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Objective To decrease the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the Mount Sinai Hospital's obstetric service, additional contact and respiratory precautions for patients and staff were implemented. Patients were allowed only one support person, SARS-CoV-2 tested on admission, and required to mask during hospitalization. Staff were required to wear masks and eye shields, gloves for all patient care, and gowns for care with SARS-CoV-2-infected patients. This study determined if the risk of endometritis/intra-amniotic infection (IAI) changed under the new pandemic precautions. Study Design A single-center, historical cohort study via electronic medical record review compared singleton deliveries among patients who labored during the "pandemic period" (from March 1 through May 31, 2020) with those who labored during the "prepandemic period" (March 1 through May 31, 2019) to determine if the risk of endometritis/IAI differed. The analysis was done using logistic regression with inverse probability of treatment weighting (IPTW) to adjust for possible differences in obstetric practice and patient population between the two periods. Results Four percent (53/1,318) of patients in the pandemic period and 5.1% (82/1,596) of patients in the prepandemic period were diagnosed with endometritis/IAI (p = 0.15). Compared with patients who delivered in the prepandemic period, those who delivered during the pandemic period had a higher body mass index at delivery (median: 28.36 [interquartile range, IQR: 25.70, 32.07] vs. 28.00 [IQR: 25.23, 31.50], p = 0.01) and experienced fewer digital exams (median: 4 [range: 1, 10] vs. 4 (range: 1, 19], p = 0.004), a practice not included in the SARS-CoV-2 prevention strategy. In multivariable logistic regression with IPTW adjusting for risk factors for endometritis/IAI, period of delivery was not associated with endometritis/IAI (odds ratio = 0.76, 95% confidence interval [0.52, 1.11], p = 0.15). Conclusion The use of respiratory and contact precautions to limit the spread of SARS-CoV-2 was not associated with risk of endometritis/IAI. Key Points Pandemic infection control precautions were not associated with a decrease in endometritis/IAIs. The early months of the pandemic were associated with the performance of fewer digital cervical exams. The early months of the pandemic were associated with a higher BMI at delivery. [ABSTRACT FROM AUTHOR]

Purpose • This study systematically assesses the correlation between asymptomatic endometrial thickening after the age of 50 and the risk of endometrial cancer (EC). Methods • A comprehensive search was conducted using the Cochrane Library, Web of Science, PubMed, ProQuest, and Chinese biomedical literature databases Wanfang, Weipu, and CNG until August 2022. The included literature was analyzed using RevMan 5.3 software to explore heterogeneity in each study. Results • Five studies were finally included. The assessment of odds ratio (OR) heterogeneity between women with endometrial thickening and the risk of EC showed P = .18, I2=95%, indicating significant heterogeneity. A random- effects model was applied for meta-analysis, revealing a result of 0.96, 95% CI (0.92, 1.02), P = .18, indicating no statistical significance between the two groups (P > .05). The funnel plot demonstrated asymmetry, suggesting evident publication bias. Conclusion • There is no consistent correlation between asymptomatic endometrial thickening and the occurrence of EC in individuals over 50 years of age. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States. Study Design The 2000–2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified. Common infection diagnoses during delivery hospitalizations analyzed included (i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv) cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends in sepsis and infection during delivery hospitalizations were analyzed. The associations between sepsis and infection and common chronic health conditions including asthma, chronic hypertension, pregestational diabetes, and obesity were analyzed. The associations between clinical, demographic, and hospital characteristics, and infection and sepsis were determined with unadjusted and adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted odds ratios with 95% confidence intervals as measures of association. Results An estimated 80,158,622 delivery hospitalizations were identified and included in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614 had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound infections (0.3%). Infection and sepsis were more common in the setting of chronic health conditions. Evaluating trends in individual infection diagnoses, endometritis and wound infection decreased over the study period both for patients with and without chronic conditions, while risk for pyelonephritis and pneumonia/influenza increased. Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Risks for adverse outcomes including mortality, severe maternal morbidity, the critical care composite, and acute renal failure were all significantly increased in the presence of sepsis and infection. Conclusion Endometritis and wound infections decreased over the study period while risk for sepsis increased. Infection and sepsis were associated with chronic health conditions and accounted for a significant proportion of adverse obstetric outcomes including severe maternal morbidity. Key Points Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Endometritis and wound infection decreased over the study period. Infection and sepsis accounted for a significant proportion of adverse obstetric outcomes. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion The aim was to explore Endometrial cancer (EC) survivors' experiences of being offered nutrition and well‐being advice.This qualitative study was conducted at two tertiary centres in Aotearoa New Zealand. Semi‐structured conversations with people who had completed treatment for EC in the past 12 months were undertaken to explore how they were offered nutrition and well‐being advice as part of standard follow‐up care. Interviews were analysed using reflexive thematic analysis.Fifteen people of Pacific, Māori and European ethnicity participated. Five themes were derived: (i) isolation and vulnerability, (ii) importance of language, (iii) inconsistent availability and relevance of nutrition and well‐being information, (iv) competing priorities and influences and (v) holistic and culturally responsive support. People often experienced judgement associated with their weight as part of their care, with limited understanding of their lived realities. Nutrition and well‐being advice was not widely available or accessible, and people had to explicitly ask for it. Social and environmental factors were barriers to making changes to health behaviours. A need for culturally safe holistic care was identified.Enhancing survivorship after EC is ultimately premised on providing culturally safe and responsive care. Expanding workforce training in communication around high weight as well as education and self‐assessment of cultural safety could enable aspects of this. A holistic care program could facilitate wider access to nutrition and well‐being advice and better meet the needs of this population. [ABSTRACT FROM AUTHOR]

The uterine environment provides necessary conditions for the existence of endometrial microbiota, which in turn plays an important role in maintaining the homeostasis of the uterine environment. The endometrial microbiome is highly susceptible to external factors such as age, hormones, menstrual, pregnancy, etc. When the microbiota is imbalanced, it will further promote the occurrence of uterine diseases such as endometritis and endometrial cancer. Regulating the microbiome of the endometrium is of positive significance for promoting uterine health. Among them, antibiotics, probiotics, prebiotics, and microbial transplantation may be important pathways for regulating endometrial microbiota in the future. However, there is currently no unified plan for evaluating the endometrial microbiota. In addition, due to the small sample size, it is easy to be contaminated by exogenous bacterial DNA, which poses great challenges for studying the mechanism of microbial community regulating uterine health. Therefore, there are still many areas worth exploring for the future of endometrial microbiome. [ABSTRACT FROM AUTHOR]

Aim: To investigate variation in the diagnosis and treatment of chronic endometritis (CE) at the national level in Japan. Methods: We performed a nationwide survey targeting all assisted reproductive technology (ART) facilities across Japan between 2021 and 2022. Diagnostic methods, criteria, and first‐ and second‐line treatment protocols for CE were collected via a questionnaire. Results: Among 616 ART facilities, 437 responded to the survey (response rate: 70.9%) of which 339 (77.6%) implemented diagnosis and treatment of CE. In the diagnosis of CE, 214 (63.1%) facilities used CD138 immunohistochemical staining of endometrial tissue, while hysteroscopy was the most frequently used as an adjunct diagnostic method (241 facilities, 71.1%). The most frequent cutoff value of CD138‐positive cells for diagnosing CE was 3–5 cells/20 high‐power fields (50%), but 7.9% (17 facilities) and 5.1% (11 facilities) used cutoff values of 1 and 2 cells, respectively. The most common first‐ and second‐line treatment methods were doxycycline (210 facilities, 61.9%) and ciprofloxacin + metronidazole (164 facilities, 48.0%), respectively. Conclusions: There is considerable variation in the number of CD138‐positive cells used for diagnosing CE. Establishing unified diagnostic criteria and therapeutic methods for CE is essential to provide standardized medicine for CE at the national level. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety and effectiveness of high‐dose oral medroxyprogesterone acetate (MPA) therapy as a fertility‐sparing treatment for patients diagnosed with atypical endometrial hyperplasia (AEH) and endometrioid carcinoma G1 without myometrial invasion (G1EC). Particular attention was given to the extended administration and readministration of MPA for patients with persistent disease following initial treatment and those with recurrence. Methods: We conducted a retrospective analysis of data from 79 patients who underwent daily oral MPA treatment between 2005 and 2024 at Nagoya University Hospital. Patient characteristics, treatment outcomes, factors contributing to recurrence, and post‐MPA therapy pregnancies were examined. Results: MPA therapy achieved a remarkable complete response (CR) rate of 91.1%. The median time to achieve CR was 26.0 and 40.0 weeks for AEH and G1EC patients, respectively. Importantly, 27 patients (39.7%) attained CR after more than 6 months of treatment, including 8 patients (11.8%) who achieved CR after more than a year of treatment. The recurrence rates were 52.9% for AEH and 64.7% for G1EC. Twenty eight patients resumed MPA treatment, and 23 achieved second CR. Notably, recurrence was not associated with clinical factors such as age, body mass index, or post‐CR pregnancy. Among patients who attempted pregnancy after achieving CR, 22 live births were successfully achieved. Conclusions: High‐dose oral MPA therapy demonstrated both safety and efficacy for preserving fertility in patients with AEH and G1EC, resulting in a high CR rate. MPA extension and readministration proved to be beneficial strategies for managing patients with recurrence and persistent disease following initial treatment. [ABSTRACT FROM AUTHOR]

Introduction: Catamenial pneumothorax is a rare but potentially life-threatening condition that affects women of reproductive age. It is characterized by the recurrent occurrence of pneumothorax during or around the menstrual period. The pathophysiology of catamenial pneumothorax is not well understood, but is thought to be related to the presence of endometrial tissue in the pleural cavity. Case Presentation: A 42-year-old woman was referred to our outpatient department for further thoracic surgical treatment. She already had two previous episodes of pneumothorax that occurred during her menstrual period. A chest X-ray revealed a right-sided pneumothorax and she was admitted to the hospital where a chest tube was placed to treat the pneumothorax. CT scan revealed the presence of endometrial tissue under the right diaphragm. The patient underwent a total laparoscopic hysterectomy to remove the source of endometrial tissue. The subdiaphragmatic endometrial tissue was also removed. She subsequently underwent thoracoscopic treatment to treat the pneumothorax. Conclusion: The aim of this study was to review the clinical features, diagnostic criteria, and treatment options for catamenial pneumothorax. In addition, the study highlights the importance of a multidisciplinary approach to the management of catamenial pneumothorax, involving pulmonologists, gynecologists, and thoracic surgeons. Further studies are needed to optimize the management of this rare condition. [ABSTRACT FROM AUTHOR]

The endometrium undergoes cyclical changes in response to hormones and there is a certain degree of heterogeneity among individuals. In vivo identification of the physiologic changes of the endometrium and the pathologic process of related diseases is challenging. There have been recent advances in the use of organoids that mimic the characteristics of the corresponding organs and the morphologic, functional, and personalized characteristics involved in different stages of diseases. In this paper, we discuss the process of creating endometrial organoids, cell sources, types of extracellular matrices, and their application in the study of physiologic endometrial states and various diseases. Synopsis: The paper explores endometrial organoids, their use in studying physiologic states and diseases, and recent advancements in this field. [ABSTRACT FROM AUTHOR]

In this focused genetic case–control study, we analyzed two functional single-nucleotide variants (SNVs) associated with breast cancer risk (rs2046210, rs9383590) and one risk SNV for an implantation defect and infertility (rs9340799) for their association with endometriosis susceptibility, progression and ESR1 gene regulation in endometriosis patients. The rs2046210, rs9383590 and rs9340799 SNVs were genotyped in 153 endometriosis patients and 87 control subjects with Caucasian ancestry. We analyzed the association of all SNVs with endometriosis susceptibility in all patients and in subgroups and assessed the concordance between the SNVs. Quantitative reverse transcription PCR was used to determine ESR1 gene expression in the eutopic endometrial tissue of the controls and endometriosis patients. The heterozygous rs2046210 GA genotype was associated with significantly increased endometriosis risk, particularly in younger, leaner and infertile women and with an increased ESR1 gene expression in the eutopic endometrium of these patients, compared to controls. The minor AA genotype of rs2046210 was identified as a potential risk factor for endometriosis progression in women with mild endometriosis. The results from this analysis indicate that rs2046210 may be a functional genetic variant associated with endometriosis development and progression. [ABSTRACT FROM AUTHOR]

Background Local institutional guidelines and order sets were updated in June 2023 to recommend first-line cefoxitin monotherapy for the treatment of intra-amniotic infections (IAIs) and endometritis. This study evaluated the clinical impact of this change. Methods This was a retrospective, observational cohort study in an 11-campus health system comparing clinical outcomes of patients with chorioamnionitis, endometritis, or septic abortion receiving intravenous antimicrobial therapy before and after implementation of first-line cefoxitin monotherapy recommendations for the treatment of these infections. Primary outcome was a composite of serious clinical events postdelivery (ie, intensive care unit admission, death, hospital readmission related to IAI or endometritis within 30 days, additional surgery or procedures, or deep surgical site infection). Baseline characteristics between the pre- and post-cefoxitin groups were compared via Student's t tests for continuous variables and chi-square tests for categorical variables. Outcomes were evaluated via generalized linear modeling. Results A total of 472 patients were enrolled, 350 (74%) in the pre-cefoxitin group and 122 (26%) in the post-cefoxitin group. Groups were significantly different by race, healthcare payor, and hospital campus. Cefoxitin was rarely used in the pre-cefoxitin group (n = 2, <0.1%) and commonly used in the post-cefoxitin group (n = 112, 91.8%). After controlling for group differences, odds of experiencing serious clinical event postdelivery in the post-cefoxitin group were noninferior to those in the pre-cefoxitin group (adjusted odds ratio,.37; 95% CI,.17–.76; P =.010). Conclusions Local institutional guidelines with predominant use of cefoxitin therapy were noninferior to traditional antimicrobial therapy regimens for the treatment of IAI. [ABSTRACT FROM AUTHOR]

Introduction: Endometrial cancer is currently the most common malignancy of the female reproductive system. The significance of the disease is determined by the search for additional biomarkers with the aim to optimize earlier diagnosis and to help for timely treatment. The objective of this study was to assess the serum levels of fibronectin (FN) in patients with malignant endometrial pathology and to compare them with patients with benign pathology and healthy women. Material and methods: We analyzed serum FN levels in women with malignant and benign pathology of the endometrium. Blood serum samples were collected from 100 patients - 50 diagnosed with endometrial cancer and 50 with confirmed endometrial polyps. In addition, 50 control subjects were tested. Fibronectin levels were measured by enzyme-linked immunosorbent assay (ELISA) according to the protocol Results: Statistical analysis was performed and the results demonstrated statistical significances (p = 0.008) of FN levels in the group with endometrial cancer (mean 482.73, median 409.12 μg/ml) compared to the control group (mean 346.86, median 258.87 μg/ml), but no significant difference in FN levels was observed between the group with endometrial malignancy and the group with benign pathology of the endometrium. In addition, in the cancer group FN levels did not show any significant differences depending on the histologic type. Conclusions: The serum FN concentration can be used as an additional tumor marker for gynecological malignancies and can be a potential diagnostic and prognostic marker for malignant endometrial pathology as well as for other gynecological malignancies. [ABSTRACT FROM AUTHOR]

Background: The local application of stains or dyes during endoscopy is referred to as "chromoendoscopy" in an attempt to improve tissue identification, distinction, and diagnosis. Objectives: To judge the value of chromohysteroscopy in identifying endometrial abnormalities that are too subtle for standard hysteroscopy to detect. The histopathology from routine endometrial sampling and chromohysteroscopy was compared. Methodology: This interventional prospective study included 49 women with abnormal uterine bleeding. First of all, a 4 mm diameter hysteroscope was used to perform a diagnostic hysteroscopy. Between the 20th and 25th day of their menstrual cycle, patients were booked for blind endometrial sampling and chromohysteroscopy directed biopsies. Results: Focal staining had higher sensitivity, specificity and accuracy 65.5%, 95% and 77.6% respectively, for detection of endometrial pathologies compared with diffuse staining. Focal dark pattern was significantly associated with, submucous myoma, endometrial hyperplasia, necrotic mass, endometritis, simple and complex endometrial hyperplasia with atypia and endometrial carcinoma. Conclusion: The diagnostic precision of traditional hysteroscopy is enhanced with chromohysteroscopy. In cases of Abnormal Uterine Bleeding (AUB), it is a useful, affordable diagnostic for identifying endometrial diseases. [ABSTRACT FROM AUTHOR]

The endometrium is an important part of women's bodies for menstruation and pregnancy. Various proteins are widely expressed on the surface of endometrial cells, and glycosylation is an important post-translational modification of proteins. Glycosylation modification is closely related not only to endometrial receptivity but also to common diseases related to endometrial receptivity. Glycosylation can improve endometrial receptivity, promote embryo localization and trophoblast cell adhesion and invasion, and contribute to successful implantation. Two diseases related to endometrial receptivity include endometriosis and endometrial cancer. As a common benign disease in women, endometriosis is often accompanied by an increased menstrual volume, prolonged menstrual periods, progressive and aggravated dysmenorrhea, and may be accompanied by infertility. Protein glycosylation modification of the endometrial surface indicates the severity of the disease and may be an important pathogenesis of endometriosis. In cancer, glycosylation modifications on the surface of tumor cells can be a marker to distinguish the type and severity of endometrial cancer. This review highlights the role of protein glycosylation in embryo–maternal endometrial dialogue and explores its potential mechanisms in diseases related to endometrial receptivity, which could provide a new clinical approach for their diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Endometrial stem/progenitor cells are a type of stem cells with the ability to self-renew and differentiate into multiple cell types. They exist in the endometrium and form niches with their neighbor cells and extracellular matrix. The interaction between endometrial stem/progenitor cells and niches plays an important role in maintaining, repairing, and regenerating the endometrial structure and function. This review will discuss the characteristics and functions of endometrial stem/progenitor cells and their niches, the mechanisms of their interaction, and their roles in endometrial regeneration and diseases. Finally, the prospects for their applications will also be explored. [ABSTRACT FROM AUTHOR]

Background: Uterine rupture is a rare, but dangerous obstetric complication that can occur during trial of vaginal birth. Methods: The aim of this study was to evaluate the relationship between peripartum infection at the first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. We conducted a retrospective case-control study from March 2014 to October 2020 at a single academic medical center. The study group included women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who went through a successful vaginal birth after cesarean section (VBAC) without evidence of dehiscence or uterine rupture. We compared the rate of peripartum infection during the first cesarean delivery (CD) and other relevant variables, between the two groups. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful VBAC as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p = 0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk factor for uterine rupture at the subsequent trial of labor after CD (95% confidence interval, p = 0.034). Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. [ABSTRACT FROM AUTHOR]

The objective: to study clinical and diagnostic features of the benign endometrial conditions in the postmenopausal women. Materials and method. 64 postmenopausal patients with various severity of postmenopausal vaginal bleeding were examined. All patients underwent clinical, radiological, laboratory and histological examinations, reproductive history data and body mass index indicators were evaluated. Of them 33 persons were diagnosed with complex endometrial hyperplasia without atypia, 16 women – endometrial polyp and 15 women – hyperplasia with atypia. Routine gynecological examination including abdominal and pelvic examination following transvaginal ultrasound examination for the determination of the uterine and ovarian volume as well, as the endometrial thickness were conducted. Patients included in the study underwent computer tomography and magnetic resonance imaging as indicated. All patients with endometrial pathology underwent endometrial biopsy by standard dilatation and curettage or Pipelle-biopsy with histological examination of the obtained material. The concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), estradiol, estrone, progesterone, prolactin, and testosterone were determined in blood serum. Results. It was confirmed that in 87,5% of cases endometrial hyperplasia manifested with vaginal bleeding. Endometrial thickness in examined persons ranged from 14.1±1.6 mm in patients with atypical endometrial hyperplasia to 21.3±4.8 mm in patients with complex endometrial hyperplasia without atypia. The study of blood levels of hormones found that postmenopausal patients with endometrial hyperplasia have lower FSH concentration, LH/FSH ratio, estradiol, testosterone levels, with significantly high values of prolactin, DHEAS and estrone. During the postmenopausal period, hyperplasia was developed in 10% of cases by the presence of bleeding, and 86.2% of cases by the presence of blood spotting. Conclusions. The study suggests that high body mass index, numerous artificial abortions, high blood levels of estrone, DHEA-S and prolactin as well as increased thickness of endometrium influence the frequency of endometrial hyperplasia in postmenopausal women. [ABSTRACT FROM AUTHOR]

Objective: Atypical polypoid adenomyoma (APA) is a rare benign tumor frequently diagnosed in young women that may coexist with or progress to atypical endometrial hyperplasia (EAH) or endometrioid endometrial carcinoma (EEC). This study aimed to investigate which subset of patients with APA are prone to concurrent or subsequent EAH or EEC, evaluate the necessity of progestin treatment in patients with APA only after achieving a complete response (CR) through hysteroscopic lesion resection, and assess the impact of concurrent APA on the fertility-preserving treatment of EAH or EEC. Methods: This retrospective single-center study analyzed 86 patients with APA treated at the Obstetrics and Gynecology Hospital of Fudan University between January 2010 and October 2021. Patients with EAH or EEC only who underwent fertility-preserving treatment during the same period were matched in a 2:1 ratio with patients with concurrent APA and EAH or EEC. The clinicopathological characteristics, treatments, and prognosis were analyzed. Results: The median patient age was 31 years (range 21–47 years). Among the 86 included patients, nine underwent total hysterectomy, 62 received conservative treatment, and the remaining 15 were lost to follow-up. A comparison of the 16 patients with APA only versus the 58 patients with APA and concurrent or subsequent EAH or EEC revealed that a homeostasis model assessment of insulin resistance (HOMA-IR) of > 2.2 (P = 0.047) and high-density lipoprotein (HDL) concentration of < 1.2 mmol/L (P = 0.028) were independent risk factors for EAH or EEC in patients with APA. Among the 17 patients with APA only who received conservative treatment and achieved a CR after hysteroscopic lesion resection, 13 received hormone treatment for a median duration of 6.3 months. The median follow-up time for these 17 patients was 49.0 months, during which no recurrence of APA was observed, but six patients developed endometrial hyperplastic diseases. Regarding the impact of concurrent APA on fertility-preserving treatment for EAH or EEC, the median time to achieve a CR was 24.0 weeks (95% confidence interval [CI]: 23.0–40.4) in the APA group and 26.0 weeks (95% CI: 24.3–32.3) in the non-APA group (P = 0.424). There were no significant differences between the two groups in the outcomes of fertility-preserving treatment. Conclusion: Patients with APA only may still develop endometrial hyperplastic diseases after complete resection of the lesion under hysteroscopy to achieve a CR, particularly those with a HOMA-IR of > 2.2 or HDL concentration of < 1.2 mmol/L. Concurrent APA did not affect the efficacy of fertility-preserving treatment in patients with EAH or EEC. [ABSTRACT FROM AUTHOR]

This study investigates the association between body mass index (BMI) and the composition of the endometrial microbiota in infertile women of childbearing age. This is a retrospective clinical study comparing the endometrial microbiota across body weight in 132 patients presenting for care at an infertility clinic. The reason for infertility was recurrent pregnancy loss (RPL) or implantation failure with a prior IVF cycle. Microbe analysis was completed by Igenomix Laboratory (Valencia, Spain) using two comprehensive panels. Patients were separated into three groups based on their results: normal, dysbiotic, and pathogenic. Prevalence of these groups was compared across BMI categories and statistical analysis was used to determine significance. Of the 132 endometrial samples collected, 80 (60.6%) were normal, 16 (12.1%) were dysbiotic, and 36 (27.3%) were pathogenic. Patients with a BMI ≥ 30 showed a statistically significant increase in pathogenic endometrium compared to normal weight controls (p = 0.029). Our conclusion is that the prevalence of pathogenic endometrium was significantly higher in the obese group compared with normal weight controls. There is a possible association between obesity and the endometrial microbiome. [ABSTRACT FROM AUTHOR]

Problem: A comprehensive analysis was conducted to explore the scientific output on immune‐related recurrent pregnancy loss (RPL) and its key aspects. Despite the lack of clear explanations for most RPL cases, immune factors were found to play a significant role. Method of Study: The study utilized a bibliometric approach, searching the Web of Science Core Collection database for relevant literature published between 2004 and 2023. Results: The collected dataset consisted of 2228 articles and reviews, revealing a consistent increase in publications and citations over the past two decades. The analysis identified the United States and China as the most productive countries in terms of RPL research. Among the institutions, Fudan University in China emerged as the top contributor, followed by Shanghai Jiaotong University. Kwak‐kim J was the most prolific author, while Christiansen Ob had the highest number of co‐citations. The top 25 co‐cited references on diagnosis, treatment, and mechanisms formed the foundation of knowledge in this field. By examining keyword co‐occurrence and co‐citations, the study found that antiphospholipid syndrome and natural killer cells were the primary areas of focus in immune‐related RPL research. Additionally, three emerging hotspots were identified: chronic endometritis, inflammation, and decidual macrophages. These aspects demonstrated increasing interest and research activity within the field of immune‐related RPL. Conclusions: Overall, this comprehensive bibliometric analysis provided valuable insights into the patterns, frontiers, and focal points of global scientific output related to immune‐related RPL. [ABSTRACT FROM AUTHOR]

Background & Objective: Endometrial hyperplasia is the primary precursor of endometrial cancer in the female reproductive system, with abnormal uterine bleeding (AUB) being the predominant manifestation of this condition. The purpose of this study was to determine the prevalence of endometrial hyperplasia and its correlation with various factors among patients presenting with abnormal uterine bleeding. Materials & Methods: This cross-sectional descriptive-analytical study reviewed the hospital records of all patients with abnormal uterine bleeding admitted to Ali Ebn-e Abi Taleb Hospital in Zahedan from April 2015 to April 2018. Data were analyzed using the SPSS. Results: The prevalence of endometrial hyperplasia was estimated to be 20.3%. The average age of the study subjects was about 45 years. The highest number of patients (37, 52.9%) belonged to the age group of 36-50 years. Among the different types of endometrial hyperplasia observed, the most common was "simple non-atypical hyperplasia" found in 45 patients (64.3%), while the least common was "simple atypical hyperplasia" observed in three patients (4.3%). Overall, "non-atypical hyperplasia" (including both simple and complex types) was present in 58 patients (82.85%). The prevalence of infertility, obesity, hypertension, diabetes, premature menarche, late menopause, family history, oligomenorrhea, and polycystic ovary syndrome (PCOS) was reported in 7.1%, 32.9%, 24.3%, 22.9%, 8.5%, 13.6%, 7.1%, 5.7%, and 3.4% of cases, respectively. Conclusion: women with a history of diabetes, hypertension, and obesity are at an increased risk of developing endometrial hyperplasia. Therefore, it is crucial to evaluate these patients for the presence of endometrial hyperplasia. [ABSTRACT FROM AUTHOR]

Background and Objective: In endometrial cytology, differentiating endometrial glandular stromal breakdown (EGBD) from endometrial endometrioid carcinoma (G1-EEC) is often difficult. In this study, we provided a new focus on chondroitin sulfate (CS), a major substrate component of the endometrial stroma, and assessed the diagnostic utility of Alcian Blue (AB) staining in the differential diagnosis in liquid-based cytological (LBC) samples. Materials and Methods: LBC specimens from 19 patients with a proliferative endometrium, 36 with EGBD, and 30 with G1-EEC who underwent endometrial cytology were stained with AB (pH 1.0), and their reactivity was observed. In addition, immunocytochemical staining of CS and CD31 was performed for five cases each to evaluate their interrelationship with blood vessels. Results: Regarding the 30 G1-EEC cases, at least one of the three representative staining patterns was observed by AB staining: dot-like, microtubular, and finely branched linear patterns. Moreover, the inner portion of the tubular material observed by AB staining expressed CD31. Conversely, in the 36 EGBD cases, only five metaplastic clusters with irregular protrusions and condensed stromal clusters (CSCs) showed a dot-like positive pattern, and background CSCs did not show reactivity to AB staining in any of the cases. Furthermore, the vascular structure expressing CD31 in cell clusters was also unclear. Conclusions: We demonstrated that AB staining shows different staining patterns in G1-EEC and EGBD, reflecting their different tissue structures. Our data provide new insights into endometrial cell diagnosis changes and demonstrate that AB staining is a potential new diagnostic aid tool for the differentiation of G1-EEC from EGBD. [ABSTRACT FROM AUTHOR]

Objective To evaluate whether use of both preoperative 2% chlorhexidine gluconate abdominal cloth and 4% chlorhexidine gluconate vaginal scrub is effective in reducing surgical site infections (SSIs) in patients undergoing cesarean delivery after labor. Study Design This is a single-center, randomized clinical trial in which patients were randomized 1:1 to receive 2% chlorhexidine gluconate cloth applied to the abdomen in addition to the application of 4% chlorhexidine gluconate vaginal scrub versus standard of care. The primary outcome was rate of SSIs, including endometritis, by 6 weeks postdelivery. The secondary outcomes were other wound complications (erythema at the operative site, skin separation, drainage, fever, hematoma, seroma) by 6 weeks postdelivery, hospital readmission for wound complications, and day of discharge after cesarean delivery. Results A total of 319 patients between September 2018 and February 2021 met eligibility criteria: 160 were randomized to the chlorhexidine gluconate abdominal cloth and vaginal scrub group and 159 were randomized to the standard of care group. The groups did not have significant differences in maternal demographic characteristics. Of the 302 (95%) individuals included in primary analysis, there was no statistically significant difference in SSI and endometritis rate by 6 weeks postdelivery (6.6% in chlorhexidine vs. 5.3% standard of care, p = 0.65). Secondary outcomes were also similar among the two groups. Conclusion The combination of preoperative 2% chlorhexidine gluconate abdominal cloth and 4% chlorhexidine gluconate vaginal scrub does not appear to reduce the risk of SSI with cesarean delivery after trial of labor when compared with standard of care. Key Points Preoperative chlorhexidine abdominal cloth/vaginal scrub does not decrease SSI in cesarean after labor. Preoperative chlorhexidine abdominal cloth/vaginal scrub does not decrease other wound complications in cesarean after labor. There was no difference in discharge day, 2-week or 6-week SSI rates. [ABSTRACT FROM AUTHOR]

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Caesarean section rate is increasing and postoperative wound infection is a major health‐threatening complication after caesarean section (CS). The aim of this study was to evaluate the efficacy of Cefazolin at different time for post‐caesarean delivery. The aim of this study was to compare the use of Cefazolin at different times on infections after CS. The time of antibiotic use in CS can be divided into two groups: before skin incision (SI) and after cord clamping (CC). In this study, 268 relevant articles were found in the database, and finally, 10 articles were analysed. This study included a total of 5256 cases of caesarean section. The data on wound infections, endometritis, urinary tract infections and fever were analysed. Perform an analysis of the data using RevMan 5.3. The results showed that cefazolin before SI reduced wound infection compared to after CC (odds ratio [OR], 0.51; 95% CI: 0.37–0.69; p < 0.0001). Cefazolin prophylactically used before SI reduce endometritis after CS compared to after CC (OR, 0.52; 95% CI: 0.35–0.77; p = 0.001). There was no significant difference in urinary tract infections after CS between cefazolin prophylactically used before SI and after CC (OR, 0.80; 95% CI: 0.50–11.28; p = 0.35). There was no significant difference in fever after CS between the prophylactic use of cefazolin before SI and after CC (OR, 0.60; 95% CI: 0.26–11.43; p = 0.225). Cefazolin before SI reduces wound infection and endometritis after CS. [ABSTRACT FROM AUTHOR]

Objective: To explore the application of neutrophils to lymphocytes ratio (NLR), platelet to lymphocyte ratio (PLR) and monocyte to lymphocyte ratio (MLR) in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. Methods: 80 patients with endometrial malignant tumor diagnosed in our hospital from January 2019 to December 2022 were selected as the study group, and 74 patients with benign uterine diseases confirmed by pathology in our hospital during the same period were randomly selected as the control group. The differences of NLR, PLR and MLR in the peripheral blood of patients in each group were compared, and the value of individual indicators in the diagnosis of endometrial malignant tumor was evaluated using the Receiver Operating Characteristic (ROC) curve. Results: In peripheral blood, the NLR, PLR and MLR value in patients with endometrial cancer (EC) were significantly higher than those in patients with benign uterine diseases (P < 0.05). The area under the curve (AUC) of NLR, PLR, MLR in peripheral blood were 0.777, 0. 675 and 0.698. The best cutoff values were 2.02, 132.06 and 0.166. The sensitivity and specificity were 62.5% and 79.7%, 62.5% and 63.5%, 81 3% and 47.3%. The combination of these three indicators can significantly improved the diagnostic efficiency in endometrial cancer (AUC = 0.780), and the sensitivity and specificity were 60% and 83.8%. Conclusions: In peripheral blood, NLR, PLR and MLR have certain diagnostic value in the differential diagnosis of endometrial cancer. When NLR, PLR and MLR are elevated, we should be alert to the occurrence of endometrial malignant tumors, and the combined diagnostic efficiency is high. [ABSTRACT FROM AUTHOR]

Objective To investigate the correlation between tongue and pulse indicators and the outcome of live birth in patients undergoing frozen-thawed embryo transfer (FET), as well as the association between these indicators and patients' endocrine parameters. Methods This study was conducted at Reproductive Medicine Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China, from March 8, 2021 to January 5, 2022. Patients undergoing FET were divided into live birth and non-live birth groups according to their live birth outcome. The differences between the endocrine parameters [basic follicle stimulating hormone (b FSH), basic luteinizing hormone (b LH), basic estradiol (b E2), basic progesterone (b P), basal endometrial thickness, follicle stimulating hormone (FSH) on endometrial transition day, luteinizing hormone (LH) on endometrial transition day, estradiol (E2) on endometrial transition day, progesterone (P) on endometrial transition day, and endometrial thickness on endometrial transition day] and the tongue and pulse indicators [tongue body (TB)-L, TB-a, TB-b, tongue coating (TC)-L, TC-a, TC-b, perAll, perPart, h1, h4, h5, t1, h1/t1, and h4/h1] of patients in the two groups were analyzed, with the correlation between these variables analyzed as well using Spearman's correlation coefficient. Multivariate logistic regression was employed to identify the influential factors in the live birth prediction models across various datasets, including Model 1 consisting of endocrine indicators only, Model 2 solely consisting of tongue and pulse indicators, and Model 3 consisting of both tongue, pulse, and endocrine indicators, as well as to evaluate efficacy of the models derived from different datasets. Results This study included 78 patients in live birth group and 144 patients in non-live birth group. Compared with non-live birth group, live birth group exhibited higher levels of TB-L (P = 0.01) and TB-a (P = 0.04), while demonstrated lower levels of b FSH (P = 0.01), perAll (P = 0.04), and h4/h1 (P = 0.03). The Spearman's correlation coefficient analysis revealed statistically significant correlation (P < 0.05) between TB-L, TB-b, TC-L, TC-b, perAll, perPart, h4, h5, t1, h1/t1 and b FSH, b LH, basal endometrial thickness, LH on endometrial transition day, E2 on endometrial transition day, P on endometrial transition day, and endometrial thickness on endometrial transition day in live birth group. The multivariate logistic regression analysis showed that the prediction Model 3 for live birth outcome [area under the curve (AUC): 0.917, 95% confidence interval (CI): 0.863 - 0.971, P < 0.001] surpassed the Model 1 (AUC: 0.698, 95% CI: 0.593 - 0.803, P = 0.001), or the Model 2 (AUC: 0.790, 95% CI: 0.699 - 0.880, P < 0.001). The regression equations for the live birth outcomes, integrating tongue and pulse indicators with endocrine parameters, included the following measures: FSH on endometrial transition day [odds ratio (OR): 0.523, P = 0.025], LH on endometrial transition day (OR: 1.277, P = 0.029), TB-L (OR: 2.401, P = 0.001), perPart (OR: 1.018, P = 0.013), h1 (OR: 0.065, P = 0.021), t1 (OR: 4.354, P = 0.024), and h4/h1 (OR: 0.018, P = 0.016). Conclusion In infertility patients undergoing FET, there exists a correlation between tongue and pulse indicators and endocrine parameters. The corporation of tongue and pulse indicators significantly improved the predictive capability of the model for live birth outcomes. Specifically, tongue and pulse indicators such as TB-L, perPart, h1, t1, and h4/h1 exhibited a discernible correlation with the ultimate live birth outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). Material and Methods: This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. Results: A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. Conclusion: This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia. [ABSTRACT FROM AUTHOR]

Infertility is a disease with a complex pathophysiology and concurrent presence of gynaecological and reproductive disorders associated with it. A significant hurdle that infertility faces is the limitation of the success rate per couple per cycle in one assisted reproductive technology treatment. A central role is played by the complex embryo endometrial crosstalk that has been a subject of study since the very beginning of natural conception failures. The endometrium is a key player in the attempt for a healthy live birth. Thought to be previously sterile, the uterus is now known as home to a unique community of microorganisms. The microbiota and their genomic content: the endometrial microbiome is a complex and heterogeneous endocrine system that plays a pivotal role in the master orchestration of successful embryo implantation in a receptive uterine cavity. The microbial community inside the uterus is now known to influence reproductive pathologies and complex aetiologies that influence infertile outcomes. This review is aimed to understand the correlations of the endometrial microbiome and more specifically, bacterial communities and their pathophysiology in reproductive pathologies leading to infertility. The role of personalised regimens and therapies for treatment through nutritional, microbiotic or pharmaceutical interventions is discussed. The use of selected strains that are part of this bacterial community as probiotics could be a successful therapy for uterine diseases and concomitant infertility alongside nutritional and pharmaceutical interventions. Further longitudinal studies in infertile patients with specific pathologies with stratified selection are necessary to progress microbiome evaluation and eventually, modulation for infertility. [ABSTRACT FROM AUTHOR]

Hypoxia-inducible factor 1 alpha (HIF-1α) is a major molecular mediator of the hypoxic response. In the endometrium, local hypoxic conditions induced by hormonal fluctuations and endometrial vascular remodeling contribute to the production of HIF-1α, which plays an indispensable role in a series of physiological activities, such as menstruation and metamorphosis. The sensitive regulation of HIF-1α maintains the cellular viability and regenerative capacity of the endometrium against cellular stresses induced by hypoxia and excess reactive oxygen species. In contrast, abnormal HIF-1α levels exacerbate the development of various endometrial pathologies. This knowledge opens important possibilities for the development of promising HIF-1α-centered strategies to ameliorate endometrial disease. Nonetheless, additional efforts are required to elucidate the regulatory network of endometrial HIF-1α and promote the applications of HIF-1α-centered strategies in the human endometrium. Here, we summarize the role of the HIF-1α-mediated pathway in endometrial physiology and pathology, highlight the latest HIF-1α-centered strategies for treating endometrial diseases, and improve endometrial receptivity.

Objective As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m 2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m 2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40–49.9, 50–59.9, 60–69.9, and >70 kg/m 2). Results Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50–59.9 kg/m 2 ; 13.7% BMI: 60–69.9 kg/m 2 ; and 21.9% BMI >70+ kg/m 2 ; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50–59.9 kg/m 2 ; 6.2% for BMI: 60–69.9 kg/m 2 ; and 9.4% for BMI >70+ kg/m 2 ; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m 2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m 2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37–29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35–4.02 for BMI 50–59.9 kg/m 2 ; aOR = 4.91, 95% CI: 2.07–11.7 for BMI of 60–69.9 kg/m 2 ; and aOR = 36.2, 95% CI: 7.45–176 for BMI >70 kg/m 2). Conclusion Women with BMI 50 to 70+ kg/m 2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m 2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. Key Points Women with super obesity have higher rates of wound complications. Women at extremes of obesity experience worse postpartum infectious morbidity. More research is needed on effective strategies to minimize morbidity in this population. [ABSTRACT FROM AUTHOR]

To determine the clinical predictors of response rate, progression-free survival (PFS), and overall survival (OS) to pembrolizumab in advanced or recurrent, mismatch repair deficient (MMRd) or Microsatellite Instability-High (MSI-H) endometrial adenocarcinomas. A retrospective, single institution study was conducted among women with recurrent or advanced MMRd or MSI-H endometrial adenocarcinomas treated with single-agent pembrolizumab at our institution from 2017 to 2021. Logistic regression was used for univariable and multivariable analyses. PFS and OS were estimated using the methods of Kaplan and Meier and modeled via Cox proportional hazards regression. Log-rank test was used for intergroup comparisons based on body mass index (BMI). Among the 44 patients included in the analysis, the median BMI was 32.9 (range 18.5–51.8). Median cycles of pembrolizumab given was 11.5 (range 2–37). Median follow-up was 33 months (range 5–61) with a response rate of 63.6% and stable disease rate of 75%. When stratified by obesity status (BMI ≥ 30), disease control rate was 59.8% in patients with a BMI < 30 and 85.2% in patients with a BMI ≥ 30 patients (p = 0.05). On multivariable analysis, obesity was associated with increased rate of disease control (OR 4.03, 95%CI 1.09, 28) while prior smoking was associated with decreased rate of disease control (OR 0.18, 95%CI 0.03, 0.85). PFS was significantly increased among patients with a BMI ≥ 30 (p = 0.03) but OS was similar (p = 0.5). In this retrospective study, obesity is associated with increased rates of disease control and improved PFS in patients treated with pembrolizumab for recurrent or advanced MMRd/MSI-H endometrial adenocarcinomas. • Obesity is a known risk factor for many cancers, yet is associated with improved treatment response in some tumor types. • Obesity is associated with improved disease control in patients with MMRd endometrial cancer when treated with pembrolizumab. • PFS was significantly increased among patients with a BMI ≥ 30 but overall survival was similar. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a common chronic disorder, which leads to dysmenorrhea, dyspareunia, pelvic chronic pain, and infertility. It affects ∼6% to 10% of the general female population. However, the etiology of endometriosis remained unclear. We aimed to systematically assess the association between pelvic inflammatory disease (PID) and the risk of endometriosis. Materials and Methods: Eligible studies published until May 21, 2022, were retrieved from the PubMed, EMBASE, and Web of Science databases. The studies were included based on the following criteria: (1) original articles on the association between PID and risk of endometriosis; (2) randomized controlled trials and cross-sectional, case–control, and cohort studies; and (3) studies involving humans. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies included in this systematic review. The association between PID and risk of endometriosis was evaluated using the overall odds ratio (OR) and correlative 95% confidence interval (CI). Results: The meta-analysis included 14 studies with 747,733 patients. The mean prevalence of PID in women with endometriosis was 33.80%. Our quantitative synthesis revealed that endometritis was associated with a significantly increased risk of endometriosis (OR: 1.63, 95% CI: 1.53–1.74, I2 = 59%). Conclusion: We study a statistically significant association between PID and the risk of endometriosis. In particular, endometritis might play an important role in endometriosis, based on the lower heterogeneity of the subgroup analysis. This finding suggests that reducing the incidence of endometritis might aid in the prevention and treatment of endometriosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cavernous hemangiomas are rare and have various non‐specific clinical presentations, such as menorrhagia. It can mimic different diseases such as endometrial polyps. Pathologists and gynecologists should be aware of performing histopathological examinations of this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions. Internal genital tract hemangiomas are rare and can be divided into capillary and cavernous. We present a rare case of cavernous hemangioma (CH) of the corpus in a young, non‐pregnant woman. The patient was a 28‐year‐old woman who had complained of menorrhagia for 2.5 years. Sonography showed a hypoechoic intramural area measuring 35 × 23 mm. Histomorphology revealed neoplastic proliferation of dilated thin‐walled arteries of various sizes within the myometrium. Due to the variable clinical presentations of CH, histopathological examination should be performed for an accurate diagnosis. It is a rare entity and we recommend training pathologists and gynecologists on this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features. However, the accurate evaluation of ultrasound images relies heavily on the experience of radiologist. Therefore, a stable and objective computer-aided diagnostic model is crucial to assist radiologists in diagnosing endometrial lesions. Methods: Transvaginal ultrasound images were collected from multiple hospitals in Quzhou city, Zhejiang province. The dataset comprised 1875 images from 734 patients, including cases of endometrial polyps, hyperplasia, and cancer. Here, we proposed a based self-supervised endometrial disease classification model (BSEM) that learns a joint unified task (raw and self-supervised tasks) and applies self-distillation techniques and ensemble strategies to aid doctors in diagnosing endometrial diseases. Results: The performance of BSEM was evaluated using fivefold cross-validation. The experimental results indicated that the BSEM model achieved satisfactory performance across indicators, with scores of 75.1%, 87.3%, 76.5%, 73.4%, and 74.1% for accuracy, area under the curve, precision, recall, and F1 score, respectively. Furthermore, compared to the baseline models ResNet, DenseNet, VGGNet, ConvNeXt, VIT, and CMT, the BSEM model enhanced accuracy, area under the curve, precision, recall, and F1 score in 3.3–7.9%, 3.2–7.3%, 3.9–8.5%, 3.1–8.5%, and 3.3–9.0%, respectively. Conclusion: The BSEM model is an auxiliary diagnostic tool for the early detection of endometrial diseases revealed by ultrasound and helps radiologists to be accurate and efficient while screening for precancerous endometrial lesions. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review is to identify common hysteroscopic findings suggestive of endometritis, chronic or subclinical, based on current scientific evidence. Data sources were MEDLINE, Embase, PubMed and other sources of grey literature. Four (4) authors independently selected studies addressing hysteroscopic detection of CE based on specific and clearly stated hysteroscopic criteria. The diagnosis was confirmed by histologic assessment, as stated in the materials and methods of these studies included. The initial search identified 599 studies, of which 21 met the inclusion criteria. Significant heterogeneity among published studies on Chronic endometritis (CE) remains the main limitation in performing a metanalysis and further analysis of diagnostic accuracy on the subject. Hysteroscopy is an important diagnostic tool in cases of chronic endometritis when accompanied by endometrial biopsies. Clinicians relate hyperaemia and endometrial oedema with chronic endometritis while more than half include micropolyposis as a pathognomonic feature of this subclinical condition. Micropolyps, stromal oedema, haemorrhagic spots, strawberry aspect, and hyperaemia are proposed as adequate indicators of hysteroscopic evidence of CE according to the literature. The impact of CE in long-term reproductive outcomes remain unclear, thus clinicians ought to communicate this to the patients and provide treatment where clinically appropriate. In addition, we present hysteroscopic images of histologically confirmed CE cases that could play the role of a hysteroscopic atlas. [ABSTRACT FROM AUTHOR]

What is the goal of a gynecologist? Treat a symptom or improve herd fertility? How do you improve herd fertility? Treating a symptom? Is endometritis a pathology or a symptom? If it is a symptom, what pathology is endometritis a symptom of? Next, the authors critically analyze the therapeutic approach used for the treatment of clinical and subclinical endometritis in cattle. [ABSTRACT FROM AUTHOR]

In this report, we describe recovery of multiple drug resistance organism resistant to most of the antibiotics with coexistence of ESBL, Carbapenam and AmpC ß-lactamase genes isolated from the bovine clinical endometritisin the Mathura region of India.Sampling involvesuterine discharge collected from 70 postpartum cattle diagnosed with metritis. Out of 62 bacterial isolates recovered, seven were showing carbapenamase resistant phenotype baseddisc diffusion test. MIC testing and phenotypic detection methodconfirmed resistance to imepenam for isolates of Pseudomonas aeruginosa (n=1),E. coli (n=2) and Enterobacter agglomerance (n=1). Multiplex PCR based genotyping confirmed presence Ambler class B Carbapenemase (VIM and IMP), along with TEM and CTX-M type ESBL respectively. All four isolates were phenotypically confirmed as AmpC β-lactamase producers. [ABSTRACT FROM AUTHOR]

Recent advances in surgical technology and innovative techniques have revolutionized surgical gynecology, including transcervical hysteroscopic procedures. Surgical lasers (Nd-Yag, Argon, diode, and CO2 lasers) have been promoted to remove a variety of gynecological pathologies. For hysteroscopic surgery, the diode laser represents the most versatile and feasible innovation, with simultaneous cut and coagulate action, providing improved hemostasis compared with CO2 laser. The newest diode laser devices exhibit increased power and a dual wavelength, to work precisely with reduced thermal dispersion and minimal damage to surrounding tissues. Their efficacy and safety have been validated both in the hospitals as well as in the office setting. Updated evidence reports that several hysteroscopic procedures, including endometrial polypectomies, myomectomies and metroplasties can be successfully performed with a diode laser. Therefore, this review aimed to give a deeper understanding of the role of laser energy in gynecology and subsequently in hysteroscopy in order to safely incorporate this technology into clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Initially, medical treatment options are preferred in patients with abnormal uterine bleeding (AUB) who are hemodynamically stable. The aim of the present study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in reducing bleeding symptoms in patients with AUB stratified by underlying pathology. Material and Methods: In line with the polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia), coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified classification system, patients who were administered LNG-IUD due to adenomyosis, endometrial hyperplasia, leiomyoma and AUB due to not otherwise classified causes were included in the study. Results: A total of 172 otherwise patients with a mean age of 42.58±5.00 years were included. The distributions in the adenomyosis, endometrial hyperplasia, leiomyoma and otherwise unclassified groups were 30.8%, 12.8%, 26.2%, and 30.2%, respectively. Overall effectiveness of LNG-IUD in reducing menstrual bleeding was 82%. The proportion whose bleeding decreased was 95.50% in the endometrial hyperplasia group, 88.70% in the adenomyosis group, 55.60% in the leiomyoma group and 92.30% in the not otherwise classified group. The power of the current study was 99%. The efficacy of LNG-IUD was significantly less in the leiomyoma group (p<0.05) and thus this group were more likely to require surgical intervention. The overall incidence of spotting was 50%. Amenorrhea developed in 14% of patients. Conclusion: While LNG-IUD was more effective in reducing symptoms of AUB in patients with adenomyosis, endometrial hyperplasia and not otherwise classified causes, LNG-IUD was less effective in cases of leiomyoma. [ABSTRACT FROM AUTHOR]

Background/Aim: Breast cancer is the leading cause of cancer-related fatalities in women. Tamoxifen, a selective estrogen receptor modulator (SERM), is frequently employed for chemoprevention in hormone receptor (HR)-positive breast cancer patients due to its anti-estrogenic impact on breast tissue. Nevertheless, tamoxifen exhibits agonistic effects on the endometrium, particularly in postmenopausal women. This study aims to assess gynecological issues and endometrial pathologies that emerge during the treatment and follow-up phases of women diagnosed with HR-positive/negative breast cancer. Methods: This cohort study involved a data review from 857 breast cancer patients diagnosed over a decade at a tertiary center. Histopathological endometrial findings were evaluated for 166 patients who underwent gynecological consultations before breast cancer treatment with normal examination results and underwent invasive assessments due to gynecological symptoms that arose during treatment and followup. The study encompassed cases culminating in total abdominal hysterectomy and bilateral salpingooophorectomy (TAH+BSO). Results: The study analyzed 166 cases meeting the inclusion criteria. The mean age at breast cancer diagnosis was 48 years with a standard deviation of 8.4 years, and the average follow-up duration was 4.1 (3.8) years. The predominant histopathological type was invasive ductal carcinoma (75.3%). Of the cases, 68.6% occurred during premenopausal and 31.4% during postmenopause. HR positivity was identified in 136 cases (81.9%), while 30 (18.1%) exhibited negative HR status. Among HR-positive cases, 113 (83.0%) received tamoxifen treatment, while 23 (17.0%) were treated with letrozole. Common clinical findings during and after treatment encompassed increased endometrial thickness (ET) and abnormal uterine bleeding (AUB). Histopathological evaluation of invasive procedures prompted by increased ET indicated the following frequent endometrial findings: proliferative endometrium (33.1%), endometrial polyp (20.5%), and endometrial hyperplasia (EH) without atypia (9%). The histopathological outcomes of invasive procedures prompted by AUB included atrophic endometrium (11.4%), proliferative endometrium (3.6%), and endometrial cancer (1.8%). Among the endometrial malignancies, three occurred in the premenopausal phase and four in the postmenopausal phase. Notably, three of the seven endometrial malignancies were observed in the tamoxifen hormone therapy group, all HR-positive. Four cases were from the non-tamoxifen hormone therapy group with negative HR status. Conclusion: Globally, breast cancer ranks as the most prevalent malignancy in women. Tamoxifen, a frequently utilized adjuvant therapy post breast cancer surgery, can exert diverse effects on gynecological organs, encompassing benign pathologies like increased ET and malignant pathologies like uterine neoplasia. There is a rising suspicion that etiopathogenetic factors contributing to breast cancer progression might also precipitate uterine cancer, irrespective of tamoxifen use. Vigilant patient monitoring is paramount for detecting uterine neoplasia and other gynecological pathologies. [ABSTRACT FROM AUTHOR]

The article focuses on the assessment and management of postmenopausal bleeding (PMB), emphasizing the importance of thorough diagnostic evaluation to distinguish between benign and malignant causes. It highlights the role of transvaginal ultrasound (TVUS) and hysteroscopy in guiding treatment decisions.

The aim of this study is to evaluate COMT2, COMT3, CYP1B1, and ESR1 gene polymorphisms and occurrence of endometrial polyps. In addition, we intended to evaluate the clinical and epidemiological features of patients with and without the presence of the disease, characterizing the possible risk factors. A cross-sectional study was performed, with a total of 309 women, including 236 in the group of women with endometrial polyp confirmed by hysteroscopy and anatomical pathological examination and 73 in the group of people with diagnostic hysteroscopy without abnormal findings from the macroscopic point of view. Polymorphisms of four genes were studied: COMT2 (rs4680), COMT3 (rs5031015), CYP1B1 (rs1056836), and ESR1 (rs2234693). Polymorphism genotyping was determined using real-time polymerase chain reaction. Considering the results, no differences were identified between the two groups with respect to age, body mass index, diabetes, dyslipidemia, or smoking. The group of women without endometrial polyps showed higher use of hormone therapy than the other group (16.4 percent versus 3.8 percent, p <.001). The COMT2, COMT3, CYP1B1, and ESR1 genes exhibited no significant difference for the occurrence of endometrial polyp between the two groups. The research concluded that no correlation was identified between the genetic polymorphisms evaluated and the presence of endometrial polyps. [ABSTRACT FROM AUTHOR]

Introduction: National Institute for Health and Care Excellence Guideline 88 advocates outpatient hysteroscopy in preference to transvaginal ultrasound for premenopausal women with heavy menstrual bleeding, who are suspected of having submucosal fibroids, polyps or endometrial pathology. The guideline, however, analysed outdated studies that provided low-quality evidence. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound in detecting endometrial pathology; and to evaluate the cost-effectiveness of outpatient hysteroscopy if it were to be used in preference to transvaginal ultrasound. Methods: A health service evaluation was conducted at a district general foundation trust between 1 January 2019 and 31 March 2019 of all premenopausal women with heavy menstrual bleeding. A cost-effectiveness analysis was also performed to evaluate the financial implication of outpatient hysteroscopy being used in preference to transvaginal ultrasound. Results: 100 patients were included in the study. For the detection of endometrial pathology, transvaginal ultrasound had a positive predictive value of 65.2%; negative predictive value of 98.5%; sensitivity of 93.75%; specificity of 88.89% and an accuracy of 89.77%. For identifying endometrial polyps, submucosal fibroids and endometrial thickening, transvaginal ultrasound had a positive predictive value of 33.3%, 85.7% and 50%, respectively. It would have cost the Trust 78.7% more if National Institute for Health and Care Excellence's recommendation was carried out, with a 23.4% increase in workload in the hysteroscopy department, and a decrease of 7.8% transvaginal scans performed. Conclusion: Outpatient hysteroscopy is costly and would increase the workload burden in the hysteroscopy department. Transvaginal ultrasound has a high sensitivity, specificity and accuracy in detecting endometrial pathology therefore it should remain as the initial diagnostic investigation. [ABSTRACT FROM AUTHOR]

Simple Summary: Bacterial endometritis is among the most common causes of subfertility in mares and has a major economic impact on the equine breeding industry. The sensitivity of detecting microbes using culture-based methods, irrespective of the sample collection method (whether double-guarded swab, low-volume lavage [LVL], or endometrial biopsy) is low, leading to a high rate of false negative samples. Here, using 16S rDNA sequencing, we found that the equine uterus does harbour a distinct microbiome during the estrus phase of the cycle. The microbial community was similar in composition as well as relative abundance at both phyla (Proteobacteria, Firmicutes and Bacteroidota) and genus (Klebsiella, Mycoplasma, and Aeromonas) level, regardless of the sampling technique. The present information about the equine endometrial microbiome could pave the way for innovative treatment methods for endometrial disease and assist sub-fertile mares. This, in turn, could lead to a reduction in the routine use of antibiotics in the equine breeding industry. Bacterial endometritis is among the most common causes of subfertility in mares. It has a major economic impact on the equine breeding industry. The sensitivity of detecting uterine microbes using culture-based methods, irrespective of the sample collection method, double-guarded endometrial swab, endometrial biopsy, or uterine low-volume lavage (LVL), is low. Therefore, equine bacterial endometritis often goes undiagnosed. Sixteen individual mares were enrolled, and an endometrial sample was obtained using each method from all mares. After trimming, quality control and decontamination, 3824 amplicon sequence variants were detected in the dataset. We found using 16S rRNA sequencing that the equine uterus harbors a distinct resident microbiome during estrus. All three sampling methods used yielded similar results in composition as well as relative abundance at phyla (Proteobacteria, Firmicutes, and Bacteroidota) and genus (Klebsiella, Mycoplasma, and Aeromonas) levels. A significant difference was found in alpha diversity (Chao1) between LVL and endometrial biopsy, suggesting that LVL is superior at detecting the low-abundant (rare) taxa. These new data could pave the way for innovative treatment methods for endometrial disease and subfertility in mares. This, in turn, could lead to more judicious antimicrobial use in the equine breeding industry. [ABSTRACT FROM AUTHOR]

Objective Urinary tract infections are among the most common infections during pregnancy. The association between symptomatic lower urinary tract infections during pregnancy and fetal and maternal complications such as preterm birth and low birthweight remains unclear. The aim of this research is to evaluate the association between urinary tract infections during pregnancy and maternal and neonatal outcomes, especially preterm birth. Study Design This study is a secondary analysis of a multicenter prospective cohort study, which included patients between October 2011 and June 2013. The population consists of women with low risk singleton pregnancies. We divided the cohort into women with and without a symptomatic lower urinary tract infection after 20 weeks of gestation. Baseline characteristics and maternal and neonatal outcomes were compared between the two groups. Multivariable logistic regression analysis was used to correct for confounders. The main outcome was spontaneous preterm birth at <37 weeks. Results We identified 4,918 pregnant women eligible for enrollment, of whom 9.4% had a symptomatic lower urinary tract infection during their pregnancy. Women with symptomatic lower urinary tract infections were at increased risk for both preterm birth in general (12 vs. 5.1%, adjusted OR 2.5; 95% CI 1.7–3.5) as well as a spontaneous preterm birth at <37 weeks (8.2 vs. 3.7%, adjusted OR 2.3; 95% CI 1.5–3.5). This association was also present for early preterm birth at <34 weeks. Women with symptomatic lower urinary tract infections during pregnancy are also at increased risk of endometritis (8.9 vs. 1.8%, adjusted OR 5.3; 95% CI 1.4–20) and mastitis (7.8 vs. 1.8%, adjusted OR 4.0; 95% CI 1.6–10) postpartum. Conclusion Low risk women with symptomatic lower urinary tract infections during pregnancy are at increased risk of spontaneous preterm birth. In addition, an increased risk for endometritis and mastitis postpartum was found in women with symptomatic lower urinary tract infection during pregnancy. Key Points UTIs increase the risk of preterm birth. UTIs increase the risk of endometritis postpartum. UTIs increase the risk of mastitis postpartum. [ABSTRACT FROM AUTHOR]

Recurrent implantation failure (RIF) remains a challenging problem in assisted reproductive technology (ART). Further insights into uterine abnormalities that can disturb embryo implantation should be obtained. This review provides an overview of the effects of organic and non‐organic uterine disorders on endometrial receptivity. The results suggest that various uterine pathologies can lead to defective embryo implantation via multiple mechanisms. In particular, uterine adenomyosis dysregulates molecular and cellular interactions that are vital for successful embryo implantation with a background of chronic inflammation, which may be alleviated by pretreatment with a gonadotropin‐releasing hormone agonist. Uterine myomas can cause endometrial deformation and adverse alterations in uterine contractility. Nonetheless, the effectiveness of myomectomy remains debated, and endometrial polyp removal may be considered, particularly in patients with RIF. Chronic endometritis abrogates the appropriate uterine immunological environment critical for embryo implantation. Abnormal endometrial microbiota have been suggested to influence endometrial receptivity; however, supporting evidence is currently scarce. Platelet‐rich plasma therapy may be a potential treatment for thin endometria; nevertheless, further validation is required. Endometrial receptivity analysis can detect dysregulation of the window of implantation, and new non‐invasive methods for predicting endometrial receptivity have recently been proposed. However, numerous issues still need to be fully clarified. Further clinical and basic studies are necessary to investigate the pathophysiology of defective endometrial receptivity and identify optimal treatments for patients undergoing ART, especially those with RIF. [ABSTRACT FROM AUTHOR]

Key content: Women receiving estrogen replacement require concomitant progestogen to prevent endometrial hyperplasia and carcinoma.A variety of progestogens are used in hormone replacement therapy (HRT), with different advantages and disadvantages and routes of administration.Progestogenic side effects may be mild but can be debilitating and lead to the discontinuation of HRT, so progestogens should be tailored to the individual woman.Combined HRT containing estrogen and progestogens may be associated with a small increase in the absolute risk of breast cancer, which is not seen in women taking estrogen alone. However, this risk is small, particularly when compared with other modifiable lifestyle risk factors.The addition of certain progestogens to estrogen in the long term may be associated with an increased risk of heart disease, breast cancer and dementia. Learning objectives: To understand relative advantages and disadvantages of the different progestogens, regimens and routes of administration.To be aware of current evidence for types, dose and routes of administration of different progestogens.To be able to prescribe progestogens safely in terms of side effect and risk profiles that are individualised to the patient. Ethical issues: Well‐informed counselling including absolute, individualised risks for women considering HRT with a progestogenic component is essential to allow patients to make well‐informed choices. [ABSTRACT FROM AUTHOR]

Female patients are at a greater risk for infections such as urinary tract infections and mastitis, as well as complications from abortions/miscarriages, and sexually transmitted infections. This review highlights risk factors, pathogenesis, complications, diagnostic, and treatment modalities associated with the following infections: mastitis, sexually transmitted diseases, postpartum/abortion-related infections, and urinary tract infections. [ABSTRACT FROM AUTHOR]