A new perspective on Endometrial Carcinoma classification and management strategies in context of molecular subtypes.

Endometrial cancer is the most common gynecological cancer and the second most prevalent female malignancy in the developed world. It is typically diagnosed in postmenopausal women, presenting with the characteristic clinical symptom of uterine abnormal bleeding. In the past, only two histological types were considered. However, it has become increasingly evident that endometrial cancer is a clinically heterogeneous disease, and this heterogeneity is closely associated with the diversity of underlying molecular alterations. The Cancer Genome Atlas classification has significantly advanced the diagnosis, risk stratification, and management of endometrial cancer by categorizing it into four molecular subgroups, each characterized by distinct mutational burdens and copy number alterations.

Birth plan - legal and medical aspects.

A birth plan is a document that defines mother's preferences and expectations regarding childbirth and early puerperium. The purpose of the birth plan is to establish communication about mother's birth wishes and to properly convey them to the health care providers. With increasing computerization of society, birth plan is currently the subject of heated debate. In this article, we present historical view of the birth plan, as well as current legislation regarding the birth plan, as we do not consider legal awareness of obstetricians to be sufficient at the moment. The purpose of this article is to appeal to the professional public so they have up-to-date information about the birth plan, especially in discussions with patients, but also during forensic procedures. The preservation of excellent perinatological results under our circumstances is only possible by providing professional, empathetic and very intimate health care in hospital institutions.

Caesarean section on request - a controversial request or the patient's right?

Caesarean section on request, a request that we have been encountering more and more recently. This can be interpreted as a primary caesarean section performed as a request of the mother without any relevant obstetrical or other medical indications in order to avoid vaginal delivery. The most common reason for mothers' requests for caesarean section is the fear of childbirth and the associated pain. Currently, medicine recognises the patient's right to actively participate in the choice of treatment procedures, including methods of delivery. We have accepted patients' claim for various aesthetic surgical interventions, in case they provide informed consent. The same principle should be maintained for caesarean sections on request.

Trophoblast stem cells, trophoblast invasion, and organoids - advancements in gynecology.

The human placenta serves as a vital barrier between the mother and the developing fetus during pregnancy. A defect in the early development of the placenta is associated with severe pregnancy disorders. Despite its complex development, various molecular processes control placental development, and the specialization of trophoblast cells is still not fully understood. One primary obstacle is the lack of suitable cell model systems. Traditional two-dimensional (2D) cell cultures fail to mimic in vivo conditions and do not capture the intricate intercellular interactions vital for studying placental development. However, three-dimensional (3D) organoid models derived from stem cells that replicate natural cell organization and architecture have greatly improved our understanding of trophoblast behavior and its medicinal applications. Organoids with relevant phenotypes provide a valuable platform to model both placental physiology and pathology, including the modeling of placental disorders. They hold great promise for personalized medicine, improved diagnostics, and the evaluation of pharmaceutical drug efficacy and safety. This article provides a concise overview of trophoblast stem cells, trophoblast invasion, and the evolving role of organoids in gynecology.

Home births as a "right" of female patients in the context of medicine, legislation and court jurisprudence.

Currently, in the Czech Republic and Slovakia, more and more women prefer a planned home birth to a hospital birth, despite the fact that the hospital provides a safe environment for laboring women, thanks to the possibility to intervene at any time in case of complications. These women consider childbirth a natural process, while obstetric care is often considered unnecessary. According to the World Health Organization, birth can only be defined as physiological after birth. Even though women can give birth without medical assistance, it is not possible to identify in advance the mothers and newborns who will need some kind of intervention during childbirth. Although a planned home birth is associated with fewer maternal interventions and the probability of a spontaneous vaginal birth, compared to a planned hospital birth, the risk of neonatal death is two- to three-times higher.

Epidermolysis in a newborn of a mother affected by covid-19 in the 3rd trimester of pregnancy.

Covid-19, caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although this infection primarily presents with respiratory symptoms, the number of reported extrapulmonary manifestations, including dermatological, is also increasing. A group of pregnant women is particularly susceptible to respiratory diseases, but with regard to covid-19, there is still limited data on the course of infection in pregnancy in relation to the possibility of vertical transmission. We present the case of a 30-year-old unvaccinated patient with a history of overcoming covid-19 infections in the 7th month of pregnancy, and with persistent skin lesions. The patient gave birth to a mature newborn with epidermolytic lesions on a bullous base. In the differential dia-gnostic process, Staphylococcal scalded skin syndrome and epidermolysis bullosa were ruled out in the newborn. Considering the clinical findings and epidemiological history of the mother, we assume a possible vertical transmission of covid-19 with skin manifestation of the disease in the newborn.

Effect of umbilical cord drainage after spontaneous delivery in the third stage of labor.

Umbilical cord drainage involves releasing the cord clam from the umbilical cord after separation of the newborn from the maternal end of the umbilical cord. Consequently, there is emptying of blood from the placenta. This procedure is part of the active management of the third stage of labor (TSL). OBJECTIVE: This study is intended to provide knowledge about the duration of TSL and the risk of retention of the placenta using umbilical cord drainage and the no-drainage procedure. MATERIALS AND METHODS: A prospective randomized study of the management of the third stage of labor in 600 patients. The patients were equally divided into two groups with umbilical cord drainage (300) and without umbilical cord drainage (300). TSL was actively managed by FIGO (the International Federation of Gynecology and Obstetrics) recommendations. We monitored the duration of TSL and retention of the placenta after a 30 min period. RESULTS: The mean duration of TSLwas 6.8 ± 0.4 min in the drainage group and 11.6 ± 0.8 min in the control group. We conclude that umbilical cord drainage significantly shortens the duration of TSL (P = 0.026) as well as reduces the risk of placental retention. In a group where we use the drainage of the umbilical cord, placental retention 30 min after delivery of the fetus occurred in four cases while the second set occurred in 14 cases (RR 3.62; 95% CI 1.18-11.14). CONCLUSION: We assume that during umbilical cord drainage, the collapse of thin-walled uteroplacental vessels occurs earlier causing bleeding from these vessels between the placenta and the uterine wall, and therefore, earlier separation of the placenta occurs. Of course, the drainage of the umbilical cord is only one step in the algorithm of active management at the third stage of labor according to FIGO.

Outcome of a patient with Herlyn-Werner-Wunderlich syndrome treated with Balloon septostomy - pre- and postsurgical ultrasound findings.

Herlyn-Werner-Wunderlich syndrome is an unusual congenital anomaly defined by a triad of congenital defects of the female urogenital tract - homolateral renal agenesis, uterus duplex and obstructed hemi-hematometrocolpos whose etiology remains still unclear. Pelvic pain, dysmenorrhea and palpable mass due to the hematocolpos or hematometra are the most common clinical symptoms. Endometriosis is considered to be a prevalent finding in these young patients possibly explaining the pathophysiological mechanism of endometriosis as the result of retrograde menstruation. Early diagnosis and subsequent treatment are important to prevent the development of severe complications. In general, clinical and reproductive outcomes after drainage of the hematometrocolpos are reported to be satisfactory. A 13-year-old patient presented with pelvic pain and was diagnosed with OHVIRA syndrome treated with Balloon septostomy.

Fetal neck giant hemangioma associated with postnatal arising Kasabach-Merritt syndrome.

We report a prenatal ultrasound dia-gnosis of giant neck hemangioma at 30+1 weeks in a fetus resulting in the postnatal development of Kasabach-Merritt syndrome. Ultrasound scan revealed a large isoechoic mass occupying the whole neck, infiltrating the nasopharyngeal cavity, tongue, lower lip and mandible. Complex sonographic visualization with 2D and 4D was helpful in the process of parental counseling.

The influence of preferred habitat and daily range of the European hare on its contamination by heavy metals: a case study from the West Carpathians.

The Spisská Magura mountain range, located in the Middle Spis, is one of the regions in Slovakia most contaminated by heavy metals resulting from mining and smelting activities. Heavy metals and other potentially toxic elements have accumulated in mountain areas via atmospheric transport. The influence of the daily range size of the European hare on its contamination by heavy metals was investigated in three habitat types (forest, woodland edge, meadow) in the Spisská Magura mountain range in the West Carpathians. Individual hares (n = 21) were traced and located by GPS following snowfall. Pair samples of their faeces (n = 64) and food (n = 64) were collected from feeding sites. The maps created were used for determination of the size of the daily range as being small or large. All hares that have a small daily range avoid meadows and open spaces due to the higher predation risk. However, individuals with a large daily range feed in all habitats, including meadows. Hares with a small daily range in a forest habitat ingested higher amounts of bio-elements Ca, Cr, S, and Mn as well as higher amounts of heavy metals Ba and Pb than hares with a large daily range. Moreover, dominant hares with a small daily range, with access to abundant food sources in a forest habitat, may gradually take on higher levels of bio-elements including heavy metals that are present in their food source. In contrast, in the woodland edge, hares with a small daily range had a smaller concentration of Ca, Cr, Mn, S, Ba, and Pb compared to hares with a large daily range. Caecotrophy plays a very significant role as far as the intake of nutrients and other elements is concerned. We found significant dependence between concentrations of the elements Cr, S, Ba, Pb, and Cd in the food of European hares and in their faeces.

Temporal and seasonal changes in mercury accumulation in Tatra chamois from West Carpathians.

The main aim of this study was to determine the concentration of total mercury (T-Hg) in different tissues, hair, and faeces from a long-lived animal that actively lives in the subalpine and alpine zone within temperate climate zone throughout the year. Levels of T-Hg in samples from naturally deceased Tatra chamois (n = 72) from the Tatra Mountains (Slovakia) were determined using direct mercury analyses on the basis of dry weight. The mercury concentrations in hair samples were compared over the last three decades. Seasonal changes in mercury concentration and differences in the amounts of mercury in various tissues, hairs, and faeces between age and sex groups were also studied. The highest mercury concentrations in organs were found in the kidneys of Tatra chamois, with mean values of 0.45 ± 0.07 µg/g (dry weight) for adults (n = 18) and 0.39 ± 0.12 µg/g (dry weight) for juveniles (n = 6). These values are considerably high compared to expected Hg levels in wild ungulates from foothill and mountain areas in the temperate zone. Juveniles had higher levels of T-Hg in their muscles (0.011 ± 0.001 µg/g dry weight, n = 10) and faeces (0.189 ± 0.025 µg/g dry weight, n = 7) when compared to adults that had 0.007 ± 0.001 µg/g dry weight of T-Hg in muscles (n = 29) and 0.113 ± 0.015 µg/g dry of T-Hg weight in faeces (n = 19). T-Hg concentrations in individual tissues (heart, kidney, liver, lungs, spleen, tongue, muscle, bone), hairs, and faeces were not significantly different between males and females. Mercury levels in the hair of Tatra chamois have increased significantly since the 1990s (median value of T-Hg: 0.025 µg/g dry weight) with the highest values presenting during the 2000s (0.029 µg/g dry weight). Since 2010 (0.016 µg/g dry weight), levels have declined when compared to those observed during the 1990s and 2000s. Therefore, we can conclude that T-Hg deposition in alpine areas of the Tatra Mountains shows a declining trend since the 2010s. T-Hg concentrations in the heart, muscle, and hair were higher in summer compared to winter. Seasonal changes in mercury concentrations are likely most related to the seasonal availability of food, but may also be related to moulting periods, and this correlation must be explored further.

Relationship between heavy metal accumulation and histological alterations in voles from alpine and forest habitats of the West Carpathians.

The interaction between toxic heavy metals and bio-elements in internal organs and femoral bones and their potential impacts on bone structural properties and renal histopathological changes in bank voles and snow voles were investigated. Our results reveal that heavy metals Hg and Pb accumulate more in femoral bones of alpine habitats than forests. In snow voles, the parameters of the primary osteons' vascular canals (length, average perimeter and area) simultaneously decreased with an increase of Pb and Sr. Wider primary osteons' vascular canals of snow voles contained decreased levels of K, but increased Ba. In bank voles, the number of primary osteons increased in alpine habitats along with K, Hg, and Pb accumulation. In the kidneys of bank voles, rising levels of Rb, Hg, and Zn were detected in alpine habitats. Hg increases the most in kidney tissue from alpine habitats in both vole species, and Hg levels (mean value 0.25 µg/g, max. value 0.55 µg/g) in the renal tissues of bank voles from alpine localities are similar to Hg levels from Hg-polluted industrial areas in other studies. This reflects that alpine areas of the Tatra Mountains are highly contaminated with Hg. The intensity of renal hemosiderosis relates significantly to Zn, Fe, and Cu levels in snow voles, with Fe and Zn levels in bank voles from forest habitats, and with Rb in bank voles from alpine habitats. The intensity of tubule necrosis in renal tissues of bank voles from alpine habitats was negatively related to Se content. In bank voles from forest habitats, significant positive correlations were found between the intensity of glomerular hyperplasia and amounts of Zn. The interactions of the detected element's association with bone tissue and internal organs are discussed.

Occurrence and vertical distribution of Ca, Cl, Cr, Fe, Mn, Mo, K, Rb, Sr, S, Sn, and Zn in the skull bones of alpine bullhead (Cottus poecilopus) in the West Carpathians.

The aim of this study was to examine the contents of calcium, chlorine, chromium, iron, manganese, molybdenum, potassium, rubidium, strontium, sulfur, tin, and zinc in the bones of the alpine bullhead (Cottus poecilopus) related to its vertical distribution in the mountain river Javorinka. This river is located on the northern side of the High Tatras, the West Carpathians. Sampling took place during 2017, 2018, and 2019. One hundred three individuals of bullheads were collected. Only deceased individuals were selected for sampling; there was no deliberate harm to any sampled individuals. Weight, body length, and head length and width were measured. The amounts of Ca, Rb, and Mo were significantly dependent on the altitude and the fish size. At higher altitudes, there are smaller fish that colonize more inaccessible waters with smaller habitat flow options and these smaller fish contain relatively more Ca, Rb, and Mo in their skulls than large fish. The presence of Mn, Sr, and Zn was related to the altitude. Concentrations of Zn and Sr increase with altitude in the alpine bullhead skulls. The amounts of S, Cl, K, Cr, Sn, and Mo did not differ among fish living at different elevations.