Unexplained infertility (UI) affects a significant portion of couples worldwide, posing challenges for effective treatment. The prognostic nutritional index (PNI), traditionally used in oncology, has been adapted to evaluate reproductive outcomes, particularly in the context of in vitro fertilization (IVF).

This study analyzed 198 non-obese couples undergoing IVF for UI at a tertiary care center between February 2023 and December 2024. This study assessed the correlation between the PNI, comprehensive hematological profiles, and IVF outcomes, including embryo quality and pregnancy. The PNI was obtained through serum albumin and lymphocyte counts.

The PNI was elevated in the high-quality embryos (51.65 ± 5.09) compared to those of mild-quality (48.10 ± 2.82) and low-quality (44.20 ± 4.16) (p = 0.0001). A higher PNI was associated with improved embryo quality, with an odds ratio of 11.859 (p = 0.0001) for higher quality embryos. Other inflammatory markers did not demonstrate a predictive value for IVF outcomes (p > 0.05). The PNI yielded an area under the curve (AUC) value of 0.895 (95% confidence interval (CI): 0.85–0.94; p = 0.001), indicating robust discrimination. At a cutoff of 46.5, the PNI demonstrated 81.2% sensitivity and 80.1% specificity, further underscoring the potential of this index as a discriminative marker.

The PNI serves as a strong indicator of IVF outcomes, correlating directly with embryo quality and the success of fertility treatments. Moreover, the predictive potential of the PNI for embryo quality in reproductive medicine highlights the intersection of nutritional and immunological status with reproductive health, offering a framework for enhancing clinical assessments in IVF.

Intestinal endometriosis occurs when endometrial-like tissue infiltrates the intestinal wall, most often affecting the sigmoid colon and rectum.

Between January 2012 and February 2025, patients with intestinal endometriosis who underwent surgery were examined in five tertiary referral centers: Istanbul Sultan Abdülhamid Han Research and Training Hospital, Izmir Katip Çelebi University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Başakşehir Çam and Sakura City Hospital, and Izmir City Hospital. Preoperative symptoms, demographic characteristics, menstrual status, operative times, intraoperative blood loss, surgical and pathological findings, antibiotic use, and postoperative complications were retrospectively reviewed.

Emergency surgery was required in a significant number of patients (n = 35, 71.4%), primarily due to intestinal obstruction or acute abdomen presentations. Resection procedures included anterior or low anterior resections for rectosigmoid involvement and colectomies for colonic disease (n = 21, 42.9%), appendectomies performed for acute appendicitis (n = 26, 53.1%), and small bowel resections for small intestinal diseases (n = 2, 4.1%). Postoperative complications were observed in 8 patients, including ileus (n = 2), infections requiring antibiotics (n = 2, Grade II), intra-abdominal abscess requiring percutaneous drainage (n = 1, Grade IIIa), bleeding requiring reoperation (n = 1, Grade IIIb), incisional hernia (n = 1, Grade IIIa), and fat necrosis (n = 1, Grade I). Histopathological examination revealed transmural (full-thickness) bowel wall involvement in three patients and muscularis propria-limited involvement in two patients. One case involved a 67-year-old postmenopausal woman who presented with bowel obstruction and required emergency surgery. Intraoperatively, a rectosigmoid stricture without a visible tumor was identified.

Surgeons and clinicians should maintain a high index of suspicion for endometriosis in postmenopausal patients presenting with nonspecific gastrointestinal symptoms or when unexpected findings are encountered during abdominal surgery. Considering intestinal endometriosis in the differential diagnosis, even in the absence of typical risk factors such as hormone replacement therapy or a prior history of endometriosis, is essential for improving diagnostic accuracy and patient outcomes.

This study aims to investigate the delivery modes, indications for cesarean section, and perinatal outcomes of infants with macrosomia in primiparous women, with a particular focus on those with gestational hyperglycemia who have achieved satisfactory glycemic control, as well as those with normal blood glucose levels.

A retrospective cohort study was conducted in 269 primiparous women with infants affected with macrosomia at Haidian Maternal and Child Health Hospital in Beijing (2022–2024). These women had no prior history of uterine surgery, breech presentation, placenta previa, or any other conditions that would necessitate a cesarean section. The participants were categorized into two groups based on their blood glucose levels: a hyperglycemic group consisting of 107 cases (after excluding 2 cases due to inadequate blood glucose control) and a normal blood glucose group with 160 cases. This study compared various factors between the two groups, including basic demographic information, mode of delivery, reasons for the cesarean sections, and any complications that arose during delivery. Primary outcomes included cesarean section rates and perinatal outcomes.

The cesarean section rate was notably higher in the hyperglycemic group compared to those with normal blood glucose levels, while the rate of vaginal deliveries, including those assisted by forceps, was lower in the hyperglycemic group. This difference in delivery methods was statistically significant (χ² = 4.132; p < 0.05). Additionally, within the hyperglycemic group, babies born via cesarean section due to fetal macrosomia had a significantly greater birth weight than those delivered vaginally (Z = 3.500; p < 0.05). A similar trend was observed in the normal blood glucose group, where cesarean section deliveries also resulted in higher birth weights compared to vaginal deliveries (Z = 3.750; p < 0.05). Furthermore, the hyperglycemic group exhibited a higher incidence of shoulder dystocia and intrapartum fever compared to the normal blood glucose group, with these differences being statistically significant (p < 0.05).

For primiparous women with infants who possessed macrosomia, the cesarean section rate in the hyperglycemic group was higher than that in the normal blood glucose group, and the incidence of shoulder dystocia in the hyperglycemic group was higher than that in the normal blood glucose group. Therefore, using a fetal weight of ≥4150–4190 g as the cesarean section indication for macrosomia is recommended, whether for pregnant women with normal blood glucose levels or those with gestational hyperglycemia who have good blood glucose control.

Atypical recurrent implantation failure (RIF) poses a challenge for freeze-thawed embryo transfer (FET) as current interventions showing limited efficacy. Autologous platelet-rich plasma (PRP) may improve the pregnancy outcomes, but its value before FET in such patients remains unclear.

A retrospective analysis was conducted on the medical records of patients with atypical RIF (a history of one or two prior failed embryo transfers) who underwent another FET in Reproductive Medicine Center of Zhongda Hospital between January 1, 2022, and June 1, 2024. Patients who received autologous PRP intrauterine infusion before FET were designated as the PRP group (n = 59), while matched patients from the same period who did not receive PRP served as the control group (n = 79). The two groups were compared for endometrial thickness on the day of embryo transfer, biochemical pregnancy rate, embryo implantation rate, clinical pregnancy rate, and early miscarriage rate.

No statistically significant differences were observed in the baseline characteristics between the control and PRP groups (all p > 0.05). The PRP group had a significantly higher biochemical pregnancy rate (66.10% vs. 45.57%), embryo implantation rate (43.75% vs. 30.83%), and clinical pregnancy rate (57.63% vs. 39.24%) compared to the control group (p < 0.05).

For patients with atypical RIF, intrauterine infusion with autologous PRP can increase the embryo implantation and clinical pregnancy rates in subsequent FET cycles.

Gefitinib is a tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR), mainly used for non-small cell lung cancer. Because EGFR is also highly expressed in placental tissue, its use has been explored in the treatment of ectopic pregnancy. This review examines the available evidence on the safety and effectiveness of combining gefitinib with methotrexate for the treatment of ectopic pregnancy.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across PubMed, Web of Science, ProQuest, and Google Scholar for English-language studies published between 2013 and 2023 comparing gefitinib plus methotrexate to methotrexate alone. Study quality was assessed using Joanna Briggs Institute (JBI) tools for quasi-experimental studies and case reports. Meta-analysis was performed using OpenMeta-Analyst with a random-effects model at a 0.05 significance level and 95% confidence intervals (CI).

Of 162 identified studies, five met the inclusion criteria, and three were included in the meta-analysis, comprising 526 participants. The pooled analysis revealed no statistically significant difference in complete resolution rates between the combination therapy group (69.3%) and the methotrexate-alone group (75.5%) (relative risks (RR): 1.004, 95% CI: 0.802–1.257; p = 0.973; I² = 63.96%). Adverse events were generally mild and self-limiting, with rash (60.8%) and diarrhea (46.5%) being the most common. Serious adverse events were rare (<4%) and occurred at similar rates in both groups.

These findings suggest that while the combination of gefitinib and methotrexate is safe, it does not significantly enhance treatment outcomes compared to methotrexate alone in managing ectopic pregnancy.

The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42024500567; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024500567).

Missed abortion (MA), a type of spontaneous abortion, has become increasingly common in early pregnancy. Retained embryos may lead to dead fetus syndrome or severe hemorrhage, affecting the physical and mental health of women. This study selected MA patients undergoing uterine evacuation to construct a predictive model for factors that influence subsequent pregnancy failure, aiming to improve patient prognosis.

A retrospective analysis of 466 women with MA after a complete uterine curettage (May 2021–May 2023) was conducted. Patients were randomly divided into a modeling (326) and a validation (140) group; the modeling group was further classified by re-pregnancy outcome. Logistic regression was used to assess risk factors for re-pregnancy failure after a complete uterine curettage for MA. The nomogram model was constructed in R software. The receiver operating characteristic (ROC) curve was plotted to evaluate the discriminative power of the nomogram model. A decision curve analysis (DCA) was used to assess the clinical value of the model.

Among 466 women, 88 (18.89%) experienced pregnancy failure. A total of 62 (19.02%) women experienced failure in the modeling group (n = 326). Multivariate logistic regression analysis identified age, prior induced abortions, early uterine fluid accumulation during re-pregnancy, complicated polycystic ovary syndrome, and transforming growth factor beta 1 (TGFβ1) as risk factors for re-pregnancy failure after complete curettage of the uterine cavity for MA (p < 0.05), while matrix metalloproteinase 9 (MMP9) reduced the risk of re-pregnancy failure (p < 0.05). The area under the curve (AUC) of the modeling group was 0.957, and the slope of the calibration curve was close to 1, with a Hosmer-Lemeshow (H-L) test value of χ² = 6.968 and p = 0.696. The AUC in the validation group was 0.990, and the slope of the calibration curve was close to 1, with an H-L test value of χ² = 6.859 and p = 0.676. The DCA curve showed that the high-risk threshold probabilities for the two groups were 0.07–0.78 and 0.08–0.84, respectively. The nomogram model was then used to evaluate the clinical utility of predicting re-pregnancy failure after MA curettage.

Age, number of previous induced abortions, early uterine fluid accumulation during re-pregnancy, complicated polycystic ovary syndrome, MMP9, and TGFβ1 are influencing factors for re-pregnancy failure after complete curettage of the uterine cavity for MA. A prediction model constructed from these factors accurately estimated the postoperative risk of recurrent pregnancy loss.

Postpartum depression (PPD) is a common maternal mental health disorder with serious consequences for both mothers and infants, especially in low- and middle-income countries. This study aimed to assess the prevalence of PPD and identify associated risk factors among postpartum women in central Vietnam.

A cross-sectional study was conducted on 906 women who delivered at Hue Central Hospital from May 2022 to May 2023. Participants were recruited during the third trimester and screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of ≥10. Multivariable logistic regression identified independent predictors of PPD.

The mean participant age was 28.4 ± 5.4 years. PPD prevalence was 17.1%. Significant predictors included being unmarried (adjusted Odds Ratio [aOR] = 4.55, 95% CI: 1.80–11.52), unintended pregnancy (aOR = 1.72, 95% CI: 1.05–2.83), emotionally abusive husband (aOR = 3.71, 95% CI: 2.30–5.96), no babysitters (aOR = 3.95, 95% CI: 2.45–6.36), no husband’s support in childcare (aOR = 2.42, 95% CI: 1.60–3.67).

Nearly one in six women in this Vietnamese cohort experienced PPD. Key risk factors were social and reproductive, highlighting the importance of addressing marital status, pregnancy planning, partner violence, and familial support. These findings support integrating targeted mental health screening and support services into routine postpartum care.

Breast cancer (BC) is a major global malignancy with rising incidence. The lack of effective traditional anti-human epidermal growth factor receptor 2 (HER2) therapies for HER2-low BC underscores the critical need to identify this subtype early. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomics can help to differentiate between HER2-low and HER2-zero BC, although this method has limited contrast and access. Ultrasound (US) is a cost-effective technique, although radiomics research remains limited, and traditional radiomics largely ignores peritumoral value. This study aimed to determine whether intra- and peritumoral radiomic features observed by grayscale US can differentiate between HER2-low and HER2-zero BC.

This retrospective diagnostic study enrolled 209 consecutive BC cases from May 2022 to January 2024. These cases were categorized as HER2-low (immunohistochemistry (IHC) 1+/2+, no erythroblastic leukemia viral oncogene homolog 2 (ERBB2) fluorescence in situ hybridization (FISH) amplification, n = 129) or HER2-zero (IHC 0, n = 80). Patients were age-matched and randomly assigned (block size = 10) to the training (n = 155) and validation (n = 54) cohorts, with predefined exclusion criteria applied (e.g., missing pathological data, poor US quality). After calibration, two experienced radiologists performed blinded manual intratumoral region-of-interest (ROI) segmentation (ITK-SNAP v3.8.0), with interoperator consistency confirmed by immunocytochemistry (ICC) >0.75. Pyradiomics was used to automate the expansion of the 1 mm and 2 mm peritumoral regions, feature extraction, and z-score normalization. Features were filtered via Spearman’s correlation, Mann-Whitney U test, and least absolute shrinkage and selection operator (LASSO) regression (10-fold cross-validation for optimal λ). A predictive model for HER2 status was built using LASSO regression (variance inflation factor (VIF) <1.2 to avoid multicollinearity), and the performance of this model was evaluated for accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curves (area under the curve, AUC), calibration curves (Hosmer-Lemeshow test), and decision curve analysis (DCA). A radiomic nomogram integrating radiomic and clinical signatures was evaluated in the validation cohort. Statistical analyses were performed using R v4.2.2 (two-sided p < 0.05 for significance).

The clinical model showed limited discrimination in the test set (AUC = 0.594). A total of 3320 radiomic features were extracted from intratumoral, as well as 1 mm and 2 mm peritumoral regions, with the selection of 30, 19, and 24 features, respectively, via LASSO regression. The intratumoral-only model had AUCs of 0.730 (training) and 0.649 (test), while the intratumoral + 1 mm peritumoral model exhibited enhanced performance (training AUC = 0.852; test AUC = 0.868). The 2 mm peritumoral-integrated model demonstrated a high AUC in the training set (0.918), but poor performance in the test set (AUC = 0.509). A combined model (intratumoral + 1 mm peritumoral features + clinical factors) was used to generate a nomogram (no multicollinearity, VIF: 1.039–1.179) with AUCs of 0.882 (training) and 0.835 (test). The DCA confirmed the clinical utility of the combined model, although the diagnostic performance of the model was slightly lower than that of the intratumoral + 1 mm peritumoral model.

Combining 1 mm peritumoral radiomics with intratumoral and clinical data improves the discrimination of HER2-low from HER2-zero BC (AUC = 0.882), thus reducing the need for biopsy and assisting with therapy planning. Optimizing peritumoral margins enhances diagnostic accuracy, thereby validating radiomics for BC subtyping.

To evaluate the effects of holistic postural rehabilitation exercise in combination with electrical stimulation and biofeedback on urinary incontinence (UI) symptoms and pelvic floor muscle strength in patients suffering postpartum pelvic floor dysfunction.

A single-anonymized, randomized controlled trial was conducted from January 2021 to December 2022. A total of 120 patients, 42 days postpartum and diagnosed with pelvic floor dysfunction at three medical institutions in a certain city (Beijing, China), were enrolled and randomly assigned into the experimental group (n = 41) or control group (n = 46) using a random number table; thus, 87 medical records were included in the analysis. The experimental group received holistic postural rehabilitation exercises and electrical stimulation biofeedback therapy, while the control group received conventional Kegel exercises and electrical stimulation biofeedback therapy. Pelvic floor muscle strength and pelvic floor function were assessed at 42 days postpartum (baseline), 1 month, and 3 months post-intervention using the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire, to evaluate bladder symptoms, bowel symptoms, and UI. The scores of the two groups were compared.

The experimental group exhibited significantly improved Class I pelvic floor muscle strength compared to the control group at a statistical level (p = 0.00). For UI symptoms, the frequency of urine leakage differed significantly at 3 months post-intervention (p = 0.03). The results of the comparison between the analysis groups: At all three time points (baseline, 1 month, and 3 months), comparisons of each index yielded p > 0.05. The analysis concludes that total PFDI-20 scores or any subscale scores did not differ significantly instatistical level between the groups at any time point. According to the analysis results of pelvic floor physiological indicators After the 3-month intervention, both groups exhibited improvements in postpartum pelvic floor muscle recovery. However, when comparing Type I muscle strength, the experimental group out performed the control group statistically (p < 0.05). At baseline, the severity of UI symptoms did not present an obvious difference in statistical level between the two groups, indicating good baseline consistency. After 3 months of intervention, the frequency of urinary leakage differed a lot. The intergroup comparison showed that t = 4.83 and p = 0.03 (< 0.05), suggesting that the experimental group achieved remarkably larger improvement in reducing urinary leakage frequency versus the control group.

Holistic postural rehabilitation exercise combined with electrical stimulation biofeedback can reduce the frequency and volume of postpartum UI, improve Class I fibromuscular muscle strength, and enhance pelvic floor stability and function. However, the effects on pelvic organ prolapse (POP), colorectal and anal dysfunction, and lower urinary tract symptoms were not significant and warrant further clinical investigation.

The study has been registered on https://clinicaltrials.gov/ (registration number: ChiCTR2000029618, registration link: https://www.chictr.org.cn/showprojEN.html?proj=48903).

To examine the mechanisms underlying changes in ovarian function after total hysterectomy, identify relevant risk factors, and summarize clinical management strategies for such changes.

The pathogenesis of impaired ovarian function post-total hysterectomy involves three key pathways: (1) reduced ovarian blood supply due to uterine artery ligation; (2) neuroendocrine imbalance caused by abnormal gonadotropin levels; (3) oxidative stress and fibrosis induced by chronic inflammation.

Total hysterectomy is associated with diminished ovarian reserve, including a 20–30% decrease in anti-Müllerian hormone (AMH), elevated serum follicle-stimulating hormone (FSH) levels, and an approximate 3–4-year acceleration of menopause. Risk factors include the surgical approach (e.g., laparoscopic electrocoagulation decreases AMH by 40% vs. 20% with open surgery), unilateral ovarian preservation (increases the risk of menopause by 2.93-fold compared to bilateral preservation), and age <40 years (increases the risk of postoperative ovarian failure).

Personalized clinical management, including preoperative assessment of AMH levels and ovarian blood flow, preference for ovarian and uterine artery-preserving techniques (e.g., STHMUV, uterine blood supply-preserving hysterectomy technique), and postoperative hormone/pelvic floor function monitoring may mitigate damage to ovarian function. To optimize long-term outcomes, future research should focus on vasoprotective strategies and precision interventions guided by biomarkers.

A hypoplastic uterus is a rare anomaly often considered incompatible with successful pregnancy due to inadequate uterine size, thin myometrium, and poor vascularization.

This case reports on a 29-year-old primigravida with a hypoplastic uterus who achieved a full-term pregnancy complicated by central placenta previa and placenta increta. At 37 + 4 weeks of gestation, a cesarean delivery yielded a healthy neonate; however, the patient required an emergent hysterectomy due to extensive uterine rupture and uncontrolled hemorrhage.

This case highlights the importance of meticulous prenatal surveillance in patients with uterine anomalies and underscores the potential necessity for timely intervention to avert life-threatening complications.

This study aimed to develop a nomogram model integrating virtual touch tissue imaging quantification (VTIQ) with clinicopathological features to predict postoperative breast cancer recurrence, guide individualized treatment, and improve prognosis.

This study retrospectively included 420 female patients who underwent radical mastectomy for breast cancer and received an elastography touch imaging quantification examination before surgery at our hospital (2017–2022). The patients were divided into training and validation sets at a ratio of 7:3. After a 3-year follow-up, both cohorts were stratified into recurrence and non-recurrence groups. Clinicopathologic characteristics and VTIQ parameters (shear wave velocity, SWV) were compared between the two groups. A nomogram for predicting postoperative recurrence in breast cancer was developed using multivariable logistic regression. The performance was evaluated using a receiver operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis (DCA) to assess discrimination, calibration, and clinical usefulness.

The training set showed significantly higher SWV values in recurrent patients than in non-recurrent patients (p < 0.05). Logistic regression identified histological grade (odds ratio (OR): 3.36, 95% confidence interval (CI): 1.23–9.19), calcification (OR: 3.16, 95% CI: 1.15–8.68), estrogen receptor (ER)/progesterone receptor (PR) (OR: 2.74, 95% CI: 1.03–7.31), and SWV (OR: 3.71, 95% CI: 1.75–7.84) as independent predictive factors for postoperative recurrence of breast cancer (p < 0.05). The area under the ROC curve (AUROC) was 0.789 (95% CI: 0.729–0.850) for the training set and 0.728 (95% CI: 0.615–0.841) for the validation set. These findings indicate that the nomogram model demonstrates good discrimination for the postoperative recurrence of breast cancer. Calibration and DCA curves confirmed that the predicted probabilities of the model closely matched the actual pathological grading results, demonstrating the clinical utility of the model.

The nomogram model integrating VTIQ parameters with clinicopathological features demonstrates good predictive value for postoperative recurrence of breast cancer. This model provides an important reference for identifying patients at high risk of recurrence before surgery and may improve patient prognosis.

This review aimed to provide an updated overview of progestin-primed ovarian stimulation (PPOS) outcomes across different patient groups, particularly in egg donation, fertility preservation, preimplantation genetic testing (PGT), and endometriosis.

We performed a focused narrative review of the literature in the PubMed/MEDLINE databases, identifying randomized trials, cohort studies, systematic reviews, and meta-analyses comparing PPOS to gonadotropin-releasing hormone (GnRH) agonist and GnRH-antagonist protocols (search completed to April 2025). Selection emphasized high-quality evidence and recent comprehensive reviews across different patient groups.

PPOS demonstrated efficacy across various clinical scenarios, including oocyte donation, fertility preservation, PGT, polycystic ovary syndrome (PCOS), low and high ovarian responses, and endometriosis. While overall neonatal safety is acceptable, some concerns persist regarding specific progestins, such as dydrogesterone.

PPOS protocols represent valid, non-inferior alternatives to GnRH antagonists in various clinical populations when an oocyte- or embryo-freezing strategy is employed.

Yam Polysaccharide (YP) is a major bioactive component extracted from the common yam rhizome and has been shown to have an antidiabetic effect. Previous research has demonstrated the association between gut microbiota (GM) and gestational diabetes mellitus (GDM); however, whether GM is essential for mediating the antidiabetic effects of YP in GDM remains unclear.

A high-fat and fructose diet (HFD) was administered to mice before and after pregnancy to induce GDM. An oral glucose tolerance test (OGTT) was performed, and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated to evaluate glucose metabolism. The GM composition was analyzed using 16S rRNA sequencing.

During pregnancy, mice fed an HFD exhibited significant weight gain accompanied by impaired glucose tolerance. These metabolic disturbances were alleviated by YP treatment. Furthermore, consuming an HFD induced marked alterations in GM diversity compared to the control group, characterized by increased abundance of Alloprevotella and decreased abundance of the Lachnospiraceae NK4A136 group. Importantly, YP administration reversed these HFD-induced microbial changes.

These findings suggest that modulation of the GM is one mechanism underlying the antidiabetic effects of YP in GDM.

The cervical switch (SWI)/sucrose non-fermentable (SNF) related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4 (SMARCA4)-deficient undifferentiated tumor (SMARCA4-UT) constitutes a rare, highly aggressive malignancy that is currently unclassified by the World Health Organization (WHO). The published literature comprises predominantly sporadic case reports. Clinically characterized by an unfavorable prognosis, distinctive histopathological morphology, and specific immunophenotypic profiles, a cervical SMARCA4-UT exhibits relatively nonspecific molecular alterations that closely mirror those of a thoracic SMARCA4-UT. Notably, optimal therapeutic algorithms and management paradigms remain incompletely delineated.

We report a case of cervical SMARCA4-UT in a 58-year-old female presenting with persistent abnormal uterine bleeding. The initial clinical evaluation, including ultrasonography, identified a cervical mass. The patient was subsequently referred to a hospital. Comprehensive staging, using whole-body positron emission tomography-computed tomography (PET-CT) and pelvic magnetic resonance imaging (MRI), confirmed a large cervical neoplasm consistent with clinical stage IV disease, precluding radical surgical resection. Analysis of biopsy specimens demonstrated partial pan-cytokeratin [anti-epithelial cytokeratin 1 (AE1)/anti-epithelial cytokeratin 3 (AE3)] immunoreactivity, focal claudin-4 expression, and complete loss of SMARCA4 protein expression. Next-generation sequencing (NGS) identified a microsatellite instability-high (MSI-H) status, with mutations in genes such as phosphatase and tensin homolog deleted on chromosome ten (PTEN) and AT-rich interaction domain 1A (ARID1A), among others; notably, pathogenic SMARCA4 mutations were absent. A definitive diagnosis of SMARCA4-UT was established. Therapeutic intervention comprised percutaneous radioactive seed implantation followed by combination chemotherapy with etoposide-cisplatin (EP regimen) plus bevacizumab, complicated by bone marrow suppression. Therapy was transitioned to pembrolizumab combined with paclitaxel-carboplatin (TP regimen). Disease progression prompted the reversion to a reduced EP regimen with bevacizumab dosage. The patient demonstrated sustained disease control from her third discharge until the conclusion of the follow-up.

Single-agent immunotherapy has shown limited efficacy in the inoperable setting, whereas combination chemotherapy regimens incorporating anti-vascular endothelial growth factor (VEGF) agents may have conferred a clinical benefit for tumor control.

Previous research has demonstrated the associations between educational attainment, economic status, and postpartum depression (PPD). However, the associations between educational attainment, household income, and PPD based on Mendelian randomization (MR) have yet to be fully elucidated. Moreover, whether household income serves as a mediator in the association between education and PPD remains unclear.

Using single-nucleotide polymorphisms (SNPs) extracted from genome-wide association studies (GWAS) as instrumental variables (IVs), we assessed the associations between education, household income, and PPD using MR analysis methods, such as inverse-variance weighting (IVW). The mediating effect was evaluated by examining (1) the association between education and household income and (2) the role of household income in the education—PPD relationship. Sensitivity analyses, including MR-Egger intercept analysis, leave-one-out analysis, Cochran’s Q test, and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO), were performed to assess robustness.

The MR analysis indicated that higher education (odds ratio (OR) = 0.877, 95% confidence interval (CI): 0.828–0.930; p = 1.050 × 10^-5) and greater household income (OR = 0.443, 95% CI: 0.204–0.962; p = 0.040) were both associated with a reduced risk of PPD. Furthermore, we identified a significant association between education and household income (OR = 1.095, 95% CI: 1.085–1.105; p = 2.805 × 10^-87). The mediation analysis demonstrated that household income partially mediated the relationship between education and PPD, with an indirect effect of –0.074 (95% CI: –0.146 to –0.004), accounting for 56.67% of the total effect.

These findings suggest that household income significantly mediates the association between education and PPD. Moreover, higher education and increased household income can serve as important protective factors against PPD, underscoring the necessity for socioeconomic interventions aimed at reducing the risk of PPD.

This study aimed to determine the effect of hypertensive disorders during pregnancy, systolic blood pressure (SBP), and diastolic blood pressure (DBP) on maternal and fetal mortality and morbidity.

This retrospective cohort study included 195 women aged ≥18 years with hypertensive disorders during pregnancy who underwent caesarean section between 2012 and 2017. Patients were divided into groups based on their hypertensive diagnosis (25 with gestational hypertension (GHT), 164 with preeclampsia, 6 with eclampsia) or the recorded SBP or DBP readings at delivery. Logistic regression and linear regression were used to examine associations between hypertensive diagnosis, DBP at delivery, SBP at delivery, and the development of adverse maternal and fetal outcomes after adjusting for confounders.

Multivariable regression analysis revealed a trend toward an increased risk of intrauterine growth restriction (IUGR) (adjusted risk ratio (aRR) = 2.92; p = 0.09) in patients with eclampsia compared to those with GHT, while patients with preeclampsia had a significantly increased risk of IUGR (aRR = 2.77; p = 0.003). Patients with preeclampsia also had a threefold increased risk of premature delivery (aRR = 3.29; p < 0.004), while those with eclampsia had a fourfold increased risk (aRR = 4.09; p = 0.002) compared to patients with GHT. Both groups also had significantly lower fetal birth weights than the GHT group. A DBP of ≥90 mmHg during delivery was associated with significantly reduced fetal birth weight (coefficients (Coef.), –381.5, 95% confidence interval (CI), –739.6 to –23.4; p = 0.04). No significant differences were observed in the outcomes between patients with an SBP value <140 mmHg during delivery and those with a SBP recording ≥140 mmHg.

SBP and DBP are important parameters in the maternal early warning criteria. Strict DBP monitoring may help to increase patient safety, especially in patients with preeclampsia or eclampsia.

Current evidence on prognostic factors affecting outcomes in serous ovarian cancer (SOC) is limited, with many studies evaluating only a narrow range of variables. This study aimed to assess survival patterns and prognostic determinants among SOC patients treated at our institution.

We conducted a retrospective analysis of women diagnosed with SOC based on histopathological and cytopathological analyses between January 2016 and December 2023. The collected data included demographic characteristics, comorbidities, laboratory parameters, histological grade, tumour stage, surgical approach, postoperative residual disease, chemotherapy regimens, targeted therapy use, postoperative complications, and clinical outcomes. The primary endpoints were overall survival (OS) and mortality.

A total of 302 patients with SOC were included, with a median age of 52 years (mean 51.4 ± 10.0 years). Of these, 116 patients (38.4%) had high-grade serous ovarian cancer (HGSOC), and 119 patients (39.4%) were at clinicopathological stages III/IV. Comorbidities were present in 32.1% of patients but did not significantly affect survival. Multivariate analysis identified the following independent prognostic factors (ranked by hazard ratio): human epididymis protein 4 (HE4) positivity (hazard ratio [HR] = 1.856), tumour stage (HR = 2.411), histological grade (HR = 3.415), achieving R0 resection status (HR = 3.316), use of targeted therapies (HR = 4.498), and adequacy of chemotherapy cycles (HR = 2.663).

OS in SOC was significantly influenced by HE4 expression, tumour stage, histological grade, surgical resection status, targeted therapy, and the number of chemotherapy cycles (p < 0.05). These findings highlight the importance of early diagnosis, optimal cytoreduction, complete chemotherapy, and incorporation of targeted treatments to improve patient outcomes.

Proper invasion and growth of trophoblast cells are crucial for the prevention of preeclampsia. This pilot study, conducted with a small sample size, focused on the regulatory effects of interferon-inducible protein 10 (IP-10) and lipoxin A4 (LXA4) on HTR-8-SVneo trophoblast cells.

A total of 5 patients with preeclampsia and 5 normotensive pregnant women were enrolled in this study. Serum and placental levels of IP-10, LXA4, and the LXA4 receptor (ALX) were measured. Both IP-10 and ALX were silenced in HTR-8-SVneo cells. The effects on HTR-8-SVneo cell behaviors were assessed using wound healing assay, transwell assay, colony formation assay, Cell Counting Kit-8 (CCK8) assay, flow cytometry, and terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling (TUNEL) staining. Inflammatory and oxidative stress markers were measured using biochemical assay. Apoptosis-related proteins were measured via western blotting.

High levels of IP-10 and low levels of LXA4, accompanied by decreased ALX expression, were observed in patients with preeclampsia. IP-10 knockdown significantly stimulated the invasion, migration and proliferation of HTR-8-SVneo cells while inhibiting apoptosis, whereas ALX silencing exerted the opposite effects. Silencing of IP-10 or ALX also produced opposing effects on the regulation of oxidative stress and inflammation in HTR-8-SVneo cells.

Although this pilot study has a small sample size (n = 5 per group) and inherent limitations, it provides noteworthy preliminary evidence of an antagonistic relationship between IP-10 and LXA4 in HTR-8-SVneo cells.

The interpregnancy interval (IPI) is a significant factor influencing pregnancy outcomes, particularly in women with a prior cesarean section. Understanding how IPI influences maternal complications and pregnancy outcomes is crucial for guiding post-cesarean pregnancy management.

A retrospective cohort study was conducted on 1803 women who underwent cesarean delivery at Guangzhou Women and Children’s Medical Center between January 1, 2011, and June 30, 2022. Those with a first cesarean delivery followed by one or more subsequent births were included. Participants were assigned into four IPI-based groups for comparison. Data of clinical characteristics (including age, marital status, mode of delivery, newborn weight, and medical history), maternal complications [including gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, polyhydramnios, oligohydramnios, placenta accreta, and placenta previa], and pregnancy outcomes [including fetal distress, macrosomia, postpartum hemorrhage, premature rupture of membranes (PROM), and preterm birth] were collected and analyzed using univariate and multivariate logistic regression.

Significant differences in clinical characteristics and maternal complications were observed across the IPI groups after cesarean section. Women with IPIs of ≥60 months had the highest mean age (34.09 ± 2.92, p < 0.001) and increased risks of GDM (26.04%, p = 0.021) and placenta accreta (7.29%, p = 0.010). The IPI group of <18 months exhibited the highest rates of gestational hypertension (15.15%) and oligohydramnios (4.55%). Significant associations between IPI and adverse pregnancy outcomes, such as fetal distress and PROM, were observed, particularly at the extremes of IPI (<18 months and ≥60 months). After adjusting for potential confounding factors, including age and history of gestational hypertension, preeclampsia, postpartum hemorrhage, macrosomia, placenta previa, and fetal distress, multivariate logistic regression analysis revealed that the risk of GDM was significantly reduced in the 18–23 months IPI group compared to the 24–59 month group [adjusted odds ratio (OR) = 0.630; 95% confidence interval (CI): 0.431–0.920; p < 0.017]. Gestational hypertension was strongly associated with shorter IPIs, whereas preeclampsia and placenta accreta were more common with longer IPIs. The risk of PROM increased with both very short and very long IPIs. Postpartum hemorrhage was more frequent in the 18–23 months group, and preterm birth risk increased significantly with IPIs of ≥60 months.

Both short and long IPIs following a cesarean section are associated with specific adverse maternal complications and pregnancy outcomes. Individualized counseling and planning for subsequent pregnancies may benefit women with a history of cesarean delivery to minimize these risks.

To investigate the predictive value of the mid-trimester Naples Prognostic Score (NPS) for the subsequent preeclampsia development.

This retrospective nested case-control study included 249 women, comprising 120 who developed preeclampsia and 129 normotensive controls, who delivered between January 2019 and January 2024. Laboratory parameters, including complete blood count and biochemical markers, were obtained at 20–24 weeks of gestation. The NPS was calculated based on the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin, and total cholesterol levels, using cutoff values adapted from oncology literature. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive performance of the NPS.

Women who developed preeclampsia had significantly higher mid-trimester NPS scores compared with controls (median [interquartile range] (IQR): 3.0 (3.0–3.0) vs. 2.0 (1.0–2.0), p < 0.001). ROC analysis demonstrated good diagnostic performance of the NPS (area under the curve (AUC) = 0.886; 95% confidence interval (CI): 0.846–0.926) with an optimal cutoff value of 2.5 yielding a sensitivity of 85.0% and a specificity of 82.9%. In the multivariate logistic regression analysis, the NLR (adjusted odds ratios (aOR) = 4.127), lymphocyte count (aOR = 0.266), serum albumin (aOR = 0.412), and total cholesterol (aOR = 0.993) were identified as independent predictors of preeclampsia, whereas the composite NPS was not retained in the final model.

The NPS demonstrated excellent screening performance for predicting preeclampsia, primarily driven by its inflammatory components, particularly the NLR. Although NPS provides practical clinical utility as a composite screening tool, its underlying inflammatory parameters appear to be the true mechanistic predictors. Further validation using pregnancy-specific cutoff values is warranted before routine clinical implementation.

Endometriosis affects an estimated 10% of women of reproductive age and is characterized by chronic pelvic pain, infertility, and an increased risk of ovarian cancer. Laparoscopy remains the diagnostic gold standard for endometriosis; however, this technique is an invasive procedure. Therefore, non-invasive alternatives, such as serum biomarkers (e.g., carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), and human epididymis protein 4 (HE4)) and ultrasound, represent promising techniques but currently lack consistent accuracy. Thus, this study aimed to evaluate the diagnostic efficacy of CA125, HE4, and ultrasound, individually and in combination, for detecting endometriosis.

A retrospective analysis was conducted involving 51 patients with endometriosis and 52 healthy controls. Serum levels of CA125 and HE4 were measured by chemiluminescence, and ultrasound examinations were performed. Diagnostic performance was evaluated using sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curves.

CA125 levels were significantly elevated in patients with endometriosis (1.90 ± 0.39, log10) compared to controls (1.06 ± 0.22, log10; p < 0.001), yielding an area under the curve (AUC) of 0.97 (95% confidence interval (CI): 0.94–1.00), with a sensitivity of 94.23% (95% CI: 0.87–1.01), specificity of 92.16% (95% CI: 0.85–1.00), positive predictive value (PPV) of 92.18% (95% CI: 0.85–1.00), negative predictive value (NPV) of 94.21% (95% CI: 0.87–1.01), and accuracy of 93.20% (95% CI: 0.88–0.98). In contrast, HE4 did not exhibit a significant difference (p = 0.156). Ultrasound demonstrated a sensitivity of 72.55% (95% CI: 0.60–0.85), a specificity of 100.00% (95% CI: 1.00–1.00), PPV of 100.00% (95% CI: 1.00–1.00), NPV of 78.79% (95% CI: 0.69–0.89), and an accuracy of 86.41% (95% CI: 0.80–0.93). Combining CA125 and ultrasound enhanced the diagnostic accuracy to 95.15% (95% CI: 0.91–1.00), achieving a sensitivity of 92.16% (95% CI: 0.85–1.00), PPV of 97.92% (95% CI: 0.94–1.02), NPV of 92.73% (95% CI: 0.86–1.00), and specificity of 98.08% (95% CI: 0.94–1.01) (AUC: 0.96, 95% CI: 0.92–1.00).

Combining CA125 and ultrasound significantly improves the non-invasive diagnosis of endometriosis, providing high sensitivity and specificity. This approach may reduce the reliance on laparoscopy, thereby facilitating earlier intervention. However, as this is a small-scale retrospective cohort study, larger sample cohorts are required for future validation to confirm these findings.

The factors associated with high-risk human papillomavirus (HR-HPV) clearance and its regulation following conization of cervical HPV-associated lesions remain unclear.

Information was extracted on patients who underwent cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) at the Affiliated Hospital of Qingdao University and Zhucheng People’s Hospital between September 2014 and September 2020. We compared postoperative HR-HPV clearance between the CKC and LEEP groups using Kaplan-Meier (K-M) curves and calculated the restricted mean survival time (RMST) for each group. Subsequently, we employed univariate and multivariate logistic regression analyses to determine independent prognostic factors.

In total, 339 patients were enrolled, including 182 patients who underwent CKC (53.7%) and 157 patients who underwent LEEP (46.3%). The HPV16/18 regression rates were 92.2% and 85.7% in the CKC and LEEP groups, respectively. Patients who underwent LEEP experienced a longer HR-HPV regression period than those who underwent CKC, along with significantly lower regression rates [hazard ratio (HR): 0.795; 95% confidence interval (CI): 0.223–0.974; p = 0.049]. The RMST of HR-HPV positivity after surgery was 5.23 months in the CKC group and 5.79 months in the LEEP group (p = 0.463). Multivariable analysis identified LEEP as an independent risk factor for persistent positive HR-HPV after surgery (odds ratio (OR): 5.730; 95% CI: 1.236–26.568; p = 0.026).

CKC is associated with faster, more complete clearance of HR-HPV compared with LEEP. Procedure selection should prioritize adequate excision while preserving healthy tissue. Nonetheless, prospective, standardized studies are needed to confirm these findings.

Pelvic organ prolapse (POP) is a prevalent gynecological disorder affecting approximately one-third of women worldwide, characterized by the descent of pelvic organs and associated with symptoms such as pelvic pressure, incontinence, and sexual dysfunction, all of which significantly impair quality of life. This study investigated the relationship between episiotomy and the development of POP in women with a history of vaginal delivery.

A retrospective cross-sectional study was conducted on a cohort of 1030 women admitted to two tertiary university hospitals between 2021 and 2024. Demographic, obstetric, and clinical data were collected, and POP was diagnosed using the Pelvic Organ Prolapse Quantification (POP-Q) system.

The median age of the participants was 44 (18–70) years, and POP was diagnosed in 321 (31.2%) patients. Women with POP had significantly higher age (p < 0.001), body mass index (BMI) (p < 0.001), waist-to-hip ratio (WHR) (p < 0.001), gravidity (p < 0.001), parity (p < 0.001), menopausal status (p < 0.001), macrosomic delivery (p < 0.001), and episiotomy rates (p < 0.001) compared with those without POP. However, smoking history (p < 0.001) and induced delivery (p < 0.001) were significantly higher in those without POP. Median episiotomy was significantly associated with posterior POP (p < 0.001), while mediolateral episiotomy was significantly associated with apical POP (p < 0.001). Age (odds ratio [OR] = 1.094, 95% confidence interval [CI]: 1.060–1.128, p < 0.001), BMI (OR = 1.464, 95% CI: 1.346–1.593, p < 0.001), parity (OR = 16.907, 95% CI: 10.508–27.203, p < 0.001), macrosomic delivery (OR = 8.221, 95% CI: 3.104–21.773, p < 0.001), and episiotomy (OR = 11.533, 95% CI: 5.660–23.501, p < 0.001) were strongly associated with increased risk of POP. However, smoking (OR = 0.073, 95% CI: 0.025–0.217, p < 0.001) was strongly associated with a decreased risk of POP.

Episiotomy was independently associated with increased odds of POP, underscoring the importance of its selective use in obstetric practice.