% confidence interval (CI). Sensitivity and subgroup analyses were carried out to evaluate the stability of results and identify potential sources of heterogeneity.

Results: Ten cohort studies involving 2007 patients were included in the meta-analysis. High SII levels were significantly associated with reduced OS (HR = 2.45; 95% CI: 1.56-3.86, p = 0.001), PFS (HR = 2.93; 95% CI: 1.88-4.58, p < 0.00001), and CR (HR = 0.23, 95% CI: 0.11-0.50; p = 0.0002) in patients with CC. Subgroup analyses suggested that SII was more effective in predicting outcomes in Asian patients with CC.

Conclusions: High SII levels are significantly associated with reduced OS, PFS, and CR in CC. Therefore, SII is a promising biomarker for predicting outcomes and informing treatment decisions for immunotherapy in CC.

Background: This study aimed to investigate the potential causal association between chronic hepatitis B (CHB) infection and the risk of pre-eclampsia/eclampsia using a Mendelian randomisation (MR) design.

Methods: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from three large-scale datasets. For CHB infection, we used data from 351,885 individuals UK Biobank. For pre‑eclampsia/eclampsia, we analysed two FinnGen datasets with sample sizes of 118,291 and 126,760 individuals, respectively. Genetic variants strongly associated with CHB infection (p < 5 × 10^-8) were selected as instrumental variables. The inverse-variance weighted (IVW) method was employed as the primary analysis. Sensitivity analyses included MR-Egger regression, weighted median, weighted mode and MR-PRESSO. Cochran's Q test and MR-Egger intercept tests were performed to assess heterogeneity and horizontal pleiotropy, respectively.

Results: MR analysis revealed significant positive genetic associations between CHB infection and increased risk of pre-eclampsia (OR = 1.154, 95%CI = 1.014-1.313, p = .029) and eclampsia (OR = 1.561, 95%CI = 1.030-2.366, p = .035). Findings were robust across sensitivity analyses for both outcomes.

Conclusions: Our study provides genetic evidence that CHB infection increases the risk of both pre-eclampsia and eclampsia. These findings suggest that considering CHB status as a risk factor and implementing targeted HBV screening programmes may be beneficial for pregnant women.

Bisphenol A and di-(2-ethylhexyl) phthalate are among the most widespread endocrine-disrupting chemicals (EDCs), widely present in consumer products and the environment. Preclinical studies have shown that these compounds and their metabolites may interfere with key reproductive processes, including folliculogenesis and steroidogenesis. However, translating these findings into clinical relevance remains challenging. Human studies have yielded conflicting results, with some suggesting associations between EDC levels and reduced ovarian reserve or poorer in vitro fertilisation outcomes, while others report no significant correlations. Differences in study design, population characteristics and exposure assessment contribute to this heterogeneity. Despite the current limitations, the topic warrants attention within reproductive medicine, particularly from a preventive perspective. While evidence remains inconclusive, raising awareness and considering lifestyle factors potentially linked to environmental exposures may be a reasonable step in clinical practice. Further studies are needed to clarify their clinical impact and to guide evidence-based reproductive care.

Background: Although most cases of endometrial cancer (EC) are diagnosed at an early stage with favourable outcomes, the prognosis for advanced or recurrent disease remains poor, highlighting the need for novel therapeutic targets. This study aimed to examine the correlation between Cyclin B1 (CCNB1) and Cyclin B2 (CCNB2) expression and disease severity in EC through bioinformatics analysis.

Methods: Common differentially expressed genes were identified in two EC cohorts from the Gene Expression Omnibus. A protein-protein interaction (PPI) network was constructed to identify hub genes. Aberrant expression of the hub genes was validated in external datasets. Their prognostic values were evaluated in a cohort from The Cancer Genome Atlas (TCGA). Knockdown of the hub genes was conducted to explore their functions in the malignant behaviour of EC cells in vitro.

Results: CCNB1 and CCNB2 were identified as the top 2 hub genes in the PPI network. High CCNB1/CCNB2 expression was significantly associated with shorter survival in EC patients. Overexpression of CCNB1/CCNB2 in endometrial tumour tissue was validated in public datasets. In TCGA cohort, high expression of CCNB1/CCNB2 correlated with greater disease severity and predicted poor prognosis. In addition, high expression of CCNB1/CCNB2 was strongly associated with immune cell infiltration, as well as increased expression of immune checkpoint genes and mismatch repair genes. Furthermore, knockdown of CCNB1/CCNB2 significantly suppressed the proliferation, migration, and invasion of HEC-1 and Ishikawa cells in vitro.

Conclusions: CCNB1 and CCNB2 may serve as potential prognostic markers and therapeutic targets for the management of EC.