Obstetrics and Gynecology Science最新文献

Objective: Office hysteroscopy (OH) is widely used to diagnose and manage intrauterine pathologies. However, pain remains the primary factor that contributes to OH failure. This study aimed to assess the effect of virtual reality (VR) on pain reduction during OH.

Methods: A prospective randomized controlled clinical trial was conducted at a university hospital between July and November 2024. The study involved 50 women undergoing OH randomly allocated to receive immersive VR videos during the procedure or standard care. The main outcome measure was self-reported intraoperative pain evaluated using a numerical rating scale. Other measures included satisfaction, duration, and success of the procedure.

Results: Mean pain scores were 6.16±1.86 in standard care group and 4.88±1.69 in VR group (difference, 1.28; 95% confidence interval [CI], 0.27 to 2.29; P=0.014). After adjusting for other variables, no statistically significant relationship was found between VR and severe pain (odds ratio, 0.75; 95% CI, 0.15 to 3.87; P=0.73); only severe anxiety in women and procedure duration were associated with severe pain.

Conclusion: Virtual reality did not significantly reduce pain severity during hysteroscopy. However, severe pain was associated with high anxiety and a longer procedure duration. These findings suggest that VR may not effectively mitigate severe pain, whereas managing anxiety and minimizing procedure time could be more effective strategies.

Objective: BReast CAncer (BRCA) gene mutations increase the risk of epithelial ovarian and fallopian tube cancers. Genetic counseling and screening play a crucial role in identifying individuals at risk. Assessing knowledge, attitudes, and practices (KAP) related to BRCA mutations among family members of affected individuals can assist in early detection and preventive strategies. This study aims to evaluate KAP among family members of patients with these cancers to identify gaps and improve awareness.

Methods: A cross-sectional survey was conducted between March and November 2024, involving 215 participants with a family history of epithelial ovarian or fallopian tube cancer. Data were collected through structured interviews.

Results: The mean age of participants was 47.3 years; 42.8% were single and 44.2% were nulliparous. Most participants (65.6%) had one affected relative, with 86.5% being first-degree relatives. Only 16.3% had heard of BRCA mutations and 18.2% were aware of their association with ovarian cancer. The most commonly recognized ovarian cancer symptom was abdominal swelling. The highest mean KAP score was associated with the belief that regular pelvic examinations should be performed. Multivariate analysis identified independent factors influencing the desire for BRCA screening, including an attitude score of ≥25 (adjusted odds ratio [AOR], 12.638; P<0.001), follow-up duration of >5 years (AOR, 2.504; P=0.016), and ongoing or ineffective treatment (AOR, 4.303; P<0.001).

Conclusion: Substantial gaps in KAP regarding BRCA mutations persist among family members of affected individuals. Targeted educational interventions and healthcare initiatives are essential to enhance awareness and support informed decision-making in high-risk populations.

Artificial intelligence (AI) and machine learning (ML) are transforming cervical cancer research and offering advancements in diagnosis, prognosis, screening, and treatment. This review explores ML applications with particular emphasis on prediction models. A comprehensive literature search identified studies using ML for survival prediction, risk assessment, and treatment optimization. ML-driven prognostic models integrate clinical, histopathological, and genomic data to improve survival prediction and patient stratification. Screening methods, including deep-learning-based cytology analysis and human papillomavirus detection, enhance accuracy and efficiency. ML-driven imaging techniques facilitate early and precise cancer diagnosis, while risk prediction models assess susceptibility based on demographic and genetic factors. AI also optimizes treatment planning by predicting therapeutic responses and guiding personalized interventions. Despite significant progress, challenges remain regarding data availability, model interpretability, and clinical implementation. Standardized datasets, external validation, and cross-disciplinary collaborations are crucial for implementing ML innovations in clinical settings. Subsequent investigations should prioritize joint initiatives among data scientists, healthcare providers, and health authorities to translate AI innovations into real-world applications and to enhance the impact of ML on cervical cancer care. By synthesizing recent developments, this review highlights the potential of ML to improve clinical outcomes and shaping the future of cervical cancer management.

Objective: Random blood glucose (rBG) levels are commonly measured in Japan; however, no standardized cutoff values exist for glucose tolerance screening in early pregnancy. The contribution of glycated hemoglobin (HbA1c) and glycated albumin (GA) measurements to the diagnosis of gestational diabetes mellitus (GDM) remains unclear. Therefore, we aimed to evaluate the significance of these glycemic indicators in early pregnancy for predicting GDM.

Methods: This observational cohort study enrolled pregnant women who underwent initial prenatal examinations to determine their rBG, HbA1c, and GA levels at a rural maternity facility. Clinical data were retrospectively reviewed.

Results: A total of 449 patients were analyzed, comprising 394 with normal glucose tolerance (NGT) and 55 with GDM. The rBG, HbA1c, and GA levels were significantly higher during early pregnancy in women who developed GDM than in those with NGT. Receiver operating characteristic curve analysis revealed that the areas under the curve (AUC) for rBG, HbA1c, and GA were 0.733, 0.591, and 0.608, respectively, with cutoff values of 100 mg/dL, 5.2%, and 14.6%, respectively. These cutoff values had sensitivities of 52.7%, 70.9%, and 36.4% and specificities of 87.6%, 43.4%, and 82.5%, respectively. The product of rBG and HbA1c levels demonstrated improved performance, with an AUC of 0.750, cutoff value of 509, 63.6% sensitivity, and 83.5% specificity.

Conclusion: Glucose tolerance screening in early pregnancy using an rBG level of 100 mg/dL and an HbA1c level of 5.2% as cutoff values may help identify high-risk cases and enable early diagnosis of GDM.

Objective: Fertility preservation is vital for adolescent and young adult (AYA) cancer patients. Sperm cryobanking is a key option, but age-related factors influencing its efficiency remain unclear. This study evaluated the impact of age on cryobanking attempts, success rates, and disposition outcomes among AYA patients with cancer aged 11-25 years.

Methods: We retrospectively analyzed 298 AYA patients with cancer referred for fertility preservation counseling over 9 years. Data on cryobanking attempts, success rates, and disposition outcomes were stratified by age group (11-15, 16-20, and 21-25 years). Logistic regression was used to assess factors influencing these outcomes.

Results: The mean age was 16.0 years, with leukemia (22.5%), sarcoma (22.1%), and lymphoma (17.1%) being the most common diagnoses. Among the cohort, 72.1% attempted cryobanking, with lower attempt rates in the youngest group (59.6%) compared to 82.2% and 88.2% in the older groups, respectively. Younger age was a significant predictor of not attempting cryobanking (adjusted odds ratio, 5.059; P=0.001); however, age did not affect the success of sperm cryobanking among patients who attempted it. Disposition analysis showed that 77.2% of samples remained in storage, while 16.2% were discarded; although disposal was often influenced by family decisions, no significant predictors of disposal were identified.

Conclusion: Younger patients are less likely to attempt sperm cryobanking, although success rates among those who do are comparable across age groups. While most patients continued storage, higher disposal rates in younger groups highlight the need for strategies to increase participation and support informed decision-making.

Objective: In this study, we developed a novel detection strategy based on volatile organic compound (VOC) sensing. Persistent infection by human papillomavirus (HPV) may cause biological changes in the cervical epithelium, leading to VOC production.

Methods: This study included 200 urine samples from cervical cancer patients and controls that were HPV-negative. Urine samples were collected and measured using a gas sensor array composed of a matrix of 10 sensors. For each analyzed sample, the instrument produced a vector signal encoding the VOC emitted from the urine (urine prints). The urine prints of cervical cancer patients were differentiated from those of healthy controls.

Results: Identification of VOC for cervical cancer detection showed reliable accuracy (91% sensitivity, 85% specificity, and 89% accuracy).

Conclusion: Our.

Results: demonstrated the applicability of VOC sensing for cervical cancer detection and its potential application in treatment monitoring.

This systematic review and meta-analysis of randomized controlled trials (RCTs) assessed the effect of L-carnitine (LC) supplementation on the fertility outcomes of patients with polycystic ovary syndrome (PCOS). Online databases (Scopus, Web of Science, Cochrane Library, EMBASE, and PubMed) were searched to identify eligible RCTs published until March 2024. A dose-response meta-analysis was performed using a random-effects model. Meta-regression was also performed to investigate the source of heterogeneity based on the LC dose and duration of treatment. The pooled analysis included eight RCTs with 1,046 participants. The LC-treated group had significantly increased chemical and clinical pregnancy rates, ovulation rate, progesterone levels, number of preovulatory follicles >17 mm in diameter, and endometrial thickness compared to the untreated groups. The meta-analysis model indicated that LC supplementation did not change the serum levels of estrogen and testosterone; however, the dose-response meta-analysis indicated that prolonged LC intake significantly increased estrogen levels. LC supplementation has significant effects on fertility outcomes of women with PCOS. Additional large-scale longer RCTs are required to confirm the findings of this study.

Objective: Placenta accreta spectrum (PAS) is a leading cause of massive obstetric hemorrhage, particularly when the placenta is removed or unintentionally disrupted during cesarean hysterectomy. In this video, we demonstrate an alternative surgical approach via the posterior vaginal fornix for performing cesarean hysterectomy in patients with PAS.

Methods: A cesarean hysterectomy for a case of placenta percreta was performed using the posterior vaginal fornix approach. This technique focuses on avoiding bleeding due to placental disruption and preventing urinary bladder injury.

Results: We summarize the steps of the procedure, including ligation of the vascular pedicles, entry into the retroperitoneal space to identify vital structures and control bleeding, dissection along avascular plane to delineate organ borders, and posterior culdotomy followed by en bloc uterine amputation to avoid urinary bladder injury and minimize blood loss.

Conclusion: The posterior vaginal fornix approach for cesarean hysterectomy in patients with PAS is an effective technique for minimizing bleeding from the highly vascular placental area. Additionally, it offers the advantage of reducing the risk of unintentional urinary bladder injury, thereby improving surgical outcomes in these challenging cases.

Objective: This study aimed to evaluate the effects of narrowband ultraviolet B (UVB) irradiation on bone and muscle health in postmenopausal women.

Methods: A randomized controlled trial was conducted involving 70 postmenopausal women with vitamin D deficiency (<20 ng/mL) and osteopenia. Participants were randomly assigned to two groups. For 6 months, 35 postmenopausal women in study group A received three weekly sessions of narrowband UVB therapy and vitamin D supplements in the form of 100,000 international unit (IU) cholecalciferol weekly as loading therapy for 8 weeks. This was followed by the daily administration of cholecalciferol 3,000 IU as maintenance therapy for 16 weeks. The control group B consisted of 35 postmenopausal women who were administered vitamin D supplements alone for 6 months. Enzyme-linked immuno sorbent assay kits were used to test the serum levels of 25-hydroxyvitamin D (25(OH)D), dual-energy X-ray absorptiometry (DEXA) (DMS, Occitanie, France) was used to test the bone mineral density of the lumbar spine and right femur, and a Biodex System 3 (Biodex Medical Systems Inc., Shirley, NY, USA) isokinetic dynamometer was used to assess the peak torque of the extensors and flexors of the dominant knee.

Results: Serum 25(OH)D levels (P=0.000), Lumbar T-score (P=0.008), femoral T-score (P=0.002), and knee extensor peak torque (P=0.030) significantly increased in both groups after 6 months of treatment, favoring study group A over the control group B.

Conclusion: Narrowband UVB combined with vitamin D3 supplementation is more effective than vitamin D supplementation alone.