The application of chemotherapy using the combination of platinum and taxane agents is now considered the standard treatment option for ovarian cancer. Notably, cells respond to DNA damage by promoting DNA repair; however, when repair is insufficient, cell death is induced. The abnormality of the nuclear pore complex (NPC) also leads to nuclear envelope destruction and disrupts transmembrane transport, leading to abnormal substance exchange. Therefore, this study aimed to analyze the mechanisms through which DNA damage induced by carboplatin and paclitaxel contributes to the treatment of ovarian epithelial cancer and to explore the role of DNA damage in mediating the anti-tumor effects of these compounds.
Cell proliferation, cell cycle progression, and apoptosis were examined in four ovarian epithelial cancer cell lines following treatment with carboplatin, paclitaxel, or a combination of both compounds. A water-soluble tetrazolium-1 (WST-1) assay was employed to assess proliferation, flow cytometry was used for cell cycle analysis, and an immunofluorescence (IF) assay was utilized to detect apoptosis in the MES-OV (MOV), A2780, OVCAR-3, and OVCAR-5 cell lines. An IF assay was also used to evaluate nuclear structure and assess DNA damage.
Our study revealed that carboplatin and paclitaxel inhibited cell proliferation and induced cell cycle arrest, which was caused by DNA damage. In addition, paclitaxel induced an irreversible DNA damage, characterized by multimicronucleation, which is associated with NPC inhibition.
Carboplatin and paclitaxel inhibit the proliferation of ovarian cancer cells, induce cell cycle arrest, and promote apoptosis by inducing DNA damage. This is associated with irreversible micronucleation and may be linked to NPC suppression, as well as the disruption of the microfilament and microtubule assembly. Moreover, studying the formation and anti-tumor mechanism of irreversible micronucleation has potential implications for enhancing the efficacy of cytotoxic chemotherapy in killing tumor cells.
To retrospectively investigate the efficacy and influencing factors of tibolone and estradiol plus dydrogesterone in improving bone mineral density (BMD) in peri- and post-menopausal women, to provide a basis for clinical management.
Women aged 40–60 years who were undergoing menopausal transition or were post-menopausal, and who attended the menopause clinic at the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, between January 3, 2011, and May 11, 2020, were included in this study. Participants received tibolone or estradiol plus dydrogesterone for the management of menopause-related symptoms. Demographic characteristics were recorded, and BMD was measured using dual-energy X-ray absorptiometry at baseline and at 1, 2, and 3 years post-treatment to compare the efficacy of the two treatments in improving BMD.
The use of estradiol plus dydrogesterone showed an increasing trend in the BMD of the lumbar spine, total hip, and femoral neck after 1 and 2 years of treatment, with a decrease in the third year. Tibolone treatment showed a decreasing trend in BMD after 1, 2, and 3 years, indicating that estradiol plus dydrogesterone is superior to tibolone in improving BMD. After 3 years of tibolone treatment, changes in BMD were correlated with age, height, weight, and body mass index (BMI), whereas after 3 years of estradiol plus dydrogesterone treatment, changes in BMD showed no significant correlation with age, height, weight, and BMI.
Both estradiol plus dydrogesterone and tibolone are beneficial for maintaining BMD in peri- and post-menopausal women, with estradiol plus dydrogesterone demonstrating greater advantage over tibolone.
Endometrial cancer (EC) is the most common gynecological malignancy, and its incidence has recently increased. Several screening tools have been developed, including the Papanicolaou (Pap) smear, cervical methylation test, traditional transvaginal ultrasound (TVU), three-dimensional TVU (3D-TVU), circulating tumor DNA (ctDNA), and direct endometrial sampling. Each screening methods differ in characteristics, cost, and accuracy.
A systematic review was conducted to assess publications offering different perspectives on screening methods for EC and to identitify viable methods in practice, using PubMed and Google Scholar for studies published between 1995 and 2024. In addition, different strategies were summarized, and their cost-effectiveness was evaluated.
Known detection methods include various screening tools. Herein, we provide a comparison of current early diagnostic and screening tools for EC and their accuracy, and review existing knowledge on screening methods while identifying viable methods for clinical practice. Currently, no optimal screening method exists for EC.
With the increasing global incidence of EC, the demand for effective EC screening is more noteworthy. Concerning cost-effectiveness, convenience, and complications, it has been suggested that TVU or DNA methylation testing in cervical samples may be preferable options. Additionally, differential diagnosis of other etiologies and patient education regarding red-flag signs are also important.
Summarize evidence across six common pregnancy complications—gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), thyroid dysfunction, intrahepatic cholestasis of pregnancy (ICP), hyperemesis gravidarum (HG), and preterm birth (PTB)—and clarify short- and long-term consequences for mothers and their children.
Adverse outcomes converge on shared pathways: abnormal placental development and perfusion, inflammatory and oxidative stress signaling, endocrine and metabolic dysregulation, and epigenetic remodeling at imprinted loci. These processes program fetal organ systems (brain, heart, lungs, kidneys) and shape lifelong disease risk.
GDM increases large-for-gestational-age birth, respiratory morbidity, and later metabolic disease. HDP drive fetal growth restriction and enduring cardiovascular and neurocognitive sequelae. Thyroid dysfunction worsens obstetric outcomes and may impair offspring neurocognition. ICP raises risks of PTB and stillbirth. HG is associated with low birth weight and small for gestational age. PTB independently predicts lifelong cardio-respiratory, endocrine, and neurodevelopmental disorders. Management spans glucose control; antihypertensive therapy and magnesium sulfate; levothyroxine or antithyroid drugs; ursodeoxycholic acid; antiemetics and nutritional support; progesterone and antenatal corticosteroids. Emerging precision strategies target angiogenic balance, inflammation, and the microbiome.
Pregnancy complications are sentinel events with intergenerational implications. Stage-appropriate screening, timely intervention, and longitudinal follow-up are essential, while multi-omics research and placental-targeted trials are needed to validate strategies that mitigate offspring risk across the life course.
The assessment of the fertility window can be approached from the point of view of the analysis of biochemical and hormonal changes related to the ovarian physiology of the hypothalamic-pituitary-gonadal axis. These changes at the target organ level determine the biophysical characteristics of cervical secretion. The present study examined the Peak (P)-type crystallization pattern of cervical secretions in relation with to the clinical assessment of the fertile window.
A prospective study was conducted in 45 subfertile patients undergoing sterility evaluation following Natural Procreative Technology and Restorative Reproductive Medicine approaches. 18 of the 45 subfertile patients met the inclusion criteria and completed a sterility work-up, along with a multidisciplinary assessment of the fertile window. In this selected sample, the P-type crystallization pattern was analyzed during the fertile window by performing a liquid endocervical biopsy. Finally, a randomly selected subgroup of 6 patients was assessed for pregnancy outcomes.
The fertile window was assessed in all participants. 18 digital captures (40%) were true positives, with P-type crystallization observed and a sensitivity of 100%. 27 captures (60%) were true negatives, with 100% specificity. Zero false-negatives or false-positives were observed. Live-birth pregnancy was achieved in 83% (5/6) of patients with positive P-type crystallization results in the randomly selected subgroup. The most fertile-window days were identified in all cases between three days before the estimated day of ovulation (EDO) until peak-day P (-3 EDO until P-Day). P-type crystallization, characterized by maximal branching and a tricolor pattern in a hexagonal configuration, was observed in 100% of the study group.
This study supports the integration of cervical secretion elasticity and transparency assessment with crystallization analysis, within an objective reference framework. The triad of (a) high-quality cervical secretion, (b) accurate fertile window diagnosis, and (c) the hexagonal P-type crystallization pattern may collectively contribute to predicting positive pregnancy outcomes.
The study has been registered on https://www.isrctn.com/ (registration number: ISRCTN18705969; registration link: https://www.isrctn.com/ISRCTN18705969).
Conservative uterine leiomyoma treatment options are limited. There is an unmet need for well-tolerated, non-invasive treatments that can be safely used long-term to reduce fibroid burden and symptoms. We investigated the efficacy of epigallocatechin gallate (EGCG) from green tea, in combination with vitamins D and B6, for fibroid reduction and improvement of symptoms.
In this single-center study, we enrolled Korean, reproductive age women aged 18–50 years with confirmed uterine leiomyoma, with fibroids ≥3 cm in the longest dimension. Participants received EGCG 150 mg, vitamin D3 25 μg/1000 international units (IU), and vitamin B6 5 mg in tablet form for 16 weeks, and were instructed to take 2 tablets each morning. Participants completed a pictorial bleeding assessment chart (PBAC) during menstruation, and uterine fibroid symptom (UFS) severity and quality of life (QoL) assessments before and after treatment. The primary endpoint was the change in largest fibroid volume at 16 weeks. Outcomes were compared using a paired t-test or Wilcoxon’s signed rank test based on satisfaction of the normality assumption.
After 16 weeks, 31/33 patients (93.9%) showed a reduced fibroid volume. Mean fibroid volume was significantly reduced by 12.7% (675.57 vs. 590.00 mm3, respectively; p < 0.001). Significant volume reductions were observed across all age groups, with the greatest reduction observed in the 41–50-year age group (–16.0%). While there was no significant improvement in mean PBAC scores, UFS-severity and UFS-QoL scores improved in 72.7% and 81.8% of patients, respectively, with significant improvements in mean scores compared to baseline (p = 0.002 and p = 0.008, respectively). No adverse events were reported.
The use of EGCG/vitamin D3/vitamin B6 represents an effective and well-tolerated non-hormonal and non-surgical treatment for reproductive age women with symptomatic uterine leiomyoma.
This study is registered on the Korean Clinical Research Information Service (CRIS) https://cris.nih.go.kr/cris/search/detailSearch.do?seq=30490&search_page=L (registration number: KCT0010798).
Ectopic pregnancy is a major early-pregnancy cause of maternal mortality, and hysteroscopy is the gold standard for uterine cavity assessment, offering direct visualization, accurate pathology, easy biopsy, and immediate therapeutic intervention. However, no studies have evaluated whether hysteroscopy improves subsequent pregnancy outcomes in infertile women with a prior ectopic pregnancy. This study aimed to evaluate the necessity of routine office hysteroscopy prior to the first embryo transfer in infertile women with a history of ectopic pregnancy, based on the hypothesis that hysteroscopy may assist in identifying intrauterine pathologies that could impact pregnancy outcomes.
We conducted a single-center retrospective cohort study including consecutive patients with a history of ectopic pregnancy at a university-affiliated hospital between January 2018 and December 2022. Patients were divided into two groups according to whether they underwent hysteroscopy prior to embryo transfer. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups.
A total of 714 patients were included in the analysis. Following PSM, no significant differences in baseline characteristics were observed between the two groups. The clinical pregnancy rate was 58.26% in the hysteroscopy group and 53.22% in the non-hysteroscopy group (p = 0.397). Subgroup analysis revealed that patients diagnosed with and treated for chronic endometritis (CE) exhibited a higher spontaneous miscarriage rate (46.90%) and a lower live birth rate (25.00%) compared to the disease-free group (miscarriage rate 18.00%, live birth rate 45.61%), the endometrial polyps (EP) group (miscarriage rate 10.00%, live birth rate 52.31%), and CE + EP group (miscarriage rate 25.00%, live birth rate 44.26%).
Routine hysteroscopy prior to first embryo transfer in women with a history of ectopic pregnancy did not significantly improve clinical pregnancy rates. However, hysteroscopy proved valuable in identifying intrauterine abnormalities such as CE and EP, which were associated with adverse reproductive outcomes. Further prospective studies are warranted to determine whether targeted diagnosis and management of these conditions can improve live birth rates in this population.
Cesarean hysterectomy is a common approach to managing placenta accreta spectrum (PAS); however, the morbidities related to cesarean hysterectomy are not yet fully understood. This study aimed to investigate urinary incontinence (UI) symptoms and sexual function in patients who underwent hysterectomy due to PAS.
This prospective cohort study was conducted at Basaksehir Cam and Sakura City Hospital in Istanbul, Turkey. The study group included 51 patients who had a cesarean hysterectomy due to PAS and 51 patients in the control group who underwent a cesarean section (CS) at term. Patients in both groups were evaluated 6 to 12 months after surgery. The patients completed the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) for UI symptoms and the Female Sexual Function Index (FSFI). The PAS group was further divided into patients with and without bladder invasion of the placenta.
The ICIQ-FLUTS total score, as well as the filling, voiding, and incontinence subdomain scores, and post-void residual urine volume, were statistically significantly higher in the PAS group than in the control group (p < 0.05). The FSFI total score and the subdomain scores for arousal, lubrication, orgasm, satisfaction, and pain were statistically significantly lower in the PAS group than in the control group (p < 0.05). Subgroup analysis of the PAS group showed no statistically significant difference in UI and sexual function between hysterectomized patients with and without placental invasion of the bladder.
Patients with PAS who undergo cesarean hysterectomy have a higher incidence of UI and impaired sexual function postoperatively compared to patients who undergo ordinary CS, regardless of bladder invasion.
This review aimed to provide a thorough analysis of the recent advancements in placenta-targeted drug delivery systems to manage preeclampsia (PE).
This article presents a comprehensive review of advancements in placenta-targeted drug delivery to manage PE. Moreover, this review emphasizes the assessment of various delivery routes and the selection of suitable drug carriers, incorporating relevant findings from both preclinical and clinical trials. By examining the mechanisms of action, benefits, and potential applications of placenta-targeted drug delivery, this article seeks to offer valuable insights and guidance for future research.
Preclinical studies indicate that targeted drug delivery systems, which employ various methods, including intravenous or intraperitoneal administration and utilize carriers like antibody-conjugated nanoparticles, produce significantly higher concentrations of drugs in the placenta compared with non-targeted methods. The targeted approach has shown promising results in animal models of PE, often leading to improvements in maternal health indicators, such as lower blood pressure and reduced protein levels in urine, as well as enhanced fetal outcomes, including improved growth and decreased inflammation. While the clinical translation of these findings into practice remains in its early phases, initial clinical trials are currently assessing the safety and preliminary effectiveness of these innovative delivery systems. Although these early results suggest potential advantages, larger and more comprehensive trials are required to draw definitive conclusions about the efficacy of these delivery systems.
Placenta-targeted drug delivery represents an innovative and promising strategy for managing PE. This approach addresses the limitations of traditional therapies by enabling localized and high-concentration drug delivery, which could significantly improve outcomes for both mothers and their infants. Finally, while preclinical data offer encouraging results, continued research aimed at optimizing delivery methods, creating advanced drug carriers, and conducting thorough clinical trials remains essential.
To construct and compare the predictive efficacy of the random forest (RF) model and gradient boosting machine (GBM) model for long-term recurrence of endometriosis (EMs) treated by laparoscopy combined with gonadotropin releasing hormone agonist (GnRHa).
A total of 254 patients with EMs who underwent laparoscopy combined with GnRHa in The First Affiliated Hospital, College of Medicine, Zhejiang University from July 2022 to December 2023 were retrospectively collected. All patients were followed up for 1 year, and the long-term number of recurrences was recorded. The corresponding influencing factors were obtained by single factor analysis, and the risk prediction model of the long-term recurrence of sub-EMs was constructed based on RF and GBM models. At the same time, the receiver operating characteristic (ROC) curve and calibration were used to compare the predictive value of the model constructed by the two algorithm models for long-term recurrence of EMs.
Univariate analysis showed that the course of disease, preoperative dysmenorrhea history, preoperative uterine cavity operation history, tender posterior fornix and revised American Fertility Society (r-AFS) stage were the influencing factors of postoperative recurrence in patients with EMs treated by laparoscopy combined with GnRHa (p < 0.05). Based on univariate analysis, RF and GBM models were constructed. The order of importance of the predictors of laparoscopy combined with GnRHa in the treatment of EMs was r-AFS staging, course of disease, tender posterior fornix, history of intrauterine operations and history of preoperative contraception. The ROC curve results of the RF model showed that the area under curve (AUC) of the model in the training set was 0.902 (95% CI: 0.857–0.947), and the sensitivity and specificity were 100.00% and 63.50%, respectively. The AUC in the validation set was 0.859 (95% CI: 0.741–0.976), and the sensitivity and specificity were 69.20% and 92.90%, respectively. The results of the ROC curve of the GBM model showed that the AUC of the GBM model in the training set was 0.851 (95% CI: 0.781–0.920), and the sensitivity and specificity were 89.20% and 68.20%, respectively. The AUC in the validation set was 0.852 (95% CI: 0.713–0.990), and the sensitivity and specificity were 76.90% and 87.50%, respectively. The calibration curve shows that the prediction probabilities of the RF model and the GBM model are highly consistent with the actual prediction in both the training set and the validation set. The results of Delong test showed that the training set AUC of RF model was better than that of GBM model, and the difference was statistically significant (Z = 2.838, p = 0.005). There was no significant difference in the validation set AUC between the RF model and the GBM model (Z = –0.239, p = 0.811).
r-AFS staging, course of disease, tender posterior fornix, history of intrauterine operations and history of preoperative laparoscopy are the influencing factors in the long-term recurrence of EMs treated by laparoscopy combined with GnRHa. RF and GBM models can effectively predict the recurrence of such patients after treatment.
The menopausal phase represents a pivotal transition in a woman’s reproductive life, characterized by a wide spectrum of somatic, psychological, and urogenital symptoms. Research indicates that, despite the severity of these symptoms, women encounter multiple barriers when seeking medical care. This study aims to assess the prevalence and severity of menopausal symptoms among women in Saudi Arabia, as well as the barriers to seeking medical consultation for their management.
A cross-sectional study was conducted in 2024 among 430 perimenopausal and postmenopausal women in Saudi Arabia using a self-administered online questionnaire. Data were collected on demographics, menopausal symptom severity using the menopause rating scale (MRS), and barriers to seeking medical advice. Statistical analyses were performed using SPSS version 27.
The mean MRS score was 17.28 ± 9.43, with 52.5% of participants reporting severe to very severe symptoms. Physical and mental exhaustion was the most prevalent symptom (84.9%), while the belief that menopausal symptoms are a natural part of aging was the most frequently reported barrier to seeking medical advice (45.1%). Severe to very severe menopausal symptoms were significantly more common among married participants. In addition, older age, higher educational level, unemployment, and the presence of a chronic disease were identified as risk factors for greater symptom severity.
More than half of the women in this study experienced severe to very severe menopausal symptoms. There is a critical need for enhanced health education to promote strategies for alleviating these symptoms and to emphasize the importance of seeking appropriate medical care.
To elucidate the prenatal ultrasonographic characteristics and clinical prognosis of fetal intestinal volvulus in the absence of malrotation, a rare and potentially life-threatening condition.
A retrospective analysis was conducted on seven cases of fetal intestinal volvulus diagnosed prenatally using ultrasound at the Women and Children’s Hospital, School of Medicine, Xiamen University, between July 2021 and December 2024. Ultrasonographic findings, including the whirlpool and vascular spiral signs, were correlated with postnatal surgical or autopsy outcomes, operative reports, intraoperative findings, postoperative pathology, and clinical recovery data.
Maternal age ranged from 24 to 34 years, with initial diagnoses made at 23–33 weeks of gestation. All seven cases exhibited whirlpool and vascular spiral signs, with additional findings including bowel dilation (7/7), ascites (6/7), abdominal pseudocysts (2/7), and coffee bean sign (2/7). A total of 27 ultrasound examinations were performed, with whirlpool and vascular spiral signs detected in 20 of the 27 examinations. Six fetuses were born alive (five preterm) and underwent neonatal surgery, confirming volvulus with necrosis and intestinal atresia (four type III) in five cases. One pregnancy was terminated because of parental concerns about severe complications, with an autopsy confirming volvulus and necrosis.
Fetal intestinal volvulus exhibits distinct ultrasonographic features, including whirlpool and vascular spiral signs, which enable early and precise prenatal diagnosis. This provides a critical foundation for timely intervention decisions and improved perinatal outcomes. Prenatal ultrasound is instrumental in identifying volvulus early, facilitating multidisciplinary perinatal collaboration, optimizing prenatal counseling, and enhancing fetal outcomes through timely postnatal management.
To evaluate the efficacy of laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies through a literature review comparing the extraperitoneal and transperitoneal approaches.
A comprehensive computerized search of PubMed, Embase, the Cochrane Library, Medline, Web of Science, and other relevant databases was conducted, covering the period from January 2010 to January 2025, to collect studies that compared the transperitoneal and extraperitoneal approaches to laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies. Relevant data were extracted and analyzed using the Review Manager (RevMan) version 5.4.1 statistical software. Outcome indexes included operation time, intraoperative blood loss, number of para-aortic lymph nodes dissected, hospitalization days, and incidence of surgical complications.
A total of 525 manuscripts were retrieved, of which 8 were included. Our analysis showed no statistically significant differences between the extraperitoneal and transperitoneal groups in terms of operative time, intraoperative bleeding, and hospitalization days. However, the complication rate was significantly lower in the extraperitoneal group than in the transperitoneal group. Additionally, the number of para-aortic lymph nodes (PAL) retrieved was significantly higher in the extraperitoneal group compared to the transperitoneal group [mean difference (MD) = 0.43, 95% confidence intervals (CI) (0.13 to 0.72, p = 0.004)].
Laparoscopic para-aortic lymphadenectomy for gynecologic malignancies offers several advantages when performed via the extraperitoneal route. This approach reduces surgical trauma, shortens hospital stay, lowers the rate of complication, and increases the number of lymph nodes that can be resected compared to the transperitoneal route.
The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251033897; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033897).
This study evaluated whether abdominal scar tissue characteristics, duration of corset use, and striae gravidarum (SG) density are associated with the severity of intra-abdominal adhesions (IAA) in repeat cesarean sections (CS).
This study prospectively recruited 800 women in their third trimester of pregnancy who were admitted to our clinic for repeat CS. Data was collected on the number of previous CS, history of corset use after prior CS, and demographic characteristics. Abdominal scar characteristics were visually classified by surface appearance (dimpled, smooth, or raised) and pigmentation status (hyperpigmented or normal). SG density was determined using Davey’s scoring system. IAA were classified intraoperatively according to the Nair classification system.
Among the 800 participants, 220 (27.5%) had no IAA, 296 (37.0%) had filmy adhesions, 136 (17.0%) had more than two dense adhesions, 124 (15.5%) had very dense adhesions, and 24 (3.0%) had a frozen pelvis. Univariate analysis showed significant associations between IAA scores and maternal age, height, body mass index (BMI) gravida, parity, and the number of previous CS (p < 0.001 for all). In multivariable analysis, the number of previous CS remained significantly associated with IAA scores. For each additional previous CS, the odds of developing dense adhesions increased nearly threefold (odds ratios [OR] = 2.85, 95% confidence intervals [CI]: 2.10–3.88, p < 0.001). In contrast, no significant associations were found between IAA scores and scar tissue characteristics, scar tissue pigmentation, SG density, history of corset use, or smoking (p > 0.05).
Preoperative evaluation of scar tissue characteristics, SG density, and history of corset use did not predict the presence or severity of IAA before elective CS. However, a significant association was observed between the number of previous CS and IAA. No significant association was observed between smoking and IAA.
Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can occur in a wide range of anatomical locations. Fat-forming SFT is a rare morphological variant of SFT characterized by an additional adipocyte component and a clinical course ranging from benign to overtly malignant.
We report the case of a 65-year-old gynecologic patient presenting with a large mass in the left adnexal region, which was found during surgery to originate from the retroperitoneal area. Histological and immunohistochemical (IHC) analyses revealed dense spindle cells that were positive for cluster of differentiation 34 (CD34), cluster of differentiation 99 (CD99), B-cell lymphoma 2 (BCL-2), and signal transducer and activator of transcription 6 (STAT6). Together with the presence of S-100-positive adipocytes within the tumor, the IHC results confirmed the diagnosis of fat-forming SFT. The patient showed no signs of recurrence or metastasis 24 months after surgery, and lifelong follow-up was planned.
Although fat-forming SFT is very rare in gynecology, this diagnosis should be considered whenever a large pelvic or retroperitoneal mass is identified prior to surgical intervention.
Type A2 gestational diabetes mellitus (A2GDM) is a challenging subtype of gestational diabetes, requiring insulin therapy in addition to exercise and dietary interventions. While multiple daily subcutaneous injections of regular insulin (RI) and insulin pumps are commonly used, their clinical efficacy and impact on maternal and infant metabolic indices remain unclear.
This retrospective study included 98 patients with A2GDM admitted to Puer People’s Hospital between March 2021 and September 2023. Patients were divided into a control group (n = 41) and an experimental group (n = 57) receiving insulin via an insulin pump. Both groups received treatment until delivery, and treatment efficacy, glucose metabolism, lipid metabolism, and maternal and infant complications were compared.
Pre-pregnancy, the experimental group had a lower body mass index (BMI) and fewer cases with a family history of diabetes. The experimental group achieved blood glucose targets faster, required a lower insulin dose, and had fewer hypoglycemic events (p < 0.05). Post-treatment, the experimental group showed greater improvements in fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbAlc), and homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profile (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]), with significantly better maternal and neonatal outcomes (p < 0.05). Complication rates were lower in the experimental group, including pregnancy-induced hypertension, cesarean section, polyhydramnios, and neonatal complications like macrosomia, hypoglycemia, and jaundice.
Multiple subcutaneous injections via insulin pump, that simulates physiological insulin secretion, requires a lower insulin dose for managing A2GDM and demonstrates superior efficacy in blood glucose control, improvement of glucose and lipid metabolism, as well as enhancement of both maternal and neonatal outcomes.
Menopause imposes a significant physical and emotional burden on women, affecting their quality of life and overall health. Beyond these challenges, the decline in estrogen levels during menopause is closely associated with adverse changes in bone health and an increased risk of developing metabolic syndrome (MetS), both of which contribute to long-term morbidity. The primary hypothesis of the current study was that the co-existence of low bone mineral density (BMD) and MetS would exacerbate the severity of menopausal symptoms. As the most bothersome menopausal symptoms typically emerge one year before the final menstrual period and gradually subside thereafter, we investigated BMD, MetS, and menopause-related symptoms in postmenopausal women within 10 years of menopause onset.
A total of 193 postmenopausal women were included in this cross-sectional study, which was conducted at a university hospital in Istanbul. At baseline, participants were categorized into MetS and non-MetS groups based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. For comparative analyses, participants were stratified according to MetS status and BMD. Women with osteopenia or osteoporosis based on BMD measurements were combined into the low BMD group. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS).
Women with MetS were significantly older and had a longer duration of menopause than those without MetS. All MRS scores were comparable between the MetS and non-MetS groups. Women with low BMD were older, had a longer duration of menopause, and a lower body mass index (BMI) compared to those with normal BMD. The MRS urogenital symptom subscale score was significantly higher among women with low BMD (p = 0.019). Severe urogenital symptoms were observed among women with co-existence of MetS and low BMD. Correlation analyses between MRS scores and other variables yielded negligible negative correlations with age.
Low BMD was associated with higher scores on the urogenital subscale of the MRS, whereas MetS showed no significant relationship with menopausal symptoms. Women with both low BMD and MetS experienced more severe urogenital symptoms.
Postpartum ovarian vein thrombophlebitis (POVT) is a rare yet potentially life-threatening complication. This study assesses the diagnostic utility of clinical manifestations and semi-quantitative parameters derived from non-contrast computed tomography (CT).
A total of 34,140 postpartum patients at People’s Hospital of Yuxi City from December 2017 to October 2024 were included. Among them, only 24 POVT cases and 42 non-POVT puerperal women had complete clinical and CT datasets. In both groups, the CT attenuation values of the ovarian vein (OV) and inferior vena cava (IVC), OV diameter, CT attenuation difference (OV CT value minus IVC CT value), and OV/IVC attenuation ratio (OV CT value divided by IVC CT value) were recorded. Comparisons were made between the two groups regarding D-dimer levels, OV width, CT attenuation values, and OV/IVC attenuation ratio. Data were analyzed using SPSS version 27.0, the chi-square test, or the Mann-Whitney U test conducted at a significance level of <0.05.
D-dimer levels were significantly higher in the POVT group (7.66 ± 4.94 vs. 1.94 ± 0.91 μg/mL, p < 0.01). Semi-quantitative non-contrast CT metrics showed strong diagnostic performance: OV width ≥0.90 cm (sensitivity 91.70%, specificity 95.20%), thrombus CT value ≥46.00 HU (sensitivity 100%, specificity 100%), CT attenuation difference ≥12.50 HU (sensitivity 95.30%, specificity 100%), and OV/IVC attenuation ratio ≥1.10 (sensitivity 95.30%, specificity 100%) clearly distinguished POVT from non-POVT patients (p < 0.01).
Non-contrast CT provides a valuable imaging modality for identifying POVT. D-dimer levels, combined with semi-quantitative CT parameters—OV width, thrombus CT value, CT attenuation difference, and OV/IVC attenuation ratio—can significantly improve diagnostic precision.
Preeclampsia (PE) is a common pregnancy complication and involves placental dysfunction and ischemia. Microvascular-Flow (MV-Flow) imaging was utilized to quantitatively assess placental microvascular architecture in PE. MV-Flow was also used to compare the microvascular architecture between PE and normal pregnancies, as well as between early- and late-onset PE cases.
The study enrolled 87 consecutive singleton pregnancies that underwent MV-Flow imaging examination between June 2021 and December 2021. Among these, 50 were normotensive pregnancies and 37 were PE pregnancies. The PE group was further stratified into early-onset (<34 weeks gestational age [GA], n = 25) and late-onset (≥34 weeks GA, n = 12) subtypes. Among the 50 normal cases, 38 were <34 weeks, and 12 were ≥34 weeks. MV-Flow technology was used to measure the placental vascular index (VIMV). The VIMVs for the middle and peripheral placental segments were referred to as VIMV-m and VIMV-p, respectively. Placental VIMVs were compared between PE and normotensive pregnancies, as well as between early- and late-onset PE cases. Perinatal outcomes were evaluated in pregnancies complicated by PE. A p-value < 0.05 (two-sided) was considered to be statistically significant.
No significant difference between the VIMV-p and VIMV-m was observed in either the normotensive or PE group, and neither parameter correlated with GA. Both VIMV-p and VIMV-m were significantly lower in early-onset PE cases compared to normotensive pregnancies <34 weeks GA (p < 0.001). Similarly, late-onset PE cases also showed lower VIMV-p and VIMV-m compared to normotensive pregnancies ≥34 weeks GA (p < 0.001). No significant differences were observed between early- and late-onset PE cases in either VIMV-p (p = 0.170) or VIMV-m (p = 0.471). Among PE pregnancies, placental VIMV measurements revealed no significant differences between appropriate-for-GA (AGA) and small-for-GA (SGA) neonates (VIMV-p: 21.40 [17.70–27.30] vs. 21.50 ± 2.50, p = 0.949; VIMV-m: 21.30 [17.50–27.50] vs. 22.80 ± 6.40, p = 0.881).
MV-Flow imaging enables quantitative assessment of microvascular architecture in PE placentas. Both early- and late-onset PE pregnancies showed significantly lower placental VIMV compared to normotensive pregnancies, supporting the clinical utility of MV-Flow for the evaluation of placental perfusion in PE. Furthermore, no significant difference in placental VIMV was observed between early- and late-onset PE, suggesting a similar impairment of placental perfusion in both subtypes.
Preeclampsia (PE), a severe pregnancy complication, is a major contributor to maternal and perinatal morbidity and mortality worldwide. Matrix metalloproteinases (MMPs) and their tissue inhibitors of metalloproteinases (TIMPs) are implicated in the pathogenesis of PE. This study aimed to evaluate maternal plasma levels of MMP-2, MMP-3, MMP-9, TIMP-1, and TIMP-2 in normal and preeclamptic pregnancies across gestational trimesters to assess their predictive value.
This case-control study included a total of 138 pregnant women: 72 with normal pregnant women (controls) and 66 women diagnosed with PE, recruited at Hanoi Obstetrics and Gynecology Hospital between July 2022 and June 2024. In the second trimester (14–28 weeks), the PE and control groups included 14 and 18 women, respectively. In the third trimester (29–41 weeks), the study included 52 women with PE and 54 controls. Plasma concentrations of MMP-2, MMP-3, MMP-9, TIMP-1, and TIMP-2 were measured using enzyme-linked immunosorbent assay (ELISA). Correlations between MMPs, TIMPs, MMP/TIMP ratios, and PE severity indices were analyzed using Spearman’s correlation. Receiver operating characteristic (ROC) analysis evaluated the diagnostic and predictive utility of these markers.
Maternal plasma levels of MMP-2 and TIMP-2 were significantly higher in the PE group compared to controls during both the second and third trimesters (p < 0.05). The MMP-2/TIMP-2 ratio was significantly lower in the PE group during the third trimester (p = 0.002). MMP-3 levels were markedly elevated in PE patients (p < 0.001) and were positively correlated with plasma creatinine and proteinuria. In contrast, MMP-9 levels were significantly reduced in the PE group across both trimesters (p < 0.05), whereas TIMP-1 levels showed no significant difference between groups. Notably, MMP-9 was strongly correlated with TIMP-1 in PE, and both markers correlated with systolic blood pressure (SBP). ROC curve analysis indicated the combination of MMP-2 and TIMP-2 as the best predictor of PE in the second trimester, while TIMP-2 was the most predictive marker in the third trimester.
Elevated plasma MMP-2 and TIMP-2 levels, particularly in the second trimester, show potential as biomarkers for identifying patients at risk of PE. TIMP-2 appears promising for prediction in the third-trimester. These findings warrant further investigation for potential clinical application.
In males with extremely severe oligospermia (MESO), single density gradient centrifugation (SDGC) has low sperm enrichment efficiency, making intracytoplasmic sperm injection (ICSI) challenging. This study aimed to determine whether double density gradient centrifugation (DDGC) can efficiently enrich sperm from MESO samples and whether these sperm are safe for clinical use.
MESO was defined as having ≤2000 motile sperm/mL of semen, whereas males with severe oligospermia (MSO) were defined as having 2000–10,000 motile sperm/mL. We compared sperm recovery between SDGC and DDGC in MESO samples and retrospectively analyzed in vitro fertilization (IVF) data from 39 MESO cases (sperm prepared using DDGC) and 78 MSO cases (sperm prepared using SDGC) collected from 2017 to 2023. The SDGC group served as the control group.
The results showed that the sperm recovery rate of DDGC was approximately three-fold higher than that of SDGC in MESO samples. We hypothesized that in normal semen samples, sperm aggregate into a pellet during centrifugation, enabling efficient enrichment by SDGC. In MESO, where sperm count is extremely low, sperm fail to form a pellet, leading to slower sedimentation and lower recovery rates with SDGC, thereby necessitating additional centrifugation. Importantly, sperm prepared by DDGC from MESO semen samples showed comparable in vitro and in vivo embryo developmental parameters to sperm prepared by SDGC. Interestingly, the DDGC group showed a significantly higher usable blastocyst formation rate compared to SDGC group (73.48% vs. 62.63%, p = 0.009).
In conclusion, DDGC can effectively enrich sperm from MESO samples, and no obvious adverse clinical outcomes were observed. The method is simple, requires no additional equipment, and may be considered as a routine sperm preparation technique for MESO in clinical use. However, the long-term safety of using DDGC for sperm preparation from MESO for ICSI still requires further confirmation, and more effective methods for sperm enrichment from MESO are needed.