Endocervical Research Articles

P-744 A new hysteroscopic-assisted mock embryo transfer (HAMET) to predict success in ART cycles

Abstract Study question Could HAMET increase pregnancy rates in predicted and unexpected difficult transfer patients? Summary answer Data of this study show a strong correlation between HAMET and pregnancy rates. What is known already Mock embryo transfer is regularly performed to adequately plan the correct strategy for positioning embryos inside the uterus of patients predicted to have difficult access to uterine cavity procedure. Study design, size, duration This is a single-center, observational, retrospective study conducted at S.I.S.Me.R. center in Bologna, Italy. 1184 consecutive diagnostic hysteroscopies were performed for patients suffering for primary or secondary infertility before ART. All patients from 18 to 49 years old underwent a mock embryo transfer performed with 10 to 15 μl of methylene blue dye. Diagnostic hysteroscopy was performed immediately after mock embryo transfer to assess if the dye has entered the uterine cavity. Participants/materials, setting, methods Out of the 1184 patients who underwent hysteroscopy, in 617 patients 1118 transfers were executed after IVF-ICSI cycles. Patients were subdivided in: group A where whole cavity including fundus was filled by blue; group B where cavity but not fundus was filled by methylene blue; group C patients with partial captation or with no captation at all of dye. The difficulty of mock embryo-transfer (scale 1 to 3) was also recorded by the physician. Main results and the role of chance the results of 1118 transfers are summarized in the table below. While patients with whole cavity plus fundal captation (group A) had the highest implantantion rate (IR) compared to group B and C, reflecting the same difference in the clinical pregnancy rate (CPR), the live birth rate (LBR) was statistically superior only for group A when compared to group B. Limitations, reasons for caution Main limitation of these findings is the absence of control group. Wider implications of the findings HAMET is able to predict which patients have the higher chances to achieve a pregnancy and, even more important, a term pregnancy. The use of HAMET it is also useful to assess the capability of physicians to enter the uterine cavity when the cervical canal route is not regular. Trial registration number not applicable

Third-Trimester Fetoscopic Ablation Therapy for Types II and III Vasa Previa

(Abstracted from Am J Obstet Gynecol 2024;230:87.e1–87.e9) Vasa previa is diagnosed when fetal blood vessels develop near or covering the internal cervical os and is associated with high perinatal morbidity and mortality due to vessel injury. The ability to detect vasa previa prenatally has greatly reduced the impact on perinatal morbidity and mortality by allowing for preterm cesarean delivery before the rupture of membranes.

A prospective study on risk factors associated with the development of isthmocele after caesarean section.

The primary objective was to detect the number of women developing isthmocele following lower segment caesarean section. The secondary objectives included analysing the risk factors associated with developing isthmocele and measuring the agreement between Transvaginal Ultrasonography (TVS) and Saline infusion Sonohysterography (SIS) in diagnosing Isthmocele. This study was conducted in the Department of Obstetrics and Gynecology and focused on women who had undergone Lower Segment cesarean Section (LSCS). The study aimed to detect any indentation of at least 2mm in the scar site, known as isthmocele, using Transvaginal Ultrasound (TVS) and Saline Infusion Sonography (SIS) between 6weeks and 6months after delivery. Along with the primary objective, the study also evaluated several secondary outcomes such as maternal comorbidities, closure techniques, and labor details. The evaluation of isthmocele followed the 2019 modified Delphi consensus approach. In our study, we found that 30% of our study population had isthmocele. We also observed that the number of previous caesarean deliveries, maternal BMI, duration of surgery, and characteristics of the previous CD scar were significantly associated with the development of isthmocele. When we compared the diagnostic methods, we found that TVS and SIS had similar limits of agreement for clinically important isthmocele parameters. However, we noticed a difference in the length and distance of isthmocele from the internal os, which we observed through Bland Altman plots. Our research has shown that women who have undergone multiple caesarean deliveries, have a higher maternal body mass index (BMI), and experienced longer surgery duration are at a significantly higher risk of developing isthmocele. To prevent its development, it is recommended to promote vaginal birth after caesarean delivery whenever feasible, manage maternal obesity early on, and provide adequate surgical training to medical professionals. Additionally, transvaginal ultrasound (TVS) is an effective method for detecting isthmocele and can be used interchangeably with saline-infused sonography (SIS).

Steel bar penetrating cervical spinal canal without neurological injury: A case report

BACKGROUND We report a rare case of cervical spinal canal penetrating trauma and review the relevant literatures. CASE SUMMARY A 58-year-old male patient was admitted to the emergency department with a steel bar penetrating the neck, without signs of neurological deficit. Computed tomography (CT) demonstrated that the steel bar had penetrated the cervical spinal canal at the C6–7 level, causing C6 and C7 vertebral body fracture, C6 left lamina fracture, left facet joint fracture, and penetration of the cervical spinal cord. The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team. During the surgery, we found that the cervical vertebra, cervical spinal canal and cervical spinal cord were all severely injured. Postoperative CT demonstrated severe penetration of the cervical spinal canal but the patient returned to a fully functional level without any neurological deficits. CONCLUSION Even with a serious cervical spinal canal penetrating trauma, the patient could resume normal work and life after appropriate treatment.

Altered vaginal cervical microbiota diversity contributes to HPV-induced cervical cancer via inflammation regulation.

Cancer has surpassed infectious diseases and heart ailments, taking the top spot in the disease hierarchy. Cervical cancer is a significant concern for women due to high incidence and mortality rates, linked to the human papillomavirus (HPV). HPV infection leads to precancerous lesions progressing to cervical cancer. The cervix's external os, near the vagina, hosts various microorganisms. Evidence points to the link between vaginal microbiota and HPV-induced cervical cancer. Cervical cancer onset aligns with an imbalanced Th1/Th2 immune response, but the role of vaginal microbiota in modulating this imbalance is unclear. In this study, we collected vaginal samples from 99 HPV-infected patients across varying degrees of lesions, alongside control groups. These samples underwent bacterial DNA sequencing. Additionally, we employed Elisa kits to quantify the protein expression levels of Th1/Th2 cytokines IL2, IL12, IL5, IL13, and TNFa within the centrifuged supernatant of vaginal-cervical secretions from diverse research subjects. Subsequently, correlation analyses were conducted between inflammatory factors and vaginal microbiota. Our findings highlighted a correlation between decreased Lactobacillus and increased Gardenerella presence with HPV-induced cervical cancer. Functionally, our predictive analysis revealed the predominant enrichment of the ABC transporter within the vaginal microbiota of cervical cancer patients. Notably, these microbiota alterations exhibited correlations with the production of Th1/Th2 cytokines, which are intimately tied to tumor immunity. This study suggests the potential involvement of vaginal microbiota in the progression of HPV-induced cervical cancer through Th1/Th2 cytokine regulation. This novel insight offers a fresh perspective for early cervical cancer diagnosis and future prevention strategies.

Comparative study of photodynamic therapy (PDT) of cervical low-grade squamous intraepithelial lesion (LSIL)

BackgroundPrevention of high-risk HPV (HR-HPV) infection and effective medical intervention of persistent HPV infection and precancerous lesions are critical for the prevention of cervical cancer. AimsThe aim of this retrospective comparative study was to evaluate the outcomes of ALA PDT and observation only in the management of low-grade squamous intraepithelial lesions (LSIL). MethodsIn PDT Group (n = 138), ALA PDT was applied to patients with colposcopic biopsy confirmed cervical LSIL accompanied with HR-HPV infection longer than 1 year or HPV 16/18 subtype infection. Cervical LSIL only patients received 3 times of ALA PDT and those with concurrent cervical canal or vaginal lesions received 6 times ALA PDT. Control Group (n = 69) received observation only. Colposcopy, TCT and HPV typing were performed before and after treatment. Patients were followed up for up to two years. ResultThe observation group showed 26.1%, 34.8% and 53.6% HR-HPV negative conversion at 3-6, 12 and 24 months, respectively. LSIL regression rate of the observation group was 33.33%, 36.23% and 65.22% at 3-6, 12 and 24 months, respectively. There was 62.32%, 80.56% and 89.22% patients achieved HPV clearance at 3-6, 12 and 24 months after PDT treatment, respectively. The LSIL remission rate was 89.86%, 94.40% and 96.08% at 3-6, 12 and 24 months after ALA PDT, respectively. The abnormal TCT (≧ ASCUS) was reduced from 92% to 10.1%, 4.6% and 3.9% at 3-6, 12 and 24 months after ALA PDT, respectively. The patient age was not a factor affecting the clearance of HPV infection and the LSIL regression rate of PDT treatment. ConclusionsThis study demonstrates that the application of multiple ALA PDT treatments has added value in achieving both short-term and long-term HPV and lesion clearance.

Assessment and correction of local antimicrobial protection factors in women with chronic recurrent vulvovaginal candidiasis and type 2 diabetes mellitus

Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria, decreased phagocytic activity of NG in vaginal secretions by 25.8%, impairment of their spontaneous and latex-induced NBT-reducing activity by 35.2%, functional reserve by 23.0% relative to reference values. The use of the drug Genferon® as part of complex therapy for rVVC contributed to a decrease in the number of Candida spp. in 1st and 3d months of observation after completion of anti-relapse therapy, normalization of cellular factors of innate immunity of the mucous membranes, faster resolution of the clinical manifestations of an episode of the disease. The decrease in the number of relapses over a 12-month observation period compared to the control group was also facilitated by an increase in the protective properties of the vaginal mucosa due to the restoration of the vaginal microbiota with the help of lactobacilli acidophilus. Conclusion. The etiological agents of rVVC in women of late reproductive age are C. albicans and C. glabrata. Subcompensated DM 2 is a risk factor for rVVC, which requires additional monitoring of microbiological parameters of the vaginal microbiota. rVVC in women with DM 2 is associated with an increase in the number of NG in the vaginal secretion, a decrease in their phagocytic activity and functional reserve compared to the reference values. Combination therapy of rVVC with topical recombinant interferon α2b, benzocaine and taurine in the formulation of Genferon® (suppositories) is an effective method to improve the clinical and immunological efficacy of therapy.

Use of transrectal high-frequency ultrasound in assessment of middle compartment prolapse.

To investigate the superiority of transrectal high-frequency ultrasound (TRUS) in precise assessment of middle compartment prolapse in comparison with routine transperineal ultrasound (TPUS). Prospectively analyzed and compared detection rates of entire cervical length and uterine descent on TPUS and TRUS in 101 patients with pelvic organ prolapse (POP). Detection rates of entire cervix on TRUS were significantly higher than those on TPUS both at rest and during Valsalva maneuver (90.10% VS 49.50%, 92.08% VS 9.90% respectively, both p < 0.05). Uterine descent was able to be evaluated in 92.08% of patients by TRUS and in 5.94% of patients by TPUS, which was statistically significant (p < 0.05). The interobserver repeatability for the measurements of anterior lip, cervical canal and posterior lip on TRUS was excellent. The mean lengths of anterior lip, cervical canal and posterior lip were significantly increased during Valsalva maneuver than those measured at rest (p < 0.05). And mean length of anterior lip was longer than posterior lip both at rest and during Valsalva (p < 0.05). TRUS can significantly raise detection rates of entire cervix, and make the direct evaluation of uterine descent feasible. TRUS can be used as a complementary method to TPUS to attain more comprehensive and accurate presurgical imaging information in middle compartment prolapse patients.

Role of dynamic ctDNA monitoring in cervical and anal epidermoid carcinomas under curative chemoradiation.

3141 Background: Cervical and anal canal squamous cell carcinoma (SSC) are a significant health problem in underdevelopment countries. Definitive chemoradiation (CRT) is the standard-of-care (SOC) approach for curative treatment in locally advanced disease. Due to the common substantial local inflammation during CRT, the conventional clinical image cannot identify non-responders early. In this scenario, the evaluation of circulating tumor DNA (ctDNA) is a promising tool for real-time tumor response monitoring. Methods: We performed a prospective multicentric cohort study of patients treated between 2020 and 2023 in tertiary oncologic centers in Brazil to evaluate the role of ctDNA dynamic monitoring in epidermoid cervical (CC) and anal cancer (AC) T1-4, N0-1, M0 by AJCC 8th edition and candidates to complete curative CRT. The cDNA was assessed by Signatera test at D1, D29, immediately post-treatment, 8 weeks (w) post-CRT, 24w post-CRT, every 6 months (m) in the first 1-2 years(y), and yearly at 3-5y of follow-up (FUP). The primary endpoint was to estimate the correlation of ctDNA with a tumoral response assessed by conventional routine image and clinical evaluation at 8w. Secondary endpoints included a correlation between ctDNA results at different time points with progression-free survival (PFS) and overall survival (OS). The predictive potential of the biomarker was evaluated using receiving operating characteristic (ROC) curve analysis. Results: We included 33 patients, and 27 were evaluable with ctDNA, with a median FUP of 10m. The majority were female (n=23, 85.1%), and 3 (11%) were HIV-positive(+). Most patients presented with positive nodes and stage III disease (n=18, 66.6%). In the AC group (n=15), the majority received CRT with capecitabine and cisplatin (n=12, 55.5%); in the CC group (n=12), all pts received cisplatin. All pts tested expressed ctDNA+ before treatment. At 8w, images had a sensitivity of 42.8% and specificity of 100% for disease progression (area under the curve [AUC] 0.714), while ctDNA yielded a sensitivity of 85.7% and specificity of 89.4% (AUC 0.875). The ctDNA+ immediately after CRT ended (32%) was consistent with ctDNA+ at 8w (30.7%) and 24w (30%). Pts with ctDNA+ immediately post CRT have a higher risk of disease progression with PFS of 8.2m in ctDNA+ and not reached in ctDNA- group (HR:17.5; IC95%:1.9-157.3; p=0.01). Data are immature for OS analysis. Conclusions: CtDNA immediately post-CRT has a high predictive value in patients with anal and cervical tumors in early access CRT non-responders, who are at a high risk of disease progression. This biomarker should be considered for tailoring strategies of treatment escalation in this population.

Ultrasonography and Pregnancy Outcome in Threatened Abortion: A Prospective Observational Study

Background: Women who experience vaginal bleeding in the early stages of their pregnancy should be extremely worried about the phenomenon of "threatened abortion". Predicting the course of a pregnancy and choosing the best management techniques are critical to providing the best possible care for patients. The purpose of this investigation's prospective observational design was to learn more about the predictive power of ultrasound and how it may affect the medical management of upcoming abortions. Method: For the study, 200 first trimester pregnant women who showed indicators of an imminent abortion were gathered between X and Y. We looked at the fetus's heart, the size of the cervical canal, and a few other parts of the gestational sac using ultrasonography. Furthermore, records pertaining to the existence of extra data, like subchorionic hematoma, were found. Numerous exams were conducted to monitor the pregnancy's development. Results: Of the research's participants, 35% miscarried for unidentified reasons, and 65% were able to bring their pregnancies to term. The pregnancy's outcome could be accurately predicted based on the ultrasonography results. More specifically, there was a significant correlation between the development of a visible gestational sac and the presence of fetal heart activity and a higher chance of a successful pregnancy outcome. This was a strong relationship. On the other hand, women who had a subchorionic hematoma or a shorter cervical length were found to have a significantly higher risk of miscarriage. These findings show the value of ultrasonography as a technique for forecasting the course of pregnancies that are at risk of ending because of difficulties connected to the threat of abortion. Conclusion: Investigation's prospective observational design shows how ultrasound can be used to evaluate the advancement of pregnancy to determine cases where an abortion is likely to occur soon. Clinical decision-making based on ultrasound findings can improve patient management plans, patient counseling, and care for expectant patients. If prompt intervention using ultrasonographic signs improves the results of pregnancy at high risk, more research is needed to make that determination. Keywords: Ultrasonography, Threatened Abortion, Subchorionic Hematoma, and Ultrasound Markers

Oestrogen and progesterone concentrations in intrapartum cows with insufficient cervix dilation

AbstractThe cervix is an important organ that has to dilate sufficiently at delivery to allow the foetus to transition to extrauterine life. Insufficient dilatation of the cervix (IDC) is a frequent cause of dystocia in cattle. The mechanisms underlying cervical opening and the pathogenesis of IDC are still widely unclear. Systematic studies on the relationship between IDC and steroid hormones have been limited and have yielded inconsistent findings. This study aimed to measure oestrogen and progesterone (P4) concentrations in intrapartum cows presented with dystocia due to IDC and in a comparison (C) group of cows with eutocic delivery. Before any obstetrical procedures, and right after the initial evaluation, blood samples were taken from IDC and C animals. Concentrations of P4, oestradiol‐17β (E2), free total oestrogens (FTE) and conjugated total oestrogens (CTE) were measured by established radioimmunoassays. Concentrations of P4 (p = .538), FTE (p = .065) and CTE (p = .605) were not statistically different between C and IDC groups. However, E2 levels in group C were significantly lower when compared to those in the IDC group (p = .013), which is inconsistent with the function of oestrogens in cervical dilatation. The correlation analysis demonstrated significant positive correlations between the pairs P4 versus FTE, P4 versus E2 and FTE versus E2 in group C and between the pair FTE versus E2 in group IDC. In conclusion, the results suggest that local activities of steroids relevant to the aetiology of IDC are not reflected by concentrations in the systemic circulation or that other factors are clearly more important.

STUDY OF THE CONCEPT OF UTERUS IN AYURVEDA WITH APPLIED ASPECTS

The Uterus is the child bearing organ in female, situated in the pelvis between the bladder and rectum. The uterus can be divided into an upper part, consisting of the fundus and the greater part of the body and a lower part consisting of the body, and of the cervix. The upper narrow end is called the internal os and the narrow lower end is called the external os. The cavity of the uterus communicates with that of the vagina through the external os. The study aims to evaluate various terminologies related to the uterus and its parts in Ayurveda. Morphological considerations of various terminologies along with applied aspects with references were studied. The present study is designed to analyze the concept of the uterus from Ayurvedic classics and interpreted. Elucidated terminologies were analyzed from structural anatomy, dimensions, location, and applied aspects. Various terminologies are used to represent the Uterus and its parts which can be correlated as follows- Uterus: Yoni, Phalayoni, Garbhasaya , Garbhakosha, Kukshi, Kshetra. Cervix with External Os: Garbhamarga, Garbhachidra. Fallopian tube /Uterine tubes: Raktavahasrota, Artavahasrotamsi, Artavavahasrotas, Artavavahamarga. Blood Supply: Artavavahasrotamsi, Artavvahinyadhamani.

Changes in canal diameter and cervical lordosis in patients who underwent en-bloc laminoplasty for the treatment of cervical spinal stenosis

Objective: Cervical spinal canal-expanding laminoplasty has been recognized as an alternative to cervical laminectomy, especially in multilevel cervical myelopathy due to spinal stenosis. This study aimed to determine the effects of En-block laminoplasty on cervical sagittal balance, cervical spine biomechanics and whether it is sufficient to preserve cervical canal diameter and lordosis and whether it causes additional lordosis or kyphosis in cases of cervical narrow spinal canal. Methods: Thirty-eight cervical narrow canal patients operated on between 2008 and 2020 were retrospectively evaluated and the results of 24 laminoplasty patients were evaluated. Spinal tomography results for the evaluation of canal diameter changes and X-ray results for cervical sagittal balance evaluation were compared with each other in the early postoperative period and 3 years later. For cervical lordosis assessment, Cobb and C2-C7sagital vertical axis measurements were performed using the PACS system. Results: Fifteen patients were male and 9 were female. The mean age was 65.55±11.56 years (min-max: 58-84) and the mean follow-up period was three years. Two patients had one level stenosis, 4 had two levels, 7 had three levels, and 11 had four or more levels. Radiculopathy was present in 17 patients (71.8%) and myelopathy in 7 patients (29.1%). There was no statistically significant difference in the frequency of myelopathy/radiculopathy between genders. When all distances were considered, no statistical difference was observed in the early postoperative period (median ten days) and late postoperative period (median 3 years) in terms of canal diameters. No measurement value could be obtained for any level diagnosed as restenosis or requiring reoperation. Loss of lordosis was measured in only one patient. Otherwise, lordosis was preserved in all cases at late conversion. Conclusions: The results of our study showed that en-block laminoplasty after the cervical narrow spinal canal was sufficient to maintain the cervical canal diameter in the long term with appropriate patient and surgical technique.

CELASTO (Cervical ELASTOgraphy) pilot study — the use of cervical elastography during pregnancy

BACKGROUND: Ultrasound assessment of cervical length is an integral part of a comprehensive examination during pregnancy, but it does not provide a complete picture of structural changes in the cervix. The use of E-Cervix elastography is a promising method to assess cervical remodeling throughout the gestation period. AIM: The aim of this study was to evaluate the possibility of using automated cervical elastography in clinical practice to analyze the main parameters of cervical elasticity and hardness in pregnancy. MATERIALS AND METHODS: This prospective pilot study included 136 patients with singleton pregnancies at gestational ages ranging from 7+0 to 41+0 weeks. Cervical elastography was performed using E-Cervix software of the W10 diagnostic ultrasound system (Samsung Medison Co., Ltd., South Korea) with evaluation of quantitative parameters such as hardness ratio, elasticity contrast index, internal os, external os. RESULTS: Correlation analysis showed that hardness ratio decreased with increasing gestational age (ρ = −0.439) and decreasing cervical length (ρ = 0.408; p 0.001). In the group of patients with cervical length less than 25 mm, there was a decrease in hardness ratio compared to the control group (48.0 vs. 63.8%, respectively; p 0.001). The elasticity contrast index score, which reflects cervical tissue heterogeneity, increased with gestational age and cervical shortening (ρ = 0.368 and −0.450, respectively), the parameter being higher in patients with cervical length less than 25 mm [4.73 (IQR 4.21–5.90); p 0.001]. The increase in internal os and external os with gestational age (ρ = 0.433 and ρ = 0.365, respectively; p 0.001) indicates softening of the cervix and is accompanied by its shortening. CONCLUSIONS: Results indicate decreased hardness and increased elasticity of the cervix with increasing gestational age and decreased cervical length. E-Cervix technology allows for assessing structural changes in the cervix throughout pregnancy, starting from early gestation.

Does cervical root canal preparation influence the quality of endodontic treatment? A systematic review

Cervical preparation aims to remove dentin prominences located in the cervical region of the root canal. However, there is no consensus in the literature regarding the importance of this operative maneuver in endodontic treatment. The objective of this systematic review was to answer the question: Does cervical root canal preparation influence the quality of endodontic treatment? Material and methods: Electronic databases (Medline/PubMed, Lilacs, Scopus, Embase, Scientific Electronic Library Online – SciELO, and Central Register of Controlled Trials – Central) were searched until July 2023, without language or year restriction. Grey literature was also searched through Google scholar and OpenGrey repository. Only in vitro studies were included that evaluated the influence of cervical preparation on endodontic treatment. Relevant results were summarized and evaluated. The risk of bias was also assessed in the studies. Results: Initial screening of databases resulted in 235 studies, of which 80 were excluded for being duplicates. Of 155 eligible papers, twenty-nine studies met the inclusion criteria and were selected for full-text reading. Most of studies included in this review were qualified with low risk of bias. Five studies showed moderate risk. Conclusion: Based on the analyzed studies, it is possible to conclude that performing the cervical preparation facilitates the execution of the steps of odontometry and mechanical chemical preparation in clinical practice.

A Three-Dimensional Morphological Assessment for Evaluating Pre- and Postsurgery in Cervical Laminoplasty

ObjectiveThe efficacy of medical treatments and the changes in radiological imaging before and after treatment have consistently remained pivotal factors. This is particularly critical for surgical procedures, where precise evaluation of disparities pre- and post-surgery or the accuracy of implantation is paramount. Based on three-dimensional morphological interests, we provide an automatic quantification evaluation method that delivers an evident base for assessing the outcomes of a widely employed surgical technique, cervical laminoplasty. MethodsThe sample study included patients who underwent cervical laminoplasty for cervical spondylotic myelopathy/ossification of the longitudinal ligament. We present a superimposition method that facilitates a unique and precise assessment between pre and post-surgery. The degree of expansion was evaluated by the canal volume increase and canal expansion rate after surgery. ResultsThere were 31 patients with 112 vertebral segments measured. The target cervical's pre- and post-operative canal areas were 122.63 ± 30.34 and 196.50 ± 37.10 mm2, respectively (P < 0.001). The average cervical canal expansion rate was 64.42%. The expansion effect of C5 cervical laminoplasty was the maximum (71.01%), and the canal volume of other segments expanded by approximately 60%. The functional outcomes demonstrated significant improvements in symptoms. ConclusionsThe quantification evaluation method can be utilized for any morphology changes before and after laminoplasty, as it does not lead to errors or variations from different inspection machines or human factors. The automatic method delivers an evident base for assessing the outcomes of a widely employed surgical technique.

A novel technique for the measurement of cervical length in non-pregnant women.

Cervical elongation is considered a risk factor for pelvic organ prolapse treatment failure in uterine preservation surgery. Consensus has not been reached regarding what is considered a normal cervical length, or how to measure it. Our primary aim was to test a new technique for measuring cervical length. We enrolled women undergoing hysterectomy, with or without pelvic organ prolapse (for all indications except cervical tumours/history of cervical operations). Their cervical lengths were measured both by ultrasound and anatomical measurement. The external length of the cervix was measured using Doppler location of the uterine artery near the cervical-uterine junction as the proximal point and compared to the ultrasound measurement of the cervical canal. The uterine specimen was used to record anatomical cervical measurements as well as uterine corpus length. Baseline characteristics such as age, body mass index and pelvic organ prolapse quantification were also collected. Twenty women were eligible for evaluation. We found the average anatomical cervical canal length was (ccAN) 33.95 mm (range ± 9.23) and by external measurement (ceAN) 36.80 mm (range ± 7.54). We found a significant, high-powered correlation between our ultrasound and anatomical measurements in both techniques, as well as between the two ultrasound techniques. We also found a negative correlation between cervical length and women's age (rp = -0.443, P = 0.05). Transvaginal ultrasound measurement of cervical length using the location of the uterine artery was found to have a strong correlation to the anatomical cervical length and can be used for the measurement of normal cervical length.

Primary Ewing’s sarcoma of the uterine cervix: a case report and review of the literature

BackgroundEwing’s sarcoma (ES) is an aggressive cancer of bone and soft tissue, most of which tend to occur in the bone. Extraosseous Ewing’s sarcoma (EES) of the cervix is extremely rare.Case presentationIn the present work, we reported a 39-year-old cervical EES patient with a 2.5*2.1*1.8 cm tumor mass. According to previous literatures, our case is the smallest tumor found in primary cervical ES ever. The patient initially came to our hospital due to vaginal bleeding, and then the gynecological examination found a neoplasm between the cervical canal and partially in the external cervical orifice. The diagnosis of EES was confirmed below: Hematoxylin & Eosin staining (H&E) revealed small round blue malignant cells in biopsy specimens. Immunohistochemistry (IHC) showed the positive staining for CD99, NKX2.2, and FLI1. Disruption of EWSR1 gene was found by fluorescence in situ hybridization (FISH), and the EWSR1–FLI1 gene fusion was determined by next-generation sequencing (NGS). The patient received laparoscopic wide hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, and postoperative adjuvant chemotherapy and remained disease free with regular follow-up for 1 year.ConclusionsThrough a systematic review of previously reported cervical ES and this case, we highlighted the importance of FISH and NGS for the accuracy of ESS diagnosis, which could assist on the optimal treatment strategy. However, due to the rarity of the disease, there is no standard treatment schemes. Investigation on molecular pathological diagnosis and standardization of treatment regimens for cervical ES are critical to patients’ prognosis.

Vasa Previa and the Role of Fetal Fibronectin and Cervical Length Surveillance: A Review.

Vasa previa is a pregnancy complication that occurs when unprotected fetal blood vessels traverse the cervical os, placing the fetus at high risk of exsanguination and fetal death. These fetal vessels may be compromised by fetal movement and compression, leading to poor oxygen distribution and asphyxiation. Diagnostic tools for vasa previa management and preterm labor (PTL) include transvaginal ultrasound, cervical length (CL) surveillance and use of fetal fibronectin (FFN) testing. These tools can prove to be quite useful as they allow for lead time in the prediction of PTL and spontaneous rupture of membranes which can result in devastating outcomes for pregnancies affected by vasa previa. We conducted a literature review on vasa previa management and the usefulness of FFN and CL surveillance in predicting PTL and found 36 related papers. Although there is limited research available to show the impact of FFN and CL surveillance in the management of vasa previa, there is sufficient evidence to support FFN and CL surveillance in predicting the onset of PTL, which can have devastating consequences for the pregnancies affected. It can be extrapolated that these tools, by helping to determine pregnancies at risk for PTL, could improve management and outcomes in patients with vasa previa. Future studies investigating the management of vasa previa with FFN and CL surveillance to reduce the burden of PTL and its associated comorbidities are warranted.

The categorization of opaque pathologies outside of contrast media in hysterosalpingography which facilitate interpretation: A pictorial review.

Hysterosalpingography (HSG) is a practical and reliable imaging method to evaluate the cervical canal, uterine isthmus, uterine cavity, and fallopian tubes. Using HSG, opaque pathologies outside of contrast media can be detected as well as pathologies of uterus and fallopian tubes. We aim to present and categorize some uncommon and interesting abnormal findings that are located outside of the contrast areas in HSG. This is a pictorial review that depicts various types of HSG images that include opaque pathologies outside of the contrast areas. Images have been extracted from valuable archives collected over 50 yr by professor Shahrzad. A plain pelvic film contains soft tissues of the pelvis, bony structures, artifacts, or foreign bodies. Categorization might easily help the radiologist to interpret the HSG cliché. Opaque pathologies outside of contrast area in HSG can be categorized into 2 groups: "Pelvic Tissue Related" and "Foreign Bodies". Pelvic tissue abnormalities might have a gynecologic or non-gynecologic source. Foreign bodies can be located in the pelvis or outside of the body. HSG is a reliable and inexpensive procedure. Familiarity with the pathologies of pelvic tissues and the accurate interpretation of HSG images are important.