Turkish Journal of Obstetrics and Gynecology最新文献

Objective: To assess the possible association of two single-nucleotide polymorphisms (SNPs), PD-1.3 (+7146G/A) and PD-1.5 (+7785C/T), with endometrial cancer (EC) susceptibility. In addition, the correlations between these SNPs and available clinicopathologic characteristics of patients with EC were investigated.

Materials and methods: In this case-control study, 147 women with pathologically confirmed EC and 258 age- and ethnically matched healthy women were enrolled between June 2019 and May 2022. Genomic DNA was extracted, and genotyping of PD-1.3 (+7146G/A) and PD-1.5 (+7785C/T) SNPs was performed. Haplotype analysis was also performed. Pearson's chi-square test with Yates correction was used to evaluate differences in allele and genotype distributions. The 95% confidence interval and odds ratio were determined using an unconditional logistic regression model.

Results: There were no remarkable differences in the allele and genotype distributions of PD-1.3 (rs11568821) and PD-1.5 (rs2227981) between healthy controls and EC patients. However, there was a remarkable difference in the AC haplotype between the control and EC groups. No association was found between the investigated SNPs and the clinicopathologic features of EC.

Conclusion: Our results indicated that the aforementioned SNPs were not related to the risk of EC in the southern Iranian population.

Objective: Endometriosis is associated with various symptoms, but their severity varies from case to case. In this study, we investigated the reality of symptoms presented by patients with clinically early-stage endometriosis-associated ovarian cancer (EAOC) and explored the relationship between symptoms and laboratory/imaging findings, pathological findings, and prognosis.

Materials and methods: This was a retrospective case-control study of patients who received initial surgical treatment and were diagnosed with clinically early-stage EAOC, including ovarian endometrioid carcinoma (OEC), ovarian clear cell carcinoma (OCCC), and seromucinous borderline tumor (SMBT). Patients with OEC/OCCC diagnosed between 2006 and 2016 and those with SMBT diagnosed between 2006 and 2020 were included. Chi-square and Kaplan-Meier estimates were used for statistical analyses.

Results: One hundred-seven patients (OEC, n=31; OCCC, n=39; SMBT, n=37) were included. Fifty-nine (55.1%) patients presented with symptoms, and the proportion of patients with OEC who presented with symptoms was significantly higher than that of others (OEC, 77.4%; OCCC, 43.6%; SMBT, 48.6%). The details of symptoms differed significantly among the pathological types (lower abdominal pain/abdominal discomfort/abnormal bleeding, OEC: 11/8/9; OCCC: 6/12/1; SMBT: 15/5/3). Only in the OEC group did symptomatic patients show significantly higher white blood cell (WBC) count and neutrophil/lymphocyte (N/L) ratio (symptomatic vs. asymptomatic, median: WBC count: 7250 vs. 5000, p=0.008; N/L ratio: 4.6 vs. 1.7, p=0.013). None of the asymptomatic patients showed recurrence during follow-up.

Conclusion: Patients with EAOC show varying symptoms depending on the histological type of the tumor. Laboratory findings underlying symptoms also vary by histopathological type, which may reflect differences in the carcinogenesis process.

Objective: One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II.

Materials and methods: In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups.

Results: Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02).

Conclusion: Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.

Objective: To predict lymphovascular space invasion (LVSI) positivity in early-stage (stage 1-2) endometrial cancer (EC) using a predictive model with prognostic factors of EC.

Materials and methods: We included 461 patients who underwent total hysterectomy and bilateral salpingo-oophorectomy with pelvic-paraaortic lymphadenectomy as the primary treatment for presumed early-stage EC at our clinic between 2010 and 2020. Moreover, all surgical specimens were examined histopathologically for the positivity or negativity of LVSI, and the patients were divided into two groups based on these pathologic outcomes. Age, menopausal status, histological type (type 1-2), histological grade (grades 1-2-3), depth of myometrial invasion, and peritoneal cytology results were recorded and analyzed as clinicopathological and demographic characteristics of the patients. The Loess algorithm determined the relationship between the observed and predicted outcomes. The distinction between the algorithms was evaluated by calculating the C-index.

Results: LVSI positivity was significantly associated with advanced age, menopause, type 2 EC, advanced histological grade, malignant peritoneal cytology, cervical involvement, and a tumor exceeding 50% of the myometrial depth (p<0.001, respectively). Remarkably, LVSI was most strongly associated with three explanatory variables: 1- More than 50% myometrial invasion [odds ratio (OR): 3.78; 95% confidence interval (CI): 1.80-7.60], 2- Advanced histological grade [OR=1.98 (1.20-3.20) 95% CI], 3- Malignant peritoneal cytology [OR= 3.06 (1.40-6.30) 95% CI]. The penalized maximum likelihood estimation model correctly classified 87% of the included patients (C-index: 0.876).

Conclusion: Our predictive model may help predict LVSI based on different prognostic factors. The prognostic factors included in the nomogram were significantly associated with LVSI, particularly myometrial invasion depth of more than 50%, advanced histological grade, and malignant peritoneal cytology.

Objective: The most common indications for Levonorgestrel intrauterine device (LNG-IUD) are contraception and management of abnormal uterine bleeding (AUB). This study was conducted with the aim of exploring the differences in the clinical profile and outcome of women using LNG-IUD for contraception and AUB.

Materials and methods: This was a retrospective comparative cross-sectional study of women who underwent LNG-IUD (52 mg) between 2012 and 2017. Their electronic health records were reviewed until the last documented follow-up or until December 2021.

Results: A total of 235 women had LNG-IUD with an age range of 21 to 62 years and a mean of (37.98 years±6.76). Of these women, 153/235 (65.1%) had it for contraception and 82/235 (34.89%) had it for AUB. The follow-up was 1-94 months with (mean ± SEM) follow-up for the AUB group of (21.48±2.31) months and for contraception group was (20.74±1.76) months (p-value of 0.80). There was a significant difference between the two groups in the age and body mass index (BMI), where women who had LNG-IUD for AUB were older (mean of 42.54±6.49 years, p-value <0.001) and had higher BMI (31.88±7.52 kg/m², p-value =0.011). All LNG-IUDs that were indicated for contraception were inserted in an outpatient setting. However, 68.3% in the AUB, the insertion was in the operating theater in conjunction with hysteroscopy. After combining both expulsion and removal of LNG-IUD during the follow-up period, there was no significant difference between the 2 groups in the overall retention rate during the follow-up (p-value =0.998).

Conclusion: this study shows that women using LNG-IUD for the management of AUB are older and have a higher BMI compared with those using it for contraception. AUB women experienced more expulsion compared with the contraception group, but there was no difference between the 2 groups in the overall survival/retention of LNG-IUD.

Objective: Our goal is to improve the understanding of human papillomavirus (HPV) and its vaccination among obstetrics and gynecology trainees and young specialists worldwide.

Materials and methods: This cross-sectional study was conducted through an online survey consisting of 28 questions by the World Association of Trainees in Obstetrics and Gynecology between February and August 2023. The questionnaire collected demographic data of the study participants and assessed the respondents' knowledge and perception of HPV, HPV vaccines, and vaccine dosing schedule.

Results: Two hundred five Ob/Gyn trainees and young Ob/Gyns from 52 countries completed the survey. The majority of respondents were trainees (158, 77.1%). Most trainees and young Ob/Gyns learned about HPV for the first time during medical school (149, 72.6%). Almost all (204, 99.5%) Ob/Gyns responded that HPV was sexually transmitted. More than half of the respondents had not received HPV vaccination (110, 53.7%). The vaccine was recommended for respondents mostly by their Ob/Gyn senior colleagues (110, 53.7%). Most of the respondents knew how to manage HPV-positive patients (179, 87.3%).

Conclusion: This study suggests that even though knowledge on HPV and its vaccination is satisfactory among trainees and young Ob/Gyns, HPV vaccination remains deficient. There is a need to understand, educate, and address the potential problem that lies underneath.

Objective: MCAM-1 (CD146) is an endothelial cell adhesion molecule belonging to the immunoglobulin superfamily. Recent studies have identified CD146 expression as a critical marker for tumor progression, migration, and metastasis in various malignancies. This study aimed to evaluate CD146 immunohistochemical expression in various gynecological cancers.

Materials and methods: This study was conducted in a tertiary medical center in central India. A total of 49 gynecological cancer cases and 16 site-matched controls were included. The cases comprised 27 cervical, 10 endometrial, 10 ovarian, and two miscellaneous cancers. CD146 immunohistochemistry was performed and assessed for immunoreactivity score (IRS), microvascular density (MVD), and microvascular caliber (MVC). An IRS of 5 or more was considered CD146 positive.

Results: The p-values for CD146 positivity for cases vs. control were 0.0531, 0.0580, and 0.007 for cervical, endometrial, and ovarian sites, respectively. The mean MVD was found to be significantly higher in cases compared with benign tissues (p-value <0.00001), and the mean MVC of cases was found to be smaller when compared with the controls (p-value <0.0001).

Conclusion: MVD by CD146 was found to be higher in gynecological malignancies, highlighting its role in cancer neo-angiogenesis and its potential therapeutic role. CD146 epithelial expression was also significantly higher in ovarian cancers. Further studies with a larger sample size are required to confirm that this protein may be a potential theognostic target in gynecological cancers.

Objective: The cause of implantation defects in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) has not been clearly established. We aimed to evaluate the immunohistochemical changes in HOXA-11, β1 integrin, focal adhesion kinase (FAK), cluster of differentiation 44 (CD44), and extracellular matrix protein 1 (ECM1) molecules during the receptive endometrial period in patients with RIF and RPL.

Materials and methods: This study was retrospectively conducted at a university hospital. After the exclusion of cases with pathology that may cause a change in the level of receptors in the endometrium, biopsies performed during the receptive period were selected, and the patients were categorized into RPL (n=15), RIF (n=16), control (n=16) groups. All preparations were immunohistochemically stained for HOXA-11, β1 integrin, FAK, CD44, and ECM1.

Results: HOXA-11 and β1 Integrin expression changes were similar between the RIF and control groups. However, FAK expression was significantly increased in the RIF group (p<0.01). Additionally, ECM1 and CD44 expressions were significantly decreased in the RIF group compared with the control group (p<0.01). There was no significant difference in the endometrial staining of HOXA-11, FAK, and ECM1 in patients with a history of RPL. However, β1 Integrin and CD44 levels were significantly decreased in the RPL group compared with the control group (p<0.05).

Conclusion: Implantation is a complex process, and altered adhesion mechanisms involved in endometrial receptivity may be related to defective implantation in patients with RIF and RPL. Among the adhesion molecules, the expression of CD44, β1 integrin, FAK, and ECM1 molecules varies in inappropriate implantation compared with the normal population.

Objective: The main aim of this study was to investigate the differences in maternal serum thiol/disulfide homeostasis among women with abortion imminens (AI), missed abortion (MA), and healthy pregnancies during the first trimester.

Materials and methods: This was a prospective case-control study. This study was conducted on pregnant women who visited the Obstetrics Clinic at University of Health Sciences Turkey, Etlik Zübeyde Hanım Gynecology Training and Research Hospital and were diagnosed with either AI or MA during the 6^th to 14^th weeks of pregnancy. The participants had a normal pregnancy follow-up, no chronic illnesses, and did not take any multivitamin or antioxidant supplements except for folic acid. The study incorporated 33 pregnant women with AI, 36 with MA, and 40 with normal pregnancies. Age, and body mass index were matched across the three groups. This study used a recently developed automated spectrophotometric technique to quantify thiol/disulfide concentrations.

Results: The AI group had considerably elevated levels of total thiol and native thiol (SH) compared with the MA group. Nevertheless, there was no notable disparity observed between the group of healthy pregnancies and the other two groups. Serum disulfide (SS) levels did not exhibit any significant variations among the three groups. Similarly, the ratios of SS/SH, SS/total thiol, and SH/total thiol did not show any significant differences between the groups (p>0.05).

Conclusion: Patients with MA had decreased levels of total thiol and SH, which possess antioxidant capabilities, compared to the AI group. A decrease in antioxidant levels in the body may contribute to the etiology of MA. When considering our findings alongside existing literature, it remains inconclusive whether the serum thiol-disulfide ratio can predict a healthy pregnancy or MA following AI. Therefore, it is not yet seen as a promising diagnostic tool for assessing pregnancy viability. Additional investigation is required to establish the influence of dynamic thiol/disulfide homeostasis on early pregnancy loss.