Use of the Endometriosis Fertility Index to Predict Natural Pregnancy after Endometriosis Surgery: A Single-Center Study.

AIMS: Our objective was to predict natural pregnancy after endometriosis surgery using the endometriosis fertility index (EFI). METHODS: A retrospective medical records review was conducted, examining patients surgically treated for endometriosis at a single center in Korea between January 2009 and February 2015. In total, 68 women attempting natural conception were analyzed by assessing age, preoperative serum CA-125, body mass index, revised American Fertility Society (rAFS) stage, EFI, and pregnancy outcome. Kaplan-Meier estimates and log-rank tests were used to generate cumulative natural pregnancy rate curves based on an EFI cut-point. A receiver-operating characteristic (ROC) curve was plotted for EFI. RESULTS: Seventy-seven patients attempted conceptions, resulting in 33 natural and 9 assisted conceptions. Excluding assisted conceptions, the mean EFI scores of 68 women who were not pregnant and pregnant were 5.43 ± 0.36 and 6.88 ± 0.28 respectively. The relation between EFI and natural pregnancy was significant (cumulative overall pregnancy rate, p = 0.006), whereas rAFS stage was not (univariate logistics, p = 0.853). The cut-point for maximum natural pregnancy outcomes was 6 (area under ROC curve = 0.710, 95% CI 0.586-0.835). CONCLUSION: The EFI is a reliable staging system for predicting natural pregnancy after endometriosis surgery. EFI scores can be used to guide postoperative treatment of women with endometriosis.

Clinical and pathological comparisons of adnexal torsion between pregnant and non-pregnant women.

AIM: We evaluated and compared the clinical and pathological differences between pregnant and non-pregnant women with adnexal torsion. METHODS: We retrospectively reviewed 239 women with adnexal torsion from January 2006 to December 2015 in a tertiary hospital. The clinical and pathological differences between pregnant and non-pregnant women who underwent surgery for adnexal torsion were analyzed. RESULTS: The most common pathologies were corpus luteum cysts in pregnant women and dermoid cysts in non-pregnant women. Eight of the pregnant women (24.2%) had a history of exogenous ovarian stimulation, and their episodes were only caused by corpus luteum or a stimulated ovary. In pregnant women, 72.7% of the torsion occurred before the 14th week of gestation. CONCLUSION: The common pathology causing adnexal torsion was different, depending on the pregnancy status. Exogenous ovarian stimulation increases the risk of adnexal torsion, and the majority of episodes occurred in the first trimester in pregnant women.

Role of B-Cell Translocation Gene 1 in the Pathogenesis of Endometriosis.

Estrogen affects endometrial cellular proliferation by regulating the expression of the c-myc gene. B-cell translocation gene 1 (BTG1), a translocation partner of the c-myc, is a tumor suppressor gene that promotes apoptosis and negatively regulates cellular proliferation and cell-to-cell adhesion. The aim of this study was to determine the role of BTG1 in the pathogenesis of endometriosis. BTG1 mRNA and protein expression was evaluated in eutopic and ectopic endometrium of 30 patients with endometriosis (endometriosis group), and in eutopic endometrium of 22 patients without endometriosis (control group). The effect of BTG1 downregulation on cellular migration, proliferation, and apoptosis was evaluated using transfection of primarily cultured human endometrial stromal cells (HESCs) with BTG1 siRNA. BTG1 mRNA expression level of eutopic and ectopic endometrium of endometriosis group were significantly lower than that of the eutopic endometrium of the control group. Migration and wound healing assays revealed that BTG1 downregulation resulted in a significant increase in migration potential of HESCs, characterized by increased expression of matrix metalloproteinase 2 (MMP2) and MMP9. Downregulation of BTG1 in HESCs significantly reduced Caspase 3 expression, indicating a decrease in apoptotic potential. In conclusion, our data suggest that downregulation of BTG1 plays an important role in the pathogenesis of endometriosis.

Perinatal and childhood outcomes of children born to female cancer survivors in South Korea.

Despite the increasing number of female cancer survivors, uncertainty remains regarding potential adverse health outcomes for their offspring. Comprehensive population-based studies would be invaluable for female cancer survivors in making decisions about their future. This study uses the National Health Information Database to investigate perinatal and long-term outcomes of offspring born to mothers with a history of cancer. In a South Korean cohort of 95,264 women aged 15-40 diagnosed with cancer between 2007 and 2010, we evaluated the outcomes of 15,221 children born to 11,092, cancer survivors. We selected 147,727 women without a history of cancer and 201,444 children as a control group. Our study found that children of female cancer survivors have a significantly higher odds ratio of primary outcomes including preterm birth, low birth weight, neonatal intensive care unit admission, and death. While there was no difference in the rate of death within 1 year of birth between the two groups, the total death rate during the follow-up period was significantly higher in children born to mothers with cancer. After adjusting for gestational age and birth weight, there was no statistically significant increased hazard ratio of secondary outcomes including cancer, chromosomal abnormalities, cerebral palsy, delayed development, epilepsy, language disorder, or hearing impairment.

Clinical Characteristics and Risk of Hypoxemia Development in Women Infected with SARS-CoV-2 during Pregnancy.

PURPOSE: There is limited information on the clinical characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and risk factors for hypoxemia development were investigated in pregnant women with coronavirus disease-2019 (COVID-19). MATERIALS AND METHODS: From August 2020 to February 2022, we performed a retrospective cohort study of 410 pregnant women with COVID-19. The clinical characteristics and prognoses were compared between pregnant COVID-19 patients requiring oxygen and those who did not. RESULTS: Of 410 patients, 100 (24.4%) required oxygen therapy. Among them, fever [163 (52.6%) vs. 81 (81.0%), p<0.001] and cough [172 (56.4%) vs. 73 (73.0%), p=0.003] were more frequently observed than in non-oxygen group. The proportion of unvaccinated women was higher in oxygen group than in non-oxygen group [264 (85.2%) vs. 98 (98.0%), p=0.003]. During the Omicron wave, patients were more likely to have no oxygen requirement [98 (31.6%) vs. 18 (18.0%), p=0.009]. The risk of hypoxemic respiratory difficulty increased if SARS-CoV-2 infection occurred during the third trimester [adjusted odds ratio (aOR) 5.083, 95% confidence interval (CI): 1.095-23.593, p=0.038] and C-reactive protein (CRP) was elevated (≥1.0 mg/dL) at admission (aOR 5.878, 95% CI: 3.099-11.146, p<0.001). The risk was higher in unvaccinated patients (aOR 5.376, 95% CI: 1.193-24.390, p=0.028). However, the risk was lower in patients during the Omicron wave (aOR 0.498, 95% CI: 0.258-0.961, p=0.038). CONCLUSION: A quarter of SARS-CoV-2-infected women developed hypoxemic respiratory difficulty during pregnancy. SARS-CoV-2 infection during the third trimester, CRP elevation at admission, and no vaccination increased the risk of hypoxemia in pregnant women.

Fabrication of 3D Printed Ceramic Part Using Photo-Polymerization Process.

Ceramics are high-strength and high-temperature resistant materials that are used in various functional parts. However, due to the high strength and brittleness properties, there are many difficulties in the fabrication of complex shapes. Therefore, there are many studies related to the fabrication of ceramic parts using 3D printing technology optimized for complex shapes. Among them, studies using photo-polymerization (PP) 3D printing technology with excellent dimensional accuracy and surface quality have received the most widespread attention. To secure the physical properties of sintered ceramic, the content and distribution of materials are important. This study suggests a novel 3D printing process based on a high-viscosity composite resin that maximizes the content of zirconia ceramics. For reliable printing, the developed 3D printers that can adjust the process environment were used. To minimize warpage and delamination, the divided micro square pattern images were irradiated in two separate intervals of 1.6 s each while maintaining the internal chamber temperature at 40 °C. This contributed to improved stability and density of the sintered structures. Ultimately, the ceramic parts with a Vickers hardness of 12.2 GPa and a relative density of over 95% were able to be fabricated based on a high-viscosity resin with 25,000 cps.

Highly Porous-Cellulose-Acetate-Nanofiber Filters Fabricated by Nonsolvent-Induced Phase Separation during Electrospinning for PM2.5 Capture.

Highly porous-cellulose-acetate (CA) nanofibers were prepared by an electrospinning process based on a nonsolvent-induced phase separation (NIPS) mechanism, and their PM2.5 capture efficiencies were evaluated. The NIPS condition during the electrospinning process was achieved by selecting appropriate good and poor solvents based on the Hansen solubility parameters of CA. N,N-dimethylacetamide (DMAc) was used as the good solvent, while dichloromethane (DCM), tetrahydrofuran (THF), and acetone were used as poor solvents. Porous-CA nanofibers were observed upon using the binary solvent systems of DCM:DMAc = 1:9, DCM:DMAc = 2:8, and THF:DMAc = 1:9, and the CA nanofibers formed using the DCM/DMAc system with DCM:DMAc = 1:9 were found to have the highest specific surface area of 1839 m2/g. Based on the optimized binary solvent system with DCM:DMAc = 1:9, porous-CA nanofibers were prepared and characterized according to the CA content in the electrospinning mixture. The results confirmed that a porous structure was formed well from the surface to the core of the nanofibers. The composition range of the ternary mixture of CA and two solvents capable of producing porous-CA nanofibers was mapped on a ternary phase diagram, and highly efficient PM2.5 capture with 98.2% efficiency was realized using porous-CA nanofibers obtained using a 10 wt.% CA solution. This work provides a new strategy for improving the efficiency of porous-nanofiber filters for PM2.5 capture.

Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae.

ABSTRACT: Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55-5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ±â€Š1.25 vs 2.02 ±â€Š1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.

Efficacy and Safety of a Standardized Soy and Hop Extract on Menopausal Symptoms: A 12-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Objectives: Soy and hop extracts have been investigated as alternatives for hormone replacement therapy. However, their combined efficacy is not known. We investigated the efficacy and safety of a combined soy and hop extract on postmenopausal symptoms. Design: Double-blinded, randomized controlled trial. Settings/Location: Gynecological outpatient clinic of tertiary hospital. Subjects: Seventy-eight women with moderate or severe menopausal symptoms assessed as modified Kupperman Menopoausal Index (KMI) scores >20. Interventions: They received either a combined soy and hop extract (n = 38) or placebo (n = 40). Outcome measures: Menopausal symptoms were evaluated through self-reporting of modified Kupperman Menopausal Index (KMI) scores at baseline and after 6 and 12 weeks. We assessed serum levels of bone metabolism biomarkers, ultrasonographic parameters, hormone profiles, compliance, and safety. Results: After 12 weeks of the treatment, treatment group scores decreased by 20.61 points compared with 14.80 points in the placebo group (p < 0.05). Fatigue, paresthesia, arthralgia, and myalgia, palpitation and vaginal dryness significantly improved more in the treatment group compared with the placebo group after 12 weeks (p < 0.05). Urine N-telopeptide in participants ≥50 years in the treatment group showed a reduced increase. Endometrial thickness and hormonal profiles did not show significant changes in either group. No serious adverse events were reported. Conclusion: The results suggest that 190 mg of combined soy and hop extract is safe and effective for improvement of menopausal symptoms. CRIS No.: KCT0006019.

Polycystic ovarian morphology is associated with primary dysmenorrhea in young Korean women.

OBJECTIVE: This study was aimed at identifying a correlation between polycystic ovarian morphology (PCOM) and the severity of primary dysmenorrhea in young Korean women. METHODS: A total of 592 patients who visited a tertiary hospital from March 2008 to March 2015 for dysmenorrhea were examined. After excluding those with secondary causes of menstrual pain (for example, myoma, adenomyosis, endometriosis, and pelvic inflammatory disease), 361 women were recruited and retrospectively analyzed. Severe dysmenorrhea was defined as a visual analog scale (VAS) score ≥6. RESULTS: The mean patient age was 23.0±4.0 years, the average menstrual cycle length was 34.4±23.7 days, and the average pain intensity was VAS 6.7±0.1 at baseline. PCOM was assessed by ultrasound in 54 women (15%). Patients with severe menstrual pain were more likely to have irregular menstrual cycles (P=0.03) and heavy menstrual flow (P=0.01) than those with mild menstrual pain. After adjusting for weight, height, menstrual cycle interval, and menstrual flow in the logistic regression analysis, PCOM (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.05-4.97; P=0.04) and heavy menstrual flow (OR, 1.85; 95% CI, 1.05-3.28; P=0.04) were found to be significant independent factors influencing pain. CONCLUSION: Our study shows that PCOM may have a correlation with the severity of primary dysmenorrhea. Since PCOM may play a role in the development of menstrual pain, patients with PCOM should be under active surveillance with resources for prompt pain management readily available. It may also be necessary to further investigate the molecular mechanisms of pain development in primary dysmenorrhea.

Comparison of congenital malformations among babies born after administration of letrozole or clomiphene citrate for infertility treatment in a Korean cohort.

This retrospective study investigated and compared the incidence of congenital foetal anomalies after letrozole versus clomiphene citrate (CC) administration for infertility treatment. Data from 142 newborns were included: letrozole group, n = 83; CC group, n = 61. Congenital anomalies were found in 7.2% (6/83) patients in the letrozole group and 18.0% (11/61) patients in the CC group, with no significant between-group difference (p = .066). Major congenital anomaly rate was 2.4% (2/83) in the letrozole group and 3.3% (2/61) in the CC group, with no significant between-group difference (p > 0.999). There was no significant difference in major and minor congenital anomalies between the groups after excluding premature infants (birth at a gestational age of <37 weeks), low birth weight, and very low birth weight. The results of this study demonstrate the stability of letrozole compared to that of CC for infertility treatment in pregnant women.

A risk prediction model for medical treatment failure in tubal pregnancy.

OBJECTIVE: Methotrexate is an alternative treatment for tubal pregnancy. However, despite initial treatment, ∼15% of women eventually require surgery. This study aimed to identify the risk factors for medical treatment failure in tubal pregnancy and apply them to a risk prediction model. STUDY DESIGN: This single-center retrospective cohort study included 123 participants initially treated medically for tubal pregnancy between January 2006 and December 2015. Logistic regression analysis was used to construct a risk prediction model (visually presented as a nomogram) for medical treatment failure. Model performance was assessed using discrimination and calibration. The medical treatment failure rate was 36.6%. The prediction model integrated the presence of a gestational sac, ectopic mass size, and follow-up ß-human chorionic gonadotropin levels above cut-off values on days 4 and 7. The model used the following cut-off values: increased ß-human chorionic gonadotropin levels by 1028.6 mIU/mL, 1.0457-fold higher than baseline level on day 4; and increased ß-human chorionic gonadotropin levels by 1233 mIU/mL, 1.3025-fold higher than baseline level on day 7. RESULTS: The corresponding areas under the receiver-operating characteristic curves were 0.8135 (95% confidence interval, 0.733-0.893) for the day 4 model and 0.8600 for the day 7 model (95% confidence interval, 0.788-0.932). Comparison of the day 4 and 7 models revealed no significant difference in their predictive abilities (P = 0.4318). CONCLUSIONS: This model identified a substantial proportion of the participants who experienced medical treatment failure for tubal pregnancy. It was visualized as a nomogram, facilitating clinical application.

Primary malignant melanoma of cervix and vagina.

Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.