Search Results (100)

Objective: To develop machine learning models by integrating transvaginal ultrasound (TVUS) with clinical indicators, conduct visual analysis of the models, and systematically assess their diagnostic efficacy in differentiating early cervical neoplastic lesions. Methods: A total of 144 eligible patients (84 cases of early cervical cancer and 60 cases of cervical myoma) admitted to the First Affiliated Hospital of Chongqing Medical University from January 2018 to August 2025 were retrospectively enrolled in this study. Their clinical data, human papillomavirus (HPV) test results, Thinprep Cytologic Test (TCT) findings, TVUS images and magnetic resonance (MR) imaging data were collected and subjected to comprehensive statistical analysis. Univariate and multivariate Logistic Regression analyses were performed to identify independent differentiating factors for lesion classification. Eleven machine learning models were subsequently constructed, and their diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and the DeLong test. Finally, a nomogram was developed based on the optimal-performing model for clinical visualization. Results: The TVUS–clinical indicator integration model identified five independent differentiating factors: HPV status, TCT findings, menopausal status, ultrasonic tumor blood supply, and ultrasonic tumor morphology. In contrast, the MR–clinical indicator integration model screened out three independent factors: HPV status, TCT findings, and intratumoral signal intensity on MR T2-weighted imaging (T2WI). The TVUS integration model demonstrated marginally superior diagnostic performance, with a sensitivity of 0.988, specificity of 0.983, and an area under the ROC curve (AUC) of 0.991, compared with the MR integration model (sensitivity: 0.952, specificity: 0.950, AUC: 0.975); however, this difference in AUC values was not statistically significant (p = 0.911). Among the 11 machine learning models, the Logistic Regression model exhibited optimal classification performance and stability. DCA curves confirmed that all constructed models outperformed single-index diagnostic strategies in clinical decision-making for lesion differentiation. A nomogram was further established based on the Logistic Regression model for intuitive clinical application. Conclusions: Multiple machine learning models integrating TVUS with clinical indicators are successfully developed, and a corresponding nomogram is constructed in this study. Full article

Background/Objectives: Teratomas are the most common germ cell tumors, occurring mainly in the gonads. Extragonadal germ cell teratomas (EGGCTs) are less common but can develop anywhere along the midline structures, with uterine location being extremely rare. On an ultrasound, uterine teratomas are frequently misinterpreted as polyps or myomas. Case Presentation: We report a 27-year-old asymptomatic woman who was diagnosed with a mature uterine teratoma originating from the lower uterine segment and extending to the cervix. We treated this patient with the IBS^® Integrated Bigatti Shaver. This is the first reported case of the IBS^® being used to remove uterine teratomas. At follow-up, the patient recovered uneventfully and subsequently achieved a successful term pregnancy. Conclusions: Preoperative MRI is recommended for uterine teratomas. The IBS^® technique offers an effective and fertility-preserving approach for excising uterine teratomas, providing rapid procedure, superior visualization, and the prevention of tumor dissemination. In this report, we discuss the mechanism, diagnosis, and treatment of teratomas and review the previous literature. Full article

Cerebral small vessel disease (CSVD) is a leading cause of stroke, cognitive impairment, and vascular dementia, yet disease-modifying therapeutic strategies remain limited. Emerging evidence suggests that sleep fragmentation (SF), a common and often under-recognized feature of aging and cardiometabolic disorders, plays a pivotal role in CSVD pathogenesis by disrupting the glymphatic system, the brain’s primary waste clearance pathway. Sleep-dependent glymphatic function facilitates the removal of neurotoxic metabolites and maintains neurovascular homeostasis. In contrast, SF impairs cerebrospinal fluid (CSF)–interstitial fluid (ISF) exchange, promotes perivascular space enlargement, endothelial dysfunction, blood–brain barrier (BBB) breakdown, and chronic neuroinflammation, hallmarks of CSVD. This review synthesizes current mechanistic, preclinical, and clinical evidence linking SF to glymphatic dysfunction and small vessel pathology, framing these interactions as a sleep–glymphatic–vascular continuum underlying CSVD progression and cognitive decline. We further explore the emerging therapeutic potential of tocotrienols (T3), vitamin E isoforms with potent antioxidant, anti-inflammatory, and vasculoprotective properties, as modulators of neurovascular integrity within this continuum. Although direct evidence linking T3 to glymphatic regulation remains limited, converging data support their capacity to preserve endothelial function, attenuate oxidative stress, and stabilize astrocytic and BBB dynamics, mechanisms highly relevant to glymphatic and microvascular health. By integrating sleep biology, glymphatic neuroscience, and nutritional vascular protection, this review highlights hypothesis-generating preventive and therapeutic avenues for CSVD and delineates key knowledge gaps, including the need for longitudinal human studies, standardized glymphatic imaging, objective sleep phenotyping, and interventional trials to establish causal and translational relevance. Full article

Background/Objectives: Uterine fibroids are the most common benign neoplasms of the female genital tract, with a prevalence of 20% to 40% among women of reproductive age. Their management in the context of Assisted Reproductive Technologies (ART) represents a major clinical challenge, characterized by controversies, contrasting approaches, and a lack of shared guidelines. Indeed, the detrimental effects of fibroid treatments are not well known and may be influenced by the size, location, and number of fibroids. The impact of hysteroscopic myomectomy in women affected by submucosal myomas (FIGO classification type: G0–G2) is well documented in the current literature; however, the impact of intramural and subserosal myoma removal (FIGO types 3–8), in particular those <4/5 cm in diameter, remains controversial. The aim of the present study is to introduce and share a pragmatic surgical approach to uterine fibroid management prior to In Vitro Fertilization (IVF), to reduce the knowledge gap regarding uterine fibroid treatment. Methods: We conducted a retrospective observationally study that included 94 cases of infertile women, who underwent myomectomy at our IVF centre at Sandro Pertini Hospital, Rome, Italy, between 2020 and 2025. These patients met the inclusion criterion of having an idiopathic/tubal factor of infertility and were aged < 40. We evaluated a group of 17 women (group A) who underwent hysteroscopic myomectomy for submucosal fibroids (FIGO types 0–2) and a group of 39 women (group B) who underwent open (laparotomic) myomectomy for intramural/subserosal fibroids (FIGO types 3–8). Group B was compared with a control group of 38 women who were similar in terms of all demographic and clinical parameters and myoma features (group C) and did not want to undergo a myomectomy procedure. All surgical procedures were executed by the same expert surgeon following our proposed model: submucosal fibroids were always removed by operative hysteroscopy, while intramural/subserosal fibroids were removed if there were three or more and if they were at least 1 ≥ 3 cm in size. All enrolled patients subsequently underwent IVF treatment at our centre, which consisted of an antagonist protocol for ovarian stimulation, and all transferred embryos were of good quality according to the recent European Society of Human Reproduction and Embryology (ESHRE) classification. Results: In group A, we observed an implantation rate of 41% and a clinical pregnancy rate of 35.2%, and these results are consistent with the current literature. In group B, we obtained statistically significant differences in the implantation (31% vs. 12.9%) and pregnancy rates (28.1% vs. 7.8%) compared to group C (p = 0.02 and p = 0.03, respectively). In addition, the live birth rate was statistically higher compared to that in group C (p < 0.01). Miscarriage and preterm delivery rates were lower in group B, although the differences were not statistically significant. No severe post-surgical complications, such as uterine rupture, were observed during subsequent pregnancies. Conclusions: Despite the limited patient sample size, the monocentric experience, and the retrospective design, we emphasize the effectiveness of our proposed surgical model in women affected by myomas. Indeed, the surgical treatment of submucosal, intramural, and subserosal lesions may improve ART and pregnancy outcomes (through a higher implantation rate, pregnancy rate, and live birth rate, as well as a lower miscarriage/preterm rate). Full article

(1) Background: Transvaginal RFA is a minimally invasive treatment for myomas in women opting for uterus preservation. The present study aimed to evaluate the efficacy and safety of transvaginal RFA to treat myomas, reduce symptoms, decrease myoma volume, and identify prognostic factors for predicting treatment response. (2) Methods: The study group included 45 women treated for uterine fibroids at the Gynecological and Obstetrics Clinical Hospital in Poznań. From 1 July 2024 to 31 March 2025, a total of 45 transvaginal radiofrequency ablation (TV-RFA) procedures were performed. (3) Results: Ultrasound findings revealed that fibroid dimensions and volume significantly decreased at 1-month follow-up compared to those at pre-procedure (88.7 ± 116.3 vs. 64.6 ± 82.6 cm³; p = 0.003). Ultrasound findings demonstrated that fibroid depth (4.8 ± 2.1 vs. 4.1 ± 2.2; p = 0.01) and fibroid volume (88.7 ± 116.3 vs. 82.4 ± 93.9 cm³; p = 0.02) were significantly decreased at 3-month follow-up compared to their pre-procedure values. Menstrual bleeding duration showed significant differences between the pre-procedure state and 1-month follow-up (N = 23; T = 2; Z = 4.14; p < 0.001) and 3-month follow-up (N = 8; T = 1; Z = 2.38; p = 0.017), with a significant reduction after the RFA procedure. Significant differences were observed in bleeding severity at pre-procedure and at 1-month follow-up (N = 22; T = 11.5; Z = 3.73; p < 0.001); however, no significant differences in bleeding severity were noted at the 3-month follow-up (N = 7; T = 4; Z = 1.69; p = 0.09). These results should be interpreted cautiously due to the small number of patients with complete 3-month follow-up. (4) Conclusions: Transvaginal radiofrequency ablation is an effective, precise, and safe minimally invasive approach for treating uterine fibroids. These preliminary findings are promising but require confirmation in larger cohorts with longer follow-up. Full article

The main goal of this study was to consider the role of obesity/overweight as a potential modifier of associations between gene single nucleotide polymorphisms (SNPs) affecting the sex hormone-binding globulin level (SHBG_level) and uterine myoma (UM). In the two women cohorts differentiated by body mass index (BMI) (BMI ≥ 25, n = 782 [379 UM/403 control] and BMI < 25, n = 760 [190 UM/570 control]), the association of genome-wide association studies (GWAS)-correlated SHBG_level-tied nine loci with UM was studied by method logistic regression with a subsequent in-depth evaluation of the functionality of UM-causal loci and their strongly linked variants. BMI-conditioned differences in the associations of SHBG_level-tied loci with UM were revealed: in the BMI < 25 group, a variant rs17496332 (A/G) PRMT6 was UM-correlated (OR = 0.70; p_perm = 0.024), and in the BMI ≥ 25 cohort, a SNP rs3779195 (T/A) BAIAP2L1 was UM-associated (OR = 1.53; p_perm = 0.019). Both the UM-causal loci and their proxy SNPs have pronounced probable functionality in the organism as a whole, as well as in the liver (the SHBG synthesis place), adipose tissue, uterus, etc., thereby influencing significant processes for UM biology such as regulation of the gene transcription, embryogenesis/development, cell proliferation/differentiation/apoptosis, metabolism, lipid exchange, etc. In conclusion, the results of our work demonstrated, for the first time, the essential role of obesity/overweight as a meaningful modifier of associations between SHBG_level-tied polymorphisms and UM. Full article

The goal of this study was to identify factors associated with pain sensitivity, procedural discomfort, and referral for surgical hysteroscopy, aiming to improve office hysteroscopy success rates. This was an observational prospective cross-sectional study that analyzed data from women who underwent outpatient hysteroscopy between October 2022 and October 2023. Epidemiological, clinical, and procedural data were collected from medical records. Pain levels were assessed using a visual analog scale (VAS), categorized as acceptable (0–6) or severe (7–10). Statistical analyses were performed to explore associations between patient characteristics and pain levels, with p-values < 0.05 considered significant. This study evaluated 1662 women. The mean age was 54.0 (±12.4) years, and 59.1% were postmenopausal. Nulliparity, menopause, lower body mass index (BMI), and fewer vaginal deliveries were associated with higher pain levels (p < 0.05). Cervical stenosis significantly increased procedural pain: 20.8% and 27.6% of patients with stenosis resolved during the procedure, respectively, reported severe pain. In the multivariate logistic regression analysis, protective factors against severe pain included having ≥2 vaginal deliveries (OR 0.53, 95% CI 0.39–0.72), patent internal (OR 0.53, 95% CI 0.38–0.75) and external cervical orifices (OR 0.47, 95% CI 0.30–0.72), presence of myomas (OR 0.53, 95% CI 0.34–0.83), and biopsy performance (OR 0.55, 95% CI 0.41–0.74). Severe pain, uterine lesions, and stenosis were the main reasons for surgical referral. Lower BMI, nulliparity, menopause, and cervical stenosis were significant predictors of increased pain during outpatient hysteroscopy. These findings may help identify patients at higher risk for procedural discomfort and support strategies to improve success of office hysteroscopy. Full article

Background: Uterine leiomyomas are the most common pelvic tumors in women of reproductive age. There is no clear conclusion in the literature regarding the pathophysiology of these conditions. STAT proteins stimulate the transcription of target genes. STAT-3 leads to an increase in VEGF levels and plays a role in tumorigenesis. IL-26 and other cytokines are vital immune response mediators. Cytokine dysregulation affects the immune response of various organs and tissues, making them prone to various diseases, such as inflammation, infection, and tumors. Methods: In the present study, we aimed to determine whether STAT-3 and IL-26 play a role in the development of uterine leiomyoma. This case–control study included 38 patients who underwent hysterectomy due to uterine leiomyoma and 30 patients who underwent hysterectomy due to non-organic benign gynecological causes other than myoma. Sections from the myometrium of the control group and the leiomyoma tissue of the case group were subjected to immunohistochemical staining for STAT-3 and IL-26. Results: When the uterine tissue sections of the control group incubated with STAT-3 were examined under a light microscope, the smooth muscle and fibroblast cells in the myometrium were STAT-3-negative, while the number of smooth muscle and fibroblast cells showing strong STAT-3-staining in the leiomyoma sections was high. When the uterine tissue sections incubated with IL-26 were examined under a light microscope, the normal smooth muscle and fibroblast cells in the control group were IL-26-negative, while there was an increase in the number of cells showing strong IL-26-staining in the leiomyoma smooth muscle and fibroblast cells. Conclusions: Our findings show that STAT-3 and IL-26 levels are significantly increased in uterine leiomyomas, and this increase may play a role in the growth and progression of uterine fibroids. The current results may enable the development of innovative treatment options, as they demonstrate the role of novel pathways in the formation of uterine fibroids. Full article

The maternal circulating proteome reflects critical physiological adaptations during pregnancy, yet standardized reference profiles for early gestation are lacking. In this prospective study, we employed targeted liquid chromatography–multiple reaction monitoring–mass spectrometry (LC-MRM-MS) with stable isotope-labeled (SIS) standards to characterize the serum proteome of 83 women with uncomplicated singleton pregnancies between 11⁺² and 13⁺⁶ weeks’ gestation. Robust analysis quantified 115 proteins (83% of targets), with 101 meeting ICH M10 standards. These included 38 FDA-approved, 19 CVD-related, and 25 CLIA-approved biomarkers. We identified 43 proteins significantly associated (p < 0.05) with gestational age, maternal factors (BMI, age, parity, and myomas), and fetal sex. Key findings included identification of 12 proteins significantly associated with trisomy risk (|R| = 0.21–0.45, p < 0.05) and extreme physiological variability in pregnancy zone protein (PZP, 123.9-fold), followed by apolipoprotein (a) (LPA; 9.9-fold) and pregnancy-associated plasma protein A (PAPP-A, 9.3-fold). In contrast, hemopexin (HPX) demonstrated remarkable stability (CV = 8.5%), suggesting its utility as a reference marker. The study successfully implemented multiples of the median (MoM) transformation for clinical standardization of protein profiles, with RobNorm proving particularly effective for batch-effect correction in our dataset. These methodological advances, combined with the establishment of comprehensive pregnancy-specific reference ranges, provide a valuable foundation for future research. The optimized analytical framework and protein signatures identified in this work not only enable the development of next-generation screening approaches but also offer new insights into the molecular adaptations occurring during early pregnancy. Full article

Uterine leiomyoma (uterine fibroids, UF) are benign myometrium tumors that affect up to 70% of the female population and may lead to severe clinical symptoms. Despite the high prevalence, pathogenesis of UF is not understood and involves cytokines, steroid hormones, and growth factors. Additionally, an increased deposition and remodelling of the extracellular matrix is characteristic for UF. Vitamin D seems to play a new role in UF. Interestingly, hypovitaminosis D correlates with a higher prevalence of myomas and the severity of the myomas. Administration of vitamin D in women with insufficiency (serum level <30 ng/mL) restored the vitamin D status and reduced the mild symptoms of myomas. In addition, inflammatory processes may play a role. In the past years, it has become clear that cessation of inflammation is an active process driven by a class of lipid mediator molecules called specialized pro-resolving mediators (SPM). Inadequate resolution of inflammation is related to several chronic inflammatory diseases and several studies have proven the crucial role of SPMs in improving these diseases. In this review, we will give an overview on processes involved in UF growth and will give an overview on the modern view regarding the concept of inflammation and the role of SPMs in resolution of inflammation, especially in chronic inflammatory diseases. Full article

Objectives: The objectives are to evaluate the influence of different maternal characteristics on ultrasound image quality and operator satisfaction, and to assess, preliminarily, a rating scale to stratify the difficulty level of ultrasound examination in early gestation. Methods: A multicentric observational study of ultrasound scans was carried out on singleton pregnant women undergoing routine gestational ultrasound at 11–14 weeks and 19–21 weeks of gestation at two Prenatal Care Centers in the Apulia region (Southern Italy). Inclusion criteria included the presence of one or more limiting features, i.e., obesity, retroverted uterus, myomas, previous abdominal surgery, and limited echo-absorption. Each woman was given an overall pre-echographic limiting score from 0 to 9. The outcome measure was the operator’s satisfaction with the examination, scored on a Likert scale. Nested linear regression models (raw, semi- and fully adjusted) were built for each of the two trimesters on the pre-ecographic limiting score (0–9 points) as dependent variables, with the operator’s satisfaction as the regressor. Results: The whole sample included 445 pregnant women. The two-center samples did not show statistically different baseline features. The operator’s satisfaction with the sonographic examination was significantly (and inversely) related to the pre-echographic limiting score, regardless of the mother’s age, the operator performing the ultrasound, the Hospital Center where the ultrasound examination was performed, and the duration of the sonographic examination. Conclusions: A number of maternal conditions need to be monitored for good ultrasound performance; using a specific rating scale to stratify the level of difficulty of the ultrasound examination at early gestation could represent a potentially useful tool, although it requires further validation. Full article

Background: This study was designed to evaluate and contrast the surgical outcomes between coaxial robotic single-site myomectomy (RSSM) performed using the da Vinci Xi system and da Vinci SP system. Methods: A retrospective review was conducted on 81 women who underwent coaxial RSSM and 108 women who underwent myomectomy with the da Vinci SP system between October 2020 and January 2024. Propensity score matching was performed based on myoma count, the dominant myoma’s maximum diameter, and the myoma type according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Patient characteristics and surgical outcomes were evaluated and compared between the two groups. Results: Compared to the SP group, the coaxial RSSM group showed significantly lower estimated blood loss (102.33 ± 61.01 vs. 203.98 ± 163.15 mL, p < 0.001), shorter operative time (91.22 ± 18.25 vs. 148.69 ± 45.62 min, p < 0.001), and smaller hemoglobin decrement (1.69 ± 0.93 vs. 2.85 ± 1.30, p < 0.001). However, hospital stay was shorter in the SP group than in the coaxial group (2.06 ± 0.24 vs. 4.07 ± 0.76 days, p < 0.001). There were no statistically significant differences in postoperative complications, including ileus, fever, or wound dehiscence. Additional comparisons using cases performed by four different surgeons yielded results consistent with the one-to-one surgeon comparison. Conclusions: Coaxial RSSM was associated with a shorter operative time and lower blood loss compared to SP myomectomy. A prospective study is warranted to validate and further compare the surgical outcomes of the two techniques. Full article

Background and Objectives: We compared mini-laparoscopic and laparoscopic hysterectomy in terms of surgery duration, postoperative pain, conversion rate, blood loss, postoperative complications (Clavien-Dindo classification), and the length of hospital stay. Materials and Methods: Patients were recruited between 1 January 2017 and 1 January 2024, at the Department of Gynecology, “Villa Sofia-Cervello” Hospital. Indications for hysterectomy included uterine myoma, endometriosis, endometrial hyperplasia, adenomyosis, high-grade cervical dysplasia, early-stage endometrial cancer, and microinvasive cervical cancer. Patients were divided according to treatment into conventional laparoscopic hysterectomy (LH) with all 5 mm ports or the needlescopic approach (minilaparoscopic hysterectomy [MLH]), using 3 mm instruments. Postoperative pain was assessed using the visual analog scale (VAS) at multiple time points (2, 6, 12, and 24 h post-surgery). Results: A total of 308 patients were enrolled, with 153 women in the LH group and 155 in the MLH group. The surgery duration was on average 105.5 min in LH and 98.8 min in MLH (p < 0.0001). The intraoperative blood loss averaged 195.1 mL in LH and 100.3 mL in MLH (p < 0.001). The average length of hospital stay was 4.0 days for women undergoing LH compared to 3.2 days for women undergoing MLH (p < 0.001). Conclusions: This retrospective study demonstrated that MLH is an effective and functional technique for treating various gynecological conditions, with advantages in terms of aesthetic outcomes and reduced perioperative pain and recovery times. The positive results, supported by key parameters such as surgical duration, blood loss, and complications, could serve as a foundation for future studies on larger populations and for improving clinical practices in gynecology. Full article

Background/Objectives: The degree of vascularization of myomas plays an important role in both diagnosis and the selection of appropriate treatment. This is particularly relevant for minimally invasive therapies such as uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), or radiofrequency ablation (RFA) in uterine myomas, as their effectiveness is highest in well-vascularized lesions. This study aimed to analyze the perfusion of uterine myomas using dynamic contrast-enhanced magnetic resonance imaging and to develop a new quantitative classification of lesion vascularization, referencing the Funaki classification. Methods: The study included 56 female patients. Three parameters were determined for each lesion: the maximum signal enhancement (Ratio), time to peak, and mean signal intensity (Mean). A KMeans cluster analysis (k = 3) was performed, dividing the data into three groups corresponding to Funaki types I–III. Results: Significant differences were observed between the groups. Type III myomas were found only in older patients, which may be relevant when qualifying patients for vascularization-targeted therapies such as HIFU or radiofrequency ablation. Conclusions: The proposed classification may serve as a basis for automating the assessment of myomas and supporting clinical decision-making. Full article

Uterine fibroids represent a prevalent category of tumors encountered in females of reproductive age, may present as singular or multiple entities and can manifest a variety of symptoms, which can negatively affect women’s daily lives. Pharmacological interventions may prove to be ineffective, occasionally costly, and associated with adverse effects. In instances where symptoms escalate in severity, myomectomy becomes a requisite as uterine-preserving operative therapy. Myomectomy can be performed utilizing laparoscopic, robotic, laparotomic, vaginal or hysteroscopic techniques. Given the abundant vascular supply to the myometrium, with blood being delivered to the uterus via the uterine arteries, myomectomy carries a considerable risk of significant hemorrhage during and subsequent to the surgical procedure, with the related complications. This paper aims to elucidate the conventional methodologies employed to mitigate hemorrhage during myomectomy and in the immediate postoperative phase, evaluating the effect of chemical interventions (such as vasopressin, octreotide, tranexamic acid, and uterotonics) alongside mechanical strategies (including uterine artery clamps, embolization, and tourniquets) to curtail bleeding during the myomectomy process. Furthermore, the potential of employing the intracapsular myomectomy technique without reliance on other traditional approaches was explored. This surgical method is grounded in the principles of the biological and anatomical characteristics of the fibroid, facilitating the enucleation of the myoma from its pseudocapsule. This anatomical entity, which is formed by the myoma throughout its development within the myometrium, enables the fibroid to be detached from the uterine musculature and supplies the requisite neurovascular support for its sustenance. Finally, the narrative review also shows how the intracapsular approach, which uses the fibroid’s biology, reduces bleeding during myomectomy. Full article