First report of robotic-assisted total hysterectomy using the Hugo™ RAS system.

This study describes the first reported treatment of a benign gynecological disease with the Medtronic's Hugo™ RAS System, the first robot-assisted device used in the field of gynecology in Japan. Patients who underwent robot-assisted total laparoscopic hysterectomy with the Hugo™ RAS System at the Tottori University Hospital between March 2023 and June 2023 were included in this study. In the first case, the patient was in her 40 s and had uterine fibroids. We describe our experience and compare the device with the conventional da Vinci surgical system. We discuss the key features of the Hugo system (including the independent arms, open console, and pistol-shaped handle), the convenience of robotic surgery, the potential to improve quality of life, and how this technology could revolutionize the field of surgery.

Role of tenascin C in lesion formation in early peritoneal endometriosis.

OBJECTIVE: To identify cytokines or extracellular matrix components that contribute to adhesion to, and invasion of, the peritoneum, proximal to lesions in the early phase of endometriosis. DESIGN: Laboratory-based study. SETTING: University Hospital and Laboratory of Animal Science. PATIENTS AND ANIMALS: Five women with ovarian endometrioma, 138 wild-type (WT) C57BL/6N mice, and 48 Tenascin C (Tnc) knockout (TncKO) mice. INTERVENTIONS: To establish a murine endometriosis model, 20 pieces of minced uterine tissue fragments from each horn were administered intraperitoneally to syngeneic mice. Three days later, endometriotic lesions and peritoneal tissues were collected. Separately, we transfected human peritoneal mesothelial cells (HMrSV5) or human endometrial stromal cells (hESCs) with Tnc small interfering ribonucleic acid. MAIN OUTCOME MEASURES: We employed a polymerase chain reaction array to profile gene expression in the murine peritoneum, in both peritoneum distal to lesions and peritoneum surrounding lesions (PSL). The expression of upregulated genes in the PSL was verified in the peritoneal samples by real-time reverse transcription-polymerase chain reaction. TncKO mice were used to investigate the role of Tnc in the development of endometriosis. We evaluated the proliferative activity or inflammatory state of lesions by Ki67 or CD3 immunostaining. Intraperitoneal distribution of macrophages was assessed by fluorescence-activated cell sorting. Using Tnc small interfering ribonucleic acid, we examined the invasive capacity of hESCs in a coculture system with HMrSV5. RESULTS: Tnc gene expression was significantly higher in PSL than in peritoneum distal to lesions. The weight and number of TncKO lesions in TncKO hosts were lower than those of WT lesions in WT hosts. In contrast, the weight and number of nonattached TncKO lesions in TncKO hosts were higher than those of nonattached WT lesions in WT hosts. We observed decreased Ki67-positive cells or H-scores for CD3, a lower proportion of M1 macrophages, and a higher proportion of M2 macrophages in TncKO lesions in TncKO recipients. Silencing of Tnc expression in hESCs and HMrSV5 diminished the invasivity of hESCs. CONCLUSION: Tnc may be a crucial factor in the development of early peritoneal endometriosis.

Huge Leiomyomas Arising from Bilateral Uterine Remnants in a Mayer-Rokitansky-Küster-Hauser Syndrome Patient with Coexisting Myotonic Dystrophy Type 1: A Case Report and Literature Review.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is a rare congenital anomaly of the genital tract. Since the secretion of sex hormones from the ovaries is preserved, leiomyomas and adenomyomas, which are estrogen-dependent diseases, may develop from the uterine remnant. In contrast, patients with myotonic dystrophy type 1 (DM1), the most common dystrophy in adults, are considered to be at high risk for benign tumors of the female reproductive system, such as uterine leiomyomas and ovarian cysts. A rare case of huge leiomyomas arising from bilateral uterine remnants in a woman with MRKHS with coexisting DM1 is presented. Her chief complaint was abdominal distension. On pelvic magnetic resonance imaging (MRI), two solid pelvic masses showing low signal intensity on T2-weighted imaging were seen. Both the uterine corpus and cervix were unclear, but bilateral ovaries were observed normally on MRI. Two uterine leiomyoma-like masses connected by a band of fibrous tissue were found by laparotomy. As with the MRI findings, the uterine cervix and vagina could not be detected macroscopically. Normal bilateral adnexa and round ligaments were identified. All of her symptoms improved after hysterectomy.

Increased chemokine ligand 26 expression and its involvement in epithelial-mesenchymal transition in the endometrium with adenomyosis.

OBJECTIVE: Adenomyosis is a gynecologic disorder characterized by symptoms of dysmenorrhea, abnormal uterine bleeding, and infertility. This study aimed to analyze the expression profiles of key inflammatory cytokines in the endometrium with adenomyosis and their involvement in epithelial-mesenchymal transition (EMT). STUDY DESIGN: Endometrial tissues collected from premenopausal women with (n = 3) or without (n = 3) adenomyosis during the secretory phase were subjected to DNA array analysis to examine inflammatory cytokines. The gene and protein expression levels were re-evaluated by reverse transcription-polymerase chain reaction (n = 19) and immunohistochemistry (n = 56). Immunohistochemical analysis using the Histo-scores of chemokine ligand 26 (CCL26) and EMT-related factors was performed with uterine tissues resected for adenomyosis (n = 37), including those from patients treated with gonadotropin-releasing hormone agonist (GnRHa). An invasion assay was also performed using endometrial epithelial cells. RESULTS: DNA array results showed that CCL26, IL-1B, and CCL3 were upregulated. CCL26 mRNA expression was markedly higher in the endometrium with adenomyosis than in that without adenomyosis. Immunohistochemical analysis revealed that CCL26 expression was elevated in the epithelial cells of the basal layer of the endometrium with adenomyosis than in that without adenomyosis regardless of GnRHa treatment. In the basal layer of the endometrium with adenomyosis, CCL26 expression was positively correlated with neural-cadherin and ZEB1 expression; additionally, the cases with intrinsic-type adenomyosis had high expression levels of CCL26 and ZEB1. Exogenous CCL26 promoted the invasive activity of endometrial epithelial cells. CONCLUSIONS: CCL26, an inflammatory mediator, may be involved in the pathogenesis of adenomyosis by inducing EMT in the basal layer of the endometrium.

A controlled clinical trial comparing potent progestins, LNG-IUS and dienogest, for the treatment of women with adenomyosis.

PURPOSE: To evaluate the efficacy of two progestins, levonorgestrel intrauterine system (LNG-IUS) and dienogest (DNG), for adenomyosis. METHODS: This study enrolled 157 women with adenomyosis, randomized to either LNG-IUS (n = 76) or DNG (n = 81) groups as a controlled clinical trial for 72 months. Participants were classified by three different localizations of adenomyosis: diffuse, focal, and extrinsic. VAS (Visual analog scale) score, days, and amount of uterine bleeding were assessed. Uterine volume or bone mineral density (BMD) were measured by three-dimensional ultrasonography or dual-energy X-ray absorptiometry. RESULTS: LNG-IUS and DNG comparably reduced pain scores in patients with adenomyosis. With regard to pain control, DNG offered greater efficacy than LNG-IUS in 3 months of treatment. In all types of adenomyosis, the days of bleeding after 12 months with DNG were significantly decreased compared to those with LNG-IUS. The decrease of whole uterine body was transient in any subtypes. A comparable decrease in BMD due to age-related changes in both groups was observed. CONCLUSIONS: LNG-IUS and DNG could be useful for long-term management of adenomyosis. In terms of durations of uterine bleeding, DNG was superior to LNG-IUS for 6 years.

Optical analysis of enamel and dentin caries in relation to mineral density using swept-source optical coherence tomography.

The aim of this study was to evaluate the signal intensity and signal attenuation of swept source optical coherence tomography (SS-OCT) for dental caries in relation to the variation of mineral density. SS-OCT observation was performed on the enamel and dentin artificial demineralization and on natural caries. The artificial caries model on enamel and dentin surfaces was created using Streptococcus mutans biofilms incubated in an oral biofilm reactor. The lesions were centrally cross sectioned and SS-OCT scans were obtained in two directions to construct a three-dimensional data set, from the lesion surface (sagittal scan) and parallel to the lesion surface (horizontal scan). The integrated signal up to [Formula: see text] in depth (IS200) and the attenuation coefficient ([Formula: see text]) of the enamel and dentin lesions were calculated from the SS-OCT signal in horizontal scans at five locations of lesion depth. The values were compared with the mineral density obtained from transverse microradiography. Both enamel and dentin demineralization showed significantly higher IS200 and [Formula: see text] than the sound tooth substrate from the sagittal scan. Enamel demineralization showed significantly higher IS200 than sound enamel, even with low levels of demineralization. In demineralized dentin, the [Formula: see text] from the horizontal scan consistently trended downward compared to the sound dentin.

Clinical assessment of non carious cervical lesion using swept-source optical coherence tomography.

Non-carious cervical lesions (NCCLs) involve various forms of tooth loss with different etiologies. This study aimed to utilize swept-source optical coherence tomography (SS-OCT) at 1300 nm wavelength range in vitro and in vivo to evaluate and clarify the mechanism of NCCLs. In the in vitro phase, a dentin attenuation coefficient (µt ) derived from the SS-OCT signal at NCCL was compared with mineral loss obtained from transverse microradiography (TMR) to determine a µt threshold to discriminate demineralization of cervical dentin in vivo. In the clinical study, 242 buccal surfaces were investigated in 35 subjects. Presence and dimensions of NCCLs, cervical cracking and the degree of demineralization at the exposed cervical dentin were determined using SS-OCT. Dentin demineralization was observed in 69% of NCCLs. SS-OCT results confirm that dentin mineral loss and occlusal attrition were associated with larger NCCLs, and can be considered as an etiological factor in formation and progress of these lesions. (A) We determined the attenuation coeffcient (µt ) threshold of SS-OCT signal for the detection of demineralization (1.21) from in vitro study. DEM: demineralized dentin, sound: sound dentin. (B) Using the µt threshold, we observed NCCLs in vivo to detect the demineralization in cervical dentin. SS-OCT scanning was performed along the red line. (C) SS-OCT image obtained along the red line in B. In SS-OCT, brightness of dentin beneath the NCCL was increased (arrow) compared with intact zone. The cervical dentin was slightly demineralized (µt : 1.25). e: enamel, d: dentin, g: gingiva.

Detection of occlusal caries in primary teeth using swept source optical coherence tomography.

This study aimed to investigate swept source optical coherence tomography (SS-OCT) as a detecting tool for occlusal caries in primary teeth. At the in vitro part of the study, 38 investigation sites of occlusal fissures (noncavitated and cavitated) were selected from 26 extracted primary teeth and inspected visually using conventional dental equipment by six examiners without any magnification. SS-OCT cross-sectional images at 1330-nm center wavelength were acquired on the same locations. The teeth were then sectioned at the investigation site and directly viewed under a confocal laser scanning microscope (CLSM) by two experienced examiners. The presence and extent of caries were scored in each observation. The results obtained from SS-OCT and conventional visual inspections were compared with those of CLSM. Consequently, SS-OCT could successfully detect both cavitated and noncavitated lesions. The magnitude of sensitivity for SS-OCT was higher than those for visual inspection (sensitivity of visual inspection and SS-OCT, 0.70 versus 0.93 for enamel demineralization, 0.49 versus 0.89 for enamel cavitated caries, and 0.36 versus 0.75 for dentin caries). Additionally, occlusal caries of a few clinical cases were observed using SS-OCT in vivo. The results indicate that SS-OCT has a great detecting potential for occlusal caries in primary teeth.

Noninvasive cross-sectional imaging of proximal caries using swept-source optical coherence tomography (SS-OCT) in vivo.

The aim of this study was to determine the diagnostic accuracy of swept-source optical coherent tomography (SS-OCT) in detecting and estimating the depth of proximal caries in posterior teeth in vivo. SS-OCT images and bitewing radiographs were obtained from 86 proximal surfaces of 53 patients. Six examiners scored the locations according to a caries lesion depth scale (0-4) using SS-OCT and the radiographs. The results were compared with clinical observations obtained after the treatment. SS-OCT could detect the presence of proximal caries in tomograms that were synthesized based on the backscatter signal obtained from the proximal carious lesion through occlusal enamel. SS-OCT showed significantly higher sensitivity and larger area under the receiver operating characteristic curve than radiographs for the detection of cavitated enamel lesions and dentin caries (Student's t -test, p < 0.05). SS-OCT appears to be a more reliable and accurate method than bitewing radiographs for the detection and estimation of the depth of proximal lesions in the clinical environment.