Filip Andrzej Dabrowski

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrial-like tissue outside the uterine cavity, affecting up to 10% of women of reproductive age. Despite extensive research, its pathogenesis remains incompletely understood, and clinically useful non-invasive diagnostic tools are still lacking. Increasing evidence identifies hypoxia as a key microenvironmental factor promoting lesion establishment and persistence. Cellular responses to hypoxia are mediated by hypoxia-inducible factor 1 alpha (HIF-1α), which coordinates transcriptional programs involved in angiogenesis, inflammation, estrogen biosynthesis, extracellular matrix remodeling, and cell survival. A critical consequence of this hypoxia-driven signaling is the dysregulation of cell adhesion molecules (CAMs), which directly facilitates ectopic implantation and lesion progression. Adhesion-related molecules implicated in endometriosis include integrins, selectins, cadherins (E-cadherin, N-cadherin, CDH12, T-cadherin), claudins, intercellular adhesion molecules (ICAMs), matrix metalloproteinases (MMPs), and anthrax toxin receptor 2 (ANTXR2). Altered expression and activity of these molecules enhance attachment to the peritoneum, immune cell recruitment, angiogenesis, and extracellular matrix remodeling, thereby sustaining chronic inflammation and lesion growth. Beyond their pathogenetic role, CAMs are increasingly recognized as clinically relevant diagnostic and therapeutic targets in endometriosis. Within this group, P-selectin emerges as a particularly promising candidate, as its association with disease-related inflammatory activity supports its potential utility as a non-invasive biomarker and as a therapeutic target, exemplified by preclinical studies using the monoclonal antibody inclacumab. In parallel, growing evidence supports the diagnostic relevance of other adhesion-related molecules, including N-cadherin, ICAM-1, and MMP-9. Furthermore, therapeutic strategies targeting adhesion-related pathways - either directly or through modulation of hypoxia-responsive signaling - have demonstrated promising results in preclinical studies. This review highlights cell adhesion molecules as central effectors of hypoxia-driven mechanisms in endometriosis and underscores their relevance for the development of mechanism-based diagnostic and therapeutic approaches, complementing existing hormonal and symptomatic treatments.

Objective: To develop and internally validate a machine‐learning (ML) model for first‐trimester screening that prioritizes fetal euploidy reassurance and to compare its performance with the conventional Combined Screening Test (CST). Methods: This retrospective diagnostic‐accuracy study included 13,755 singleton pregnancies with known cytogenetic outcomes screened between 2019 and 2023. A calibrated extreme‐gradient‐boosting model was developed using a stratified 60–20–20 split into training, validation, and independent test sets. Predictors included routine maternal, biochemical, and ultrasound variables. Performance was compared with CST using accuracy, discrimination, and stratified analyses by maternal age and CST risk category. Results: In the independent test set, ML achieved higher accuracy than CST (89.9% vs. 82.2%) by reducing false alarms among euploid pregnancies (10.2% vs. 18.0%), a 43% relative reduction. Discrimination was excellent for both methods (ML AUC 0.97; CST AUC 0.93), without a significant difference. Both methods missed two aneuploid pregnancies. Gains were greatest in pregnancies aged ≥ 35 years and in the CST high‐risk and intermediate‐risk categories. Conclusion: A reassurance‐oriented ML approach preserved aneuploidy detection while substantially reducing false alarms. External validation is required before clinical implementation.

Background/Objectives: Endometriosis is a prevalent gynecological illness associated with chronic pain, inflammation, and infertility, as ectopic endometrial lesions are formed. No fully effective treatment is available, and the pathogenesis of this disease is unclear. The survival of ectopic endometrial cells is facilitated by their low susceptibility to apoptosis, an immunosuppressive environment, and local angiogenesis. Chromogranin A (CgA), a glycoprotein prohormone, modulates various processes including angiogenesis and innate immunity, and its higher levels are detected in neuroendocrine tumors and inflammatory disorders. Since endometriosis may be considered an autoinflammatory disorder, this study aimed to evaluate serum and peritoneal fluid concentrations of CgA and its derivatives, catestatin and pancreastatin, and to correlate these levels with disease severity. Methods: The study was conducted on samples of serum and peritoneal fluid (PF) obtained from 65 women diagnosed with endometriosis and from 60 control individuals who underwent surgery for other reasons. The concentrations of CgA, catestatin, and pancreastatin were assessed in the collected samples by specific enzyme-linked immunosorbent assays. Results: CgA, catestatin, and pancreastatin concentrations were significantly higher in the sera and PF of endometriosis patients compared to controls. There was a correlation between their serum and PF levels, and all tested factors were correlated with each other in both serum and PF. Serum concentrations of CgA, catestatin, and pancreastatin were also associated with disease progression. Receiver operating characteristic (ROC) analysis further confirmed that endometriosis is associated with increased circulating CgA, catestatin, and pancreastatin levels, suggesting that they may be considered markers of endometriosis. Conclusions: The upregulation of CgA and its derivatives in endometriosis may indicate their role in the disease pathogenesis and implicate them as potential diagnostic markers and/or therapeutic targets.

Background: Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are benign hepatic tumors that predominantly affect women of reproductive age and are associated with hormonal and metabolic factors. While FNH is a non-progressive lesion without malignant potential, HA carries a relevant risk of hemorrhage and malignant transformation. Differentiation between these entities remains challenging due to overlapping imaging features. Although contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic reference standard, its cost, limited availability, and contraindications restrict routine long-term use. Therefore, contrast-enhanced ultrasound (CEUS) has emerged as an alternative modality for follow-up. This study evaluated the effectiveness of CEUS in long-term monitoring of FNH and HA compared with MRI. Methods: Patients with imaging-confirmed FNH or HA underwent paired CEUS and MRI examinations within 48 h at baseline and follow-up. Lesion size was assessed using maximal and minimal diameters, and longitudinal changes were classified according to RECIST-like criteria. Paired non-parametric statistical tests were applied. Results: 41 benign liver lesions (28 FNH and 13 HA) were analyzed across 92 paired examinations. Baseline lesion measurements were comparable between CEUS and MRI. A statistically significant difference was observed in the assessment of the largest lesion diameter, while no significant differences were detected for the shortest diameter. Longitudinal evaluation showed no significant differences between modalities in detecting lesion size changes. Response classification was concordant in 42 of 51 follow-up assessments, with stable disease as the most frequent outcome. Conclusions: After definitive diagnosis, CEUS may serve as a reliable standalone modality for routine long-term surveillance of FNH and HA in clinically stable patients. Its performance in lesion measurement and response assessment is comparable to MRI, while offering advantages in cost, accessibility, and patient tolerability. MRI may be reserved for cases with suspicious changes on CEUS.

Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies before the 22nd gestational week and affects 10–15% of clinical pregnancies. Despite extensive diagnostics, over 50% of RPL cases remain unexplained, suggesting an important role for immunological mechanisms. Sex hormones (SH) are key regulators of immune responses during pregnancy; however, their influence on immune checkpoint proteins (ICPs) is poorly understood. This study evaluated the effects of progesterone, β-estradiol, and dihydrotestosterone (DHT) on ICP expression on immune cells, including Treg, NK, NKT, TC, Th, and T cells, collected from pregnant women and patients with unexplained RPL (uRPL). Peripheral blood mononuclear cells from 20 pregnant women and 20 uRPL patients were cultured for 48 h with SH. The expression of the first generation of ICPs—PD-1 and TIM-3—and the second—LAG-3, TIGIT, and VISTA—on T, NK, and NKT cells was analyzed by the flow cytometry method. In pregnant women, SH exerted modest effects, with DHT increasing VISTA and LAG-3 expression, while progesterone and estradiol mainly upregulated LAG-3 and TIM-3 on cytotoxic cells. In contrast, uRPL immune cells showed pronounced SH sensitivity, characterized by increased TIM-3 and VISTA expression and reduced TIGIT expression, particularly after DHT stimulation. In conclusion, SH modulates ICP expression in a cell-specific manner, with stronger effects observed in uRPL patients’ lymphocytes. These findings highlight a potential role for hormonal and ICP-targeted strategies in RPL management.

Indocyanine green (ICG) is widely used in minimally invasive surgery for real-time fluorescence imaging of vascular, biliary, and urological structures. Although its intravenous use has been extensively validated, data on intraureteral administration remain scarce, particularly regarding renal safety. We report the case of a 50-year-old woman undergoing laparoscopic bilateral endometrioma excision with intraureteral ICG instillation for ureteral visualisation. Despite an uneventful surgery, the patient developed anuria and acute kidney injury (AKI) within 24 h, requiring temporary hemodialysis. Imaging demonstrated bilateral renal dysfunction without evidence of ureteral transection. Renal function gradually improved with supportive care, and dialysis was discontinued. This is, to our knowledge, the first reported case of AKI following intraureteral ICG use. Potential mechanisms include dye-induced tubular toxicity, ischemic injury, and multifactorial perioperative stressors. Given the increasing adoption of near-infrared fluorescence in gynecologic and urologic surgery, our case highlights the urgent need for systematic studies on the renal safety of intraureteral ICG administration. Until further evidence emerges, surgeons should use the technique with caution, particularly in patients with preexisting risk factors for AKI.

This manuscript presents a comprehensive narrative review of the applications of polysomnography in infants. Considering the growing interest in the early identification of sleep-disordered breathing and its impact on the development of the nervous system, this is an exceptionally important and clinically relevant topic. There is a significant need for a proper understanding of the concept of polysomnography, which would enable its appropriate use in both diagnosis and treatment. This issue becomes particularly important given the limited number of scientific reports addressing the neonatal and infant periods. Objective: The usefulness of polysomnography during the first year of a child’s life. Methods: Between February and August 2025, a review of publications presenting aspects of polysomnography was conducted. Special attention was given to studies concerning the infant period, published between January 2015 and January 2025. The selection was carried out through the PubMed National Library of Medicine search engine, using the following keywords: “polysomnography”, “obstructive sleep apnea”, and “infant.” Results: Based on detailed inclusion criteria, 90 out of 1200 publications were qualified for analysis. Conclusions: Polysomnography is used both in the diagnostic process and in qualification for surgical treatment. It enables actions aimed at multidisciplinary management that improve patient outcomes while simultaneously reducing factors that worsen prognosis. At the same time, its usefulness in evaluating the therapeutic process and assessing improvement after both noninvasive and invasive interventions should be emphasized.

Indocyanine green (ICG) is a fluorescent agent which is characterized by a wide range of applications in the proper visualization of the operating field, differentiation of vital structures, and localization of lesions to be excised. An investigation and overview of novel approaches of indocyanine green in modern gynecological oncology was conducted, including ovarian cancer surgery with its compartmental approach and compartmental surgery in endometrial cancer. Ureteral visualization and perfusion, lymphography, lymph node transfers, or the localization of anastomotic leakage in bowel surgery are examples of applications aimed at reducing the risk of surgical complications and improving the patients’ quality of life. The general use of indocyanine green in lymph node detection, subcategorized and analyzed, is constantly improved and reviewed. A therapeutic approach with macromolecules is being tested in preclinical models. Early results could suggest the future application of indocyanine green not only in broad-sense imaging but also as a cytotoxic agent conjugated with macromolecules. Further studies on the application of indocyanine green in laparoscopy, open surgery, and finally as a curative cytotoxic agent are needed.

Robotic surgery has irreversibly transformed the landscape of contemporary operative medicine in recent years. Not only in gynecology, but in general surgery, urology, and even classically open fields like thoracic surgery. In Poland, we are witnessing the dynamic development of this technology, which has recently begun to mark its presence ever more strongly in operative gynecology. Compared to slow implementation of laparoscopy in the late 1990s and early 2010s, launch of robotic devices has an incredibly fast pace. In only ten years we moved from only one operating system to seventy-seven hospitals and 224 qualified surgeons in 2024 [1]. The time has come to reflect on the direction in which modern surgical interventions are heading, and an attempt to outline the prospects and challenges faced by Polish hospitals and physicians.