Long-Term Amnioinfusion through an Intrauterine Catheter in Preterm Premature Rupture of Membranes before 26 Weeks of Gestation: A Retrospective Multicenter Study.

INTRODUCTION: The objective of this study was to elucidate the efficacy of long-term amnioinfusion on perinatal outcomes in patients with preterm premature rupture of membranes (PPROM) before 26 weeks' gestation. MATERIAL: A total of 31 patients with PPROM at a periviable gestational age (21 + 0-25 + 0 weeks) were enrolled. Long-term amnioinfusion was performed in 22 patients, and 9 patients did not receive amnioinfusion. Data were collected retrospectively from 2 clinical sites between January 2017 and March 2019. RESULTS: In the medical management group, there was a significantly higher rate of chorioamnionitis compared to the long-term amnioinfusion group (89 vs. 15%, p = 0.001). The latency period between PPROM and delivery was higher in the amnioinfusion group (median, 5.5 vs. 3 weeks, p = 0.04). The frequency of bronchopulmonary dysplasia was higher in the control group compared to the amnioinfusion group (89 vs. 40%, p = 0.03). The rates of other neonatal complications were similar in both groups. CONCLUSIONS: Long-term amnioinfusion through an intrauterine catheter in PPROM before 26 weeks' gestation may improve pregnancy and newborn outcomes.

Primary Amenorrhea Due to Anatomical Abnormalities of the Reproductive Tract: Molecular Insight.

Congenital anomalies of the female reproductive tract that present with primary amenorrhea involve Müllerian aplasia, also known as Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), and cervical and vaginal anomalies that completely obstruct the reproductive tract. Karyotype abnormalities do not exclude the diagnosis of MRKHS. Familial cases of Müllerian anomalies and associated malformations of the urinary and skeletal systems strongly suggest a complex genetic etiology, but so far, the molecular mechanism in the vast majority of cases remains unknown. Primary amenorrhea may also be the first presentation of complete androgen insensitivity syndrome, steroid 5α-reductase type 2 deficiency, 17ß-hydroxysteroid dehydrogenase type 3 deficiency, and Leydig cells hypoplasia type 1; therefore, these disorders should be considered in the differential diagnosis of the congenital absence of the uterus and vagina. The molecular diagnosis in the majority of these cases can be established.

Gynaecological infections in paediatric and adolescent gynaecology: a review of recommendations.

Inflammation within the genital organs in women is an important problem in gynaecology and venereology. Understanding the factors contributing to the inflammatory process and the role of defence mechanisms against their occurrence is important in terms of prevention and treatment. It is especially visible in paediatric gynaecology, where inflammatory diseases of the vulva, dermatoses, injuries and the effects of possible sexual harassment may overlap.

The importance of use of the FSFI questionnaire in gynecology and venerology: a pilot study.

INTRODUCTION: The Female Sexual Function Index (FSFI) is recognized as an excellent tool for assessing female sexuality and screening female sexual dysfunction, but it also has important venereological implications as sexually transmitted diseases result from human behaviour in the sexual sphere. It is influenced by socio-economic, psychological and cultural factors. AIM: To present the results of an attempt to implement FSFI in gynaecological practice. MATERIAL AND METHODS: The study comprised 91 women aged 20-35 (mean: 24.3 ±4.0) undergoing prophylactic gynaecological examinations. All of them voluntarily agreed to fill in the FSFI questionnaire, and provide data on weight, height, hormone treatments, the age of menarche and sexual initiation and information essential in health promotion and prevention, including the prevention of sexually transmitted diseases. RESULTS: The average age of the first sexual intercourse was 18.2 ±2.4. The total FSFI score ranged from 3.8 to 35.1 points (mean: 27.4 ±6.5). As many as 34.1% of the women presented with FSFI < 27.50, suggesting an increased risk of sexual dysfunction. Patients' age as well as the age of menarche were both negatively correlated with desire. The mean FSFI scores for almost all of the domains and the FSFI total score were higher for women taking oral contraceptives, although statistically significant differences were detected only for the orgasm domain. CONCLUSIONS: A high percentage of sexually active Polish women presented with FSFI below the threshold, suggesting some grade of sexual dysfunction. Gynaecological and STI medical history should be extended to include issues related to female sexual function.

Syphilis: then and now.

Getting to know the history of syphilis should begin with an attempt to establish the original source of its spread throughout the world. The dispute about the origin of syphilis, a sexually transmitted infection caused by Treponema pallidum (subspecies pallidum), had not been resolved even as late as in the twenty-first century, and to this day the supporters and opponents of the thesis that syphilis was brought to Europe by Christopher Columbus' sailors have been fighting without solid and sustainable foundations. The French named syphilis "the Neapolitan disease", while the Italians called it "the French disease".

Oral-genital human papillomavirus infection in Polish couples: frequent detection of HPV 42.

BACKGROUND: Human papillomavirus (HPV) contributes to the development of cervical and oropharyngeal tumors. The increased incidence of HPV associated oropharyngeal tumors is lately being observed also in Polish population. The worldwide distribution of HPV varies and the studies rarely combine analysis of virus genotypes in both: genital and oropharyngeal locations. Therefore, in our study, we investigated HPV distribution in both anatomical sites of females with previous history of cervical cancer or with pre-cancerous lesion and their partners to establish the dominant types in Polish couples in genital and oropharyngeal areas, as they can be easily sexually transmitted. METHODS: The study group consisted of 197 females and their partners. Each female had current or previous cervical pathology and HPV detected in gynecological swab with the use of Anyplex™ II HPV28 Detection system. This system is based on multiplexed real time PCR and enables detection of 19 high-risk and 9 low-risk HPVs. RESULTS: Beside women, the virus was found in 114/197 of men in their foreskin swabs. Additionally, HPV was detected in oropharyngeal swabs of 39/197 female and 56/197 male participants. HPV 16/31/42/39/54 dominated in female and HPV 66/42/16/31/53 in male genital locations. The incidence of HPV in oropharynx was lower, top five genotypes included: HPV 6/39/42/35/16 in women compared to HPV 39/6/42/40/33 in men. HPV16 was the most frequently detected virus type, found in 70/197 examined cervical swabs. It was significantly more prevalent as single infection in females, previously treated for the cervical cancer (p = 0.035). Moreover, regular presence of low risk type 42 was noticeable in both sexes, in both kind of swabs. There was a trend observed towards its prevalence as single infectious agent in women with previous history of cervical cancer (p = 0.069). CONCLUSIONS: Our results showed the distribution of HPV genotypes in Polish couples, in which each woman is HPV positive, indicating a common infection of HPV 42, regardless of sex and anatomical site. These findings shed new light on HPV 42 significance, however they should be verified on a larger group of Polish participants, followed regularly in 6 months intervals, in oral as well as in genital areas.

The Role of Matrix Gla Protein (MGP) Expression in Paclitaxel and Topotecan Resistant Ovarian Cancer Cell Lines.

The major cause of ovarian cancer treatment failure in cancer patients is inherent or acquired during treatment drug resistance of cancer. Matrix Gla protein (MGP) is a secreted, non-collagenous extracellular matrix protein involved in inhibition of tissue calcification. Recently, MGP expression was related to cellular differentiation and tumor progression. A detailed MGP expression analysis in sensitive (A2780) and resistant to paclitaxel (PAC) (A2780PR) and topotecan (TOP) (A2780TR) ovarian cancer cell lines and their corresponding media was performed. MGP mRNA level (real time PCR analysis) and protein expression in cell lysates and cell culture medium (Western blot analysis) and protein expression in cancer cells (immunofluorescence analysis) and cancer patient lesions (immunohistochemistry) were determined in this study. We observed increased expression of MGP in PAC and TOP resistant cell lines at both mRNA and protein level. MGP protein was also detected in the corresponding culture media. Finally, we detected expression of MGP protein in ovarian cancer lesions from different histological type of cancer. MGP is an important factor that might contribute to cancer resistance mechanism by augmenting the interaction of cells with ECM components leading to increased resistance of ovarian cancer cells to paclitaxel and topotecan. Expression found in ovarian cancer tissue suggests its possible role in ovarian cancer pathogenesis.

Child sexual abuse as an etiological factor of overweight and eating disorders - considerations for primary health care providers.

Despite the recognition of the clinical importance of child sexual abuse, primary health care providers are often not ad-equately prepared to perform medical evaluations and diagnose child sexual maltreatment. Paper presents basic symptoms and signs of CSA, which may suggest the need for further patient's diagnosis and referral. Since the great majority of sexually abused children do not have any abnormal physical findings, special attention is paid to the silent warning signs of CSA, such as changes in attitude towards own body and eating habits. Numerous studies suggest that victims of CSA may develop obesity or eating disorders of various forms and intensities.

The incidence of cervical intraepithelial neoplasia in a population of pregnant women with an abnormal cytology.

OBJECTIVES: To assess the incidence of cervical intraepithelial neoplasia - SIL and cervical cancer in a population of pregnant women with an abnormal cytology. MATERIAL AND METHODS: In pregnant women with abnormal cytology results according to The Bethesda System, a verifying diagnostics was carried out, including colposcopy and cervical biopsy. RESULTS: The most common histological and oncologic diagnosis in the whole study group of pregnant women were HGSIL changes, covering cervical intraepithelial neoplasia of medium and high grade - CIN 2 and CIN 3. CONCLUSIONS: HGSIL changes are the most common oncological pathology in a population of pregnant women with an abnormal cytology. Precise risk identification of HGSIL changes with the use of molecular tests can significantly reduce the number of surgical procedures in a population of pregnant patients with a cytological diagnosis of ASCUS and LSIL.

Comparison of the diagnostic value of cervical cytology and HPV HR DNA testing for the diagnosis of low-grade and high-grade squamous intraepithelial lesions across different age groups.

OBJECTIVES: To assess the diagnostic value of cervical cytology and HPV HR DNA testing for the diagnosis of low grade and high-grade squamous intraepithelial lesions across different age groups. MATERIAL AND METHODS: The study included 1103 patients, age 25-70 years. All patients underwent in-depth diagnostic tests following either an abnormal Pap test result or a clinically suspicious cervical lesion. In all women the following examinations were performed: a molecular test detecting 14 high-risk types of HPV, a colposcopy examination, as well as directed-biopsy of the cervix. The studied population was subdivided into four age groups. RESULTS: It was observed that the percentage of high grade squamous intraepithelial lesions (HSIL) and cancers increased with women's age. Sensitivity of both methods for detecting high-grade squamous intraepithelial lesions was highest for women aged 40-49 years. Sensitivity values of HPV testing was higher than that of cervical cytology among women under age 50. CONCLUSIONS: Specificity of HPV testing increased significantly with age of women and was several fold higher across all age groups than the specificity of cervical cytology.

The problem of vaginismus with congenital malformation of the genital tract.

The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and/or any object, despite the woman's expressed wish to do so" is vaginismus. Early traumatic sexual experiences (e.g. sexual abuse), religious orthodoxy, low self-esteem and body image, negative attitudes about sexuality, lack of knowledge about sex and fear responses are some of the traditional etiological correlates of vaginismus. Vaginismus is largely a diagnosis of exclusion. An interview is crucial in differentiating the causes of this disease and it should involve the following key questions: -whether the contraction of the vaginal muscles was recorded from the first sexual contact and still remains a need for sexual satisfaction is achieved without relations vaginal or -symptom occurs for some time and what circumstances it bound or -contraction of the muscles is independent of the will, reflex and is at the very idea of sexual intercourse, and -that the contraction of the vaginal muscles occurs when you try to enter the member into the vagina which is very painful. The physical, gynecological and sexuological examinations exclude local causes of the disease. The mainstay of treatment in the majority of cases is psychosexual support. The cause of organic vaginismus is congenital malformation of the genital tract. It results from abnormal development of genital paramesonephric (Müllerian) ducts and the urogenital sinus, which are structures involved in the process of oviduct, uterus, and vagina organogenesis. This has strong implications in the practices of gynecology and sexuology in general, not only in adolescent gynecology and sexuology. Vaginismus with congenital malformation is an important problem in these fields.

Application of positron emission tomography (PET/CT) in diagnosis of breast cancer. Part I. Diagnosis of breast cancer prior to treatment.

Positron emission tomography with computed tomography (PET/CT) is gaining popularity as a method for overall staging assessment of breast cancer. Currently, it is not a part of the routine workup before the beginning of treatment, because of insufficient sensitivity for the detection of small tumors (due to its limited spatial resolution), the heterogeneity of radiotracer uptake by the primary tumor, and unsatisfactory sensitivity in detection of lymph node metastases (particularly when they are small). Nevertheless, it should be considered when there is a high risk of metastases, because then initial PET/CT examination allows for accurate staging and may change the treatment algorithm in up to almost 50% of stage III patients, due to detection of distant and lymph node metastases throughout the whole body. Despite the discussed limitations of PET/CT, there is ongoing research concerning the recommendations for the examination prior to treatment. For a particular group of patients with high risk of metastases, PET/CT may be expected to become a part of the routine workup as the most appropriate staging method.

The application of positron emission tomography (PET/CT) in diagnosis of breast cancer. Part II. Diagnosis after treatment initiation, future perspectives.

Similarly to the applications described in the first part of this publication, positron emission tomography with computed tomography (PET/CT) is also gaining importance in monitoring a tumour's response to therapy and diagnosing breast cancer recurrences. This is additionally caused by the fact that many new techniques (dual-time point imaging, positron emission tomography with magnetic resonance PET/MR, PET/CT mammography) and radiotracers (16α-18F-fluoro-17ß-estradiol, 18F-fluorothymidine) are under investigation. The highest sensitivity and specificity when monitoring response to treatment is achieved when the PET/CT scan is made after one or two chemotherapy courses. Response to anti-hormonal treatment can also be monitored, also when new radiotracers, such as FES, are used. When monitoring breast cancer recurrences during follow-up, PET/CT has higher sensitivity than conventional imaging modalities, making it possible to monitor the whole body simultaneously. New techniques and radiotracers enhance the sensitivity and specificity of PET and this is why, despite relatively high costs, it might become more widespread in monitoring response to treatment and breast cancer recurrences.

Ten years of anti-HPV vaccinations: what do we know?

Human papillomavirus (HPV) is one of the most important carcinogens in humans. Vaccines against HPV are now considered the first anti-cancer vaccinations. Since 2007, in many developed countries, there have been recommendations present for preventive vaccines against HPV. At present, the degree of implementation of these recommendations depends on a number of country-specific factors such as the health care system organization or the ways of funding. HPV vaccines are primarily to prevent the development of cervical cancer and other genital cancers. Therefore, only their long-term effectiveness can be measured, when a correspondingly large cohort of vaccinated teenagers reaches the age of the greatest incidence of these cancers. However, great care should be taken in assessing the results of vaccinations due to the possibility of misinterpretation and possible erroneous data. Undoubtedly, teenagers are the target population of HPV vaccines. However, vaccinating young sexually active women is also justified from an individual point of view. A 9-valent vaccine has been registered in the USA and in Europe - including Poland - as one of the three preventive vaccines. It is recommended to vaccinate women between 13 and 26 and men between 13 and 21, previously unvaccinated. It is also recommended to vaccinate men aged 26 years or less who have sexual relations with other men and people with reduced immunity, including HIV-positive people who have not been vaccinated previously.

Sexual activity of women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS)--preliminary study.

OBJECTIVES: The aim of the study was to assess sexual activity of women with Mayer-Pokitansky-K0ster-Hauser syndrome (MRKHS) in relation to age-matched con trots. The hypotheses on differences betwedn them in regard to various types of sexual activity and its characteristics were verified. MATERIAL AND METHODS: 31 patients with MRKHS and 31 healthy women were examined. Psychosexual biography by M. Beisert was used to gain information on autoerotic and dyadic behavior: Phi-coefficient and U Mann-Whitney test were performed. RESULTS: Women with the MRKHS started autoerotic be ha vior at a similar age (U=58, 00; ns), practiced masturbation with the same frequency (in adolescence--U=350,00; ns and adulthood--U=137.50; ns) and manifested a similar level of sexual arousal (U=326,50; ns) as the age-matched controls. They declared experiencing vaginal (Phi=0.507; p<0.001) and oral (Phi=0.318; p<0.05) intercourse less frequently than healthy women. They also initiated dyadic sexual activity at a higher age than the controls (petting U=182,00; p<0.01; req=0.41; vaginal intercourse (U=64.00; 0<0.001; req = 0.59; oral contact (U=91.50; p<0.05; req=0.56) with exception of anal intercourse, where the age of initiation was the same in both groups (U=30,50; ns). Women in both groups experienced similar orgasm frequency during petting (U=108.50; ns), oral intercourse (U=97.50; ns), anal Tntercourse (U=25.50; ns). However, patients with the MPKHS reported significantly lower frequency of orgasm during vaginal intercourse (U=60.50; p<0.05; req=0.36). CONCLUSIONS: Sexual development of patients with the MRKHS and healthy women is partly similar Differences in dyadic sexual activity are not limited to vaginal intercourse thus are probably determined by biological conditions and their psychological implications.

Overweight, obesity and female sexuality in perimenopause: a preliminary report.

INTRODUCTION: The research was conducted among patients of the Department of Perinatology and Gynaecology of the Poznan University of Medical Sciences. Its aim was to investigate the influence of overweight and obesity on female sexuality during the perimenopausal period. Preliminary results of the research are presented in the thesis, which was as a matter of fact intended as a preliminary report. The examination of sexual functions of the patients was performed with the use of the Female Sexual Function Index (FSFI) form. MATERIAL AND METHODS: Sixty-one women during the perimenopausal period filled out the survey, with the average age of these women being 51 years. Forty-two of the examined women had an appropriate body mass index (BMI), i.e. between 18.5 and 25, while for 19 of the women, the BMI was above normal. For statistical analysis and in order to assess the differences between the two above-mentioned groups of patients, the nonparametric Mann-Whitney test was applied. A statistically significant value was assumed at p < 0.05. The results of the conducted research indicated no such difference between the women with differing BMI for the specific domains of the FSFI test. RESULTS: The results obtained show that research in the area needs to be continued. CONCLUSIONS: All the hitherto existing scientific studies also seem to indicate that the influence of overweight and obesity on female sexuality during the perimenopause has not yet been unambiguously proven. Beyond any doubt, however, sexual disorders appear in women at this time of life and the factors which determine them can vary greatly. Given the character of the situation, women ought to be supported both by a team of specialists representing different branches of medicine as well as by their relatives. The whole situation also calls for more research of the important subject matter.

Expression of the MT1 melatonin receptor in ovarian cancer cells.

Ovarian cancer (OC) is the leading cause of death among women with genital tract disorders. Melatonin exhibits oncostatic properties which it may effect through binding to its membrane receptor, MT1. The aim of this study was to determine the expression of MT1 in OC cells and to correlate this with clinical and pathological data. Immunohistochemistry was performed on 84 cases of OC. Normal ovarian epithelial (IOSE 364) and OC (SK-OV-3, OVCAR-3) cell lines were used to examine the MT1 expression at protein level using the western blot and immunofluorescence technique. The expression of MT1 was observed as cytoplasmic-membrane (MT1(CM)) and membrane (MT1(M)) reactions. A positive correlation between MT1(CM) and MT1(M) was found in all the studied cases. There were no significant differences between the expression of MT1(CM), MT1(M), and histological type, staging, grading, presence of residual disease, or overall survival time. Immunofluorescence showed both MT1(M) and MT1(CM) expression in all the tested cell lines. Western blot illustrated the highest protein level of MT1 in IOSE 364 and the lowest in the OVCAR-3. The results indicate the limited prognostic significance of MT1 in OC cells.

Effects of AIDiet intervention to improve diet quality, immuno-metabolic health in normal and overweight PCOS girls: a pilot study.

This study was conducted in two groups of girls with PCOS (polycystic ovary syndrome) categorized as slim (group N) and overweight-to-obese (group Ov/Ob). The study's primary outcome was to assess the impact of a 12-week anti-inflammatory diet (AIDiet) intervention, without energy deficit, on daily diet quality improvement, evaluated according to the KIDMED index. The secondary outcome was improving inflammatory, redox, hormonal, and metabolic statuses. In the study, which was completed by 13 girls from the Ov/Ob group and 19 girls from the N group, a significant improvement in the mean KIDMED score was obtained. Moreover, the intervention significantly improves concentration of total antioxidant capacity (TAC), fasting insulin, and the homeostatic model assessment for insulin resistance (HOMA-IR) index, in the Ov/Ob group, while both groups experienced a reduction in the concentration of interleukin (IL)-1 and IL-6, tumour necrosis factor (TNF-α), and androstenedione. The AIDiet intervention effectively improved the quality of the subjects' diets, which was associated with the improvement of hormonal and immuno-metabolic markers. However, these changes in normal-weight patients were observed regardless of body weight reduction. ClinicalTrials.gov Identifier NCT04738409.

[Positron emission tomography (PET) in malignant ovarian tumors]. / Pozytonowa tomografia emisyjna (PET) w nowotworach zlosliwych jajnika.

Accessibility of positron emission tomography integrated with computed tomography (PET/CT) has improved significantly in recent years. PET/CT with the use of 18F-deoxyglucose (FDG) is widely used in patients with ovarian malignancies at different stages of the management. FDG PET/CT shows high diagnostic accuracy in the differentiation of benign and malignant ovarian lesions with the exception of borderline tumors that may cause false negative results. Moreover FDG PET/CT is used in some centers for preoperative staging and determining the prognosis of ovarian cancer However further studies including larger groups of patients are needed to confirm the applicability of FDG PET/CT in case of the two abovementioned indications. Until now, the best documented indication for FDG PET/ CT in patients with ovarian cancer has been the detection of recurrence, especially in subjects with elevated CA 125 marker and negative results of other imaging techniques. This review focuses on the applicability of PET with the use of FDG in ovarian malignancies and points out to the limitations of this method.

[Sexuality of a woman with Mayer-Rokitansky-Küster-Hauser syndrome--case report]. / Seksualnosc kobiety z zespolem Mayera-Rokitanskyego-Küstera-Hausera--opis przypadku.

Aplasia or hypoplasia of the uterus and the vagina are pivotal elements of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Psychosexual functioning of women with MRKH syndrome remains to be fully elucidated. Detailed analysis of sexuality of a 31-year-old woman with MRKH syndrome (type MURCS) and with a history of surgical creation of the vagina was performed. Both, biological and psychosocial determinants were investigated in great detail. Genital malformations were found to have significant impact on the sexual identity and sexual behavior of the patient.