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Abstract Background Previous studies have shown clinical relevance of programmed death-ligand 1 (PD-L1) and soluble PD-L1 (sPD-L1) in human cancers. However, still contradictory results exist. Our aim was evaluation of PD-L1-expressing monocytic myeloid-derived suppressor cells (M-MDSCs), monocytes/macrophages (MO/MA), tumour cells (TC) and immune/inflammatory cells (IC) as well as investigation of the sPD-L1 in ovarian cancer (OC) patients. Methods The group of 74 pretreatment women were enrollment to the study. The expression of PD-L1 on M-MDSCS and MO/MA was assessed by flow cytometry. The profile of sPD-L1 was examined with ELISA. The expression of PD-L1 in mononuclear cells (MCs) was analyzed using real time PCR. PD-L1 immunohistochemical analysis was prepared on TC and IC. An in silico validation of prognostic significance of PD-L1 mRNA expression was performed based microarray datasets. Results OC patients had significantly higher frequency of MO/MA versus M-MDSC in the blood, ascites and tumour (each p 0.05). Significantly higher accumulation of blood-circulating M-MDSC, MO/MA, PD-L1+M-MDSC, PD-L1+MO/MA and sPD-L1 was observed in patients versus control (p 0.05). The expression of PD-L1 was significantly higher on IC versus TC (p 0.05) except higher level of PD-L1+TC in the endometrioid versus mucinous tumours. Interestingly, blood-circulating sPD-L1 positively correlated with PD-L1+M-MDSCs (p = 0.03) and PD-L1+MO/MA (p = 0.02) in the blood but not with these cells in the ascites and tumours nor with PD-L1+TC/IC (each p > 0.05). PD-L1 and sPD-L1 were not predictors of overall survival (OS; each p > 0.05). Further validation revealed no association between PD-L1 mRNA expression and OS in large independent OC patient cohort (n = 655, p > 0.05). Conclusions Although PD-L1 may not be a prognostic factor for OC, our study demonstrated impaired immunity manifested by up-regulation of PD-L1/sPD-L1. Furthermore, there was a positive association between PD-L1+ myeloid cells and sPD-L1 in the blood, suggesting that sPD-L1 may be a noninvasive surrogate marker for PD-L1+myeloid cells immunomonitoring in OC. Overall, these data should be under consideration during future clinical studies/trials.

Introduction Data on the possible role of peritoneal fluid free radical-mediated oxidative damage in the pathogenesis of endometriosis still remains inconsistent. The aim of the study was to determine iron metabolism markers and their influence on oxidative stress arameters in the peritoneal fluid of women with endometriosis. Material and Methods 110 women with endometriosis and 119 patients with benign ovarian cysts were included in the study. All visible peritoneal fluid was aspirated during laparoscopy from the anterior and posterior cul-de-sacs. under direct vision to avoid blood contamination. Haemoglobin, iron, total oxidative status, and total antioxidant status were measured using standard colourimetric kits. Results Haemoglobin, iron levels, as well as total oxidative status values were significantly higher, whereas total antioxidant status values were significantly lower in the peritoneal fluid of patients with endometriosis, in comparison to the reference groups. No differences were observed in peritoneal fluid concentrations of all parameters measured in relation to the phase of the menstrual cycle. Conclusions Peritoneal fluid of women with endometriosis is characterized by disrupted iron metabolism. This is most likely related to an increased number of erythrocytes in the peritoneal cavity of endometriotic women, which leads to a higher concentration of haemoglobin in this environment. Impaired iron homeostasis may have a significant influence on the pathophysiology of peritoneal endometriosis by the direct impact of haemoglobin derivatives and/or formation of the pro-inflammatory and pro-oxidative environment. Peritoneal cavity oxidative stress occurs predominantly in women in advanced stages of the disease.

An amendment to this paper has been published and can be accessed via the original article.

Myeloid-derived suppressor cells (MDSCs) expansion is a hallmark of cancer. Three major MDSC subsets defined as monocytic (M)-MDSCs, polymorphonuclear (PMN)-MDSCs and early stage (e)MDSCs can be revealed in human diseases. However, the clinical relevance and immunosupressive pattern of these cells in epithelial ovarian cancer (EOC) are unknown. Therefore, we performed a comprehensive analysis of each MDSC subset and immunosupressive factors in the peripheral blood (PB), peritoneal fluid (PF), and the tumor tissue (TT) samples from EOC and integrated this data with the patients' clinicopathological characteristic. MDSCs were analyzed using multicolor flow cytometry. Immunosuppressive factors analysis was performed with ELISA and qRT-PCR. The level of M-MDSCs in the PB/PF/TT of EOC was significantly higher than in healthy donors (HD); frequency of PMN-MDSCs was significantly greater in the TT than in the PB/PF and HD; while the level of eMDSCs was greater in the PB compared with the PF and HD. Elevated abundance of tumor-infiltrating M-MDSCs was associated with advanced stage and high grade of EOC. An analysis of immunosuppressive pattern showed significantly increased blood-circulating ARG/IDO/IL-10-expressing M- and PMN-MDSCs in the EOC patients compared with HD and differences in the accumulation of these subsets in the three tumor immune microenvironments (TIME). This accumulation was positively correlated with levels of TGF-β and ARG1 in the plasma and PF. Low level of blood-circulating and tumor-infiltrating M-MDSCs, but neither PMN-MDSCs nor eMDSCs was strongly associated with prolonged survival in ovarian cancer patients. Our results highlight M-MDSCs as the subset with potential the highest clinical significance.

Recent evidence suggests that immunological aspects play a pivotal role in this disorder. Toll-like receptor 2 (TLR2) is crucial in recognizing microbial infections and mediating innate immune response. The objective of our study was to rate with flow cytometry the levels of several subsets of dendritic cells, monocytes, and basic peripheral blood lymphocytes expressing TLR2, aiming at the determination of a possible correlation between the expression of TLR2 and the clinical outcomes of endometriosis in 40 patients and 40 age-matched healthy women. Our study showed the importance of TLR2 expression, mainly on myeloid dendritic cells (mDCs) and B cells in patients with endometriosis. Both mDCs BDCA1+CD19-TLR2+ and B lymphocytes CD19+TLR-2+ proved useful in the differentiation of affected individuals with stages 3–4 of the disease (area under the receiver operating characteristic curve /AUC/ = 0.96, p < 0.0001 for mDCs; AUC = 0.78, p = 0.0001 for B lymphocytes), and those presenting adhesion (AUC = 0.92, p < 0.0001 for mDCs; AUC = 0.82, p < 0.0001 for B lymphocytes) or infertility (AUC = 0.83, p < 0.0001 for mDCs; AUC = 0.73, p = 0.006 for B lymphocytes). Our findings suggest that the levels of TLR2-expressing cells, particularly mDCs and B lymphocytes, may be an effective biomarker of endometriosis, because the disease currently lacks clinically useful noninvasive biomarkers enabling early and cost-effective diagnosis.

Introduction and objective The objective of the study was to present preliminary results of a pilot study concerning the level of knowledge of gynaecological prevention, conducted in teenagers referred by court rulings to a juvenile attendance centre. Material and Methods The instrument was an anonymous survey questionnaire completed by participants in health prevention classes in late 2010 and early 2011. The studied group consisted of teenagers aged 15–17 years (mean age: 15.72 years, median = 16 years, SD = 0.679) who were under probation officers’ supervision in the Zamość region of south-eastern Poland. The sample size was 101 persons – 51 boys (50.50%), 50 girls (49.5%). Results According to the respondents, the most important reasons for seeing a gynaecologist were: menstrual disorders (70.30%), suspicion of pregnancy (63.37%) and pain or burning sensations while urinating (58.42%). The following were regarded as prevalent cancers in women: cancers of the breast (99.01%), cervix (89.1%), and ovaries (62.38%). Over 92% of subjects stated that it was possible to protect oneself from cervical cancer, but only 41.5% of respondents indicated the correct definition of the term ‘cytology’. Statistical analysis focused on differences between genders. A higher self-assessment of mental health was shown in boys. Conclusions Teenagers of similar background may find it more difficult to gain access to knowledge about health prophylaxis, including gynaecological prevention. Efforts should be intensified in order to ‘equalize health opportunities’ through appropriate preparation of teaching curricula (including health education and philosophy of medicine).

Introduction and objective. The objective of the study was to present preliminary results of a pilot study concerning the level of knowledge of gynaecological prevention, conducted in teenagers referred by court rulings to a juvenile attendance centre. Materials and method. The instrument was an anonymous survey questionnaire completed by participants in health prevention classes in late 2010 and early 2011. The studied group consisted of teenagers aged 15–17 years (mean age: 15.72 years, median = 16 years, SD = 0.679) who were under probation officers’ supervision in the Zamość region of south-eastern Poland. The sample size was 101 persons – 51 boys (50.50%), 50 girls (49.5%). Results. According to the respondents, the most important reasons for seeing a gynaecologist were: menstrual disorders (70.30%), suspicion of pregnancy (63.37%) and pain or burning sensations while urinating (58.42%). The following were regarded as prevalent cancers in women: cancers of the breast (99.01%), cervix (89.1%), and ovaries (62.38%). Over 92% of subjects stated that it was possible to protect oneself from cervical cancer, but only 41.5% of respondents indicated the correct definition of the term ‘cytology’. Statistical analysis focused on differences between genders. A higher self-assessment of mental health was shown in boys. Conclusions. Teenagers of similar background may find it more difficult to gain access to knowledge about health prophylaxis, including gynaecological prevention. Efforts should be intensified in order to ‘equalize health opportunities’ through appropriate preparation of teaching curricula (including health education and philosophy of medicine).

Introduction . Vulvo-vaginal-gingival syndrome is a rare variant of lichen planus. The disease affects mucous membranes of the oral cavity and genitals. It usually affects middle-aged females and most frequently presents as painful erosions. First-line treatment includes topical and systemic corticosteroids. If untreated, the disease may result in mucocutaneous scarring and stricture formation in affected organs. Therefore early diagnosis and appropriate treatment is essential. Objective . To present a patient with vulvo-vaginal-gingival syndrome treated with methylprednisolone, cyclosporin and tacrolimus ointment. Case report . A 54-year-old female patient with a several-year history of oral and genital complaints, formerly treated for periodontosis and candidiasis, was admitted to the Department of Dermatology in Lublin, where on the basis of clinical features and laboratory findings a diagnosis of vulvo-vaginal-gingival syndrome was established. The treatment included intravenous steroid pulse, cyclosporin A and 0.1% tacrolimus ointment and resulted in healing of erosions and regression of symptoms. Conclusions . A multidisciplinary approach is necessary in the treatment and management of vulvo-vaginal-gingival syndrome. The disease should be taken into consideration in differential diagnosis of chronic inflammations affecting the oral cavity and genital mucous membranes, with erosions dominating in the clinical picture.

Hot flashes and night sweats are common menopausal symptoms, which influence greatly the quality of women’s lives, often by eliminating them from professional or everyday lives. Etiopathogenesis of symptoms has not been fully explained. A great role is attributed to sudden decrease of estrogens, disorders of neurotransmitters and neuromodulators activity such as noradrenalin, dopamine, serotonin and thermoregulation disorders. Estrogen and estrogen-progestogen therapy is recommended as the most effective treatment for vasomotor symptoms. Yet, more and more consideration should be given to selective inhibitors of serotonin and noradrenalin, gabapentin.

Introduction: Ovarian cancer is a neoplasm characterised by considerable mortality. The aim of numerousstudies which have been conducted is to determine the impact of clinical and biochemical parameters onovarian cancer prognosis, survival and treatment. Serum CA 125 is mainly used to monitor treatment, detectrecurrence and predict response to chemotherapy. Increased epidermal growth factor receptor (EGFR) cancertissue expression facilitates cell proliferation, apoptosis inhibition and increase of angiogenesis. Material and methods: A group of 74 patients treated with surgery and chemotherapy due to ovarian cancerwere included in the study. The analysis of clinical parameters (age, tumour histology and grading, clinical stage according to FIGO, type of surgery) as well as CA 125 concentration and EGFR cancer tissue expression in relationto 5-year survival rates was performed. Results: 5-year survival rates were significantly related to: histological grading, clinical FIGO stage, theextent of primary surgery and cancer recurrence. The best predictors of increased survival rates in ovariancancer patients were: high histological grade, low clinical FIGO stage, optimal debulking and no recurrence.Statistical multivariate analysis did not demonstrate the influence of EGFR on 5-year survival rate in ovariancancer patients. However, the considerable and unequivocal impact of the last result of CA 125 concentration,the extent of surgical treatment, histological diagnosis and clinical FIGO stage, in relation to 5-year survival rate,was demonstrated. Conclusion: The results suggest a considerable and significant impact of CA 125 concentration, histologicaldiagnosis, clinical FIGO stage, and optimal debulking, on the 5-year survival rates of patients with ovarian cancer.

Introduction: Ovarian cancer is mostly diagnosed in postmenopausal women. The hormonal microenvironmentof ovarian tumour development in pre- and postmenopausal women is different. The environment mayinfluence the molecular basis of ovarian cancer. Podoplanin is a proven marker of lymphangiogenesis and isengaged in tumour progression and metastasis. Objectives: The aim of our study was to assess podoplanin expression at the mRNA level in ovarian serousand mucinous adenocarcinoma. Material and methods: mRNA expression of podoplanin was assessed in 42 ovarian cancer patients bymeans of real-time PCR. Results: Podoplanin was expressed at the mRNA level in all ovarian cancer patients. It was significantlylower (p < 0.001) in cancer tissues (RQ = 4.46) than in healthy control (RQ = 13.03). No significant differenceswere found in podoplanin expression either between pre- and postmenopausal women or in relation to FIGOand grading. Conclusion: Decreased podoplanin expression is characteristic for serous and mucinous ovarianadenocarcinoma.

This study shows short heparin characteristics used in venous thromboembolism. The research history andthe way of selected heparin synthesis are shortly described. The sequence of drugs showed in the study is basedon their chronological introduction into medical practice.

The etiopathogenesis of endometriosis still remains unknown. Recent data provide new valuable information concerning the role of oxidative stress in the pathophysiology of the disease. It has been proved that levels of different lipid peroxidation end products are increased in both peritoneal fluid (PF) and serum of endometriotic patients. We assessed the concentration of oxidized low-density lipoproteins (oxLDL) in PF of 110 women with different stages of endometriosis and 119 women with serous () or dermoid () ovarian cysts, as the reference groups. PF oxLDL levels were evaluated by ELISA. We found that concentrations of oxLDL in PF of endometriotic women were significantly higher compared to women with serous but not dermoid ovarian cysts. Interestingly, by analyzing concentrations of oxLDL in women with different stages of the disease, it was noted that they are significantly higher only in the subgroup of patients with stage IV endometriosis as compared to women with ovarian serous cysts. In case of minimal, mild, and moderate disease, PF oxLDL levels were similar to those noted in reference groups. Our results indicate that disrupted oxidative status in the peritoneal cavity of women with endometriosis may play a role in the pathogenesis of advanced stages of the disease.

Presence of fibrothecoma is not usually accompanied by elevated levels of tumor markers. In recent years, however, there have been isolated reports of fibrothecoma and Meigs’ syndrome, accompanied by an increase in tumor markers. We present a case of fibrothecoma with Meigs’ syndrome and elevated levels of both CA-125 (cancer antigen 125) and HE-4 (human epididymis protein 4). In this paper, we present a case of Meigs’ syndrome associated with an increased CA-125 and HE-4 level due to ovarian fibrothecoma.