Routine Gynecologic Examination Research Articles

Female sexual function in long-term cervical cancer survivors compared with healthy women and women affected by benign gynecological disorders

ObjectiveTo compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases. Study designFrom January 1, 2010 to January 31, 2019, a case-control study was conducted to compare the female sexual function of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a routine gynecological examination (n=46) or for a benign gynecological disorder (symptomatic, n=113; asymptomatic, n=26).We prospectively assessed the female sexual function using the Female Sexual Function Index (FSFI). For the contrastive analysis hypothesis, we employed R statistical software. ResultsCervical cancer survivors reported lower sexual activity rates than controls, in general, did (47.12% vs. 88.65%, p=0.0001), and, particularly, compared with healthy and symptomatic controls (47.12% vs. 82.61%, p=0.003; 47.12% vs. 87.61%, p=0.0001, respectively).Sixty and fifty-eight hundredths percent of the cervical cancer survivors experienced female sexual dysfunction, mainly due to hypoactive sexual desire (93.27%). Female sexual dysfunction was diagnosed in 64.32% of the controls, with sexual arousal disorders being the most common diagnosis (44.86%).Compared with controls, cervical cancer survivors exhibited considerably lower FSFI total scores and in sexual desire and lubrication domains (p <0.000; p <0.0001; p=0.023). ConclusionsCervical cancer survivors had worse female sexual function and less sexual activity than controls did, although scores in both groups were in range of FSD. Rates of female sexual dysfunction were similar across cervical cancer survivors and controls, with hypoactive sexual desire and sexual arousal disorders as the most common diagnoses, respectively.

The Need for Gynecological Ultrasound Examination on IUD Acceptors

Maternal Mortality Rate (MMR) signifies the number of women who perish due to pregnancy-related complications or their treatment per 100,000 live births, with septic shock emerging as a notable contributor. One such complication linked to septic shock is the rare but perilous translocation of intrauterine devices (IUDs), leading to potential uterine perforation. A recent case of maternal death underscored the urgency of prompt intervention in intraabdominal IUD translocations, with the delay stemming from the refusal of necessary surgical procedures. This tragic incident emphasizes the critical need for timely detection and management of IUD translocations to avert life-threatening complications. Integrating routine gynecological ultrasound examinations to assess uterine shape for prospective IUD acceptors and promoting informed consent through engagement with family members, community leaders, and policymakers is essential in mitigating the risk of maternal mortality associated with such complications.

Causes of abnormal uterine bleeding in women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified at a tertiary care hospital: A cross-sectional study

Abstract Background: Approximately 10%–25% of women are affected with abnormal uterine bleeding (AUB). It is essential to have a thorough understanding and knowledge about the disease, causative factors, pathophysiology, incidence and prevalence of various causative factors, clinical presentations, and diagnostic aids for an early prediction and diagnosis of disease to treat the condition at the earliest possible phase and with minimum morbidity and costs. Objective: The objective of this study was to study the causes of AUB women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified (PALM COEIN). Materials and Methods: It was a hospital-based prospective study among 136 patients with AUB aged 20–60 years. History, general and gynecological examination, and routine gynecological examination were done using speculum examination of the vagina and the cervix and a bimanual examination. Routine investigations and an ultrasonography were done. Some were subjected to PAP smear as a routine procedure. Results: Women aged 31–50 years and multiparous were most affected with AUB in 84.6% and 88.9% of cases, respectively. According to the International Federation of Gynecology and Obstetrics type classification, the most common type of presentation was heavy menstrual bleeding in 54% of cases. The most common presenting symptom was pain in the abdomen in 4.4%. The most common-related symptom was spasmodic dysmenorrhea in 36%. The most common clinical sign was pallor in 25%. The most common associated comorbidity was anemia in 49%. Leiomyoma was the most common ultrasound diagnosis of underlying pathology in 52.2%. The most common cause of AUB as per PALM COEIN was AUB leiomyoma in 52.2%. Conclusion: Our study shows that the causation of AUB was multifactorial (though in some cases, solitary lesions were found) involving the entire female reproductive system resulting in a single common presentation as AUB.

Uterine fibroids - a literature review

Uterine fibroids are the most common benign neoplastic lesions occurring in women. They are formed as a result of proliferation of smooth muscle tissue cells. Their appearance and proliferation are influenced by both genetic and environmental factors. 70% of them remain asymptomatic, so they are often detected only during a routine gynecological examination or pelvic imaging studies. Uterine myomas can generate pelvic and lower abdominal discomfort and pain, abnormal, prolonged, heavy bleeding, anemia, dyspareunia, frequent urination, bloating, constipation, abdominal cramps, low back pain and obstetric complications. Available therapeutic strategies include conservative, pharmacological and surgical treatment. The choice of a particular method is considered on an individual basis and depends on the presence of clinical symptoms, the size, location of the myomas, or the age and procreative plans of the patient.

Plasma metabolomics for diagnostic biomarkers on ectopic pregnancy

Metabolomics is a relatively novel omics tool to provide potential biomarkers for early diagnosis of the diseases and to insight the pathophysiology not having discussed ever before. In the present study, an ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was employed to the plasma samples of Group T1: Patients with ectopic pregnancy diagnosed using ultrasound, and followed-up with beta-hCG level (n = 40), Group T2: Patients with ectopic pregnancy diagnosed using ultrasound, underwent surgical treatment and confirmed using histopathology (n = 40), Group P: Healthy pregnant women (n = 40) in the first prenatal visit of pregnancy, Group C: Healthy volunteers (n = 40) scheduling a routine gynecological examination. Metabolite extraction was performed using 3 kDa pores - Amicon® Ultra 0.5 mL Centrifugal Filters. A gradient elution program (mobile phase composition was water and acetonitrile consisting of 0.1% formic acid) was applied using a C18 column (Agilent Zorbax 1.8 μM, 100 x 2.1 mm). Total analysis time was 25 min when the flow rate was 0.2 mL/min. The raw data was processed through XCMS – R program language edition where the optimum parameters detected using Isotopologue Parameter Optimization (IPO). The potential metabolites were identified using MetaboAnalyst 5.0 and finally 27 metabolites were evaluated to be proposed as potential biomarkers to be used for the diagnosis of ectopic pregnancy.

Women's perceptions and preferences for cervical cancer screening in light of updated guidelines.

Updated risk-based guidelines for cervical cancer screening (CCS) allow for individualized screening that minimizes unnecessary testing. However, these guidelines are complex and may not be easily understandable to patients. To describe women's perceptions and preferences about CCS in light of recent guideline changes. This qualitative study conducted in February 2020 used online, text-based focus groups with a sample of US women (n = 49) ages 27-45. After participants completed a short demographic survey, an experienced moderator used a semistructured guide to solicit participants' perceptions of routine gynecologic care and CCS. We summarized survey data using descriptive statistics. Two authors analyzed transcripts using conventional content analysis and met with other team members to resolve discrepancies and determine final themes. Most participants were non-Hispanic White (65%), had health insurance (90%), and reported having a routine gynecologic examination in the past year (70%). We identified four common themes: (1) low perceived risk of human papillomavirus (HPV) coupled with low knowledge about HPV as a causative factor for cervical cancer, (2) confusion about-and mistrust of-recent individual risk-based guidelines that determine the indicated timing and type of CCS test (Pap or HPV testing), (3) mixed opinions about performing a self-swab for HPV testing, and (4) conflicting perceptions of trust toward providers and the health care industry. Findings highlight women's uncertainty and hesitancy about updated CCS guidelines. Provider-patient communication strategies should consider women's gaps in knowledge about HPV, include the rationale for guidelines and types of tests, and build trust between patients and providers.

Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study.

The aim of this study was to explore risk factors of recurrent bacterial vaginosis (RBV) among women of reproductive age. This cross-sectional study was carried out in real-world conditions. Women with RBV were selected, and simultaneously uncomplicated bacterial vaginosis (UBV) and those who underwent routine gynecological examination and had normal vaginal microflora were also recruited as the control. Totally, 316 participants were enrolled. Univariate analysis showed that unemployment, desserts, and wiping were related to UBV, while there was no definite relationship between education, high body mass index, smoking, sedentary lifestyle, and RBV or UBV. History of human papillomavirus infection, contraceptive methods, age at first sexual intercourse, and not cleaning vulva during sexual activity were connected with UBV, while the history of other vaginitis and number of sexual partners in the previous year were related to both RBV and UBV. Multivariate logistic regression analysis revealed that lower educational level increased the risk of suffering RBV. Interestingly, no smoking was a protective factor. Moreover, the absence of other vaginitis and an exclusive sexual partner could also weaken the risk of incurring RBV. These various adverse factors alter endocrine function and vaginal immunity, further leading to the recurrence of BV. It is necessary to take corresponding measures to avoid risk factors and to help lessening the prevalence of RBV among women of reproductive age.

Malignant neoplasm of the sigmoid colon found accidentally during a routine gynecological examination

Malignant neoplasm of the sigmoid colon found accidentally during a routine gynecological examination

P-684 Subclinical hypothyroidism and ovarian reserve indices in women with normogonadotropic anovulation

Abstract Study question Does subclinical hypothyroidism (SCH) affect ovarian reserve indices in women with Polycystic Ovary syndrome (PCOS) or other forms of Hypothalamic-Pituitary-Ovarian Axis Dysfunction (HPOD)? Summary answer SCH increases Anti-Müllerian hormone (AMH) concentration, but has no influence on Follicle-stimulating hormone (FSH). What is known already In PCOS, anovulation is caused by the arrest of growing follicles due to increased frequency and amplitude of luteinizing hormone (LH) pulses, resulting in increased number of pre-antral and antral follicles, and concentration of AMH. In other cases of HPOD, the causes of anovulation are more diverse and have not yet been clearly identified. Thyroid hormones can modify the function of the HPO axis, affecting the maturation of follicles. While overt hypothyroidism is treated to improve ovulation and fertility, the effect of subclinical hypothyroidism (SCH) and the presence of circulating antithyroid antibodies (ATA) on ovarian function is uncertain. Study design, size, duration A prospective cohort tertiary single-center study (consent no. 1072.6120.172.2022) included women aged 18-45, examined due to menstrual disorders and/or infertility, from July to August 2022. Only women without previously diagnosed thyroid dysfunction were included. All enrolled women gave informed written consent to participate in the study. Participants/materials, setting, methods Women underwent routine gynecological examination and pelvic ultrasound. Blood sample was tested for AMH, FSH, Luteinizing hormone (LH), Thyroid-stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies concentrations. The Rotterdam-ESHRE-ASRM criteria were used to diagnose PCOS and its phenotypes. HPOD was diagnosed according to WHO classification. SCH was defined as TSH &amp;gt; 2.5 uIU/ml with normal thyroid function. The above parameters within subpopulations were calculated using regression analysis, Kruskal-Wallis and post-hoc tests. Main results and the role of chance The study included 51 euthyroid women aged 18-40. PCOS was diagnosed in 42/51 (82.35%) women, including PCOS-A phenotype in 31/51 (60.78%), PCOS-B in 5/51 (9.8%), PCOS-D in 6/51 (11.76%) women, and HPOD in 9/51 (17.65%) women. There was a significant positive correlation between the concentration of TSH and AMH in the studied population - with the increase of TSH value, the concentration of AMH increased (r = 0.4, p = 0.0035). The mean AMH concentration significantly differed between the groups and equaled to 55.4, 39.4, 31.1, 24.0 pmol/l in PCOS-A, PCOS-B, PCOS-D and HPOD (p = 0.05), respectively. The mean anti-TPO concentration was significantly different between the groups and was equal to 18.2, 19.0, 14.6, 10.9 U/ml in PCOS-A, PCOS-B, PCOS-D and HPOD (p = 0.05), respectively. There was no significant difference in FSH, LH, TSH, anti-TG concentrations between the groups. Limitations, reasons for caution The limitations of the study are small study group and single-center nature. Wider implications of the findings SCH increases the concentration of AMH, which in PCOS may exacerbate the symptoms of anovulation. Whether treatment of subclinical hypothyroidism affects ovarian reserve indices and improves ovarian function remain a subject of further research. Trial registration number 1072.6120.172.2022

Investigation and influencing factors on pelvic floor muscle strength of 929 adult females in gynecological outpatient department

Objective: To investigate the present situation of pelvic floor muscle strength, and to analyze the factors affecting pelvic floor muscle strength. Methods: The data of patients who were admitted into the general outpatient department of gynecology, Peking University People's Hospital from October 2021 to April 2022 were collected, and the patients who met the exclusion criteria were included in this cross sectional study. The patient's age, height, weight, education level, defecation way and defecation time, birth history, maximum newborn birth weight, occupational physical activity, sedentary time, menopause, family history and disease history were recorded by questionnaire. Morphological indexes such as waist circumference, abdomen circumference and hip circumference were measured with tape measure. Handgrip strength level was measured with grip strength instrument. After performing routine gynecological examinations, the pelvic floor muscle strength was evaluated by palpation with modified Oxford grading scale (MOS). MOS grade>3 was taken as normal group and ≤3 as decreased group. Binary logistic regression was used to investigate the related factors of deceased pelvic floor muscle strength. Results: A total of 929 patients were included in the study, and the average MOS grade was 2.8±1.2. By univariate analysis, birth history, menopausal time, defecation time, handgrip strength level, waist circumference and abdominal circumference were related to the decrease of pelvic floor muscle strength (all P<0.05). By binary logistic regression analysis, the level of handgrip strength (OR=0.913, 95%CI: 0.883-0.945; P<0.001) was correlated with normal pelvic floor muscle strength; waist circumference (OR=1.025, 95%CI: 1.005-1.046; P=0.016), birth history (OR=2.224, 95%CI: 1.570-3.149; P<0.001), sedentary time> 8 hours (OR=2.073, 95%CI: 1.198-3.587; P=0.009) were associated with the decrease of pelvic floor muscle strength. Conclusions: The level of handgrip strength is related to the normal pelvic floor muscle strength of females, while the waist circumference, birth history and sedentary time>8 hours are related to the decrease of pelvic floor muscle strength of females. In order to prevent the decrease of pelvic floor muscle strength, it is necessary to carry out relevant health education, enhance exercise, improve the overall strength level, reduce daily sedentary time, maintain symmetry, and carry out comprehensive overall intervention to improve pelvic floor muscle function.

Controlling Nutritional Status score and postmenopausal osteoporosis.

This study investigated the association between CONUT score and postmenopausal osteoporosis. Postmenopausal women who were seen at an outpatient clinic in a tertiary hospital for routine gynecologic examination between January 2017 and June 2022 were included in the study. Based on their T-scores, a total of 423 women were divided into two groups. Group 1 included 216 women with osteoporosis (T-score < -2.5 SD), and group 2 included 207 women with normal bone mineral density (T-score > -1 SD). The formula for the CONUT score corresponds to collection of scores from albumin, total cholesterol, and total lymphocyte count. Higher scores indicate poorer nutritional control. Mean age and mean age at menopause were similar in both groups. The duration of menopause, however, was higher in the women with osteoporosis (11.55 ± 6.82 vs 9.202 ± 6.14 y, P < 0.001). The 25-hydroxy vitamin D level was low in both groups. Body mass index of women with normal bone mineral density was higher than that of women with osteoporosis (31.54 ± 4.19 vs 28.52 ± 4.43 kg/m 2 , P < 0.001). The CONUT scores of the two groups were calculated and found to be higher in women with osteoporosis (3.180 ± 1.804 vs 0.391 ± 0.687, P < 0.001). According to the receiver operating characteristic curve analysis of the CONUT score for predicting osteoporosis, the area under the curve was calculated as 0.932, with a sensitivity of 86.6% and a specificity of 91.1% ( P < 0.001). Diet plays an important role in the development of osteoporosis. In this study, it was shown that there is a relationship between CONUT score and osteoporosis.

ICTP concentration in cervical-vaginal fluid as a potential marker of membrane collagen degradation before labor.

Numerous physical and chemical processes lead to rupture of membranes. Within the fetal membranes there are numerous types of metalloproteinases, which cause collagen type I degradation. The C-terminal telopeptide of colagen type I (ICTP) is the breakdown product of type I collagen. The aim of the study was to determine whether ICTP is secreted into the vaginal-cervical fluid (VCF) in the case of physiological rupture of the membranes of the fetus before delivery. The study was conducted in March 2021 at the Department of Obstetrics and Perinatology of the Jagiellonian University in Cracow, Poland. Twenty-three cases were included in the study. During routine gynecological examination with the use of specula, VCF was collected twice in a volume of 50 µL. The obtained material was then subjected to enzyme immunoassay using the Human C-telopeptide of type I collagen (ICTP) ELISA Kit (Catalog Number. CSB-E10363h). The concentration of ICTP in the sample was calibrated. The concentration range that the device can detect was 25 ng /mL-800 ng/mL. The presence of ICTP in the VCF was confirmed. The minimum concentration was 43.72 ng/mL, the maximum was 762.59, in five cases the concentration was outside the maximum scale of the device. ICTP was confirmed in the VCF of pregnant women before physiological delivery. Further studies are required to accurately evaluate ICTP as a marker of the processes of collagen degradation in fetal membranes in the mechanism of physiological labor and premature rupture of the membranes.

Role of ultrasonography in the diagnosis of adnexal masses

Introduction: Adnexal masses are considered to be one of the most common findings that have been encountered in routine gynaecological examination. And ultrasonography solely stayed as the most commonly implemented imaging modality to identify benign from malignant adnexal masses. The aim of the current study was to determine the accuracy of transvaginal ultrasonography (TVUS) in diagnosis of adnexal masses. Materials and Methodology: This study was adopted to be conducted as a prospective study where in 56 female patients were included in the study who were containing 60 adnexal masses. The proposed study was rendered to be around 6 months. And all the study participants were provided their informed consent for carrying out and wilful participation in this study. P value less than 0.05 was considered as statistically significant.Results: Over 47(78%) masses reported in some patients were observed to be benign and 13(22%) were proved to be malignant. The mean age of the patients ranged from 22-65 years and the mean age in those benign group ranged between 42.7±10.2 and those in malignant observed to be 51.2±12.6 and the p – value observed to be ranged less than 0.001.Conclusion: Ultrasound is recommended to be a very useful highly diagnostic and a reliable modality with good sensitivity.

Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3).

The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Cervical Cancer Screening among Female Refugees in Jordan: A Cross-Sectional Study.

Background: Cervical cancer (CC) is mainly linked to infection with a high-risk oncogenic human papillomavirus (HPV), with 85% of deaths occurring in developing countries. Refugees are less likely to be aware of screening methods and to have routine gynecological examinations. Methods: This is a cross-sectional study involving a total of 359 women aged 19–64 living in the Jerash camp in Jordan. Data were collected using a carefully developed and validated questionnaire. Results: A total of 359 participants were included in the study, with a mean age of 38.99 ± 10.53. Participants demonstrated fair knowledge of CC risk factors (4.77 ± 2.85 out of 11). Among the participants, 73.5% had heard of the cervical smear test; however, only 12.8% had actually undergone the test, with a mean total number of smear tests performed of 1.48 ± 0.79 and the mean age at the time of the first test was 32.5 ± 7.89. Conclusions: Refugee women have a fair level of knowledge of CC risk factors but are unmotivated to have a Pap smear test to screen for CC. Efforts should be made to raise awareness about the issue and promote testing for underrepresented women in refugee camps.

662 Recurrent inflammatory diseases of the urogenital tract associated with cytomegalovirus infection

ObjectiveRecurrent inflammatory diseases of urogenital tract (UGT) associated with CMVI and other viral infections is a difficult practical and scientific problem because of the often unpredictable answer of a pathologic process to the treatment. Late diagnosis and ineffective therapy of patients with CMVI and other viral diseases of UGT increase cases of infertility and reduce the quality of life of patients. Study design: 1037 patients, women between 19 to 49 years old (average age 29,02), complaining of itching, burning, discharge, redness, swelling of the vagina and labia, recurrent inflammatory process, burning and pain during urination underwent routine gynecological examination and smears for PCR test “Femoflor” from the cervix, vagina, urethra for detection of CMVI and microbe associations. Results: In 100 patients (9, 64%) the persistence of CMV infection on the mucous membrane of the cervix and urethra was revealed. Monoinfection was detected in 13 patients (13%) In 74 patients (74% )- a violation of the biocenosis of the UGT (Gardnerella spp.), Candida spp in 18 patients (18%), Chlamydia in 6 patients (6%), Ureaplasma spp in 53 patients (53%), M.hominis in 11 patients (11%), M.genatalium - 1 patient (1%), in 1 patient (1%) - Tr. vaginalis. 15% of smears showed LSIL, 1% HSIL, and in 1/3 cases of dysplasia - HPV -test (28 types) was negative. In 67%, the inflammatory process and reactive changes were diagnosed. In 3%, polyps of the cervical canal were detected, in 2% - polyps of the endometrium, that relapses after hysteroscopy and hormons. In 2% of cases was chronic urethritis with the no effectiveness of antibiotics. Conclusions: According to our results if there are clinical symptoms of infections of UGT, CMVI diagnosis is necessary in routine practice. To determine the CMV infection is preferable to study material from the cervical canal, vagina, urethra with DNA detection (PCR method).

Significance of Magnetic Resonance Imaging Combining with Detection of Serum HE4, TSGF, and CD105 Levels in Diagnosis and Treatment of Moderate to Advanced Cervical Cancer

Objective. To explore the significance of magnetic resonance imaging (MRI) combining with detection of serum HE4, TSGF, and CD105 levels in diagnosis and treatment of moderate to advanced cervical cancer. Methods. By means of retrospective study, 50 patients diagnosed with moderate to advanced cervical cancer by cervix biopsy pathology examination in our hospital from October 2018 to October 2019 were selected as the study group, and another 50 healthy individuals who did not have cervical cancer after routine gynecological examination and conventional ultrasound examination in the same period were selected as the control group. At the time of enrollment and 3 months after treatment, all study subjects received MRI examination and serological examination, and their HE4 and TSGF levels were measured by the enzyme-linked immunosorbent assay (ELISA) and chromatography method, respectively, and additionally, the immunohistochemistry SP method was adopted for patients in the study group to measure the microvessel density (MVD) marked by CD105. The relationship between MRI staging and FIGO staging was assessed, the efficacy of combining MRI with detection of serum HE4, TSGF, and CD105 levels in diagnosing moderate to advanced cervical cancer was calculated by plotting the ROC curve, and the imaging changes and serological changes of tumor tissue before and after treatment were analyzed. Results. There were 3 of 4 patients in stage IIa and 14 of 15 patients in stage IIIb presenting MRI findings compatible with clinical examinations; 26 patients in stage IIb and 5 patients in stage IVb presenting MRI findings totally compatible with clinical examination. Before treatment, MRI finding of cervical lesion was irregular soft tissue mass, T1WI appeared isointensity or hyperintensity, and obvious lesion enhancement could be seen by enhanced scan. T2WI appeared mixed signal intensity or hyperintensity, with necrotic tissue and fat suppression being hyperintensity. After treatment, lesions shrunk, originally abnormal signals in 5 patients disappeared, and T1WI and T2WI signals in 45 patients presented no difference compared to before treatment. After T1WI enhancement, mild enhancement could be seen in 41 cases and no enhancement in 4 cases. The CD105-MVD of the study group was (68.98 ± 5.23); before and after treatment, the differences in HE4 and TSGF levels between the study group and the control group were significant ( P &lt; 0.001 ). The sensitivity, specificity, and accuracy rate of diagnosis of MRI diagnosis were respectively 82.0% (41/50), 90.0% (45/50), and 86.0% (86/100), and for the diagnosis combining with serum HE4, TSGF, and CD105 levels, they were 96.0% (48/50), 96.0% (48/50), and 96.0% (96/100), respectively, and AUC (95% CI) = 0.960 (0.908–1.000). Conclusion. MRI staging is objective and accurate and has higher sensitivity when combined with serum HE4, TSGF, and CD105 levels in diagnosing moderate to advanced cervical cancer. All MRI, HE4, and TSGF can reflect the treatment effect of patients and are of great importance to efficacy assessment.

A Capillary Electrophoresis Method for Analyzing the Diversity of Vaginal Microbiome

16S ribosomal RNA (rRNA) gene sequence analysis is the common method to identify the bacteria in human vaginal flora. While specific DNA primers were designed to target 16S rRNA gene sequences, DNA fragment analysis using capillary electrophoresis can obtain more accurate qualitative and quantitative information on the microbiome. This study aimed to assess the ability of capillary electrophoresis method to analyze the diversity of vaginal microbiome and provide a theoretical basis for the accurate gene detection of vaginal flora. We collected 75 vaginal secretion samples from female outpatients aged 25 - 50, who had undergone rou-tine gynecologic examinations in Fujian provincial hospital from March 2021 to April 2021. Clinical diagnosis was based on the results of microscopic examination of Gram-stained specimens and biochemical tests of bacteria (pH value, catalase, leukocyte esterase, sialidases, β-glucuronidase, and acetylglucosaminidase). Vaginal secretion samples were collected and then total bacterial DNA was extracted. We used six pairs of fluorescent dye tagged specific primers that were designed based on the 16S rRNA genes of four Lactobacillus species (L. iners, L. crispatus, L. jensenii, L. gasseri), Gardnerella vaginalis, and Atopobium vaginae. PCR products of six species of bacteria were detected and analyzed by a 3130 Genetic Analyzer. Seventy-five samples were divided into two groups according to the vaginal microbiome evaluation, including 50 cases which had vaginal bacteria balance and 25 cases which had vaginal bacteria disorder. PCR amplification of 16S ribosomal RNA genes of L. iners, L. crispatus, L. jensenii, L. gasseri, Gardnerella vaginalis, and Atopobium vaginae was successfully performed on the DNA extracted from vaginal secretion samples. Four Lac-tobacillus species were detected in 4 - 33 cases of "Balance" group, and Gardnerella vaginalis was detected in 23 cases of "Disorder" group and, simultaneously, Atopobium vaginae was detected in 20 cases. Based on the technique of DNA fragment analysis using capillary electrophoresis method, the most common vaginal bacteria in Chinese healthy women are L. iners and L. crispatus. Gardnerella vaginalis and Atopobium vaginae are the most common pathogenic bacteria detected in the patients who had vaginal bacteria disorder. Using capillary electrophoresis method to detect the vaginal bacteria will be useful for accurate identifica-tion of vaginal microbiome. There will be an application value to find out the composition of the vaginal microbiome rapidly and detect specific gene markers to identify potential pathogenic bacteria when women are at risk of serious illness before they develop obvious symptoms.

Accuracy Of the Gynecology Imaging Reporting And Data System Based Upon Ultrasound Evaluation Of Adnexal Lesions

Background: Globally as growing occurrence ratio of ovarian cancer as well as efficacy of Gynecologic-Imaging Reporting-and-Data-System GI-RADS to diagnose pathologies like ovaries cancer, we designed for evaluating the presentation of diagnosis of this system to differentiate among the adnexal benign and malignant lesions. For routine gynecologic examinations, pelvic ultrasound is generally used, consequential in analysis of adnexal lesions, main stream of which are benign or functional. Though, because of probable difficulties including benign adnexal cyst (i.e. pelvic pain and adnexal torsion) as well as ultimate significance of initial analysis as well as cure of ovarian cancer, precise ultrasound analysis of adnexal lesions is important in clinical run through Methods: We searched google scholar and pubmed form 2000 to December 2019. Selection criteria reporting on the accuracy of GI-R-A-D-S system in ultrasound. Results: In this study, we evaluated 197 women with suspected appendicitis. The proportions of GI-RADS II, III, IV and V were 34.5 (69 cases), 38.0 (76 cases), 19.5 (39 cases) and 6.5 (13 cases). For the high-risk and low-risk GI-RADS subtypes, 72.5% were classified as GI-RADS II and III, and 26 were classified as GI-RADS IV and V, respectively. Conclusive histopathologic analysis was testified for 158 cases. Histopathologic assessment designated that 12(7.6%) of were malignant masses as well as 146(92.6%) were benign. Associating by histopathologic analysis, the GIRADS system specificity, sensitivity, negative predictive value and positive predictive value, as well as negative LR were 91.6, 80.82, 28.2, 99.1, 4.77, and 0.10, correspondingly. The accurateness of the scoring system was 81.64%. Conclusion: This systemic review concluded that by Gynecologic-Imaging-Reporting-Data System, we could measure the possibility of malignant stage through such an organized along with modest recording system thus that system could be valuable in clinician to perform a suitable clinical organization Keywords: Adnexal Diseases, Ovarian Neoplasms, Ultrasonography.

Three‐dimensional gynaecological ultrasound, part one: How, when and why?

AbstractMost high‐end ultrasound systems now incorporate three‐dimensional imaging as a standard feature. As such, the use of three‐dimensional ultrasound is becoming routine in many facets of medical ultrasound, especially obstetrics and gynaecology. Three‐dimensional ultrasound can enhance or even alter a diagnosis in many gynaecological pathologies. However, like any technique, the usefulness and accuracy of the application relies on the operator having adequate application knowledge and technical acquisition skills to be able to use it to its full potential. This is the first part of a two‐part series on this topic. This article serves to educate sonographers and other ultrasound users on how to incorporate a three‐dimensional ultrasound assessment into their routine gynaecological examinations, why this should be done and how to overcome some of the pitfalls encountered with this technique.