Sexual well-being is a vital aspect of the overall quality of life. Sexual self-efficacy is a key factor in improving of women’s sexual well-being. This study aimed to determine the effect of counseling based on functional analytic psychotherapy (FAP)-enhanced cognitive therapy (CT) on sexual self-efficacy in married adolescent women.
This prospective clinical trial, conducted in 2019, used a pre-test/post-test design with a control group. The study included 80 urban and rural married adolescents who met the inclusion criteria and were referred to the health centers in Darab and surrounding villages. Out of 350 participants, 150 adolescents were included in the study and were allocated to two groups. The counseling program for the intervention group was carried out by the researcher over 16 sessions, held twice a week for 90 minutes each. In contrast, the control group received routine education. The intervention group received counselling based on FAP-enhanced CT, while the control group did not receive this training during the study. The data collected from the questionnaires were imported into SPSS 24, and analyses were performed using analysis of covariance (ANCOVA), paired t-test, and independent t-test.
There was no significant difference in sexual self-efficacy between the two groups at pre-test time (p > 0.05); however, a significant difference was observed at post-test (p < 0.0001). Additionally, there was a significant difference between the mean scores of sexual self-efficacy before and after the intervention in the intervention group (p < 0.0001), while no significant difference was observed in the control group (p = 0.25).
The results suggest that counselling based on FAP-enhanced CT provided to married adolescent women significantly improves their sexual self-efficacy.
The trial protocol was registered with the Iranian Registry of Clinical Trials on 16/06/2019, IRCT20190217042736N1 (https://www.irct.ir/trial/37718).
The number of nulliparous pregnant women of advanced maternal age, defined as 35 years or older, has increased in Japan, but there has not been a study comparing labour progression between pregnant women of advanced maternal age and young pregnant women. Therefore, we aimed to evaluate roughly whether labour progression times differed according to maternal age, with cervical dilation and foetal station used as the endpoints.
We retrospectively reviewed the medical records of 1573 nulliparous women who had spontaneous vaginal delivery (929 patients), were administered an intravenous uterotonic agent (372 patients) or underwent emergency caesarean section (272 patients) at Kinan Hospital. We collected data on the patient characteristics and reviewed vaginal examination data for comparisons of labour progression. The endpoints were cervical dilation of 10 cm (full dilation) and foetal station of 2 cm, as these metrics are sufficient for vacuum-assisted vaginal delivery (sufficient descent). Data on the elapsed time between the recorded time of each stage of labour and the endpoint were obtained from two groups, namely, pregnant women of advanced maternal age and young pregnant women, and compared.
The percentages of women of advanced maternal age were higher among those who underwent emergency caesarean section and intravenous uterotonic agent administration. When the characteristics of the pregnant women of advanced maternal age were compared to those of the young pregnant women among the 929 patients with spontaneous vaginal delivery, differences in “blood loss amount” and “vacuum delivery status” were detected. However, regarding labour progression, there was almost no difference in any of the stages when the elapsed times between each stage and full dilation or sufficient descent were compared.
We did not detect a clear impact of maternal age on labour progression in the groups of nulliparous women who had spontaneous vaginal delivery after women who underwent emergency caesarean section or intravenous uterotonic agent administration were excluded; however, further studies with larger sample sizes of women of advanced maternal age may be needed.
We aimed to evaluate breast-conserving surgery plus sentinel lymph node biopsy in affecting breast cosmetic appearance and systemic stress of breast cancer patients.
A total of 150 early breast cancer patients admitted between January 2020 and September 2022 were retrospectively analyzed. Propensity score matching was performed to minimize selection bias based on baseline characteristics, resulting in two matched groups of 55 patients each. The observation group received breast-conserving surgery and sentinel lymph node biopsy, while the control group underwent breast-conserving surgery and axillary lymph node dissection.
The observation group experienced shortened operation time and extubation time compared with the control group, and there were significantly different blood losses between the two groups (p < 0.05). The observation group was significantly superior to the control group in terms of the postoperative quality of life (p < 0.05). After treatment, the levels of plasma procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) in the two groups decreased. By contrast to those in the control group, PCT, TNF-α, carcinoembryonic antigen and carbohydrate antigen 125 presented significantly reduced levels in the observation group following treatment (p < 0.05). The observation group, compared to the control group, exhibited significant improvement of the breast appearance (p < 0.05). No significant difference was observed between the two groups regarding human epidermal growth factor receptor-2 (HER-2) expression (p > 0.05).
Breast-conserving surgery and sentinel lymph node biopsy are simple and can reduce the complications and benefit the recovery of patients.
Stress urinary incontinence (SUI) is prevalent and significantly impacts morbidity. While some risk factors for SUI have been identified, those specifically related to the severity of SUI have not been thoroughly investigated.
This study recruited elderly female patients with SUI, aged over 60 years old, from Wuhan, Hubei, China, between October and November 2020. Data collection encompassed demographic information, clinical features (including obstetric history, chronic diseases, Urogenital Distress Inventory-6 (UDI-6), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores), as well as physical examinations (including assessments of pelvic floor muscle strength, pelvic organ prolapse quantification (POP-Q) system, and pelvic floor ultrasound imaging).
Univariate analysis revealed that a history of postpartum urinary incontinence and chronic constipation significantly influenced the severity of SUI symptoms in the elderly (p < 0.05). Additionally, age, the number of vaginal deliveries, and a history of chronic cough were correlated with the severity of SUI symptoms, with p-values of 0.05, 0.08, and 0.12, respectively. Factors such as pelvic floor muscle strength, vaginal wall prolapse, uterine prolapse, and the morphology of the largest urethral opening all significantly impacted the severity of SUI symptoms in this population (p < 0.05). Multivariate logistic regression analysis identified age, the number of vaginal deliveries, chronic constipation, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, and the shape of the maximum urethral opening as independent factors influencing SUI severity in older women (p < 0.05). The results of the Hosmer-Lemeshow test indicate that the model fits well (p = 0.37).
Age, the number of vaginal deliveries, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, chronic constipation, and a funnel-shaped maximum urethral opening are associated with increased severity of SUI symptoms in elderly women. The severity of SUI escalates with advancing age and an increased number of vaginal deliveries.
Prenatal ultrasound has always been difficult to classify fetal corpus callosum abnormalities. This paper aims to evaluate the added value of fetal magnetic resonance imaging (MRI) to ultrasound in detecting fetal corpus callosum anomalies and the consistency of the classification of prenatal ultrasound and magnetic resonance imaging for corpus callosum anomalies.
A retrospective analysis was performed of fetuses with abnormal cavum septi pellucidi who had ultrasonography and MRI in utero in Sichuan Maternal and Child Health Hospital and Wenjiang District Maternal in China and Child Health Hospital from January 2018 to December 2023. Fetal corpus callosum anomalies are classified according to the severity of the findings. The classification results of MRI were used as the diagnostic criteria. The findings detected on ultrasound (US) were compared to those detected on MRI. and the receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of prenatal ultrasound in diagnosing corpus callosum anomalies. The Kappa test was used to analyze the consistency of prenatal ultrasound and MRI in the classification of corpus callosum anomalies.
Of the 203 cases of fetuses with abnormal cavum septi pellucidi, 143 cases (70.4%) were normal, 34 cases (16.7%) had complete agenesis of the corpus callosum, and 18 cases (8.9%) had partial agenesis of the corpus callosum. Eight cases (3.9%) had dysplasia of the corpus callosum. The area under the ROC curve of prenatal ultrasound for the diagnosis of corpus callosum anomalies was 0.840 (95% confidence interval (CI) 0.782–0.888), the sensitivity was 75.00%, and the specificity was 93.01%, The positive likelihood ratio was 10.7 and the negative likelihood ratio was 0.3. Prenatal ultrasonography and MRI had moderate concordance in the classification of corpus callosum anomalies (Kappa = 0.673, p < 0.001). The concordance was good in diagnosing complete agenesis of the corpus callosum (Kappa = 0.862, p < 0.001), while the concordance was moderate in diagnosing partial agenesis of the corpus callosum (Kappa = 0.643, p < 0.001).
Prenatal ultrasonography is accurate and effective in the diagnosis of corpus callosum anomalies. Magnetic resonance imaging can provide more information in the classification of corpus callosum anomalies and the diagnosis of neurologic complications. The MRI should be combined with ultrasonographic transverse, midsagittal, and coronal views to evaluate the classification of corpus callosum anomalies.
The prognosis of patients with early diagnosis of malignant endometrial lesions is good. We aimed to identify benign and malignant lesions in endometrial tissue, explore effective methods for assisting diagnosis, and improve the accuracy and precision of identifying endometrial lesions.
1142 ultrasound radiomics and 18 clinical features from 1254 patients were analyzed, from which 36 features were selected for machine learning. We sketched the region of interest (ROI) of the abnormalities on the ultrasound images. Then, the radiomics features were extracted. Six common machine learning algorithms, including Support Vector Machine (SVM), Logistic Regression, Decision Tree, Random Forest, Gradient Boosting Tree, and k-Nearest Neighbors, were employed to identify benign and malignant changes in endometrial tissue. Cross-validation and grid search techniques for hyperparameter tuning were utilized to obtain the best model performance. Accuracy, precision, sensitivity, F1-scores, area under the curve (AUC), cross-validation average score and bootstrap average accuracy were also used to evaluate algorithm performance, classification accuracy, and generalization capability.
We combined 21 ultrasound characteristics and 15 clinical characteristics to develop and validate six common machine learning algorithms. After internal validation, the best models were the Random Forest models, with accuracy of 89%, precision of 93%, sensitivity of 97%, F1-score of 95%, and AUC of 95%, as well as a 10-fold cross-validation average score of 95% and bootstrap average accuracy of 94%, implying flawless classification in the test set.
We identified the clinical and ultrasound features in the early diagnosis of benign or malignant lesions in endometrial tissue. And Random Forest model algorithms have demonstrated excellent performance in identifying benign and malignant changes in endometrial tissue. This is significant for enhancing early diagnostic accuracy and improving treatment outcomes and long-term management.
Previous research has revealed that utilizing videos or images to educate primiparas about labor analgesia yields significantly superior results. WeChat supports various types of media, making it an ideal carrier for educational content. We have established a WeChat public account where educational content is presented through videos, images, and relevant scientific articles. We will investigate the effectiveness of WeChat public platform in primiparas analgesia education.
Primiparas were randomly assigned to either the WeChat public account education group (W group) or traditional bedside education group (B group). The labor analgesia knowledge questionnaires, self-rating anxiety scales, and the time taken for positioning were compared between the two groups. Additionally, satisfaction with labor analgesia was evaluated post-delivery.
A total of 90 primiparas were completed the study. Compared to the B group, primiparas in the W group had higher scores on labor analgesia knowledge questionnaire (55 ± 11.1 vs. 65 ± 9.2, p = 0.001), lower anxiety scores (51.4 ± 5.4 vs. 48.9 ± 4.6, p = 0.02), shorter positioning time (27.5 ± 7.9 s vs. 20.1 ± 9.2 s, p = 0.001) than those in the B group. The satisfaction of anesthesiologists with body positioning and the satisfaction of primiparas with labor analgesia were similar between the two groups.
The use of WeChat public platform for labor analgesia education can enhance primiparas understanding and cooperation during the procedure, decreasing maternal anxiety. It also benefits anesthesiologists by improving work efficiency. It has significant clinical value and promising prospects for promotion.
The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025231).
Placenta previa (PP) combined with placenta accreta spectrum (PAS) is a serious obstetric condition that increases the risk of maternal and fetal complications. Early diagnosis is therefore crucial for improving outcomes. The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) combined with three serological markers (alpha-fetoprotein [AFP], creatine kinase [CK], and soluble fms-like tyrosine kinase-1 [sFlt-1]) for the diagnosis of PP with PAS.
This retrospective study included 243 patients with suspected PP and PAS treated at two hospitals between August 2018 and August 2023. Patients were divided into two groups based on surgical and pathological findings: PP+PAS (+) and PP+PAS (–). The serum levels of AFP, CK, and sFlt-1 were measured, and optimal diagnostic thresholds were determined using receiver operating characteristic (ROC) curve analysis. The diagnostic performance of MRI, serological markers, and a combination of the two was compared with that of surgical pathology.
Serum AFP, CK, and sFlt-1 levels were significantly higher in the PP+PAS (+) group compared to the PP+PAS (–) group. The optimal thresholds of AFP, CK, and sFlt-1 for the diagnosis of PP+PAS (+) were 58.49 U/mL, 168.25 U/mL, and 2.28 ng/mL, respectively. A combined diagnostic approach using MRI and serological markers showed good accuracy, with a Kappa coefficient of 0.850, indicating good agreement with surgical pathology.
Combining MRI with serological markers (AFP, CK, and sFlt-1) provides enhanced diagnostic accuracy for detecting PP with PAS as compared to either method alone. This approach can facilitate early diagnosis, improve clinical decision-making, and reduce the risks associated with surgical intervention.
The cesarean section rate is high in countries such as Türkiye, Egypt, and Brazil. The aims of this study were to determine whether the cesarean section rate during labor induction is high in late-term cephalic pregnancies and to evaluate the related factors.
This retrospective descriptive study was conducted with 254 patients with a cephalic fetal presentation who were admitted in the labor unit of a tertiary center for induction of labor (IOL) at ≥41 0/7 weeks of gestation. The patients were evaluated in terms of demographic characteristics, Bishop score, labor induction method (dinoprostone or oxytocin administration), IOL duration, vaginal delivery rate, cesarean section rate, indication for cesarean delivery, 5-min Apgar score, fetal requirement for neonatal resuscitation, oxygen treatment, and neonatal intensive care unit admission.
The study population comprised 254 patients, of whom 181 (71.3%) had a vaginal delivery and 73 (28.7%) had a cesarean delivery. To evaluate the factors that affect labor induction failure and cesarean indication, the patients were divided into two groups: the nulliparous (n: 122) and multiparous (n: 132). The cesarean section rates in the nulliparous and multiparous groups were 44.3% (n: 54/122) and 14.4% (n: 19/132), respectively. According to the multivariate logistic regression, being nulliparous, having a male fetus were found to be the associated risk factors for cesarean delivery (p < 0.05).
The study results suggest that the cesarean section rate during labor induction is higher in low-risk, late-term cephalic pregnancies. Nulliparity, male fetal sex were risk factors for cesarean delivery.
Pelvic organ prolapse (POP) significantly impacts the quality of life, particularly in older women with a history of vaginal deliveries. Although conservative treatments provide some symptom relief, surgical interventions are more effective for managing POP. This study compares the outcomes and effectiveness of sacrospinous ligament fixation (SSLF) and laparoscopic lateral suspension (LLS) surgeries in the treatment of POP.
This retrospective comparative cohort study included patients with symptomatic stage 2 or higher apical POP, treated at a tertiary hospital in Turkey between April 2021 and June 2022. Patients were treated with either SSLF or LLS surgeries and underwent preoperative and postoperative evaluations using the Prolapse Quality of Life (P-QoL) questionnaire and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Patients were divided into two groups: SSLF (n = 47) and LLS (n = 44). The primary outcome was the rate of anatomical failure, while secondary outcomes included improvements in functional capability and quality of life.
The study found that the rate of postoperative anterior compartment failure was significantly lower in the LLS group compared to the SSLF group (p = 0.005). The success rate of LLS for apical prolapse was 100%, compared to 93.6% for SSLF. In the posterior compartment, SSLF demonstrated a higher success rate (86.2%) than LLS (68.5%). Both procedures improved P-QoL scores and the PISQ-12 subscales; however, a significant improvement in total PISQ-12 scores was observed only in the LLS group (p = 0.009).
Both SSLF and LLS are effective in treating POP and enhancing quality of life. However, LLS demonstrated higher success rates for anterior and apical prolapse, while SSLF was more effective in addressing in posterior compartment defects.
Recently, serial ultrasound assessment of cervical length has been proposed as an alternative management of history-indicated cerclage. To investigate the efficacy of prophylactic cerclage among women who had previously experienced mid-trimester pregnancy loss by comparing the outcomes between women who chose history-indicated cerclage and those who chose serial ultrasound assessment.
We examined the medical records of women who delivered at our hospital between 2010 and 2018 and extracted cases with a history of mid-trimester pregnancy loss between 14 and 25 weeks' gestation. We compared the women with and without history-indicated cerclage. For women who choose expectant management, cervical length was assessed by transvaginal ultrasound every two weeks, and ultrasound-indicated cerclage was performed. The primary outcome was preterm birth before 28 or 34 weeks.
The study criteria were met by 63 women; among these, 28 had received history-indicated cerclage. The incidence of preterm birth at 28 and 34 weeks was similar between the two groups. However, among the 30 women who experienced painless cervical dilation at prior pregnancy loss, history-indicated cerclage showed significant low preterm birth rate compared with expectant management: 2/22 (9.1%) vs. 4/8 (50.0%) at <28 weeks (p = 0.029) and showed a lower preterm birth rate: 3/22 (13.6%) vs. 4/8 (50.0%) at <34 weeks (p = 0.06).
History-indicated cerclage can be considered in women with a history of mid-trimester pregnancy loss who experience painless cervical dilation.
Insulin-regulated aminopeptidase (IRAP) is involved in insulin sensitivity and glucose metabolism and is important in the pathophysiology of type 2 diabetes. Serum IRAP levels are strongly associated with type 2 diabetes and insulin resistance. The aim of this study was to evaluate the IRAP level as a potential biomarker for the early diagnosis and management of insulin resistance in women with gestational diabetes mellitus (GDM).
This cohort study included 40 women with GDM and 40 women with healthy pregnancies. Maternal serum IRAP levels were measured with enzyme-linked immunosorbent assay (ELISA) and compared between the two groups.
The mean serum IRAP level was significantly lower in the GDM group (0.73 ± 0.12 ng/mL) compared to the controls (0.92 ± 0.10 ng/mL) (p = 0.001). Pairwise comparisons indicated, that diet modified and insulin treated GDM subgroups had significantly lower serum IRAP levels than the control group (p < 0.017 and p < 0.017, respectively). Serum IRAP levels showed significant negative correlations with fasting glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR) levels and hemoglobin A1c (HbA1c) (r = –0.541, p = 0.001; r = –0.447, p = 0.001; r = –0.584, p = 0.001; r = –0.361, p = 0.001). The optimum serum IRAP cut-off value was calculated to be 0.857 ng/mL, with a sensitivity of 85% and a specificity of 80% for the prediction of GDM (p = 0.001).
The serum IRAP level in pregnant women diagnosed with GDM was significantly lower than in healthy pregnant women. Moreover, the serum IRAP level was negatively correlated with the levels of insulin, HbA1c, and HOMA-IR. These findings suggest that low serum IRAP level could be a novel biomarker for the prediction of GDM.
The study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT06716320).
Severe endometrial injury constitutes a significant risk to female fertility, often leading to the development of intrauterine adhesions. Pyroptosis, a form of programmed cell death associated with inflammation, is initiated by the cleavage of gasdermin family proteins by caspase, which has been implicated in endometrial injury. In recent years, hydrogen sulfide (H2S), a gaseous signaling molecule, exerts significant regulatory effects on pyroptosis in diverse pathological processes. The aim of this study is to elucidate the role of H2S in facilitating functional recovery of the endometrium following injury in a murine model.
A prospective laboratory based randomized control trial was performed to evaluate the protective role of H2S in endometrial injury. Ethanol-induced endometrial injury mouse models were established and H2S donor sodium hydrosulfide (NaHS) was randomly administered to the injured mice. Western blot analysis was conducted to assess changes in the expression of endogenous H2S metabolism and pyroptosis-related markers and histological analysis (Hematoxylin & Eosin and Masson staining) was employed to examine alterations in endometrial morphology. Finally, a fertility test was performed to evaluate the restoration of the uterine function.
Following endometrial injury, the expression of key endogenous H2S enzymes-cystathionine β-synthase (CBS), cystathionine γ-lyase (CSE), and 3-mercaptopyruvate sulfurtransferase (MST)-is significantly reduced, while the levels of pyroptosis-related proteins are elevated (p < 0.05). However, treatment with H2S resulted in an increase in the expression of endogenous H2S enzymes and a decrease in pyroptosis-associated proteins compared to the Model group (p < 0.05). Moreover, endometrial morphology and embryo count showed the most pronounced improvement in the H2S treatment group (p < 0.05).
This study confirms the therapeutic efficacy of H2S in facilitating the recovery of injured endometrium and revealed its potential therapeutic mechanism, offering a promising therapeutic avenue for patients with severe endometrial injury.
A prevalent condition during pregnancy, gestational diabetes mellitus (GDM) affects a significant proportion of pregnancies worldwide and poses substantial risks to maternal as well as fetal health. Polymorphisms in the glucokinase (GCK) and glucokinase regulatory protein (GCKR) genes, which are crucial for glucose homeostasis, may modulate susceptibility to GDM. Hence, this meta-analysis aimed to assess the relationship between GDM and polymorphisms in GCK (rs1799884, rs4607517) and GCKR (rs780094, rs1260326).
In this systematic review, we retrieved data from PubMed, EMBASE, Medline, EBSCO, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) databases. Studies were critically appraised using the Newcastle-Ottawa Scale, and meta-analyses were performed using STATA 12.0. The odds ratios (ORs) were calculated with 95% confidence intervals (CIs) and heterogeneity was assessed with Cochran’s Q test as well as I2 statistical tests, respectively. Moreover, Begg’s test helped in evaluating publication bias.
We included 20 studies, comprising 9745 GDM women and 15,830 controls. All genetic models showed a strong correlation between the GCK rs1799884 polymorphism and GDM, with carriers of the A allele exhibiting an increased risk. Conversely, GCK rs4607517, GCKR rs780094, and rs1260326 were not significantly associated. However, heterogeneity was influenced by ethnicity and diagnostic criteria.
The GCK rs1799884 polymorphism can be a potential predictive marker because it is significantly associated with an increased risk of GDM.
This review was conducted to explain how menopausal hormone therapy (MHT) benefits cardiovascular diseases (CVDs) and how to control the risk of breast cancer.
Estrogen deficiency, altered energy homeostasis, adipocyte changes, inflammation, and insulin resistance are responsible for the development of metabolic syndrome and CVDs. Estrogen influences hypothalamic function and maintains the energy balance, protecting menopausal women from these cardiovascular risk factors. However, estrogen metabolism plays a crucial role in the genotoxic pathway that leads to breast cancer. Moreover, MHT is associated with cell proliferation and mutation signaling pathways in breast cancer, as well as the process of growing the breast cancer stem cell.
While MHT may have favorable effects when started early, introducing it later in the course of atherosclerosis may pose major dangers, underlining the importance of timing in hormone therapy. Estrogen-only therapy has a greater favorable effect on CVDs than the estrogen-progesterone combination. Although the connection between MHT and breast cancer is well-documented, significant knowledge gaps remain, especially regarding the long-term effects of newer MHT formulations. Current studies support using the lowest effective dose for the shortest possible duration, with a focus on tailoring therapy to individual risk factors, such as obesity, smoking, and alcohol consumption. Thus, MHT should be customized due to the intricacy of individual risk factors and differences in responses to therapy.
Although MHT is effective for controlling CVDs in women entering menopause, it must be used with caution, especially in women at high risk of breast cancer.
Preeclampsia (PE) is a common complication of pregnancy and there is currently a lack of valuable diagnostic and predictive methods for it. This study aimed to explore the association between renal function markers, blood lipid levels in late pregnancy and PE, then assess the combined predictive value for PE.
This was a retrospective case-control study that selected 263 eligible patients in late pregnancy diagnosed with PE as the case group and 264 healthy parturients as the control group. All participants were hospitalized from January 2021 to December 2023. The levels of serum renal function [creatinine (Cr), uric acid (UA) and urea] and blood lipid [total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL)] were compared between two groups. Logistic regression analysis was used to explore the association between these indicators and PE. Then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of them for PE. p < 0.05 was considered statistically significant.
Univariate analysis showed that the PE group had significantly higher levels of TG, Cr, UA, and urea than the control group [3.56 (3.01–4.38) mmol/L vs. 2.98 (2.50–3.42) mmol/L, 54.00 (47.00–62.00) μmol/L vs. 46.00 (42.00–51.00) μmol/L, 367.00 (305.50–425.00) μmol/L vs. 278.00 (244.00–306.00) μmol/L, 3.50 (2.75–4.40) mmol/L vs. 2.90 (2.60–3.55) mmol/L respectively]. Multivariable analysis showed that the serum TG [adjusted odds ratio (AOR) = 1.827 (95% confidence interval (95% CI) = 1.277–2.615)], Cr [AOR = 1.066 (95% CI = 1.028–1.106)] and UA [AOR = 1.016 (95% CI = 1.011–1.022)] were risk factors for PE (p < 0.001). ROC curves revealed that areas under the curve (AUC) were 0.703 (95% CI = 0.658–0.747), 0.734 (95% CI = 0.691–0.777) and 0.822 (95% CI = 0.786–0.857) respectively. The AUC, sensitivity and specificity of the combination of TG, Cr and UA were 0.864 (95% CI = 0.833–0.896), 76.4%, and 84.8%.
The increased levels of serum TG, Cr and UA imply greater possibility of PE, thus they are considered as the risk factors. And their combination has a certain predictive value for PE, which may offer a fresh, convenient and efficient method for the diagnosis and treatment of PE.
This review aims to improve the accuracy and efficacy of ultrasound diagnosis of fetal bradyarrhythmias. Fetal arrhythmias represent 10% to 20% of referrals to specialized clinics for the evaluation of fetal heart rhythm abnormalities
Various methods are available for assessing fetal heart rhythm through ultrasound and fetal echocardiography, which facilitate accurate diagnosis and help determine the optimal management strategies. Despite advancements in diagnostic techniques, the absence of studies with a substantial number of cases has resulted in significant variability in treatment approaches, influenced by local expertise and available resources.
Fetal bradycardias can be transient or persistent conditions. Differentiating between them is critical for determining appropriate management. Second-trimester physiological transient bradycardia is characterized by temporary decelerations in fetal heart rate that resolve spontaneously to normal rhythm without requiring treatment or follow-up. In contrast, isolated or immune-mediated complete atrioventricular block may progress rapidly to hydrops, requiring close monitoring, medical intervention, and, in some cases, early delivery.
In this review, we provide a comprehensive overview of all types of fetal bradycardias and the intrauterine management strategies used for their treatment.
Accurate assessment of lymph node involvement is essential for prognosis and guiding treatment decisions in gynecological cancers, as it directly influences therapeutic strategies and patient outcomes. However, conventional imaging techniques, such as ultrasound and computed tomography (CT), demonstrate limited accuracy in determining the nature of lymph nodes. This study implements three-dimensional shear wave elastography (3D-SWE), an innovative technique that quantifies the stiffness of inguinal lymph nodes (ILN) in patients with gynecological cancers. This approach offers a more comprehensive assessment of ultrasound elastography compared to traditional methods.
This retrospective study evaluated 120 ILNs from patients with gynecological cancers who underwent conventional ultrasound (US), two-dimensional shear wave elastography (2D-SWE), and multiplanar 3D-SWE. The diagnostic performance was analyzed using receiver operating characteristic (ROC) methodology, enabling a comprehensive comparison of the sensitivity and specificity of 3D-SWE relative to conventional ultrasound and 2D-SWE. Pathology results from lymph node resections or biopsies served as the reference standard.
Final pathology confirmed 65 metastatic and 55 benign lymph nodes. The maximum (Emax) and average (Emean) elasticity values from 2D-SWE and 3D-SWE for malignant lymph nodes were significantly higher than those for benign lymph nodes (p < 0.0001). ROC analysis indicated that for identifying metastatic lymph nodes, the area under the curve (AUC) values were 0.798 for 2D-SWE Emax, and 0.828, 0.839, and 0.816 for the transverse, sagittal, and coronal planes of 3D-SWE Emax, respectively. The differences between these AUC values were not statistically significant (p > 0.05). Furthermore, Emax values consistently surpassed Emean values in terms of characterization accuracy across modalities. Although no significant differences were observed between 2D-SWE and 3D-SWE, the sagittal view Emax yielded the best AUC, indicating optimal diagnostic precision overall.
3D-SWE, particularly using the sagittal Emax parameter, effectively distinguishes benign lymph nodes from metastatic ones by quantitatively evaluating the stiffness of ILNs in relation to gynecological tumors. Serving as a dependable diagnostic method for lymph nodes, 3D-SWE may help reduce the necessity for invasive biopsy procedures in some cases.