Gynecologic and Obstetric Investigation最新文献

{"title":"The #Enzian Classification as a Predictor of Hormonal Therapy Response in Endometriosis-Associated Pain: A Retrospective Cohort Study in a Referral Center.","authors":"Sofia Gambigliani Zoccoli, Antonio La Marca, Martina Di Gianvito, Riccardo Cuoghi Costantini, Matilde Morini, Emma Bertucci, Carlo Alboni","doi":"10.1159/000550102","DOIUrl":"10.1159/000550102","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate whether ultrasound-based #Enzian classification predicts pain profiles and response to hormonal therapy in patients with endometriosis. Endometriosis is a chronic inflammatory disease affecting 10% of reproductive-age women, often causing debilitating pelvic pain. Although #Enzian is validated for surgical planning, its predictive role in medical therapy remains unexplored.</p><p><strong>Design: </strong>A retrospective cohort study, including 89 premenopausal patients referred between 2018 and 2023, was conducted. Hormonal therapies included progestin-only pills (dienogest - POP-D or other progestins - POP-O), combined estrogen-progestin pills (dienogest - EP-D or other EP-O), or norethisterone acetate. Pain was assessed via a 0-10 VAS at baseline, ≥3 months, and ≥6 months.</p><p><strong>Participants/materials, setting, methods: </strong>Patients had ultrasound-confirmed endometriosis and were hormone therapy-naïve for ≥6 months. Baseline evaluation included demographic data, reproductive history, prior surgeries, and six pain domains. #Enzian classification mapped lesion location and size (A: rectovaginal/vagina; B: uterosacral/parametria; C: rectum; FA: adenomyosis; FB: bladder; FU: ureter; FI: intestine above rectum; FO: extra pelvic; O: ovary; P: peritoneum; T: fallopian tubes/adhesions). Linear regression and linear mixed-effects models assessed associations between #Enzian compartments and pain trajectories.</p><p><strong>Results: </strong>Dysmenorrhea occurred in 86.5%, and dyspareunia occurred in 56.2%. Ovarian endometriomas (O) were present in 76.4%, deep infiltrating endometriosis (A, B, C) in 51.7%, and adenomyosis (FA) in 66.3%. POP-D was most effective in reducing ovulatory pain in ovarian (O), uterosacral/parametria (B), rectal (C), and tubal/adhesion (T) involvement, while EP-D was superior for dyspareunia in T. Chronic pelvic pain (CPP) remained refractory. Higher total #Enzian scores correlated with reduced therapy efficacy.</p><p><strong>Limitations: </strong>Retrospective design, single-center, small sample, use of aggregated pain scores, and incomplete follow-up may limit generalizability.</p><p><strong>Conclusion: </strong>Ultrasound-based #Enzian classification correlates with lesion distribution and predicts hormonal therapy efficacy. POP-D therapy is superior at lower #Enzian scores; CPP remains challenging. Findings support individualized medical management and warrant prospective validation including multidimensional pain and quality-of-life assessments.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference Range for Amniotic Fluid Bile Acids and Bilirubin in Uncomplicated Pregnancies.","authors":"David Danon, Asaf Romano, Orith Waisbourd-Zinman, Tal Cozacov, Bella Davidov, Yuval Gielchinsky, Yinon Gilboa, Ron Bardin","doi":"10.1159/000550971","DOIUrl":"10.1159/000550971","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of the study were to establish reference values for bile acids and bilirubin levels in amniotic fluid and to assess their correlation to amniotic fluid digestive enzymes in normal pregnancies as a foundation for future diagnostic studies.</p><p><strong>Design: </strong>A prospective cross-sectional study was conducted.</p><p><strong>Participants: </strong>Pregnant women with singleton pregnancies at 17-23 weeks undergoing amniocentesis for standard indications were selected for the study.</p><p><strong>Setting: </strong>A single tertiary care center was chosen for the study.</p><p><strong>Methods: </strong>Amniotic fluid levels of bile acids, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, and γ-glutamyl transferase (GGT) were measured. Gestational age-specific reference ranges were established.</p><p><strong>Results: </strong>A total of 133 women were recruited. The most common indication for amniocentesis was advanced maternal age. The 5th, 50th, and 95th percentiles of bile acids for the entire cohort were 1.3, 7.2, and 30.8 µ<sc>m</sc>, respectively. There was no significant change in bile acid levels throughout gestational weeks. Mean, standard deviation, and median values for all hepatobiliary enzymes were calculated. On regression analysis a significant positive correlation between bile acids and GGT was found.</p><p><strong>Limitations: </strong>Absence of pathological cases for comparison and relatively small sample size at 22-23 weeks was considered a limitation.</p><p><strong>Conclusion: </strong>Reference values for amniotic fluid bile acids and bilirubin at 17-23 weeks in normal pregnancies were established. The significant correlation between bile acids and GGT, combined with the direct biological relevance of bile acids in biliary pathology, suggests potential utility as complementary or alternative biomarkers in pregnancies complicated with non-visualization of the fetal gallbladder.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.3,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Body Mass Index and Dysmenorrhea in Women with Endometriosis: A Systematic Review and Meta-Analysis.","authors":"Shant Apelian, Hugh S Taylor","doi":"10.1159/000551182","DOIUrl":"10.1159/000551182","url":null,"abstract":"<p><strong>Background: </strong>Dysmenorrhea is a debilitating symptom in patients with endometriosis, contributing significantly to disease burden. While the relationship between body mass index (BMI) and dysmenorrhea in these patients is unclear, emerging evidence suggests BMI may be correlated with pain in the presence of endometriosis.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the association between BMI and dysmenorrhea in women with endometriosis.</p><p><strong>Search strategy: </strong>We systematically searched PubMed, Scopus, Web of Science, and Google Scholar from inception to November 15, 2024.</p><p><strong>Selection criteria: </strong>Eligible studies for this review included original observational articles reporting outcomes related to the prevalence of dysmenorrhea in relation to body weight in patients with confirmed endometriosis.</p><p><strong>Data collection and analysis: </strong>Data for a two-way contingency table were extracted from the articles, and odds ratios (ORs) for the association between BMI categories and dysmenorrhea were calculated. These individual ORs were pooled using a random-effects model.</p><p><strong>Main results: </strong>Six studies involving 2,274 women with endometriosis were included. The meta-analysis revealed that underweight individuals with endometriosis had significantly higher odds of experiencing dysmenorrhea compared to non-underweight patients (OR = 1.38, 95% CI = 1.05-1.80, I2 = 0.00%) or to those with normal weight (OR = 1.39, 95% CI = 1.05-1.83, I2 = 0.00%). No significant association was found between dysmenorrhea and overweight or obese individuals. Sensitivity analyses showed variability in the findings based on the exclusion of certain studies. No publication bias was detected in the analysis.</p><p><strong>Conclusions: </strong>There was an association between underweight status and dysmenorrhea in endometriosis. We speculate that managing weight and nutrition may be useful in mitigating dysmenorrhea symptoms. However, due to the study limitations, prospective trials are needed to test the ability of diet to alleviate pain.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Sodium Butyrate Supplementation on Insulin Resistance and Adipose Tissue Modulation in Murine Models of Polycystic Ovary Syndrome.","authors":"Mariana Muros Ferreira, Yasmin Silva Frank, Giuliana Petri, Juliana Mora Veridiano, Nuha Ahmad Dsouki, Beatriz da Costa Aguiar Alves Reis, Carina Ulsen, Jhonatan Jair Arismendi Florez, Luciano Melo Pompei, Marcelo Luiz Steiner, Bianca Bianco","doi":"10.1159/000551076","DOIUrl":"10.1159/000551076","url":null,"abstract":"<p><strong>Objectives: </strong>Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting up to 10% of women of reproductive age, commonly associated with visceral obesity, insulin resistance, and chronic low-grade inflammation. Sodium butyrate, a microbial-derived short-chain fatty acid, has been proposed as a therapeutic agent due to its anti-inflammatory and metabolic regulatory properties. However, its efficacy under hyperandrogenic and pro-inflammatory conditions remains uncertain.</p><p><strong>Design: </strong>Experimental study using prepubertal female BALB/c mice (n = 40) allocated into five groups: control (CT), high-fat diet (HFD), DHEA (HFD + dehydroepiandrosterone), BUT (HFD + sodium butyrate), and DHEA+BUT (HFD + DHEA + sodium butyrate).</p><p><strong>Participants/materials, setting, methods: </strong>Hyperandrogenism was induced by subcutaneous DHEA implants, and obesity by a high-fat diet (60% kcal from fat). Sodium butyrate (100 mg/kg/day) was administered by oral gavage during the last 40 days of the 90-day protocol. This five-group design allowed the evaluation of butyrate effects in obesity alone (BUT) and in the combined obese-hyperandrogenic state (DHEA + BUT). Body weight, glucose tolerance, adipose depot weights, gene expression (IL-6, TNF-α, UCP1), serum adipokines.</p><p><strong>Results: </strong>Butyrate-treated groups, particularly DHEA + BUT, exhibited greater body weight gain and adipose tissue expansion than controls (p < 0.01). Glucose tolerance tests revealed impaired glycemic control in all HFD-fed groups, with the BUT group showing the highest peaks (p < 0.05). IL-6 and TNF-α expression were upregulated in visceral adipose tissue of butyrate-treated animals, while adiponectin levels were reduced in DHEA + BUT.</p><p><strong>Limitations: </strong>The modest number of animals per group reduced statistical power, reflecting constraints in breeding and availability of age-matched BALB/c mice. Their relatively small adipose depots limited tissue yield for molecular and histological assays. Daily oral gavage, required for precise dosing, was technically challenging and led to the loss of one DHEA+BUT animal.</p><p><strong>Conclusions: </strong>In this model of preestablished obesity and hyperandrogenism, sodium butyrate supplementation was not metabolically protective. Instead, it exacerbated adipose inflammation, altered adipokine profiles, and impaired glucose regulation. These findings underscore the context-dependent nature of butyrate's effects and suggest caution in extrapolating its benefits to hyperandrogenic or obesity-associated PCOS phenotypes.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Recombinant Human Follicle-Stimulating Hormone:Recombinant Human Luteinizing Hormone in a 2:1 Ratio versus Highly Purified Human Menopausal Gonadotropin Alone in Ovarian Stimulation for Medically Assisted Reproduction Treatment Using in vitro Fertilization/Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis.","authors":"Michael H Dahan, Juan-Enrique Schwarze, Shiv Shanker Gupta, Brooke Hayward, Robert Fischer, Sandro C Esteves, Ming-Jer Chen, Kaylen M Silverberg, Luis Guzmán, Daniele Santi, Ido Feferkorn, Thomas M D'Hooghe, Carlo Alviggi","doi":"10.1159/000550420","DOIUrl":"10.1159/000550420","url":null,"abstract":"<p><strong>Introduction: </strong>Investigation of the number of oocytes recovered from different ovarian stimulation (OS) protocols is essential, as oocyte number is positively associated with the number of good-quality embryos obtained; however, there are few data comparing the number of oocytes retrieved following OS with recombinant or urinary gonadotropins.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of published evidence was performed to compare the number of oocytes retrieved with recombinant human follicle-stimulating hormone:recombinant human luteinizing hormone (r-hFSH:r-hLH) in a 2:1 ratio versus highly purified human menopausal gonadotropin (HP-hMG) alone from day 1 of OS. The literature search was conducted according to PRISMA guidelines (<ext-link ext-link-type=\"uri\" xlink:href=\"https://www.prisma-statement.org/\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">https://www.prisma-statement.org/</ext-link>) using Medline, EMBASE, Biosis, SciSearch, and TOXCENTER on STN. Studies were included if they reported on r-hFSH:r-hLH in a 2:1 ratio versus HP-hMG alone, both administered from day 1 of OS, and the results for the number of oocytes retrieved were presented for both interventions. Data were extracted from the full articles independently by two reviewers (J.-E.S. and B.H.). Results were analyzed using a random-effects meta-analysis model. Any potential risk of bias was assessed using the ROBINS-I tool. Secondary outcomes were the number of mature (MII) oocytes, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate.</p><p><strong>Results: </strong>Six studies were included in the meta-analysis (5,287 cycles): four non-interventional studies, one non-interventional cross-over study, and one randomized controlled trial. The number of oocytes per cycle was significantly higher in women treated with r-hFSH:r-hLH 2:1 compared with those treated with HP-hMG alone (mean difference 1.43, 95% confidence interval [CI]: 0.18-2.69; p = 0.025). Clinical pregnancy rate per started cycle was significantly higher with r-hFSH:r-hLH 2:1 compared with HP-hMG (rate ratio 1.18, 95% CI: 1.06-1.33; p = 0.004; five studies). There were insufficient data to draw any firm conclusions on the other secondary outcomes.</p><p><strong>Conclusions: </strong>The higher number of oocytes retrieved with r-hFSH:r-hLH is a pertinent finding, owing to the well-established positive association between oocyte number and reproductive outcomes. Although we report a higher clinical pregnancy rate for r-hFSH:r-hLH 2:1, limited data prevented us from drawing firm conclusions regarding live birth outcomes.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.7,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosonographic Insights into Maternal Vitamin D Deficiency: Early Markers of Fetal Cortical Development.","authors":"Deniz Taşdemir, Murat Haksever","doi":"10.1159/000551073","DOIUrl":"10.1159/000551073","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the association between maternal vitamin D status and fetal cortical maturation using detailed neurosonographic assessment at 28-30 weeks of gestation.</p><p><strong>Methods: </strong>This prospective observational study included 422 singleton pregnancies evaluated between 28 and 30 gestational weeks. Maternal serum 25-hydroxyvitamin D [25(OH)D] was measured by chemiluminescence immunoassay and categorized as deficient (<20 ng/mL), insufficient (20-30 ng/mL), or sufficient (>30 ng/mL). Fetal neurosonography was performed with a GE Voluson E8 system to quantify sulcal depths (insula, Sylvian, parieto-occipital, calcarine, and cingulate fissures), corpus callosum thickness, cavum septum pellucidum length, operculization, and cortical maturation grades. Interobserver reliability, correlation, regression, and receiver operating characteristic (ROC) analyses were conducted.</p><p><strong>Results: </strong>Of 422 women, 280 (66.4%) were vitamin D deficient, 110 (26.1%) insufficient, and 32 (7.6%) sufficient. Deficient participants showed significantly lower mean insula, parieto-occipital, and calcarine fissure depths and thinner corpus callosum (p < 0.05). Operculization and cortical maturation grades were also reduced (p = 0.02 and p = 0.01, respectively). Maternal 25(OH)D levels positively correlated with calcarine fissure depth (r = 0.42, p < 0.001) and cortical maturation grade (r = 0.45, p < 0.001). After adjustment for gestational age, vitamin D deficiency independently predicted low cortical maturation (≤ grade 3) (adjusted OR 2.56, 95% CI: 1.34-4.89, p = 0.004). ROC analysis demonstrated good discriminatory ability (AUC = 0.74, p < 0.001), with an optimal vitamin D threshold of ≈ 21 ng/mL yielding 78% sensitivity and 65% specificity.</p><p><strong>Conclusion: </strong>Maternal vitamin D deficiency during the late second to early third trimester is associated with delayed fetal cortical sulcation and reduced operculization grades. Quantitative neurosonography can noninvasively identify early neurodevelopmental vulnerability related to suboptimal maternal vitamin D status, supporting the role of adequate vitamin D as a modifiable determinant of fetal brain development. Given the high prevalence of hypovitaminosis D observed in this cohort, assessment of maternal 25(OH)D levels may be justified in high-risk or high-prevalence populations. Based on commonly applied clinical thresholds, supplementation of approximately 600 IU/day for vitamin D-sufficient women, 1,000 IU/day for those with insufficiency, and 1,500-2,000 IU/day for deficient women may be considered.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Cervicovaginal Melatonin Levels in Relation to HPV Infections and the Development of High-Grade Squamous Intraepithelial Lesions.","authors":"Belma Gözde Özdemir, Osman Yıldırım, Şeyma Kılıç, Ahmet Bilgi, Fikret Akyürek, Çetin Çelik","doi":"10.1159/000550377","DOIUrl":"10.1159/000550377","url":null,"abstract":"<p><strong>Objectives: </strong>Human papillomavirus (HPV) infection establishes persistent infection in cervical epithelial cells, leading to Deoxyribonucleic Acid (DNA) damage, inflammation, and oxidative stress. This process predisposes to the development of precancerous lesions. Melatonin is believed to play a role in this pathogenesis, as it can inhibit viral persistence by reducing oxidative damage and modulating the immune response. This study aimed to investigate the effect of melatonin levels in cervicovaginal fluid on HPV infection leading to High-grade Squamous Intraepithelial Lesion (HSIL).</p><p><strong>Design: </strong>A total of 89 women aged 22-55 years were enrolled and divided into three groups: HPV-positive with HSIL (n=30), HPV-positive without HSIL (n=30), and HPV-negative controls (n=29)-prospective experimental melatonin marker study. Participants/Materials: Three groups were formed. The two HPV-positive groups were divided into those that developed HSIL and those that did not. The control group was then considered HPV and HSIL negative.</p><p><strong>Setting: </strong>The study was conducted at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine,2025.</p><p><strong>Methods: </strong>Melatonin levels were measured in all three groups. A total of 89 people were evaluated in the study, with 30 patients in each of the two HPV-positive groups and 29 patients in the control group.</p><p><strong>Results: </strong>No sociodemographic difference was found between the groups (p>.05). Melatonin levels were lower in the group developing HSIL than in the group not developing HSIL and the control group (p<.05).</p><p><strong>Limitations: </strong>However, this study is limited by a single-time measurement, a relatively small sample size, and a single-center design, which may restrict the generalizability of the findings.</p><p><strong>Conclusion: </strong>Low cervico-vaginal melatonin levels were significantly associated with HSIL progression, suggesting its potential role as a biomarker.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mendelian Randomization Analyses Reveal Causal Relationships between Brain Structural Connectivity and Risk of Polycystic Ovary Syndrome.","authors":"Huimin Niu, Lian Xia, Xinyi Zhang, Chuning Lin, Yao Ge, Yuan Chen, Feng Sun, Feng Jiang, Chuyan Wu","doi":"10.1159/000546487","DOIUrl":"10.1159/000546487","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the relationship between brain structural connectivity and polycystic ovary syndrome (PCOS).</p><p><strong>Design: </strong>Two-sample Mendelian randomization (2SMR) was conducted by querying a relevant European population genome-wide association studies (GWAS) database about the anatomical connections of the brain and polycystic ovarian syndrome from the Ieu Open GWAS Project database. Two hundred six brain structural connectivity-related single-nucleotide polymorphisms (SNPs) were evaluated as instrumental variables (IVs).</p><p><strong>Methods: </strong>To investigate the potential causal effect between brain structure and PCOS, we applied several statistical models, including inverse variance weighting (IVW), weighted median (WME), MR-Egger regression, simple mode, and weighted mode approaches.</p><p><strong>Results: </strong>IVW analysis indicated significant associations between certain white matter tracts and PCOS risk, including the connection between the right default mode network and the amygdala (OR = 1.559; 95% CI = 1.028-2.36; p = 0.037), as well as the pathway linking the right somatomotor and limbic networks (OR = 1.800; 95% CI = 1.077-3.009; p = 0.025). Additionally, negative correlations with PCOS risk were observed in white matter tracts involving limbic-control and limbic-thalamic connections across both hemispheres, as well as in the left somatomotor-control circuit. Horizontal pleiotropy was not detected by heterogeneity tests or sensitivity analyses that used the leave-one-out approach.</p><p><strong>Limitations: </strong>More research involving bigger and more heterogeneous cohorts is necessary to evaluate the functional consequences of anatomical brain changes in PCOS.</p><p><strong>Conclusion: </strong>The structural integrity of white matter tracts linking the right default mode network to the amygdala and connecting the right somatomotor and limbic networks appears to be causally associated with the development of PCOS.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"86-100"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shore-Up, a Novel Technique with Tensor Threads in Women with Stress Urinary Incontinence: A Pilot Study.","authors":"Cristina Pages-Garcia, Begona Pellicer-Iborra, Maria Coret-Cebamanos, Laura Fuentes-Aparicio","doi":"10.1159/000546004","DOIUrl":"10.1159/000546004","url":null,"abstract":"<p><p><p>Background: Stress urinary incontinence (SUI) commonly affects women's quality of life. The widespread recommendation of using non-absorbable meshes has delayed a more definitive surgical solution. Newer, less invasive biomaterial treatments show promise.</p><p><strong>Objective: </strong>Our aim was to describe and evaluate a new urethral suspension technique called \"shore-up,\" performed with APTOS® resorbable tensor threads on an outpatient procedure.</p><p><strong>Design: </strong>A pilot study was conducted.</p><p><strong>Participants: </strong>32 SUI women, unresponsive to conservative treatment, participated in the study.</p><p><strong>Settings: </strong>The study was conducted at the HM IMI Clinic, Toledo, Spain.</p><p><strong>Method: </strong>Patients completed validated incontinence questionnaires (Sandvik and ISCQ SF) before and at 1, 2, 6, and 12 months post-procedure. A blinded analysis of results was conducted.</p><p><strong>Results: </strong>Women with SUI of different degrees: mild (3/32), moderate (19/32), severe (8/32), and very severe (2/32) showed a significant improvement (p < 0.05) in scores on both tests. After 12 months, a success rate of 72% (23/32) without SUI was observed, 16% with mild (5/32) and 12% with moderate SUI (4/32). None of them required hospitalization or post-surgical assistance, and the most frequent complications were extrusion of the final thread end through the vagina in 33% (9/32), transient dyspareunia in 6% (4/31), and early suture dehiscence in 6% (2/32).</p><p><strong>Conclusion: </strong>The shore-up technique is a promising, minimally invasive option for managing SUI, offering high efficacy, safety, and patient satisfaction.</p><p><strong>Limitations: </strong>This is a small study, and further research is recommended to confirm these findings (ethic code 23.02.2155-GHM). </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Plane Assessment of Prolapse Degree and Pelvic Organ Prolapse Quantification Scores after Three-Dimensional Reconstruction of Female Pelvic Organ Prolapse.","authors":"Lifan Shen, Huijun Bai, Xueyu Sun, Ping Liu, Chunlin Chen","doi":"10.1159/000546464","DOIUrl":"10.1159/000546464","url":null,"abstract":"<p><p><p>Objectives: This study aimed to combine dynamic magnetic resonance imaging (MRI) with three-dimensional (3D) reconstruction and form a plane based on osseous structures to evaluate the degree of pelvic organ prolapse (POP). The correlation of this novel evaluation approach with the POP-Q system was assessed.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 71 POP patients with POP-Q stage ≥II. The dynamic MRI images of those patients were reconstructed in three dimensions. A plane was created by using the midpoint of the line between the inferior margins of the two pubic bones and the starting points of the superior margins of the bilateral sacrotuberous ligaments (the pubic inferior midpoint - sacrotuberous ligament starting point superior edge plane). Distances from the lowest point of the anterior vaginal wall, cervix, and rectal ampulla to this evaluation plane were measured, modeled, and categorized. The consistency and correlation of the categorized results with POP-Q scores were verified by performing a kappa analysis and Spearman's rank correlation analysis, respectively.</p><p><strong>Results: </strong>The highest consistency with POP-Q scores was found in the prolapse of the central pelvic cavity (kappa = 0.713, p < 0.05), followed by the anterior POP (kappa = 0.427, p < 0.05), and posterior POP (kappa = 0.261, p < 0.05), with all showing statistically significant differences. The strongest positive correlation was observed between central POP and POP-Q scores (r = 0.864, p < 0.01), followed by posterior POP and POP-Q scores (r = 0.710, p < 0.01), with both exhibiting a strong positive correlation. Anterior POP and POP-Q scores showed a moderate positive correlation (r = 0.586, p < 0.01).</p><p><strong>Conclusions: </strong>The results of the proposed evaluation method were highly consistent in the anterior and central pelvic cavities and strongly correlated in the central and posterior pelvic cavities. In particular, the assessment of the posterior cavity showed a strong positive correlation with that of the POP-Q system. The evaluation plane demonstrated high consistency and correlation with the POP-Q system. </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"65-75"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}