Vpliv zdravljenja kroničnega endometritisa na uspešnost postopkov zunajtelesne oploditve – sistematični pregled literature

Izhodišča: Kronični endometritis (KE) poteka z blagimi kliničnimi znaki in naj bi bil povezan z neplodnostjo, s ponavljajočimi se splavi in ponavljajočo se neuspelo ugnezditvijo zarodka v postopkih oploditve z biomedicinsko pomočjo (OBMP). Ker si mnenja o ugotavljanju in zdravljenju KE v postopkih OBMP medsebojno nasprotujejo, smo si zastavili cilj sistematično pregledati članke o vplivu zdravljenja KE na reproduktivni izid pri neplodnih ženskah v postopkih OBMP. Metode: Pregledali smo zbirko Medline. Uporabili smo deskriptorje iz tezavra Medical subject headings (Mesh), ki so vključevali ključne besede kronični endometritis (angl. chronic endometritis) in zdravljenje (angl. treatment) ter nosečnost (angl. pregnancy). Vključili smo raziskave od januarja 1971 do marca 2022. Rezultati: V pregled smo vključili 8 raziskav, ki so uporabile različne sheme zdravljenja. Večina raziskav je ugotavljala statistično pomembne razlike v reproduktivnem izidu po zdravljenju KE. Zaključek: Zdravljenje KE lahko pozitivno vpliva na izid v sledečih si OBMP postopkih, vendar so še potrebne nadaljnje večje randomizirane študije

Obravnava endometrioze v pomenopavznem obdobju

Endometrioza je bolezen, ki lahko prizadene 2–5 % vseh žensk v pomenopavznem obdobju. Gre za bolezen, pri kateri se endometrijske žleze in stroma nahajajo zunaj maternice. O pomenopavzni endometriozi je zaenkrat v literaturi še malo znanih podatkov. V sklopu diagnosticiranja je v tem obdobju v ospredju predvsem skrb, da gre morda za maligno bolezen. Poročila v literaturi opisujejo ponovitev endometrioze v pomenopavznem obdobju kot tudi nastanek endometrioze »de novo«. Zdravljenje izbire simptomatske endometrioze v pomenopavzi je kirurško z odstranitvijo vsega vidnega endometriotičnega tkiva zaradi višjega tveganja za ponovitev bolezni in preobrat v maligno bolezen. Hormonsko zdravljenje po menopavzi (MHZ) se pogosto uporablja za lajšanje simptomov in preprečevanje izgube kostne mase. Obstajajo raziskave, ki dokazujejo, da MHZ lahko ponovno aktivira endometriotična žarišča in celo spodbuja maligno preoblikovanje žarišč pri ženskah z anamnezo endometrioze. Glede na ne povsem razjasnjena tveganja MHZ pri tovrstnih bolnicah se svetuje dodatna previdnost

Vaginal Stenosis After Cervical Cancer Treatments: Challenges for Reconstructive Surgery.

Cervical cancer is one of the most frequent gynecological malignancies, and its incidence is strictly related to the adequate implementation of screening programs and human papillomavirus vaccinati..

Breastfeeding education: where are we going? A systematic review article

Background: UNICEF (United Nations International Children’s Emergency Fund) and WHO estimate that if all babies were breastfed for at least the first six months of their lives, the rate of morbidity and malnutrition would sig-nificantly decrease all over the world. In this view, these two organizations promoted a worldwide campaign for breastfeeding, creating the Baby Friendly Hospital Initiative (BFHI) that encourages good practices for the promotion of breastfeeding in hospitals. The aim of our study was to review the available evidence regarding the positive effects of breastfeeding, in order to suggest to most appropriate strategy to support it. Methods: The main databases including Scopus, PubMed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to breastfeeding education. The main terms used to literature search were "Breastfeeding education", Breastfeeding support", and “Breastfeeding healthcare policy”. The timeframe in-cluded the obtained articles was from 1980 to 2015. Results: Our analysis confirms that healthcare providers play a pivotal role in education and encouraging mothers to begin and continue breastfeeding. In this view, the adequate training of healthcare providers seems to be mandatory in order to support this practice. Moreover, adequate facilities are needed in order to promote and support breastfeeding. Conclusion: Considering the available evidence, breastfeeding should be supported among all the mothers. Based on the positive data emerging from the public awareness campaign in different Countries of the world, we strongly en-courage an accurate training for doctors and midwives and the implementation of adequate facilities in order to sup-port breastfeeding

Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis

The theory of retrograde menstruation as aetiopathogenesis of endometriosis formulated by John Sampson in 1927 shows clear shortcomings: this does not explain why retrograde menstruation is a physiological process that affects 90% of women, while endometriosis occurs in only 10% of cases; it also does not explain the endometriotic foci distant from the pelvis, nor explains the cases of endometriosis in male patients. The immunological alterations of the peritoneal fluid explains the effects of disease, such as the inhibition of the physiological processes of cytolysis, but does not explain the cause. There is evidence to support the hypothesis that ectopic müllerian remnants of the endometrium, endocervix and endosalpinx are items from the genital ridge leaked during organogenesis. It is known that tissues derived from coelomatic epithelial and mesenchymal cells have the potential to metaplastically differentiate into epithelium and stroma. In addition, the phenotype of the ectopic endometrial cells is significantly different from those ectopic. There is scientific evidence that, during organogenesis, the genes of the Homeobox and Wingless family play a fundamental role in the differentiation of the ducts of Muller and development of the anatomical structure of the urogenital tract. We present here a hypothesis that deregulation of genes and the Wnt signaling pathway Wnt/β-catenin leads to aberrations and deregulation within the mesoderm, thus, may cause aberrant placement of stem cells. In addition, immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, creating the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells

The Effect of Transcutaneous Application of Gaseous CO2 on Diabetic Symmetrical Peripheral Neuropathy—A Double-Blind Randomized Clinical Trial

Aim: Diabetic symmetrical peripheral neuropathy is a common complication of diabetes mellitus. Patients treated with transcutaneous CO2 application for chronic wounds reported an improvement in peripheral sensations. This study aimed to evaluate the effect of transcutaneous application of gaseous CO2 on diabetic symmetrical peripheral neuropathy. Methods: A prospective randomized, double-blind study was performed at the University Medical Center Ljubljana between September 2019 and September 2020. Sixty consecutive patients with diabetes with a unilateral chronic wound were randomized into either a study group that received transcutaneous CO2 therapy or a control group that received placebo treatment with air. Results: Vibration, monofilament sensation, and temperature of the big toe improved significantly in the study group (p < 0.001, for vibration sensation, monofilament test and temperature of the big toe), but not in the control group (p = ns for all evaluated outcomes). Conclusion: According to our results, a transcutaneous application of gaseous CO2 shows promising results in treating diabetic symmetrical peripheral neuropathy. Considering the major consequences of sensory loss leading to foot ulceration and possibly amputation, we believe this treatment approach deserves future attention and investigation as a treatment modality of diabetic symmetrical peripheral neuropathy

ELECTRON MICROSCOPE COMPARISON OF ENDOMETRIUM FROM UTERINE SEPTUM AND ENDOMETRIUM FROM THE LATERAL WALL

Background. Septate uterus is an important risk factor for spontaneous abortion and preterm delivery. The role of septate uterus in infertility is still questionable. The mechanism of the adverse effects of a septate uterus is not yet understood. The basic theory proposes that the septum represents a less suitable environment for a developing embryo when compared to the unaffected uterine wall. The aim of our study was to compare the endometrial surface morphology in women with septate uterus. Material and methods. This prospective observational study includes endometrial biopsies that were taken from  women with uterine septum. We have included 30 consecutive women who came for the hysteroscopic resection of the septum. The operation was scheduled at the time of the implantation window; an endometrial biopsy was performed and samples were taken from the septum and from the lateral wall and compared under electron microscope. Pinopode development stage and the number of endometrial glands were the main outcome measures. Results. Comparison of the endometrium from the septum with that of the lateral wall showed no difference in the number of endometrial glands (2.0 endometrial glands seen at 250 × magnification vs. 2.5; ns ), not even in the pinopode stage (17.7 day vs. 18.1 day, ns). Conclusions. To our knowledge, there are three researches that have compared endometrium from the septum to the endometrium from the lateral wall in infertile women and all have differences in observed parameters. Our results cannot support earlier findings. The question of mechanism, how septum influences on pregnancy should be further investigated in the larger sample

Kaj vemo o vplivu prehrane na endometriozo in njene simptome

Endometrioza je kronična vnetna bolezen, ki prizadene 6–10 % žensk v rodnem obdobju. Njeni simptomi vplivajo tako na fizično kot tudi psihično in socialno življenje in so eden od glavnih vzrokov za odsotnost žensk z dela in od pouka. Uspešnost medikamentnega in kirurškega zdravljenja endometrioze je omejena, zato bolnice iščejo dodatne možnosti za lajšanje simptomov, ki med drugim pogosto vključujejo prilagoditev prehrane. Danes lahko prosto dostopno na spletu najdemo številne diete za bolnice z endometriozo, ki pa so jih pogosto zasnovale bolnice same in ne temeljijo na znanstvenih dokazih. Prehrana pri endometriozi je tako vse pogostejši predmet raziskovanja. Številne raziskave nakazujejo pozitiven vpliv določenih hranil na pojavnost in simptome, povezane z endometriozo. Da bi dobili boljši vpogled v vlogo prehrane pri endometriozi, smo pregledali literaturo, ki opisuje vpliv hranil ali prehrane na pojavnost endometrioze in na simptome, povezane z njo

Cryopreservation induces changes in the expression of noncoding RNAs in semen: a mini-review

Semen cryopreservation is an important approach for preserving male fertility, and thawed semen is often used in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) procedures. This process has been used for decades and seems both safe and efficient, despite causing cryodamage to spermatozoa, including the impairment of sperm functions, with decreased viability and motility being the main indicators of poor sperm quality post-thawing. Although an increase in sperm DNA fragmentation is common during cryopreservation, data on how cryopreservation affects sperm at the molecular level are scarce. There are especially limited data on the influence of sperm cryopreservation on spermatozoa non-coding RNA (ncRNA) stability and expression. To date, only three publications have explored this issue in human sperm samples, and there have been only a few more studies in animals, including mouse, bull, ram, boar and giant panda. The results of studies on human and animal semen indicate that cryopreservation affects ncRNA expression, which could crucially affect fertilization and embryonic development. Moreover, a study employing boar spermatozoa further showed that alterations in ncRNA expression also depend on the sperm cryopreservation protocol used, and a study employing human spermatozoa showed that microRNA (miRNA) expression changes during cryostorage. Therefore, the effects of cryopreservation on ncRNA expression in spermatozoa should be studied more thoroughly, mostly because sperm cryopreservation is important for medically assisted reproduction. Furthermore, despite the wide usage of sperm cryopreservation, how cryopreservation changes sperm at the molecular level and whether these changes have any effect on future generations have not been determined

Risk of Reintervention or Postoperative Bleeding after Laparoscopy for Benign Gynecological Disease: a Clinical Prediction Model

Objective: To develop a clinically applicable prediction tool to early seek for postoperative major complications after laparoscopic surgery for benign pathologies. Design: Retrospective analysis of prospectively collected data Setting: Tertiary-care University Hospital Participants: Reproductive aged women undergoing laparoscopy for benign conditions Methods: Anamnestic, intraoperative, and postoperative characteristics from January 2019 to December 2021 were retrospectively reviewed. Patients with postoperative complications (reintervention or postoperative bleeding) were matched in a 1:2 ratio with women with same surgical indications without complications. Cases and controls were matched for preoperative hemoglobin, hematocrit, weight, height, body mass index (BMI), age and blood volume. A prediction model was created by inserting multiple independent modifying factors through logistic regression. The receiver operating characteristic (ROC) curve was used to evaluate the predictive accuracy of the model, and the Hosmer-Lemeshow (H-L) test was carried out to evaluate the goodness- of-fit and a calibration curve was drawn to confirm the predictive performance. A nomogram was depicted to visualize the prediction model. Results: Thirty-nine complicated procedures were matched with 78 uncomplicated controls. According to the multivariate logistic regression analysis findings, the prediction model was developed using C reactive protein (CRP), intraoperative blood loss and 24 hours postoperative urinary volume, therefore a nomogram was generated. The area under the ROC curve (AUC) of the prediction model was 0.879, depicting good accuracy, the sensitivity was 60.00%, while specificity reached 93.59%. The H-L test (χ2 = 4.45, p= 0.931) and the calibration curve indicated a good goodness-of-fit and prediction stability. Limitations: The retrospective design, moderate sensitivity and study population limit the generalization of the findings, requiring additional research. Conclusions: This prediction model based on CRP, intraoperative blood loss and 24 hours postoperative urinary volume might be a potentially useful tool for predicting reintervention and postoperative bleeding in patients undergoing planned gynecological laparoscopy