Ginekologia polska最新文献

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique that combines natural orifice access with endoscopic visualization and instrumentation. Minimally invasive surgery has revolutionized gynecologic practice by reducing postoperative morbidity and enhancing recovery. vNOTES represents a novel advancement, utilizing the vaginal route to access the peritoneal cavity without abdominal incisions. This technique offers potential benefits including scarless surgery, decreased postoperative pain, and shortened hospital stays. This review summarizes the surgical technique, clinical applications, advantages, limitations, and future perspectives of vNOTES in gynecologic surgery.

Objectives: We used the National Nosocomial Infections Surveillance (NNIS) risk index to determine risk factors associated with surgical site infections (SSIs) following gynecologic surgeries.

Material and methods: A retrospective study was conducted based on the medical records of 185 patients with SSIs, following gynecologic surgeries at a Grade A tertiary gynecologic and obstetric hospital in southwest China during September 2013-June 2021.

Results: Suspected risk factors associated with SSIs were: length of hospital stay, age, whether the patient had cancer, whether the patient had chemotherapy or high-dose antibiotic therapy before surgery, duration of surgery, amount of blood loss, and whether a blood transfusion was done. It was found that SSIs were more likely to occur in cancer patients with an NNIS risk index score of 1 and in patients with preoperative chemotherapy and an NNIS risk index score of 2. Among the patients with an NNIS risk index score of 2, the older the patient, the higher incidence of SSIs.

Conclusions: Gynecologic surgery teams should pay more attention to the independent risk factors associated with SSIs determined by the NNIS risk index score to prevent SSIs following gynecologic surgeries, thus ensuring patient safety.

Objectives: To evaluate relationship between sFlt-1/PlGF ratio, clinical characteristics and outcomes of pre-eclampsia.

Material and methods: Retrospective analysis of 29 pregnant women with pre-eclampsia who had measured sFlt-1/PlGF ratio was conducted using electronic medical records from Obstetrics and Perinatology ward of University Hospital in Cracow.

Results: Women median age: 33.5 years, number of pregnancies: one 52%, two 15%, three 18%,more than three 15%, number of deliveries: one 59.3%, two 37%, three 3.7%, median body mass index during hospitalization: 29.4 kg/m². Chronic diseases apart from hypertension: 67% of women (diabetes 37%, hypothyroidism 26%, obesity 11%). Median newborns birth weight: 1640 g, median Apgar score at 5 minutes: 8, median umbilical cord blood pH: 7.32. Fetal growth restriction: 28.6% of cases. All deliveries were by c-section. Median gestational age at delivery: 32 weeks. sFlt-1/PlGF ratio was inversely correlated with gestational age at delivery (r = -0.42, p = 0.02). The median sFlt-1/PlGF ratio was higher in women with severe pre-eclampsia (n = 15) than in those with mild pre-eclampsia (n = 14) (211 vs. 57, p < 0.001). sFlt-1/PlGF ratio of > 85 had a sensitivity of 80% and a specificity of 71% for predicting severe pre-eclampsia.

Conclusions: sFlt-1/PlGF ratio is useful in assessing the severity and prognosis of pre-eclampsia. sFlt-1/PlGF ratio should not be used as a sole criterion for making clinical decisions, but as an adjunct to other clinical and laboratory parameters.

Sperm DNA integrity assessment provides essential information that traditional semen parameters may not detect. Studies indicate that DNA fragmentation is an independent indicator of semen quality and fertility, which can explain cases of male infertility, especially when basic semen tests show normal results. Using sperm DNA fragmentation assessment techniques should be considered as an addition to traditional semen tests in male infertility diagnostics.

Objectives: Some studies indicate the role of transforming growth factor-beta 1 (TGF-beta 1) in the development of endometriosis. However, the lack is studies assessed its plasma levels as a biomarker of endometrioma. Therefore, this study aimed to analyze plasma, peritoneal, and endometrioma fluid TGF-beta 1 concentrations in women operated on for ovarian endometriosis.

Material and methods: A cross-sectional cohort study involved 56 women operated on for ovarian endometriosis. Body mass, height, and waist circumference were measured, as well as body mass index (BMI) being calculated. Plasma, peritoneal, and endometrioma fluid TGF-beta 1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Levels TGF-beta 1 were significantly higher in plasma than in both fluids (1286.1 pg/mL vs 114.7 pg/mL; p < 0.001 and 114.7 pg/mL vs 33.6 pg/mL; p < 0.001) and in endometrioma fluid than in peritoneal fluid (114.7 pg/mL vs 33.6 pg/mL; p < 0.001). There were also positive correlations between TGF-beta 1 levels in endometrioma and peritoneal fluids and plasma (r = 0.46; p < 0.001; r = 0.30; p < 0.05, respectively). There were no associations between TGF-beta 1 in plasma, endometrioma, peritoneal fluid, and endometriosis stage.

Conclusions: Our results suggest that plasma TGF-beta 1 concentration can be considered as a biomarker of endometrioma.

Objectives: Irisin is an adipomyokine that has an inhibitory effect on inflammation and possesses anticancer activity. It inhibits cancer cell proliferation, metastasis, and invasion through various signaling pathways associated with carcinogenesis. It has been described to be associated with a number of malignancies in various locations. It has been recognized that it may be a biomarker and prognostic factor in some malignancies. In addition, studies indicate irisin's possible role in treating malignant lesions.

Material and methods: In material including 129 cases of endometrial cancer and normal endometrium in a control group of 18 women with uterine myomas.

Results: There were no statistical differences in irisin protein expression. There were also no differences in irisin expression according to clinical stage, type, and histopathological differentiation.

Conclusions: Further clinical studies are needed to evaluate irisin activity in endometrial cancer.

Objectives: Pregnant women are at higher risk of severe course of COVID-19. The vaccination against COVID-19 is recommended in pregnant and breastfeeding women. The aim of the study was to assess the attitude towards vaccination against COVID-19 among Polish pregnant or breastfeeding women.

Material and methods: A cross-sectional survey study was performed from April 20th, 2021, to October 23rd, 2021, using an online questionnaire distributed via social media. Women who weren't Polish or didn't live in Poland were excluded from the study.

Results: The study group consisted of 662 women. Their median age was 32.5 years (interquartile range IQR: 27.25-33.75 years). Most of the women lived in acity with over 500000 inhabitants (333/662, 50.30%), were in a relationship (658/662, 99.40%), had higher education (559/662, 84.44%), were currently employed (326/662, 49.25%), but not in a medical field (574/662, 86.71%). Willingness to be vaccinated was expressed in 231/662 (34.89%) of the surveyed women. A positive attitude towards vaccinations was more common among women working in the medical field (p = 0.006679), with higher education (p = 0.000054), who trusted their doctors (p = 0.003900), thought that vaccines against COVID-19 were effective (p < 0.00001), and those afraid of COVID-19 (p < 0.00001).

Conclusions: The study showed that only one third of the surveyed women wanted to be vaccinated against COVID-19. Women working in the medical field, with higher education, who trusted their doctors, thought that vaccines against COVID-19 were effective, and those afraid of COVID-19 were more prone to be vaccinated against COVID-19 with recommended vaccines. Educational role of healthcare workers might be crucial for increasing the COVID-19 vaccine coverage in pregnant and breastfeeding women.

Objectives: To evaluate the role of human chorionic gonadotropin (hCG) change in the 48 h prior to methotrexate treatment as a predictor for treatment success of ectopic pregnancy.

Material and methods: This was a retrospective cohort study. A total of 179 women who diagnosed with ectopic pregnancy and given a single dose (50 mg/m²) of methotrexate were included in this study from January 1, 2016 to December 31, 2017. Serum hCG levels and clinical data were collected and compared between the success and failure groups, the percentage increment of hCG levels during the 48 hours prior to methotrexate injection was used to create a receiver operating characteristic (ROC) curve to determine the optimal cut-off value for predicting treatment success.

Results: The success rate of treating ectopic pregnancy with a single dose of methotrexate was 70.9%. The optimal cut-off value for percentage increment of serum hCG levels before methotrexate injection was determined to be 12.56%, with a specificity of 60.66% and sensitivity of 55.69%. The area under the receiver operating characteristic curve (AUC) was 0.646 (p < 0.01).

Conclusions: A lower 2-day hCG percentage increment before methotrexate injection was found to be associated with successful treatment of ectopic pregnancy, with a cut-off value of 12.56%. However, caution should be exercised when deciding on methotrexate treatment versus surgery for ectopic pregnancy patients.

Objectives: To assess alexithymia and affective temperament in patients with polycystic ovary syndrome (PCOS) and compare these patients to a group of patients undergoing endocrinological evaluation without a diagnosis of PCOS (non-PCOS). Additionally, the study explored the relationship between affective temperament, alexithymia, body mass index (BMI), and the severity of hirsutism in the PCOS group.

Material and methods: A total of 46 patients with PCOS and 28 non-PCOS patients were recruited for the study. All participants underwent endocrinological and gynecological diagnostics. Alexithymia was assessed using the TAS-20 questionnaire, while affective temperament was evaluated with the TEMPS-A questionnaire.

Results: Both PCOS and non-PCOS patients were found to fall within the "intermediate alexithymic" range. Patients with PCOS exhibited more pronounced cyclothymic temperament (p=0,019), and the difference in irritable temperament was close to statistical significance (p=0,072). In a stepwise linear regression analysis, total alexithymia emerged as a statistically significant positive predictor of BMI in PCOS group (β=0.368, p=0.012).

Conclusions: Patients with PCOS exhibit higher cyclothymic temperament compared to the non-PCOS group. Both groups show "intermediate alexithymia", which could impact treatment adherence and mental health, highlighting the importance of psychological interventions for improving outcomes and quality of life.