BMC Women's Health最新文献

Background: Obstetric vesico-vaginal fistula is a known complication that can occur following damage to the bladder wall during prolonged obstructed labor and operative delivery. Urinary incontinence following the repair of obstetric fistula remains a significant health problem and can greatly damage a women's ability to function confidently. There are approximately two million women suffering from urinary incontinence following obstetric fistula repair, most of whom are primarily in Africa.

Objective: We aimed to systematically review and conduct meta-analysis on the magnitude of urinary incontinence among women following successful obstetric fistula repair in sub-Saharan African countries.

Methods: We thoroughly searched online database including Medline, Scopus, Science Direct, Excerpta Medica Database, African Journals Online and Google Scholar for eligible articles from their inception to November 10, 2024. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 checklist. To generate pooled prevalence of urinary incontinence, we used random-effects model. The presence of publication bias was determined using a funnel plot and Egger's regression test.

Results: Out of 1044 articles found following our initial search and after titles and abstracts review, we considered 277 full text articles for inclusion. Lastly, a total of 12 articles from five sub-Saharan African countries comprising 6,104 participants met the inclusion criteria for quantitative meta-analysis. The pooled prevalence of urinary incontinence following obstetric fistula repair was 16.32% (95%CI: 11.80, 20.84; I2 = 96.5%, P < 0.001).

Conclusion and implications: Overall, our findings show post-fistula repair incontinence remains an important clinical problem. Therefore, we believe that policy planners and researchers of sub-Saharan African nations may use the findings of the current study for evidence based care planning and patient counseling strategy.

Registration: Registered in PROSPERO under protocol number CRD42023416541.

Background: Unexplained recurrent spontaneous abortion (URSA) is a major problem in the field of human reproductive health. At present, several circRNAs have been reported to be differentially expressed and play an important biological function in pregnancy-related diseases. However, the role of circRNAs in URSA remains unclear.

Methods: Levels of circRNA and miRNA were examined by RT-qPCR. The si-RNA and overexpression plasmid were respectively used to silence and overexpress circRNA-ZFAND6. We investigated the biological function of circRNA-ZFAND6 on trophoblasts through CCK8, EdU, Flow cytometric assay, Wound-healing assays and Transwell. Dual luciferase activity assay was conducted to identify the interaction between miR-575 and circRNA-ZFAND6.

Results: We confirmed that circRNA-ZFAND6 was a stable circular RNA and was mostly localized in the cytoplasm. CircRNA-ZFAND6 was downregulated in placental villous tissues of URSA. CCK-8 and EdU assays showed that circRNA-ZFAND6 promoted the proliferation of HTR-8/SVneo cells. Flow cytometry and western blot assays prompted that circRNA-ZFAND6 obviously reduced cells apoptosis. Scratch wound healing and transwell assays revealed that circRNA-ZFAND6 had no effect on cell migration and invasion. CircRNA-ZFAND6 worked by adsorbing miR-575 through the ceRNA mechanism. MiR-575 can inhibit the proliferation and promote the apoptosis of HTR8/SVneo cells. SOD2 was identified as a direct target of miR-575 and was associated with mitochondrial apoptosis. Transmission electron microscopy, TMRM and ROS staining assays both suggested that circRNA-ZFAND6 affected mitochondrial apoptosis. Excessive trophoblast apoptosis was a key event to promote the development of URSA.

Conclusion: CircRNA-ZFAND6, which is low expressed in URSA and regulates the apoptosis of trophoblast cells, may affect the expression of SOD2 and thus affect mitochondrial apoptosis by regulating miR-575. This is closely related to the occurrence of URSA.

Background: Endometriosis is a chronic inflammatory gynecological disease. Previous studies have explored relationships between endometriosis and the microbiota, but none have focused on differences in gut microbiota between early-stage and late-stage endometriosis patients or their connections to dysmenorrhea symptoms. This study compared gut microbiota compositions between early-stage and late-stage endometriosis patients using amplicon sequencing and further analyzed their dysmenorrhea symptoms.

Methods: To minimize seasonal and dietary impacts, we recruited Guangdong residents hospitalized for surgery at Zhujiang Hospital. Participants underwent preoperative screening based on enrollment criteria and fecal samples were collected. Endometriosis was classified according to the American Society for Reproductive Medicine (ASRM) staging system based on surgincal and pathological findings. Stage I-II cases were designated as early-stage endometriosis, and Stage III-IV as late-stage endometriosis.

Results: A total of 112 patient fecal samples were collected, with 75 (median age, 32 years [range, 18-49 years]) meeting the enrollment criteria, including 39 early-stage (32 Stage I and 7 Stage II) and 36 late-stage (16 Stage III and 20 Stage IV) patients. The gut microbiota structure and functions in early-stage patients significantly differed from those in late-stage cases. Dysmenorrhea was associated with specific microbial traits. Late-stage patients with dysmenorrhea displayed distinctly different gut profiles compared to other endometriosis groups. Bartonella, Snodgrassella, and other taxa were enriched in late-stage cases, while Bacteroides, and Prevotella were decreased.

Conclusion: The gut microbial community structure in early-stage endometriosis patients significantly differs from that in late-stage cases, with late-stage patients experiencing dysmenorrhea displaying particularly distinct gut profiles. Predicted functional analysis indicated suppressed steroid biosynthesis pathways in the gut of late-stage endometriosis patients. In conclusion, it is plausible that the multiple effects of steroids on the lower gastrointestinal tract may involve microbiota alterations, suggesting the need for further investigations.

Background: Sacral neuromodulation (SNM) is an established therapy in urology and gastroenterological surgery for treatment of overactive bladder symptoms, urge urinary incontinence or fecal incontinence. SNM has also been used with good results in patients with chronic pelvic pain (CPP). Our aim was to analyze long-term results of SNM in Finnish patients with endometriosis related CPP.

Methods: This is a register-based retrospective study including all the endometriosis patients treated with SNM for CPP in Finland between 2004 and 2017. There were four centers where these procedures were performed, two University Hospitals and two Central Hospitals. Long-term results were assessed by phone interview in spring 2021.

Results: A total of 16 women with endometriosis, with a median age of 39 (25-50) years, underwent SNM treatment for chronic pelvic pain (CPP), with the median follow-up time of 73 (48-85) months. The Implantable Pulse Generator (IPG) was implanted to 14 patients (88%). By the end of the follow-up period, 10 patients (62,5% of all patients and 71% of those who received IPG) had a functional SNM. Pain was assessed by numeral rating scale (NRS) and decreased from a median of 7.4 (3.6-10) to 2.3 (0-6.5).

Conclusions: SNM could be a good option in the treatment of endometriosis related chronic pelvic pain when standard therapy is not enough.

Background: Palmitoylation, a post-translational lipid modification, has garnered increasing attention for its role in inflammatory processes and tumorigenesis. Emerging evidence suggests a potential association between palmitoylation and inflammatory responses in the pathogenesis of endometriosis. However, the precise mechanistic interplay remains elusive, necessitating further investigation.

Methods: This study integrated transcriptomic analysis and Mendelian randomization (MR) to identify a causal gene set implicated in endometriosis. Differentially expressed genes (DEGs) were first identified in the training dataset using the limma package in R. Weighted gene co-expression network analysis (WGCNA) was subsequently performed, leveraging Single Sample Gene Set Enrichment Analysis (ssGSEA)-derived scores of palmitoylation-related genes (PRGs) as phenotypic traits to identify key modular genes. The intersection of these key modular genes with DEGs yielded a refined gene set. Machine learning algorithms were then applied to further optimize gene selection, followed by external validation, immune infiltration analysis, RNA network construction, and exploration of potential targeted drug candidates.

Results: Through a rigorous screening process, VRK1, GALNT12, and RMI1 emerged as key genes associated with palmitoylation, exhibiting significant downregulation in endometriosis samples (P < 0.05), indicative of a potential protective role. Immune infiltration analysis further revealed strong correlations between these genes and M2 macrophages as well as resting Natural Killer (NK) cells. Additionally, investigations into the targeted RNA network and drug association profiling provided novel insights, laying the groundwork for future high-quality validation studies.

Conclusions: This study employed a comprehensive analytical framework to identify palmitoylation-associated key genes in endometriosis. The integration of immunoinfiltration analysis, RNA network construction, and drug association profiling offers valuable insights for advancing clinical diagnostics, disease monitoring, and therapeutic development in endometriosis.

Background: While physical performance is closely linked to cardiovascular health, further research is essential to elucidate the association of physical tests in the early screening for cardiovascular risk (CVR), underscoring the potential for these assessments to enhance preventive healthcare strategies.

Objectives: To investigate the association between the Handgrip Strength (HGS) test and CVR in women with obesity, as well as to evaluate the predictive value of the HGS test as a CVR screening tool in this population.

Methods: Fifty-five eligible women with obesity, aged 40 to 65 years, were studied. The Framingham Global Risk Score was used to classify participants into low-risk and moderate/high-risk groups. Dual X-ray Absorptiometry was used to assess body composition. Additionally, clinical and biochemical parameters, along with HGS, were evaluated. Data were analyzed using the logistic regression analysis, and the positive and negative predictive values were calculated; accuracy was defined through the ROC curve and the Youden index. Statistical significance was set at 5%.

Results: The prevalence of the moderate/high CVR was 49%. The menopause [0.14 (0.03-0.52), p = 0.003] and handgrip strength [0.90 (0.82-0.99), p = 0.046] were associated with cardiovascular risk, independent of the clinical and biochemical parameters. The optimal cutoff points for screening CVR were ≤ 37.8 kg for HGS [AUC = 0.73 (0.59-0.84), p = 0.003].

Conclusion: HGS and menopause are significantly associated with CVR in women with obesity, highlighting the importance of considering physical evaluation in early clinical screening for CVR. The simple measure of HGS emerged as a promising tool for cardiovascular prevention in this population.

Background: The optimal duration of extended endocrine therapy (ET) for women with hormone receptor-positive (HR-positive) early-stage postmenopausal breast cancer remains uncertain. This meta-analysis systematically evaluated the optimal time to prolong aromatase inhibitors ( AIs) therapy for postmenopausal early stage breast cancer who received initial endocrine therapy.

Methods: PubMed, Web of Science, Ovid, Scopus, EmBase, and Cochrane Library were searched for randomized controlled trials (RCTs) using keywords related to breast cancer, HR-positive, AIs, and tamoxifen (TAM). Disease-free survival (DFS) was used as the primary endpoint. Meta-analysis was performed using STATA 16.0 and Revman 5.4 statistical software. Hazard ratio (HR) with its corresponding 95% confidence intervals (CI) was used as an effective indicator to assess DFS, OS, and subgroups of extended ET. Relative ratio (RR) was used to assess adverse events.

Results: The study included four RCTs involving 8,748 patients with HR-positive breast cancer. Pooled data showed an improvement in DFS when extending endocrine therapy from 5 to 7-8 years (HR = 0.82, 95% CI: 0.73 ~ 0.93), especially in patients with tumor size ≥ 2 cm (HR = 0.69, 95% CI: 0.49 ~ 0.98), estrogen receptor (ER) and progesterone receptor (PR) positive (HR = 0.77, 95% CI: 0.67 ~ 0.89), human epidermal growth factor receptor 2 (HER-2) positive or negative (HR = 0.85, 95% CI: 0.74 ~ 0.97; HR = 0.44, 95% CI: 0.22 ~ 0.89) and previous chemotherapy (HR = 0.80, 95% CI: 0.68 ~ 0.95). However, DFS has not improved with the extension from 7-8 to 10 years (HR = 0.97, 95% CI: 0.85 ~ 1.10). Furthermore, we found no significant difference in overall survival (OS), adverse events (AEs) analysis revealed a significant increase in the incidence of arthralgia, osteoporosis, bone fractures and asthenia after extended AIs.

Conclusions: The proportion of patients with breast cancer receiving ET extended beyond 5 years has increased, while the extension of AIs treatment from 5 to 7-8 years may be an option for high-risk patients with well-tolerated tumor size ≥ 2 cm, HR-positive, and previous chemotherapy. However, a variety of adverse events may accompany ET therapy, the identification of factors that may benefit breast cancer patients requires further randomized controlled studies.

Prospero registration number: CRD42022335497.

Objective: To estimate the association between cervico-vaginal microbiota and cervical cancer in Sub-Saharan Africa.

Study design: Systematic Review and Meta-Analysis.

Method: The databases, PubMed and African Journal Online (AJOL), as well as Google Scholar, were accessed. All primary studies (cross-sectional, cohort and case control) that reported cervical cancer, risk factors and cervico-vaginal microbiota in Sub-Saharan Africa, which were written in English language, were screened. Methodological and quality assessment of included studies was carried out using Joanna Briggs Institute (JBI) quality assessment tool. Random effects model meta-analysis was performed using MedCalc statistical software version 20.0.1 to evaluate the pooled prevalence of cervico-vaginal microbiota and prevalence was determined using the Freeman-Tukey double arcsine transformation. Heterogeneity between studies was assessed using the I-squared (I²) test and publication bias evaluated using Egger's statistical test. The study protocol was registered with the PROSPERO database (No: CRD42024495232).

Results: The review involved screening of a total of 1,151 articles and 15 articles, which met the inclusion criteria, were finally used for the review and meta-analysis. Cervico-vaginal risk factors noted in our study comprised infection with high risk human papilloma virus (hrHPV), human Immune virus (HIV), Trichomonas vaginalis, Porphyromonas, Prevotella, and Anaeromonas. The pooled prevalence of HPV in the included studies was 40% (95% Confidence interval [CI]- 24%, 56%) and pooled prevalence of HIV as a risk factor was 19% (95% CI- 3%, 44%). For each individual meta-analysis, high heterogeneity was observed with I² of 98.97 (HPV) and 99.33 (HIV) at p-values ≤ 0.01. Egger's tests for regression intercept in funnel plots indicated no evidence of publication bias while JBI result showed high quality of included articles.

Conclusion: This systematic review and meta-analysis revealed that cervico-vaginal microbiota, such as Porphyromonas, Prevotella, and Trichomonas vaginalis, along with high-risk HPV and HIV infection, increase cervical cancer risk in Sub-Saharan Africa. To reduce this burden, integrating microbiota management, sexual health education and HPV vaccination, is crucial.

Background: Accurate size and stage estimation is important to monitor tumor response and plan further treatment in breast cancer patients undergoing neoadjuvant chemotherapy. To evaluate the accuracy of imaging findings [ultrasound (US) and magnetic resonance imaging (MRI)] for tumor size and stage estimations in early breast cancer patients and to elucidate the factors influencing tumor stage assessment.

Methods: We retrospectively enrolled consecutive women having pathologically confirmed breast cancer (stage T1/T2, 199 patients and 201 lesions) and preoperative records available for both US and MRI. The concordance between imaging-determined and pathological tumor size and stage was explored. The McNemar's test was conducted to compare the concordance between imaging-determined tumor size and imaging-determined tumor stage. Multivariate logistic regression was used to analyze the factors that influenced the accuracy.

Results: The concordance between US-determined and pathological tumor size (71.1%) was comparable to MRI-pathology concordance (72.6%). MRI-determined stage concordance (73.6%) was comparable to US-determined stage concordance (69.2%). Tumors with a larger pathological size, were more likely to be underestimated by US or MRI in terms of tumor size and stage (all P < 0.05).

Conclusion: Tumor size and tumor stage concordance did not significantly differ between US and MRI in early breast cancer patients; US could be the first choice for tumor size estimation and tumor staging.

Background: Menstruation remains a taboo topic that is rarely discussed openly, even though nearly half of the world's population experiences it. Studies have shown that women wish to have more information about menstrual care worldwide. It is therefore crucial to break the taboo and support women in their quest for information. This study aims to investigate informational needs related to menstruation among Dutch women, in order to improve menstrual literacy.

Methods: A qualitative exploratory design with focus group discussions was used. Participants were recruited at the gynaecology outpatient clinic of Máxima MC and through social media posts. A total of 24 Dutch women (aged between 20 and 62 years), who currently menstruate or have menstruated, participated in three focus group discussions. A thematic analysis was used to analyse the data.

Results: Participants indicated that schools or family members had not provided them with sufficient information about menstruation prior to their menarche. This lack of information resulted in shame, taboos, and bullying. Furthermore, difficulties in communicating about menstrual complaints with friends, family and medical professionals were reported, resulting in a lack of information about which complaints are normal and when to seek help. Participants suggested creating an easily accessible online platform, categorized according to life stage (for example, menarche, midlife, towards menopause).

Conclusions: This qualitative study shows that Dutch women perceive information regarding menstruation as inadequate. It is recommended to re-evaluate menstrual education in school and combining information in one practical, patient-oriented website. For clinicians, it is important to realize menstrual knowledge of patients may be minimal and thus to support their patients in accessing reliable sources.