Search Results (41)

Introduction: Renal malacoplakia is a rare chronic granulomatous disease, often associated with immunosuppression and persistent Gram-negative infections, particularly Escherichia coli. Case Presentation: We present a case involving a 31-year-old woman with hypertension, gestational diabetes, and prior uterine curettage after labor induction for preeclampsia at 23 weeks. She developed urinary sepsis post-procedure. Imaging revealed bilateral nephromegaly, while laboratory tests showed acute kidney injury (KDIGO stage III), anemia, and thrombocytopenia. Blood and urine cultures grew Escherichia coli. Renal biopsy confirmed malacoplakia, demonstrating PAS-positive Michaelis–Gutmann bodies and Von Hansemann cells. The patient responded to prolonged antibiotic therapy and supportive care. Discussion and Conclusion: This case highlights the importance of considering renal malacoplakia in patients with atypical urinary tract infections and nephromegaly, particularly in obstetric settings. Histopathological confirmation is essential, and timely treatment with intracellularly active antibiotics can lead to favorable outcomes. Early diagnosis is critical to prevent irreversible renal damage. Full article

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted. Full article

Background/Objectives: Adenomyosis is a benign gynecological disorder associated with abnormal uterine bleeding, dysmenorrhea, and subfertility. Its pathogenesis has not yet been elucidated. The most widely accepted theory points to repeated mechanical or hormonal stress at the endometrial–myometrial interface, leading to activation of the tissue injury and repair (TIAR) mechanism. Studies suggest that the immune system may play a role in disease pathogenesis, but inconsistencies persist due to differences in studied samples and evaluated menstrual cycle phases. The goal of our study was to apply a novel technique (multiplex) to investigate different immune cell phenotypes in uteri from adenomyosis patients according to the cycle phase. Methods: This study analyzed immune cell populations in adenomyotic uteri using immunohistochemistry and multiplex immunofluorescence on 30 adenomyotic and 15 healthy hysterectomy samples. Results: Compared to eutopic endometrium, transitional and adenomyotic lesions displayed reduced immune infiltrates, particularly T cells, NK cells, B cells, macrophages, and dendritic cells. Conversely, mast cells were significantly elevated in transitional lesions. Conclusions: The present study suggests mast cell implication in adenomyosis development and pain, through their implication in tissue remodeling, angiogenesis, and neurogenic inflammation. Transitional lesions highlighted the progressive nature of adenomyosis, supporting the TIAR hypothesis. These findings emphasize the importance of mast cells in disease progression and underscore the need for further studies to explore immune-targeted therapies. Full article

Background: Cesarean deliveries have increased in recent years worldwide. This increase translates into an escalation of obstetrical complications that could lead to permanent injuries. Comprehensive knowledge of the risk factors for uterine scar defects and their probability factor could guide gynecologists towards decreasing the percentage of scar defects and reducing the morbidity produced by a scarred uterus. Methods: A review of the literature published in the last 10 years produced a number of 80,085 articles, from which we screened 147 articles and selected 11 recently published papers, attempting to rank the most frequently described risk factors in terms of probability. A total number of 11,349 patients who underwent CS were included from the 11 studies. Results: Cesarean scar defects developed in 19.42% of cases; our results showed that the highest probability was given by single-layer suture, with gestational diabetes being the main patient-related risk factor for scar defects. A definitive ranking of the risks is difficult to assess, because different studies focus on certain risks and most of the relevant data are missing or are omitted. Conclusions: In this study, we investigate the most common risk factors that give rise to the development of cesarian scar defects, conducting a ranking of these risks from the most probable to the least important, in order to facilitate informed decision making for providers. Full article

Background: Cadmium (Cd) is a highly toxic heavy metal. There are very few studies about the effects of Cd on reproductive health and metabolism, and even fewer on metabolic disorders in the uterus of mice in labor. This study is the first to establish a model of Cd exposure in the uterus of laboring mice and investigate the underlying metabolic mechanisms through transcriptomic analysis. Methods: Pregnant mice received intraperitoneal injections of CdCl₂ (1.5 mg/kg) on gestational days 12.5, 14.5, and 16.5 were set up as the experimental group (Cd group), and pregnant mice injected with saline were set up as the control group (CT group). A total of 738 differentially expressed genes (DEGs) were screened using DESeq2 software, including 326 upregulated genes and 412 downregulated genes. Results: Through enrichment databases including the KEGG, GO, Reactome, and PANTHER, we identified 76 metabolism-related DEGs and performed protein–protein interaction (PPI) network analysis. The PPI results were visualized using Cytoscape software and further analyzed, with 18 hub genes (maximum clique centrality score > 10) identified through the MCC algorithm of the Cytohubba plugin. The results showed that the highest-scoring hub genes included mt-Co2, mt-Co3, mt-Atp6, mt-Atp8, mt-Nd3, and mt-Nd4l, which are involved in mitochondrial energy metabolism. The remaining lower-scoring hub genes were primarily associated with coagulation processes. Pathway analysis revealed hub genes predominantly involved in oxidative phosphorylation, complement and coagulation cascades, the cGMP-PKG signaling pathway, and thermogenesis. Conclusion: This study successfully established a Cd exposure-induced uterine injury model, providing valuable references for human reproductive health research. Full article

Berberine and carvacrol have demonstrated anti-inflammatory effects; however, their therapeutic potential in endometritis remains unclear. (Aims) This study aimed to examine the anti-inflammatory properties of berberine and carvacrol in a murine model of endometritis, with a focus on the underlying molecular mechanisms. (Main methods) The model was established via vaginal instillation of 0.1 mL of a mixture containing Escherichia coli, Staphylococcus aureus, and Group B Streptococcus, followed by treatment with 0.1 mL of berberine (4 mg/mL) and carvacrol (0.125 mg/mL) six days post-infection. All mice were euthanized on day 13, and uterine tissues were collected for subsequent analyses. (Key findings) Treatment with berberine and carvacrol significantly reduced tissue injury associated with endometritis, decreased mRNA expression of TLR2 and TLR4 (p < 0.01), and inhibited the phosphorylation of NF-κB and MAPK pathway-associated proteins, as well as the mRNA expression and levels of pro-inflammatory cytokines. (Significance) Berberine and carvacrol exhibit significant therapeutic effects against bacterial-induced endometritis by reducing TLR2 and TLR4 expression, inhibiting NF-κB and MAPK pathway activation, and decreasing pro-inflammatory cytokine production, thus demonstrating robust anti-inflammatory activity. Full article

Endometritis poses a significant challenge to the dairy industry, impairing bovine reproductive performance and causing substantial economic losses. Although Morinda officinalis oligosaccharides (MOO) exhibit anti-inflammatory properties, their therapeutic potential against endometritis remains unclear. This study investigated MOO’s protective effects against LPS-induced uterine injury in mice and inflammation in bovine endometrial epithelial cells (BENDs), and explored the underlying mechanisms. In mice, MOO attenuated uterine inflammation by improving histopathology, reducing pro-inflammatory cytokines and decreasing oxidative stress. In BEND cells, MOO alleviated LPS-induced inflammation, oxidative stress, and apoptosis via downregulating pro-inflammatory mediators (IL-1β, IL-6, TNF-α, IL-8, TLR4, RELA), restoring antioxidant enzymes (HMOX1, NQO1, Nrf2, NOX4), and modulating apoptosis markers (BAX, cleaved CASP3, CASP9, BCL2). MOO reduced ROS accumulation, preserved mitochondrial membrane potential, and inhibited calcium influx. Critically, the calcium channel agonist Bay K 8644 reversed MOO’s protective effects, confirming calcium signaling modulation as a key mechanism. This study provides the first evidence that MOO mitigates LPS-induced uterine damage and BENDs inflammation through calcium signaling regulation, suggesting its potential for treating inflammation-related reproductive disorders in livestock. Full article

Background: In dairy cows, the stress-related cortisol level increases the susceptibility to postpartum uterine diseases. Oxidative stress is an important component of the disease process and causes morphological and functional alterations in the bovine endometrium. Selenium (Se) has an antioxidant property, and an appropriate Se supplementation is recommended to enhance bovine disease resistance. Methods and results: Here, we aimed to answer two questions: (1) how does cortisol affect the oxidative status of bovine endometrial cells; and (2) does Se supplementation protect cells from oxidative injury with a high cortisol condition? The oxidative stress of primary bovine endometrial epithelial cells (BEECs) was established by Escherichia coli lipopolysaccharide (LPS) stimulation, as marked by the increased oxidative markers and the suppressions of antioxidant indicators and Nrf2 signaling. In the absence of LPS, cortisol levels of 15 ng/mL showed a more significant antioxidative effect than cortisol levels of 5 and 30 ng/mL. In the presence of LPS, cortisol levels of 15 and 30 ng/mL elicited antioxidation, whereas 5 ng/mL of cortisol did not. Regardless of LPS stimulation, Se pretreatment of 1, 2, and 4 μM protected BEEC from oxidative stress, as evidenced by the decreased oxidative markers, increased antioxidant indices, and the activated Nrf2 signaling. With the presence of 30 ng/mL of cortisol, there was an enhanced Se antioxidant effect, which can be abolished by the block of cortisol receptor. Conclusions: Both cortisol and Se elicited antioxidant properties in BEEC through the Nrf2 pathway. In addition, the Se antioxidation was enhanced by cortisol. Full article

During the postpartum period, domestic ruminants suffer elevated endogenous cortisol levels, which are associated with an increased risk of uterine infections. Selenium is a trace mineral nutrient with beneficial impacts on animals. The study aimed to investigate whether selenium yeast (SeY) could attenuate Escherichia coli (E. coli)-induced endometrial injury in goats with high cortisol background. Goats were examined after oral SeY administration for 21 days and were treated with glacial acetic acid, E. coli, and hydrocortisone to establish an endometritis model with high cortisol background. The results showed that endometrial injury caused by E. coli was aggravated under high cortisol background. Supplementation with SeY alleviated endometrial inflammation and serum LDH content. The mRNA expression of pro-inflammatory cytokines and defensin beta 2 and the phosphorylation level of the mitogen-activated protein kinase (MAPK) and nuclear factor kappa-b (NF-κB) signaling pathways were decreased by SeY supplementation. Total antioxidant capacity and antioxidant enzymes activities were increased by SeY supplementation, but malondialdehyde and 4-hydroxynonenal content were decreased. Moreover, nuclear factor erythroid-2 related factor 2 (NRF2) in the nucleus, heme oxygenase-1, and NAD(P)H quinone dehydrogenase 1 were increased by SeY supplementation. So, supplementation with SeY alleviated E. coli-induced endometritis in goats by activating the NRF2 pathway and inhibiting the activation of the MAPK and NF-κB pathways under postpartum stress. Full article

Background and Objectives: Cesarean hysterectomy is a critical intervention often required to manage life-threatening postpartum hemorrhage (PPH) due to complications such as uterine atony, abnormal placental implantation, or traumatic rupture. Although lifesaving, the procedure is associated with significant risks and complications. This study investigates the causes and outcomes of cesarean hysterectomy, focusing on complications arising from the procedure. Materials and Methods: A retrospective analysis was conducted on 82 women who underwent cesarean hysterectomy at Afzali Pour Hospital between 2018 and 2022. All patients were followed for 42 days post-surgery to evaluate outcomes and complications. Data were extracted from electronic medical records, encompassing demographic, obstetric, and clinical details, including age, body mass index, previous cesarean sections, indications for cesarean deliveries, causes of hysterectomy, and complications. The primary outcome was to determine the causes of cesarean hysterectomy, while the secondary outcome assessed the complications associated with the procedure. Stepwise logistic regression analysis was utilized to identify significant predictors of complications. Results: The study included 82 women who underwent cesarean hysterectomy. The mean age of the participants was 35.2 years (SD = 5.4), with a range from 24 to 48 years. The average BMI was 29.1 kg/m² (SD = 4.3), with 45% of the women classified as overweight or obese (BMI ≥ 25). The majority of the patients (70%) had a history of two or more previous cesarean sections, and the most common indication for cesarean hysterectomy was abnormal placentation, including placenta accreta (58%). Uterine rupture was reported in 13% of the cases. In terms of complications, bladder injury was the most common, occurring in 33.33% of women, followed by fever (20%), ureteral injury (13.33%), and hematoma (8.89%). Stepwise logistic regression analysis revealed that higher BMI significantly increased the odds of the outcome (OR = 4.18, 95% CI: 1.66–10.51, p = 0.002), and the number of previous cesarean sections was also a significant predictor (OR = 2.30, 95% CI: 1.17–4.53, p = 0.016). Conclusions: Placenta accreta and previa were the most frequent causes of cesarean hysterectomy, with bladder injury and fever being the most common complications. A higher number of previous cesareans and higher BMI significantly increase the likelihood of complications. Understanding these risk factors can improve patient management and surgical outcomes, highlighting the importance of careful monitoring and preoperative planning in women with a history of cesarean deliveries. Full article

Background and Objectives: Postmenopausal women are often treated with exogenous female hormones to alleviate physical symptoms and support mental health. We posit that women treated with estrogen fare better following burn injury. Materials and Methods: De-identified patient data were obtained from TriNetX, a global healthcare research network. Adult postmenopausal women were enrolled if they were diagnosed with burn injury within 10 years after menopause onset. Patients with pre-existing abnormal uterine bleeding, gynecologic cancer, and chronic liver or heart disease were excluded. The population was grouped into those who received and those who did not receive estrogen treatment (ET) for evaluation of subsequent complications. Cohort balancing was performed using the exact match approach of Inverse Probability Treatment Weighting (IPTW). The average treatment effects (ATEs) and confidence intervals were computed for these balanced cohorts. Results: Postmenopausal women with ET had a lower risk of endometrial hyperplasia and malignancy 3 months (ATE = −0.005, −0.006) and 3 years (−0.007, −0.008) after mild burn injury (less than 20% of total body surface area) (p < 0.05), regardless of age. At the 3-month timepoint, postmenopausal women aged 45–65 with ET exhibited preventive effects against acute kidney injury (−0.0332), cerebral infarction (−0.0279), breast cancer (−0.0278) and severe sepsis (−0.011) after mild burn injury (p < 0.05) compared to women who did not receive ET. After 3 years, 45–65-year-old women with ET exhibited decreased rates of breast cancer (−0.0479) and endometrial hyperplasia (−0.0116) (p < 0.05) compared to those without ET. Conclusions: Estrogen treatment decreases the risk probabilities of breast cancer and other complications in postmenopausal women from 3 months to 3 years after mild burn injury. Full article

Introduction: Uterine penetrating wounds in pregnant women are rare. Usually, they are caused by traffic accidents, but sometimes they are an effect of violence, accidental injuries, or deliberate self-harm. Case Report: We present a case of a stab wound to the uterus in a 25-year-old woman in the 37th week of pregnancy, which was the result of a knife attack. Emergency splenectomy and cesarean section were performed less than an hour after the attack. The child required resuscitation and long-term intensive therapy. Both the woman and the newborn survived; however, the newborn’s condition remained poor. The child died a few months later, according to community-acquired pneumonia. Discussion: Cases of wounds penetrating the uterus have been described for many years around the world. They are often the result of violence, most often from the partner. Statistically, pregnant women are more likely to be victims of violence. Sometimes, the wounds penetrating the uterus are accidental and arise, for example, as a result of a fall. A rare but not isolated case is self-mutilation to terminate a pregnancy. Women often inflict such injuries on themselves using sharp tools, sometimes firearms. There are also cases of another person helping to terminate a pregnancy in this way. Conclusions: Violence against women, including pregnant women, remains a significant social problem in all regions of the world and poses a challenge to uniformed services, medical professions, and social services. Regardless of the mechanism of injury, in the event of an imminent threat to the life of the mother and fetus, it is crucial to make quick decisions aimed at saving lives. Full article

Premature deliveries and preterm newborns are of a special significance to obstetricians. Despite great improvement in neonatal intensive care in the last two decades, prematurity is still the leading cause of neonatal mortality and morbidity. Complications associated with premature deliveries are malpresentation, prolapse of the umbilical cord, entrapment of some parts of the fetal body, as well as severe bruising or bone fractures. The injuries may also include soft tissue damage, neurological injury, or intracranial hemorrhage. Small body weight as well as the unaccomplished development of fetal vital systems make preterm newborns vulnerable to delivery trauma. The main goal of a cesarean section in extremely preterm deliveries is to reduce the number of these complications. On the other hand, premature deliveries are associated with an undeveloped lower uterine segment and other difficulties encountered during the operation, which make the procedure more complicated and difficult to perform. Therefore, the preterm delivery or delivery of a fetus with growth retardation is of great concern. In our review, we investigated previous publications regarding en caul deliveries, mostly cesarean sections. We concentrated on the neonatal outcomes and tried to establish the optimal mode and time for a premature delivery. Full article

Background: Postoperative nausea and vomiting (PONV) remains a frequent and uncomfortable complication in women undergoing robotic gynecological procedures. Despite the use of various preventive strategies, PONV continues to negatively impact recovery and increase healthcare expenses. This study aimed to evaluate whether the preoperative use of sugar-free chewing gum could effectively minimize the dependence on anti-emetic drugs in women undergoing robot-assisted laparoscopic surgery for uterine myomas. Methods: In this randomized, single-blind study, 92 adult women scheduled for robot-assisted laparoscopic surgery were enrolled. The participants were randomly assigned to one of two groups: a gum-chewing group, which was instructed to chew sugar-free gum for 15 min in the preoperative holding area, or a control group that did not chew gum. The primary outcome was the requirement for anti-emetic medication within the first hour after surgery, when the patient was in the post-anesthesia care unit (PACU). Secondary outcomes included the overall frequency of anti-emetic use. To assess the intervention’s effectiveness independent of any other factors, no prophylactic anti-emetics were administered during surgery. Results: Of the 92 participants, 89 completed the study, with 44 assigned to the gum-chewing group and 45 to the control group. The gum-chewing group showed a significantly lower rate of PONV, requiring anti-emetic treatment (79.5%), compared to the control group (95.6%). Additionally, the control group demonstrated a higher overall need for anti-emetic medications. Notably, there were no reported adverse effects, such as jaw discomfort, dental injuries, or gastric regurgitation, in either group. Conclusions: Chewing sugar-free gum for 15 min prior to surgery was found to be a safe, simple, and effective method to reduce the occurrence of PONV in women undergoing robot-assisted laparoscopic surgery for benign uterine tumors. This non-invasive intervention reduced the reliance on anti-emetic drugs and improved patient comfort, without introducing risks. These findings suggest that preoperative gum chewing could be routinely implemented in clinical settings to enhance surgical outcomes. Full article

Transplantation of decellularized uterus tissue showed promise in supporting regeneration following uterine injury in animal models, suggesting an alternative to complete uterus transplantation for uterine factor infertility treatment. However, most animal studies utilized small grafts, limiting their clinical relevance. Hence, we used larger grafts (20 × 10 mm), equivalent to nearly one uterine horn in rats, to better evaluate the bioengineering challenges associated with structural support, revascularization, and tissue regeneration. We analyzed histopathology, employed immunohistochemistry, and investigated gene expression discrepancies in growth-related proteins over four months post-transplantation in acellular grafts and those recellularized (RC) with bone marrow-derived mesenchymal stem cells (bmMSCs). RC grafts exhibited less inflammation and faster epithelialization and migration of endogenous cells into the graft compared with acellular grafts. Despite the lack of a significant difference in the density of CD31 positive blood vessels between groups, the RC group demonstrated a better organized myometrial layer and an overall faster regenerative progress. Elevated gene expression for Vegf, Cd44, and Itgb1 correlated with the enhanced tissue regeneration in this group. Elevated Tgfb expression was noted in both groups, potentially contributing to the rapid revascularization. Our findings suggest that large uterine injuries can be regenerated using decellularized tissue, with bmMSCs enhancing the endogenous repair mechanisms. Full article