From an immunological perspective, changes in cytokine levels can shift the immune response, potentially affecting the development of endometrial polyps (EPs). The relationship between the balance of T helper 1 (Th1)/T helper 2 (Th2) and T helper 17 (Th17)/Regulatory T (Treg) cytokines and the pathogenesis of EPs is an area of ongoing research. This study aims to investigate the role of Th1/Th2 and Th17/Treg immune imbalances in the pathogenesis of EPs.
A total of 79 patients were included in this prospective laboratory-based study. The experimental group included 20 patients with single EPs, 20 with multiple EPs, and 19 with postmenopausal EPs. The control group included 20 individuals with proliferative endometriums. Immunohistochemical staining was performed to investigate the expression of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), interferon-gamma (IFN-γ).
The levels of TNF-α, IFN-γ, IL-17 and transforming growth factor-β (TGF-β) in the single EP group were higher than in the control group (pTNF-α = 0.001, pIFN-γ < 0.001, pIL-17 < 0.001, pTGF-β < 0.001), while the level of IL-6 in the stroma was lower than in the control group (pIL-6 < 0.001). The levels of IL-2, IFN-γ, IL-4, IL-17 and TGF-β in the glands of the multiple EPs group were higher than in the glands of the control group (pIL-2 = 0.041, pIFN-γ < 0.001, pIL-4 = 0.044, pIL-17 < 0.001, pTGF-β < 0.001). The levels of IL-4, IL-6, TNF-α, and IL-17 in the postmenopausal single polyp group were lower than in the total control group (pIL-4 = 0.020, pIL-6 = 0.002, pTNF-α < 0.001, pIL-17 = 0.006), while the levels of IL-2, IFN-γ and TGF-β in the glands were higher than in the control group (pIL-2 = 0.002, pIFN-γ = 0.002, pTGF-β = 0.005).
Th1/Th2 and Th17/Treg immune imbalances are one of the causes of EPs.
This study is a prospective cohort study that aimed to explore the mechanism involved in myocardial energy metabolism disturbance in breast cancer patients with stages I to II. Notably, myocardial energy metabolism disturbance is induced by epirubicin, cyclophosphamide, and paclitaxel taxane (EC-T) sequential chemotherapy after breast-conserving surgery.
Stage I and stage II breast cancer patients treated in the breast or oncology departments of the hospital from February 2021 to May 2023 were invited to participate in the study. The patients were treated with EC-T sequential chemotherapy after breast-conserving surgery. The patients were divided into a control group (no cardiotoxic event, n = 155) and an observation group (cardiotoxic event, n = 45) based on clinical evaluations and laboratory tests. All patients signed informed consent for the protocol during study inclusion. Two groups were compared for clinically relevant differences. Blood biochemical analyses were performed to detect the levels of myocardial injury and myocardial oxidative stress. Enzyme linked immunosorbent assay (ELISA) was employed to detect serum mitochondrial respiratory enzyme activity. Cardiac magnetic resonance spectroscopy (MRS) was used to detect myocardial energy metabolism. The blood flow and metabolic status of the heart were assessed by positron emission tomography (PET).
The general data were identical in the two groups (p > 0.05). The observation group had significantly higher levels of troponin, creatine kinase, creatine kinase-MB (CK-MB) isoenzyme, and lactate dehydrogenase compared with the control group; meanwhile, the activities of complex I, complex III, and complex V were significantly lower (p < 0.05). In the observation group, the levels of adenosine triphosphate and creatine phosphate were lower than those in the control group, while the levels of reactive oxygen species (ROS) and malondialdehyde (MDA) were higher (p < 0.05). The levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the observation group were lower than those in the control group, while the levels of pyruvate and β-hydroxybutyric acid were higher (p < 0.05). Moreover, cardiac blood flow, myocardial glucose uptake, myocardial fatty acid uptake, and myocardial metabolic efficiency in the observation group were lower compared with the control group (p < 0.05).
In breast cancer patients with stages I to II who were receiving an EC-T sequential chemotherapy regimen, myocardial energy metabolism disorders are associated with increased markers of myocardial injury. This phenomenon is associated with decreasing mitochondrial respiratory enzyme activity, changes in energy metabolic pathways, and reduced cardiac blood flow and metabolic efficiency. These results suggest that EC-T chemotherapy may cause direct damage to cardiomyocytes and affect the normal metabolic function of the heart.
The incidence of pregnancies with premature rupture of membranes (PROM) is between 1% and 10% worldwide. This study aimed to examine the perinatal and early neonatal outcomes in PROM in a reference healthcare maternity in a low- and middle-resource country of sub-Saharan Africa.
A cross-sectional study with an analytical focus was conducted from 2019 to 2023, involving 789 PROM cases out of 22,570 deliveries, representing 3.5% of the total admissions. This study analyzed demographic data, obstetric history, prenatal care, and perinatal outcomes. Univariate and multivariate statistical analyses were performed to identify risk factors for maternal and neonatal complications.
The average age of the pregnant women was 32 years, with 76.7% aged between 20 and 40 years. The majority of births (62.9%) occurred between 28 and 34 weeks of gestation (WG), indicating a high prevalence of prematurity in the studied sample. Full-term births (>37 weeks) accounted for only 15.3%, indicating a concerning proportion of preterm deliveries. The majority of the women were unemployed (66.0%), and 40.7% had no formal education. An obstetric history of preterm premature rupture of membranes (PPROM) was reported in 57.4% of cases, and 16.7% had cervical incompetence. The median number of prenatal visits was 4 (range: 0–8). Neonatal mortality was 11.2%, with preterm infants accounting for 70.5% of the deaths. Delayed admission (>24 hours) and abnormal amniotic fluid (AF) were significantly associated with maternal infections (p < 0.001). The multivariate analysis revealed delayed admission [adjusted odds ratio (aOR): 19.82; p < 0.001] and abnormal AF (aOR: 4.38; p < 0.001) as strong predictors of maternal infections. For neonatal mortality, delays of more than 72 hours (aOR: 1.88; p = 0.007) and low birth weight (aOR: 42.55; p < 0.001) were also identified as risk factors.
PROM is a common obstetric emergency associated with significant morbidity, limited resources, and socioeconomic challenges. This study highlights management gaps, emphasizing the need for improved prenatal care, early risk factor prevention, and the adaptation of strategies to local contexts to reduce complications.
Chromosomal microarray analysis (CMA) is the recommended genetic test for fetuses with increased nuchal translucency (NT); however, its use in Latin America remains limited. The objective of this study was to determine the prevalence of genetic testing in fetuses with increased NT in Panama and across Latin America.
We conducted a retrospective cohort study of 1512 women who underwent first-trimester screening in Panama, along with a systematic review and meta-analysis of studies reporting genetic testing in Latin America. A comprehensive literature search was conducted across MEDLINE (via PubMed), Epistemonikos, LILACS, BRISA, SciELO, and Google Scholar, covering studies from inception to June 2023 was updated to December 2023. The extracted data included population, setting, timing, and genetic testing methods. The Joanna Briggs Tool was used to assess the risk of bias. Pooled prevalence estimates were calculated using random-effects models.
Among 1236 fetuses in the Panamanian cohort, 77 (6.23%) had NT ≥95th percentile. The systematic review included 11 studies encompassing 842 fetuses diagnosed with increased NT. The overall proportion of fetuses undergoing invasive testing was 0.31 (95% confidence interval [CI]: 0.28–0.33). Anomalies were found in 63% of cases with increased NT. CMA was not reported in any of the studies.
Most patients in Latin America do not undergo invasive testing, and conventional karyotyping remains the most frequently performed method. To date, no studies have reported the use of CMA in this context. Therefore, the findings of this study highlight significant gaps in access to genetic testing, emphasizing the need for strategic initiatives to improve test availability and build capacity for implementing microarray analysis in the region.
The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42023398899; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023398899).
High-intensity focused ultrasound (HIFU) represents a new technology in the treatment of uterine fibroids. The curative effect of HIFU is affected by the blood supply of uterine fibroids. Oxytocin is an effective medication for promoting uterine contractions and reducing blood flow to uterine fibroids. This study aimed to evaluate the safety and efficacy of oxytocin-enhanced HIFU in treating uterine fibroids.
A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted (up to December 14, 2024). Cohort studies reporting the impact of oxytocin on HIFU outcomes were included. A meta-analysis was performed using RevMan 5.3 software, focusing on the non-perfused volume percentage (NPV%). The NPV% is typically used to represent the effective ablated tissue volume, which is then used to calculate the ratio of the non-perfused volume to the volume of the primary fibroids after HIFU treatment.
Seven studies met the screening criteria, three of which had a primary outcome measure including NPV%. A meta-analysis showed that oxytocin significantly increased NPV% [mean difference (MD): 13.31, 95% CI: 9.17–17.44; p < 0.00001], with low heterogeneity (I2 = 26.00%). Minimal and transient side effects were reported.
Oxytocin enhances the efficacy of HIFU for uterine fibroids by increasing the NPV% and improving procedural outcomes. Nonetheless, further studies are needed to confirm the long-term benefits and safety of oxytocin in conjunction with HIFU.
The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42024627652, registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024627652)
Oocyte donation combined with in vitro fertilization and embryo transfer (IVF-ET) technology enables women who are unable to obtain or use their own oocytes due to advanced age or various causes of ovarian dysfunction, to achieve motherhood.
Despite the maturity and widespread application of oocyte donation IVF-ET technology, numerous ethical and administrative controversies persist regarding the sources and modes of oocyte donation, eligibility criteria for donors and recipients, the number of oocytes donated or received, compensation for oocyte donation, and the disclosure of information between donors and recipients.
In-depth discussion and thorough consideration of these issues are necessary to provide revisions of assisted reproductive management policies and to resolve ethical controversies, thereby promoting the standardized implementation of oocyte donation in IVF-ET.
This review examines the major ethical controversies and management challenges in oocyte donation. These include issues such as informed consent, the commodification of oocytes, and potential risks to donors. Informed consent is a crucial element, requiring that donors fully understand the procedures, potential consequences, and broader implications before decision-making.
Oxytocin, a peptide hormone, plays several physiological roles in the human body, particularly during childbirth and lactation. Inappropriate use of oxytocin may cause adverse events. Although acute coronary syndromes associated with oxytocin are rare, they should not be overlooked.
A 44-year-old female underwent hysteroscopic surgery for endometrial and cervical polyps, which were accompanied by increased menstrual flow. During the procedure, oozing from the wound was observed. To promote uterine contraction, oxytocin (10 U) was administered in 100 mL of 0.9% normal saline (NS) via slow intravenous infusion. Five minutes after the infusion, ST-segment elevation in lead II was noted. Oxytocin was immediately discontinued, and symptomatic treatment, including esmolol, was initiated. Under continuous cardiac monitoring, the dosage of medications was gradually adjusted, leading to the stabilization of vital signs, including blood pressure, heart rate, oxygen saturation, and respiration. The patient was discharged on the fifth postoperative day and has since been regularly followed up in the cardiology clinic. To date, no abnormalities have been observed.
This case underscores the importance of thoroughly informing patients about the potential uses and adverse effects of oxytocin prior to surgery. During the procedure, strict adherence to the indications for oxytocin use and close monitoring of vital signs are essential. This case serves as a reminder of the need for vigilance in managing potential complications associated with oxytocin administration.
Group visits have been widely utilized in the management of chronic diseases and have demonstrated favorable clinical outcomes. Therefore, by leveraging this model, we implemented group visits for patients undergoing preimplantation genetic testing (PGT). This study aimed to explore the effects of the group visit model on patient anxiety levels, social support, disease-related knowledge, and satisfaction with health education of patients undergoing PGT.
A total of 120 patients undergoing PGT for the first time at our reproductive center from 5 March 2022 to 31 October 2022 were randomly divided into the control and intervention groups. The control group received routine health education, and the intervention group received family-centered group health education. The knowledge of PGT, satisfaction with health education, along with anxiety and social support levels, were compared between the two groups before and after the intervention. The differences were statistically significant at p < 0.05.
Overall, 113 participants completed the intervention, with 55 assigned to the control group and 58 to the intervention group. Participants in the intervention group exhibited significantly reduced anxiety levels and substantial improvements in social support, disease knowledge, and satisfaction with health education compared to those in the control group.
The implementation of family-centered group health education for patients undergoing PGT is effective in clinical practice and warrants widespread adoption.
The study has been registered on https://www.chictr.org.cn/ (registration number: ChiCTR2300069544; registration link: https://www.chictr.org.cn/showproj.html?proj=172588).
Polycystic ovary syndrome (PCOS) is related to persistent low-grade inflammation and oxidative stress (OS). Resveratrol (RSV) exhibits potent anti-inflammatory and antioxidant effects, suggesting therapeutic potential for PCOS. However, its precise mechanisms of action, particularly concerning ferroptosis remain unclear. This study aimed to investigate whether RSV ameliorates PCOS by modulating inflammation, OS and ferroptosis features, thereby offering novel insights into its therapeutic role.
PCOS was induced in mice through once-daily subcutaneous dosing of dehydroepiandrosterone (DHEA: 0.6 mg/kg), alongside a 21-day continuous high-fat diet regimen. Following successful model induction, the mice were assigned to the PCOS group or the RSV group. RSV was orally gavaged at doses of 20 and 40 mg/kg/day for 30 days. The body weight, ovarian weight and estrous cycle were monitored. Serum is used for the detection of hormones [follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and inflammatory markers [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)]. Then the ovarian tissue samples were utilized for the assessment of OS indicators [malondialdehyde (MDA), glutathione (GSH)], glutathione peroxidase 4 (GPX4), and transcriptomic profiling.
RSV was shown to reduce body weight and ovarian weight. RSV also ameliorated symptoms of PCOS by decreasing chronic inflammation, OS and ferroptosis features in the ovaries. All the detected inflammatory factors in the PCOS group were significantly higher than those in the control group (IL-1β, p < 0.0001; IL-6, p < 0.001; TNF-α, p < 0.01) and were significantly decreased with the supplementation of RSV. Ovarian tissue MDA levels were markedly elevated in PCOS mice compared to controls (p < 0.0001), with RSV treatment significantly attenuating this increase. While GSH levels were significantly depleted in PCOS ovaries compared to controls (p < 0.0001), with RSV treatment effectively restoring concentrations. Western blot analysis revealed that GPX4 expression in ovaries was significantly diminished in the PCOS group compared with the control group (p < 0.01), but this reduction was effectively reversed by RSV treatment.
RSV demonstrated therapeutic efficacy in PCOS mice by normalizing hormonal profiles and mitigating chronic inflammatory responses and oxidative damage. Furthermore, our investigation also revealed that RSV ameliorates PCOS pathology by modulating GPX4 pathways, which is consistent with ferroptosis features.
Dysmenorrhea is a common condition that affects many women during their reproductive years and can lead to significant disruptions in daily life. While studied extensively worldwide, only limited research has been conducted on the severity and effects of dysmenorrhea in women from the Eastern region of Saudi Arabia. Therefore, this study aimed to examine the prevalence of dysmenorrhea and its impact on women from this region, using the Work ability, Location, Intensity, Duration of Dysmenorrhea (WaLIDD) score to assess the severity of dysmenorrhea across multiple dimensions.
A cross-sectional study was conducted at the University of Hafr Al Batin to determine the severity of dysmenorrhea among 291 female students using the WaLIDD score. Data on demographic characteristics, clinical history, and menstrual patterns were collected through an online questionnaire. Statistical analyses, including Fisher’s exact test and ANOVA test, were performed using R Studio.
Among the participants, 13.1% had no or mild dysmenorrhea (no-to-mild), 47.4% had moderate dysmenorrhea, and 39.5% had severe dysmenorrhea. Severe dysmenorrhea was associated with significantly higher body mass index (BMI) (p = 0.024), a history of gynecological disease (p = 0.029), and seeking medical consultation (p < 0.001). Severe dysmenorrhea was also significantly associated with irregular cycles (p = 0.003), heavier menstrual flow (p < 0.001), and functional impairment (p < 0.001).
Dysmenorrhea is highly prevalent and has significant effects on the daily life of young women in the Eastern region of Saudi Arabia. BMI and menstrual characteristics play key roles in the severity of dysmenorrhea, thereby highlighting the need for targeted interventions and increased awareness to improve management strategies.
Breast cancer among adolescent and young adult (AYA) women requires greater awareness and concern due to the aggressive nature of the tumor. Therefore, this study aimed to examine the spatiotemporal trends in the burden of breast cancer in AYA women between 1990 and 2019.
Data on breast cancer in AYA women were obtained from the Global Burden of Disease (GBD) 2019 study, and the estimated annual percentage change (EAPC) was computed to assess trends over time.
In 2019, the age-standardized prevalence rate (ASPR) of breast cancer among AYA women was 94.8 per 100,000 population, while the age-standardized incidence rate (ASIR) was 11.29 per 100,000 population. From 1990 to 2019, the age-standardized mortality rate (ASMR) declined from 3.02 (95% uncertainty interval (UI): 2.78–3.26) to 2.86 (95% UI: 2.58–3.17) per 100,000 population, and the EAPC was –0.41 (95% confidence interval (CI): –0.53 to –0.30). The age-standardized disability-adjusted life year (DALY) rate (ASDR) was 165.2 (95% UI: 148.54–182.26) in 2019, and the EAPC was –0.34 (95% CI: –0.46 to –0.23). The regions with a mid-level sociodemographic index (SDI) exhibited the fastest increases in both the ASPR and ASIR, with EAPCs of 1.77 (95% CI: 1.66 to 1.84) and 1.57 (95% CI: 1.45 to 1.67), respectively. There was an increased trend in the ASDR and ASMR in the low-middle and low SDI regions. The most substantial contributors to the DALYs and death were alcohol consumption, tobacco use, and low physical activity, which were closely followed by high fasting plasma glucose and higher red meat consumption.
We comprehensively evaluated the burden of breast cancer in AYA women while considering factors such as SDI, age, risk elements, and geographical distribution. These findings could inform resource allocation and the development of effective policies.
In assisted reproductive technology, particularly in vitro fertilization (IVF), optimizing ovarian stimulation protocols using individualized recombinant follicle-stimulating hormone (FSH) preparations, such as follitropin delta, has gained attention for its potential to improve treatment outcomes and reduce the risk of ovarian hyperstimulation syndrome (OHSS). This study aimed to evaluate the efficacy of combining follitropin delta and clomiphene citrate (CC) in women with a suboptimal response to ovarian stimulation using follitropin alpha during IVF.
A retrospective study was conducted in women undergoing two consecutive IVF cycles at the Military Institute of Clinical Embryology and Histology, Vietnam. The first cycle utilized follitropin alpha, followed by a second cycle with follitropin delta plus CC. Embryological outcomes were assessed, including the number of stimulated follicles, the number of oocytes retrieved, and embryo quality at cleavage and blastocyst stages. A mixed-effects model with a negative binomial or Poisson distribution was applied to analyze repeated measurements within the same individual.
A total of 57 women were included in the final analysis. Following a suboptimal response to follitropin alpha, ovarian stimulation with follitropin delta plus CC resulted in a significant increase in the number of total day 3 embryos (p = 0.018), total day 5–6 embryos (p = 0.017), and good-quality blastocysts (p = 0.028). The number of stimulated follicles also showed a trend toward improvement (p = 0.043). No significant differences were observed in the number of oocytes retrieved or metaphase II (MII) oocytes.
In women who previously demonstrated a suboptimal ovarian response, follitropin delta combined with CC was associated with improved embryological outcomes compared to conventional follitropins. These findings suggest that combining follitropin delta and CC may optimise ovarian response and embryo quality in this patient population. Further studies are warranted to confirm these results and assess the impact of this combination treatment on clinical pregnancy and live birth rates.
Macrosomia is a significant perinatal complication with potential risks for both mother and child. Although diabetes is a known major risk factor, specific clinical and metabolic factors contributing to macrosomia in non-diabetic pregnancies are not fully understood. Therefore, this study aimed to explore the clinical characteristics and potential metabolic risk factors associated with non-diabetes-related neonatal macrosomia. Additionally, this study aimed to examine the relationship between metabolic dysregulation and the presence of exosomes in umbilical cord blood.
A retrospective analysis of 356 non-diabetic pregnant women (170 non-diabetic pregnant women with macrosomic infants and 186 normal pregnant women) was conducted. Additionally, umbilical cord blood plasma samples were collected from 16 participants (8 macrosomia and 8 normal deliveries). After separating exosomes from plasma, RNA was extracted and sequenced. Weighted gene co-expression network analysis (WGCNA) was used to explore the correlation between clinical characteristics and gene expression.
Among the baseline characteristics, the pre-pregnancy body mass index (BMI) and overall weight gain in non-diabetic mothers with macrosomic infants were significantly higher than those in the normal group (p < 0.05). The lipid profiles revealed that triglyceride (TG) and low-density lipoprotein (LDL) levels were significantly elevated, whereas the high-density lipoprotein (HDL) levels were significantly decreased (p < 0.05). Logistic regression analysis showed that pre-pregnancy BMI, gestational weight gain, LDL levels, and alkaline phosphatase (ALP) levels in the third trimester were risk factors for macrosomia, while primiparas and HDL levels were protective factors. WGCNA analysis revealed that the expression of the mRNA royalblue module and the lncRNA darkgrey module presented a significant positive correlation with gestational weight gain (p < 0.05). Compared to the normal group, the expressions of transmembrane protein 175 (TMEM175) and HIF1A antisense RNA 2 (HIF1A-AS2) were downregulated, whereas the expressions of phosphoglycerate kinase 1 (PGK1) and methionine adenosyltransferase 2B (MAT2B) were upregulated in the exosomes derived from the umbilical cord blood plasma in the macrosomic group.
Messenger RNAs (mRNA) (TMEM175, PGK1, MAT2B) and long non-coding RNAs (lncRNA) (HIF1A-AS2) may potentially contribute to the development of fetal macrosomia in non-diabetic pregnancies.
Uterine fibroids represent the most frequent benign tumor of the uterus in women of reproductive age. They may be discovered accidentally or can be symptomatic. They pose substantial intraoperative challenges due to the increased risk of bleeding. Despite the rising incidence of fibroids during pregnancy, there is no consensus on the optimal strategy to minimize bleeding during cesarean section (C-section). This review aims to synthesize and critically examine the current evidence on medical, surgical, interventional, and innovative experimental approaches for reducing intraoperative bleeding during C-section. We aim to provide an up-to-date, evidence-based overview to guide clinical decision-making and highlight a gap in knowledge for future research.
Three electronic databases were searched using the keywords: “fibroids”, “intraoperative bleeding”, “cesarean myomectomy”, and “pregnancy”, following the inclusion criteria set. Eligible studies were analyzed, and the extracted data were examined for duplication before inclusion in the review. Four major categories of interventions were identified for reducing intraoperative bleeding: medical, surgical, innovative, and experimental methods. For each technique, relevant data were recorded and synthesized into tables.
Medical techniques were effective, although they had side effects, and their efficacy could be enhanced when used in combination. Surgical techniques proved effective when medical approaches failed, especially in complicated cases. Emerging modalities show promising efficacy with minimal impact on future fertility, but they need further validation.
A personalized, multidisciplinary approach is needed to effectively reduce and manage intraoperative bleeding. Current practice should shift toward risk stratification using predictive tools to estimate bleeding preoperatively. Surgical teams should develop personalized bleeding-control strategies incorporating appropriate pharmacological agents. Future research should examine the integration of artificial intelligence (AI)-based risk modeling and three-dimensional (3D)-printed surgical planning to optimize maternal safety while preserving fertility.
The number of laparoscopic surgeries has been increasing in regional core hospitals, and procedures involving total laparoscopic hysterectomy (TLH) are being performed more frequently. Therefore, the importance of data acquisition and analysis of TLH procedures has increased. In particular, examining the risks of complications for improving surgical procedures and patient selection is considered especially crucial in regional healthcare settings, where medical resources are relatively limited. To determine the prevalence of and risk factors associated with the occurrence of the major intraoperative complications of TLH, we performed a multivariate analysis using records from our hospital.
We retrospectively reviewed the medical records of 548 patients who underwent TLH to treat uterine diseases from 1 January 2010 to 31 December 2024. Among these patients, 27 patients were identified with major intraoperative complications, such as organ injury and massive blood loss. First, we conducted simple comparisons using Fisher’s exact test (two-tailed) for 22 representative factors related to patient characteristics. Then, we performed a multivariate logistic regression analysis to assess the effects of nine representative factors, including both preoperative and intraoperative/postoperative factors.
According to the results of the Fisher’s exact test (two-tailed) and multivariate analysis, we detected significant impacts of (1) high body mass index (BMI) (defined as 30 kg/m2 or greater), (2) hypermenorrhea, and (3) coexistent ovarian endometriotic cysts among the preoperative factors and (1) high BMI (defined as 30 kg/m2 or greater), (2) hypermenorrhea, (3) intraoperative findings of adhesions, and (4) heavy uterine weight (500 g or greater) among the intraoperative/postoperative factors.
This study identified certain trends in risk factors associated with major intraoperative complications of TLH, using a relatively simple analysis. These findings may provide important information when TLH is considered a surgical option. Based on these findings, future studies with more sophisticated methodologies will be necessary to provide additional insights.
Brain resting-state functional networks are extensively utilized in research on psychiatric disorders. Meanwhile, pregnancy promotes specific and substantial changes in neural structure and network integration, which are most prominent in the default mode network (DMN). Prior studies have established a relationship between hypertensive disorders in pregnancy (HDP) and mental disorders. Nevertheless, the causal influence of brain resting-state functional networks on HDP is poorly understood.
A bidirectional two-sample Mendelian randomization (MR) framework was applied to estimate the causal effects of 191 resting-state functional magnetic resonance imaging (rsfMRI) phenotypes (sample size: 34,691) on five HDPs, and vice versa. The five HDP conditions were gestational hypertension (GH), pre-eclampsia (PE), eclampsia, chronic hypertension, and PE superimposed on chronic hypertension.
Forward MR estimates identified a potential causal relationship between one rsfMRI phenotype (attention, salience, and motor network) and chronic hypertension in pregnancy. The MR analysis of the reverse direction revealed that chronic hypertension in pregnancy may exert a causal influence on three rsfMRI phenotypes: the motor and subcortical-cerebellum network, the attention, salience, and motor network, and the subcortical–cerebellum and motor network. The causal relationship between the attention, salience, and the motor network and chronic hypertension in pregnancy was found to be bidirectional.
Our findings reveal a potential causal relationship between altered patterns of intrinsic brain connectivity and chronic hypertension in pregnancy. These results provide crucial evidence for an association between chronic hypertension in pregnancy and alterations in functional brain networks.
This study is a prospective cohort study. It aims to investigate the relationship between blood gas parameters and neonatal respiratory outcomes and to develop a prognostic prediction model.
A total of 163 preterm newborns who satisfied the diagnostic criteria outlined in the European Guidelines for the Prevention and Treatment of NRDS-2010 from January 2022 to January 2025 were included. The baseline data of mothers and newborns were collected, and the blood gas parameters were dynamically monitored at 6, 12, 24, and 48 h after birth, including pH, oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2), lactic acid (Lac), and oxygenation index (OI), as well as PaO2/fraction of inspired oxygen (FiO2). Elastic net regression and the Boruta algorithm were used to screen predictive variables, and a multivariate Cox proportional hazards regression model was established. The performance of the model was evaluated using a time-dependent receiver operating characteristic (ROC) curve, Bootstrap resampling calibration curve, and decision curve analysis (DCA).
The poor prognosis group (n = 30) experienced a higher rate of maternal pregnancy comorbidities (50.0% vs. 26.3%; p = 0.011), had a smaller gestational age (29.4 weeks; p = 0.019), lower birth weight (1412.5 g; p < 0.001) and 5-minute Apgar score (p = 0.034), and a higher need for initial mechanical ventilation (53.3% vs. 27.1%; p = 0.005). Dynamic monitoring revealed significant acidosis in the early phase (6 hours), which remained at persistently low levels even at 48 hours. The OI progressively increased, oxygenation efficiency declined, and lactate clearance was markedly delayed. Elastic net regression (optimized λ = 0.1759 via 10-fold cross-validation) and Boruta algorithm screening identified core variables for inclusion in a multivariate Cox regression. Meanwhile, △OI_24 h (hazard ratio (HR) = 1.82, 95% confidence interval (CI) 1.51–2.21; p < 0.001) and Lac_48 h (HR = 1.95, 95% CI: 1.40–2.73; p < 0.001) were identified as independent risk factors. The model predicted a 7-day poor prognosis with an area under the ROC curve of 0.96 (95% CI 0.92–1.00). A 1000 Bootstrap validation model demonstrated high concordance between predicted and actual risks. The DCA indicated that the model provided a significant clinical net benefit compared to intervention or no intervention strategies when the risk threshold exceeded 0.15.
△OI_24 h and Lac_48 h serve as core early warning indicators for poor prognosis in NRDS. The model was constructed using elastic net regression and the Boruta algorithm, demonstrating robust predictive performance and clinical utility, and providing a basis for early risk stratification.
This study aimed to explore the differences in the detection rates of chromosomal abnormalities in simple and complex congenital heart disease (CHD) and the association between these rates and genetic factors.
A total of 211 fetuses diagnosed with CHD through prenatal ultrasound at the fetal medicine unit of Zhejiang Jiaxing Maternal and Child Health Care Hospital from July 2017 to December 2023 were retrospectively analyzed. Cases were classified as simple or complex cardiac malformations. Chromosomal microarray analysis (CMA) was used as the primary genetic assessment following invasive sampling in all CHD cases. Clinical exome sequencing (ES) or Trio exome sequencing (Trio-ES) was applied prenatally when the CMA results were nondiagnostic.
Of the 211 fetuses, 62.6% and 37.4% presented with simple and complex malformations, respectively. The CMA reported an overall positive rate of 19.0% across all cases: 11.4% for simple cardiac malformations and 31.6% for complex cardiac malformations. The detection rate of chromosomal abnormalities was significantly higher in complex cases (22.8%) than in simple malformations (6.1%; p < 0.001). Among the isolated CHD cases, 8.7% exhibited chromosomal abnormalities, predominantly in complex malformations (20.0% vs. 2.9% for simple malformations; p < 0.001). Meanwhile, the rate was high (23.5%) in non-isolated CHD, but simple and complex malformations did not differ significantly. ES was performed for 32 cases with negative CMA results. One pathogenic (P)/likely pathogenic (LP) variant was identified through Trio-ES in simple malformations, while two P/LP variants were detected in complex malformations.
Differentiated genetic assessments could be included in prenatal diagnosis, because complex CHD correlated strongly with chromosomal and genetic anomalies rather than with simple malformations. This finding, although based on a small population, suggests that non-cardiac anomalies may be important indicators for genetic testing regardless of the complexity of heart defects. Therefore, genetic testing could be offered to patients with simple or isolated CHD.
Postpartum anemia remains common and undermines early recovery. We aimed to identify risk factors for postpartum anemia among immediate postpartum women at a Peruvian Air Force hospital.
We conducted a retrospective case-control study at the Central Hospital of the Peruvian Air Force (Lima, Peru) from January to December 2024, including 120 immediate postpartum women (55 cases with postpartum anemia; 65 controls without). Data were abstracted from standardized medical records and analyzed using bivariate tests and logistic regression.
Postpartum anemia occurred in 45.8% of women. In bivariate analyses, fewer prenatal visits (median 9 vs. 10; p = 0.030) and antenatal anemia (25.5% vs. 0.0%; p < 0.001) were associated with postpartum anemia. In the adjusted model, prenatal visits showed a marginal inverse association (adjusted odds ratio [aOR] = 0.86; 95% confidence intervals [CI]: 0.74–1.01; p = 0.060). No significant associations were found for education, marital status, parity, mode of delivery, body mass index (BMI), or gestational weight gain. Antenatal anemia was excluded from the multivariable model because of perfect prediction.
In this cohort, fewer prenatal visits showed a marginal association with immediate postpartum anemia, while antenatal anemia was the dominant risk factor. Practice should prioritize timely third-trimester hemoglobin screening and correction of antenatal anemia, reliable iron-folate supply with adherence support, and immediate postpartum testing with structured discharge counseling, with targeted counseling for women with antenatal anemia or fewer prenatal visits.
The global rise in pregnancies following assisted reproductive technology (ART) use has prompted ongoing evaluations into the impact of this technology on maternal and neonatal outcomes. Thus, this study aimed to compare outcomes between ART-conceived pregnancies and spontaneously conceived pregnancies, stratified by singleton and multiple pregnancies.
We conducted a single-center retrospective cohort study at Gyeongsang National University Changwon Hospital in South Korea, using the medical records of women who delivered between January 2023 and December 2024. A total of 921 pregnancies were included, comprising 816 singleton pregnancies and 105 multiple pregnancies. Maternal and neonatal baseline characteristics were compared between ART-mediated and spontaneous conceptions within each gestational category. Outcomes assessed included postpartum hemorrhage (PPH), preterm birth (PTB), small for gestational age (SGA), neonatal intensive care unit (NICU) admission, 5-minute Apgar score < 7, and neonatal death. Multivariable logistic regression was performed to estimate adjusted odds ratios (aORs), controlling for relevant confounders.
Most maternal and neonatal outcomes did not significantly differ between ART-mediated and spontaneous conceptions in either singleton or multiple pregnancies. There were no statistically significant differences in the rates of PTB, SGA, NICU admission, low 5-minute Apgar score, and neonatal death between the groups. However, there was a significantly higher incidence of PPH in ART-conceived singleton pregnancies (25.7% vs. 9.4%), which remained significant in the multivariable analysis (aOR: 3.64, 95% confidence interval (CI): 2.21–5.98; p < 0.001). No significant difference in PPH incidence was observed in the multiple pregnancy cohort.
Overall, most outcomes were comparable between ART-mediated and spontaneous conceptions. However, ART-conceived singleton pregnancies showed a significantly higher risk of PPH, even after adjusting for confounders. These findings underscore the need for heightened surveillance for PPH in ART-mediated singleton pregnancies, even in the absence of other risk factors.
Endometriosis (EMS), which affects >10% of women, is characterized by painful symptoms, such as dysmenorrhea. Meanwhile, the gut microbiota is linked to EMS; however, the relationship between the gut microbiota and EMS-related pain remains unclear.
This study conducted 16S rRNA sequencing on fecal samples from 20 patients with EMS and dysmenorrhea, 13 patients with EMS but not dysmenorrhea, and 12 healthy controls.
Carbohydrate antigen 125 (CA125) levels were significantly higher in patients with EMS and dysmenorrhea. No significant differences in α- and β-diversity values were observed among the three groups (p > 0.05). However, Proteobacteria and Subdoligranulum showed increased abundance trends in patients with EMS and dysmenorrhea. Acinetobacter and Colidextribacter were less abundant in patients with EMS and dysmenorrhea than in those without dysmenorrhea (p < 0.05). Faecalicoccus pleomorphus and its genus also showed consistent depletion. At the genus level, a correlation analysis of the differential microbes revealed that UCG_005 and UCG_002 were central nodes in the correlation network (p < 0.05). Functional prediction indicated significant enrichment in cofactor and vitamin metabolism pathways in the EMS group with dysmenorrhea (p < 0.05). Several differential microbes, such as Faecalicoccus, Colidextribacter, and Acinetobacter, were negatively correlated with pain severity. Receiver operating characteristic curve analysis identified 10 microbial species with moderate diagnostic potential (area under the curve >0.7) for discriminating patients with EMS and dysmenorrhea, notably Ligilactobacillus.
These results highlight distinct microbial alterations and functional pathways associated with EMS-related pain, suggesting potential diagnostic biomarkers for this condition.
Passing from the first to the third trimester of pregnancy is correlated with a significant increase in pelvic anterior tilting that relates to lumbopelvic morbidities. Additionally, cesarean section (CS) is linked to lumbopelvic morbidities. This study measured the pelvic tilt angle and pelvic torsion in postpartum women who underwent CS after the end of the puerperium. The aim was to determine whether these kinematic pelvic measures persist or are corrected by the end of the puerperium. Therefore, the study compared these measures to those of the control group that had never been pregnant.
This study followed the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for the cross-sectional comparative design, with retrospective classification of exposure (CS vs. nulliparous controls), in which 42 women were categorized into two equal-sized groups. Group (A) was 21 women who delivered by CS. Group (B) was 21 women who served as controls, who never experienced pregnancy. Women in the CS group were measured at 6–12 weeks postpartum. The digital pelvic inclinometer (DPI) was used to estimate the pelvic tilt angle.
The statistical analysis yielded non-significant differences between both groups in the right and left pelvic tilt angles (p = 0.385 and 0.762), respectively. Also, there was a non-significant difference in pelvic torsion between the two groups (p = 0.519). An analysis of covariance (ANCOVA) model adjusting for multiple physical covariates confirmed that the group differences in pelvic tilt and pelvic torsion remained non-significant.
By 8 weeks postpartum, pelvic tilt and torsion in post-CS women return to near-normal levels, with residual differences that are negligible both statistically and clinically compared with the controls.
The study has been registered on https://clinicaltrials.gov/ (registration number: NCT06019962; registration link: https://clinicaltrials.gov/study/NCT06019962?cond=NCT06019962&rank=1).