Oxidative Imbalance in Endometriosis-Related Infertility-The Therapeutic Role of Antioxidants.

Endometriosis in half of affected women is closely related to problems with fertility. Endometriosis-associated infertility is caused by a wide range of abnormalities affecting the female reproductive tract, from oocyte quality impairment to disturbances in the eutopic endometrium or mechanical abnormalities resulting from disease progression. Since supportive antioxidant therapies, in addition to surgical treatment or assisted reproductive techniques (ARTs), have overall been proven to be effective tools in endometriosis management, the objective of our review was to analyze the role of antioxidant substances, including vitamins, micronutrients, N-acetylcysteine (NAC), curcumin, melatonin, and resveratrol, in endometriosis-related infertility. Most of these substances have been proven to alleviate the systemic oxidant predominance, which has been expressed through decreased oxidative stress (OS) markers and enhanced antioxidative defense. In addition, we demonstrated that the predominant effect of the aforementioned substances is the inhibition of the development of endometriotic lesions as well as the suppression of pro-inflammatory molecules. Although we can undoubtedly conclude that antioxidants are beneficial in fertility support, further studies explaining the detailed pathways of their action are needed.

Immune Checkpoints in Endometriosis-A New Insight in the Pathogenesis.

Endometriosis (EMS) is an oestrogen-dependent, chronic disease affecting women of a reproductive age. One of the important factors involved in the development of this disease is the complex disorders associated with the functioning of the immune system. Recent evidence has shown that EMS development is associated with changes in systemic and local immunity, including functional disturbances of effector and antigen-presenting cells. One of the reasons for immune imbalance can be the improper expression of immune checkpoints (ICPs). ICPs and their ligands are responsible for maintaining self-tolerance and the modulation of the initiation, duration, and magnitude of the immune response of effector cells in normal tissues to avoid tissue damage. Considering the complex nature of co-stimulatory or co-inhibitory ICPs and the signalling between effector cells and APCs, we hypothesise that changes in cells' activity caused by ICPs may lead to serious immune system disturbances in patients with endometriosis. Moreover, both upregulation and downregulation in the expression of ICPs may be implicated in this process, including the reduced activity of effector cells against endometrial implants and disturbances in the antigen-presenting process. In this narrative review, we discuss, for the first time, key findings from the emerging literature, describing the associations between ICPs and their possible implication in the pathogenesis of endometriosis.

Immune Dysregulation in Endometriomas: Implications for Inflammation.

The most common manifestation of endometriosis, a condition characterized by the presence of endometrial-like tissue outside of the uterus, is the endometrioma, a cystic ovarian lesion. It is a commonly occurring condition associated with chronic pelvic pain exacerbated prior to and during menstruation, as well as infertility. The exact pathomechanisms of the endometrioma are still not fully understood. Emerging evidence suggests a pivotal role of immune dysregulation in the pathogenesis of endometriomas, primarily influencing both local and systemic inflammatory processes. Among the factors implicated in the creation of the inflammatory milieu associated with endometriomas, alterations in both serum and local levels of several cytokines stand out, including IL-6, IL-8, and IL-1ß, along with abnormalities in the innate immune system. While numerous signaling pathways have been suggested to play a role in the inflammatory process linked to endometriomas, only NF-κB has been conclusively demonstrated to be involved. Additionally, increased oxidative stress, both resulting from and contributing to endometriomas, has been identified as a primary driver of both systemic and local inflammation associated with the condition. This article reviews the current understanding of immune dysfunctions in the endometrioma and their implications for inflammation.

The Efficacy and Safety of Transvaginal Ethanol Sclerotherapy in the Treatment of Endometrial Cysts-A Systematic Review.

Endometriosis, as a chronic disorder that is a source of severe pain ailments and infertility, requires a comprehensive therapeutic approach. Sclerotherapy, consisting of the administration of sclerosing agents into the cyst, is a constantly evolving minimally invasive treatment method for this disease. Hence, the main objective of this systematic review was to evaluate the impact of its most often used variant, transvaginal ethanol sclerotherapy, on endometriosis-related symptoms, endometrial cyst recurrence rate, ovarian reserve, assisted reproductive technology (ART) outcomes, and pregnancy outcomes, as well as to assess potential complications resulting from this treatment. This systematic review was undertaken using PubMed, Scopus, Web of Science, and Cochrane Library databases on 24 November 2023. The risk of bias in included studies was assessed with the use of the Newcastle-Ottawa scale (NOS) and the revised Cochrane risk of bias 2.0 tool for randomized controlled trials. From the 1141 records obtained from all databases, 16 studies have been included in this review. The use of ethanol sclerotherapy was characterized by a low rate of post-procedural complications. The recurrence rate of endometrial cysts after the procedure depended on the ethanol instillation time within the cyst. Although ethanol sclerotherapy had negligible influence on ovarian reserves when compared to laparoscopic cystectomy, the effects of both these methods on pregnancy outcomes were comparable. This review identifies that sclerotherapy is safe, provides significant relief of symptoms, and does not impair the reproductive potential of the patients.

How Can Selected Dietary Ingredients Influence the Development and Progression of Endometriosis?

Endometriosis is a chronic, hormone-dependent disease characterized by the presence of endometrial tissue in ectopic locations. Since the treatment options for this disease are still limited, and the cure rate is unsatisfactory, the search for ways to treat symptoms and modify the course of the disease is of key importance in improving the quality of life of patients with endometriosis. So far, the literature has shown that nutrition can influence endometriosis through hormonal modification and altering the inflammatory or oxidative response. Since the importance of nutrition in this disease is still a subject of scientific research, we aimed to summarize the current knowledge on the role of dietary modifications in endometriosis. Our review showed that nutrients with anti-inflammatory and antioxidant properties, including most vitamins and several trace elements, may influence the pathogenesis of endometriosis and can be considered as the nutrients preventing the development of endometriosis. However, despite the many discoveries described in this review, further interdisciplinary research on this topic seems to be extremely important, as in the future, it may result in the development of personalized therapies supporting the treatment of endometriosis.

Time Perspective as a Mediator of Depressive Symptoms in Patients with Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy characterized by oligo- or anovulation, clinical and/or biochemical markers of hyperandrogenism, and polycystic ovaries, and it is associated with an increased prevalence of depression. Research conducted on psychiatric patients has shown correlations between depression and decreased cognitive function. The aim of this study was to examine the possible mediation of the time perspective (TP) in the development of depressive symptoms in patients with PCOS. METHODS: A study was conducted on 83 patients with PCOS and 65 healthy women. Standardized questionnaires were used to assess depressive symptoms (Beck Depression Inventory-BDI-II) and time perspective (Zimbardo Time Perspective Inventory-ZTPI). RESULTS: Our study revealed an indirect influence of depressive symptoms on PCOS through the positive future time perspective. In the logistic regression model, which included depression and a given time perspective as predictors of PCOS, only the future TP (ß = -0.004, p < 0.003, OR = 1.004, 95% CI [1.001, 1.008]) was significantly independently related to the occurrence of PCOS. CONCLUSIONS: Our result is another argument for the role of psychoeducation and appropriate communication with a patient from the risk group in a way that builds hope and allows to regain influence on life situation.

Elastography and Metalloproteinases in Patients at High Risk of Preterm Labor.

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Its etiopathology is multifactorial; therefore, many of the tests contain the assessment of the biochemical factors and ultrasound evaluation of the cervix in patients at risk of preterm delivery. The study aimed at evaluating the socioeconomic data, ultrasound examinations with elastography, plasma concentrations of MMP-8 and MMP-9 metalloproteinases, and vaginal secretions in the control group as well as patients with threatened preterm delivery (high-risk patients). The study included 88 patients hospitalized in the Department of Obstetrics and Pregnancy Pathology, SPSK 1, in Lublin. Patients were qualified to the study group (50) with a transvaginal ultrasonography of cervical length (CL) ≤ 25 mm. The control group (38) were patients with a physiological course of pregnancy with CL > 25 mm. In the study group, the median length of the cervix was 17.49 mm. Elastographic parameters: strain and ratio were 0.20 and 0.83. In the control group, the median length of the cervix was 34.73 mm, while the strain and ratio were 0.20 and 1.23. In the study group, the concentration of MMP-8 in the serum and secretions of the cervix was on average 74.17 and 155.46 ng/mL, but in the control group, it was significantly lower, on average 58.49 and 94.19 ng/mL. The concentration of MMP-9 in both groups was on the same level. Evaluation of the cervical length and measurement of MMP-8 concentration are the methods of predicting preterm delivery in high-risk patients. The use of static elastography did not meet the criteria of a PTB marker.

[Ultrasound evaluation of fetal adrenal gland volume. The role of fetal adrenal glands in the pathogenesis of preterm labor]. / Ultrasonograficzna ocena objetosci nadnerczy plodu. Rola nadnerczy w patogenezie porodu przedwczesnego.

Preterm labor remains to be one of the most important challenges of contemporary perinatology and constitutes the main reason of perinatal mortality and prematurity of neonates. Studies on preterm labor have confirmed the mutual interactions of several different hormonal systems while the activation of hypothalamic- pituitary- adrenal axis seems to have the greatest influence. It has been also suggested that size and mass of fetal adrenal glands may be associated with the risk of preterm labor. Several authors have shown that the evaluation of fetal adrenal gland volume may be a useful marker of fetal growth during pregnancy. Technological advancements enabled the development of three-dimensional ultrasound evaluation (3D) of the fetal adrenal glands, facilitating a more precise evaluation of their volume. Also, it seems to have higher sensitivity and specificity than two-dimensional ultrasonography (2D). Studies have confirmed a direct relationship between fetal adrenal gland size and the onset of preterm labor within at least 1 week since the ultrasound exam. They have also suggested that in a physiological pregnancy the relation between fetal zone and the whole organ remains constant throughout the pregnancy. Disruption of these proportions and fetal zone enlargement are considered to be a marker of labor cascade and preterm labor with significantly higher sensitivity and specificity than ultrasound evaluation of the cervical length and assessment of the fetal fibronectin concentration.

[Ultrasound evaluation of fetal adrenal gland volume. The role of fetal adrenal glands in the pathogenesis of preterm labor]. / Ultrasonograficzna ocena objetosci nadnerczy plodu. Rola nadnerczy w patogenezie porodu przedwczesnego.

Preterm labor remains to be one of the most important challenges of contemporary perinatology and constitutes the main reason of perinatal mortality and prematurity of neonates. Studies on preterm labor have confirmed the mutual interactions of several different hormonal systems while the activation of hypothalamic-pituitary-adrenal axis seems to have the greatest influence. It has been also suggested that size and mass of fetal adrenal glands may be associated with the risk of preterm labor Several authors have shown that the evaluation of fetal adrenal gland volume may be a useful marker of fetal growth during pregnancy Technological advancements enabled the development of three-dimensional ultrasound evaluation (3D) of the fetal adrenal glands, facilitating a more precise evaluation of their volume. Also, it seems to have higher sensitivity and specificity than two-dimensional ultrasonography (2D). Studies have confirmed a direct relationship between fetal adrenal gland size and the onset of preterm labor within at least 1 week since the ultrasound exam. They have also suggested that in a physiological pregnancy the relation between fetal zone and the whole organ remains constant throughout the pregnancy Disruption of these proportions and fetal zone enlargement are considered to be a marker of labor cascade and preterm labor with significantly higher sensitivity and specificity than ultrasound evaluation of the cervical length and assessment of the fetal fibronectin concentration.

Conservative management after prenatal ultrasound diagnosis of meconium periorchitis.

Meconium periorchitis is caused by the leakage of meconium from a bowel perforation into the peritoneal cavity via a patent processus vaginalis into the scrotal sac during fetal life or in the early postnatal period. Intrauterine meconium peritonitis causes sterile inflammatory response and calcification. Here, we describe a prenatally diagnosed case of meconium periorchitis. During the ultrasound scan at 29 weeks' gestation, enlargement of the scrotum with many small hyperechogenic masses and normal anatomy of testis was observed. Our case is the 11th prenatally diagnosed case presented in the worldwide literature and the first one described in Poland. This case confirms the latest tendency for the conservative management of meconium periorchitis and an asymptomatic postnatal course.

[Elafin and its influence on the patomechanism of preterm labor]. / Elafina i jej wplyw na patomechanizm porodu przedwczesnego.

The prevention of infection in pregnancy is critical to provide an appropriate fetal development and term delivery. Natural antimicrobials are the mediators of innate immune system with antibacterial, anti-viral and anti-fungal properties. It has been found that these antimicrobials play the great role in a homeostasis of bronchial and intestine epithelium, endometrium and epidermis. The activity of elafin--neutrophil elastase inhibitor--has been found in female reproductive system microenvironment (cervix, endometrium and fallopian tube) with the highest expression in the endometrium of non-pregnant women during ovulation and menstruation. The influence of elafin has been established on the maintenance of early pregnancy and the patomechanism of preterm labor and other pathology of pregnancy. Elafin level in amniotic fluid has been confirmed to be decreased in cases of preterm rupture of membranes (PROM). The protein may be a good marker of preterm labor and use in its diagnostics and treatment.

[Diagnostic usefulness of uterine artery Doppler]. / Przydatnosc diagnostyczna badania dopplerowskiego tetnic macicznych.

Doppler waves present hemodynamic state of vascular bed. This method is used in a diagnostic of pathological states in pregnancy. Basing on the observation of curve shape of uterine artery blood flow, we may conclude about its vascular resistance, wall tension and amount of blood. Several studies confirmed the opportunity of the use of Doppler uterine artery in a diagnosis and prognosis of complicated pregnancies. The incidence of notch in uterine artery blood flow was observed in pregnancies with incomplete trophoblast invasion and inadequate placentation. Many studies confirmed that bilateral notch might be associated with increased likelihood of different pregnancy complications, particularly pregnancy--induced hypertension (PIH) and intrauterine growth restriction (IUGR). The results of the most recent trials include the possibility of the use Ut-PI in a distinguishing of abnormal biochemical, prenatal tests in chromosomal aberrations and different pathological states in pregnancy such as preeclampsia and fetal hypotrophy.