Mendelian randomization analysis of the association between human blood cell traits and uterine polyps

Human blood cells (HBCs) play essential roles in multiple biological processes but their roles in development of uterine polyps are unknown. Here we implemented a Mendelian randomization (MR) analysis to investigate the effects of 36 HBC traits on endometrial polyps (EPs) and cervical polyps (CPs). The random-effect inverse-variance weighted method was adopted as standard MR analysis and three additional MR methods (MR-Egger, weighted median, and MR-PRESSO) were used for sensitivity analyses. Genetic instruments of HBC traits was extracted from a large genome-wide association study of 173,480 individuals, while data for EPs and CPs were obtained from the UK Biobank. All samples were Europeans. Using genetic variants as instrumental variables, our study found that both eosinophil count (OR 0.85, 95% CI 0.79–0.93, P = 1.06 × 10−4) and eosinophil percentage of white cells (OR 0.84, 95% CI 0.77–0.91, P = 2.43 × 10−5) were associated with decreased risk of EPs. The results were robust in sensitivity analyses and no evidences of horizontal pleiotropy were observed. While we found no significant associations between HBC traits and CPs. Our findings suggested eosinophils might play important roles in the pathogenesis of EPs. Besides, out study provided novel insight into detecting uterine polyps biomarkers using genetic epidemiology approaches.

Management of Partial Hydatidiform Mole and Subsequent Intrauterine Adhesions: A Case Report and Literature Review

Background: Gestational trophoblastic disease (GTD) originates from placental tissue and is among rare human tumors that can be cured even in the presence of widespread metastases. The most common form of GTD is hydatidiform mole (HM), commonly referred to as molar pregnancy. Molar pregnancies have the potential to locally invade the uterus and metastasize and result as a result of gestational trophoblastic neoplasia. Intrauterine adhesions (IUAs) is a condition where scar tissue develops within the uterine cavity, often following a procedure. Hysteroscopy has been established as the criterion standard for the diagnosis of IUAs, although the optimal adjuvant treatment after surgical intervention remains unclear. ‎ Case: A 35-year-old-female underwent suction curettage a week after the detection of a molar pregnancy. Two months later, she suffered from amenorrhea and hormonal therapy was initiated. Saline-infusion sonogram was tried and failed due to cervical stenosis. IUAs leading to scar tissue developed along with uterine polyps. Hysteroscopy successfully lysed IUAs and uterine polyps. The patient conceived two months after stopping hormonal therapy and proceeded to a pregnancy which resulted in a healthy live birth. Conclusion: Although the etiology of the patient’s molar pregnancy is still unknown, this report demonstrates the need to utilize hysteroscopy as a primary and early mode of treatment if IUAs are found in patients along with providing adjuvant treatment while utilizing clinical judgement in order to prevent IUAs recurrence. The patient conceived four months after the hysteroscopy resulting in a healthy live birth. Article Type: Clinical Experience

Inhibitory role of Metformin for tamoxifen induced ‎uterine cell proliferation in diabetic ‎patients with ER-‎positive Breast cancer

The objective of the current work to evaluate the role of metformin in inhibiting the tamoxifen induced ‎endometrial ‎changes in diabetic patients with ER-positive breast cancer, a case-control study, carried out between December 2018 to May 2019, forty ‎diabetic women in postmenopausal phase with ER+ breast cancer on tamoxifen (20mg/day), ‎metformin ‎‎(1700 mg/day) GROUP A, and 40 diabetic patients with ER+ breast cancer on the ‎same dose of tamoxifen, but other hypoglycemic agent GROUP B, were selected as controls. ‎Uterine thickness was assessed by ultrasonography imaging at the beginning of treatment with ‎tamoxifen and after 2 years of treatment. Hysteroscopy ‎was done, and pathological findings also ‎recorded.‎ Mean uterine thickness of diabetic patients on other hypoglycemic was ‎significantly higher than diabetic patients on metformin (14.79±3.6 vs 4.37±1.8). Uterine ‎thickness >5mm were 2 (5%) vs ‎36 (85%) reported with the diabetic patient on metformin and the ‎diabetic patient on ‎other oral hypoglycemic group. Three cases (7.5%) of the diabetic patients ‎on other hypoglycemic agent were developed uterine polyps, and one case (2.5%) of diabetic ‎patients on metformin were developed uterine polyps. One case (2.5%) of uterine carcinoma ‎was reported with diabetic patients on other hypoglycemic group.‎ In conclusions metformin significantly inhibit tamoxifen-induced endometrial changes and ‎offers favorable endometrium protection.

A Comparative Study of Hysteroscopic Morcellation or Resection of Uterine Polyps

Summary The aim of the study was to analyse the intraoperative parameters of hysteroscopic morcellation (HM) and conventional resectoscopy in the treatment of uterine polyps (UP). A total of 177 patients with ultrasound imaging of UP were included in a prospective study from February 2015 to February 2017. Out of them, 98 (55.4%) underwent HM and 79 (44.6%) had hysteroscopic resection (HR). We analyzed the following intraoperative parameters: total duration of the procedure, total operating time, time for dilation, actual operating time for HM/HR, the total amount of fluid distension media and fluid deficit. The mean operating time, measured as a total duration of the procedure, total operating time and actual operating time, was significantly shorter in the HM group, as compared to HR group, 8.27 and 19.48 minutes (min) – p<0.001, 6.15 and 16.33 min (p<0.001), 3.28 and 11.70 min (p<0.001), respectively. The total amount of fluid distension media was trustworthy lower in the HM group compared to HR, 446.02 ml and 2225.57 millilitres (ml) – p<0.001, respectively, as well as for the fluid deficit parameter – respectively 83.78 ml and 413.48 ml (p<0.001). This warrants the assumption that HM is an effective alternative to conventional resectoscopy for removal of UP with a favorable perioperative outcome.