Treatment Of Uterine Fibroids Research Articles

Evaluation of physician experience in achieving non-perfused volume ratio of high-intensity focused ultrasound ablation for uterine fibroids: a multicentre study.

ObjectiveTo evaluate the effect of different levels of physician experience on the high-intensity focused ultrasound (HIFU) ablation of uterine fibroids and to provide a reference for the use of non-perfused volume ratio (NPVR) standards during training.MethodsThis prospective multicentre study enrolled patients with uterine fibroids. The effect of the physician’s level of experience on the outcomes under different NPVR standards and the learning curve of six centres without HIFU experience were analysed. The impact of patient demographic and clinical characteristics were also evaluated.ResultsA total of 1352 patients from 20 centres were included in the study. The median NPVRs were 92.00%, 88.10% and 92.86% in the no experience group, inexperienced group and experienced group, respectively. Posterior wall fibroids, lateral wall fibroids and fundus fibroids were inversely correlated with NPVR, while experienced physicians were positively correlated with NPVR. With NPVR ≥ 70% and NPVR ≥ 80% standards, physicians in the no experience group completed the learning curve on the 11th and 16th procedure, respectively. Physicians under a standard of an NPVR ≥ 90% did not complete the learning curve.ConclusionsNPVR ≥ 80% is a standard that is worth using for HIFU treatment of uterine fibroids.

Electrochemical Sensor for Detection of Mifepristone and Cinnamic acid for Treatment of Uterine Fibroids using Immobilized Double-Stranded DNA on the AuNPs modified glassy carbon electrode

Electrochemical Sensor for Detection of Mifepristone and Cinnamic acid for Treatment of Uterine Fibroids using Immobilized Double-Stranded DNA on the AuNPs modified glassy carbon electrode

Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy

Objective: To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids. Methods: A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups. Results: The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups (χ²=0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion: Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

A Modified Bowel Displacement Technique for Magnetic Resonance Imaging–Guided Focused Ultrasound Surgery in the Treatment of Uterine Fibroids and Adenomyosis

The clinical application of magnetic resonance imaging-guided focused ultrasound (MRgFUS) surgery for treatment of symptomatic uterine fibroids is often limited because of the bowel between the abdominal wall and uterus. If bowels are in the pathway of sonication path, firstly filling the bladder, then filling the rectum, and emptying the bladder subsequently can be used to avoid them in recent research. The purpose of this study was to evaluate whether the modified bowel displacement technique (rectal filling first and then bladder filling, with or without subsequent bladder emptying) was feasible to create secure acoustic window. A total of 78 patients who had undergone MRgFUS treatment for uterine fibroids and adenomyosis from January 2020 to November 2020 were included in this retrospective study. Of the 78 patients, 19 patients were treated using a modified bowel displacement technique, whereas the rest of the patients did not require intestinal displacement. High-intensity focused ultrasound was performed using GE Sightec HDXT 1.5 Tesla MR and ExAblate high-intensity focused ultrasound system. Of the 19 patients requiring bowel displacement techniques, 17 patients successfully completed MRgFUS surgery. Magnetic resonance imaging-guided focused ultrasound surgery was feasible in 4 patients after rectal filling, bladder filling, and subsequent bladder emptying. The others received ablation through the extended bladder because of bowel descending after emptying the bladder. The surgery caused no intestinal or uterine complications and no serious discomfort to the patient. The modified bowel displacement technique was effective in displacing interposed bowels during MRgFUS treatment to create safe acoustic pathway for ablating uterine fibroids and adenomyosis.

The use of green tea in the treatment of symptomatic uterine fibroids

Background: Green tea is a natural product, commonly used by women for multiple purposes. Epigallocatechin gallate (EGCG), the major catechin in green tea, exhibits several useful biological effects, including anti-inflammatory, antiproliferative, and antioxidant effects. A study conducted by the US Department of Agriculture reported that green tea has potent anticancer effects against a wide range of human cancer cells. Green tea’s polyphenols are considered responsible for these positive effects, and most notably EGCG has been shown to inhibit key pathways of tumor growth. Objective: Aim of the work was to study the effects of epigallocatechin gallate (EGCG), an extract of green tea on human leiomyoma and quality of life in women with symptomatic uterine fibroids. Patients and methods: A Prospective, sealed envelopes, randomized control trial was conducted including 75 reproductive-age women with symptomatic uterine fibroids (UF) were recruited for this study. All subjects had at least one fibroid lesion ≥ 2 cm³, as confirmed by transvaginal ultrasonography. The subjects had been randomized by SNOSE (Sequentially Numbered Opaque Sealed Envelopes); to oral daily treatment with either 900 mg of green tea extract or only symptomatic treatment for 4 months. The duration of study was about 3 years.

180 A Translational Approach to Uterine Fibroids in Black Women and Latinas

OBJECTIVES/GOALS: Uterine fibroids (UF), non-cancerous myometrial neoplasms, affect 11 million women in the US. In qualitative research, experiences of Black women (BW) and Latinas (HL) with UF are understudied. UF etiology is poorly understood, and most symptoms are focused on decreasing UF symptoms. This study will showcase a translational approach in studying UF. METHODS/STUDY POPULATION: A community-engaged research process will be used throughout the study. We have a partnership with the Fibroid Foundation (FF), a UF advocacy organization. For our first aim, we have held community-engagement (CE) studios to provide insight for best practices in creating and implementing culturally appropriate studies with ethnoracially diverse women regarding topics of UF. Our CE studios set the foundation for the second aim, which will be in-depth interviews assessing the sociocultural impacts among pre-menopausal BW and HL with UF. The women will be recruited through the FFs social media platform. To address lack of treatment options in UF, we will be focusing on JAK 2/3 pathway. We will be performing immunofluorescence on tissue microarrays on over 100 patient samples with extensive clinical and survey data. RESULTS/ANTICIPATED RESULTS: We held two CE studios, one with BW with UF and another with HL without UF. These participants were chosen as patient stakeholders. One theme from the CE studio was that both groups mentioned a cultural impact around menstrual health and UF discussions. The participant stakeholders provided insight to other influences in their journey that will be used to develop the interview guide questions for Aim 2. We expect the individual interviews to show similar experiences as our CE studio experiences. We anticipate more in-depth conversations about the sociocultural and ethnoracial factors impacting UF treatment. For Aim 3, we hypothesize that there will be increased JAK 2/3 expression in UF of patients with higher sympton burden and larger fibroid volume. DISCUSSION/SIGNIFICANCE: Implementing a community-engaged research framework provides a foundation for qualitative and translational gynecologic research in BW and HL. This project will contribute insight to their UF experience. There is a lack of innovative treatments, and we have access to valuable patient tissue and data that can be used for potential molecular targets.

Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids - five-year experience.

Uterine fibroids (UF) are the most common benign tumors of the female reproductive organ. It is crucial to recognize that the appropriate treatment of UFs requires an individualized approach. The present paper aimed at the presentation of the five-year experience of our center in the treatment of UFs with the use of magnetic resonance-guided high-intensity ultrasound (MR-HIFU) therapy. The study enrolled a total of 1284 patients with symptomatic UFs. The Sonalleve MR-HIFU system (Philips Ingenia 3.0T System) was used for magnetic resonance imaging (MRI) qualification and treatment. The group of patients qualified for thermal ablation included 356 (28%) women. No significant differences were observed between the group undergoing thermal ablation and patients who were disqualified. A complete procedure was performed in 22.6% of patients who presented at the center. Non-perfused volume (NPV) is one of the most important parameters assessed during MR-HIFU procedures. The mean NPV value in the present study was 71%. The average UF volumes decreased by 27% at three-month follow-up ultrasound, by 34% after six months and by 39% as shown by MRI measurements performed 6 months post-treatment. According to our data, MR-HIFU therapy is associated with good clinical outcomes in patients with symptomatic UFs. The method facilitates a marked symptom reduction and, in many cases, diminishing tumor volume. The presented five-year outcomes as regards our experience in the MR-HIFU therapy of patients with symptomatic UFs indicate that the method offers an attractive alternative to the traditional methods of UF treatment in selected cases.

The significance of transcervical ultrasound-guided radiofrequency ablation in the treatment of symptomatic fibroids: results of an expert consensus from German-speaking countries

Uterine fibroids are one of the most common diseases in female patients, lead mainly to bleeding disorders and lower abdominal pain, and reduce the chance of having children. In recent years we have seen a trend towards more and more pharmacotherapies and minimally invasive organ-preserving treatments. One novel and innovative procedure for an organ-preserving treatment of symptomatic uterine fibroids is the transcervical ultrasound-guided radiofrequency ablation (TRFA). TRFA has been used in Germany since 2013 and later found use in other German-speaking countries as well. There have now been more than 1200 TRFA treatments performed in Germany, Austria, and Switzerland. Experts from these three countries came together for a consensus meeting to analyze the significance of the procedure in the overall concept of the treatment of symptomatic uterine fibroids.

Identification and Validation of miRNA-TF-mRNA Regulatory Networks in Uterine Fibroids.

Uterine fibroids (UF) are the most common benign gynecologic tumors and lead to heavy menstrual bleeding, severe anemia, abdominal pain, and infertility, which seriously harm a women’s health. Unfortunately, the regulatory mechanisms of UF have not been elucidated. Recent studies have demonstrated that miRNAs play a vital role in the development of uterine fibroids. As a high-throughput technology, microarray is utilized to identify differentially expressed genes (DEGs) and miRNAs (DEMs) between UF and myometrium. We identified 373 candidate DEGs and the top 100 DEMs. Function enrichment analysis showed that candidate DEGs were mainly enriched in biological adhesion, locomotion and cell migration, and collagen-containing extracellular matrix. Subsequently, protein-protein interaction (PPI) networks are constructed to analyze the functional interaction between DEGs and screen hub DEGs. Subsequently, the expression levels of hub DEGs were validated by real-time PCR of clinical UF samples. The DGIdb database was used to select candidate drugs for hub DEGs. Molecular docking was applied to test the affinity between proteins and drugs. Furthermore, target genes for 100 candidate DEMs were predicted by miRwalk3.0. After overlapping with 373 candidate DEGs, 28 differentially expressed target genes (DEGTs) were obtained. A miRNA-mRNA network was constructed to investigate the interactions between miRNA and mRNA. Additionally, two miRNAs (hsa-miR-381-3p and hsa-miR-181b-5p) were identified as hub DEMs and validated through RT-PCR. In order to better elucidate the pathogenesis of UF and the synergistic effect between miRNA and transcription factor (TF), we constructed a miRNA-TF-mRNA regulatory network. Meanwhile, in vitro results suggested that dysregulated hub DEMs were associated with the proliferation, migration, and apoptosis of UF cells. Our findings provided a novel horizon to reveal the internal mechanism and novel targets for the diagnosis and treatment of UF.

Innovative and conventional \u201cconservative\u201d technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment

BackgroundTo evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard “conservative” procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE).MethodsA Health Technology Assessment was conducted, assuming the payer’s perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients’ clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids’ experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy).ResultsLiterature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients’ perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients’ productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of − 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs.ConclusionsResults suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.

High-intensity focused ultrasound treatment for large and small solitary uterine fibroids

This retrospective study used data from patients treated for uterine fibroids with ultrasound-guided high-intensity focused ultrasound (USgHIFU) from April 2015 to April 2019. One hundred and seven patients with solitary fibroids were divided into two groups: (1) the L group with larger fibroids (≥10 cm) and (2) the S group with smaller fibroids (<10 cm). Using magnetic resonance imaging (MRI), we examined the efficacy of high-intensity focused ultrasound (HIFU) ablation by comparing uterine and fibroid volumes before and three months after the procedure. The three-month follow-up clinical visit used a visual analog scale and a uterine fibroid symptom health-related quality of life questionnaire to evaluate clinical symptoms. Both the L and S groups had significant reduction in uterine and fibroid volumes, but the rate was significantly higher in the S group (p < 0.05). Both groups also had improvements in clinical symptoms, but there was no statistical difference. USgHIFU reduced the size of both large and small fibroids but was most effective on fibroids smaller than 10 cm. Both the L and S groups had improved dysmenorrhea symptoms and quality of life.

The predictive value of conventional MRI combined with radiomics in the immediate ablation rate of HIFU treatment for uterine fibroids

Objective This study aimed to assess the predictive value of conventional magnetic resonance imaging (MRI) combined with radiomics in determining the nonperfused volume ratio (NPVR) following high-intensity focused ultrasound (HIFU) ablation for uterine fibroids. Methods and materials A total of 216 symptomatic uterine fibroids in 216 women were subjected to HIFU ablation from October 2015 to March 2020. Baseline clinical and MR parameters acquired before and after HIFU ablation were analyzed, and the NPVR was calculated accordingly. Radiomics features were extracted using A.K. software on T2-weighted imaging (T2WI). The minimum redundancy and maximum relevancy (mRMR) method were used to refine the selected radiomics features. Then, multiple linear regression models, the Wilcoxon signed-rank test, and Spearman’s rank correlation and Bland–Altman analyses were conducted. Results Conventional MRI combined with radiomics revealed the signal intensity on T2WI (X9), enhancement degree on T1-weighted imaging (T1WI) (X11), uterine fibroid location (X4), wavelet_glszm_SizeZoneNonUniformity first order (X12) and wavelet_HHH_firstorder_Skewness (X13) negatively affected the NPVR. The resulting regression equation was NPVR = 104.030 − 11.886 × X9 − 5.459 × X11 − 2.776 × X4 − 0.20 × X12 − 16.913 × X13. The adjusted R 2 values of the conventional MRI model and combined model were 0.385 and 0.408, respectively, and the two fitted models were statistically significant (p < 0.05). No significant differences were observed between the predicted NPVR value [81 (71, 91) %] of the combined model and the actual NPVR value [89 (77, 97) %] (p > 0.05). In addition, the predicted NPVR was correlated with the actual NPVR (r = 0.655, p < 0.001). Conclusions The efficiency of the combined model was better than that of the conventional MRI model in predicting the NPVR following HIFU ablation for uterine fibroids. Radiomics is an important supplemental modality to conventional MRI.

Implementation of an enhanced recovery after surgery program in the treatment of uterine fibroids with focused ultrasound ablation surgery

Background Enhanced recovery after surgery (ERAS) can reduce the length of hospital stay, incidence of surgery-related complications, and postoperative pain. We aimed to demonstrate the implementation of an ERAS pathway in the treatment of uterine fibroids with focused ultrasound ablation surgery (FUAS). Materials and Methods A retrospective data analysis was performed on clinical outcomes encompassing the following three phases: before ERAS (pre-ERAS), during adjustment of ERAS (interim-ERAS), and after the introduction of an ERAS program (post-ERAS). The purpose of describing the interim-ERAS was to provide references for the formulation of the program during the course of FUAS by describing the adjustment processes. Data from patients admitted to the hospital from September 2019 to December 2019 and April 2020 to November 2020 and who met the criteria for FUAS in the treatment of their uterine fibroids were examined. Length of stay, cost of surgery, postoperative pain score, utilization of postoperative analgesics, and incidence of postoperative adverse events were compared across the abovementioned three phases. Results Compared with the pre-phase, the cost of treatment and length of stay were reduced after the implementation of ERAS. The use of analgesics before leaving the operating room, as well as the incidence of postoperative nausea and vomiting, were also reduced. Conclusion The implementation of an ERAS protocol might benefit patients with uterine fibroids treated with FUAS in terms of requiring a shorter hospitalization period, lower costs, and reduced opioid use.

Comparison of computer simulations and clinical treatment results of magnetic resonance-guided focused ultrasound surgery (MRgFUS) of uterine fibroids.

PurposeMagnetic resonance‐guided focused ultrasound surgery (MRgFUS) can be used to noninvasively treat symptomatic uterine fibroids by heating with focused ultrasound sonications while monitoring the temperature with magnetic resonance (MR) thermometry. While prior studies have compared focused ultrasound simulations to clinical results, studies involving uterine fibroids remain scarce. In our study, we perform such a comparison to assess the suitability of simulations for treatment planning.MethodsSonications (N = 67) were simulated retrospectively using acoustic and thermal models based on the Rayleigh integral and Pennes bioheat equation followed by MR‐thermometry simulation in seven patients who underwent MRgFUS treatment for uterine fibroids. The spatial accuracy of simulated focus location was assessed by evaluating displacements of the centers of mass of the thermal dose distributions between simulated and treatment MR thermometry slices. Temperature–time curves and sizes of 240 equivalent minutes at 43°C (240EM43) volumes between treatment and simulation were compared.ResultsThe simulated focus location showed errors of 2.7 ± 4.1, −0.7 ± 2.0, and 1.3 ± 1.2 mm (mean ± SD) in the anterior–posterior, foot–head, and right–left directions for a fibroid absorption coefficient of 4.9 Np m–1 MHz–1 and perfusion parameter of 1.89 kg m–3 s–1. Linear regression of 240EM43 volumes of 67 sonications of patient treatments and simulations utilizing these parameters yielded a slope of 1.04 and a correlation coefficient of 0.54. The temperature rise ratio of simulation to treatment near the end of sonication was 0.47 ± 0.22, 1.28 ± 0.60, and 1.49 ± 0.71 for 66 sonications simulated utilizing fibroid absorption coefficient of 1.2, 4.9, and 8.6 Np m–1 MHz–1, respectively, and the aforementioned perfusion value. The impact of perfusion on peak temperature rise is minimal between 1.89 and 10 kg m–3 s–1, but became more substantial when utilizing a value of 100 kg m–3 s–1.ConclusionsThe results of this study suggest that perfusion, while in some cases having a substantial impact on thermal dose volumes, has less impact than ultrasound absorption for predicting peak temperature elevation at least when using perfusion parameter values up to 10 kg m–3 s–1 for this particular array geometry, frequencies, and tissue target which is good for clinicians to be aware of. The results suggest that simulations show promise in treatment planning, particularly in terms of spatial accuracy. However, in order to use simulations to predict temperature rise due to a sonication, knowledge of the patient‐specific tissue parameters, in particular the absorption coefficient is important. Currently, spatially varying patient‐specific tissue parameter values are not available during treatment, so simulations can only be used for planning purposes to estimate sonication performance on average.

The Impact of Uterine Fibroids on Fertility: How the Uncertainty Widens the Gap in Reproductive Outcomes in Black Women.

Uterine fibroids (UFs) are the most common pelvic tumor in women. While the decreased quality of life and significant morbidity has been implicated with UFs, several important questions regarding the effect of UFs on reproductive outcomes remain unanswered. Furthermore, there is a disproportionate impact of UFs in Black women, in whom these tumors are known to be more common and more severe. The racial difference in UF burden is heightened during prime reproductive years, during which Black women undergo surgical intervention at an astoundingly increased rate compared to other races. Despite this, Black women are underrepresented in UF and treatment outcome research, and thus the uncertainty of the impact of UFs and UF treatment on fertility and pregnancy outcomes in this population is less defined. The purpose of this review article is to discuss recent findings in the literature regarding the impact of uterine UFs on reproductive outcomes with a primary focus on the implications for Black women. Additionally, we briefly discuss the importance of increased UF research funding and investigation and propose actionable items to help increase the representation of Black women in UF research.

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

BackgroundAs a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.MethodsAn economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.ResultsMean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03–264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35–4.71) for major surgical complications; 6.75% (95%CI: 6.45–7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23–1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76–5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81–3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97–210.95) per week saved to return to normal activities.ConclusionsTLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.

Radiofrequency ablation procedures for uterine fibroids

This is a video presenting the two currently available FDA approved devices for radiofrequency ablation for the treatment of fibroids. The technology and tissue effects of radiofrequency ablation are reviewed. This video is intended for gynecologists who may consider performing these procedures. Surgeons are introduced to the equipment and basic steps required to perform laparoscopic ultrasound guided radiofrequency fibroid ablation using the Acessa system and transcervical ultrasound guided radiofrequency ablation using the Sonata system. This video will increase awareness of conservative surgical options for treatment of uterine fibroids using radiofrequency ablation and provide an introduction to these techniques for gynecologic surgeons who are considering adoption of this technology in their practice.

Guizhi Fuling Capsule inhibits uterine fibroids growth by modulating Med12-mediated Wnt/β-Catenin signaling pathway

Ethnopharmacological relevanceGuizhi Fuling Capsule (GFC) is a famous traditional Chinese medicine (TCM) formula recorded in Synopsis of the Golden Chamber, which has achieved obvious effects in the treatment of uterine fibroids (UFs). Aim of studyMediator complex subunit 12 (Med12) mutations were closely related to UFs in 85% of fibroid cases. The Wnt/β-Catenin signaling pathway plays an important role in the occurrence and development of UFs. This study aims to explore the pharmacological mechanism of GFC against UFs in which the Med12-mediated Wnt/β-Catenin pathway is involved. Materials and methodsMed12 was silenced in uterine fibroid cells (UFCs) using a lentivirus-based Med12 gene-specific RNA interference (RNAi) strategy. Cell proliferation was performed by CCK-8 assay, cell apoptosis and cell cycle were measured by flow cytometry. The rat model of UFs was established by injecting estradiol benzoate and progesterone. Forty-eight rats were divided into six groups, the low-dose GFC (L-GFC) group, the medium-dose GFC (M-GFC) group and the high-dose GFC (H-GFC) group were intragastrically treated with GFC solution at 0.25 g/kg, 0.50 g/kg and 1.00 g/kg per day for 8 weeks, the positive control (PC) group was administrated with mifepristone (2.70 mg/kg/day), the normal control (NC) group and the model control (MC) group were given equal volume of normal saline once a day for 8 weeks. The histopathological changes of uterine tissues were evaluated by H&E staining. The expression of Med12 in uterine tissues were detected by immunohistochemistry. The protein and mRNA levels of associated genes were evaluated by western bolt and real time-PCR, respectively. Related indicators involved in Wnt/β-Catenin pathway, such as Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7 and C-myc, were compared among different groups. ResultsThe Wnt/β-Catenin signaling pathway was inhibited after Med12 gene was knocked out in UFCs. GFC-containing serum could induce cell apoptosis, make the cell cycle stagnated in G0/G1 phase to inhibiting the proliferation and reduce the expression of Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7, and C-myc in control-shRNA cells, while had no significant effect on Med12-shRNA cells. Compared with the MC group, the weight, endometrial thickness, and pathological structure of the uterus in the GFC treated groups were significantly improved. The expression of Med12, Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7, and C-myc that related to Wnt/β-Catenin pathway in the GFC treated groups were decreased with the increase of dosage administration. ConclusionsGFC inhibited UFs growth, which was directly associated with Med12 modulated Wnt/β-Catenin signaling pathway. This study provided new perspective to understand the therapeutic mechanism of UFs.

Evaluation of marketing authorization and clinical implementation of ulipristal acetate for uterine fibroids.

ABSTRACTUlipristal acetate (UPA) is a medical treatment for uterine fibroids and was authorized for surgical pre-treatment in 2012 after the conduct of the PEARL I and II randomized controlled trials and for intermittent treatment after the observational PEARL III and IV trials. However, UPA came into disrepute due to its temporary suspension in 2017 and 2020 because of an apparent association with liver injury. This clinical opinion paper aims to review the process of marketing authorization and implementation of UPA, in order to provide all involved stakeholders with recommendations for the introduction of future drugs. Before marketing authorization, the European Medicines Agency (EMA) states that Phase III registration trials should evaluate relevant outcomes in a representative population, while comparing to gold-standard treatment. This review shows that the representativeness of the study populations in all PEARL trials was limited, surgical outcomes were not evaluated and intermittent treatment was assessed without comparative groups. Implementation into clinical practice was extensive, with 900 000 prescribed treatment cycles in 5 years in Europe and Canada combined. Extremely high costs are involved in developing and evaluating pre-marketing studies in new drugs, influencing trial design and relevance of chosen outcomes, thereby impeding clinical applicability. It is vitally important that the marketing implementation after authorization is regulated in such way that necessary evidence is generated before widespread prescription of a new drug. All stakeholders, from pharmaceutical companies to authorizing bodies, governmental funding bodies and medical professionals should be aware of their role and take responsibility for their part in this process.