Ενδομήτρια μετάδοση του ιού των ανθρωπίνων θηλωμάτων – Μια συστηματική ανασκόπηση της βιβλιογραφίας

Σκοπός: Σκοπός της παρούσας μελέτης είναι να γίνει μια συστηματική ανασκόπηση στη διεθνή βιβλιογραφία σχετικά με την ενδομήτρια μετάδοση του ιού των ανθρωπίνων θηλωμάτων και να υπολογιστεί το ποσοστό ενδομήτριας μετάδοσης του ιού σε HPV θετικές μητέρες. Δευτερευόντως θα υπολογίσουμε το σχετικό κίνδυνο ενδομήτριας μετάδοσης του ιού μεταξύ καισαρικής τομής και φυσιολογικού τοκετού Μέθοδοι: Η συστηματική ανασκόπηση έγινε με βάση τις οδηγίες PRISMA σε PubMed και Scopus. Η αξιολόγηση και η επιλογή των μελετών έγινε από δύο ερευνητές και τα δεδομένα από κάθε μελέτη που επελέγη καταγράφηκαν σε ειδικές φόρμες. Υπολογίστηκε η συχνότητα της ενδομήτριας μετάδοσης σε κάθε μελέτη και ακολούθησε μεταανάλυση και υπολογισμός της συνολικής συχνότητας. Επίσης υπολογίστηκε και ο σχετικός κίνδυνος ενδομήτριας μετάδοσης μεταξύ καισαρικής και φυσιολογικού τοκετού. Αποτελέσματα: Από 434 μελέτες επελέγησαν τελικά 9 που περιλαμβάνουν 421 HPV θετικές μητέρες και τα νεογνά τους. Από τη μεταανάλυση των δεδομένων προέκυψε μια συνολική πιθανότητα ενδομήτριας μετάδοσης του HPV 4,936% (95%CI 1,651 – 9,849) μεγάλη ετερογένεια μεταξύ των μελετών (I2 = 72,21%) ενώ ο συνολικός σχετικός κίνδυνος ενδομήτριας κάθετης μετάδοσης του ιού των ανθρώπινων θηλωμάτων μεταξύ νεογνών που γεννήθηκαν με καισαρική τομή, και νεογνών που γεννήθηκαν φυσιολογικά από θετικές στον ιό μητέρες υπολογίστηκε 0,912,χωρίς στατιστική σημασία (95%CI 0.226-3.674) και με μικρή ετερογένεια μεταξύ των μελετών (I2 24.48%).Objectives: To evaluate the percentage of antenatal vertical HPV transmission among HPV positive mothers and the relative risk of antenatal vertical HPV transmission between cesarean and vaginal delivery among HPV-positive women. Methods: This systematic review was made according to PRISMA statement. We searched PubMed and Scopus and the final articles were selected by two reviewers. Data from the selected articles were plotted, and the pooled percentage of antenatal vertical HPV transmission among HPV positive mothers as well as the pooled relative risk of antenatal vertical HPV transmission between cesarean and vaginal delivery among HPV-positive women were calculated. Results: 9 studies including 421 HPV positive mothers and their offspring were selected from 434 potential papers. Following meta-analysis, the pooled percentage of antenatal vertical HPV transmission was 4,936% (95%CI 1,651 – 9,849) with high heterogeneity between the studies (I2 = 72.22%). The pooled relative risk of antenatal vertical HPV transmission between cesarean and vaginal delivery among HPV-positive women was 0,912, with no statistical significance (95%CI 0.226-3.674) and homogeneity between the studies (I2 24.48%)

The clinicopathological characteristics and survival outcomes of primary expansile vs. infiltrative mucinous ovarian adenocarcinoma: a retrospective study sharing the experience of a tertiary centre

Mucinous ovarian carcinomas (MOCs) are rare ovarian tumours accounting for 3% of all epithelial ovarian carcinomas (EOCs). They are either expansile or infiltrative, based on the tumour's histological pattern of invasion. MOCs have a distinct molecular profile, natural history, chemo-sensitivity, and prognosis compared to other EOCs. The aim of this study was to describe patient and tumour characteristics, as well as survival outcomes of expansile and infiltrative primary MOCs. This was a retrospective cohort study conducted at a tertiary cancer centre. Patients had surgery for primary MOC between Jul 1, 2010 and Oct 28, 2022. All patients discussed at the Oxford multidisciplinary team (MDT) meeting with a diagnosis of MOC were included. We excluded patients with mucinous metastatic carcinoma (MMC), dual histological diagnoses, those who died before treatment was initiated, and patients with incomplete records. A total of 47 patients were identified and 14 were excluded. Out of the remaining 33 MOCs, 23 (70.6%) were expansile and 10 (30.4%) were infiltrative. The median follow-up was 37 months (95% CI: 14.1-69.8). Patients with infiltrative tumours were older than those with expansile tumours (median age 62 vs. 55 years, P=0.049). Infiltrative tumours were diagnosed at a more advanced International Federation of Gynaecology and Obstetrics (FIGO) stage compared to expansile tumours: FIGO stage II/III 50% vs. 8.2% (P=0.002). We found paired-box gene 8 (PAX8) more frequently expressed in expansile tumours (75% vs. 37.5%, P=0.099). Adjuvant treatment was administered in 50% of patients with infiltrative disease, compared to only 13% of those with expansile disease (P=0.036). 80% of patients who have relapsed had received adjuvant chemotherapy, compared to 17.2% of patients without relapse (P=0.012). At 3 years, there was a statistically significant difference in progression-free survival (PFS) (94.7% vs. 65.6%, P=0.02) between the expansile and infiltrative groups, but no difference in overall survival (OS) (88.8% vs. 90%, P=0.875). Patients with infiltrative tumours were older, more likely to have bilateral tumours and more likely to have an advanced FIGO stage at diagnosis. Adjuvant treatment was more likely to be administered to patients with infiltrative tumours, however, this did not prevent relapse. PFS at 3 years was significantly higher in patients with expansile tumours. PAX8 was more frequently expressed by expansile tumours

The Prognostic Characteristics and Recurrence Patterns of High Grade Endometrioid Endometrial Cancer: A Large Retrospective Analysis of a Tertiary Center

High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Ninety-six consecutive cases of HGEEC treated with primary surgery in a single Tertiary Center were retrospectively reviewed. Clinicopathological and treatment details were recorded, and all patients were closely followed up. Disease-free, overall and cancer-specific survival rates were 83.8%, 77.8% and 83.6%, respectively. Cervical stromal involvement was independently related to recurrence (HR = 25.67; 95%CI 2.95-223.30; p = 0.003) and cancer-related death (HR = 15.39; 95%CI 1.29-183.43; p = 0.031) after adjusting for other pathological and treatment variables. Recurrence rate was 16%, with 60% of these cases having lung metastases and only one case with single vaginal vault recurrence. 81.81% of the recurrences presented with symptoms and not a single recurrence was diagnosed in routine follow-up clinical examination. In conclusion, the recurrence pattern may suggest that patient-initiated follow-up (PIFU) could be considered a potential alternative to clinical-based follow-up for HGEEC survivors, especially for patients without cervical involvement and after two years from treatment. Additional caution is needed in patients with cervical stromal involvement

Mixed Endometrial Epithelial Carcinoma: Epidemiology, Treatment and Survival Rates-A 10-Year Retrospective Cohort Study from a Single Institution

Mixed endometrial carcinoma (MEEC) refers to rare endometrial tumours that are composed of two or more distinct histotypes, at least one of which is serous or clear cell. The aim of this study was to evaluate the epidemiology, treatment outcomes and survival rates of patients with mixed endometrial carcinoma. The medical records of 34 patients diagnosed with MEEC between March 2010 and January 2020 were reviewed retrospectively. Clinicopathological variables and treatment strategies were assessed, and overall survival and disease-free survival rates were evaluated. The histology of endometrioid and serous component was found in 26 (76.5%) patients, followed by serous and clear-cell components (5/34, 14.5%) and mixed endometrioid serous and clear-cell components (3/34, 8.8%). The median age at diagnosis was 70 years (range 52-84), and the median follow-up time was 55 months. The 5-year disease-free survival and the 5-year overall survival were 50.4% and 52.4%, respectively. Advanced disease stage was identified as an independent predictor of inferior disease-free (<0.003) and overall survival (p < 0.001). Except for stage, none of the traditional prognostic factors was associated with disease recurrence or death from disease. MEECs represent rare high-risk endometrial carcinomas with significant diagnostic and treatment challenges. Undoubtedly, the implementation of a molecular analysis can offer further diagnostic and management insights

Επίδραση της εμβρυϊκής υπολειπόμενης αύξησης (FGR) στην πρωτεϊνική έκφραση σε καρδιές νεογνών επίμυων (Wistar rats)

Σκοπός: Η εμβρυική υπολειπόμενη αύξηση σχετίζεται με αυξημένη καρδιαγγειακή νοσηρότητα μετά τη γέννηση. Οι αλλαγές στη δομή και τη λειτουργία της καρδιάς ως αποτέλεσμα των ενδομήτριων βλαπτικών ερεθισμάτων δεν έχει μελετηθεί επαρκώς. Σκοπός της παρούσας μελέτης είναι να μελετήσει την επίδραση της ενδομήτριας στέρησης τροφής στο πρωτέωμα της καρδιάς νεογνών που γεννηθήκαν με μειωμένο βάρος (fetal growth restricted - FGR) και φυσιολογικό (non FGR) βάρος. Μέθοδοι: Τη 14η μέρα κύησης, δέκα θηλυκοί επίμυες τυχαιοποιήθηκαν σε δύο ομάδες: (a) ομάδα με ελεύθερη πρόσβαση σε τροφή και (b) ομάδα με περιορισμένη σίτιση κατά 50%. Τα νεογνά που γεννήθηκαν από τις μητέρες που υπέστησαν στέρηση τροφής χωρίστηκαν βάσειτου βάρους γέννησης σε FGR και non-FGR, ενώ τα νεογνά των μητέρων που είχαν ελεύθερη πρόσβαση σε τροφή αποτέλεσαν την ομάδα ελέγχου. Όλα τα νεογνά θυσιάσθηκαν αμέσως μετά τη γέννηση και οι καρδιές από 11 τυχαία επιλεγμένα άρρενα νεογνά (n = 4 FGR, n = 4 nonFGR, n = 3 ομάδα ελέγχου) υπέστησαν ποσοτική πρωτεωμική ανάλυση. Αποτελέσματα: Συνολικά, ποσοτικοποιήθηκαν 7422 πρωτεΐνες (q < 0.05). Από αυτές, 1175 υπό ή υπέρ εκφράζονταν στα FGR και 231 στα non-FGR νεογνά σε σχέση με τα νεογνά της ομάδας ελέγχου, με 151 από αυτές να είναι κοινές σε FGR και non-FGR. Από τη βιοπληροφορική ανάλυση του πρωτεώματος προκύπτει ότι στα FGR νεογνά υποεκφράζεται το σηματοδοτικό μονοπάτι των ιντεγκρινών και της απελίνης, αναστέλλεται η μυϊκή συστολή και η γλυκόλυση και υπεραντιπροσωπεύεται ένα δίκτυο πρωτεϊνών που σχετίζεται με την κυτταρική επιβίωση και τον κυτταρικό θάνατο. Συμπέρασμα: Η παρούσα μελέτη δείχνει ότι FGR και non-FGR νεογνά έχουν διακριτό πρωτεωμικό προφίλ, κάτι που αποδεικνύει τη σημασία τόσο του ενδομήτριου περιβάλλοντος όσο και του βάρους γέννησης στη φυσιολογία και την ανάπτυξη της καρδιάςObjective: Fetal growth restriction is associated with increased postnatal cardiovascular morbidity. The alterations in heart physiology and structure caused by in utero nutrient deprivation have not been extensively studied. We aim to investigate the impact of maternal food restriction on the cardiac proteome of newborn rats with normal (non-fetal growthrestricted (non-FGR)) and reduced (FGR) birth weight. Methods: On day 14 of gestation, 10 timed pregnant rats were randomized into two nutritional groups: (a) Standard laboratory diet and (b) 50% global food restriction. Pups born to food-restricted mothers were subdivided, based on birthweight, into fetal growth-restricted (FGR) and non-FGR, while pups born from normally nourished mothers were considered controls. Rat neonates were euthanized immediately after birth and the hearts of 11 randomly selected male offspring (n = 4 FGR, n = 4 non-FGR, n = 3 control group) were analyzed using quantitative proteomics. Results: In total, 7422 proteins were quantified (q < 0.05). Of these, 1175 were differentially expressed in FGR and 231 in non-FGR offspring vs. control with 151 common differentially expressed proteins (DEPs) between the two groups. Bioinformatics analysis of DEPs in FGR vs. control showed decreased integrin and apelin cardiac fibroblast signaling, decreased muscle contraction and glycolysis, and over-representation of a protein network related to embryonic development, and cell death and survival. Conclusion: Our study illustrates the distinct proteomic profile of FGR and non-FGR offspring of food-restricted dams underlying the importance of both prenatal adversities and birth weight in cardiac physiology and developmen

Impact of fetal growth restriction on heart proteome of Wistar rats neonates

Objective: Fetal growth restriction is associated with increased postnatal cardiovascular morbidity. The alterations in heart physiology and structure caused by in utero nutrientdeprivation have not been extensively studied. We aim to investigate the impact of maternalfood restriction on the cardiac proteome of newborn rats with normal (non-fetal growthrestricted(non-FGR)) and reduced (FGR) birth weight.Methods: On day 14 of gestation, 10 timed pregnant rats were randomized into two nutritional groups: (a) Standard laboratory diet and (b) 50% global food restriction. Pups born tofood-restricted mothers were subdivided, based on birthweight, into fetal growth-restricted(FGR) and non-FGR, while pups born from normally nourished mothers were considered controls.Rat neonates were euthanized immediately after birth and the hearts of 11 randomly selectedmale offspring (n = 4 FGR, n = 4 non-FGR, n = 3 control group) were analyzed using quantitative proteomics.Results: In total, 7422 proteins were quantified (q < 0.05). Of these, 1175 were differentially expressed in FGR and 231 in non-FGR offspring vs. control with 151 common differentially expressed proteins (DEPs) between the two groups. Bioinformatics analysis of DEPsin FGR vs. control showed decreased integrin and apelin cardiac fibroblast signaling, decreased muscle contraction and glycolysis, and over-representation of a protein network related to embryonic development, and cell death and survival.Conclusion: Our study illustrates the distinct proteomic profile of FGR and non-FGRoffspring of food-restricted dams underlying the importance of both prenatal adversities andbirth weight in cardiac physiology and development.Σκοπός: Η εμβρυική υπολειπόμενη αύξηση σχετίζεται με αυξημένη καρδιαγγειακή νοσηρότητα μετά τη γέννηση. Οι αλλαγές στη δομή και τη λειτουργία της καρδιάς ωςαποτέλεσμα των ενδομήτριων βλαπτικών ερεθισμάτων δεν έχει μελετηθεί επαρκώς. Σκοπός της παρούσας μελέτης είναι να μελετήσει την επίδραση της ενδομήτριας στέρησης τροφής στοπρωτέωμα της καρδιάς νεογνών που γεννηθήκαν με μειωμένο βάρος (fetal growth restricted -FGR) και φυσιολογικό (non FGR) βάρος.Μέθοδοι: Τη 14η μέρα κύησης, δέκα θηλυκοί επίμυες τυχαιοποιήθηκαν σε δύο ομάδες:(a) ομάδα με ελεύθερη πρόσβαση σε τροφή και (b) ομάδα με περιορισμένη σίτιση κατά 50%. Τανεογνά που γεννήθηκαν από τις μητέρες που υπέστησαν στέρηση τροφής χωρίστηκαν βάσει τουβάρους γέννησης σε FGR και non-FGR, ενώ τα νεογνά των μητέρων που είχαν ελεύθερη πρόσβαση σε τροφή αποτέλεσαν την ομάδα ελέγχου. Όλα τα νεογνά θυσιάσθηκαν αμέσως μετάτη γέννηση και οι καρδιές από 11 τυχαία επιλεγμένα άρρενα νεογνά (n = 4 FGR, n = 4 non-FGR, n = 3 ομάδα ελέγχου) υπέστησαν ποσοτική πρωτεωμική ανάλυση.Αποτελέσματα: Συνολικά, ποσοτικοποιήθηκαν 7422 πρωτεΐνες (q < 0.05). Από αυτές,1175 υπό ή υπέρ εκφράζονταν στα FGR και 231 στα non-FGR νεογνά σε σχέση με τα νεογνά τηςομάδας ελέγχου, με 151 από αυτές να είναι κοινές σε FGR και non-FGR. Από τη βιοπληροφορική ανάλυση του πρωτεώματος προκύπτει ότι στα FGR νεογνά υποεκφράζεται το σηματοδοτικό μονοπάτι των ιντεγκρινών και της απελίνης, αναστέλλεται η μυϊκή συστολή και η γλυκόλυση και υπεραντιπροσωπεύεται ένα δίκτυο πρωτεϊνών που σχετίζεται με την κυτταρική επιβίωση καιτον κυτταρικό θάνατο.Συμπέρασμα: Η παρούσα μελέτη δείχνει ότι FGR και non-FGR νεογνά έχουν διακριτό πρωτεωμικό προφίλ, κάτι που αποδεικνύει τη σημασία τόσο του ενδομήτριου περιβάλλοντοςόσο και του βάρους γέννησης στη φυσιολογία και την ανάπτυξη της καρδιάς

Heterotopic pregnancy after bilateral salpingectomy, IVF and multiple embryos transfer. A case report and systematic review of the literature

Heterotopic pregnancy after bilateral salpingectomy is an extremely rare complication of in vitro fertilisation/embryo transfer cycles. We report a case of a ruptured abdominal pregnancy on the omentum which was the stimulus to conduct the first systematic review on this complication according to ‘PRISMA’ guidelines (PROSPERO R.No CRD42020134104). PubMed, EMBASE and OpenAIRE databases were systematically reviewed for studies reporting (a) cases or case series of, (b) heterotopic pregnancies after, (c) prior bilateral salpingectomy, and (d) embryo transfer cycles. Twenty-two articles met the selection criteria including, with our case, 28 cases. Based on the results, clinical manifestations and laboratory findings can be unspecific or misleading. Transvaginal ultrasound is the main diagnostic tool as the ectopic foetus is more frequently located in the intramural part of the fallopian tubes, the tubal stump or the ovaries. Laparotomy or laparoscopy are the main treatment options with adequate perinatal outcome

Impact of Maternal Food Restriction on Heart Proteome in Appropriately Grown and Growth-Restricted Wistar—Rat Offspring

Objective: Fetal growth restriction is associated with increased postnatal cardiovascular morbidity. The alterations in heart physiology and structure caused by in utero nutrient deprivation have not been extensively studied. We aim to investigate the impact of maternal food restriction on the cardiac proteome of newborn rats with normal (non-fetal growth-restricted (FGR)) and reduced (FGR) birth weight. Methods: On day 14 of gestation, 10 timed pregnant rats were randomized into two nutritional groups: (a) Standard laboratory diet and (b) 50% global food restriction. Pups born to food-restricted mothers were subdivided, based on birthweight, into fetal growth-restricted (FGR) and non-FGR, while pups born from normally nourished mothers were considered controls. Rat neonates were euthanized immediately after birth and the hearts of 11 randomly selected male offspring (n = 4 FGR, n = 4 non-FGR, n = 3 control group) were analyzed using quantitative proteomics. Results: In total, 7422 proteins were quantified (q < 0.05). Of these, 1175 were differentially expressed in FGR and 231 in non-FGR offspring vs. control with 151 common differentially expressed proteins (DEPs) between the two groups. Bioinformatics analysis of DEPs in FGR vs. control showed decreased integrin and apelin cardiac fibroblast signaling, decreased muscle contraction and glycolysis, and over-representation of a protein network related to embryonic development, and cell death and survival. Conclusion: Our study illustrates the distinct proteomic profile of FGR and non-FGR offspring of food-restricted dams underlying the importance of both prenatal adversities and birth weight in cardiac physiology and development

Heterotopic pregnancy after bilateral salpingectomy, IVF and multiple embryos transfer. A case report and systematic review of the literature

Heterotopic pregnancy after bilateral salpingectomy is an extremely rare complication of in vitro fertilisation/embryo transfer cycles. We report a case of a ruptured abdominal pregnancy on the omentum which was the stimulus to conduct the first systematic review on this complication according to `PRISMA&apos; guidelines (PROSPERO R.No CRD42020134104). PubMed, EMBASE and OpenAIRE databases were systematically reviewed for studies reporting (a) cases or case series of, (b) heterotopic pregnancies after, (c) prior bilateral salpingectomy, and (d) embryo transfer cycles. Twenty-two articles met the selection criteria including, with our case, 28 cases. Based on the results, clinical manifestations and laboratory findings can be unspecific or misleading. Transvaginal ultrasound is the main diagnostic tool as the ectopic foetus is more frequently located in the intramural part of the fallopian tubes, the tubal stump or the ovaries. Laparotomy or laparoscopy are the main treatment options with adequate perinatal outcome

Impact of Maternal Food Restriction on Heart Proteome in Appropriately Grown and Growth-Restricted Wistar—Rat Offspring

Objective: Fetal growth restriction is associated with increased postnatal cardiovascular morbidity. The alterations in heart physiology and structure caused by in utero nutrient deprivation have not been extensively studied. We aim to investigate the impact of maternal food restriction on the cardiac proteome of newborn rats with normal (non-fetal growth-restricted (FGR)) and reduced (FGR) birth weight. Methods: On day 14 of gestation, 10 timed pregnant rats were randomized into two nutritional groups: (a) Standard laboratory diet and (b) 50% global food restriction. Pups born to food-restricted mothers were subdivided, based on birthweight, into fetal growth-restricted (FGR) and non-FGR, while pups born from normally nourished mothers were considered controls. Rat neonates were euthanized immediately after birth and the hearts of 11 randomly selected male offspring (n = 4 FGR, n = 4 non-FGR, n = 3 control group) were analyzed using quantitative proteomics. Results: In total, 7422 proteins were quantified (q &lt; 0.05). Of these, 1175 were differentially expressed in FGR and 231 in non-FGR offspring vs. control with 151 common differentially expressed proteins (DEPs) between the two groups. Bioinformatics analysis of DEPs in FGR vs. control showed decreased integrin and apelin cardiac fibroblast signaling, decreased muscle contraction and glycolysis, and over-representation of a protein network related to embryonic development, and cell death and survival. Conclusion: Our study illustrates the distinct proteomic profile of FGR and non-FGR offspring of food-restricted dams underlying the importance of both prenatal adversities and birth weight in cardiac physiology and development