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Introduction/objectives. Romania ranks first regarding the incidence and mortality of cervical cancer (CC) in the European Union. The persistent infection with high-risk HPV subtypes is a confirmed precursor in the development of almost all invasive cervical cancers, with HPV 16 and HPV 18 being classically considered the most common oncogenic subtypes. The prevalence of various HPV strains varies widely across the globe. The objectives of this study were to determine the presence of HPV infection and the infectious viral subtype in patients with normal cervix, CIN and with cervical cancer hospitalized in our institution, as well as to evaluate the particularities of this infection according to certain clinical parameters, in order to prioritize the screening services for patients with high-risk characteristics for HPVinduced disease in our geographic region. Materials and method. A total of 77 patients admitted to the “Dominic Stanca” Clinic of Obstetrics and Gynecology, Cluj-Napoca, were enrolled in the study, grouped in three categories: Group 1 – Control (n=38), Group 2 – CIN (n=30), Group 3 – CC (n=9). For all patients, the diagnosis of the cervical condition was confirmed by histopathological examination. A complex clinical database was developed, followed by the detection of high-risk HPV strains by the HPV Genotypes 14 Real-TM Quant kit. The number of previous cyto-tumoral examinations, as well as the macroscopic appearance of the cervix at the gynecologic examination were also recorded. The SPSS v. 24.0 program was used for data analysis, considering the statistical significance at the standard level of 5%. Results. HPV infection was detected in 88.3% of the subjects and a large number of patients were coinfected with several HPV strains. The most prevalent HR strains were HPV 16, 58, 56, 52, 33 and 31. Considering a single examination, 42% of patients in the control group had abnormal cytological results (PAP III, PAP IV), probably in association with the presence of the HPV infection; however, all patients (100%) in CIN and CC groups had abnormal cytology. At the clinical examination, 26.3% of patients without neoplastic cellular changes had a cervix presenting a macroscopic lesion. When analyzing the appearance of the cervix according to the HPV status, it was found that almost half (44.11%) of the patients with microscopically normal cervix had HPV infection, in 96.8% of cases the detected strain being HPV 16. Conclusions. This study highlighted HPV 16, 58, 56 and 52 as the most prevalent strains in the analyzed population. Given the wide variability in the prevalence of HPV-HR strains by geographical area, it is important to include the most common genotypes in the test kits for each region. The appearance of a cervical lesion is associated in half of the cases with HPV 16 infection, in case of normal cytology. HPV testing could bring additional benefits in guiding the subsequent management for these patients. [ABSTRACT FROM AUTHOR]

Vaccination against human papillomavirus (HPV) was introduced into clinical practice as the most effective strategy for primary prevention of cervical cancer and HPV-induced benign or premalignant lesions. It has been demonstrated that not only adolescents but also adults respond positively to vaccine immune stimulation. A history of abnormal Pap test and genital warts or HPV infection may reduce the efficacy of vaccination, but does not contraindicate it. HPV vaccination increases the magnitude and quality of natural immunity. Radical treatments of cervical lesions do not ensure the elimination of HPV infection. Using the vaccine without the surgical removal of the HPV lesion is useless. However, combining surgical treatment and HPV vaccination can play a crucial role in reducing recurrences. Evidence supports the fact that universal vaccination, of both men and women, from adolescence to 45-50 years old, would represent the optimal modality to control HPV infection-related diseases. [ABSTRACT FROM AUTHOR]

Background. Intraabdominal obesity is considered a low level chronic proinflammatory state. The adipocyte is the central element that integrates multiple metabolic and endocrine signals. Objectives. This study monitors the metabolic effects of the administration of melatonin or melatonin associated with estrogen in surgically castrated female rats. Material and method. Experiments were performed in white female Wistar rats, with a weight of 160-200 g. At 14 days postovariectomy, a time period required for the postoperative validation of ovarian failure, with the experimental induction of artificial menopause in the studied animals, estrogen replacement treatment and combined treatment of estrogen and melatonin were initiated. The duration of the administered treatment, with the products and the doses recommended for veterinary use, was of 12 consecutive weeks. Results. Food consumption (p=0.60), glycemia (p=0.053) and TG (p=0.34) did not significantly differ between the groups. The comparison of weight and intra-retroperitoneal fat between the groups in the last week showed that groups which did not receive estrogen had a significantly higher weight and higher intra-retroperitoneal fat than groups to which estrogen was administered (p<0.001). Groups which received estrogen associated with melatonin had a lower weight and a lower intra-retroperitoneal fat compared to groups, which received estrogen alone (p<0.001). Melatonin administred alone (without estrogens) does not show any effects on weight or lipid metabolism in ovarectomised rats. Conclusion. In ovarectomised rats, the associated administration of estrogen and melatonin is correlated with: a less important increase in the body weight, under the conditions of unchanged food consumption, a decrease in intra-retroperitoneal fat, a decrease in total cholesterol, an increase in HDL-cholesterol levels. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the systemic inflammatory response in preeclampsia compared to normal pregnancy. Materials and methods: The following serum parameters were determined in three groups of patients: leukocytes, neutrophils, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and certain markers of oxidative stress. Fetal status was assessed based on the gestational age at which birth occurred, on the Apgar score, and on fetal weight. Results: In preeclampsia, a higher systemic inflammatory status was found compared to normal pregnancy. Gestational age at birth, fetal weight, and Apgar score were significantly lower in the group with preeclampsia compared to normal pregnancy. Conclusion: In preeclampsia, there is an increased systemic inflammatory response compared to normal pregnancy, which can influence fetal status at birth.

Introduction. Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the urogenital tract characterized by the triad: uterus didelphys, obstructed hemivagina and unilateral renal agenesis, which is two times more common on the right side than on the left side. The incidence of this syndrome is 0.1-3.8% and, so far, in less than 10 cases the association of this pathology with acute urinary retention has been reported. Materials and method. We present the case of a 13-year-old girl who came to our emergency room accusing pain of increased intensity in the lower abdominal floor, started insidiously a week before, accompanied by nausea, pallor, sweating, anxiety and moderate vaginal bleeding (menstrual status). The anamnesis revealed absent diuresis for about 6 hours, menarche at 12 years old, regular menstruation, oligomenorrhea and dysmenorrhea. The clinical examination revealed respiratory movements of the abdomen, distension caused by a pseudotumoral mass located subumbilically, reluctant, painful; normal external genitalia. The paraclinical examination (ultrasound and MRI) revealed: voluminous cystic mass of 155/100/100 mm located between the bladder and the rectum, suggestive of hematometrocolpos; lower it protruded into the vagina, the image being suggestive of the transverse vaginal septum; uterus didelphys; normal ovaries and fallopian tubes. Unseen left kidney – left renal agenesis. Results. Surgery was performed with urinary bladder catheterisation, incision of the septum and continuous aspiration – about 1000 ml of chocolate-like fluid, suggestive of old blood, followed by resection of the vaginal septum. Conclusions. A high rate of awareness and clinical suspicion of HWW syndrome among adolescents is necessary for both the diagnosis and the prompt surgical treatment, leading to remission of symptoms, prevention of complications and to preservation of fertility. [ABSTRACT FROM AUTHOR]

Preeclampsia is a multisystemic disease, with a prevalence of 2-5%, that affects pregnant women. Every year, 76,000 women and 500,000 fetuses die due to the complications of this pathology. The prenatal screening for preeclampsia is constantly being updated. Globally, attempts are being made to identify easily reproducible, cost-effective screening markers that determine with great accuracy the patients prone to develop preeclampsia. Thus, there are differences between the described risk factors, the screening and prevention protocols recommended by world-recognized medical associations, such as the International Federation of Obstetrics-Gynecology (FIGO) and the American College of Obstetrics-Gynecology (ACOG). According to the latest FIGO recommendations, all pregnant patients should be screened in the first trimester for preeclampsia, including: maternal risk factors, mean blood pressure, placental growth factor and uterine artery pulsatility index. Patients at increased risk of developing preeclampsia will undergo preventive treatment with aspirin between 11- 14 weeks +/- 6 days and 36 weeks of pregnancy. ACOG presents patients with a history of preeclampsia, multiple pregnancy, chronic hypertension, type 1 or 2 diabetes, kidney disease or autoimmune diseases as having an increased risk of developing preeclampsia and a need for the prophylactic administration of aspirin. There is also a difference between the risk factors presented by the two associations. In conclusion, the determination of screening markers that provide an increased identification of patients at risk of developing preeclampsia, as well as the precise determination of risk factors for preeclampsia are imperative to anticipate and initiate the preventive treatment for women at risk, decreasing the prevalence of the disease, its complications and implicitly the costs. [ABSTRACT FROM AUTHOR]

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Background. Osteoporosis has a high incidence after menopause, and at the same time the relationship between menopausal oestrogen deprivation and proinflammatory status is considered to be involved in postmenopausal bone turnover. Objective. The aim of this study was to evaluate the serum levels of IL-1β and of the TNFα in pre and postmenopausal women, as well as to investigate the relationship between these cytokines and bone mineral density. Design. A case-control study was performed during a period of 12 months. Subjects and Methods. The study included 150 women divided into 4 study groups. Serum levels of IL-1β and TNFα were determined using multiplex cytokine kits. BMD was measured by DXA at the level of the hip and lumbar spine. Results. Serum concentration of IL-1β is significantly higher in natural and surgically induced menopausal women, compared to women in the control group. Serum levels of TNFα in postmenopausal women and with surgically induced menopause are significantly higher than in fertile and premenopausal women. Serum levels of IL-1β are significantly higher in patients with osteopenia and osteoporosis compared to patients with normal BMD values. We found a negative correlation between serum levels of IL-1β, TNFα and BMD in pre and postmenopausal women, and in women with surgically induced menopause. Conclusions. Serum levels of IL- 1β and TNFα are significantly higher in menopausal women compared to fertile women. IL-1β is significantly higher in patients with osteopenia and osteoporosis than in women with normal BMD values, and IL-1β and TNFα associate negatively with BMD in pre and postmenopausal women, as well as in women with surgically induced menopause. [ABSTRACT FROM AUTHOR]

Context. Endometriosis is a common gynecological disease, characterized by ectopic deposits of endometrial tissue outside of the uterine cavity, and it is associated with pelvic pain and infertility, with an important impact on the quality of life. At this point there is a controversy regarding the etiology and pathophysiology of endometriosis and it seems that pro-angiogenic growth factors might be involved, but their role is not completely understood. Objective. To evaluate the serum concentration of the main growth factors in patients with diagnosed endometriosis compared to healthy controls. Sbjective. To evaluate the serum concentration of the main growth factors in patients with diagnosed endometriosis compared to healthy controls. Results. VEGF serum levels were significantly lower in women with endometriosis compared to controls (1.924±0.145 compared to 1.806±0.078 pg/mL, p<0.001). Serum levels of GM-CSF, b-FGF, EGF, and HGF respectively did not differ significantly between patients with endometriosis and healthy controls. G-CSF had a very low detection rate. Conclusions. The present study showed that VEGF serum levels are significantly lower in endometriosis patients compared to healthy controls, indicating a possible role in endometriosis pathogenesis. [ABSTRACT FROM AUTHOR]

Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) is a rare uterine tumor primarily affecting perimenopausal and postmenopausal women, typically aged between 45 and 55 years. Characterized by ambiguous histological features, STUMPs present diagnostic challenges as they cannot be definitively classified as benign or malignant based on morphology alone. This systematic review aims to elucidate the clinical, pathological, immunohistochemical, and treatment-related characteristics of STUMPs through an analysis of the literature from the past 20 years. The study follows PRISMA guidelines, utilizing comprehensive searches of PubMed and Scopus databases, yielding 32 studies that meet the inclusion criteria. From the analysis of these studies, it was revealed that the clinical presentations vary from common symptoms such as abnormal uterine bleeding and pelvic pain to incidental detection of uterine mass. Histologically, STUMPs demonstrate features overlapping with both leiomyomas and leiomyosarcomas, including mild nuclear atypia, low mitotic indices, and focal necrosis. Immunohistochemical markers such as p16 and p53 have been investigated for prognostic significance. Elevated p16 expression, often associated with aggressive behavior, was observed in a subset of STUMPs. Surgical management, typically involving hysterectomy or tumorectomy, is the primary treatment, though the extent of resection is variable. Adjuvant therapies are not routinely recommended, but long-term surveillance is advised, especially for high-risk patients. Recurrence rates for STUMPs are approximately 12%, with factors such as high mitotic counts and coagulative necrosis indicating higher risk. This review highlights the complexity of STUMP diagnosis and management, emphasizing the need for more precise diagnostic criteria and individualized treatment strategies. Understanding the morphological, immunohistochemical, and clinical behavior of STUMPs can improve patient outcomes and guide future research in this diagnostically challenging area.

Endometriosis is known to be a chronic, debilitating disease. The pathophysiological mechanisms of endometriosis development include local chronic inflammation and a certain degree of local immune deficit. We investigated the relationship between the endometriosis severity, IL-8, IL-10, BDNF, VEGF-A serum and tissue levels, patient-related pain, and physical activity in a cohort of 46 patients diagnosed with endometriosis who underwent surgery. The same panel of biomarkers was investigated in a control group of 44 reproductive-aged patients with non-endometriotic gynecological pathology who underwent surgical intervention. Our data show a high statistical significance between tissue expression of IL-8, IL-10, patient-related pain, and the severity of endometriosis. No relationship was identified between serum or tissue levels of VEGF-A and BDNF and the severity of endometriosis. These results validate the presence of local chronic inflammation and immune deficit, thereby creating, alongside other studies in the field, an opportunity for the development of innovative and personalized treatment approaches in endometriosis.

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention-with a focus on minimizing iatrogenic risks-conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL.

Obesity, characterized by an excess of adipose tissue, has become a significant global health issue. The prevalence of obesity has increased markedly in recent decades worldwide, with a sharp rise also observed in developing countries, particularly in urban areas. Addressing obesity during pregnancy is crucial for several reasons and presents challenges for specialists in obstetrics and gynecology., Objectives: The aim of the present study was to investigate the correlation between obesity and its implications for childbirth., Materials and Methods: We conducted a retrospective study involving 1513 patients, grouped into normal-weight, overweight, and obese categories using corrected BMI values. We performed comparative analyses to explore the association between BMI and various outcomes: the method of delivery, the Apgar score at birth, the incidence of fetal distress, fetal birth weight, the presence of pregnancy-associated pathologies, and the occurrence of postpartum hemorrhage. Descriptive statistical analysis was utilized to characterize the demographic and clinical features of the patients and newborns., Results: By examining variables such as the occurrence of fetal distress during labor, the Apgar score at delivery, and the mode of delivery, we identified an association between increasing BMI and complications during labor and delivery. The results indicate that a higher BMI is linked with increased complications and variations in the mode of delivery., Conclusions: Obesity is the most common health issue among women of reproductive age and requires long-term care. It can contribute to numerous pregnancy-associated pathologies and affect both mother and child during labor and delivery. Obesity is associated with lower Apgar scores, the increased incidence of fetal distress, and a higher rate of cesarean section deliveries. Although the absolute risk of serious complications for mother, fetus, and newborn is low among women with obesity, adopting healthy eating and exercise behaviors prior to pregnancy, ideally, or as early in pregnancy as possible, can help minimize excessive weight gain during pregnancy.

Perinatal mood and anxiety disorders (PMADs) profoundly impact maternal and infant health, affecting women worldwide during pregnancy and postpartum. This review synthesizes current research on the neurobiological effects of PMADs, particularly their influence on brain structure, function, and corresponding cognitive, behavioral, and mental health outcomes in mothers. A literature search across PubMed, PsycINFO, and Google Scholar yielded studies utilizing neuroimaging (MRI, fMRI) and cognitive assessments to explore brain changes in PMADs. The key findings indicate significant neurobiological alterations in PMADs, such as glutamatergic dysfunction, neuronal damage, and altered neural connectivity, particularly in postpartum depression (PPD). Functional MRI studies reveal distinct patterns of brain function alteration, including amygdala non-responsivity in PPD, differing from traditional major depressive disorder (MDD). These neurobiological changes are connected with cognitive impairments and behavioral modifications, impacting maternal caregiving. Understanding these alterations is fundamental for developing effective treatments. The findings emphasize the importance of focusing on maternal mental health, advocating for early detection, and personalized treatment strategies to improve maternal and child outcomes.

Introduction: Ventriculomegaly (VM) is a fetal brain malformation which may present independently (isolated form) or in association with different cerebral malformations, genetic syndromes or other pathologies (non-isolated form)., Methods: This paper aims to study the effect of ventriculomegaly on the internal tridimensional architecture of fetal brains by way of Klingler's dissection. Ventriculomegaly was diagnosed using fetal ultrasonography during pregnancy and subsequently confirmed by necropsy. Taking into consideration the diameter of the lateral ventricle (measured at the level of the atrium), the brains were divided into two groups: moderate ventriculomegaly (with atrial diameter between 13 and 15 mm) and severe ventriculomegaly (with atrial diameter above 15 mm)., Results and Discussion: The results of each dissection were described and illustrated, then compared with age-matched reference brains. In the pathological brains, fascicles in direct contact with the enlarged ventricles were found to be thinner and displaced inferiorly, the opening of the uncinate fasciculus was wider, the fornix was no longer in contact with the corpus callosum and the convexity of the corpus callosum was inverted. We have studied the prevalence of neurodevelopmental delay in children born with ventriculomegaly in the literature and discovered that a normal developmental outcome was found in over 90% of the mild VM cases, approximately 75% of the moderate and 60% in severe VM, with the correlated neurological impairments ranging from attention deficits to psychiatric disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Horgos, Mecea, Boer, Buruiana, Ciortea, Mihu, Florian, Florian, Stamatian, Szabo, Albu, Susman and Pascalau.)

Abdominal cystic masses are diagnosed during the intrauterine period and have a relatively low incidence. Fetal ovarian cysts are the most common form diagnosed prenatally or immediately after birth. The pathophysiology of the development of these types of tumors is not fully elucidated, with ovarian hyperstimulation caused by maternal and placental hormones being the most accepted hypothesis. During intrauterine development, the diagnosis of fetal ovarian cysts is most often made accidentally during usual check-up ultrasounds corresponding to the first, second, and third trimesters of pregnancy. We conducted a scoping review with the aim to map the current knowledge regarding the treatment of fetal ovarian cysts diagnosed in the intrauterine period. Focusing on the articles published in the last 10 years in the specialized literature, we tried to identify a conceptualization regarding the surveillance and treatment of these anomalies.

A fetus identified to be at risk for chromosomal abnormalities may benefit from identification of genetic defects through amniocentesis. Although the risks associated with amniocentesis are considered to be minimal, being an invasive procedure it is not completely without complications., Background and Objectives: The current study aims to identify correlations between blood contamination of samples collected during amniocentesis and certain factors dependent on the instruments used (thickness of the needle used to aspirate the fluid), the location of the placenta, and uterine vascularity (more pronounced in multiparous patients)., Materials and Methods: The study included 190 patients in the second trimester of pregnancy who met one of the criteria for invasive prenatal diagnosis (age over 35 years, high risk in first trimester screening, history of pregnancies with genetic abnormalities, etc.). The amniotic fluid samples collected from these patients were analyzed in terms of blood contamination of the amniotic fluid aspirated with maternal cells Results: Of the patients in whom the procedure was performed using 21 G size needles, 16 samples (13.33% of the total) were contaminated. None of the samples collected from patients where a 20 G needle was used were contaminated. There was a statistically significant association between the lack of contamination and the use of Doppler ultrasound in multiparous patients with anterior placenta in whom a 21-gauge needle was used for amniocentesis., Conclusions: There is an increased rate of sample contamination (statistically significant) when using 21 G needle sizes and a significant difference in contamination between primiparous and multiparous patients, with contamination being more frequent in multiparous patients. The use of Doppler ultrasonography may benefit the procedure, as the contamination rate was significantly reduced when used during amniocentesis.

Background : Cervical cancer is one of the most common malignancies in women in terms of prevalence and mortality. Cervical cancer has some particularities that distinguish it from any other oncologic pathology: first, it is completely preventable by prompt detection of its precursor, cervical intraepithelial neoplasia (CIN); second, the Human Papillomavirus (HPV) infection is a known etiological agent; third, the mean age at diagnosis is much lower than in other oncologic conditions, as a consequence of the sexually-transmitted HPV. Methods : We evaluated the expression level of several long noncoding RNAs and a microRNA in samples from 30 patients with CIN, 9 with cervical cancer and 38 normal samples using qRT-PCR technology. Results : We observed higher expression levels for MEG3, DAPK1 , MLH1 and MALAT1 in CIN samples than in normal samples, whereas TIMP3 and SOX1 had lower expression levels. For cancer samples, DAPK1 , MLH1 and MALAT1 had higher expression, and MEG3 , TIMP3 and SOX1 had lower expression when compared to normal samples. In the case of CIN versus cancer samples, only MEG3 gene showed a statistically significant difference. The expression of miR-205-5p was lower in both CIN and cancer samples compared to normal samples. Conclusion: Decreased MEG3 expression could be considered an alarm signal in the transition from a premalignant cervical lesion to invasive cancer, while altered expression levels of TIMP3 , SOX1 , MLH1 , MALAT1 and miR-205-5p could serve as early biomarkers in the diagnosis of premalignant cervical lesions. Future studies, including a larger number of patients with CIN, will be of particular importance in validating these observations.

Ovarian endometriosis is a frequent chronic gynecological disease with an uncertain evolution regarding its progression or association with ovarian malignant lesions. The present review summarized the histological aspects, gene expression and microRNA (miRNA/miR) alterations associated with ovarian endometriosis and cancer and their possible interaction. The endometriosis-ovarian cancer interaction has been proposed by certain researchers as a single entity. Histological results indicated that endometriosis has been in different circumstances coexisting with ovarian cancer, with reference to endometrioid and clear cell carcinoma. Endometriosis with moderate and severe atypia can influence cell proliferation and architecture, resulting in a possible malignant transformation. Gene expression analysis indicated that the pathologies of both endometriosis and ovarian cancer are characterized by genetic instability from a molecular point of view, as several important genetic mutations, including ARID1A, PI3KCA, PTEN, BRCA1, BRCA2, TP53 and KRAS genes, were identified. miRNA alterations have been implicated in the regulation of gene expression. Common dysregulated miRNAs, such as miR-331, miR-335, miR-891, miR-548, miR-124, miR-148, miR-215, miR-192, miR-337, miR-153, miR-155, miR-144, miR-221 and miR-3688 were extensively investigated in understanding endometriosis and ovarian cancer evolution. From a combined viewpoint including histological aspects, gene expression and miRNA alterations, it is reasonable to speculate that endometriosis is associated with ovarian cancer. Ovarian endometriosis lesions may present a risk for ovarian malignant lesions, which supports a model of endometriosis as a malignant precursor. However, the endometriosis-ovarian cancer association is not widely accepted in the literature and additional studies are required to validate this association., (Copyright: © Gaia-Oltean et al.)

Background and objective : Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods : From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results : The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions : Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

Background and objectives: The objective of this study was to evaluate the potential of first trimester uterine artery Doppler ultrasonography for the early prediction of preeclampsia (PE), in at-risk pregnant women. Materials and Methods: This was a prospective longitudinal study, including 120 Caucasian pregnant women with risk factors for PE. The potential of pulsatility indexes (PI) and notch was assessed as a tool for preeclampsia screening. Results: Doppler examination of the uterine artery performed early at 11-14 WA allows the detection of pregnancies that will develop PE with a sensitivity of 61.5% and a specificity of 63.8% based on PI analysis. Predictive power increases slightly by adding bilateral notch (sensitivity = 65.4%; specificity = 66%). Conclusions: Uterine artery Doppler examination is an effective non-invasive screening test for the development of PE in pregnancies at risk, particularly appropriate in health systems with limited means of evaluating other biomarkers.

To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ ( p < 0.001), increased LVSI ( p < 0.01) and decreased LAS ( p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54-9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45-7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79-12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > -7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

Background and objectives : As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study's aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn's birth weight was correlated with the bladder neck mobility. Materials and Methods : A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results : Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver ( p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn's birth weight, regardless of the presence of a cystocele ( p = 0.042). Conclusions : The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn's birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.

Objective:  The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). The purpose of the present study is to evaluate the correlation between a serum biomarker, progesterone, and an ultrasonographic parameter, the distance between yolk sac and embryo (DYSE) in assessing the prognosis of pregnancy outcome in the 1 st trimester., Methods:  The present study is a prospective case-control analysis that includes 2 groups of patients: 81 patients with first-trimester normal evolutive pregnancy and 89 patients with embryonic demise, all of the patients having between 6 and 11 weeks of amenorrhea. Endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20 ml of blood was collected for progesterone serum level measurement., Results:  Regarding the DYSE in the case group, lower values were observed compared with the control group, the difference being statistically significant. In the statistical analysis of serum progesterone values, statistically significant differences were observed between the 2 groups ( p  < 0.05)., Conclusion:  The DYSE has a high positive predictive value in identifying pregnancies with potentially reserved outcome, with the present study demonstrating that a DYSE < 3 mm causes an unfavorable evolution of the pregnancy. Low serum levels of progesterone are associated with an increased rate of nonviable embryos. The correlation between these two parameters increases the effectiveness of screening methods in prenatal monitoring and improves the diagnostic methods for the first-trimester pregnancies whose outcome potential can be reserved., Competing Interests: The authors have no conflicts of interests to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Background and objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall-needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner's hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR)., Competing Interests: The authors declare no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Visceral obesity is a risk factor for endometrial cancer (EC). Visceral adipose tissue secretes over 50 inflammatory cytokines that can act centrally to regulate different physiological processes of the body but also remotely involved in communicating messages from the adipose tissue to other target tissues. The purpose of this study is to demonstrate the effect of in vitro adipose mesenchymal stem cells (MSCs) on endometrial tumor cells., Materials and Methods: Adipose-derived stem cells (ASCs) were isolated from normal subcutaneous (SC) and omentum adipose tissue from one woman without any other pathologies associated during a Fallopian tube ligature intervention. From one patient with EC was also harvested both SC and omentum adipose tissue. Ishikawa cells were cultured in ASCs conditioned medium. Study outcomes included detection of adipokines in cell culture supernatants and cell lysates by the enzyme-linked immunosorbent assay (ELISA)., Results: Our results indicate that cells from the EC patient's fat tissues migrated during the first days of cultivation and had a high proliferation rate. Ishikawa cells grown in MSCs co-culture showed lower absolute values of adiponectin than the cells cultured individually, having a pro-tumoral effect. The differences were statistically significant compared to Ishikawa cells in monoculture. In supernatants of MSCs, an increase in adiponectin's values in MSCs from SC adipose tissue of the patient with EC (SC cMSCs) was observed in co-culture as compared to monocellular control culture., Conclusions: Our data confirm the hypothesis that ASCs are an important source of intracellular adiponectin, which increase the EC cell proliferation.

Background/aim: The aim of the study was to evaluate the serum concentration of main chemokines and interferons in patients with diagnosed endometriosis., Materials and Methods: A total of 160 women were divided in two study groups (group 1 - endometriosis; group 2 - healthy women). Serum levels of IFN-α, IFN-γ, MCP-1, MIP-1α, MIP-1β, RANTES, eotaxin, IL-8, MIG, IP-10, and IL-17A were measured with Human Multiplex Cytokine Panels. Results. Serum levels of IFN-γ, MCP-1, and IL-8 were significantly higher (mean 14.03, 57.24, and 534.24, respectively, compared to 0.58, 20.51, and 259.82, respectively), and serum levels of IP-10 and eotaxin were significantly lower in women with endometriosis compared to the controls (mean 1.15 and 1.01, respectively, compared to 3.90 and 3.22, respectively). Conclusions. According to our results women with endometriosis have elevated levels IFN-γ, MCP-1, and IL-8, and lower serum levels of IP-10 and eotaxin, indicating unbalanced immune activity in endometriosis.

Holoprosencephaly (HPE), a major congenital abnormality in brain development is characterized by the absence or incomplete cleavage of prosencephalon into separate hemispheres, with cyclopia as the extreme manifestation of HPE, presenting as a failure of embryonic prosencephalon to properly divide the orbits of the eye in two cavities. We report the case of a 15-year-old pregnant patient, who delivered a 34-week living fetus with alobar HPE, cyclopia and proboscis. The patient did not have any routine scans during pregnancy; her first obstetrical exam was performed at 29 weeks of gestation (WG), when a prenatal ultrasound found a fetus with alobar HPE, cyclopia, proboscis, polydactyly and single umbilical artery. Despite adequate medical and genetic counseling, the patient and her legal representative refused further investigations - magnetic resonance imaging and genetic testing. She was admitted to the hospital at 34 WG for premature rupture of membranes, with clear amniotic fluid. Twenty-four hours later, she delivered vaginally a living male fetus, weighing 1995 g. Macroscopic examination revealed umbilical cord with two vessels, fetal proboscis, cyclopia, low implanted ears, bilateral polydactyly of the upper limbs, spina bifida occulta in the sacral region. The newborn lived for 40 minutes. Microscopy of the eyeball revealed choroid, ciliary body and conjunctiva structures, with no identification of the retina, and no evidence of the optic nerve in the fragments obtained from the optic chiasm region. This case underlines the importance of early obstetrical examinations during pregnancy and raises concerns about the ethics of allowing therapeutic termination of pregnancy after 24 WG in selected cases.

Background and Aims: Endometriosis is a commonly encountered disorder in women of reproductive age, consisting of the presence of active ectopic endometrial tissue outside the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnostic tools and therapeutic options in abdominal wall endometriosis (AWE)., Methods: We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution., Results: The main characteristic of AWE were emphasized, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% of all cases an accurate diagnosis of AWE was established preoperatively., Conclusion: A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased.

Background and Aims: Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management., Method: The study included 103 patients aged between 41.5-55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39)., Results: Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes., Conclusions: Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma.

Endometrioid endometrial adenocarcinomas (EECs) are frequent genital tumors for which the clinical, imaging and histopathological integrated analysis is the basis of differential diagnosis and therapeutic attitude. This research represents a tertiary multicenter study including 58 cases examined histopathologically and immunohistochemically, surgically treated, on a five years period. The main characteristics of the patients in the study group are represented by the average age of 66 years, associated with obesity, hypertension, diabetes, history of infertility, early menopause, nulliparity or long-time oral contraception. The most important clinical sign was the menopausal or postmenopausal vaginal bleeding. The golden standard in the diagnosis of endometrial carcinoma is the dilation and curettage of the uterine cavity, followed by histopathological assessment. The association between transvaginal ultrasonography (TVUS) and endometrial biopsy increases to 100% the diagnostic sensitivity. The use of an antibodies panel that includes CK, ER, PR, vimentin can guide the diagnosis to EEC and the analysis of Ki67, p16, p53 and CEA immunoreactions can be useful both for EEC differential diagnosis and to assess the tumor aggressiveness. The interrelation between the accurate histopathological diagnosis and the adequate surgical staging is the cornerstone of curative therapy in the EEC.

Vulvar malignant melanomas are extremely rare neoplasms, representing less than 3% of all cancers in women, 9% of all external genital tract malignancies and 9% of all primary vulvar malignancies. We present the case of a 60-year-old Caucasian patient, who has been admitted in the Clinic of Obstetrics and Gynecology with polymorphic, vulvar local, pelvic-abdominal, genitourinary and general symptoms, being diagnosed with nodular and superficial spreading vulvar melanoma and multiple voluminous uterine leiomyoma with various degenerations. Our study presents the approach of this case in terms of surgical pathology, management, prognosis and outcome. Surgical treatment is the central element of therapeutic management. Vulva melanomas are in general a relatively unpredictable unfavorable prognosis. The sizes of the tumor, the thickness and micro-staging are essential factors for prognosis.

Aim of the Study: Aim of the study was to investigate interleukin (IL)-4 serum levels in patients with advanced endometriosis and whether IL-4 promoter region (-590C/T) genetic polymorphism is involved in genetic susceptibility to endometriosis., Material and Methods: IL-4 serum levels and IL-4 -590C/T genetic polymorphism were determined for 80 patients with advanced endometriosis and 85 healthy fertile women using a multiplex cytokine kit, with a Luminex 200 system; high molecular weight genomic DNA was extracted from peripheral blood leukocytes, and further analyzed by PCR amplification and restriction fragment length polymorphism (PCR-PFLP). The relationship between IL-4 serum levels, genotypes and haplotypes and the presence of endometriosis was explored., Results: Interleukin 4 serum levels were significantly higher in the endometriosis group compared to controls (138,459 compared to 84,710, p < 0.001). No significant difference was observed in IL-4 serum levels between genotypes. There were no differences in IL-4 -590C/T genotypes and allele frequencies between control women and patients with endometriosis (χ (2) = 0.496, and χ (2) = 0.928, OR = 1.3636, CI: 0.725-2.564)., Conclusions: The results suggest that in patients with advanced stages of endometriosis there is a higher serum level of IL-4, and that this value, or the presence of the disease, is not influenced by the presence of IL-4 -590C/T genetic polymorphism.

Introduction. The identification of biological markers that indicate an increased risk for the development or recurrence of endometrial cancer (EC) in obese women might be useful for decreasing EC mortality and morbidity. Glucose-regulated protein 78 (GRP78) is a major protein of the endoplasmic reticulum expressed in all normal cells. Overexpression of GRP78 has been reported to be a tumoral biomarker. Increased detection of GRP78 is positively correlated with the tumoral stage and prognosis. This study aimed to identify a correlation between intraperitoneal fat, plasma GRP78 levels, and EC. Materials and Methods. Two groups of patients were included in the study: group I, 44 patients diagnosed with EC, and group II, 44 patients without gynecological pathology or inflammatory disorders. Visceral fat was determined by ultrasound and plasma GRP78 levels were measured. Results . Plasma GRP78 levels were significantly higher in patients with EC compared to the control group. Intraperitoneal fat was in a positive linear correlation with the plasma GRP78 level ( p < 0.0001). Conclusion. The measurement of the GRP78 level associated with the determination of intraperitoneal fat can be a useful predictor for EC.

Background: Endometriosis is a frequent gynecologic disease with a severe impact on the quality of life in the affected women; its pathogenesis is yet to be fully understood, with an altered immunity as a possible key factor. The present study aimed to investigate the serum anti-inflammatory cytokine profile in the patients with endometriosis compared with the healthy controls., Materials and Methods: One hundred and sixty women were included, divided into two study groups (Group I - endometriosis; Group 2 - healthy women). We evaluated the serum levels of interleukin-1 receptor antagonist (IL-1Ra), IL-2, IL-2R, IL-4, IL-10, IL-13, and IL-15 with the use of Human multiplex cytokine panels. Statistical analyses (normality distribution analysis, independent t-test, Mann-Whitney U-test) were performed using IBM SPSS software (version 22.0) and GraphPad Prism (version 5.00); receiver operating characteristic curve were used to demonstrate the diagnostic performance of the studied markers., Results: The mean serum level of IL-1Ra, IL-4, and IL-10 were significantly higher in women with endometriosis compared to women free of disease from the control group (30.155, 138.459, and 1.489, respectively, compared to 14.109, 84.710, and 0.688, respectively; P < 0.001, P < 0.001, and P = 0.002, respectively.). No significant differences in the mean serum levels of IL-2, IL-13, and IL-15 were observed between the studied groups and IL-2R had a very low detection rate., Conclusion: Endometriosis is associated with elevated levels of anti-inflammatory cytokines, IL-1Ra, IL-4, and IL-10, markers that have a potential role as a prognostic factor for endometriosis.

Introduction: Placenta can become an attractive source of stem cells due to its known richness in cell number and accessible, non-invasive procedures to harvest them. The purpose of this study focuses on the pluripotecy of placental-derived mesenchymal stem cells through differentiation towards osteogenic and neurogenic lineages., Materials and Methods: The biological material was represented by populations of human mesenchymal stem cells isolated from chorionic villi (h-CMSCs) and amniotic membranes (h-AMSCs) of full-term placenta. The potential of h-CMSCs and h-AMSCs was assessed trough growth kinetics, differentiation towards osteogenic and neurogenic lineages and immunohistochemistry., Results and Discussion: Human chorionic and amniotic mesenchymal stem cells are CD44+ (adult mesenchymal stem cell marker), CD45-, CD34- (adult hematopoietic stem cell markers) and display specific osteogenic and neurogenic morphology. The immunohistochemistry assays show the presence of Osteopontin+ and Osteonectin+ cells (osteogenic differentiation) as well as Synaptophysin+, GFAP+ and S100+ cells (confirming the glial differentiation) and NSE+ cells, indicators of neuronal differentiation., Conclusions: Placental-derived mesenchymal stem cells show remarkable differentiation potential under appropriate culture conditions. The expressions of osteogenic and neurogenic markers support the conclusion that placenta is an excellent mesenchymal stem cell source for osteogenesis as well as neurogenesis. Future research in this area will identify the best clinical applications for this new source of stem cells.

The Aim of the Study: The aim of the study was to investigate the serum pro-inflammatory cytokine profile in patients with diagnosed endometriosis., Material and Methods: The study included 160 women, who were divided in two study groups (Group I - endometriosis; Group 2 - healthy). We evaluated the serum levels of interleukin (IL)-1β, IL-5, IL-6, IL-7, and IL-12, and of tumour necrosis factor α (TNF-α) with the use of Human Multiplex Cytokine Panels., Results: The serum level of IL-1β, IL-6, and TNF-α is significantly higher in women with endometriosis compared to women free of disease, from the control group (mean 10.777, 183.027, and 131.326, respectively, compared to 3.039, 70.043, and 75.285, respectively; p = 0.002, p < 0.001, and p = 0.015, respectively). No significant differences in the serum levels of IL-5 and IL-12 were observed between the studied groups, and IL-7 had a very low detection rate., Conclusions: Women with endometriosis have elevated levels of key pro-inflammatory cytokines, i.e. IL-1β, IL-6, and TNF-α. At the same time, IL-1β and IL-6 could be used as predictors for endometriosis.

Objectives: The apparition of sugar diabetes is produced by the decrease of the number and capacity of beta cells to secrete insulin. Cell mass recovery through cell therapy might be one of the solutions for treating this disease. The use of various cell sources of different differentiation grades has been tried over the last years. Decoding the molecular mechanisms of the pancreatic morphogenesis is essential for obtaining cells having a phenotype, which would be very similar to the mature cells located in the pancreatic endocrine component. In this study, in order to obtain pancreatic progenitors, we used stem cells harvested from the mesenchymal component of the amniotic membrane, cells with particular immunological properties, which are effective in transplant., Materials and Methods: Isolated cells from the placenta (amniotic membrane) have undergone a three-stage differentiation protocol. The modulation of glucose concentration, the type of substrate (collagen + laminin) and the use of nicotinamide and exedin-4 were the main selective conditions of differentiation microenvironment. The differentiated cells were analyzed from the point of view of proteins (immunofluorescence - IF), gene expression (real-time polymerase chain reaction - RT-PCR) and morphological changes., Results: Isolated cells from the placenta membrane induced for pancreatic differentiation expressed transcription factors, which are characteristic for pancreatic progenitors (Pdx1 and PAX4). During the experiment, the cells modified their morphology by forming islet-like clusters. They were positively for dithizone staining and expressed insulin as shown by immunocytochemistry., Conclusions: The isolated cells from the placenta can be differentiated towards pancreatic progenitors by using specific protocols.

Background/aim: In endometrial cancer, visceral obesity, as a risk factor, is associated with a chronic inflammatory process, confirmed by the elevation of serum inflammatory markers in obese patients. The aim of the present study was to evaluate the correlation between visceral fat, assessed by ultrasonography, and the systemic levels of interleukin (IL)-8 in patients with endometrial cancer. This study also evaluated the usefulness of abdominal ultrasonography in assessing the visceral fat correlated with systemic inflammatory status, as an alternative method to identify patients at risk of endometrial cancer., Materials and Methods: The study was a case-control analysis including two groups of patients: Group I: 44 patients diagnosed with endometrial cancer; group II: 44 patients with no gynecological pathology. The diagnosis of endometrial cancer was performed following histopathological examination that evaluated the tissue material obtained through endometrial biopsy. These patients underwent ultrasound examination by which intraperitoneal fat was determined. IL-8 levels were determined for each patient. The Student's t-test was used for the comparison of the means and the Mann-Whitney test for rank comparison of two independent samples., Results: In patients diagnosed with endometrial cancer, the visceral fat area evaluated by ultrasound was significantly larger (p<0.0001) compared to that of the control group. The plasma levels of IL-8 in the endometrial cancer group were significantly elevated (p<0.001) compared to the control group. A positive linear correlation was also found between the visceral fat area and plasma levels of IL-8., Conclusion: The plasma levels of IL-8 are positively linearly correlated with visceral fat. Determination of visceral fat in association with IL-8 levels may be a predictive factor for endometrial cancer.