Objective:To synthesize current evidence on the effects of natural compounds on oxidative stress and angiogenic biomarkers, particularly malondialdehyde (MDA), soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF), in experimental models of preeclampsia. Materials and Methods:A narrative review was conducted of studies retrieved from PubMed, Scopus, ScienceDirect, and Web of Science (2016-2026). Experimental animal studies that evaluated natural compounds and reported outcomes related to MDA, sFlt-1, PlGF, or angiogenic pathways were included. Study quality was assessed descriptively using the Joanna Briggs Institute framework. Results:Nine relevant experimental studies were included in the narrative synthesis. Interventions included Astragalus spp., pomegranate juice, young kopyor coconut water, soybean tempeh extract, Cosmos caudatus extract, Nigella sativa, Puerariae lobatae Radix, and olive leaf extract. Most interventions significantly reduced MDA and sFlt-1 levels, indicating reductions in oxidative stress and anti-angiogenic activity. Several compounds increased expression of PlGF and/or vascular endothelial growth factor, suggesting improved placental angiogenesis. Beneficial effects on placental morphology, blood pressure, proteinuria, and fetal outcomes were also reported. Conclusion:Natural compounds may ameliorate oxidative stress and angiogenic imbalance in experimental models of preeclampsia by reducing MDA and sFlt-1 levels and enhancing PlGF-mediated angiogenesis. These findings support their potential as adjunctive therapies for preeclampsia, although further mechanistic studies and clinical trials are needed to confirm their efficacy and safety. As this narrative review is based exclusively on findings from experimental animal models, these results should be interpreted with caution and not be directly extrapolated to clinical practice until they are confirmed by human studies.
Objective:Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is associated with lower postoperative pain, reduced analgesic requirements, and faster early postoperative recovery compared with laparoscopy in patients undergoing hysterectomy for benign indications. To compare postoperative pain and early recovery outcomes between vNOTES and conventional laparoscopy in patients undergoing hysterectomy for benign gynecologic indications. Materials and Methods:This single-center retrospective cohort study included 192 patients who underwent hysterectomy between March 2021 and September 2025. Patients were grouped according to surgical approach (vNOTES vs. laparoscopy). Postoperative pain was assessed using the visual analog scale at 6 and 24 hours. Primary outcomes were pain intensity and the requirement for additional analgesia. Secondary outcomes included operative time, change in hemoglobin, time to first flatus, and length of hospital stay. Multivariable logistic regression analysis was performed to identify predictors of analgesic requirement. Results:Of 192 patients, 75 (39.1%) underwent laparoscopy and 117 (60.9%) underwent vNOTES. Baseline characteristics were similar between groups. The vNOTES group had significantly lower pain scores at 6 and 24 hours (p=0.001) and a reduced need for additional analgesia (23.9% vs. 60.0%, p=0.001). Operative time was shorter and recovery outcomes, including time to first flatus and length of hospital stay, were significantly improved in the vNOTES group (p=0.001). Surgical approach, uterine weight, and operative time were independent predictors of analgesic requirement. Conclusion:In this retrospective cohort study, vNOTES was associated with lower postoperative pain scores, reduced analgesic requirement, and earlier recovery than conventional laparoscopy. These findings should be confirmed in prospective randomized studies.
Objective:This study investigated whether routinely used second-trimester triple screening markers (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) could help identify pregnancies at increased risk of gestational diabetes mellitus. In addition, several hematological inflammation indices were evaluated as potential adjunctive predictors. Materials and Methods:Medical records of 405 singleton pregnancies were retrospectively reviewed. All participants underwent triple screening during gestational weeks 15-20 and subsequently underwent oral glucose tolerance testing during gestational weeks 24-28. Patients were categorized, according to oral glucose tolerance test findings, as either having gestational diabetes or as normoglycemic controls. Receiver operating characteristic analyses were performed to assess both the isolated and combined predictive capacities of measurements of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. The impact of maternal body mass index on model performance was also analyzed. Results:Alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels showed poor discriminatory ability for identifying pregnancies complicated by gestational diabetes, both individually and in combined models. However, adding maternal body mass index to the combined biomarker model substantially improved predictive accuracy (area under the curve=0.809; p<0.001). None of the evaluated inflammatory indices demonstrated significant predictive performance for gestational diabetes mellitus. Conclusion:Routine second-trimester triple screening markers appear to have limited standalone value for predicting gestational diabetes. Nevertheless, incorporating maternal body mass index considerably enhances model performance and may improve clinical risk stratification.
Objective:To investigate the value of fasting bile acid (FBA) levels and liver enzymes [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). Materials and Methods:This retrospective study included 296 pregnant women diagnosed with ICP between 2020 and 2025. Patients were classified as having mild (FBA 10-40 μmol/L, n=223) or severe ICP (FBA >40 μmol/L, n=73). Clinical, laboratory, and neonatal outcomes were compared; receiver operating characteristic (ROC) analysis was performed to evaluate the predictive value of FBA for meconium passage; and patients who received ursodeoxycholic acid (UDCA) therapy were compared with those who did not. Results:Compared with the mild ICP group, patients with severe ICP had earlier gestational ages at diagnosis and at delivery, and lower birth weight and neonatal pH (all p<0.05). FBA levels were significantly associated with fetal growth restriction (p=0.042), preterm birth (p=0.003), neonatal intensive care unit (NICU) admission (p<0.001), and meconium passage (p<0.001). AST was associated only with NICU admission and meconium passage, whereas ALT showed no significant association with perinatal complications. The median FBA level was significantly higher in patients with meconium passage (105 vs. 20 μmol/L; p<0.001). ROC analysis identified an FBA cut-off of 88.45 μmol/L (area under the curve=0.694), with 57.1% sensitivity and 81.3% specificity. Conclusion:FBA is the strongest predictor of adverse perinatal outcomes in ICP. AST provides complementary prognostic information, whereas ALT has limited predictive value. Clinical management should be guided by FBA-based risk stratification and individualized timing of delivery.
Objective:To compare depressive and anxiety symptoms in women with unwanted and planned pregnancies. Materials and Methods:In this cross-sectional comparative study, we enrolled 220 pregnant women who presented to the Obstetrics and Gynecology Department of Yozgat Bozok University between January 2023 and June 2025. The study group comprised 120 women with unwanted pregnancies seeking elective termination before 10 weeks of gestation. The control group included 100 women with planned pregnancies. Socio-demographic and obstetric data were collected. Depressive and anxiety symptoms were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. Results:Women with unwanted pregnancies had a significantly higher prevalence of depressive symptoms than women with planned pregnancies (46.7% vs. 28.0%; p=0.004). In contrast, there was no statistically significant difference in the prevalence or severity of anxiety symptoms between the groups (p=0.450). Women in the unwanted pregnancy group were significantly older, had higher parity and lower educational attainment, and were more likely to be unmarried (all p<0.001). Following termination, 20.8% of women had no future contraceptive plans, whereas 40% intended to use an intrauterine device. Conclusion:Unwanted pregnancy culminating in a request for termination is a potent risk factor for depressive symptoms, particularly among socioeconomically vulnerable women, but not necessarily for anxiety. These findings underscore the critical need to integrate mental health screening, especially for depression, and comprehensive, patient-centered contraceptive counseling into routine antenatal and post-abortion care services. Addressing the psychosocial needs of this population is essential for mitigating adverse mental health outcomes.
Objective:Preeclampsia (PE), a significant challenge for health systems, is a hypertensive disorder of pregnancy. Some studies have suggested that long non-coding ribonucleic acids play a major role in the pathogenesis of PE by regulating the biological behaviors of maternal vascular smooth muscle cells and trophoblasts. In this study, the impact of the maternally expressed gene 3 (MEG3) rs4081134 gene polymorphism on susceptibility to PE has been evaluated. Materials and Methods:We conducted a case-control study comprising 130 PE patients and 140 normotensive pregnant women with normal gestational outcomes. Genotype analysis was performed using the polymerase chain reaction-restriction fragment length polymorphism method. Results:A significant association was evident between the AA genotype and PE risk under the recessive model, indicating that these may serve as protective factors against the development of PE. No significant relationships were detected between other genotypes, genetic models, or allelic distributions and PE risk. Additionally, among pregnant women with PE, a notable correlation was observed between newborn birth weight and the rs4081134 polymorphism in the MEG3 gene. Conclusion:We found a significant association between the AA genotype, as well as the recessive model of the MEG3 rs4081134 gene polymorphism, and PE deployment. Among women diagnosed with PE, MEG3 rs4081134 gene polymorphism was significantly associated with newborn's birth weight.
Objective:To compare follicular fluid (FF) cytokine and homocysteine profiles in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF), with and without sonographic endometrioma, and to explore potential inflammatory alterations associated with endometrioma in this population. Materials and Methods:This prospective comparative study was conducted among 60 women diagnosed with POR who were undergoing IVF treatment. Participants were divided into two groups according to the presence of sonographic endometrioma: Group I included women without sonographic endometrioma (n=30) and Group II included women with sonographic endometrioma (n=30). FF samples were collected during oocyte retrieval and analyzed for inflammatory biomarkers. Concentrations of interleukin-1β (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon-α2 (IFN-α2), IFN-γ, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and homocysteine were measured using LEGENDplex multiplex assays and flow cytometry. Cytokine and homocysteine levels were compared between groups. Results:Most inflammatory cytokines, including IL-1β, IL-6, IL-8, IFN-γ, and MCP-1, showed lower levels in women with sonographic endometrioma compared with women without sonographic endometrioma. In contrast, TNF-α and IL-33 levels tended to be higher in the endometrioma group. Homocysteine levels were also lower in women with sonographic endometriomas. However, none of the observed differences reached statistical significance. Overall, the findings suggested distinct, albeit non-significant, inflammatory trends in the FF microenvironment of women with POR and sonographic endometrioma. Conclusion:Women with POR and sonographic endometrioma showed altered trends in FF inflammatory-marker profiles compared with women without sonographic endometrioma; however, these differences were not statistically significant. Since the absence of sonographic endometrioma does not exclude endometriosis, the findings should be interpreted cautiously. Larger prospective studies that include IVF and assess embryological and reproductive outcomes are required to clarify the clinical significance of FF biomarkers in women with POR and endometrioma.
Objective:The 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system introduced significant changes in the classification of endometrial cancer by incorporating key pathological and molecular features. This study aimed to evaluate the impact of the revised FIGO 2023 staging system on stage distribution and adjuvant treatment decisions in patients undergoing surgical management of this malignancy. Materials and Methods:This retrospective study included 220 patients who underwent surgical staging for endometrial cancer between January 2018 and December 2025. All patients were initially staged using the FIGO 2009 classification. Cases were subsequently reclassified according to the FIGO 2023 staging criteria, using the algorithm proposed for settings in which routine molecular classification is unavailable. The McNemar test was used to compare stage categories between the two staging systems, and the Wilcoxon signed-rank test was applied to evaluate the impact of stage migration on adjuvant treatment recommendations. Results:Stage migration occurred in 12.7% of patients (28/220) following the application of the FIGO 2023 criteria, predominantly due to upstaging. The most common factor associated with stage reclassification was substantial lymphovascular space invasion (LVSI). The proportion of patients managed with observation alone significantly decreased from 44.5% to 32.7% (p<0.001), while the use of pelvic radiotherapy increased from 19.1% to 28.2% (p=0.004). Similarly, the proportion of patients receiving combined chemoradiotherapy significantly increased from 11.8% to 17.3% (p=0.012). Conclusion:The implementation of the FIGO 2023 staging system has resulted in clinically meaningful stage migration and significantly impacted adjuvant treatment strategies. In particular, the recognition of substantial LVSI as a defining feature of stage IIC disease has led to more intensive adjuvant therapy in a subset of patients previously categorized as low risk.
This paper presents a comprehensive cadaveric dissection atlas detailing the retroperitoneal anatomy essential to advanced pelvic surgery. Developed by a multidisciplinary team of anatomists, gynecologists, and gynecologic oncologists, the study provides a systematic, layer-by-layer guide for navigating the pelvic avascular spaces. It details five critical surgical corridors: the presacral (retrorectal) space, the pararectal space (divided into the Latzko and Okabayashi compartments), the paravesical space (medial and lateral compartments), the prevesical (retropubic/Retzius) space, and the medial psoas space (laterovascular plane). This atlas emphasizes the use of reliable landmarks, such as the sacral promontory, the obliterated umbilical artery, and the ureter, to define anatomical boundaries and ensure safe surgical practice. The primary objective is to maintain adequate exposure after retroperitoneal entry and to perform layer-by-layer surgical dissection to identify critical anatomical structures. The superior hypogastric plexus; hypogastric nerve; pelvic splanchnic nerves; inferior hypogastric plexus with its vesical and rectal branches; the internal iliac artery with its posterior and anterior trunk branches (including the superior gluteal, iliolumbar, lateral sacral, uterine, inferior gluteal, pudendal, obturator, middle rectal, and inferior and superior vesical arteries, and the obliterated umbilical artery); the external iliac artery; and the corresponding internal and external iliac veins were discussed. Additionally, the somatic nerves, obturator nerve, lumbosacral trunk, sacral nerves, sciatic nerve, genitofemoral nerve, and femoral nerve were reviewed. The parietal fascial planes, pubocervical fascial structure, and visceral compartments were evaluated as part of the whole. Respecting fascial planes-particularly the presacral fascia-is mandatory to avoid catastrophic hemorrhage and autonomic nerve injury. These spaces serve as the "neurovascular roadmap" for complex procedures, including radical hysterectomy, nerve-sparing pelvic surgery, pelvic lymphadenectomy, and hemorrhage control. Mastery of these interconnected retroperitoneal compartments facilitates a transition from organ-based to space-oriented surgery, significantly reducing morbidity while maintaining oncologic radicality.
Objective:Premature ovarian insufficiency (POI) is defined by irregular menstrual cycles or amenorrhea before age 40 with elevated follicle-stimulating hormone (FSH) levels. We evaluated FOXL2 and BMP15 variants in Turkish women with POI and assessed the distribution of the BMP15 promoter variant c.-9C>G in a case-control setting. Materials and Methods:Seventy-five women younger than 40 years with hypergonadotropic hypogonadism, primary/secondary amenorrhea, serum FSH ≥25 mIU/mL on two occasions at least four weeks apart, a normal 46,XX karyotype, and negative FMR1 CGG repeat testing were included. Women with prior ovarian surgery, pelvic chemotherapy/radiotherapy, or endocrine or autoimmune disease were excluded. FOXL2 and BMP15 coding regions and intron-exon junctions were analyzed by Sanger sequencing. BMP15 c.-9C>G genotype frequencies were compared with 80 ethnically matched controls with normal ovarian function. Genotype-specific analyses compared CG versus CC + GG using Fisher's exact test, with odds ratios (ORs) and 95% confidence intervals (CIs). Results:No pathogenic POI-associated variants were detected in FOXL2 or BMP15. The heterozygous BMP15 c.-9C>G variant was identified in 34/75 patients; it occurred alone in 21, with c.308A>G in 12, and with c.352G>A in 1 patient. In the case-control comparison, the CG genotype was more frequent in POI than in controls (34/75, 45.3% vs. 15/80, 18.8%) and was associated with increased POI risk (OR=3.59, 95% CI: 1.74-7.40; p=0.0005). Conclusion:No pathogenic BMP15 or FOXL2 variant was identified. The BMP15 c.-9C>G variant may be associated with susceptibility to POI in this Turkish cohort, but this finding requires confirmation in larger, unrelated, well-matched populations and functional studies.
Objective:Microplastics are ubiquitous environmental pollutants, yet their potential association with fetal growth restriction (FGR) remains unclear. This observational, analytical case-control study aimed to evaluate the presence and size characteristics of microplastics in umbilical venous blood samples from fetuses with FGR, compared with healthy controls. Materials and Methods:Fourteen pregnant women with singleton pregnancies, aged 20-36 years, who delivered between 36+0 and 39+6 weeks' gestation were included. Pregnancies were classified as FGR (n=8) or healthy controls (n=6). Maternal and neonatal characteristics, including birth weight, Apgar scores, delivery mode, ultrasound and Doppler findings, and neonatal intensive care unit admission, were recorded. Umbilical vein blood samples collected at delivery were analyzed for the presence and particle size of microplastics using micro-Raman spectroscopy. Results:Microplastics were detected in 83.3% of control cases and 50% of FGR cases, with no statistically significant difference between groups (p=0.198). Mean microplastic particle size was larger in the FGR group than in controls (54.41±20.15 μm vs. 36.28±16.33 μm), although the difference was not statistically significant (p=0.133). Birth weight was significantly lower in the FGR group (p=0.003). Conclusion:Microplastics were detected in umbilical vein blood samples of both FGR and healthy fetuses. No significant association between the presence of microplastics and FGR was observed; however, further studies with larger sample sizes are required.
Objective:To evaluate thiol-disulfide (DS) homeostasis in women with ovarian cancer and to assess its ability to distinguish malignant ovarian tumors from benign ovarian neoplasia and healthy women. Materials and Methods:This prospective comparative study included 39 women with histopathologically confirmed ovarian cancer, 30 with benign ovarian neoplasia, and 46 age- and body mass index-matched healthy women. Serum native thiol (NT), total thiol (TT), DS, and ischemia-modified albumin (IMA) levels were measured. Thiol-DS indices were calculated as DS/NT (DNT), DS/TT (DTT), and NT/TT (NTT). Data were analyzed statistically. The study was registered at ClinicalTrials.gov (NCT05011539). Results:Compared with healthy women, the ovarian cancer group exhibited lower NT, TT, and NTT values, along with higher DS, DNT, and DTT values. When malignant and benign ovarian neoplasms were compared, NT and NTT values were lower, whereas DNT and DTT ratios were higher. IMA levels did not differ between groups. Serum CA-125 levels were positively correlated with DNT and DTT, and negatively correlated with NT, TT, and NTT. Conclusion:Thiol-DS imbalance is more pronounced in ovarian cancer than in benign ovarian neoplasia and in healthy women, suggesting that these markers may be useful adjuncts in the preoperative evaluation of adnexal masses.
Objective: To test the hypothesis that flexible progestin-primed ovarian stimulation (fPPOS) is non-inferior to the gonadotropin-releasing hormone (GnRH) antagonist protocol in terms of safety and efficacy for patients undergoing controlled ovarian hyperstimulation and preimplantation genetic testing for aneuploidy (PGT-A). Materials and Methods: This retrospective analysis included data from 548 cycles involving 367 women aged 35 to 45 years. The fPPOS and GnRH antagonist groups comprised 307 cycles (56%) and 241 cycles (44%), respectively. All participants underwent absolute blastocyst culture, trophectoderm biopsy, and PGT-A, with advanced maternal age as the sole indication. The primary outcomes were incidence of premature luteinizing hormone (LH) rise (>10 mIU/mL), cycle cancellation due to premature ovulation, and euploid blastocyst rate per injected metaphase II oocyte. Spearman's rho correlation and the generalized linear model (logit) were applied for statistical analysis. Results: The incidence of premature LH rise (8.2% versus 6.6%; p=0.302) and cycle cancellation due to premature ovulation (2% versus 0.4%; p=0.112) did not differ significantly between the fPPOS and GnRH antagonist groups. Maturation, fertilization, and blastulation rates were also similar (p>0.05). The euploid blastocyst rates per biopsy (50.12% versus 53.06%; p=0.317) and per injected metaphase II oocyte (23.84% versus 23.34%; p=0.231) were comparable between groups. Secondary outcomes, including rates of positive pregnancy tests, implantation, ongoing pregnancy, biochemical pregnancy losses, and early miscarriages, were also similar (p>0.05). Conclusion: The fPPOS protocol represents a viable alternative to the GnRH antagonist protocol for patients aged 35 years or older undergoing PGT-A.
Objective:To assess the predictive value of hematologic and biochemical inflammatory indices for methotrexate (MTX) treatment outcomes in tubal ectopic pregnancy (TEP) and to develop machine learning (ML) models for individualized risk stratification. Materials and Methods:This retrospective cohort included 293 hemodynamically stable TEP patients who were treated with a single dose of MTX between January 2019 and December 2023. Demographic, clinical, ultrasonographic, and laboratory data were analyzed. Inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and fibrinogen-to-albumin ratio (FAR)-were calculated. Outcomes were categorized as single-dose MTX success, requirement for additional MTX, or surgery. Predictive accuracy of five supervised ML algorithms was evaluated using receiver operating characteristic analysis. Results:Single-dose MTX was successful in 65.5% of patients; 18.4% required an additional dose, and 16.0% underwent surgery. AISI had the highest predictive accuracy for surgery [area under the curve (AUC)=0.929], followed by SIRI (AUC=0.899) and FAR (AUC=0.847). NLR best predicted the need for additional MTX (AUC=0.675). Naïve Bayes achieved the highest performance for surgical prediction (accuracy=98.3%, AUC=0.998), while random forest and gradient boosting were most effective in predicting the need for additional MTX (accuracy=83.1%, AUC=0.884-0.896). Feature importance analyses consistently ranked AISI, SIRI, and FAR as top predictors. Conclusion:AISI, SIRI, and FAR are strong predictors of MTX failure and surgical intervention in TEP. Combining these biomarkers with ML models markedly improves predictive performance and supports a personalized approach to TEP management. Multicenter prospective validation is needed before clinical application.
Objective:This study aimed to compare estrous cycle patterns, serum hormone and cytokine levels, gene expression, and ovarian morphology between healthy and aging mice, to evaluate their potential as models of reproductive aging. Materials and Methods:Female BALB/c mice older than 9 months were used as the aged group and were compared with healthy controls (6-8 weeks old). Estrous phases were monitored for six days using vaginal cytology. Ovarian morphology was analyzed using hematoxylin and eosin staining and immunohistochemistry. Serum levels of follicle-stimulating hormone (FSH), interleukin (IL)-10, and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay. Gene expression of IL-10 and TNF-α was assessed by reverse transcription polymerase chain reaction. Results:Healthy mice cycled through all estrous phases, whereas aging mice were predominantly arrested in diestrus and exhibited increased immune-cell infiltration and inflammatory changes. Ovarian histology showed enlargement, fibrosis, and the presence of non-functional structures. Follicle counts were reduced in aging mice, though the reduction was not statistically significant. Serum FSH (1.37±0.20 vs. 1.10±0.03 pg/mL) and TNF-α (37.05±17.31 vs. 21.57±4.62 pg/mL) were significantly elevated, whereas IL-10 was significantly decreased (4.53±0.32 vs. 6.23±0.99 pg/mL) (p<0.05). TNF-α mRNA levels increased and IL-10 mRNA levels decreased; however, these changes were not statistically significant. Conclusion:Aging BALB/c mice exhibit disrupted estrous cycles, ovarian fibrosis, increased FSH and TNF-α, and reduced IL-10, changes that resemble those associated with menopause. These findings support the use of aging BALB/c mice as a model for reproductive aging and therapeutic studies.
Objective: This study evaluated the diagnostic utility of early postoperative renal ultrasound in detecting ureteral injury in patients who had undergone total laparoscopic hysterectomy (TLH) for benign indications, despite documented normal intraoperative ureteral jet flow on cystoscopy. Materials and Methods: In this retrospective cohort study at a high-volume tertiary center, data from 3,170 patients who underwent TLH between January 2022 and October 2025 were analyzed. Inclusion required normal bilateral ureteral jet flow on routine intraoperative cystoscopy, a renal ultrasound within the first 24 postoperative hours, and at least 30 days of clinical follow-up. The primary outcome was the diagnostic yield of postoperative ultrasound for identifying ureteral injuries not apparent during surgery. Injuries were confirmed by advanced imaging or surgical exploration. Results: The overall ureteral injury rate was 0.79% (n=25). Of these injuries, eight were diagnosed intraoperatively, while seventeen occurred despite documented normal bilateral ureteral jet flow during the procedure. Among the latter group, renal ultrasonography performed on postoperative day 1 detected 14 injuries, representing 56% of all injuries. Three injuries (12%) presented later, around postoperative day 10, and were not identified on initial imaging. Early postoperative ultrasonography demonstrated good sensitivity and a high negative predictive value as a screening tool. Comparison with preoperative baseline imaging enhanced diagnostic performance in identifying new-onset obstruction, particularly newly developed pelviectasis. Conclusion: Normal intraoperative ureteral jet flow does not preclude ureteral injury, particularly those with delayed presentation, such as thermal damage. Early postoperative renal ultrasonography is a valuable non-invasive screening tool that identifies a significant proportion of injuries missed by cystoscopy alone. Comparative evaluation of routine postoperative ultrasonography with preoperative imaging may provide a meaningful contribution to the early diagnosis of ureteral injury following TLH.
Letrozole and other aromatase inhibitors are increasingly recognized as first-line ovulation induction (OI) medications, offering an efficient and physiologic approach to ovarian stimulation that enhances outcomes in reproductive medicine. By selectively inhibiting aromatase and maintaining lower peripheral estrogen levels, letrozole supports mono- or bi-follicular development while reducing the risk of supraphysiologic estradiol exposure seen with traditional gonadotropin regimens. These pharmacological characteristics have contributed to its expanding use not only in OI but also in various assisted reproductive technologies. To evaluate the clinical benefits, effectiveness, and safety of using letrozole in in vitro fertilization (IVF), in vitro maturation (IVM), and OI, with particular attention to reproductive outcomes, ovarian response, endometrial effects, cycle characteristics, and treatment-related adverse events. A comprehensive systematic search covering the period from December 2000 to November 2025 was conducted across major electronic databases including PubMed, Embase, the Cochrane Library, and Google Scholar. The search strategy incorporated predefined keywords related to letrozole, aromatase inhibition, OI, IVF, and IVM. Studies involving randomized controlled trials, observational cohorts, and meta-analyses were included, while non-clinical and non-reproductive data were excluded. Relevant outcomes were extracted and synthesized qualitatively. Letrozole demonstrates broad clinical utility in reproductive medicine, spanning assisted reproductive techniques, ovarian stimulation strategies, and the management of ovarian hyperstimulation syndrome risk, ectopic pregnancy, and endometriosis-related infertility. Its targeted estrogen suppression, cost-effectiveness, and favorable safety profile make it a valuable component of individualized treatment protocols. Nonetheless, further high-quality research is required to refine optimal dosing strategies, identify ideal patient populations, and clarify long-term reproductive and obstetric safety.
To evaluate the efficacy and safety of autologous platelet-rich plasma (PRP), administered via intrauterine infusion or subendometrial injection, for improving endometrial thickness (EMT) and pregnancy outcomes in women with thin endometrium undergoing frozen-thawed embryo transfer (FET) cycles. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations. Eligible studies investigating PRP treatment for thin endometrium in FET cycles were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Pooled mean differences (MD) for EMT and aggregated proportions for pregnancy outcomes were calculated using R software. Fourteen studies involving a total of 523 patients were analyzed. PRP administration was associated with a significant increase in EMT [MD=1.61 mm, 95% confidence interval (CI): 1.21-2.01, p<0.05]. The pooled clinical pregnancy rate following PRP treatment was 41.5% (95% CI: 29.6-53.9%). Corresponding rates for ongoing pregnancy, implantation, and miscarriage were 27.3% (95% CI: 19.7-35.0%), 22.9% (95% CI: 8.5-37.2%), and 5.3% (95% CI: 2.3-8.2%), respectively. Subgroup analyses suggested that heterogeneity was partly attributable to differences in study design and PRP administration route. Autologous PRP may be a safe and potentially effective adjunct to enhance endometrial receptivity and reproductive outcomes in women with thin endometrium. Although current evidence from single-arm studies provides a useful clinical reference, well-designed, large-scale randomized controlled trials are still needed to validate these findings.
Objective:Endometriosis is a benign condition driven by estrogen and inflammation in which endometrial-like tissue develops in ectopic locations. We aimed to determine whether non-steroidal agents acting on the WNT/beta-catenin signaling axis could provide therapeutic benefit in this disease. Materials and Methods:Forty adult female mice underwent surgical creation of endometriotic implants and were then distributed into five experimental arms: untreated controls, early leuprolide (leup1d), early tinzaparin (tnz1d), delayed leuprolide (leup7d), and delayed tinzaparin (tnz7d). Early treatment groups received drug treatment beginning at postoperative hour 24, whereas delayed groups began treatment on postoperative day 8. At two weeks post-surgery, lesions were harvested for RNA extraction and transcript profiling. Tissues were also processed for hematoxylin-eosin staining with semi-quantitative grading. Immunostaining was performed using antibodies against HIF1a and WNT2. Results:The tnz7d group exhibited decreased inflammatory markers, while the leup7d group displayed reduced epithelial content; both changes resulted in lower disease severity scores. WNT2 and HIF1a immunostaining revealed greater reductions in score in the tnz7d group compared with controls and other treatment arms, but these differences were not statistically significant. Conclusion:Further investigation is warranted to determine how tinzaparin sodium and leuprolide acetate modulate the WNT/β-catenin axis for the management of endometriosis.
Objective:The aim of this study was to investigate prognostic determinants of survival in early-stage endometrial cancer (EC), focusing on clinicopathological parameters including histologic grade, tumor stage, myometrial invasion, lymphovascular space invasion (LVSI), and preoperative CA-125, as well as the role of adjuvant therapies in disease-free survival (DFS) and overall survival (OS). Materials and Methods:We retrospectively analyzed women treated surgically for International Federation of Gynecology and Obstetrics 2009 stage I-II EC at a tertiary center between January 2011 and January 2023. Demographic and pathological data were collected, including age, body mass index, reproductive history, menopausal status, comorbidities, tumor size, histologic subtype and grade, depth of myometrial invasion, LVSI, serum CA-125 levels, and surgical procedures. Adjuvant therapies-external beam radiotherapy, vaginal brachytherapy, and chemotherapy-were also documented. Associations between these variables and survival outcomes were assessed using Kaplan-Meier and Cox regression analyses. Results:A total of 241 women with early-stage EC were included. Median age was 57 years (range: 34-86 years). Of these, 181 (75.1%) were stage IA, 47 (19.5%) were stage IB, and 13 (5.4%) were stage II. Histologic grades were grade 1 in 44.8%, grade 2 in 39.0%, and grade 3 in 16.2%. During a median follow-up of 75 months, recurrence occurred in 4.6% of patients and mortality in 7.9% of patients. Univariate analysis showed that elevated CA-125, higher stage, and higher grade were associated with worse OS. Multivariate analysis identified histologic grade as an independent predictor of both OS and DFS. Neither adjuvant radiotherapy nor chemotherapy improved survival outcomes. Conclusion:Histologic grade was the strongest independent prognostic factor for OS and DFS in early-stage EC, surpassing tumor stage, myometrial invasion, and LVSI. These findings highlight the importance of comprehensive surgical staging, especially when high-grade tumors are detected intraoperatively, to ensure accurate risk stratification and appropriate use of adjuvant therapies.
