Search

The aim of the study was to determine the effectiveness of an alternative method of open fetal surgery to prevent severe unfavorable prenatal events, both for the mother and the fetus.In this study, the previously published results for a cohort of 46 patients, who had undergone intrauterine myelomeningocele repair (IUMR) at our Center by 2014, constituted the retrospective control group (CG). The MOMS protocol had been applied for hysterotomy, with an automatic uterine stapling device. The study group (SG) n = 57 was assembled during a prospective observation. IUMR was performed using an alternative method of hysterotomy, with the typical opening and closure of the uterus, without automatic stapling device, as described by Moron et al. Additionally, our single-center results were compared with the post-MOMS findings of other centers: CHOP (Children' S HOSPITAL OF PHILADELPHIA: ) and VUMC (Vanderbilt University Medical CENTER: ).No cases of delivery before 30 weeks of gestation (0%, 0/55) were observed in the study group, which is a statistically significant difference (p0.05) as compared to controls (15/44). Statistically significantly lower incidence of chorioamniotic separation (5.4% (3/55) vs CHOP 22.9% (22/96), p0.001) and contractile activity resulting in preterm labor (16.3% (9/55) vs CHOP 37.5% (36/96), p0.05) was found in the study group. Premature rupture of the membranes was statistically significantly less common in the study group as compared to controls, CHOP and VUMC (SG 12.7% (7/55) vs CG 52.2% (24/46), p0.001; vs CHOP 32.3% (31/96), p0.001; vs VUMC 22% (9/43), p0.01, respectively).The presented IUMR method is associated with improved perinatal outcomes, i.e., lower rates of preterm delivery at30 weeks of gestation, preterm premature rupture of membranes, and uterine contractility resulting in preterm delivery. That, in turn, results in lower prematurity rates and, consequently, more favorable neonatal outcomes.

Endometrial cancer remains the most common malignancy of the female genital system in developed countries. Tumor suppressor genes are responsible for controlling the cells fate in the cell cycle and preventing cancerogenesis. Gene expression affects cancer progression and is modulated by microRNAs defined as both tumor suppressors and oncogenes. These molecules indirectly regulate multiple processes like cell proliferation, differentiation and apoptosis. The aim of this study was to analyze miRNAs expression that can regulate the activity of tumor suppressor genes related to the cell cycle in patients with endometrioid endometrial cancer. The study group consisted of 12 samples that met the inclusion criteria from a total of 48 obtained. The 12 samples were used to analyze microRNA expression. Complementary miRNAs were identified using TargetScan Database and statistical analysis. MicroRNAs were determined for the tumor suppressor genes: CYR61, WT1, TSPYL5, HNRNPA0, BCL2L1 and BAK1. All the miRNAs were complementary to the described target genes based on TargetScan Database. There were five miRNAs differentially expressed that can regulate tumor suppressor genes related to the cell cycle. The distinguished miRNAs: mir-340-3p, mir-1236-5p, mir-874-3p, mir-873-5p.2 and mir-548-5p were differentially expressed in endometrial cancer in comparison to the control. Among the distinguished miRNAs, the most promising is mir-874-3p, which may have an important role in endometrial adenocarcinoma proliferation.

Objectives: The aim of the study was to compare Insulin-like Growth Factor-1 (IGF-1)concentration in pregnancies complicated by pregnancy-induced hypertension and/or intrauterine hypotrophy, and its correlation with maternal pressure and umbilical artery pulsatility and resistance indices. Material and methods: 65 pairs pregnant-newborn were included to four groups: I — control, II — PIH, III — Hypotrophy, IV — PIH and Hypotrophy. In the study we analyzed cord blood IGF-1 concentration, newborns antropometry, umbilical artery pulsatility and resistance indices and maternal pressure before delivery. Results: The concentration of IGF-1 was the lowest in IV group of hypotrophic newborns from pregnancies complicated by pregnancy-induced hypertension. In this group of patients there was strong negative correlation between IGF-1 concentration and maternal systolic and diastolic pressure. Conclusions: There is a strong negative correlation between IGF-1 concentration and maternal systolic pressure in group of hypotrophic newborns from pregnancies complicated by pregnancy-induced hypertension.

Objectives: We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and fetal/neonatal outcomes. Material and methods: We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for the early period (2005–2011 year; previous — PFSC, n = 46) and current period (2012–2015 year; current — CFSC, n = 74) to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients). Results: The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9% in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC — 90.3% and PFSC — 82.1%. Conclusions: The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

Objective: Chemical and mechanical injury in myelomeningocele (MMC) during the fetal life results in functional disorders of multiple organs. Prenatal MMC repair reduces sequelae of spinal cord injury. Design: Histopathological evaluation of dura mater and skin specimens to assess the severity of inflammatory changes. Setting: Histopathological laboratory and operated patients. Participants: 45 cases (Group I)-intrauterine surgery due to MMC and 42 cases (Group II)-postnatal surgery. Outcome measures: Specimens of the skin and of the dura mater adjacent directly to the uncovered section of the spinal cord were collected for assessment. The specimens were histopathologically evaluated to assess the severity of inflammatory changes. Results: The analysis of the severity of inflammatory changes in the skin and the dura mater showed only small lymphocytic infiltration in 5 fetuses (Group I). Medium and large infiltration in the skin and the dura mater was found in all children who underwent postnatal surgery (Group II). Lymphocytic and granulocytic infiltration in the skin and the dura mater were statistically significantly more prevalent in children who underwent postnatal surgery compared to the group of children who underwent prenatal surgery (P

Background. Oxidative stress appears to be involved in oocyte growth and maturation that when impaired results in poor embryo quality and lower potential to implant. The biochemical microenvironment of the oocyte (follicular fluid (FF)) consists of hormones and other various substances regulating the balance between oxidants and antioxidants. Aim. The aim of this study was to examine the possible impact of selected biomarkers (“every day,” hormonal biomarkers, enzymatic and nonenzymatic antioxidants, and also oxidative stress markers) in serum and FF, on embryo quality and pregnancy success in infertile women undergoing infertility treatment. Methods. All 53 patients, mean age 34.7±4.1 years, with serum AMH level≥0.7 ng/mL, were diagnosed with idiopathic infertility. They were stimulated in short antagonist protocol, followed by in vitro fertilization (IVF-ICSI intracytoplasmatic sperm injection) and a single embryo transfer. Follicular fluid was aspirated from the first mature follicle. In statistical analyses the R software was used, then all data was assessed with the Shapiro-Wilk test, logistic regression, and later the receiver operating characteristic (ROC) curve was applied using “pROC” R package. Results. We did not observe any correlation between AMH and embryo quality and pregnancy rate. Statistically significant results were only found for biomarkers examined in follicular fluid. Greater levels of GPX in FF were associated with the increased chance of producing a high quality embryo (the optimal cut-off concentration was established at over 450 lU/L.) Regarding pregnancy success, increasing levels of GR (cut-off at 21 IU/L), CuZnSOD (cut-off at 9NU/mL), and GST (cut-off at 2.5 IU/L) resulted in lower chances of a successful pregnancy. Conclusion. Our results indicate that FF markers may have some advantages in predicting embryo quality and pregnancy over AMH. The GPX system seems to be mostly related to embryo quality and pregnancy.

Introduction HE4 protein (human epididymis protein-4), which is the fourth subfraction of human epithelial protein, is a glycoprotein widely used as a tumor marker in ovarian cancer. If was first discovered in the epididymal epithelium and recognized as a protease inhibitor contributing to sperm maturation. The plasma HE4 concentration may also be increased in gynecological pathologies other than ovarian cancer. Material and methods The study was conducted between 2016 and 2017 among patients hospitalized in the Academic Department of Gynaecology. A total of 191 women were examined. Depending on the type of pathology which was the reason for hospitalization, 4 groups of patients were identified in the study. The first of these included 30 patients with ovarian cancer, the second 33 patients with benign ovarian lesion, the third 50 patients with endometrial cancer, and the fourth 28 patients with leiomyomas. Results The highest concentration of HE4 protein was found in women with ovarian cancer, and it was statistically significantly higher compared to all other groups. Lower HE4 protein concentration than in women with ovarian cancer was reported in women with endometrial cancer, but it was statistically significantly higher compared to patients with uterine fibroids. Conclusions This marker may have significant clinical value in the differentiation of benign ovarian pathology from ovarian cancer. The study confirms the validity of using HE4 results in the assessment of potential malignancy of ovarian and endometrial lesions.

Objectives: Heat shock proteins are overexpressed in many human malignancies. The role of heat shock proteins as a thera- peutic target in cancer as well as their association with drug resistance were widely documented. The aim of this study was to evaluate the concentration of IgG class HSP27 and HSP60 antibodies in serum of patients with endometrial and cervical cancer, as well as to analyse the variability of concentrations of the examined antibodies depending on the cancer stage. Material and methods: The study included 59 women with adenocarcinoma of the endometrium and 36 women with cervical cancer, the control group consisted of 54 healthy women. The concentrations of IgG class antibodies against the tested heat shock proteins were determined by an immunoenzymatic assay (ELISA) using commercial assays. Results: In both endometrial and cervical cancer, the serum concentration of IgG anti-HSP27 antibody was significantly higher than in the healthy control group. The concentration of IgG anti-HSP60 antibody in endometrial cancer, cervical cancer and healthy control was similar. The median IgG anti-HSP27 antibody serum concentration of endometrial cancer patients was not correlated with FIGO-stage. In cervical cancer inverse correlation between concentration of this antibody and FIGO stage was observed. The median IgG anti-HSP60 antibody concentration in serum of endometrial cancer patients was lower in FIGO stage I and II compared to FIGO stage IV and in FIGO stage IA compared to FIGO stage IB. Concentrations of examined antibodies correlated positively with each other, both in the group of women with cancer and in the group of healthy women. The strongest correlations were found in the group of patients with endometrial cancer. Conclusions: Concentration of anti-HSP27 antibody could help in detection of cervical and endometrial cancer. We need to look for the cut-off point in large cohort studies. Anti-HSP27 and anti-HSP60 antibodies should be further evaluated for their potential usage as biomarkers in cervical and endometrial cancer as they shown some correlation with stage of disease.

Objectives: Ovarian cancer remains a very common cause of death among women worldwide. The cause is to be found in too late of a diagnostic process and therapeutic difficulties The presence of heat shock proteins in the serum of ovarian cancer patients is still a new area of study. It is necessary to continue studies on the possibilities for using these markers to predict a patient’s response to a specific therapy and to monitor treatment progress. Material and methods: The study included 52 women with ovarian cancer, hospitalised at the Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia. The control group consisted of 25 healthy women. The levels of HSP27 in the studied sera were determined by an immunoenzymatic method (ELISA). Results: The mean concentration of HSP27 in the group of patients with ovarian cancer was significantly higher than in the control group of healthy women. We have shown that mean HSP27 levels in ovarian cancer patients increase with tumour progression and further depend on the clinical stage of the disease (FIGO). Positivity values analysis revealed in all clinical stages of ovarian cancer, excluding stage 1, it was significantly higher than in the control group, and at the 4 th stage, it is significantly higher than at the 1 st , 2 nd , and 3 rd stages. However, both for the untreated patients and those patients after chemotherapy, the mean HSP27 levels were significantly higher than in the control group. Conclusions: Our studies indicate a significant contribution of HSP27 to the pathogenesis of ovarian cancer. It seems that serum HSP27 can be a marker for this cancer’s development, and a marker for the clinical stage.

Background In this paper we focus on 46, XY pure gonadal dysgenesis-Swyer syndrome. MethodsWe present the case of a 33-year old patient and the medical procedures enabling to achieve a pregnancy in the couple struggling with infertility.We analyzed patient’s medical history, scheduled further diagnostic and therapeutic procedures that included genetic tests and consultations, MRI (magnetic resonance imaging), laparoscopy, oncological risk assesment and possibilities of pregnancy.Results Patients medical history revealed her last menstrual period dated one year before she started searching for medical help. Due to a low AMH (anti-Muellerian hormone) level, genetic consultation and genetic tests were recommended. The patient was diagnosed with Swyer syndrome. She underwent laparoscopy to search for gonadal tissue. Histopathology of removed streak tissues revealed dysgerminoma. No metastases were found in a follow up MRI. The patient decided to participate in an egg donation program.Conclusions The diagnosis of karyotype containing Y chromosome in a phenotypical adult female patient raised as female demands optimal managing. It has to cover not only psychological and fertility aspects, but also the risk of development of gonadal tumors.

The publication presents recommendations on the performance of surgical procedures in gynecology during the COVID- 19 pandemic. The recommendations were prepared by the Polish Society of Gynecologists and Obstetricians, based on current knowledge of SARS CoV-2. These recommendations contain the latest guidelines of scientific societies related to the subject of operational procedures.

Objective: This study presented outcomes of classical hysterotomy with modified antiprostaglandin therapy for intrauterine repair of foetal myelomeningocele (fMMC) performed in a single perinatal centre. Study Design: Forty-nine pregnant women diagnosed with fMMC underwent classic hysterotomy with anti-prostaglandin management, complete amniotic fluid replacement and high dose indomethacin application. Results: The average gestational age (GA) at delivery was 34.4 ± 3.4 weeks, with no births before 30 weeks GA. There were 2 foetal deaths. Complete reversal of hindbrain herniation (HH), assessed in magnetic resonance imaging at 30–31 weeks GA was found in 72% of foetuses (mostly with HH grade I prior to fMMC repair). Our protocol resulted in rare use of magnesium sulphate (6%), low incidence of chorioamniotic membrane separation – chorioamniotic membrane separation (6%), preterm premature rupture of membranes – preterm premature rupture of membranes (pPROM; 15%) and preterm labour – preterm labour (PTL; 17%). The postoperative wound continuity of the uterus was usually stable (in 72% of patients), with low frequency of scar thinning (23%). Conclusion: Our protocol results in rare use of tocolytics, and the low occurrences of CMS, pPROM and PTL in relation to other study cohorts: Management of Myelomeningocele Study, Children’s Hospital of Philadelphia, and Vanderbilt University Medical Centre.

Spina bifida (myelomeningocele) is the most prevalent developmental defect of the nervous system. In different regions of the world it affects from 0.3 to 5 per 1000 of livingneonates. It is known that the defect develops during the early fetal life however no explicit cause has been found yet. Recently it has been accepted that one of the major factors contributing to spina bifida is deficiency of folic acid in the mother’s body before and during pregnancy. The first attempts to cure myelomeningocele were taken in ancient times. More extensive knowledge of aetiology and effects of spina bifida and development of new surgical techniques allowed for management not only of the defect itself but also the consequent complications. Prenatal spina bifida repair has been performed in the USA for 20 years now while European surgeons (Poland and Switzerland) have operated myelomeningocele for 12 years. Comparative analysis carried out to evaluate the patients operated for spina bifida prenatally and postnatally pointed that those after fetal repair demand the use of ventriculoperitoneal shunt for hydrocephalus twice less frequently. Thanks to shortened exposure of the spinal cord and the spinal nerves to the toxic effect of amniotic fluid and reduced exposure to mechanical injuries, prenatal myelomeningocele repair offers better opportunities to improve motor, urinary and alimentary functions, contributing then statistically to higher quality of lives of children with spina bifida.

WstępPęknięcie pęcherza owodniowego pomiędzy 22 a 33 tygodniem ciąży (preterm premature rupture of membranes – PPROM) jest szczególnym scenariuszem klinicznym, kiedy losy noworodka są niepewne, ale jego przeżycie jest prawdopodobne. Celem pracy było przedstawienie pełnego spektrum problemów podczas diagnostyki i leczenia ciężarnej w tej szczególnie trudnej sytuacji.Materiał i metodyPrzeanalizowano przebieg leczenia u 38 pacjentek w wieku 18–42 lat, które zostały przyjęte do szpitala pomiędzy 22 a 33 tygodniem ciąży z powodu podejrzenia PPROM. Zebrano komplet danych na temat diagnostyki, leczenia i dalszego przebiegu ciąży. Uzyskane wyniki poddano analizie statystycznej.WynikiPrzedwczesne pęknięcie błon płodowych potwierdzono u 31 ciężarnych. Średni wiek ciążowy, w jakim wystąpiło PPROM, wynosił 28,2 tygodnia. Badanie ultrasonograficzne miało bardzo wysoką wartość diagnostyczną w rozpoznawaniu PPROM. Czas latencji pacjentek z potwierdzonym PPROM wynosił średnio 11 dni, jednak rozrzut uzyskiwanych wartości był znaczny (1–85 dni) i nie wykazywał istotnego związku z wiekiem ciążowym (r = 0,29, p = 0,106). W chwili zakończenia obserwacji (miesiąc po porodzie) 16% noworodków zmarło, a kolejne 16% nadal przebywało w szpitalu z niepewną prognozą co do przeżycia. W grupie, w której do rozwiązania ciąży doszło w 32 tygodniu lub później, nie odnotowano ani jednego zgonu.WnioskiŚmiertelność noworodków urodzonych wskutek PPROM przed 32 tygodniem ciąży jest zróżnicowana i zależna od wieku ciążowego. Wstępne badanie kliniczne powinno być zawsze potwierdzone przez badanie ultrasonograficzne. Ze względu na konsekwencje społeczno-ekonomiczne zagadnienie to wymaga dalszych prospektywnych badań.

Introduction Human intestinal colonization is a dynamic process that is nowadays redefining due to hygienic changes in the Polish population. Aim To analyze the development of the intestinal flora from newborns till 18-month-old infants in Poland. Material and methods 171 newborns were enrolled. We collected fecal samples at 5 timepoints (1st stool, at 3, 6, 12, 18 months). At each visit, the questionnaire concerning breastfeeding, antibiotics, probiotics was obtained including atopy family history at the first visit. Results The count of staphylococci, enterococci, lactobacilli decreased (mean 0 months vs. 18 months: 3.08 × 107 CFU/g vs. 6.35 × 106 CFU/g; 1.85 × 1010 CFU/g vs. 9.26 × 107 CFU/g; 3.3 × 1011 CFU/g vs. 3.11 × 107 CFU/g) and Clostridium difficile and Gram-negative bacilli increased (6.2 × 104 CFU/g vs. 1.34 × 105 CFU/g; 1.78 × 106 CFU/g vs. 9.03 × 107 CFU/g) during the first 18 months of life. Positive maternal atopy history influenced colonization with staphylococci in newborns, anaerobic bacteria, enterococci in 3-month-old infants and anaerobic bacteria in 6-month-old infants. Discussion Our study shows that the gut colonization is a constant process. For the first time, we present the trends in bacterial establishment in a group of more than 170 Polish children. The positive role of breastfeeding in the establishment of gut flora was previously suggested. Unexpectedly, among mostly breastfed children no relation between breastfeeding and the infantile gut microflora was found. Conclusions The intestinal colonization is continuously changed over the first 18 months of life and is influenced by positive maternal atopy history.

Introduction: The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. Objective: The aim of the study was to determine the effectiveness of alternative hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. Methods: Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort’s outcomes were compared with the historical controls and with post-MOMS results in Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). Results: In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). Conclusions: The alternative hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics.

Objectives: The role of human papilloma virus (HPV) in the development of cancerous states of female reproductive tract has been widely debated. However, the information about presence of HPV in the Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia (VIN) is missing. So far, no recommendation was made to complete HPV detection in time of vulvar biopsy or after the results of positive VIN are obtained. We aimed to assess the presence of HPV in women with vulvar intraepithelial neoplasia diagnosed at the Department of Gynecology, Obstetrics and Oncological Gynecology in Bytom, Poland. Material and methods: The retrospective examination of 120 consecutive vulvar biopsies obtained from women with persistent vulvar itching was done. Only patients with diagnosis of VIN were included in the further analysis. HPV DNA was detected using HPV Linear Array Genotyping Test including 14 HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Results: Out of 120 vulvar samples retrieved, 18 women were positive for VIN, including15 usual VIN (uVIN) and three differentiated type (dVIN ). 10 samples were eligible for DNA detection. HPV DNA was found in two women with uVIN (HPV 16 and 51). Conclusions: It is advisable to recommend HPV genotyping in women with VIN, regardless of their age and histologic type. The incidence of HPV infection in Caucasian women from the central Europe with VIN should be further studied.

Endometrial cancer is the most common malignant tumours of the female sexual organ, its incidence has been on the rise for many years. To date, there is no reliable diagnostic marker of this disease. The aim of the study was to evaluate the levels of HE4 protein in women with endometrial cancer and in women with uterine fibroids and to refer the results to healthy women of the same age. Median HE4 protein in women with endometrial cancer (n=30) was 55.5 U/ml (mean ± standard deviation 75.9 ± 50.2) and was statistically significantly higher compared to women with uterine fibroids (n=30) (36.9, 40.8 ± 18.7) and healthy women of the same age (n=50) (22.5, 23.1 ± 5.1). The HE4 concentration in women with endometrial cancer increases with the depth of endometrium infiltration described in the histopathological examination. In the group of patients with endometrial cancer, three positive linear correlations were confirmed: between the preoperative blood erythrocyte concentration and the HE4 protein concentration, between the pre-operative potassium ion concentration and the HE4 protein concentration as well as between the INR measured after surgery and the HE4 protein concentration. The authors conclude that endometrial cancer is a strong stimulus inducing the synthesis of HE4 proteins, the synthesis depends on the depth of endometrium infiltration. HE4 concentrations may be affected by higher concentrations of erythrocytes, INR and potassium. This suggests a higher value of HE4 as a cancer marker for women with endometrial cancer without comorbidities.

Background: Anti-M&uuml, llerian hormone (AMH) is considered to be one of the most significant indicators of women&rsquo, s fertility. Many studies have shown that vitamin D may modify human reproductive functions, however, the results are conflicting. The composition of follicular fluid (FF) creates the biochemical environment of the oocyte and affects its quality, which later determines the embryo quality. In this study, we aimed to revise with advanced statistical techniques the relationship between AMH and vitamin D in FF. Methods: The study was designed as a prospective single-center study in infertile patients with AMH &ge, 0.7 ng/mL who underwent controlled ovarian hyperstimulation for in vitro fertilization. AMH and vitamin D levels in FF were measured. Next, the standard and advanced statistical (including segmented regression) techniques were applied. Results: We observed a negative linear correlation between levels of AMH in serum and FF and total vitamin D concentrations up to approximately 30 ng/ml, with a statistically significant relationship in FF. Beyond that concentration, the trend was positive but statistically insignificant. Conclusions: As an existing &ldquo, change-point problem&rdquo, was noticed, we suggest segmentation in the relationship between vitamin D and AMH during infertility treatment.

Purpose Cerebral metastases develop in 10–30% of patients with breast cancer (BC) and in around 3.3 to 4% of patients with ovarian cancer (OC). The aim of the multicenter study is to investigate the correlation between the expression of estrogen alpha receptors (ERα), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), stromal cell-derived factor 1 (SDF1) and its receptor C-X-C chemokine receptor type 4 (CXCR4), breast cancer metastasis suppressor 1 (BRMS1), astrocyte elevated gene 1 (AEG1), depending on the status of BRCA1 protein, in patients suffering from OC and BC with brain metastases. Patients and methods The analysis included 51 patients: 29 with BC and 22 with OC, in whom brain metastases were disclosed. Results In most patients (65.5% of BC patients and 68.2% of patients with OC tumors) BRCA1 protein loss was found. No correlation was disclosed between the levels of ERα, PR receptors, HER2, SDF1, CXCR4, AEG1, BRMS1 and BRCA1 status, patient age, stage of disease advancement, grade of histological maturity of the cells, presence of metastases to lymph nodes. A statistically significant correlation was disclosed between the negative expression of PR receptors and a high expression of CXCR4 in patients with BC. High values of the AEG1 protein (linked to metastases) were detected alongside a high expression of BRMS1 (a suppressor of metastases). Conclusions Patients with BC and OC and brain metastases have a frequent loss of BRCA1 expression. The role of ERα, PR, HER2, SDF1, CXCR4, AEG1, BRMS1 in metastatic process needs further studies.

BACKGROUND Endometrial carcinomas (EC) differ in etiology, clinical course and prognosis. OBJECTIVES This multi-center study aimed at a closer recognition of molecular factors linked to heterogeneity of EC by evaluating estrogen and progesterone receptors, proteins dependent on MMR genes, proteins linked to poor prognosis and metastases, and mutations in BRCA1. MATERIAL AND METHODS Using sections of paraffin-embedded preparations, in 115 patients with EC type I and 31 with EC type II, expression of ERα, ERβ1, PR, MLH1, and MSH2 proteins, as well as ARID1A, c-MET and BRCA1, was estimated by immunohistochemistry using specific antibodies. RESULTS Expression of ERβ1 was augmented in EC type II, in poorly differentiated cancers and with growing clinical advancement. An augmented expression of ERα was noted in well-differentiated EC and at lower clinical stage. An increased expression of PR and decreased of MLH1 were detected in type I EC. The expression of ARID1A and c-MET proteins showed no differences between the types of EC, stages of clinical advancement or grading. In 51.6% patients with type II EC, a loss of BRCA1 expression was disclosed; in this group of cancers a decreased expression of ERα was noted. CONCLUSIONS An augmented expression of ERβ1 was linked to type II EC. A higher expression of ERα in EC cancers was associated with a lower histopathological grade. A decreased expression of MLH1 protein was estimated in EC type I. Type II EC may be connected to BRCA1 mutation.

The role of maternal vaginal bacteria on the colonization of neonatal gut is still a matter of discussion. Our aim was to estimate the role of maternal vaginal flora on the development of intestinal flora in neonates and 3-month-old infants.Seventy-nine maternal-neonatal pairs were included in the study. Vaginal swabs were taken before the rupture of membranes after admission to the delivery ward. First neonatal stool (meconium) and stool at 3-month-old infants were collected and cultured. All samples were subjected to microbiological analysis for Streptococcus, Staphylococcus, Bifidobacterium, Clostridium (including C. difficile), Lactobacillus, Escherichia coli, Klebsiella pneumoniae, and Candida.Maternal vagina was colonized mainly by streptococci (67%) followed by lactobacilli (58%) and Candida spp. (39%). Vaginal streptococci influenced the intestinal colonization in infants with staphylococci, C. difficile, and candida.Vaginal lactobacilli influenced colonization with C. difficile, and Candida. Vaginal flora is a potent factor influencing the development of bacterial flora in the neonatal and infantile gut. The extension of the observation period until 3 months of life allow to discover the potential changes in the intestinal flora of children.

Women using hormonal therapy for breast cancer are often encountered in clinical practice of breast surgeons, oncologists and gynecologists. Some of them during the course of therapy develop abnormal uterine bleeding or have ultrasound abnormalities detected. In Poland, most of them are still diagnosed using blind curettage, which does not bring a definitive diagnosis or requires repeating the diagnostic procedure. This produces unnecessary fear of malignancy in patients and increases economic costs (double curettage, unnecessary hysterectomy and its social consequences). Therefore, we studied the usefulness of hysteroscopy with targeted biopsies for further management of women treated with tamoxifen. Our goal is to provide evidence that women before entering, during and after tamoxifen treatment have hysteroscopy for endometrial assessment.

Background: Lichen sclerosus (LS) is an immune-mediated chronic dermatosis of perimenopausal women. Inflammatory infiltration has been suggested as a potential cause of LS changes in epidermis and dermis. Photodynamic therapy (PDT) is a specific noninvasive treatment based on detection and subsequent selective destruction of LS-affected tissues that are marked by a photosensitizer. Immunomodulatory and cytotoxic effects of PDT are responsible for inducing several immunologic reactions which leads to inflammatory condition improvement. The aim of the study was to determine the efficacy of photodynamic therapy for genital LS in correlation to protein expression involved in inflammatory infiltration – CD3, CD4, CD8, CD57, Granzyme B and Fascin. Material and methods: A group of patients has been treated for active LS disease, diagnosis was histologically confirmed in skin biopsies. The skin biopsies were taken and analyzed with antibodies: CD3, CD4, CD8, CD57, Granzyme B and Fascin before and after PDT treatment. Results: The study shows the efficacy of PDT in LS treatment including changes to CD3, CD4, CD57, Fascin, Granzyme B and the lymphocytic infiltration in skin sections. The proliferation index of CD4 did not differ before and after PDT. Conclusions: The PDT is a very effective therapeutic method in LS treatment.

Myelomeningocele (MMC) is the most frequent congenital defect of the central nervous system for which there is no satisfactory alternative to postnatal treatment. On the contrary prenatal MMC surgery is conducting before birth and is aimed at protecting from Chiari II malformation. The main goal of fetal MMC repair is to improve development and life quality of children with Chiari II malformation. Management of Myelomeningocele Study (MOMS) which was published in 2011 clearly confirmed effectiveness of prenatal surgery. In this paper we compare MOMS results with our own clinical experience. Thanks to high effectiveness and significant improvement in safety of maternal-fetal surgery prenatal MMC surgery become a new standard of treatment.

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho­rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates.

Rupture of membranes before 37 weeks of pregnancy occurs in 2-3% of all pregnant women and is the leadingcause of premature birth. It always significantly complicates the course of pregnancy. The scale of the problemincreases with decreasing gestational age. This paper summarizes the current state of knowledge on epidemiology,diagnosis, monitoring, available methods of treatment, and the outcome of this serious complication.