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β-Human Chorionic Gonadotropin Dynamics in Early Gestational Events: A Practical and Updated Reappraisal. 早期妊娠事件中的β-人绒毛膜促性腺激素动态:实用和最新的重新评估。
IF 1.9 Q2 Medicine Pub Date : 2024-03-07 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8351132
Demetrio Larraín, Javier Caradeux

In the last decade, the widespread use of transvaginal ultrasound and the availability of highly specific serum assays of human chorionic gonadotropin (hCG) have become mainstays in the evaluation of early pregnancy. These tests have revolutionized the management of pregnancies of unknown location and markedly reduced the morbidity and mortality associated with the misdiagnosis of ectopic pregnancy. However, despite several advances, their misuse and misinterpretations are still common, leading to an increased use of healthcare resources, patient misinformation, and anxiety. This narrative review aims to succinctly summarize the β-hCG dynamics in early gestation and provide general gynecologists a practical approach to patients with first-trimester symptomatic pregnancy.

近十年来,经阴道超声波的广泛应用和高特异性的人类绒毛膜促性腺激素(hCG)血清检测已成为评估早孕的主要方法。这些检测彻底改变了对位置不明妊娠的管理,并显著降低了因误诊宫外孕而导致的发病率和死亡率。然而,尽管取得了一些进步,这些检测方法的误用和误解仍很常见,导致医疗资源的使用增加、患者被误导和焦虑。这篇叙述性综述旨在简明扼要地总结妊娠早期β-hCG的动态变化,为普通妇科医生提供一种实用的方法来处理第一胎无症状妊娠患者。
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引用次数: 0
Demographics of Physician Associates (PAs) in Obstetrics and Gynecology: Where They Work and How They Compare to Other PAs. 妇产科助理医师(PA)的人口统计数据:他们的工作地点以及与其他助理医师的比较。
IF 1.9 Q2 Medicine Pub Date : 2024-02-21 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3057597
Melissa A Rodriguez, Roderick S Hooker, Kasey K Puckett, Andrzej Kozikowski

As of 2020, maternal and infant health in the US has worsened. At the same time, the number of health professionals available to manage female health issues is changing; the number of physicians in obstetrics and gynecology (Ob-Gyn) and midwives is decreasing, whereas the number of Ob-Gyn physician associates (PAs) is growing. We analyzed PAs practicing in the Ob-Gyn discipline, drawing on the PA Professional Profile, a database maintained by the National Commission on Certification of PAs. In 2021, there were 1,322 Ob-Gyn PAs (1.2% of all clinically active PAs). This health profession has grown by 66.9% since 2013, when only 792 PAs practiced in this specialty. As of 2021, their median age was 38, and 98.0% were female (70.1% of all PAs were female). The practice setting was between office (54.7%) and hospital (34.0%) employment, with 11.3% described as "other." In 2021, the median annual income of Ob-Gyn PAs was $105,000. With the reduction of obstetrician-gynecologists, the relative growth of PAs in this area of medicine and surgery is a natural part of the solution to the projected obstetrical physician deficit.

截至 2020 年,美国的母婴健康状况有所恶化。与此同时,可用于管理女性健康问题的医疗专业人员的数量也在发生变化;妇产科(Ob-Gyn)医生和助产士的数量正在减少,而妇产科助理医生(PA)的数量却在增加。我们利用国家助理医师认证委员会维护的数据库 "助理医师专业概况",对在妇产科执业的助理医师进行了分析。2021 年,共有 1,322 名妇产科助理医师(占所有临床活跃助理医师的 1.2%)。自 2013 年以来,这一健康专业的人数增长了 66.9%,当时只有 792 名助理医师从事这一专业。截至 2021 年,他们的年龄中位数为 38 岁,98.0% 为女性(女性占所有助理医师的 70.1%)。执业环境介于办公室(54.7%)和医院(34.0%)之间,11.3%被描述为 "其他"。2021 年,妇产科助理医师的年收入中位数为 105,000 美元。随着妇产科医生的减少,该医学和外科领域助理医师的相对增长是解决预计的产科医师短缺问题的一个自然组成部分。
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引用次数: 0
Characteristics of Serum Lipid Metabolism among Women Complicated with Hypertensive Disorders in Pregnancy: A Retrospective Cohort Study in Mainland China 妊娠期高血压并发症妇女血清脂质代谢的特征:中国大陆的一项回顾性队列研究
IF 1.9 Q2 Medicine Pub Date : 2024-02-14 DOI: 10.1155/2024/9070748
Lidong Liu, Xiaolei Zhang, Kai-gui Qin, Chengjie Xu, Fangyi Ruan, Yadan Liu, Huanqiang Zhao, Yinan Wang, Yu Xiong, Qiongjie Zhou, Xiaotian Li
Background. Altered maternal serum lipid metabolism is associated with hypertensive disorders in pregnancy (HDP). However, its range in pregnancy and characteristic among different subgroups of HDPs are unclear. Methods. Pregnant women with HDP who underwent antenatal care and delivered in Obstetrics and Gynecology Hospital of Fudan University during January 2018 to August 2022 were enrolled. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), apolipoprotein (Apo)-A, B, and E, free fatty acids (FFA), and small and dense low-density lipoprotein cholesterol (sdLDL) were measured during 4–16 weeks and 28–42 weeks of pregnancy. Results. A total of 2648 pregnant women were diagnosed with HDP, 1,880 of whom were enrolled for final analysis, including 983 (52.3%) preeclampsia (PE), 676 (36.0%) gestational hypertension (GH), and 221 (11.7%) chronic hypertension (CH). For all HDPs, serum TC, TG, LDLC, HDLC, Apo-A, Apo-B, Apo-E, and sdLDL increased significantly during pregnancy, while FFA decreased significantly. Notably, the levels of TC, LDLC, Apo-B, and sdLDL in PE group were equal to or lower than those in CH group at 4–16 weeks of pregnancy, but increased greatly during pregnancy (P<0.05). Conclusions. Maternal serum lipid levels changed through pregnancy among women with HDPs. Women complicated with PE seem to have undergone a more significant serum lipid change compared to those with GH or CH.
背景。母体血清脂质代谢改变与妊娠期高血压疾病(HDP)有关。然而,其在妊娠期的范围以及不同亚组 HDP 的特征尚不清楚。研究方法纳入2018年1月至2022年8月期间在复旦大学附属妇产科医院接受产前检查并分娩的HDP孕妇。分别在妊娠4-16周和28-42周测量总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo)-A、B和E、游离脂肪酸(FFA)以及小密度和高密度低密度脂蛋白胆固醇(sdLDL)的水平。结果共有 2648 名孕妇被诊断为 HDP,其中 1,880 名被纳入最终分析,包括 983 名(52.3%)子痫前期(PE)、676 名(36.0%)妊娠高血压(GH)和 221 名(11.7%)慢性高血压(CH)。在所有 HDPs 中,血清 TC、TG、LDLC、HDLC、载脂蛋白 A、载脂蛋白 B、载脂蛋白 E 和 sdLDL 在妊娠期间显著增加,而 FFA 则显著下降。值得注意的是,PE 组的 TC、LDLC、载脂蛋白-B 和 sdLDL 水平在妊娠 4-16 周时与 CH 组持平或更低,但在妊娠期间大幅升高(P<0.05)。结论患有 HDPs 的孕妇血清脂质水平在妊娠期间会发生变化。与 GH 或 CH 患者相比,合并 PE 的女性血清脂质变化似乎更为显著。
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引用次数: 0
Characteristics of Serum Lipid Metabolism among Women Complicated with Hypertensive Disorders in Pregnancy: A Retrospective Cohort Study in Mainland China 妊娠期高血压并发症妇女血清脂质代谢的特征:中国大陆的一项回顾性队列研究
IF 1.9 Q2 Medicine Pub Date : 2024-02-14 DOI: 10.1155/2024/9070748
Lidong Liu, Xiaolei Zhang, Kai-gui Qin, Chengjie Xu, Fangyi Ruan, Yadan Liu, Huanqiang Zhao, Yinan Wang, Yu Xiong, Qiongjie Zhou, Xiaotian Li
Background. Altered maternal serum lipid metabolism is associated with hypertensive disorders in pregnancy (HDP). However, its range in pregnancy and characteristic among different subgroups of HDPs are unclear. Methods. Pregnant women with HDP who underwent antenatal care and delivered in Obstetrics and Gynecology Hospital of Fudan University during January 2018 to August 2022 were enrolled. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), apolipoprotein (Apo)-A, B, and E, free fatty acids (FFA), and small and dense low-density lipoprotein cholesterol (sdLDL) were measured during 4–16 weeks and 28–42 weeks of pregnancy. Results. A total of 2648 pregnant women were diagnosed with HDP, 1,880 of whom were enrolled for final analysis, including 983 (52.3%) preeclampsia (PE), 676 (36.0%) gestational hypertension (GH), and 221 (11.7%) chronic hypertension (CH). For all HDPs, serum TC, TG, LDLC, HDLC, Apo-A, Apo-B, Apo-E, and sdLDL increased significantly during pregnancy, while FFA decreased significantly. Notably, the levels of TC, LDLC, Apo-B, and sdLDL in PE group were equal to or lower than those in CH group at 4–16 weeks of pregnancy, but increased greatly during pregnancy (P<0.05). Conclusions. Maternal serum lipid levels changed through pregnancy among women with HDPs. Women complicated with PE seem to have undergone a more significant serum lipid change compared to those with GH or CH.
背景。母体血清脂质代谢改变与妊娠期高血压疾病(HDP)有关。然而,其在妊娠期的范围以及不同亚组 HDP 的特征尚不清楚。研究方法纳入2018年1月至2022年8月期间在复旦大学附属妇产科医院接受产前检查并分娩的HDP孕妇。分别在妊娠4-16周和28-42周测量总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo)-A、B和E、游离脂肪酸(FFA)以及小密度和高密度低密度脂蛋白胆固醇(sdLDL)的水平。结果共有 2648 名孕妇被诊断为 HDP,其中 1,880 名被纳入最终分析,包括 983 名(52.3%)子痫前期(PE)、676 名(36.0%)妊娠高血压(GH)和 221 名(11.7%)慢性高血压(CH)。在所有 HDPs 中,血清 TC、TG、LDLC、HDLC、载脂蛋白 A、载脂蛋白 B、载脂蛋白 E 和 sdLDL 在妊娠期间显著增加,而 FFA 则显著下降。值得注意的是,PE 组的 TC、LDLC、载脂蛋白-B 和 sdLDL 水平在妊娠 4-16 周时与 CH 组持平或更低,但在妊娠期间大幅升高(P<0.05)。结论患有 HDPs 的孕妇血清脂质水平在妊娠期间会发生变化。与 GH 或 CH 患者相比,合并 PE 的女性血清脂质变化似乎更为显著。
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引用次数: 0
Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study 采用 PROMPT 对肩难产中永久性臂丛神经损伤和 III°/IV° 撕裂的影响:汉诺威队列研究
IF 1.9 Q2 Medicine Pub Date : 2024-02-03 DOI: 10.1155/2024/8712553
Spyridon Papageorgiou, Lars Brodowski, Halina Huppertz, Bettina Bohnhorst, M. Flentje, Constantin von Kaisenberg
Objective. To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears. Design. A prospective/retrospective cohort study. Setting. Hanover Medical School, Germany. Population/Sample. A self-selected population. Methods. The training period is from November 9th, 2017, until December 31st, 2019; control: January 1st, 2004, until November 8th, 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia. Results. There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts’ manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p<0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions. PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.
目的验证 PROMPT 可减少永久性臂丛神经麻痹和会阴撕裂的假设。设计。前瞻性/回顾性队列研究。地点: 德国汉诺威医学院。德国汉诺威医学院。人群/样本。自选人群。方法。培训时间为 2017 年 11 月 9 日至 2019 年 12 月 31 日;对照组:2004年1月1日至2017年11月8日。主要结果测量指标。肩难产、非永久性和永久性臂丛神经损伤(BPI)、会阴撕裂 III°/IV°、人工操作和窒息。结果。共有 22,640 例分娩,肩难产从 48/18,031 例(0.27%)增加到 23/4,609 例(0.50%)((P=0.017),OR:1.88,95% CI:(1.14; 3.09)),而臂丛神经损伤从 7/48 例(14.6%)减少到 1/23 例(4.3%)(P=0.261)。之前有 1/7 例(14.2%)永久性 BPI,之后则为 0/1 例(0%)。围产期窒息从 3/48 (6.3%) 增加到 4/23 (17.4%)(P=0.23)。然而,一年后的不良后果为零。麦克罗伯茨手法从 37/48 (77.1%) 增加到 23/23 (100%)((p=0.013),OR:1.62,95% CI:(1.33; 1.98)),内旋手法和人工拔出后臂从 6/48 (12.5%) 增加到 5/23 (21.7%)(p=0.319)。外阴切开术从5,267/18,031(29.2%)减少到836/4,609(18.1%)((p<0.001),OR:0.54,95% CI:(0.49,0.58)),而与肩难产相关的会阴撕裂III°/IV°从1/48(2.1%)增加到1/23(4.8%)(p=0.546)。阴道手术分娩率保持不变(6.5% 对 7%)。结论:PROMPTPROMPT能明显改善肩难产的处理,减少永久性臂丛神经损伤,但不能减少III°/IV°会阴撕裂。
{"title":"Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study","authors":"Spyridon Papageorgiou, Lars Brodowski, Halina Huppertz, Bettina Bohnhorst, M. Flentje, Constantin von Kaisenberg","doi":"10.1155/2024/8712553","DOIUrl":"https://doi.org/10.1155/2024/8712553","url":null,"abstract":"Objective. To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears. Design. A prospective/retrospective cohort study. Setting. Hanover Medical School, Germany. Population/Sample. A self-selected population. Methods. The training period is from November 9th, 2017, until December 31st, 2019; control: January 1st, 2004, until November 8th, 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia. Results. There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts’ manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p<0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions. PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139683257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic Test of Transforming Growth Factor-Beta 1 (TGF-β1) in Menstrual Blood with Endometriosis. 子宫内膜异位症经血中转化生长因子-β1 (TGF-β1) 的诊断测试。
IF 1.9 Q2 Medicine Pub Date : 2023-12-11 eCollection Date: 2023-01-01 DOI: 10.1155/2023/9970818
Kemas Yusuf Effendi, Excellena Nasrul, Iskandar Zulqarnain, Theodorus, Rizani Amran, Heriyadi Manan, Adnan Abadi, Fatimah Usman, Cindy Kesty

Background: Endometriosis is a benign disorder that is generally defined as the presence of endometrial glands and stroma outside their normal location. TGF-β1 is found in stromal cells and its expression is increased in epithelial cells of endometriotic cysts. Endometriosis diagnostics take a long time, so new markers are needed to diagnose endometriosis. This study aims to determine the diagnostic value of TGF-β1 in menstrual blood in diagnosing endometriosis.

Method: Diagnostic tests to compare eutopic endometrial TGF-β1 levels from menstrual blood of patients with suspected endometriosis were undertaken in the Obstetrics and Gynecology Department of Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, from July 2019 to November 2020. 50 patients who were suspected with endometriosis met the inclusion criteria. Comparison of TGF-β1 levels between endometriosis and nonendometriosis patients was analyzed using the Mann-Whitney test. The cutoff point of the TGF-β1 level towards the histopathological outcome was obtained using the ROC curve. Data analysis was performed by using SPSS version 22.0.

Results: In this study, endometriosis patients were 31.6 ± 6.55 years of age with a range of 20 to 46 years. In statistical analysis, there was no difference in BMI (p = 0.181) and BMI classification (p = 0.207), the history of contraception (p = 0.097), infertility (p = 1.000), and dysmenorrhoea (p = 1.000) between endometriosis and nonendometriosis patients. In the study, there were differences in TGF-β1 between endometriosis and nonendometriosis patients (p ≤ 0.001). By using the ROC curve, the cutoff point for TGF-β1 levels has the best sensitivity and specificity, which is 515 ng/ml. The TGF-β1 level has a sensitivity of 80%, a specificity of 90%, a positive predictive value (PPV) of 0.969, a negative predictive value (NPV) of 0.529, a positive likelihood ratio of 8, a negative likelihood ratio of 0.222, and an accuracy of 0.820 to the endometriosis outcome.

Conclusion: It can be concluded that the TGF-β1 level has a very good diagnostic value in establishing endometriosis diagnostics. This trial is registered with ISRCTN72218532.

背景:子宫内膜异位症是一种良性疾病:子宫内膜异位症是一种良性疾病,一般是指子宫内膜腺体和基质出现在其正常位置之外。TGF-β1存在于基质细胞中,在子宫内膜异位囊肿的上皮细胞中表达增加。子宫内膜异位症的诊断需要很长时间,因此需要新的标记物来诊断子宫内膜异位症。本研究旨在确定经血中的 TGF-β1 在诊断子宫内膜异位症中的诊断价值:方法:2019 年 7 月至 2020 年 11 月,在巴伦邦斯里维加亚大学医学院 Mohammad Hoesin 博士综合医院妇产科对疑似子宫内膜异位症患者经血中的异位子宫内膜 TGF-β1 水平进行诊断性检测比较。50名疑似子宫内膜异位症患者符合纳入标准。子宫内膜异位症患者与非子宫内膜异位症患者的 TGF-β1 水平比较采用 Mann-Whitney 检验法进行分析。利用 ROC 曲线得出 TGF-β1 水平与组织病理学结果的临界点。数据分析采用 SPSS 22.0 版:本研究中,子宫内膜异位症患者的年龄为(31.6±6.55)岁,范围在 20 至 46 岁之间。在统计分析中,子宫内膜异位症患者与非子宫内膜异位症患者在体重指数(P = 0.181)和体重指数分类(P = 0.207)、避孕史(P = 0.097)、不孕症(P = 1.000)和痛经(P = 1.000)方面没有差异。在研究中,子宫内膜异位症和非子宫内膜异位症患者的 TGF-β1 存在差异(p ≤ 0.001)。根据 ROC 曲线,TGF-β1 水平的临界点具有最佳的灵敏度和特异性,即 515 ng/ml。TGF-β1水平对子宫内膜异位症结果的敏感性为80%,特异性为90%,阳性预测值(PPV)为0.969,阴性预测值(NPV)为0.529,阳性似然比为8,阴性似然比为0.222,准确性为0.820:结论:TGF-β1水平在子宫内膜异位症诊断中具有很好的诊断价值。该试验已在 ISRCTN72218532 上注册。
{"title":"Diagnostic Test of <i>Transforming Growth Factor-Beta</i> 1 (TGF-<i>β</i>1) in Menstrual Blood with Endometriosis.","authors":"Kemas Yusuf Effendi, Excellena Nasrul, Iskandar Zulqarnain, Theodorus, Rizani Amran, Heriyadi Manan, Adnan Abadi, Fatimah Usman, Cindy Kesty","doi":"10.1155/2023/9970818","DOIUrl":"10.1155/2023/9970818","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a benign disorder that is generally defined as the presence of endometrial glands and stroma outside their normal location. TGF-<i>β</i>1 is found in stromal cells and its expression is increased in epithelial cells of endometriotic cysts. Endometriosis diagnostics take a long time, so new markers are needed to diagnose endometriosis. This study aims to determine the diagnostic value of TGF-<i>β</i>1 in menstrual blood in diagnosing endometriosis.</p><p><strong>Method: </strong>Diagnostic tests to compare eutopic endometrial TGF-<i>β</i>1 levels from menstrual blood of patients with suspected endometriosis were undertaken in the Obstetrics and Gynecology Department of Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, from July 2019 to November 2020. 50 patients who were suspected with endometriosis met the inclusion criteria. Comparison of TGF-<i>β</i>1 levels between endometriosis and nonendometriosis patients was analyzed using the Mann-Whitney test. The cutoff point of the TGF-<i>β</i>1 level towards the histopathological outcome was obtained using the ROC curve. Data analysis was performed by using SPSS version 22.0.</p><p><strong>Results: </strong>In this study, endometriosis patients were 31.6 ± 6.55 years of age with a range of 20 to 46 years. In statistical analysis, there was no difference in BMI (<i>p</i> = 0.181) and BMI classification (<i>p</i> = 0.207), the history of contraception (<i>p</i> = 0.097), infertility (<i>p</i> = 1.000), and dysmenorrhoea (<i>p</i> = 1.000) between endometriosis and nonendometriosis patients. In the study, there were differences in TGF-<i>β</i>1 between endometriosis and nonendometriosis patients (<i>p</i> ≤ 0.001). By using the ROC curve, the cutoff point for TGF-<i>β</i>1 levels has the best sensitivity and specificity, which is 515 ng/ml. The TGF-<i>β</i>1 level has a sensitivity of 80%, a specificity of 90%, a positive predictive value (PPV) of 0.969, a negative predictive value (NPV) of 0.529, a positive likelihood ratio of 8, a negative likelihood ratio of 0.222, and an accuracy of 0.820 to the endometriosis outcome.</p><p><strong>Conclusion: </strong>It can be concluded that the TGF-<i>β</i>1 level has a very good diagnostic value in establishing endometriosis diagnostics. This trial is registered with ISRCTN72218532.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10728358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138797674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Melatonin Ameliorates Ovarian Hyperstimulation Syndrome (OHSS) through SESN2 Regulated Antiapoptosis. 褪黑素通过SESN2调节的抗细胞凋亡改善卵巢过度刺激综合征(OHSS)。
IF 1.9 Q2 Medicine Pub Date : 2023-10-28 eCollection Date: 2023-01-01 DOI: 10.1155/2023/1121227
Min Zheng, Mei Liu, Cong Zhang

Background: Ovarian hyperstimulation syndrome (OHSS) is one of the most severe complications after ovarian stimulation during assisted reproductive technology (ART). However, its pathogenesis still remains unclear. Melatonin is an important antioxidant factor in female reproduction and Sestrin-2 (SESN2) is reported to be involved in cellular response to different stress conditions. Whether or not melatonin and SESN2 are involved in OHSS is still a question to us clinicians.

Methods and results: We collected the granulosa cells of OHSS patients and focused on the role of SESN2 in OHSS. We also studied the role and mechanism of melatonin plays in OHSS patients. We found that the expression of SESN2 was increased in the granulosa cells of OHSS patients (n = 24) than those in controls (n = 15). Incubation with angiotensin II (1 μM, 2 μM) in HUVECs and H2O2 (0.1 mM, 0.2 mM) in KGNs increased the generation of ROS concurrent with the increased expression of SESN2, while melatonin treatment partly restored SESN2 levels. The mechanism study demonstrated that SESN2 was deeply involved in the regulation of AMPK and mTOR, whereas melatonin partially restored angiotensin II or H2O2 induced the activation of AMPK phosphorylation and the inhibition of mTOR, 4EBP1 and S6K1 phosphorylation, all of which could trigger cell apoptosis.

Conclusions: These findings indicated that melatonin attenuated ROS-induced apoptosis through SESN2-AMPK-mTOR in OHSS. Thus, melatonin is likely to be a potential and important therapeutic agent for treating and preventing OHSS.

背景:卵巢过度刺激综合征(OHSS)是辅助生殖技术(ART)中卵巢刺激后最严重的并发症之一。然而,其发病机制仍不清楚。褪黑激素是女性生殖中的一种重要抗氧化因子,据报道Sestrin-2(SESN2)参与了细胞对不同应激条件的反应。褪黑素和SESN2是否参与OHSS仍然是我们临床医生的一个问题。方法和结果:我们收集了OHSS患者的颗粒细胞,并重点研究SESN2在OHSS中的作用。我们还研究了褪黑激素在OHSS患者中的作用及其机制。我们发现SESN2在OHSS患者颗粒细胞中的表达增加(n = 24)比对照组(n = 15) 。与血管紧张素II(1 μM,2 μM)和H2O2(0.1 mM,0.2 mM)增加ROS的产生同时增加SESN2的表达,而褪黑素处理部分恢复SESN2水平。机制研究表明,SESN2深度参与AMPK和mTOR的调节,而褪黑素部分恢复血管紧张素II或H2O2诱导AMPK磷酸化的激活和mTOR、4EBP1和S6K1磷酸化的抑制,所有这些都可以触发细胞凋亡。结论:这些发现表明褪黑素通过SESN2 AMPK mTOR在OHSS中减弱ROS诱导的细胞凋亡。因此,褪黑素可能是治疗和预防OHSS的一种潜在而重要的治疗剂。
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引用次数: 0
Comparing Surgical and Oncological Outcomes between Indocyanine Green (ICG) Sentinel Lymph Node Mapping with Routine Lymphadenectomy in the Surgical Staging of Early-Stage Endometrioid Endometrial Cancer. Indocyanine Green(ICG)前哨淋巴结标测与常规淋巴结切除术在早期子宫内膜样子宫内膜癌症手术分期中的手术和肿瘤结果比较。
IF 1.9 Q2 Medicine Pub Date : 2023-10-17 eCollection Date: 2023-01-01 DOI: 10.1155/2023/9949604
Krystal Miao Lin Koh, Zheng Yuan Ng, Felicia Hui Xian Chin, Wai Loong Wong, Junjie Wang, Yong Kuei Lim

Methods: A retrospective single-centre cohort study of patients with early-stage endometrioid endometrial cancer undergoing staging surgery (total hysterectomy, bilateral salpingo-oophorectomy with/without pelvic lymph node, and/or para-aortic lymph node dissection (PLND)) with either SLN mapping or routine lymphadenectomy between July 2017 and December 2018.

Results: 203 cases with clinical and radiological International Federation of Gynaecology and Obstetrics (FIGO) stage I endometrioid endometrial cancer were included, out of which 109 cases underwent SLN mapping and 94 cases complete lymphadenectomy. Compared to the PLND group, the SLN group had shorter operative time (129 vs. 162 minutes), less blood loss (100 vs. 300 ml), and decreased length of postoperative hospital stay (3 vs. 4 days) (p < 0.001). The lymph node metastases detection rate was 4.6% and 7.4% for the SLN and PLND groups, respectively (p = 0.389). With a median follow-up of 14 months for the SLN and 15 months for the PLND group, the disease-free (DFS) and overall survival (OS) were comparable for both at 13 months (p = 0.538 and p = 0.333, respectively).

Conclusion: SLN mapping has been shown to be an acceptable alternative to routine lymphadenectomy in the surgical staging of early-stage endometrial cancer in our centre, with a comparable lymph node metastases detection rate, DFS and OS, and reduction in operative morbidity. Our results with SLN mapping reproduce comparable outcomes to those reported in the literature.

方法:2017年7月至2018年12月,对早期子宫内膜样子宫内膜癌症患者进行回顾性单中心队列研究,这些患者接受分期手术(全子宫切除术、双侧输卵管-卵巢切除术,带/不带盆腔淋巴结和/或皮质旁淋巴结清扫术(PLND)),并进行SLN标测或常规淋巴结清扫纳入国际妇产科联合会(FIGO)I期癌症,其中109例进行SLN标测,94例完成淋巴结切除术。与PLND组相比,SLN组的手术时间更短(129比162 分钟),减少失血(100 vs.300 ml),术后住院时间缩短(3比4 天)(p<0.001)。SLN组和PLND组的淋巴结转移检出率分别为4.6%和7.4%(p=0.389)。中位随访14 SLN的月数和15 PLND组的无病生存期(DFS)和总生存期(OS)在13个月时具有可比性 结论:在我们中心早期癌症的手术分期中,SLN标测已被证明是常规淋巴结切除术的一种可接受的替代方法,具有相当的淋巴结转移检测率、DFS和OS,并降低了手术发病率。我们的SLN标测结果与文献中报道的结果相当。
{"title":"Comparing Surgical and Oncological Outcomes between Indocyanine Green (ICG) Sentinel Lymph Node Mapping with Routine Lymphadenectomy in the Surgical Staging of Early-Stage Endometrioid Endometrial Cancer.","authors":"Krystal Miao Lin Koh,&nbsp;Zheng Yuan Ng,&nbsp;Felicia Hui Xian Chin,&nbsp;Wai Loong Wong,&nbsp;Junjie Wang,&nbsp;Yong Kuei Lim","doi":"10.1155/2023/9949604","DOIUrl":"10.1155/2023/9949604","url":null,"abstract":"<p><strong>Methods: </strong>A retrospective single-centre cohort study of patients with early-stage endometrioid endometrial cancer undergoing staging surgery (total hysterectomy, bilateral salpingo-oophorectomy with/without pelvic lymph node, and/or para-aortic lymph node dissection (PLND)) with either SLN mapping or routine lymphadenectomy between July 2017 and December 2018.</p><p><strong>Results: </strong>203 cases with clinical and radiological International Federation of Gynaecology and Obstetrics (FIGO) stage I endometrioid endometrial cancer were included, out of which 109 cases underwent SLN mapping and 94 cases complete lymphadenectomy. Compared to the PLND group, the SLN group had shorter operative time (129 vs. 162 minutes), less blood loss (100 vs. 300 ml), and decreased length of postoperative hospital stay (3 vs. 4 days) (<i>p</i> < 0.001). The lymph node metastases detection rate was 4.6% and 7.4% for the SLN and PLND groups, respectively (<i>p</i> = 0.389). With a median follow-up of 14 months for the SLN and 15 months for the PLND group, the disease-free (DFS) and overall survival (OS) were comparable for both at 13 months (<i>p</i> = 0.538 and <i>p</i> = 0.333, respectively).</p><p><strong>Conclusion: </strong>SLN mapping has been shown to be an acceptable alternative to routine lymphadenectomy in the surgical staging of early-stage endometrial cancer in our centre, with a comparable lymph node metastases detection rate, DFS and OS, and reduction in operative morbidity. Our results with SLN mapping reproduce comparable outcomes to those reported in the literature.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50162381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pregnancies in Women with a Previous Complete Uterine Rupture. 曾发生子宫完全破裂的妇女怀孕。
IF 1.6 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-02-09 eCollection Date: 2023-01-01 DOI: 10.1155/2023/9056489
Iqbal Al-Zirqi, Siri Vangen

Objective: To study the outcomes of new pregnancies after a previous complete uterine rupture.

Design: Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities.

Method: We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described.

Results: Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta.

Conclusion: The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.

目的研究子宫完全破裂后新妊娠的结果:描述性研究基于挪威出生医学登记处、患者管理系统和医疗记录中的人口数据。样本。1967-2011年间挪威曾发生子宫完全破裂的产妇(N = 72),从2 455 797名产妇中抽取:我们测量了新的子宫完全破裂和部分破裂率,以及这些妊娠的产妇和围产期结局。结果:在 72 例产妇中,有 1 例完全破裂,1 例部分破裂:结果:在 72 名产妇中,有 37 名曾在下段(LS)发生过破裂,35 名在 LS 以外。我们发现了 3 例新的完全破裂和 6 例不严重的部分破裂,破裂率分别为 4.2% 和 8.3%。所有三例完全破裂都发生在 LS 外侧疤痕的早产期。曾在LS内发生过破裂的产妇的新发完全破裂率为0%,曾在LS外发生过破裂的产妇的新发完全破裂率为8.6%。经校正的围产期死亡率为 1.3%,早产率为 1.5%:曾发生子宫完全破裂的孕妇预后良好。早产是产科医生和母亲焦虑造成的问题;因此,分娩时机的选择是最具挑战性的。处理方法应包括仔细咨询、警惕症状,以及在怀疑子宫破裂时立即分娩。
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引用次数: 0
Prevalence, Management, and Impact of Dysmenorrhea on the Lives of Nurse and Midwife Trainees in Northern Ghana. 痛经的流行、管理和对加纳北部护士和助产士学员生活的影响。
IF 1.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/8823525
Abubakari Wuni, Brenda Abena Nyarko, Mudasir Mohammed Ibrahim, Issahaka Abdulai Baako, Iddrisu Sisala Mohammed, Camillus Buunaaisie

Background: Dysmenorrhea is the most common gynecological problem affecting the majority of female students in the nursing profession today. They often experience severe pain that is not only incapacitating but also has a significant impact on their day-to-day college life, academic, and clinical performance.

Aim: This study was conducted to assess the prevalence, management, and impact of dysmenorrhea on the lives of nurse and midwife trainees in northern Ghana.

Methods: A descriptive cross-sectional design with a quantitative approach to data collection was employed to collect data from nurse and midwife trainees in three colleges of nursing and/or midwifery in the northern region of Ghana. A proportionate stratified random sampling technique was used to recruit 303 respondents for the study. After gaining permission from various institutions, data were collected by using a structured questionnaire from 13th September to 28th October, 2022. Stata (special edition) for Windows version 17.0 was used for the statistical analyses.

Results: The study revealed a high prevalence of dysmenorrhea among female nursing students (66.7% and 95% CI: 0.611-0.720). More than half of the respondents (67.3%) experienced loss of appetite for food. The most common site of most intense pain was the pelvis and lower abdomen (98.0%). A greater proportion of students (65.8%) used antispastic drugs to reduce pain. The respondents' concentration in the classroom was greatly affected (77.2%) as well as normal physical activities (58.4%). A multivariable logistic regression analysis revealed that the odds of dysmenorrhea are 2.67 times higher when the duration of menstruation is 4-5 days (AOR = 1.82, 95% CI = 1.13-6.28, and p = 0.024) than a duration of 1-3 days. Having urinary tract infections was associated with 3.56 times higher odds of dysmenorrhea (AOR = 3.56, 95% CI = 0.98-12.86, and p = 0.053). Again, the odds of dysmenorrhea were also four times higher among respondents with a family history of the same condition (AOR = 4.05, 95% CI = 2.16-7.61, and p = 0.001).

Conclusion: The current study revealed a high prevalence of dysmenorrhea among nurse and midwife trainees in the northern part of Ghana. The majority of the respondent experienced loss of appetite and intense pain in the pelvis and lower abdomen, and their concentration during lectures was also significantly affected. The most predominant nonpharmacological method used for reducing the pain was sleep and the application of warm objects on the abdomen.

背景:痛经是当今影响大多数护理专业女学生的最常见妇科问题。他们经常经历严重的疼痛,这不仅使他们丧失能力,而且对他们的日常大学生活、学业和临床表现也有重大影响。目的:本研究旨在评估加纳北部护士和助产士培训生痛经的患病率、管理和影响。方法:采用描述性横断面设计和定量数据收集方法,从加纳北部地区三所护理和/或助产学院的护士和助产士学员中收集数据。采用比例分层随机抽样技术,共招募303名调查对象。在获得各机构的许可后,于2022年9月13日至10月28日通过结构化问卷收集数据。统计分析采用Windows 17.0版本的Stata (special edition)软件。结果:护生女生痛经发生率较高(66.7%,95% CI: 0.611 ~ 0.720)。超过一半的受访者(67.3%)经历过食欲不振。最常见的剧烈疼痛部位是骨盆和下腹部(98.0%)。使用抗痉挛药物减轻疼痛的学生比例更高(65.8%)。调查对象在课堂上的注意力(77.2%)和正常的身体活动(58.4%)受到很大影响。多变量logistic回归分析显示,月经持续时间为4 ~ 5天的患者发生痛经的几率是月经持续时间为1 ~ 3天的患者的2.67倍(AOR = 1.82, 95% CI = 1.13 ~ 6.28, p = 0.024)。尿路感染与痛经发生率高3.56倍相关(AOR = 3.56, 95% CI = 0.98-12.86, p = 0.053)。同样,有相同家族史的受访者患痛经的几率也高出四倍(AOR = 4.05, 95% CI = 2.16-7.61, p = 0.001)。结论:目前的研究显示痛经在加纳北部的护士和助产士培训生中非常普遍。大多数受访者经历了食欲不振,骨盆和下腹部剧烈疼痛,他们在讲课时的注意力也受到了显著影响。用于减轻疼痛的最主要的非药物方法是睡眠和在腹部敷暖物。
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引用次数: 0
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Obstetrics and Gynecology International
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