Obstetrics and Gynecology Science最新文献

Placental Hofbauer cells (HBCs) are specialized macrophages present in the human placenta that play a crucial role in maintaining a healthy pregnancy. These cells are derived from the fetal mesoderm and are responsible for various functions, including immune regulation, angiogenesis, and nutrient transport. In normal pregnancies, HBCs primarily exhibit an M2 or immunomodulatory phenotype, which helps maintain a tolerant and antiinflammatory environment at the maternal-fetal interface. However, in pregnancies complicated by conditions such as immunological disorders, inflammation, or infection, the phenotype and function of HBCs may be altered. Although emerging evidence has highlighted the vital role of HBCs in both normal pregnancies and those with complications, such as chorioamnionitis, gestational diabetes, preeclampsia, and viral infections, their role remains unclear. Recent research also suggests a relationship between HBCs and the development of diseases in offspring. Understanding the role of HBCs in pregnancy could provide insights into the pathophysiology of various pregnancy-related disorders and offer potential therapeutic targets for improving maternal and fetal outcomes. This review explores the functions of HBCs in normal pregnancy and their involvement in complications, emphasizing their potential as biomarkers or targets for interventions aimed at reducing the incidence of adverse pregnancy outcomes. Additionally, we reviewed their potential for perinatal research in recent studies.

Objective: To evaluate the diagnostic utility and limitations of routine p16 and Ki-67 immunohistochemistry (IHC) in detecting high-grade squamous intraepithelial lesions (HSILs) in the uterine cervix.

Methods: We reviewed 2,061 cervical biopsy records, including 271 morphologically indeterminate squamous lesions, evaluated using p16/Ki-67 IHC for HSIL detection or exclusion. HSIL was diagnosed based on p16 positivity and a high Ki-67 labeling index (Ki-LI). In cases that remained inconclusive after IHC, follow-up histological and/or cytological outcomes were assessed.

Results: p16/Ki-67 IHC established a definitive diagnosis of either HSIL or non-HSIL in 74.2% (201/271) of morphologically indeterminate cases, whereas 25.8% (70/271) remained inconclusive. p16/Ki-67 IHC contributed to diagnosing 120 HSIL cases, representing 11.9% (120/1,011) of all HSILs cases and 44.3% (120/271) of morphologically indeterminate cases. Among the 70 inconclusive cases, 58 had available follow-up data, of which 22 were subsequently diagnosed with HSIL, including 12 within 1 month of the initial biopsy. HSIL outcomes were more frequent in cases with suspicious HSIL on the initial biopsy (66.7% [12/18]). Based on the p16/Ki-LI status observed in the initial biopsy, patients with HSIL outcomes were categorized into three groups: p16-positive/low Ki-LI (54.2% [13/24]), p16-negative/high Ki-LI (50.0% [5/10]), and p16-negative/low Ki-LI (16.7% [4/24]). Multiple comparisons revealed a significant difference between the p16-positive/low Ki-LI and p16-negative/low Ki-LI groups (Benjamini-Yekutieli adjusted P=0.0435), while other comparisons were not significant.

Conclusion: p16/Ki-67 IHC significantly improved the diagnostic performance for HSIL. In cases that remain inconclusive after IHC, IHC-based risk stratification offers a valuable approach for surveillance, thus mitigating delays in HSIL diagnosis.

Gynecological cancer is a life-threatening malignancy among women. Traditional therapies, including chemotherapy, often face challenges in terms of chemotherapeutic drug solubility and resistance, specificity, tumor site targeting, and toxicity to healthy tissues, leading to shortened efficacy and unfavorable patient outcomes and survival rates in patients with gynecologic malignancies. Recently, nanotechnology-based therapeutic methods such as targeted drug delivery and phototherapies have emerged as an appropriate alternative to overcome issues associated with traditional therapeutic methods. Specifically, nanomaterials and nanomaterial-based methods enhance the delivery of therapeutic/targeting agents to tumor sites and cellular uptakes and improve the tumor-suppressing effect. This review aims to provide an overview and future perspective on the potential impact of nanotechnology-based therapeutic methods for effective therapies for gynecologic cancer.

Objective: To evaluate the incidence of sentinel lymph node (SLN) metastasis observed in patients with presumed low- and intermediate-risk endometrial cancer (EC) and change in stage and adjuvant therapy resulting from SLN analysis. Secondary objectives include assessing the rates of detection of SLN using indocyanine green (ICG) dye and complication rates.

Methods: Between March 2017 and December 2023, 210 patients were included in the study. A total of 412 SLNs were detected in 210 patients using intracervical ICG dye injections.

Results: The pathologically confirmed detection rate was >95%. A total of 25 (11.9%) patients exhibited positive sentinel metastasis detected through pathological and immunohistochemical analysis, with isolated tumor cell in 5 (2.4%), micro-metastasis in 6 (2.9%), and macro-metastasis in 14 (6.7%) patients. SLN metastasis with micro- and macro-metastases changed to stage III; therefore, adjuvant therapy was administered in the form of chemotherapy and radiation therapy. Of the 210 patients, 186 (88.5%) remained at low and intermediate risk after the final histopathological analysis. The other 24 patients exhibited SLN metastasis, high-grade EC, higher-stage detection, or high risk on molecular profiling.

Conclusion: A change in stage was observed in 11.9% of patients, and adjuvant therapy was administered to 20 patients, of whom 16 received adjuvant therapy based solely on SLN involvement (in the form of micro- and macro-metastasis), thus preventing undertreatment. Overtreatment was reduced in six patients who were classified as high-grade and non-endometrioid types with SLN metastases.

Objective: To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia.

Methods: This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated.

Results: The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (hemoglobin ≥12 g/dL) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs.

Conclusion: In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.

Objective: The performance of large language models (LLMs) and their potential utility in obstetric and gynecological education are topics of ongoing debate. This study aimed to contribute to this discussion by examining the recent advancements in LLM technology and their transformative potential in artificial intelligence.

Methods: This study assessed the performance of generative pre-trained transformer (GPT)-3.5 and -4 in understanding clinical information, as well as its potential implications for obstetric and gynecological education. Obstetrics and gynecology residents at three hospitals underwent an annual promotional examination, from which 116 of the 170 questions over 4 years (2020-2023) were analyzed, excluding 54 questions with images. The scores achieved by GPT-3.5, -4, and the 100 residents were compared.

Results: The average scores across all 4 years for GPT-3.5 and -4 were 38.79 (standard deviation [SD], 5.65) and 79.31 (SD, 3.67), respectively. For groups first-year resident, second-year resident, and third-year resident, the cumulative annual average scores were 79.12 (SD, 9.00), 80.95 (SD, 5.86), and 83.60 (SD, 6.82), respectively. No statistically significant differences were observed between the scores of GPT-4.0 and those of the residents. When analyzing questions specific to obstetrics, the average scores for GPT-3.5 and -4.0 were 33.44 (SD, 10.18) and 90.22 (SD, 7.68), respectively.

Conclusion: GPT-4 demonstrated exceptional performance in obstetrics, different types of data interpretation, and problem solving, showcasing the potential utility of LLMs in these areas. However, acknowledging the constraints of LLMs is crucial and their utilization should augment human expertise and discernment.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI).

Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported.

Conclusion: In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women.

Methods: Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled twice a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer, sexual function was examined using the female sexual function index (FSFI), and QoL was assessed through the menopause-specific quality of life questionnaire (MENQOL).

Results: The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05).

Conclusion: Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.