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Topic Review
Experimental Therapeutic Strategies for Thin Endometrium
Infertility caused by a thin endometrium remains a significant challenge in assisted reproduction and is often associated with a low success rate after treatment with assisted reproductive technology. There is a lack of consensus in the field concerning both its diagnostic criteria and clinical management. The available treatment options are few with limited efficacy. Advances in cell therapy and bioengineering have, however, shown promising results for the treatment of a thin endometrium. Notably, these novel interventions have demonstrated the ability to increase endometrial thickness, restore endometrial function, and improve reproductive outcomes.
  • 731
  • 13 Nov 2023
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. 
  • 727
  • 25 Feb 2022
Topic Review
Regulated Cell Death Mechanisms in Endometriosis
Regulated cell death (RCD) represents a distinct mode of cell demise, differing from accidental cell death (ACD), characterized by specific signaling cascades orchestrated by diverse biomolecules. The regular process of cell death plays a crucial role in upholding internal homeostasis, acting as a safeguard against biological or chemical damage.
  • 718
  • 17 Feb 2024
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.
  • 713
  • 02 Dec 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.
  • 709
  • 25 Oct 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. 
  • 708
  • 14 Jun 2022
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.
  • 705
  • 18 Oct 2023
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.
  • 704
  • 12 May 2022
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.
  • 700
  • 23 Aug 2022
Topic Review
Catastrophic Antiphospholipid Syndrome
Unlike classic antiphospholipid syndrome (APS), catastrophic antiphospholipid syndrome (CAPS) causes multiple microthrombosis due to an increased inflammatory response, known as a “thrombotic storm”. CAPS typically develops after infection, trauma, or surgery and begins with the following symptoms: fever, thrombocytopenia, muscle weakness, visual and cognitive disturbances, abdominal pain, renal failure, and disseminated intravascular coagulation. Although the presence of antiphospholipid antibodies in the blood is one of the diagnostic criteria, the level of these antibodies can fluctuate significantly, which complicates the diagnostic process and can lead to erroneous interpretation of rapidly developing symptoms.
  • 700
  • 23 Feb 2024
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.
  • 697
  • 20 Nov 2023
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. 
  • 693
  • 22 May 2023
Topic Review
Deep Infiltrating Endometriosis in Adolescence
Endometriosis has a prevalence of 10% worldwide in premenopausal women. Probably, endometriosis begins early in the life of young girls, and it is commonly diagnosed later in life. The prevalence of deep infiltrating endometriosis (DIE) in adolescence is currently unknown due to diagnostic limits and underestimation of clinical symptoms. Dysmenorrhea is a common symptom in adolescents affected by DIE, often accompanied by dyspareunia and chronic acyclic pelvic pain. Ultrasonography—either performed transabdominal, transvaginal or transrectal—should be considered the first-line imaging technique despite the potential for missed diagnosis due to early-stage disease. Magnetic resonance imaging should be preferred in the case of virgo patients or when ultrasonographic exam is not accepted. Diagnostic laparoscopy is deemed acceptable in the case of suspected DIE not responding to conventional hormonal therapy. An early medical and/or surgical treatment may reduce disease progression with an immediate improvement in quality of life and fertility, but at the same time, painful symptoms may persist or even recur due to the surgery itself. 
  • 692
  • 31 Jan 2024
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.
  • 689
  • 18 Mar 2024
Topic Review
Treatment of Peripartum Depression with Antidepressants
Peripartum or perinatal depression, which is depression arising in the period between the start of a pregnancy and the end of the first postpartum year. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers’ compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices. 
  • 686
  • 28 Feb 2022
Topic Review
Serum Human Epididymis Protein 4 and Endometrial Cancer
Human epididymis protein 4 (HE4), also known as epididymal secretory protein 4, is a glycoprotein encoded by the Whey-Acidic Four-Disulfide Core domain protein 2 (WFDC2) gene.  There may be a correlation between the tissue expression of HE4 and the molecular classification of endometrial cancer.
  • 685
  • 24 Nov 2022
Topic Review
Aberrations in Eutopic Endometrium
The “endometrial determinism” theory was proposed to account for the apparent gap between the relatively low prevalence of endometriosis and nearly universal retrograde menstruation. The theory was advanced to justify “root treatment”, intended to nip endometriosis in the bud. The theory has significant weaknesses. Critically, identified aberrations in the ectopic endometrium in endometriosis may be the consequence rather than the cause of endometriosis.
  • 682
  • 20 Feb 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.
  • 677
  • 18 Aug 2023
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).
  • 677
  • 15 Jan 2024
Topic Review
Cervicovaginal Microbiome
The cervicovaginal microbiome (CVM) denotes the microbial community that inhabits the lower female reproductive tract, principally the vaginal lumen and ectocervix, and the array of host–microbe interactions that occur there. The CVM includes bacteria, viruses, fungi, and eukaryotic microbes, plus metabolites and host immune factors present in cervicovaginal fluid. The composition and activity of this ecosystem influence local physiology, susceptibility to infections, reproductive outcomes, and long-term gynecologic health.
  • 676
  • 25 Sep 2025
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