Διερεύνηση της ασφάλειας και της αποτελεσματικότητας της διπλής ωοθηκικής διέγερσης σε γυναίκες με ελαττωμένο ωοθηκικό απόθεμα. Συστηματική ανασκόπηση και μετα-ανάλυση.

Η εργασία αποσκοπεί στην διερεύνηση της ασφάλειας και της αποτελεσματικότητας της εφαρμογής πρωτοκόλλου διπλής διέγερσης των ωοθηκών (DuoStim) και επακόλουθης διπλής ωοληψίας μέσα στον ίδιο έμμηνο κύκλο, σε ασθενείς με ελαττωμένες ωοθηκικές εφεδρείες (POR). Πραγματοποιήθηκε συστηματική βιβλιογραφική αναζήτηση στις ακόλουθες βάσεις δεδομένων: PubMed/ MEDLINE, Embase, και Cochrane Central Library και σε δημοσιεύσεις έως τον Μάρτιο του 2019. Οι προοπτικές και αναδρομικές μελέτες ομάδων (cohorts) που κρίθηκαν κατάλληλες να συμπεριληφθούν στην εργασία αναφέρονται σε γυναίκες με ελαττωμένες ωοθηκικές εφεδρείες (POR) που υποβλήθηκαν σε διπλή διέγερση (DuoStim) στην ωοθυλακική (FPS) και ωχρινική φάση (LPS) του ίδιου έμμηνου κύκλου. Κατόπιν της συστηματικής βιβλιογραφικής επισκόπησης πραγματοποιήθηκε μετα-ανάλυση επί του συνόλου των εργασιών που συλλέχθηκαν. Η μελέτη καταδεικνύει τη συσχέτιση της διπλής διέγερσης των ωοθηκών (DuoStim) με υψηλότερο αριθμό ανακτημένων ωοκυττάρων, ώριμων ωοκυττάρων MII, και καλής ποιότητας εμβρύων σε σύγκριση με τις συμβατικές προσεγγίσεις. Επιπλέον, η διέγερση κατά την ωχρινική φάση (LPS) φαίνεται να παρουσιάζει την ίδια ή ακόμα και υψηλότερη συνολική απόδοση σε σύγκριση με τη διέγερση κατά την ωοθυλακική φάση (FPS). Εν κατακλείδι, η διπλή διέγερση (DuoStim) ευνοεί ένα ενισχυμένο κλινικό αποτέλεσμα σε σχέση με τον συνολικό αριθμό των παραγόμενων ωοκυττάρων, των ώριμων ωοκυττάρων και των διαθέσιμων εμβρύων, μαζί με την ποιότητα των εμβρύων που λαμβάνονται. Δεδομένου ότι η ωχρινική διέγερση δεν φαίνεται να σχετίζεται με ανευπλοειδικά ωοκύτταρα η επιλογή αυτή μπορεί να παρουσιάζεται ως ευνοϊκότερη για την διαχείριση ασθενών με ελαττωμένες ωοθηκικές εφεδρείες, καθώς η κατάσταση τους εξαρτάται σημαντικά από τον χρόνο αντιμετώπισης, αφού επιτρέπει υψηλότερη απόδοση υγειών ωοκυττάρων κατά την διάρκεια ενός έμμηνου κύκλου.The present thesis has a primary focus on the investigation of the safety and efficacy of the dual ovarian stimulation protocol (DuoStim) and the following double ovulation within the same menstrual cycle for patients with reduced ovarian reserve (POR). A systematic bibliography review was performed in the following databases: PubMed/Medline, Embase and Cochrane Central Library along with any publications that existed up to March 2019. All prospective and retrospective cohort studies that were found eligible for inclusion referred to women with reduced ovarian reserve (POR) which were subjected to dual stimulation (DuoStim) in the follicular (FPS) and luteal (LPS) phase in the same menstrual cycle. The review was followed by an appropriate meta-analytical approach. A demonstration in regards to the association between double ovarian stimulation (DuoStim) and a higher number of retrieved oocytes, mature metaphase II cells and embryos of good quality compared to regular approaches is reflected in this thesis. Furthermore, the stimulation during the luteal phase (LPS) appears to have similar, and in some instances even higher overall performance when compared to stimulation during the follicular phase (FPS). In conclusion, the dual stimulation protocol (DuoStim) favors an enhanced clinical outcome in relation to the total number of produced oocytes, mature oocytes and available embryos along with the quality of the embryos retrieved. Unprocessed raw data indicate that the luteal phase (LPS) is not associated with a higher rate of aneuploidy. Therefore, this option might actually be more favorable for managing patients with reduced ovarian reserve since their condition is highly dependent on the timing of the treatment as it allows for a higher yield of healthy oocytes during a menstrual cycle

Biological therapies for premature ovarian insufficiency: what is the evidence?

Premature Ovarian Insufficiency (POI) is a multi-factorial disorder that affects women of reproductive age. The condition is characterized by the loss of ovarian function before the age of 40 years and several factors have been identified to be implicated in its pathogenesis. Remarkably though, at least 50% of women have remaining follicles in their ovaries after the development of ovarian insufficiency. Population data show that approximately up to 3.7% of women worldwide suffer from POI and subsequent infertility. Currently, the treatment of POI-related infertility involves oocyte donation. However, many women with POI desire to conceive with their own ova. Therefore, experimental biological therapies, such as Platelet-Rich Plasma (PRP), Exosomes (exos) therapy, In vitro Activation (IVA), Stem Cell therapy, MicroRNAs and Mitochondrial Targeting Therapies are experimental treatment strategies that focus on activating oogenesis and folliculogenesis, by upregulating natural biochemical pathways (neo-folliculogenesis) and improving ovarian microenvironment. This mini-review aims at identifying the main advantages of these approaches and exploring whether they can underpin existing assisted reproductive technologies

Plexiform tumorlet in a woman with postmenopausal endometrioid endometrial carcinoma taking tamoxifen for breast cancer: A case report

Leiomyomas are the most common benign smooth muscle tumors of the female genital tract. Among the recognized histologic variants, one of the least common is plexiform leiomyoma. When they are small, even microscopic findings, they are referred to as plexiform tumorlets.In this report the authors describe a case of plexiform tumorlet found incidentally in the hysterectomy specimen of a 64-year-old woman with concomitant endometrioid endometrial carcinoma and a previous history of invasive lobular breast carcinoma. The endometrioid endometrial carcinoma arising on a polyps was diagnosed in a curettage specimen. In the hysterectomy specimen there was no residual endometrioid endometrial carcinoma. Six uterine leiomyomas were found. A small (3 mm) well circumscribed tumor was located in the uterine wall. Histologically it consisted of small nests, islands, cords, and tubules of relatively uniform, round to oval cells surrounded by loose stroma. The differential diagnosis was challenging, and included plexiform leiomyoma, uterine tumor resembling ovarian sex cord tumor, endometrial stromal tumor, and poorly differentiated endometrial or metastatic invasive lobular breast carcinoma. After careful morphologic evaluation and appropriate use of immunohistochemical stains the diagnosis of plexiform tumorlet was made

The expression of Galectin-3 in endometrial cancer: a systematic review of the literature

Background Galectin-3 is part of a protein group called lectins and acts as a multifunctional glycoprotein due to its expression location. Galectin-3 is expressed by different human tissues. It plays a significant role in carcinogenesis and the selection of tumor-related physiological and pathological activities. Galectin-3 has been utilized through the years as a diagnostic and prognostic marker for various types of cancers. Methods and Results This review describes the outcomes of some studies on the matter that were selected appropriately through a review of the existing literature. These studies examined the levels of Galectin-3 expression in endometrial carcinomas, the outcomes, and the prognosis of these carcinomas. Two of the studies concluded that high expression of Galectin-3 is associated with a tumor's histological grade, type and depth. This enhanced nuclear Galectin-3 expression might assist in progression to atypia and neoplasia. The other three on the contrary concluded that malignant tumors had a decreased expression of Galectin-3 and that Galectin-3 played a suppressive role in tumor growth. Conclusions The part Galectin-3 might potentially have in metastasis of cancers and the offering of a better prognosis for patients is of high importance. To date, there is minimal literature regarding the effects of Galectin-3 and more research is required

Reverse Onco-Cardiology: What Is the Evidence for Breast Cancer? A Systematic Review of the Literature

Breast cancer and cardiovascular diseases (CVD) represent significant global health challenges, with CVD being the leading cause of mortality and breast cancer, showing a complex pattern of incidence and mortality. We explore the intricate interplay between these two seemingly distinct medical conditions, shedding light on their shared risk factors and potential pathophysiological connections. A specific connection between hypertension (HTN), atrial fibrillation (AF), myocardial infarction (MI), and breast cancer was evaluated. HTN is explored in detail, emphasizing the role of aging, menopause, insulin resistance, and obesity as common factors linking HTN and breast cancer. Moreover, an attempt is made to identify the potential impact of antihypertensive medications and highlight the increased risk of breast cancer among those women, with a focus on potential mechanisms. A summary of key findings underscores the need for a multisystem approach to understanding the relationship between CVD and breast cancer is also explored with a highlight for all the gaps in current research, such as the lack of clinical observational data on MI and breast cancer in humans and the need for studies specifically designed for breast cancer. This paper concludes that there should be a focus on potential clinical applications of further investigation in this field, including personalized prevention and screening strategies for women at risk. Overall, the authors attempt to provide a comprehensive overview of the intricate connections between breast cancer and cardiovascular diseases, emphasizing the importance of further research in this evolving field of cardio-oncology

Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology

The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study’s primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71

Metaplastic Matrix-Producing Carcinoma and Apocrine Lobular Carcinoma In Situ Associated with Microglandular Adenosis: A Unique Case Report

Microglandular adenosis is a non-lobulocentric haphazard proliferation of small round glands composed of a single layer of flat to cuboidal epithelial cells. The glandular structures lack a myoepithelial layer; however, they are surrounded by a basement membrane. Its clinical course is benign, when it is not associated with invasive carcinoma. In around 30% of cases, there is a gradual transition to atypical microglandular adenosis, carcinoma in situ, and invasive breast carcinoma of several different histologic subtypes, including an invasive carcinoma of no special type, metaplastic matrix-producing carcinoma, secretory carcinoma, metaplastic carcinoma with squamous differentiation, acinic cell carcinoma, spindle cell carcinoma, and adenoid cystic carcinoma. Recent molecular studies suggest that microglandular adenosis is a non-obligate precursor of triple-negative breast carcinomas. In this manuscript, we present a unique case of microglandular adenosis associated with metaplastic matrix-producing carcinoma and HER-2 neu oncoprotein positive pleomorphic lobular carcinoma in situ with apocrine differentiation in a 79-year-old patient

Early Onset Preeclampsia Diagnosis Prior to the 20th Week of Gestation in a Twin Pregnancy Managed via Selective Reduction of an Intrauterine Growth Restriction Fetus: A Case Report and Literature Review

A single, healthy, 44-year-old perimenopausal woman pursuing a pregnancy, employed donor embryos, resulting to a dichorionic diamniotic twin pregnancy. In the 18th week of gestation severe symptoms indicated early onset preeclampsia reporting severe hypertension (BP 180/90 mmHg), intense headaches and nausea as well as elevated 24-h urine protein levels (1.5 g/day). Concurrently diagnosis of an IUGR fetus was concluded. Standard pharmaceutical administration for treating preeclampsia was ordered. Persistence of symptoms indicated recommendation for pregnancy termination, however the patient opted against this. Selective embryo reduction was performed as the last resort prior to pregnancy termination. Following selective reduction the headaches and nausea were successfully subdued and the patient’s blood pressure was adjusted (mean BP 130/80 mmHg). This enabled further progression of pregnancy for an impressive 11 week-period, and a live birth on the 30th week. To conclude, only a few rare cases have been reported with diagnosis of early onset preeclampsia prior to the 20th week mark and none report live births. Albeit termination of pregnancy was recommended, the management of selective reduction of the IUGR fetus enabled successful treatment of preeclampsia coupled by a live birth of a healthy infant without any perinatal or postnatal complications reported

Axillary Lymph Node Metastasis from Ovarian Carcinoma: A Systematic Review of the Literature

Background: Axillary lymph node metastasis is a rare stage IV ovarian carcinoma manifestation. This manuscript aims to systematically review the literature regarding axillary lymph node metastasis from ovarian carcinoma. Methods: We searched three medical internet databases (PubMed, Scopus, and Web of Science) for relevant articles published until 22 July 2023. Cases describing supraclavicular or intramammary lymph node metastases and concurrent metastasis to the breast were excluded. Results: After applying eligibility/inclusion and exclusion criteria, twenty-one manuscripts describing twenty-five cases were included from the English literature. Data were collected and analyzed regarding demographic, clinical, laboratory, radiological, histopathological, and oncological characteristics. Conclusions: We analyzed the clinical and oncological characteristics of patients with axillary lymph node metastasis from ovarian carcinoma, presented either as an initial diagnosis of the disease or as a recurrent disease. The analysis we performed showed a significant difference only in the serum CA-125 level (p = 0.004) between the two groups. There was no observed difference in womens’ survival

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management