AJOG global reports最新文献_第7页

Heart failure in pregnancy and postpartum: a nationwide study over 6.3 million of pregnancies in France between 2010 and 2018 妊娠期和产后心力衰竭：一项2010年至2018年期间法国630多万例妊娠的全国性研究

AJOG global reports

Pub Date : 2025-06-22 DOI: 10.1016/j.xagr.2025.100540

Amélie Gabet PhD , Lise Legrand MD , Richard Isnard MD, PhD , Françoise Pousset MD , Jacques Blacher MD, PhD , Valérie Olié PhD

Background

Cardiovascular diseases became the first cause of maternal death in France, but only scarce epidemiological data have been published about heart failure (HF) in pregnancy/postpartum.

Objective

The aim of the present study was to describe the epidemiology of HF in pregnancy or until 6 weeks postpartum in France.

Study Design

This is an observational cohort study. Using the French National Health Insurance Information System database (Système National des Données de Santé), all women who gave birth in France after 22 weeks of gestation between January 1, 2010, and December 31, 2018, were selected. HF hospitalizations occurring during the pregnancies or 6 weeks postpartum were identified.

Results

On 6293,367 deliveries analyzed, 2241 (35.6/100,000) had at least one hospitalization for HF. This rate remained quite stable between 2010 and 2018. A total of 22.6% of these cases had heart disease history, including HF before pregnancy, and 49.0% had preceding or concomitant heart disease. Compared to women without HF, those with HF were older (32.0 [6.1] vs 29.9 [5.3] years), had more frequently multiple pregnancy (14.6% vs 1.7%), history of medically assisted reproduction (7.9% vs 3.2%), cardiovascular risk factors (arterial hypertension [17.0% vs 1.7%], gestational diabetes [15.5% vs 9.6%], obesity [14.9% vs 4.7%], tobacco smoking [12.4% vs 9.4%]), and had a lower socio-economic level with 23.4% living in the French most deprived area against 18.1% living in the least deprived area. The most frequent cardiac condition found were cardiomyopathy (29.5%), arrhythmias (14.0%), and valvulopathy (8.5%). The rate of pre-eclampsia reached 29.4% in pregnancies with HF against 2.0% in pregnancies without HF. Fetal complications were much higher in pregnancies with HF than without HF, with 11.5% vs 0.9% very/extremely preterm birth, and 5.3% vs 0.8% fetus/child death. One year after delivery, maternal death was observed in 2.2% of women with HF against <0.01% in those without HF.

Conclusion

Despite occurring in only 1 in 2808 pregnancies, HF during pregnancy or the postpartum period has a significant impact on maternal and fetal outcomes.

背景：心血管疾病已成为法国孕产妇死亡的第一大原因，但关于妊娠/产后心力衰竭（HF）的流行病学数据很少。目的本研究的目的是描述法国妊娠期或产后6周前HF的流行病学。研究设计：这是一项观察性队列研究。使用法国国家健康保险信息系统数据库（system National des donnsam），选择了2010年1月1日至2018年12月31日期间在法国怀孕22周后分娩的所有妇女。在怀孕期间或产后6周发生HF住院。结果6293,367例分娩中，2241例（35.6/10万）至少有一次HF住院。这一比率在2010年至2018年期间保持相当稳定。这些病例中有22.6%有心脏病史，包括妊娠前心衰，49.0%有既往或合并心脏病。与无心衰妇女相比，心衰妇女年龄较大（32.0[6.1]对29.9[5.3]岁），多胎妊娠发生率较高（14.6%对1.7%），有医学辅助生殖史（7.9%对3.2%），有心血管危险因素（动脉高血压[17.0%对1.7%]，妊娠糖尿病[15.5%对9.6%]，肥胖[14.9%对4.7%]，吸烟[12.4%对9.4%]），社会经济水平较低，23.4%的人生活在法国最贫困地区，18.1%的人生活在最贫困地区。最常见的心脏疾病是心肌病（29.5%）、心律失常（14.0%）和瓣膜病（8.5%）。妊高征先兆子痫的发生率为29.4%，而非妊高征的发生率为2.0%。心衰妊娠的胎儿并发症比无心衰妊娠的胎儿并发症要高得多，重度早产11.5% vs 0.9%，胎儿/儿童死亡5.3% vs 0.8%。分娩一年后，2.2%的心衰妇女出现产妇死亡，而非心衰妇女的死亡率为0.01%。结论妊娠期及产后心力衰竭发生率仅为1 / 2808，但对母胎结局有显著影响。

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引用次数: 0

Sexual behavior and its influencing factors among Uruguayan adolescents: a cross-sectional study 乌拉圭青少年性行为及其影响因素：一项横断面研究

AJOG global reports

Pub Date : 2025-06-19 DOI: 10.1016/j.xagr.2025.100538

Tonmoy Alam Shuvo MSc, Kabir Hossain MSc, Arifur Rahman MSc

Background

This study aimed to investigate the factors influencing adolescent sexual behavior in Uruguay, with a focus on socio-demographics, substance use, psychological distress, and protective factors.

Methods

We analyzed data from the 2019 Uruguay Global School-based Student Health Survey (GSHS). Chi-square tests identified variables significantly associated with sexual behavior. Mixed-effects logistic regression models estimated odds ratios, and a fully adjusted model provided adjusted odds ratios for all significant factors. All analyses were performed using R programming.

Result

Our analysis included a total of 2495 participants. Older adolescents (≥15 years) had a significantly higher likelihood of engaging in sexual behavior (AOR: 3.69, 95% confidence intervals [CI]: 2.92–4.66). Tobacco (AOR: 2.60, 95% CI: 1.91–3.55) and alcohol use (AOR: 2.09, 95% CI: 1.71–2.56) were strong risk factors, along with alcohol-related behavioral issues (AOR: 2.08, 95% CI: 1.65–2.62). Anxiety (AOR: 1.51, 95% CI: 1.09–2.08) and involvement in physical fights (AOR: 1.84, 95% CI: 1.42–2.40) increased the odds, while loneliness showed a protective effect (AOR: 0.62, 95% CI: 0.46–0.83). Parental bonding (OR: 0.54, 95% CI: 0.45–0.65), attachment (OR: 0.70, 95% CI: 0.59–0.82), and supervision (OR: 0.64, 95% CI: 0.54–0.77) showed significant effects before adjustment, but after adjustment, they became insignificant. Sedentary behavior reduced the likelihood, while truancy increased the possibility of sexual behavior among adolescents.

Conclusion

Interventions should aim to reduce adolescent sexual risk behaviors by promoting healthy practices and addressing factors such as substance use, mental health, and parental involvement to encourage safer sexual behaviors.

本研究旨在调查影响乌拉圭青少年性行为的因素，重点关注社会人口统计学、物质使用、心理困扰和保护因素。方法分析2019年乌拉圭全球校本学生健康调查（GSHS）数据。卡方检验确定了与性行为显著相关的变量。混合效应logistic回归模型估计优势比，完全校正模型提供所有显著因素的校正优势比。所有分析均使用R编程进行。结果共纳入2495名参与者。年龄较大的青少年（≥15岁）发生性行为的可能性显著较高（AOR: 3.69, 95%可信区间[CI]: 2.92-4.66）。吸烟（AOR: 2.60, 95% CI: 1.91-3.55）和饮酒（AOR: 2.09, 95% CI: 1.71-2.56）以及与酒精相关的行为问题（AOR: 2.08, 95% CI: 1.65-2.62）是很强的危险因素。焦虑（AOR: 1.51, 95% CI: 1.09-2.08）和参与身体斗争（AOR: 1.84, 95% CI: 1.42-2.40）增加了患病几率，而孤独显示出保护作用（AOR: 0.62, 95% CI: 0.46-0.83）。调整前，亲代亲和（OR: 0.54, 95% CI: 0.45-0.65）、依恋（OR: 0.70, 95% CI: 0.59-0.82）和监管（OR: 0.64, 95% CI: 0.54 - 0.77）的影响显著，调整后，影响不显著。久坐的行为降低了发生性行为的可能性，而旷课则增加了青少年发生性行为的可能性。结论干预措施应旨在通过促进健康行为，解决药物使用、心理健康和父母参与等因素，以鼓励更安全的性行为，从而降低青少年的性风险行为。

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引用次数: 0

Corrigendum to ‘Safety of quadrivalent recombinant influenza vaccine in pregnant persons and their infants’ [AJOG Global Reports Volume 4, Issue 4, November 2024, 100395] “四价重组流感疫苗对孕妇及其婴儿的安全性”的更正[AJOG全球报告第4卷，第4期，2024年11月，100395]

AJOG global reports

Pub Date : 2025-06-17 DOI: 10.1016/j.xagr.2025.100536

Amber Hsiao PhD, MPH , Arnold Yee MBA , Ruvim Izikson MD, MPH , Bruce Fireman MA , John Hansen MPH , Ned Lewis MPH , Sonja Gandhi-Banga PhD , Alexandre Selmani PhD , Oxana Talanova MD, MPH , Heidi Kabler MD , Ajinkya Inamdar MBBS, MS, MBA , Nicola P. Klein MD, PhD

引用次数: 0

Communicating uncertainty with perinatal counseling: a randomized controlled trial of a multimodal curriculum for obstetrical trainees 与围产期咨询沟通不确定性：产科实习生多模式课程的随机对照试验

AJOG global reports

Pub Date : 2025-06-13 DOI: 10.1016/j.xagr.2025.100535

Melissa Spiel DO , Eve M. Roth MD , Allison A. Merz-Herrala MD , Anna Modest PhD, MPH , Brett C. Young MD

Background

Effective communication of uncertain prognoses is a critical skill in obstetrics. Yet few curricula exist to prepare graduate medical education trainees for these high-stakes conversations.

Objective

To design and evaluate a multimodal curriculum for improving obstetric trainees' communication skills when conveying uncertain prognoses.

Methods

In this blinded, randomized controlled trial, obstetrics residents at an academic medical center were assigned to either a standard didactic session or an intervention group receiving a structured, multimodal curriculum. The intervention included a reading assignment on the SPIKES protocol and physician empathy, an instructional video, and facilitated small-group discussion. Two weeks post-intervention, all participants engaged in a standardized patient encounter simulating a periviable diagnosis of preterm prelabor rupture of membranes. Communication performance was assessed using a structured rubric, and stress levels before and after the encounter.

Results

Twenty-three obstetric trainees completed the study. The intervention group demonstrated significantly higher communication scores (mean score 19.5 vs 15.5; P=.02) and greater use of patient-centered techniques such as acknowledging anxiety and minimizing jargon. They also reported lower stress levels during the simulation (mean 3.2 vs 4.0 on a 5-point scale, P=.003). Post-intervention surveys revealed improved comfort with delivering complex prognoses and responding to emotional cues.

Conclusion

This structured SPIKES-based curriculum significantly enhanced obstetric trainees’ communication performance and confidence in simulated counseling scenarios involving uncertain prognoses. The curriculum is feasible for integration into graduate medical education and aligns with ACGME communication competencies. These findings support broader implementation of structured communication training in obstetrics to improve both learner outcomes and patient-centered care.

对不确定的预后进行有效的沟通是产科的一项关键技能。然而，很少有课程能让医学教育的毕业生为这些高风险的对话做好准备。目的设计并评价一套多模式课程，以提高产科实习生在传达不确定预后时的沟通技巧。方法：在这项盲法、随机对照试验中，某学术医疗中心的产科住院医师被分配到标准教学组或接受结构化、多模式课程的干预组。干预包括阅读SPIKES协议和医生移情，教学视频和促进小组讨论。干预后两周，所有参与者都参加了一个标准化的患者会议，模拟早产产前胎膜破裂的可存活诊断。沟通表现是用一个结构化的标准来评估的，以及交流前后的压力水平。结果23名产科实习生完成了研究。干预组的沟通得分显著高于对照组(平均19.5分vs 15.5分；P=.02)，更多地使用以病人为中心的技术，如承认焦虑和尽量减少术语。在模拟过程中，他们也报告了较低的压力水平（5分制的平均3.2 vs 4.0， P= 0.003）。干预后的调查显示，在提供复杂的预后和对情绪暗示做出反应方面，患者的舒适度有所提高。结论：这种结构化的基于spike的课程显著提高了产科学员在涉及不确定预后的模拟咨询场景中的沟通表现和信心。课程是可行的整合到研究生医学教育，并与ACGME沟通能力一致。这些发现支持在产科更广泛地实施结构化沟通培训，以提高学习者的学习效果和以患者为中心的护理。

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引用次数: 0

The incidence of peripartum invasive group A streptococcal infections and association with illicit drug use 围产期侵袭性A组链球菌感染的发生率及其与非法药物使用的关系

AJOG global reports

Pub Date : 2025-06-11 DOI: 10.1016/j.xagr.2025.100534

Elizabeth Wagman BS, Matthew Pettengill PhD, Rupsa C. Boelig MD, MS, Sarah Boudova MD, PhD

引用次数: 0

Husband’s involvement in maternal antenatal care and associated factors among pregnant women’s: study protocol for systematic review and meta-analysis 丈夫参与孕妇产前护理及相关因素：系统回顾和荟萃分析的研究方案

AJOG global reports

Pub Date : 2025-06-06 DOI: 10.1016/j.xagr.2025.100532

Aster Shiferaw MSc, Mulunesh Minale MSc

Background

The evidence of husband’s involvement in maternal antenatal care (ANC) is scant and inconsistence across each study. Therefore this systematic review and meta-analysis will be to examine (1) the characteristics of published studies on husband involvement in maternal ANC; (2) estimate the nationwide magnitude of husband involvement in maternal ANC;(3) show the significant association between husband involvement in maternal ANC and reported associated factors in published articles.

Method

This systematic review and meta-analysis will be conducted by publishing and unpublishing articles, which will be searched online through Google Scholar, PubMed, Cochrane Library, EMBASE, HINARI, and Africa Journals. The Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guideline will be used to review articles. Repeated articles will be removed by EndNote version X7.1. The data will be extracted by using the 2014 Joanna Briggs Institute Reviewers’ Manual data extraction. Critical appraisal of the studies will be done by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for cross-sectional studies tool. Begg-Mazumdar rank correlation tests and Egger’s regression tests will be used to check the presence of publication bias. The presence of heterogeneity will be assessed by Cochran’s Q statistics.

Discussion

This systematic review and meta-analysis will be the only study that investigates the magnitude and associated factors of husband’s involvement in maternal ANC. Through gathering information, the possible outcome will be to investigate and show those interested to utilize it.

背景：丈夫参与产妇产前护理（ANC）的证据很少，而且在每项研究中都不一致。因此，本系统综述和荟萃分析将检验(1)已发表的关于丈夫参与产妇ANC的研究的特征；(2)估计了全国范围内丈夫参与产妇分娩的程度；(3)在已发表的文章中显示了丈夫参与产妇分娩与报道的相关因素之间的显著相关性。方法通过谷歌Scholar、PubMed、Cochrane Library、EMBASE、HINARI和Africa Journals等在线检索已发表和未发表的文章，进行系统评价和meta分析。将使用系统评价和荟萃分析（PRISMA）指南的首选报告项目来审查文章。重复的文章将被EndNote X7.1版本删除。数据将使用2014年乔安娜布里格斯研究所审稿人手册数据提取。对研究的批判性评估将由乔安娜布里格斯研究所统计荟萃分析评估和回顾工具（JBI-MAStARI）作为横断面研究工具进行。Begg-Mazumdar秩相关检验和Egger回归检验将用于检验发表偏倚的存在。异质性的存在将通过Cochran 's Q统计来评估。本系统综述和荟萃分析将是唯一一项调查丈夫参与产妇ANC的程度和相关因素的研究。通过收集信息，可能的结果将是调查和显示那些有兴趣利用它。

{"title":"Husband’s involvement in maternal antenatal care and associated factors among pregnant women’s: study protocol for systematic review and meta-analysis","authors":"Aster Shiferaw MSc, Mulunesh Minale MSc","doi":"10.1016/j.xagr.2025.100532","DOIUrl":"10.1016/j.xagr.2025.100532","url":null,"abstract":"<div><h3>Background</h3><div>The evidence of husband’s involvement in maternal antenatal care (ANC) is scant and inconsistence across each study. Therefore this systematic review and meta-analysis will be to examine (1) the characteristics of published studies on husband involvement in maternal ANC; (2) estimate the nationwide magnitude of husband involvement in maternal ANC;(3) show the significant association between husband involvement in maternal ANC and reported associated factors in published articles.</div></div><div><h3>Method</h3><div>This systematic review and meta-analysis will be conducted by publishing and unpublishing articles, which will be searched online through Google Scholar, PubMed, Cochrane Library, EMBASE, HINARI, and Africa Journals. The Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guideline will be used to review articles. Repeated articles will be removed by EndNote version X7.1. The data will be extracted by using the 2014 Joanna Briggs Institute Reviewers’ Manual data extraction. Critical appraisal of the studies will be done by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for cross-sectional studies tool. Begg-Mazumdar rank correlation tests and Egger’s regression tests will be used to check the presence of publication bias. The presence of heterogeneity will be assessed by Cochran’s Q statistics.</div></div><div><h3>Discussion</h3><div>This systematic review and meta-analysis will be the only study that investigates the magnitude and associated factors of husband’s involvement in maternal ANC. Through gathering information, the possible outcome will be to investigate and show those interested to utilize it.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100532"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549509","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

Predicting in vitro fertilization success: the role of hyperglycosylated human chorionic gonadotropin to beta-human chorionic gonadotropin ratio in implantation and early pregnancy outcomes at a private in vitro fertilization center in Baghdad 预测体外受精成功：高糖基化人绒毛膜促性腺激素与β -人绒毛膜促性腺激素比值在着床和早期妊娠结局中的作用在巴格达一家私人体外受精中心

AJOG global reports

Pub Date : 2025-06-06 DOI: 10.1016/j.xagr.2025.100531

Rasha Fadhil Abas MRCOG, CABOG, JMCOG, MSc-ART, DGO, D.MAS, MBChB, Maad Mahdi Shallal FICOG

Background

This study explores the role of human chorionic gonadotropin (hCG) isoforms in predicting implantation success and early pregnancy outcomes in in vitro fertilization (IVF) patients. Despite advances in reproductive medicine, implantation failure, and early pregnancy loss remain significant challenges. Hyperglycosylated hCG (hCG-H) facilitates trophoblast invasion and angiogenesis, while beta-hCG (β-hCG) supports progesterone production, crucial for pregnancy maintenance. This study assesses the predictive value of these biomarkers in IVF success.

Methods

A prospective cohort study was conducted at Al-Binuk Private IVF Center in Baghdad from January to December 2024, including 100 women aged 20 to 44 years with primary or secondary infertility and normal uterine cavities. Women with endocrine disorders or uterine abnormalities were excluded. All transferred embryos were frozen day 4 or day 5 embryos and were implanted into a prepared uterus. Serum hCG levels, including hCG-H and β-hCG, were measured 10 to 11 days after embryo transfer. Data were analyzed using SPSS, and logistic regression was performed to evaluate the predictive value of these biomarkers.

Results

The mean age of participants was 34.3 years, with 54% having a normal BMI. Primary infertility was more common (73%), with an average infertility duration of 5.9 years. Half of the participants underwent their first IVF attempt. Among pregnancies, 73% resulted in a single embryo, 13% in twins, and 14% experienced pregnancy failure. Higher hCG-H and β-hCG levels were significantly associated with implantation success, and an increased hCG-H to β-hCG ratio further enhanced prediction. Logistic regression showed that higher hCG levels improved implantation success, while age negatively affected outcomes.

Conclusion

Serum hCG-H and β-hCG levels measured postembryo transfer serve as strong predictors of IVF success. Their ratio further enhances predictive accuracy, emphasizing their role in assessing pregnancy viability. Further research is needed to refine diagnostic thresholds and enhance fertility treatment strategies.

本研究探讨了人绒毛膜促性腺激素（hCG）异构体在体外受精（IVF）患者中预测植入成功和早期妊娠结局的作用。尽管生殖医学取得了进步，但着床失败和早期妊娠丢失仍然是重大挑战。高糖基化hCG （hCG- h）促进滋养细胞侵袭和血管生成，而β-hCG （β-hCG）支持孕酮的产生，对维持妊娠至关重要。本研究评估了这些生物标志物对体外受精成功的预测价值。方法于2024年1月至12月在巴格达Al-Binuk Private IVF中心进行前瞻性队列研究，纳入100名20 ~ 44岁原发性或继发性不孕、子宫腔正常的女性。排除有内分泌失调或子宫异常的妇女。所有移植的胚胎冷冻第4天或第5天胚胎并植入准备好的子宫。在胚胎移植后10至11天测定血清hCG水平，包括hCG- h和β-hCG。使用SPSS软件对数据进行分析，并进行logistic回归，评估这些生物标志物的预测价值。结果参与者的平均年龄为34.3岁，54%的人BMI正常。原发性不孕症更为常见（73%），平均不孕症持续时间为5.9年。一半的参与者进行了第一次试管婴儿尝试。在怀孕中，73%的人只产生一个胚胎，13%的人产生双胞胎，14%的人怀孕失败。较高的hCG-H和β-hCG水平与植入成功显著相关，hCG-H与β-hCG比值的增加进一步增强了预测。逻辑回归显示，hCG水平越高，植入成功率越高，而年龄对植入结果有负面影响。结论胚胎移植后血清hCG-H和β-hCG水平可作为体外受精成功率的预测指标。它们的比值进一步提高了预测的准确性，强调了它们在评估妊娠生存能力方面的作用。需要进一步的研究来完善诊断阈值和加强生育治疗策略。

{"title":"Predicting in vitro fertilization success: the role of hyperglycosylated human chorionic gonadotropin to beta-human chorionic gonadotropin ratio in implantation and early pregnancy outcomes at a private in vitro fertilization center in Baghdad","authors":"Rasha Fadhil Abas MRCOG, CABOG, JMCOG, MSc-ART, DGO, D.MAS, MBChB, Maad Mahdi Shallal FICOG","doi":"10.1016/j.xagr.2025.100531","DOIUrl":"10.1016/j.xagr.2025.100531","url":null,"abstract":"<div><h3>Background</h3><div>This study explores the role of human chorionic gonadotropin (hCG) isoforms in predicting implantation success and early pregnancy outcomes in in vitro fertilization (IVF) patients. Despite advances in reproductive medicine, implantation failure, and early pregnancy loss remain significant challenges. Hyperglycosylated hCG (hCG-H) facilitates trophoblast invasion and angiogenesis, while beta-hCG (β-hCG) supports progesterone production, crucial for pregnancy maintenance. This study assesses the predictive value of these biomarkers in IVF success.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted at Al-Binuk Private IVF Center in Baghdad from January to December 2024, including 100 women aged 20 to 44 years with primary or secondary infertility and normal uterine cavities. Women with endocrine disorders or uterine abnormalities were excluded. All transferred embryos were frozen day 4 or day 5 embryos and were implanted into a prepared uterus. Serum hCG levels, including hCG-H and β-hCG, were measured 10 to 11 days after embryo transfer. Data were analyzed using SPSS, and logistic regression was performed to evaluate the predictive value of these biomarkers.</div></div><div><h3>Results</h3><div>The mean age of participants was 34.3 years, with 54% having a normal BMI. Primary infertility was more common (73%), with an average infertility duration of 5.9 years. Half of the participants underwent their first IVF attempt. Among pregnancies, 73% resulted in a single embryo, 13% in twins, and 14% experienced pregnancy failure. Higher hCG-H and β-hCG levels were significantly associated with implantation success, and an increased hCG-H to β-hCG ratio further enhanced prediction. Logistic regression showed that higher hCG levels improved implantation success, while age negatively affected outcomes.</div></div><div><h3>Conclusion</h3><div>Serum hCG-H and β-hCG levels measured postembryo transfer serve as strong predictors of IVF success. Their ratio further enhances predictive accuracy, emphasizing their role in assessing pregnancy viability. Further research is needed to refine diagnostic thresholds and enhance fertility treatment strategies.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100531"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517739","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

TGF-β drives myofibroblast activation and inflammatory mediator production in vulvar lichen sclerosus TGF-β驱动外阴硬化地衣肌成纤维细胞活化和炎症介质产生

AJOG global reports

Pub Date : 2025-06-05 DOI: 10.1016/j.xagr.2025.100528

Sarah A. Fischer BS , Zahra Mahamed MS , Ashley Updike BS , Briana Boachie BS , Caitriona Greene BS , Ruth Agwaze BS , Kira Parr BS , Tanzy Love PhD , Adrienne D. Bonham MD , Mitchell A. Linder MD , Megan L. Falsetta PhD

Objective

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition characterized by whitening of the external genitalia, debilitating pruritus (itching), and pain. As disease advances, loss of labia, burying of vulvar anatomy (ie, clitoris, urethra, vaginal opening), and vulvar cancer can occur, yet mechanistic understanding of these events remains limited. VLS lesions appear visibly similar to scars and are frequently referred to as such. Therefore, we investigated the role of fibrosis in the VLS disease mechanism with the goal of identifying targets for new therapeutic and diagnostic strategies.

Study design

6-mm biopsies were collected from 8 participants with VLS from regions of the vulva visibly affected by lichen sclerosus (“scarred”) and adjacent unaffected areas (“unscarred”), allowing each patient to serve as their own control thus diminishing biological noise. Specimens were also used to establish fibroblast strains, and cells were stimulated with TGF-β to assess fibroblast-to-myofibroblast transitions, extracellular matrix (ECM) production, and inflammatory responses in scarred versus unscarred areas.

Results

Fibroblasts from scarred areas expressed higher levels of cytoskeletal proteins (alpha-smooth muscle actin) and inflammatory mediators (interleukin 6, prostaglandin E2) upon TGF-β stimulation compared to their unscarred counterparts. Treatment with SB-431542, a TGF-β receptor inhibitor, quelled these responses (P≤.05), indicating that these effects are mediated through the TGF-β pathway. Fibroblasts isolated from scarred tissues exhibit myofibroblast morphologies, but so do fibroblasts from unscarred areas.

Conclusion

TGF-β activates myofibroblasts and exacerbates inflammation in VLS cells from scarred areas. However, fibroblasts from both scarred and unscarred areas show similarities in morphology and ECM production, suggesting molecular changes may occur in VLS skin before visible changes are detected, which could lead to new diagnostic strategies to treat disease before irreversible architectural changes occur.

目的：硬化性地衣（VLS）是一种慢性炎症性皮肤病，其特征是外生殖器变白，虚弱性瘙痒（瘙痒）和疼痛。随着疾病的进展，可能发生阴唇丧失、外阴解剖（即阴蒂、尿道、阴道口）埋藏和外阴癌，但对这些事件的机制了解仍然有限。VLS病变看起来与疤痕明显相似，经常被称为疤痕。因此，我们研究了纤维化在VLS疾病机制中的作用，目的是确定新的治疗和诊断策略的靶点。研究设计从8名VLS患者的外阴明显受硬化地衣影响的区域（“瘢痕”）和邻近未受影响的区域（“未瘢痕”）收集6毫米活检，允许每个患者作为自己的对照，从而减少生物噪音。标本也用于建立成纤维细胞株，并用TGF-β刺激细胞，以评估疤痕区与未疤痕区成纤维细胞向肌成纤维细胞的转变、细胞外基质（ECM）的产生和炎症反应。结果疤痕区成纤维细胞在TGF-β刺激下表达更高水平的细胞骨架蛋白（α -平滑肌肌动蛋白）和炎症介质（白细胞介素6、前列腺素E2）。TGF-β受体抑制剂SB-431542可以抑制这些反应（P≤0.05），表明这些作用是通过TGF-β途径介导的。从瘢痕组织分离的成纤维细胞表现为肌成纤维细胞形态，但从未瘢痕组织分离的成纤维细胞也表现为肌成纤维细胞形态。结论tgf -β可激活瘢痕区VLS细胞的肌成纤维细胞并加重炎症反应。然而，疤痕和未疤痕区域的成纤维细胞在形态和ECM产生方面表现出相似性，这表明在检测到可见变化之前，VLS皮肤可能发生了分子变化，这可能导致在不可逆的结构变化发生之前治疗疾病的新诊断策略。

{"title":"TGF-β drives myofibroblast activation and inflammatory mediator production in vulvar lichen sclerosus","authors":"Sarah A. Fischer BS , Zahra Mahamed MS , Ashley Updike BS , Briana Boachie BS , Caitriona Greene BS , Ruth Agwaze BS , Kira Parr BS , Tanzy Love PhD , Adrienne D. Bonham MD , Mitchell A. Linder MD , Megan L. Falsetta PhD","doi":"10.1016/j.xagr.2025.100528","DOIUrl":"10.1016/j.xagr.2025.100528","url":null,"abstract":"<div><h3>Objective</h3><div>Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin condition characterized by whitening of the external genitalia, debilitating pruritus (itching), and pain. As disease advances, loss of labia, burying of vulvar anatomy (ie, clitoris, urethra, vaginal opening), and vulvar cancer can occur, yet mechanistic understanding of these events remains limited. VLS lesions appear visibly similar to scars and are frequently referred to as such. Therefore, we investigated the role of fibrosis in the VLS disease mechanism with the goal of identifying targets for new therapeutic and diagnostic strategies.</div></div><div><h3>Study design</h3><div>6-mm biopsies were collected from 8 participants with VLS from regions of the vulva visibly affected by lichen sclerosus (“scarred”) and adjacent unaffected areas (“unscarred”), allowing each patient to serve as their own control thus diminishing biological noise. Specimens were also used to establish fibroblast strains, and cells were stimulated with TGF-β to assess fibroblast-to-myofibroblast transitions, extracellular matrix (ECM) production, and inflammatory responses in scarred versus unscarred areas.</div></div><div><h3>Results</h3><div>Fibroblasts from scarred areas expressed higher levels of cytoskeletal proteins (alpha-smooth muscle actin) and inflammatory mediators (interleukin 6, prostaglandin E2) upon TGF-β stimulation compared to their unscarred counterparts. Treatment with SB-431542, a TGF-β receptor inhibitor, quelled these responses (<em>P</em>≤.05), indicating that these effects are mediated through the TGF-β pathway. Fibroblasts isolated from scarred tissues exhibit myofibroblast morphologies, but so do fibroblasts from unscarred areas.</div></div><div><h3>Conclusion</h3><div>TGF-β activates myofibroblasts and exacerbates inflammation in VLS cells from scarred areas. However, fibroblasts from both scarred and unscarred areas show similarities in morphology and ECM production, suggesting molecular changes may occur in VLS skin before visible changes are detected, which could lead to new diagnostic strategies to treat disease before irreversible architectural changes occur.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100528"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522165","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

A descriptive analysis of a fertility services waitlist in Eastern Canada 加拿大东部生育服务候补名单的描述性分析

AJOG global reports

Pub Date : 2025-06-05 DOI: 10.1016/j.xagr.2025.100525

Hannah M. Murphy BSc , Bailey P.S. Cox BSc , Heather M. Manning BSc , Zohreh Zeidy BSc , Sarah Benson MD , John D. Cullen MSc , Deanna Murphy MD , Sean Murphy MD , Sarah Healey MD , Laurie Twells PhD , Katie P. Wadden PhD

Background

Infertility is common and impacts quality of life. Maternal age is an important factor in fertility status, and therefore, timely access to care is critical. Long waits for specialist care remain a reality in Canada, representing an opportunity for early intervention.

Objective

This study aimed to characterize the population seeking infertility care in Newfoundland and Labrador (NL).

Study Design

A province-wide, cross-sectional analysis of referrals to Newfoundland and Labrador Fertility Services (NLFS) was conducted. Deidentified data were extracted from patient records. Descriptive analyses of the reason for referral, provincial geographical health zone, and female age, and a comparison of the age of patients referred across the province were completed. Historical live birth data were used to adjust for population differences.

Results

There were 317 eligible referrals received by NLFS over a 6-month period. The most common reason for referral was infertility (n=221, 70%). The overall mean age of referred females was 33.09 years (SD=5.03). The Eastern-Urban region had the highest number of referrals (n=145, 66%), which was greater than expected based on live birth rates (P≤.001). Patients referred from areas outside of the Eastern-Urban region were younger (P≤.001).

Conclusion

Infertility was the most common reason for referral. The age of females referred for infertility emphasizes the need for prompt intervention. There were differences in referral patterns across the province, including a disproportionately high referral rate in the Eastern-Urban region.

生育能力低下是一种普遍现象，影响着人们的生活质量。产妇年龄是影响生育状况的一个重要因素，因此，及时获得护理至关重要。在加拿大，长时间等待专科护理仍然是一个现实，这代表了早期干预的机会。目的本研究旨在描述纽芬兰和拉布拉多（NL）寻求不孕症治疗的人群。研究设计在全省范围内，对转介到纽芬兰和拉布拉多生育服务（NLFS）的患者进行了横断面分析。从患者记录中提取未识别的数据。对转诊原因、省地理卫生区和女性年龄进行了描述性分析，并对全省转诊患者的年龄进行了比较。历史活产数据用于调整人口差异。结果在6个月的时间里，NLFS共收到317例符合条件的转诊。最常见的转诊原因是不孕症（n=221, 70%）。女性患者总体平均年龄为33.09岁（SD=5.03）。东部城市地区的转诊人数最多（n=145, 66%），高于活产率的预期（P≤0.001）。来自东部城区以外地区的患者更年轻（P≤0.001）。结论不孕症是最常见的转诊原因。因不孕症而转诊的女性年龄强调了及时干预的必要性。全省转诊模式存在差异，包括东部城区的转诊率高得不成比例。

{"title":"A descriptive analysis of a fertility services waitlist in Eastern Canada","authors":"Hannah M. Murphy BSc , Bailey P.S. Cox BSc , Heather M. Manning BSc , Zohreh Zeidy BSc , Sarah Benson MD , John D. Cullen MSc , Deanna Murphy MD , Sean Murphy MD , Sarah Healey MD , Laurie Twells PhD , Katie P. Wadden PhD","doi":"10.1016/j.xagr.2025.100525","DOIUrl":"10.1016/j.xagr.2025.100525","url":null,"abstract":"<div><h3>Background</h3><div>Infertility is common and impacts quality of life. Maternal age is an important factor in fertility status, and therefore, timely access to care is critical. Long waits for specialist care remain a reality in Canada, representing an opportunity for early intervention.</div></div><div><h3>Objective</h3><div>This study aimed to characterize the population seeking infertility care in Newfoundland and Labrador (NL).</div></div><div><h3>Study Design</h3><div>A province-wide, cross-sectional analysis of referrals to Newfoundland and Labrador Fertility Services (NLFS) was conducted. Deidentified data were extracted from patient records. Descriptive analyses of the reason for referral, provincial geographical health zone, and female age, and a comparison of the age of patients referred across the province were completed. Historical live birth data were used to adjust for population differences.</div></div><div><h3>Results</h3><div>There were 317 eligible referrals received by NLFS over a 6-month period. The most common reason for referral was infertility (n=221, 70%). The overall mean age of referred females was 33.09 years (<em>SD</em>=5.03). The Eastern-Urban region had the highest number of referrals (n=145, 66%), which was greater than expected based on live birth rates (<em>P</em>≤.001). Patients referred from areas outside of the Eastern-Urban region were younger (<em>P</em>≤.001).</div></div><div><h3>Conclusion</h3><div>Infertility was the most common reason for referral. The age of females referred for infertility emphasizes the need for prompt intervention. There were differences in referral patterns across the province, including a disproportionately high referral rate in the Eastern-Urban region.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100525"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549510","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

Burden and risk factors of cervical cancer in Vietnam from 1990 to 2021 and forecasting to 2050—a systematic analysis from global burden disease 1990 - 2021年越南宫颈癌负担、危险因素及2050年预测——来自全球负担疾病的系统分析

AJOG global reports

Pub Date : 2025-06-04 DOI: 10.1016/j.xagr.2025.100526

Bao Huy Le MD , Thao-Ngan Nguyen Pham MD , Huong-Dung Thi Nguyen MD , Tri Cuong Phan MD , Han My Nguyen Le , Thien Tan Tri Tai Truyen MD , Tam Duc Lam MD, PhD

Background

Cervical cancer continues to be a significant global health challenge, with Vietnam facing similar concerns. Although there has been some progress in lowering its incidence and mortality rates, a comprehensive understanding of long-term trends and the factors driving these changes remains limited.

Objective

This study aimed to analyze the burden and risk factors of cervical cancer in Vietnam over a 3-decade period, from 1990 to 2021 with projection to 2050.

Study design

Our study used data from the Global Burden of Disease (GBD) 2021 estimates, developed by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. This dataset includes metrics such as incidence, prevalence, mortality, and disability-adjusted life years (DALYs), all presented as age-standardized rates (ASRs) per 100,000 individuals. We analyzed trends from 1990 to 2021 and projections for 2022 to 2050 using the Joinpoint regression model. Additionally, we examined ASRs for death and DALYs attributed to cervical cancer-related risk factors.

Results

In 2021, cervical cancer accounted for approximately 4369 deaths (95% UI: 3345–5713) in Vietnam, with ASRs for incidence, prevalence, and mortality at 16.50 per 100,000 (95% UI: 12.49–21.83), 88.11 per 100,000 (95% UI: 65.32–116.75), and 7.66 per 100,000 (95% UI: 5.90–9.94), respectively. From 1990 to 2021, trends in incidence, DALYs, and mortality followed 3 phases: a decrease in incidence from 1990 to 1992 (APC: –2.42%, 95% CI: –3.56 to –0.85), an increase from 1992 to 1996 (APC: 2.69%, 95% CI: 2.09–3.65), and a subsequent decrease from 1996 to 2008 (APC: -0.68%, 95% CI: –0.86 to –0.57), with no significant change from 2008 to 2021. Projections from 2022 to 2050 suggest an all-age DALYs rate of 147.55 (95% UI: 105.14–198.31) in 2050, with an expected rise until 2039 followed by a decline, reflecting an annual percent change of –0.2% (95% CI: –0.07 to –0.55). Major risk factors for cervical cancer in Vietnam include smoking and unsafe sexual practices, with associated age-standardized mortality rates of 0.31 (95% UI: 0.16–0.53) and 7.66 (95% CI: 5.89–9.80) per year, respectively.

Conclusion

The study reveals that, despite some progress in reducing the incidence, mortality, and DALYs associated with cervical cancer in Vietnam over the past 3 decades, the overall burden remains substantial. This study underscores the impact of key risk factors, including smoking and unsafe sex. Future research is needed to evaluate effective interventions and healthcare policies that could reduce the burden of cervical cancer and improve women’s health outcomes in Vietnam.

宫颈癌仍然是一个重大的全球健康挑战，越南也面临着类似的问题。虽然在降低其发病率和死亡率方面取得了一些进展，但对长期趋势和推动这些变化的因素的全面了解仍然有限。目的本研究旨在分析1990年至2021年（预计到2050年）30年间越南宫颈癌的负担和危险因素。我们的研究使用了由华盛顿大学健康指标与评估研究所（IHME）开发的2021年全球疾病负担（GBD）估计数据。该数据集包括发病率、患病率、死亡率和残疾调整生命年（DALYs）等指标，所有指标均以每10万人的年龄标准化率（ASRs）表示。我们使用Joinpoint回归模型分析了1990年至2021年的趋势和2022年至2050年的预测。此外，我们还检查了asr与宫颈癌相关危险因素导致的死亡和DALYs。结果2021年，越南宫颈癌死亡人数约为4369人（95% UI: 3345-5713），发病率、患病率和死亡率的asr分别为16.50 / 10万（95% UI: 12.49-21.83）、88.11 / 10万（95% UI: 65.32-116.75）和7.66 / 10万（95% UI: 5.90-9.94）。从1990年到2021年，发病率、DALYs和死亡率的趋势经历了3个阶段：1990年至1992年发病率下降（APC: -2.42%, 95% CI: -3.56至-0.85），1992年至1996年发病率上升（APC: 2.69%, 95% CI: 2.09-3.65），随后1996年至2008年发病率下降（APC: -0.68%, 95% CI: -0.86至-0.57），2008年至2021年无显著变化。从2022年到2050年的预测表明，2050年所有年龄的DALYs率为147.55 (95% UI: 105.14-198.31)，预计到2039年将上升，随后下降，反映出每年0.2%的百分比变化（95% CI: -0.07至-0.55）。越南宫颈癌的主要危险因素包括吸烟和不安全性行为，相关的年龄标准化死亡率分别为每年0.31（95%置信区间：0.16-0.53）和7.66（95%置信区间：5.89-9.80）。研究表明，尽管在过去30年中越南在降低宫颈癌的发病率、死亡率和DALYs方面取得了一些进展，但总体负担仍然很大。这项研究强调了主要风险因素的影响，包括吸烟和不安全性行为。未来的研究需要评估有效的干预措施和保健政策，以减轻越南宫颈癌的负担并改善妇女的健康结果。

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