Uterine Fibroids Patients Research Articles

Progress in High Intensity Focused Ultrasound Ablation for Fertility Preservation Therapy of Uterine Fibroids and Adenomyosis.

High intensity focused ultrasound (HIFU) is an effective and safe non-invasive treatment method, widely used in the treatment of uterine fibroids and adenomyosis in the field of gynecology. The side effects in HIFU is low in incidence and mild. HIFU can significantly alleviate the symptoms of patients, reduce lesion volumes, improve quality of life, and has good cost-effectiveness. HIFU can accurately ablate the uterine fibroids and adenomyosis lesions, without destroying normal myometrium and endometrium, and thus HIFU is a promising alternative to myomectomy in uterine fibroids patients with fertility desire. Several studies have shown that in terms of ovarian endocrine function protection, HIFU treatment is superior to uterine artery embolization, and similar to myomectomy. Existing limited researches show that patients with uterine fibroids have a favorable pregnancy rate and live birth rate, as well as a lower natural abortion rate after HIFU treatment. Pregnancy rate after HIFU treatment for uterine fibroids is not lower than myomectomy, and higher than uterine artery embolization. HIFU may have significant advantages in shortening pregnancy interval compared with myomectomy. However, the proportion of cesarean section delivery after HIFU treatment is relatively high, and gestational uterine rupture after HIFU treatment exist in literature. Higher quality clinical data is needed to confirm the pregnancy outcomes and safety after HIFU treatment in future.

Values of ultrasound elastography and progesterone receptor proteins for diagnosis and prognostic evaluation of uterine fibroid.

We aimed to study the values of ultrasound elastography (UE) and progesterone receptor (PR) proteins for the diagnosis and prognostic evaluation of uterine fibroid (UF). A total of 200 UF patients treated from January 2020 to June 2023 were selected as a UF group, and another 100 healthy women as a healthy group. Routine ultrasound parameters uterine artery pulsatility index (PI), resistance index (RI), and UE parameter strain ratio (SR) were obtained. The relative protein expressions of PRA and PRB in the peripheral blood were detected by Western blotting. The differences in these parameters and relative protein expressions of PRA and PRB were compared. The UF patients were divided into a cure group (n = 159) and a recurrence group (n = 41) according to their prognosis. The protein expressions of PRA and PRB in the UF group were higher than those in the healthy group (p < 0.05). In the recurrence group, PI and RI were lower, while SR and the protein expressions of PRA and PRB were higher than those in the cure group (p < 0.05). Age at menarche < 13 years old, intramural fibroid, PI, RI, SR, PRA, and PRB were risk factors for recurrence in UF patients (p < 0.05). The efficiency of combination of ultrasound and UE parameters, PRA and PRB for the diagnosis and prognostic evaluation of UF was significantly higher than that of any single indicator ( p < 0.05). Ultrasound and UE parameters combined with PR proteins have high efficiency for the diagnosis and prognostic evaluation of UF.

Analysis of changes in the levels of soluble molecules CD50, CD54 and CD95 in the blood serum of patients with uterine fibroids depending on the characteristics of the disease (pilot study)

Background. Currently, the search for circulating immunological and inflammatory markers that play a significant role in the pathogenesis of uterine fibroids (UF) is relevant.Aim. Changes in the serum levels of soluble molecules CD50 (sCD50), CD54 (sCD54) and CD95 (sCD95) in patients with UF depending on the characteristics of the disease.Materials and methods. The study involved 78 patients with UF aged 31–59 years and 45 clinically healthy women of comparable age. The patients were divided into the following groups depending on the localization of the myomatous node: interstitial-subserous localization (n = 17), subserous localization (n = 16), submucosal localization (n = 15), interstitial-submucosal localization (n = 15), interstitial localization (n = 15). In 34.6 % patients, the number of myoma nodes was 4–6, in 46.2 % women there were 2–3 nodes, in 19.2 % – 1 node.Determination of the serum concentration of sCD50, sCD54 and sCD95 molecules was performed using a two-site enzyme immunoassay and expressed in conventional units (U / ml).Results. The average serum concentration of sCD95, sCD54 and sCD50 in all patients with UF was significantly higher than in the control group (p &lt;0.05). The maximum level of the tested molecules was found in UF patients with submucosal localization and the presence of one myomatous node.Conclusions. The detected increase in sCD50, sCD54 and sCD95 levels in UF patients indicates the participation of these proteins in the immunopathogenesis of this pathology. The imbalance in studied proteins levels is most pronounced in submucosal localization of fibroids, which may indicate an unfavorable course of the disease and serve as an additional criterion for selecting patients in the preoperative period.

Development and validation of a deep learning-based method for automatic measurement of uterus, fibroid, and ablated volume in MRI after MR-HIFU treatment of uterine fibroids

IntroductionThe non-perfused volume divided by total fibroid load (NPV/TFL) is a predictive outcome parameter for MRI-guided high-intensity focused ultrasound (MR-HIFU) treatments of uterine fibroids, which is related to long-term symptom relief. In current clinical practice, the MR-HIFU outcome parameters are typically determined by visual inspection, so an automated computer-aided method could facilitate objective outcome quantification. The objective of this study was to develop and evaluate a deep learning-based segmentation algorithm for volume measurements of the uterus, uterine fibroids, and NPVs in MRI in order to automatically quantify the NPV/TFL. Materials and MethodsA segmentation pipeline was developed and evaluated using expert manual segmentations of MRI scans of 115 uterine fibroid patients, screened for and/or undergoing MR-HIFU treatment. The pipeline contained three separate neural networks, one per target structure. The first step in the pipeline was uterus segmentation from contrast-enhanced (CE)-T1w scans. This segmentation was subsequently used to remove non-uterus background tissue for NPV and fibroid segmentation. In the following step, NPVs were segmented from uterus-only CE-T1w scans. Finally, fibroids were segmented from uterus-only T2w scans. The segmentations were used to calculate the volume for each structure. Reliability and agreement between manual and automatic segmentations, volumes, and NPV/TFLs were assessed. ResultsFor treatment scans, the Dice similarity coefficients (DSC) between the manually and automatically obtained segmentations were 0.90 (uterus), 0.84 (NPV) and 0.74 (fibroid). Intraclass correlation coefficients (ICC) were 1.00 [0.99, 1.00] (uterus), 0.99 [0.98, 1.00] (NPV) and 0.98 [0.95, 0.99] (fibroid) between manually and automatically derived volumes. For manually and automatically derived NPV/TFLs, the mean difference was 5% [-41%, 51%] (ICC: 0.66 [0.32, 0.85]). ConclusionThe algorithm presented in this study automatically calculates uterus volume, fibroid load, and NPVs, which could lead to more objective outcome quantification after MR-HIFU treatments of uterine fibroids in comparison to visual inspection. When robustness has been ascertained in a future study, this tool may eventually be employed in clinical practice to automatically measure the NPV/TFL after MR-HIFU procedures of uterine fibroids.

Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522

INTRODUCTION: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women. METHODS: Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias. RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. CONCLUSION: Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.

“In our community, we normalize pain”: discussions around menstruation and uterine fibroids with Black women and Latinas

BackgroundUterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment.MethodsCommunity engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis.ResultsParticipants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids.ConclusionDespite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.

Integrating leiomyoma genetics, epigenomics, and single-cell transcriptomics reveals causal genetic variants, genes, and cell types

Uterine fibroids (UF), that can disrupt normal uterine function and cause significant physical and psychological health problems, are observed in nearly 70% of women of reproductive age. Although heritable genetics is a significant risk factor, specific genetic variations and gene targets causally associated with UF are poorly understood. Here, we performed a meta-analysis on existing fibroid genome-wide association studies (GWAS) and integrated the identified risk loci and potentially causal single nucleotide polymorphisms (SNPs) with epigenomics, transcriptomics, 3D chromatin organization from diverse cell types as well as primary UF patient’s samples. This integrative analysis identifies 24 UF-associated risk loci that potentially target 394 genes, of which 168 are differentially expressed in UF tumors. Critically, integrating this data with single-cell gene expression data from UF patients reveales the causal cell types with aberrant expression of these target genes. Lastly, CRISPR-based epigenetic repression (dCas9-KRAB) or activation (dCas9-p300) in a UF disease-relevant cell type further refines and narrows down the potential gene targets. Our findings and the methodological approach indicate the effectiveness of integrating multi-omics data with locus-specific epigenetic editing approaches for identifying gene- and celt type-targets of disease-relevant risk loci.

Differences in endometrial and cervical microbiome of uterine fibroids patients – A preliminary study

Differences in endometrial and cervical microbiome of uterine fibroids patients – A preliminary study

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU).

Uterine fibroids are the most common benign tumors of the uterus. Approximately 20-50% of women with myomas experience a variety of symptoms such as vaginal bleeding, abdominal pain, pelvic pain and pressure, and urological problems, possibly interfering with fertility and pregnancy. Although surgery remains the standard treatment option for fibroids, non-invasive therapeutic options, such as high-intensity focused ultrasound (HIFU), have emerged over the last dec ade. During HIFU, ultrasound is focused on the target tissue causing coagulation necrosis. HIFU has, meanwhile, become an established method for treating uterine fibroids in many countries. Clinical data have shown that it effectively alleviates fibroid-related symptoms and reduces fibroid size with a very low rate of side effects. However, there is a lack of data on how this treatment affects laboratory parameters and structural features of uterine tissue. As our center is the only one in German-speaking countries where ultrasound-guided HIFU technology is currently established, the aim of this prospective, monocentric, single-arm trial is not only to evaluate the safety and efficacy of local US-guided HIFU in symptomatic uterine fibroid patients according to GCP standards but also to explore its effects on blood parameters and the structural integrity of uterine tissue using elastographic methods.

Dysbiosis of vaginal and cervical microbiome is associated with uterine fibroids.

Dysbiosis of the female reproductive tract is closely associated with gynecologic diseases. Here, we aim to explore the association between dysbiosis in the genital tract and uterine fibroids (UFs) to further provide new insights into UF etiology. We present an observational study to profile vaginal and cervical microbiome from 29 women with UFs and 38 healthy women, and 125 samples were obtained and sequenced. By comparing the microbial profiles between different parts of the reproductive tract, there is no significant difference in microbial diversity between healthy subjects and UF patients. However, alpha diversity of UF patients was negatively correlated with the number of fibroids. Increased Firmicutes were observed in both the cervical and vaginal microbiome of UF patients at the phylum level. In differential analysis of relative abundance, some genera were shown to be significantly enriched (e.g., Erysipelatoclostridium, Mucispirillum, and Finegoldia) and depleted (e.g., Erysipelotrichaceae UCG-003 and Sporolactobacillus) in UF patients. Furthermore, the microbial co-occurrence networks of UF patients showed lower connectivity and complexity, suggesting reduced interactions and stability of the cervical and vaginal microbiota in UF patients. In summary, our findings revealed the perturbation of microbiome in the presence of UFs and a distinct pattern of characteristic vaginal and cervical microbiome involved in UFs, offering new options to further improve prevention and management strategies.

Alterations in vaginal microbiota in uterine fibroids patients with ultrasound-guided high-intensity focused ultrasound ablation.

Vaginal microbiota dysbiosis is closely related to diseases of the vagina and uterus. Uterine fibroids (UF) are the most common benign neoplasms of the uterus, and increased diversity in vaginal microbial of UF patients. High-intensity focused ultrasound (HIFU) is effective invasive treatment for fibroids in women who are not good surgical candidates. Whether HIFU of uterine fibroids will cause the change in vaginal microbiota has not been reported. We aimed to investigate the vaginal microbiota of UF patients with/without HIFU treatment using 16S rRNA gene sequencing. Vaginal secretions were collected from 77 UF patients (pre-operative and post-operative) and were used for comparative composition, diversity, and richness analyses of microbial communities. The microbial α-diversity was significantly lower in the vaginal of UF patients with HIFU treatment. The relative abundance of some pathogenic bacteria of UF patients with HIFU treatment were significantly decreased in the bacterial phylum and genus level. Proteobacteria were found to be significantly upregulated as a biomarker in the HIFU treatment group in our study. These findings might confirm the effectiveness of HIFU treatment from the point of view of microbiota.

Comparison of the Clinical Outcomes and Efficiencies of HIFU (High-Intensity Focused Ultrasound), Da Vinci Robotic Surgery and Laparoscopic Surgery for Uterine Fibroids: A Systematic Review and Meta-Analysis

Background: To compare the clinical outcomes and treatment efficiencies of advanced surgical treatments including High-Intensity Focused Ultrasound (HIFU), robotic surgery and laparoscopic surgery in the uterine fibroid patients. Methods: A total of 512 studies from 1995 to 2021 were identified by screening from Science Direct, Cochrane library, Medscape, Willey Online Library, PubMed, and Taylor Francis. From these studies 29 articles were qualitatively included in our systematic review and 24 of them considered quantitively eligible were included in the meta-analysis. Study analyzed by pooling the weighed mean difference (WMD) with the 95% confidence interval (CI) were study provided as a mean + (SD) and pooled risk ratio (RR) was expressed for dichotomous variables. Pooled results were assessed with either a random-effect or fixed-effect model. Heterogeneity was evaluated using the I2 statistic. Results: Comparison of HIFU and robotic surgeries with operation times of 86.13 ± 36.37 minutes to 120.2 ± 63 minutes and 166 ± 48.5 minutes to 278 ± 67 minutes were higher significant differences (I2 = 97%, p &lt; 0.00001), (WMD –111.88 [–189.68, –34.08]) with statistically significant (p = 0.005). Comparison of HIFU and laparoscopic surgery in operation time of 86.13 ± 36.37 minutes to 120.2 ± 63 minutes and 79 ± 30 minutes to 106.4 ± 38.5 minutes were not statistically significant (p = 0.75) with higher significant differences heterogeneity (I2 = 96%, p &lt; 0.00001), (5.51 [–27.82, 38.83]). Comparison of between blood losses and fibroid sizes at 154 ± 75 mL to 278 ± 164.6 mL and 6.5±2.9 cm to 13.6 ± 3.1 cm respectively in laparoscopic surgery was higher significant differences (I2 = 91%, p &lt; 0.0007), (WMD 202.29 [87.77, 316.80]) with statistically significant (p = 0.0005). Between hospital stay and blood loss in laparoscopic surgery at 1.2 ± 0.9 days to 5.4 ± 0.2 days and 200 ± 107 mL to 278 ± 164.6 mL showed significant differences (I2 = 90%, p &lt; 0.0001), (WMD –269.71 [–361.33, –178.09]) with statistically significant (p &lt; 0.00001) while in robotic surgery was not significant. The follow up uterine fibroid symptom &amp; health-related quality of life questionnaire (UF-QOL) at 3 months 45.3 + 26.9 to 70.6 + 26.9 in fibroids group and 61.6 + 41.4 to 79.64 + 17.91 in adenomyosis group and both shows significantly different (I2 = 83%, p = 0.02), (WMD 14.08 [4.42, 23.75]) with statistically significant (p = 0.0004) and (I2 = 97%, p &lt; 0.00001), (WMD –15.95 [–28.06, –3.84]) with (p = 0.010). SSS follow up 3 months 27.2 + 15.7 to 36.6 + 7.9 in fibroids of HIFU, the heterogeneity test showed significant differences (I2 = 95%, p &lt; 0.00001), (WMD 16.22 [8.33, 24.11]) with statistically significant (p &lt; 0.0001). In terms of pregnancy outcome, delivery outcome in live birth between HIFU and laparoscopic surgery 4 (8) within 165 (219) and (7) 23 within 158 (224), the heterogeneity was not significant (I2 = 0%, p = 0.44), (RR 1.06 [0.97, 1.17]) neither with for risk of delivering was not significant (p = 0.20). Conclusions: HIFU treatment reveals more efficient clinical and treatment outcomes than robotic or laparoscopic surgery, including improved symptoms, absence of bleeding, shorter operative time, shorter recovery time, and good benefits in both short-term and long-term quality-of-life.

Increased risk of atrial fibrillation in patients with uterine fibroids: a nationwide population-based study

Abstract Background Uterine fibroid, the most common benign neoplasm of the uterus, is associated with an elevated risk of cardiovascular disease. The link between incident atrial fibrillation (AF) and the uterine fibroid is unclear because earlier studies focused primarily on the development of atherosclerosis and hypertension. We aimed to investigate the risk of AF in patients with uterine fibroid. Methods This is a retrospective cohort study using the Korean National Health Insurance Service database (NHIS). From 2009 to 2012, a total of 2,574,349 women (20 to 40 years old) who underwent general health examinations were included. Diagnosis of uterine fibroids and surgical treatment status was defined by the international classification of diseases, 10th revision codes, and procedural codes from the Korean NHIS. The primary outcome was newly diagnosed AF. The risk of AF according to the uterine fibroids and their surgical treatment status was evaluated using Cox proportional-hazard models. Results Of the total population, the mean age was 29.76±4.27 years, and 20,682 (0.8%) were identified to have uterine fibroid. Incident AF was identified in 3,868 patients (61 in the fibroid group, 3,807 in the control group) during a mean follow-up of 7.3±1.1 years. Patients of the uterine fibroid group showed a higher incidence of AF compared to the control group (0.41 and 0.20 per 1000 person-years, respectively, Figure 1). Multivariate Cox-regression analysis presented that uterine fibroid was an independent risk factor of AF: hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.16–1.93, p=0.002. Compared to the control group, uterine fibroid patients who underwent surgical treatment tend to show a lower risk for AF (HR 1.22, 95% CI 0.79–1.90) than patients without surgical treatment (HR 1.69, 95% CI 1.24–2.30), though statistical significance was indeterminate (Figure 2). After propensity score matching, patients of the uterine fibroid group showed higher risk of AF when compared to the control group (HR 1.77, 95% CI 1.32–2.63, p&amp;lt;0.001), which was in line with our main results. The presence of uterine fibroid was consistently associated with higher risk of AF among all subgroups except for the stroke subgroup. Conclusion Patients with uterine fibroids are predisposed to an increased risk of AF compared to the control group. Careful monitoring of arrhythmia development would be warranted in patients of uterine fibroid and surgical treatment as it is associated with a modest risk decrement of incident AF. Funding Acknowledgement Type of funding sources: None.

Circ_0061140 Facilitates Adenomyosis Progression by Upregulating LIN28B in vitro

Objectives: The aim of our study was to explore the role of circular RNA_0061140 (circ_0061140) in adenomyosis progression and its associated mechanism. Design: We first analyzed the expression pattern of circ_0061140 in endometrial tissues of adenomyosis patients (n = 27) and uterine fibroid patients (n = 15). Loss-of-function experiments were conducted to analyze the biological roles of circ_0061140 in regulating the viability, apoptosis, proliferation, migration, and invasion of endometrial epithelial cells. The downstream microRNA (miRNA)/messenger RNA (mRNA) axis of circ_0061140 was predicted by bioinformatics tool Starbase, and its working mechanism was verified by rescue experiments. Methods: Cell viability, apoptosis, proliferation, invasion, and migration were assessed by cell counting kit-8 assay, flow cytometry analysis, 5-ethynyl-2′-deoxyuridine assay, transwell assay, and scratch test. The binding relationship between miR-141-3p and circ_0061140 or lin-28 homolog B (LIN28B) was verified by dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Results: Circ_0061140 expression was upregulated in adenomyosis patients. Circ_0061140 knockdown suppressed the viability, proliferation, invasion, and migration and triggered the apoptosis of endometrial epithelial cells. Circ_0061140 served as a miRNA sponge for miR-141-3p, and miR-141-3p silencing partly reversed circ_0061140 knockdown-induced effects in endometrial epithelial cells. miR-141-3p directly interacted with LIN28B mRNA. LIN28B overexpression partly diminished miR-141-3p overexpression-mediated influences in endometrial epithelial cells. Circ_0061140 knockdown downregulated LIN28B expression by elevating miR-141-3p level in endometrial epithelial cells. Limitations: The functional verification of circ_0061140/miR-141-3p/LIN28B axis was merely conducted in vitro. Conclusion: Circ_0061140 contributed to adenomyosis progression by binding to miR-141-3p to induce LIN28B expression in vitro.

Exploring the role of uterine fibroids in promotion of cardiovascular diseases by diabetes exposure: Findings from national health and nutrition examination survey 1999-2006.

ObjectiveThe relationship between uterine fibroids (UF) and cardiovascular diseases (CVDs) in the diabetes population seemed to remain undetermined in previous studies. This study aims to explore the association between UF and CVDs by using the database from the National Health and Nutrition Examination Survey (NHANES). To further evaluate the connection between UF and CVDs we also tested the potential differences due to diabetes exposure.Materials and methodsNational Health and Nutrition Examination Survey data (1999–2006) were collected and used in this study. A total of 5,509 individuals were included and analyzed. The student’s t-test and the chi-squared test were used to explore the demographic characteristic between UF and non-UF groups. Logistic regression analysis was performed to determine the odds ratios of UF and covariates.ResultsFemale participants were divided into UF (n = 694, 12.60%) and non-UF (n = 4,815, 87.40%) groups. The incidence of CVDs in UF patients (n = 245, 35.30%) were higher than non-UF individuals (n = 776, 16.12%) (p < 0.001). In addition, each subtype of CVDs were also different, which contains hypertension (33.29 vs. 15.31%, p < 0.001), heart failure (1.59 vs. 0.52%, p < 0.01), angina (2.59 vs. 0.62%, p < 0.001), heart attack (1.73 vs. 0.58%, p < 0.01) and coronary heart disease (1.44 vs. 0.54%, p < 0.01). The odds ratios of CVDs according to logistic regression were 2.840 (95% CI: 2.387–3.379) for UF patients (p < 0.001), while the odds ratios (ORs) were 1.438 (95% CI: 1.175–1.760) after taking account for the age, body mass index (BMI), diabetes, race, education, and annual family income (p < 0.001). In addition, secondary analysis indicated more adverse effects in by UF exposure on CVDs risk among non-diabetes individuals (OR = 1.389, 95% CI = 1.124–1.718, p < 0.01) than diabetes patients (p = 0.063).ConclusionOverall, UFs were positively associated with CVDs, and this effect seems blunted by diabetes exposure.

The Comparison of Life Quality between Ultrasound-Guided High-Intensity Focused Ultrasound and Laparoscopic Myomectomy for the Treatment of Uterine Fibroids.

Objective This study is aimed at comparing the uterine fibroids patients' postoperative living quality between ultrasound-guided high-intensity focused ultrasound (HIFU) and laparoscopic myomectomy. Materials and Methods A total of 164 patients were included with uterine fibroids who underwent laparoscopic myomectomy and HIFU in Cangzhou Central Hospital from September 2020 to November 2021. This study divided these objects into HIFU group and laparoscopic group, and both groups were followed up 6 months after surgery. After obtaining the results, Uterine Fibroid Symptom and health-related Quality Of Life questionnaire (UFS-QOL) and 36-Item Short Form Health Survey (SF-36) were performed before and after treatment to assess patient outcome. Results After treatments, the living quality in both groups was significantly improved compared with that before surgery, which had statistical significant (P < 0.05). After treatment, the scores of the two scales in HIFU group were significantly better than those in the laparoscopic group (P < 0.05). Conclusion In comparison with laparoscopic myomectomy, ultrasound-guided high-intensity focused ultrasound could improve the life quality of patients more effectively than traditional laparoscopic myomectomy and was helpful to the recovery and prognosis of uterine fibroids after treatment. The outcomes will provide a reference for clinicians to select a more appropriate treatment for uterine fibroids.

A contrastive study on the clinical efficacy and safety oflaparoscopic myomectomy and high intensity focused ultrasound in the treatment of uterine fibroids.

This study intended to compare the safety and clinical efficacy between two treatments of uterine fibroids: laparoscopic myomectomy (LM) and high intensity focused ultrasound (HIFU). Clinical data were collected from 587 uterine fibroid patients who were treated in The People's Hospital of Nanchuan, Chongqing from January 1, 2018 to December 31, 2019. Among the patients, 287 cases were treated with HIFU (observation group), and 300 cases were treated with LM (control group). The progression-free survival (PFS) was taken as the primary endpoint. The secondary endpoints included operation results (including operative time, intraoperative blood loss, and intraoperative fluid replacement), complications, hemoglobin level one month after surgery and clinical efficacy. In addition, the fibroid volume of the observation group before treatment and 3, 6, and 12 months after treatment were also analyzed. The operative time of observation group was evidently shortened compared to the control group, and the intraoperative blood loss and intraoperative fluid replacement of observation group were also considerably reduced (all p < 0.05), but there was no significant difference in the hemoglobin level between the two groups one month after surgery (p > 0.05). In terms of curative effect, the total effective rate of HIFU group and LM group was 98.6% (283/287) and 95.3% (286/300) respectively, with statistically significant difference (p < 0.05). In terms of complications, the incidence of bleeding and infection in HIFU group was obviously lower than that in LM group (both p < 0.05), while no significant differences were observed in the remaining complications (all p > 0.05). Fibroid volume comparisons before treatment and 3, 6 and 12 months after operation in observation group showed that fibroid volume decreased significantly (all p < 0.05). The median follow-up time was 30.6 months. The mean PFS of patients in the observation group and control group was 29.71 months (95% CI 28.24-29.75) and 26.74 months (95% CI 26.49-28.33), respectively (HR 0.47; 95% CI, 0.29 to 0.76; Log-rank p = 0.0019). HIFU could improve the intraoperative efficacy and reduce the complications of patients with uterine fibroids and has excellent performance in improving clinical efficacy and prolonging PFS. HIFU can be used as an alternative to surgical treatment.

Uterine Fibroid Patients Reveal Alterations in the Gut Microbiome.

The gut microbiota is associated with reproductive disorders in multiple ways. This research investigated possible differences in gut microbiome compositions between patients with uterine fibroids (UFs) and healthy control subjects in order to further provide new insight into its etiology. Stool samples were collected from 85 participants, including 42 UF patients (case group) and 43 control subjects (control group). The gut microbiota was examined with 16S rRNA quantitative arrays and bioinformatics analysis. The α-diversity in patients with UFs was significantly lower than that of healthy controls and negatively correlated with the number of tumorigeneses. The microbial composition of the UF patients deviated from the cluster of healthy controls. Stool samples from patients with UFs exhibited significant alterations in terms of multiple bacterial phyla, such as Firmicutes, Proteobacteria, Actinobacteria, and Verrucomicrobia. In differential abundance analysis, some bacteria species were shown to be downregulated (e.g., Bifidobacteria scardovii, Ligilactobacillus saerimneri, and Lactococcus raffinolactis) and upregulated (e.g., Pseudomonas stutzeri and Prevotella amnii). Furthermore, the microbial interactions and networks in UFs exhibited lower connectivity and complexity as well as higher clustering property compared to the controls. Taken together, it is possible that gut microbiota dysbiosis has the potential as a risk factor. This study found that UFs are associated with alterations of the gut microbiome diversity and community network connectivity. It provides a new direction to further explore the host–gut microbiota interplay and to develop management and prevention in UF pathogenesis.

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.

An evaluation of relugolix/estradiol/norethindrone acetate for the treatment of heavy menstrual bleeding associated with uterine fibroids in premenopausal women

ABSTRACT Introduction Uterine Fibroids (UFs) are the most predominant benign tumor in women who are coming of reproductive age, and causes intense economic load priced in billions of US dollars. Historically, surgery has been the main definitive treatment, albeit less attractive nowadays, especially for women with future fertility plans. Therefore, studies to explore the pharmacological treatment options are increasing especially as those that are currently available are limited for short-term use only. Areas covered This drug evaluation features the clinical results from previous and ongoing studies of relugolix, in combination with the add back therapy of estradiol (E2) and norethindrone acetate (NETA), as a novel, orally administered, nonpeptide antagonist of gonadotropin-releasing hormone (GnRH) for the management of heavy menstrual bleeding (HMB) in premenopausal women with UFs. Expert opinion The combination of relugolix/E2/NETA is an encouraging, well-tolerated and noninvasive pharmacological option for UFs patients. Relugolix induced a concentration-dependent decrease in HMB. However, it should be used with hormonal add-back therapy (E2+ NETA) to avoid induced hypoestrogenic side effects, importantly bone mineral density loss. Moreover, symptoms will likely resume shortly after the termination of the relugolix combination administration.