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Topic Review
Fournier’s Gangrene Therapy in Gynecological Patients
Fournier’s gangrene (FG) is a serious pathology of the soft tissues and fascia of the perineum and genital region with a high morbidity and mortality rate. In recent years, the SGLT-2 inhibitor oral antidiabetic has been related to this entity. According to the new warnings from the main drug agencies, a compilation of cases has been initiated to establish or deny a possible causal relationship. Most of these cases have been reported in men. However, it is important not to underestimate this entity in the gynecological field, since it is extremely serious and requires intense and rapid aggressive treatment based on surgery and empiric antibiotherapy. Later, some cares are needed to involve surgical reconstruction of the defects introduced by debridement. As a result of the low incidence of FG, clinical trials’ data may be insufficient to robustly assess this issue because of the limited numbers of participants. Real-world evidence may help to clarify the association between SGLT2i and FG. 
  • 754
  • 26 May 2022
Topic Review
Multimodal Treatment of Cervical Cancer in Disease Stage
Cervical cancer continues to be among the most common malignancies in women, and important measures have been taken to reduce its incidence. The first and most important steps to achieve this goal are oriented toward prevention through screening programs and vaccination, mainly against oncogenic human papillomavirus (HPV) strains 16 and 18. The therapeutic approach is based on the diagnosis and treatment guidelines for cervical cancer, which establish for each stage (FIGO, TNM) specific conduct. These guidelines summarize quite precisely the elements of therapeutic practice, but, in some places, they leave optional variants based on which nuanced approaches could be established. 
  • 754
  • 13 Jul 2023
Topic Review
Recurrent Implantation Failure
Recurrent implantation failure (RIF) is an undefined, quite often, clinical phenomenon that can result from the repeated failure of embryo transfers to obtain a viable pregnancy. Careful clinical evaluation prior to assisted reproduction can uncover various treatable causes, including endocrine dysfunction, fibroid(s), polyp(s), adhesions, uterine malformations. 
  • 752
  • 16 Feb 2022
Topic Review
Metabolic Syndrome and PCOS
Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases among women of reproductive age and is associated with many metabolic manifestations, such as obesity, insulin resistance (IR) and hyperandrogenism.
  • 750
  • 29 Mar 2022
Topic Review
Genetic Mutations in Mitochondrial-Driven Cancer Growth in Tumors
Here focus on mitochondrial changes in breast and gynecological (endometrial and ovarian) cancers in general. Additionally, How their frequently altered genes (BRCA1/2, HER2, PTEN, PIK3CA, CTNNB1, RAS, CTNNB1, FGFR, TP53, ARID1A, and TERT) affect the mitochondria, highlighting potential therapeutic targets in these malignancies, tailored to their genetic profile was also discussed. 
  • 746
  • 06 May 2023
Topic Review
Physiological Cooperation between Aquaporin 5 and TRPV4
Aquaporins—among them, AQP5—are responsible for transporting water across biological membranes, which is an important process in all living organisms. The transient receptor potential channel 4 (TRPV4) is a cation channel that is mostly calcium-permeable and can also be activated by osmotic stimuli. It plays a role in a number of different functions in the body, e.g., the development of bones and cartilage, and it is involved in the body’s osmoregulation, the generation of certain types of sensation (pain), and apoptosis. Earlier studies on the uterus and the literature data aroused the interest in the physiological role of the cooperation of AQP5 and TRPV4. Understanding the cooperation between AQP5 and TRPV4 may contribute to the development of new drug candidates and the therapy of several disorders (e.g., preterm birth, cataract, ischemia/reperfusion-induced edema, exercise- or cold-induced asthma).
  • 744
  • 14 Oct 2022
Topic Review
Oestradiol Regulation of Lipid Metabolism in Gynaecological Cancers
Cancer cells undergo metabolic reprogramming to support cell proliferation, growth, and dissemination, a trait now considered a hallmark of cancer. Alterations in lipid metabolism, and specifically, the uptake and synthesis of fatty acids (FAs), constitute one well-documented aspect of this reprogramming. Fatty acids (FAs) are carboxylic acids, consisting of hydrocarbon chains with varying degrees of length, branching and saturation. They act as primary building blocks for lipid species, such as phospholipids, sphingolipids and triglycerides, all of which participate in a wide array of biological processes. In addition to these roles, FAs are also well established as having a critical role in altering gene transcription by regulating the activity of FA-sensitive transcription factors, particularly sterol-regulatory element-binding protein (SREBP) and peroxisome proliferator-activated receptors (PPARs). More recently, dysregulated FA metabolism has been reported and studied in many cancer types, including gynaecological cancers. FA metabolism supports tumorigenesis and cancer progression through a range of processes, including membrane biosynthesis, energy storage and production, and generation of signalling intermediates. Female sex hormones, specifically oestradiol, play a crucial role in regulating FA metabolism and are also implicated in promoting the risk of gynaecological cancers. The increased risk for these cancers and their pathogenesis has been epidemiologically linked to abnormally high levels of serum oestradiol. Emerging evidence indicates aberrant FA metabolism is postulated to be mediated by the action of oestradiol, either directly via their classical, oestrogen receptor (ER)-mediated pathways, or indirectly through the insulin-like growth factor I (IGFI) receptors (IGIFR), with the levels of serum oestradiol and the IGFIR pathway both dysregulated, not only in gynaecological cancers but also in obesity.  However, the mechanisms linking oestradiol to the dysregulation of FA metabolism in these cancer types are still underexplored.
  • 737
  • 12 May 2022
Topic Review
Outcomes of Preeclampsia in Offspring
Preeclampsia is a multisystemic clinical syndrome characterized by the appearance of new-onset hypertension and proteinuria or hypertension and end organ dysfunction even without proteinuria after 20 weeks of pregnancy or postpartum. Residing at the severe end of the spectrum of the hypertensive disorders of pregnancy, preeclampsia occurs in 3 to 8% of pregnancies worldwide and is a major cause of maternal and perinatal morbidity and mortality, accounting for 8–10% of all preterm births. 
  • 735
  • 22 May 2023
Topic Review
Treatment of Vulvovaginal Atrophy
Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. 
  • 732
  • 14 Jun 2022
Topic Review
Risk Factors of Preventable Adverse Events in Obstetrics
(Preventable) Adverse Events (pAEs) are an inherent part of all medical care. Obstetrics is characterized by a very high expectation regarding safety and has rare cases of harm, but extremely high individual consequences in case of pAEs. However, no "state of the art" definition of preventability exists. Relevant obstetric risk factors related to error categories need to be identified and categorized to target pAEs. If risk factors can be modified in the future, pAEs in obstetrics and consequent patient harm could be reduced. 
  • 730
  • 25 Feb 2022
Topic Review
Expression of PD-1 and PD-L1 in Endometrial Cancer
The landscape of diagnosing and treating endometrial cancer is undergoing a profound transformation due to the integration of molecular analysis and innovative therapeutic approaches. Tailoring treatments based on specific biomarkers has evolved into a standard practice in both initial and recurrent therapy protocols. Diverse biological abnormal changes in pathways have been discerned in EC cells. This has prompted the active development of novel therapeutic drugs and biomarkers, including immunomodulation inhibitors targeting programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1), to address these anomalies.
  • 725
  • 25 Oct 2023
Topic Review
Pathogenesis of Endometriosis-Associated Ovarian Cancer
Endometriosis is a chronic, universal, and prevalent disease estimated to affect up to 1:10 women of reproductive age. Endometriosis-associated ovarian cancer (EAOC) developing at reproductive age is challenging and of concern for women and practitioners alike. In the systematic review and meta-analysis, the summary relative risk of EAOC was estimated as 1.93 compared to women with no endometriosis.
  • 724
  • 02 Dec 2022
Topic Review
HPV Behavior in Oral and Vaginal Cavity
Human genital papilloma virus infection is the most prevalent sexually transmitted infection in the world. It is estimated that more than 75% of sexually active women contract this infection in their lifetime. In 80% of young women, there is the clearance of the virus within 18–24 months.
  • 722
  • 18 Mar 2024
Topic Review
Ontogenetic Anatomy
Ontogenetic anatomy is a relatively novel concept based on embryologic development. During early embryologic development, the proliferating groups of cells do not mix with each other. They form units—ontogenetic compartments—which can be identified and mapped in mature organisms. The ontogenetic cancer field model was developed by Höckel and considered malignant tumor growth as an anisotropic process. According to the theory, tumor growth is confined by a permissive compartment during the long time of its natural history, and the compartment’s borders are tumor suppressive. It is also a predictive model, which contributes to selecting the proper surgical procedure for every single patient according to the probability of the compartment’s involvement. The term “meso” is widely used in ontogenetic surgery. It is an abbreviation of “mesentery”, which differs from the classical anatomical definition. In general, the term “mesentery” means the structure attaches the organ to the posterior abdominal wall and is covered by the peritoneum on both sides. In ontogenetic anatomy, the prefix “meso-” defines a compartment derived from distinct primordial tissue. Mesotissues abut the corresponding organ, although their origin differs from the organ. It contains fibro-fatty tissue, blood vessels, lymphatics, and nerves. Sometimes, meso-structures are enveloped by an easily dissectible fascia (e.g., mesorectum and mesorectal fascia); in other cases, it could not be dissected in an avascular plane and the related veins may communicate between different compartments (e.g., the Mullerian compartment and mesobladder).
  • 716
  • 15 Jan 2024
Topic Review
Prevention and Treatment of Preeclampsia
Preeclampsia (PE) is a pregnancy-specific disorder affecting 4–10% of all expectant women. It greatly increases the risk of maternal and foetal death. Although the main symptoms generally appear after week 20 of gestation, scientific studies indicate that the mechanism underpinning PE is initiated at the beginning of gestation. It is known that the pathomechanism of preeclampsia is strongly related to inflammation and oxidative stress, which influence placentation and provoke endothelial dysfunction in the mother.
  • 715
  • 18 Oct 2023
Topic Review
Glycosylated Antitumor Ether Lipids
Recurrent epithelial ovarian cancer (EOC) coincident with chemotherapy resistance remains the main contributor to patient mortality. There is an ongoing investigation to enhance patient progression-free and overall survival with novel chemotherapeutic delivery, such as the utilization of antiangiogenic medications, PARP inhibitors, or immune modulators. Glycosylated antitumor ether lipids (GAELs) are synthetic glycerolipids capable of killing established human epithelial cell lines from a wide variety of human cancers, including EOC cell lines representative of different EOC histotypes. Importantly, GAELs kill high-grade serous ovarian cancer (HGSOC) cells isolated from the ascites of chemotherapy-sensitive and chemotherapy-resistant patients grown as monolayers of spheroid cultures. In addition, GAELs were well tolerated by experimental animals (mice) and were capable of reducing tumor burden and blocking ascites formation in an OVCAR-3 xenograft model. Overall, GAELs show great promise as adjuvant therapy for EOC patients with or without chemotherapy resistance.
  • 714
  • 23 Aug 2022
Topic Review
Preimplantation Genetic Testing for Cancer Predisposition Syndromes
Cancer Predisposition Syndromes (CPSs), also known as Hereditary Cancer Syndromes (HCSs), represent a group of genetic disorders associated with an increased lifetime risk of developing cancer.
  • 714
  • 20 Nov 2023
Topic Review
Oxidative stress related Hallmarks of Premature Ovarian Insufficiency
Premature ovarian insufficiency (POI) is a condition that arises from dysfunction or early depletion of the ovarian follicle pool accompanied by an earlier-than-normal loss of fertility in young women. Oxidative stress has been suggested as an important factor in the decline of fertility in women and POI. Genetic defects causing dysfunction in DNA repair machinery and mitochondria and leading to dysfunction of the host’s antioxidant defences are likely to contribute to increased oxidative stress. Furthermore, an overactive immune system can lead to oxidative stress. On the other hand, iatrogenic POI, such as that induced by chemotherapy and radiotherapy, will result in increased oxidative stress due to tissue damage and apoptosis.
  • 708
  • 18 Aug 2023
Topic Review
Premature Ovarian Insufficiency
A major obstacle contributing to the decreased efficacy of in vitro fertilization (IVF) programs is the prevalence of diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI, or premature ovarian failure—POF) in infertile patients. In addition, the age-related decline in follicle number leads to a lower availability of oocytes in IVF cycles in the poor prognosis group characterized by a poor response to ovarian stimulation, resulting in a higher dropout rate of ART cycles and a lower number of live births.
  • 706
  • 09 Jan 2024
Topic Review
Bisphenol A on Feto-Maternal Compartments
Several pathways were shown to be possibly affected by bisphenol A, leading to dysregulations in structural and endocrine foundation in the placenta, potential induction of senescence and failure of decidualization in the decidua, and possible propagation of inflammation in the fetal membranes. Combined, these actions may eventually counteract bisphenol-induced relaxation of the myometrium and promote contractility alongside fetal membrane weakening. In totality, these individual impairments in gestation-critical processes may lead to failure of maintenance of pregnancy, and thus effecting preterm birth.
  • 702
  • 28 Mar 2022
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