Sonographic Assessment of Complex Ultrasound Morphology Adnexal Tumors in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

BACKGROUND: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. METHODS: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20-42 years old) with a mean gestation age of 13.5 (range: 8-31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. RESULTS: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR- = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70-75%) except for SRR (53%). CONCLUSION: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

Body image in perimenopausal women.

INTRODUCTION: Menopause is the last natural menstruation, followed by a period of 12 months during which no bleeding occurs (WHO). This natural process results from the phasing out of the physiological activity of the ovaries and involves numerous psychological and somatic disturbances. Although perimenopausal ailments are experienced by most women, the correlation between their perception of the bodies and biopsychosocial functioning in the climacteric period is not fully understood. The aim of the study was to determine whether women's body image varies depending on the period of their reproductive life. MATERIAL AND METHODS: 113 women aged 25-60 were examined (both menopausal and postmenopausal) with the control group comprising 58 women. The following scales were used: the Appearance-Related Picture Self-Appraisal Form and the Appearance Self-Appraisal Scale. RESULTS: The study demonstrated statistically significant differences between the groups on 7 scales and the overall score. It can be said that postmenopausal women, whose ovarian activity has nearly ceased, in comparison with those in the premenopausal and menopausal groups attribute lower importance to the following areas of the body: eyes, nose, mouth, stomach, buttocks, thighs, and calves. The mean values of satisfaction in the three groups under comparison were not statistically different. CONCLUSIONS: The subjects of the postmenopausal group attribute lower importance to different body areas, deriving greater satisfaction from their own bodies.

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight.

OBJECTIVES: The aim of the study is to determine the impact of the experimental diabetes and the chronic hypoxia on pregnancy development and rat fetal body weight. MATERIAL AND METHODS: The experiment was performed on female Wistar rats. Animals were divided into the experimen-tal groups. I - Controls, II - Untreated diabetes, III - Insulin-treated diabetes, IV - No diabetes with chronic hypoxia, V - Untreated diabetes and chronic hypoxia, VI - Insulin- treated diabetes and chronic hypoxia. Diabetes was induced in groups II, III, V and VI with intraperitoneal injection of streptozocin (STZ) at a dose of 40 mg/kg. Chronic hypoxia was induced by placing dams (groups IV, V and VI) in conditions of 10.5% oxygen and 89.5%. Insulin was administered subcutaneously at the dose of 9 IU/kg. Starting from the 6th day after STZ injection and chronic hypoxia conditions animals were caged together for 12 hours for 3 consecutive days to ensure fertilization. On day 21 of gestation the animals were decapitated, the fetuses were removed and weighted. RESULTS: Mean fetal body weight in separate groups were: I - 5.38 g, II - 6.04g, III - 5.32g, IV- 5.56 g, V - 3.45 g, VI - 6.23 g. CONCLUSIONS: Pre-existing type 1 diabetes does not affect fetal body weight compared to healthy newborn control rats. Pro-longed hypoxia does not impact on fetal body weight. Chronic hypoxia during pregnancy complicated with untreated type 1 diabetes mellitus leads to significant reduction of fetal body weight. Insulin treatment reversed the detrimental effect of chronic hypoxia on fetal development.

Plasma C16-Cer levels are increased in patients with preterm labor.

INTRODUCTION: The pathogenesis of preterm labor is fragmentarily explained. The most widely accepted theory points out to infection and inflammation as possible causes, which can be mediated by potentially different factors, including sphingolipid mediators. Sphingolipids are a class of lipids that have been shown as important mediators in various cell processes such as: proliferation, growth, apoptosis, stress response, necrosis and inflammation. The aim of the study was to assess plasma concentrations of selected sphingolipids in patients with preterm labor. MATERIAL AND METHODS: We used ultra-high performance liquid chromatography with triple mass spectrometry (UHPLC-ESI-MS/MS) to assess plasma concentrations of the 11 sphingolipids in patients presenting with symptoms of preterm labor (n=61) and threatened preterm labor (n=40). RESULTS: We observed a statistically significant increase (p-value<0.004) in plasma concentrations of C16-Cer in patients with preterm labor as compared to the control group. We also found C16-Cer to be the best predictor of preterm labor in the group of patients with symptoms occurring after 32 weeks of gestation. CONCLUSIONS: Our findings show a possible involvement of selected sphingolipids, especially C16-Cer, in the pathogenesis of preterm labor. Their role as predictors of preterm delivery needs to be validated in the future on larger group of patients.

Knowledge of the Disease, Perceived Social Support, and Cognitive Appraisals in Women with Urinary Incontinence.

Social support and knowledge of the disease have been shown to facilitate adaptation to a chronic disease. However, the adaptation process is not fully understood. We hypothesized that these factors can contribute to better adaptation to the disease through their impact on disease-related cognitive appraisal. To analyze the links between social support and the knowledge of the disease, on one hand, and disease-related appraisals, on the other hand, one hundred fifty-eight women with stress UI, aged 32 to 79, took part in the study. Questionnaire measures of knowledge of UI, social support, and disease-related appraisals were used in the study. The level of knowledge correlated significantly negatively with the appraisal of the disease as Harm. The global level of social support correlated significantly positively with three disease-related appraisals: Profit, Challenge, and Value. Four subgroups of patients with different constellations of social support and knowledge of the disease were identified in cluster analysis and were demonstrated to differ significantly on four disease-related appraisals: Profit, Challenge, Harm, and Value. Different cognitive appraisals of UI may be specifically related to social support and knowledge of the disease, with social support affective positive disease-related appraisals, and the knowledge affecting the appraisal of Harm.

Management of uterine leiomyosarcoma.

The low incidence of uterine sarcomas requires many issues associated with its biology and clinical course to be followed with more research. Unsatisfactory surgical outcomes and a high risk of cancer dissemination make it worthwhile to consider the feasibility of supplementary systemic treatment. The currently employed chemo- and hormonal therapy is characterised by low efficacy. There is some hope in reports on targeted treatment. However, a comprehensive assessment of the efficacy of this kind of therapy is restricted by a small number of patients using it. Moreover, clinical studies using targeted therapies involve patients with a highly advanced disease, and the therapeutic results are assessed mainly via analysis of progression-free survival but not the clinical response.

Coping with stress and quality of life in women with stress urinary incontinence.

INTRODUCTION: Urinary incontinence (UI) involves uncontrolled leakage of urine through the urethra as a result of damage to its sphincter muscle and a disturbed function of the urogenital diaphragm within the pelvis minor. The symptoms of UI radically impair psychological, somatic, and social functioning. The aim of each disease stress coping process is to reduce the impact of harmful agents as well as the acquisition of necessary preventive measures in order to combat the disorder. Aim of the study was to assess the relationship between coping styles used when dealing with stress associated with disease and the quality of life. MATERIAL AND METHODS: The study was carried out at an outpatients' clinic located in the Lublin Province (eastern Poland), covering 150 women with diagnosed stress urinary incontinence, aged between 32 and 79. The following methods were used: (a) Coping Inventory for Stressful Situations (Endler, Parker) to assess coping styles, (b) CASP-19 scale (Higgins, Hyde, Wiggins, Blade) to measure the overall quality of life, and (c) Urinary Incontinence Life Quality Scale (Szymona-Palkowska, Kraczkowski). RESULTS: The preferred style in the studied group of women was Task-Oriented Coping. This style is associated with a low score on the Independence from Symptoms scale and low Control, being simultaneously correlated with Autonomy and Self-Realisation. Emotion-Oriented Coping is associated with low psychological, physical and social well-being, as well as with little independence from the disease symptoms, little pleasure and self-realisation, but it gives a sense of internal control. Avoidance-Oriented Coping does not significantly correlate with any of the Overall Quality of Life dimensions. CONCLUSIONS: Women suffering from UI tend to try to solve their problem by means of cognitive transformation. In their situation, clinging to the problem turns out to be a depressing factor and entails a lower quality of their life.

[Influence of chronic hypoxia on optical density of µ-opioid receptors in fetal rat brain]. / Wplyw dlugotrwalego niedotlenienia na gestosc optyczna receptorów µ-opioidowych w mózgu plodów szczurzych.

UNLABELLED: Fetal brain is considered to be the major body organ, critical for the future quality of human life. Offspring exposed to prenatal hypoxia has been evidenced to experience behavioral abnormalities as a result of the injury sustained by neuronal cells in the brain. The relatively early appearance of opioid receptors proved susceptible to endogenous and exogenous factors. Increased concentrations of neurotransmitters in the maternal circulation and amniotic fluid induced by hypoxic exposure imply their role in the regulation of cellular division and differentiation processes. Endogenous neuropeptides and specific opioid receptors are distributed in those brain structures that are associated with behavior and reproduction. Fetuses exposed to the adverse effects of increased opioid level incur structural brain tissue abnormalities. OBJECTIVES: The present study seeks to determine the effects of long-term hypoxic exposure during gestation on the expression of opioid receptors in specific brain regions in both sexes. MATERIAL AND METHODS: The study was conducted on pregnant Sprague-Dawley rats, (120 days old, body weight between 250 and 300 g). Experiments were carried out in order to determine the effect of long-term hypoxia on µ-opioid receptor density in selected structures of fetal central nervous system: caudate-putamen (CPu), zona germinata (ZG), nucleus accumbens (NA), olfactory tubercle (OT), Median Part Medial Preoptic Area (MMPoA) and Lateral Part Medial Preoptic Area (LMPoA). Pregnant female rats were assigned to two research groups: the control group (N=6) and the experimental group subject to prolonged hypoxia for 24 hours from the gestational day 15 to gestational day 20 (E-15-E20). At E-21 rats were sacrificed, their fetuses were removed and their brains were incubated with radioligands. The µ-opioid receptor incubation in selected brain structures was performed with a specific radioisotope [3H]DAMGO [tyrosyl-3,5,-3H(N)-D-Ala-Gly-N-methyl-Phe-Gly-enkephalin]. Optical density of µ-opioid receptors was determined at E-21 of gestation during long-term exposure to chronic hypoxia induced from E-15 to E-21 of gestation. Experimental model coupled with an innovative autoradiography allowed for a precise assessment of the lesions sustained by fetal brain tissues due to hypoxia and the adaptive mechanisms of the central nervous system in reaction to hypoxic exposure. RESULTS: Statistically significant chronic hypoxia (p<0.05) downregulated the values of µ-opioid receptors optical density in relation to control group in CPu and ZG. Chronic hypoxia in ZG substantially reduces the values of µ-opioid receptors optical density in males (p<0.05). The differences among remaining groups did not show to be statistically significant. CONCLUSIONS: The obtained results of µ-opioid receptor expression can be detected in specific fetal brain regions that mediate sexual behavior and may be attributable to behavioral changes of experimental animals due to hypoxic exposure during gestation.

Chemokines profiling of patients with preterm birth.

INTRODUCTION: Nowadays it is thought that the main cause of premature birth is subclinical infection. However, none of the currently used methods provide effective prevention to preterm labor. The aim of the study was to determine the concentration of selected chemokines in sera of patients with premature birth without clinical signs of infection (n = 62), threatened preterm labor (n = 47), and term births (n = 28). METHOD: To assess the concentration of chemokines in the blood serum, we used a multiplex method, which allows the simultaneous determination of 40 chemokines per sample. The sets consist of the following chemokines: 6Ckine/CCL21, Axl, BTC, CCL28, CTACK/CCL27, CXCL16, ENA-78/CXCL5, Eotaxin-3/CCL26, GCP-2/CXC, GRO (GRO α /CXCL1, GRO ß /CXCL2 and GRO γ /CXCL3), HCC-1/CCL14, HCC-4/CCL16, IL-9, IL-17F, IL18-BPa, IL-28A, IL-29, IL-31, IP-10/CXCL10, I-TAC/CXCL11, LIF, LIGHT/TNFSF14, Lymphotactin/XCL1, MCP-2/CCL8, MCP-3/CCL7, MCP-4/CCL13, MDC/CCL22, MIF, MIP-3 α /CCL20, MIP-3- ß /CCL19, MPIF-1/CCL23, NAP-2/CXCL7, MSP α , OPN, PARC/CCL18, PF4, SDF-1/CXCL12, TARC/CCL17, TECK/CCL25, and TSLP. RESULTS: We showed possible implication of 4 chemokines, that is, HCC-4, I-TAC, MIP-3 α , and TARC in women with symptoms of preterm delivery. CONCLUSION: On the basis of our findings, it seems that the chemokines may play role in the pathogenesis of preterm labor. Defining their potential as biochemical markers of preterm birth requires further investigation on larger group of patients.

Selected determinants of quality of life in women with urinary incontinence.

Urinary incontinence (UI) is one of the most common diseases in women. It involves uncontrolled leaking of urine through the urethra. UI incidence depends on age and in certain age groups it can affect up to 60% of the female population. The symptoms can be persistent and due to their embarrassing nature they can lead to significant deterioration of quality of life and psychological functioning. The aim of this study was to investigate the relationship between the quality of life and selected aspects of functioning. Seventy female outpatients of a public clinic in Naleczów, Poland, were examined, and the following methods were used: the Urinary Incontinence Life Quality Scale (Szymona-Palkowska, Kraczkowski), Disease-Related Appraisal Scale (Janowski, Steuden), Coping Inventory for Stressful Situations (Endler, Parker), Disease-Related Social Support Scale (Brachowicz, Janowski, Sadowska), and the Knowledge Appraisal Scale for Urinary Incontinence (Szymona-Palkowska, Kraczkowski). The obtained results suggest that the strongest predictors for the quality of life with UI would be: perception of the disease as an injustice and a challenge (a reverse relationship) and an avoidance-oriented style of coping with stress through companionship seeking (a positive relationship). The duration of the disease and the level of related knowledge proved to be crucial in the analysis of one dimension, i.e. distance to the symptoms.

The obstetrical history in patients with Pfannenstiel scar endometriomas--an analysis of 81 patients.

INTRODUCTION: The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. MATERIALS AND METHODS: We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. RESULTS: In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21-3.83; OR = 2.18, 95% CI = 1.22-3.89]. CONCLUSIONS: Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.

[Maternal serum concentration of angiogenic factors: PIGF, VEGF and VEGFR-1 and placental volume in pregnancies complicated by intrauterine growth restriction]. / Ocena lozyskowych czynników angiogennych (PIGF, VEGF, VEGF R1) oraz objetosci lozyska w ciazach powiklanych opóznieniem wzrastania wewnatrzmacicznego plodu (IUGR).

INTRODUCTION: Pathomechanism of intrauterine growth restriction is a complex issue, involving many different factors, and is still undergoing an investigation. Improper placental angiogenesis, resulting in placental pathology, is considered to be one of the most important causes of IUGR. Placental vascular growth factors--placental growth factor (PIGF), vascular endothelial growth factor (VEGF) and its receptor (VEGFR-1), are involved in the mechanism of placental vascular development and maternal endothelial function during the pregnancy. AIM: The aim of our study was to evaluate the maternal serum concentration of vascular growth factors (PIGF, VEGF) and their receptor (VEGFR-1), as well as the placental volume in pregnancies complicated by IUGR, and to compare the results with healthy control groups. MATERIAL AND METHODS: 20 patients with intrauterine growth restriction and 18 healthy pregnant women were recruited. Their blood serum samples were assayed for the placental growth factor (PIGF), vascular endothelial growth factor (VEGF) and their receptor (VEGFR-1). These placental factors were measured with the ELISA- method (R@D Systems Kits. In all cases the placental volume was assessed with an ultrasound (Voluson V730 GE) with VOCAL (Virtual Organ Komputer-aided AnaLysis). RESULTS: Our investigation revealed significantly lower maternal serum concentrations of PIGF in pregnancies with IUGR, comparing to the controls in the third trimester. In most cases, VEGF concentrations were undetectable in the maternal serum both, in the second as well as in the third trimester. In the 2nd trimester VEGFR-1 concentrations were statistically higher in the investigated group. In the 3rd trimester the concentrations of VEGFR-1 were higher in the investigated group, but the difference has not achieved the level of statistical importance. The mean placental volume was lower in the investigated group but with not statistical gnificance. CONCLUSIONS: Presented and documented dependencies may indicate the involvement of angiogenic factors in a pathomechanism of intrauterine growth restriction process. It seems that the measurement of placental volume may be useful in IUGR diagnosis. However, it should be a complementary examination only, due to technical limitations.

[Sonoangiography and logistic regression analysis in the preoperative differentiation of ovarian tumors]. / Sonoangiografia i zastosowanie logistycznej analizy regresji w przedoperacyjnej charakterystyce guzów jajnika.

OBJECTIVE: To apply logistic regression analysis for several clinical and sonographic data for the construction of a predictive model that could be helpful in the preoperative differentiation of adnexal masses. MATERIALS AND METHODS: Two hundred and eight women with tumors thought to be of adnexal origin were examined preoperatively. Initial analysis included age and menopausal status, ultrasound derived morphological features of adnexal masses (unilateral/bilateral tumors, papillae, septae, tumor size and volume) as well as color Doppler criteria such as PI, RI, Peak Systolic Velocity, PSV assessment. In all examinations we used B&K 2002 ADI (Denmark) and Kretz Voluson V730 (Austria) scanners with transvaginal probes 5-9 MHz. Stepwise logistic regression analysis was used to construct a predictive model that would allow probability of malignancy calculation for individual patient. RESULTS: There were 159 benign and 49 malignant masses. Seven cancers were in FIGO stage one. Statistical analysis revealed that only 5 of initially tested 14 variables had significant influence on the regression equation. These were: age, bilateral mass, presence of septa > 3 mm, papillary projections > 3 mm in the tumor wall and subjective color scale assessment according to Timmerman et al. (1999). Sensitivity and specificity at the 50% probability level of malignancy in the studied tumor were 77.5% and 96.8%, respectively. When 25% cut-off probability level was used, sensitivity increased to 87.7% and specificity dropped to 89.9%. Prospective testing in a new group of 30 patients (5 ovarian cancers) gave sensitivity of 80% and specificity of 100%. CONCLUSIONS: The use of logistic regression analysis can help in modeling clinical and sonographic data. Our model had better predictive value than individual tests and allowed to calculate true probability figure of ovarian malignancy for any given patient with adnexal mass.