This meta-analysis aimed to comprehensively assess the relationship between serum vascular endothelial growth factor (VEGF) levels and the prognosis of ovarian cancer. Recently, VEGF has been widely recognized as an important biomarker in tumorigenesis and development. Thus, this study aimed to clarify this association to provide evidence for clinical practice.

A comprehensive literature search was conducted in PubMed, Wiley Library, Web of Science, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI) databases from inception to June 30, 2024. A total of 2767 records were initially identified and screened; 9 studies met the inclusion criteria and were included in the meta-analysis. Data were analyzed using RevMan 5.3 and R 4.4.2 software. The quality of the included studies was assessed according to predetermined criteria.

This meta-analysis revealed that serum VEGF levels were significantly higher in ovarian cancer patients than in the normal control group (mean difference [MD] = 210.00; 95% confidence interval [CI]: 96.92–323.09). In addition, serum levels of VEGF were significantly higher in patients with advanced ovarian cancer compared with those with early-stage ovarian cancer (MD = –173.88, 95% CI: –290.28 to –57.49). Analysis of serum VEGF levels before and after surgical treatment showed a significant decrease after surgery (MD = 242.92, 95% CI: 154.66–331.17). Prognostic analysis showed a significant association between serum VEGF levels and overall survival (OS) (hazard ratio (HR) = 2.48, 95% CI: 1.84–3.34). However, the association with disease-free survival (DFS) was not statistically significant (HR = 1.29, 95% CI: 0.87–1.93).

This meta-analysis demonstrates that elevated serum VEGF levels are associated with ovarian cancer progression and reduced overall survival. Although no significant association with DFS was found, serum VEGF levels remain a potential predictive biomarker worthy of further investigation. Future large-scale prospective studies are needed to confirm the clinical utility of serum VEGF in the management of ovarian cancer.

The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251090777; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251090777).

This study aimed to investigate the causal relationship between educational attainment and stress urinary incontinence (SUI) using Mendelian randomization (MR) analysis, as well as to explore the potential mediating roles of body mass index (BMI), chronic obstructive pulmonary disease (COPD), and insulin-treated diabetes.

Genome-wide association studies (GWAS) data for educational attainment levels were obtained from the Social Science Genetic Association Consortium (SSGAC); SUI data were sourced from the Integrative Epidemiology Unit Open GWAS Project (IEU OpenGWAS project); and data for BMI, COPD and insulin-treated diabetes were obtained from the FinnGen database. The inverse variance weighted (IVW) method was used as the primary analytical approach to investigate causal relationships. Sensitivity analyses, including heterogeneity tests, pleiotropy tests, funnel plot, and leave-one-out sensitivity analysis, were conducted to assess the robustness of the results.

A causal relationship was observed between higher educational attainment and a reduced risk of SUI (odds ratio [OR] = 0.995, 95% CI: 0.993–0.996, p = 1.851 × 10^-10). Besides, higher educational attainment was associated with lower BMI (OR = 0.817, 95% CI: 0.792–0.843, p = 4.825 × 10^-37) and diabetes (OR = 0.661, 95% CI: 0.615–0.709, p = 2.266 × 10^-30). Genetically predicted higher BMI (OR = 1.002, 95% CI: 1.000–1.003, p = 0.048) and insulin-treated diabetes (OR = 1.001, 95% CI: 1.000–1.002, p = 0.012) were associated with an increased risk of SUI. Sensitivity analyses confirmed the robustness of the findings. Mediation analyses showed that BMI (8.08%, p = 0.048) and insulin-treated diabetes (7.47%, p = 0.004) partially mediated the protective effect of higher educational attainment on SUI risk.

Improving educational attainment levels may reduce the risk of SUI. Furthermore, BMI and insulin-treated diabetes partially mediate the protective effect of higher educational attainment on SUI risk.

The incidence of macrosomia is rising worldwide. This study aimed to investigate the epidemiological characteristics and risk factors of macrosomia in a specific region of China. In addition, we evaluated the impact of gestational diabetes mellitus (GDM) interventions among outpatients.

This retrospective study included 6803 singleton term live births at People’s Hospital of Fuyang from July 1, 2023 to June 30, 2024. Participants were categorized into a macrosomia group and a non-macrosomia group. GDM cases, were further divided into an intervention group, which received outpatient GDM management and a control group (standard care). Key indicators included macrosomia-related measures (neonatal birth weight and maternal and fetal parameters), GDM related measures and epidemiological indices. The statistical methods we employed include the Mann-Whitney U Test, the χ² test or Fisher’s exact test, as appropriate. Logistic regression (univariate and multivariate) was utilized to calculate the odds ratio and confidence interval for macrosomia risk. Receiver operating characteristic (ROC) analysis, using Youden’s index and 70%/30% training/validation split was used to determine the optimal cut-off values.

The incidence of macrosomia in this hospital was 7.29% (496/6803), while the incidence of GDM was 7.11% (484/6803). Except for maternal age, all other demographic characteristics were significantly higher in the macrosomia group compared to the non-macrosomia group, including pre-pregnancy weight, pre-delivery weight, and abdominal circumference (AC) (p < 0.05). After adjusting for confounding factors, logistic regression analysis identified pre-delivery weight, history of macrosomia, biparietal diameter (BPD), AC and GDM as independent risk factors for macrosomia (p < 0.05). Especially the occupation and GDM may be independent risk factors (OR > 1). Intervention through a GDM outpatient clinic resulted in significantly lower pre-delivery weight and reduced weight gain during pregnancy compared to the control group (p < 0.05). Following adjustment for confounding factors, multivariate analysis found that structured intervention in the GDM outpatient clinic significantly reduced the risk of macrosomia (p = 0.002).

Pregnant women in this region of China exhibit a high incidence of overweight and macrosomia. Pre-pregnancy weight, pre-delivery weight, pre-pregnancy BMI, and weight gain during pregnancy identified as independent risk factors for macrosomia. Each of these factors can be controlled. Intervention through GDM outpatient clinics can promote healthier eating habits and significantly reduce the incidence of macrosomia, weight gain during pregnancy, and the excessive weight gain during pregnancy.

This meta-analysis aimed to evaluate the association between maternal smoking during pregnancy and the risk of Attention-Deficit/Hyperactivity Disorder (ADHD) in offspring. This association is complex and may be influenced by genetic confounding, as individuals with ADHD are at higher risk of engaging in smoking behaviors.

The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched to identify relevant literature. Prospective cohort studies that met the inclusion criteria entered the data extraction process. Selected data for analysis included risk estimates in form of odds ratios (ORs), hazard ratios (HRs), or risk ratios (RRs), along with 95% CIs. Sensitivity and bias analysis were also performed.

A total of 14 prospective cohorts comprising 1,763,268 participants were eligible for the analysis. Smoking during pregnancy was associated with an increased risk ADHD in the offspring (pooled RR = 1.55 [95% CI: 1.25–1.86], p < 0.001). This association decreased slightly after subgroup analysis based on adjustment for maternal ADHD (RR = 1.47 [95% CI: 1.08–2.01], p < 0.001). This observation was replicated after adjustment for study location, maternal age, alcohol consumption, maternal socioeconomic status, and ADHD history.

Based on the evidence presented in this systematic review and meta-analysis, maternal smoking during pregnancy is associated with an increased risk of ADHD in offspring. Therefore, pregnant women should be encouraged to quit smoking and to avoid exposure to tobacco smoke.

The study has been registered on https://www.crd.york.ac.uk/PROSPERO/search (registration number: CRD420251274456; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251274456).

First primary breast cancer (FPBC) and second primary breast cancer (SPBC) differ in clinical presentation, pathological features, molecular subtypes, and prognosis. This study compared the incidence, clinical characteristics, and survival outcomes of FPBC and SPBC from 2010 to 2021 using the Surveillance, Epidemiology, and End Results (SEER) database, and analyzed the impact of different treatment regimens on survival across patient subgroups.

A total of 595,903 FPBC patients and 31,055 SPBC patients from the SEER database (2010–2021) were included in this study. The analysis focused on the incidence rates, demographic characteristics, and survival-related factors for both FPBC and SPBC. Additionally, the impact of different treatment regimens on survival was also evaluated.

Between 2010 and 2021, the incidence of SPBC showed a consistent increase, whereas the incidence of FPBC remained relatively stable, showing no significant upward or downward trend. SPBC patients exhibited a significantly worse survival prognosis compared with FPBC patients. Multivariate analysis identified age, race, marital status, year of diagnosis, tumor location, laterality, grade, SEER stage, histologic type, breast subtype, chemotherapy, surgery, radiation, and combination therapy as independent prognostic factors influencing long-term survival. The study also compared the impact of different treatment strategies on survival among FPBC and SPBC patients with varying clinical and demographic characteristics.

This study demonstrates that SPBC patients have a significantly worse survival prognosis compared with FPBC patients. The poorer prognosis of SPBC is closely associated with pathological features, suboptimal treatment response, and the site of the prior primary cancer.

Caroli disease is a rare ductal plate malformation. While most polycystic kidney and hepatic disease 1 (PKHD1)-related biliary phenotypes arise from compound-heterozygous variants, the prenatal implications of homozygous variants remain unclear. Reporting the first prenatal diagnosis linked to a homozygous PKHD1 variant, along with the diagnostic workflow, has direct implications for genetic counseling and recurrence prevention strategies.

A 25-year-old woman, gravida 2, presented with isolated fetal intrahepatic bile duct dilatation at 22⁺⁵ weeks of gestation. Ultrasound showed arborizing, avascular tubular channels; and fetal magnetic resonance imaging (MRI) confirmed diffuse intrahepatic involvement with normal renal anatomy. Karyotype analysis and chromosomal microarray were normal. Trio-exome sequencing identified a homozygous PKHD1 c.2507T>C (p.Val836Ala) variant, and Sanger sequencing confirmed parental heterozygosity. Interval surveillance documented enlargement to 47 × 37 × 24 mm. Following multidisciplinary counseling, the pregnancy was electively terminated, and no autopsy was performed. The early, isolated hepatobiliary presentation contrasts with previously reported compound-heterozygous cases.

Combined ultrasound, fetal MRI, and trio-exome sequencing established an etiologic prenatal diagnosis and refined the differential diagnosis from choledochal cyst and cystic biliary atresia. The homozygous c.2507T>C variant likely confers a dosage-dependent, more severe fetal phenotype, thereby expanding the PKHD1-associated spectrum and strengthening genotype–phenotype correlations. These findings provide direct clinical utility and educational value by highlighting key imaging features, outlining a stepwise genomic diagnostic workflow, and emphasizing the utility of preimplantation genetic testing to prevent recurrence.

Multiparametric magnetic resonance imaging (mpMRI), including dynamic contrast-enhanced (DCE) imaging, can assess deep myometrial invasion (DMI) and cervical stromal invasion (CSI) in endometrial cancer (EC). However, the need for gadolinium injection increases potential risks. Thus, whether comparable diagnostic performance can be achieved without gadolinium becomes a critical clinical question.

We retrospectively analyzed 138 patients with EC from the first hospital of Putian City. T2-weighted imaging (T2WI) was combined with diffusion-weighted imaging (DWI) and DCE to form the T2&DWI and T2&DCE groups, respectively. Two senior radiologists independently evaluated each image set according to standardized criteria and were blinded to the pathology. A case was categorized as positive if either DMI or CSI was identified on any sequence within the image set. A more senior radiologist resolved any discrepancies. Two additional combinations were formed to generate a high-sensitivity group and a high-specificity group for secondary analysis. The diagnostic performance of the four image sets was evaluated using postoperative pathology as the reference standard.

Among all cases, 31 had DMI, and 12 had CSI. Agreement between the two readers for the same sequence combination and between sequence combinations for the same reader was high. For DMI, the sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) analysis for the area under curve (AUC) were as follows: T2&DWI group, 0.806, 0.935, 0.906, and 0.871; T2&DCE group, 0.710, 0.935, 0.884, and 0.822; high-sensitivity group, 0.839, 0.916, 0.899, and 0.877; high-specificity group, 0.774, 0.944, 0.906, and 0.811. For CSI, the corresponding results were: T2&DWI group, 0.833, 0.984, 0.971, and 0.909; T2&DCE group, 0.917, 0.984, 0.978, and 0.950; high-sensitivity group, 0.917, 0.976, 0.971, and 0.946; high-specificity group, 0.833, 0.992, 0.978, and 0.913. DeLong’s pairwise comparisons showed no statistically significant differences (p > 0.05), with the Holm correction for multiple comparisons yielding consistent results. The McNemar test for paired comparisons among the four sequence combinations also revealed no significant differences between the groups.

The T2&DWI group demonstrated diagnostic performance comparable to that of the other groups to evaluate DMI and CSI, with no statistically significant differences, suggesting it may serve as a non-contrast alternative to mpMRI with DCE in specific clinical settings.

Fetal growth restriction (FGR) is a common pregnancy complication and a major contributor to increased perinatal morbidity and mortality. Our previous studies have shown that the mannose-6-phosphate receptor (M6PR) is significantly upregulated in the placenta of cases of selective FGR (sFGR). This study aimed to evaluate the M6PR levels in maternal serum during pregnancy as a novel biomarker for predicting FGR and its subtypes.

From an established prospective pregnancy cohort, we selected 256 singleton pregnancies with FGR and 233 matched controls for analysis. Serum samples collected during gestation were analyzed for M6PR levels using MILLIPLEX® human cytokine magnetic bead panels. Receiver operating characteristic (ROC) analysis assessed the predictive value of M6PR.

The log₁₀ multiples of the median (MoM) of M6PR were significantly lower in the FGR group than in the control group during the third trimester, with an area under the ROC curve (AUC) of 0.736. When FGR was divided into early-onset and late-onset groups in the third trimester, the log₁₀ MoM of M6PR was significantly lower in the early-onset FGR group compared to the control group, with an AUC of 0.723. Similarly, the log₁₀ MoM of M6PR was significantly lower in the late-onset FGR group than in the control group, with an AUC of 0.645.

M6PR concentrations declined significantly during the third trimester, suggesting that M6PR may serve as a novel biomarker for predicting FGR. Integrating M6PR with existing biomarkers has been shown to enhance overall predictive accuracy, supporting timely clinical interventions.

To provide an updated synthesis of the current knowledge on the epidemiology, pathophysiology, genetic basis, diagnostic strategies, and management of recurrent hydatidiform mole (RHM), incorporating recent molecular and clinical findings.

We conducted a narrative review of peer-reviewed literature, focusing on genetic, epigenetic, molecular, and clinical studies addressing the pathogenesis, diagnostic strategies, and clinical management of RHM.

Mutations in maternal-effect genes, primarily nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain-containing 7 (NLRP7) and KH domain-containing 3-like (KHDC3L), account most familial cases, while other subcortical maternal complex (SCMC) genes, including peptidyl arginine deiminase 6 (PADI6), nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain-containing 5 (NLRP5), transducin-like enhancer of split 6 (TLE6), zygote arrest 1 (ZAR1), and oocyte-expressed protein (OOEP), have also been implicated. Histological features, such as villous edema, circumferential trophoblastic hyperplasia, and the presence or absence of embryonic or fetal tissue, remain crucial in diagnosis, complemented by p57 immunohistochemistry (IHC) and short tandem repeat (STR) genotyping. Although many cases can be explained by genetic mutations, others may result from epimutations, mosaicism, or polygenic inheritance. Reproductive counseling now incorporates molecular diagnostics. While in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) or preimplantation genetic testing (PGT) may reduce recurrence risk, donor oocytes remain the only definitive option for women with confirmed mutations.

RHM represents a unique model of imprinting disorders in which defective oocyte biology leads to abnormal conceptions. Integration of molecular diagnostics with clinical management offers a precision medicine approach, while future research may identify new avenues for prevention and targeted interventions.

Progesterone elevation (PE), defined as ≥0.9 ng/mL on the day of human chorionic gonadotropin (hCG) administration, is associated with significantly lower clinical pregnancy rates following fresh embryo transfer. To mitigate the risk of PE, this study aimed to develop and validate a nomogram for predict its occurrence prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles, based on baseline patient characteristics.

This retrospective study analyzed data from patients who underwent controlled ovarian stimulation using either a gonadotropin-releasing hormone (GnRH) antagonist or agonist protocol at the Reproductive Center of Changzhou Maternal and Child Health Care Hospital between January 1, 2017, and December 31, 2019. Patients were excluded for reasons such as advanced maternal age, male factor infertility, or known chromosomal abnormalities. The cohort was randomly divided into a training set (n = 1882) and a validation set (n = 807) at a 7:3 ratio to develop and validate the nomogram, respectively.

Multivariate logistic regression analysis identified the ovulation induction protocol, basal progesterone level, and body mass index (BMI) as independent predictors of PE. The resulting nomogram demonstrated good calibration and discrimination, with an area under the curve (AUC) of 0.734 (95% confidence interval [CI]: 0.713–0.754) in the training cohort and 0.732 (95% CI: 0.700–0.763) in the validation cohort. Furthermore, decision curve analysis confirmed the model’s strong clinical utility.

We developed a user-friendly nomogram incorporating the ovulation induction protocol, basal progesterone, and BMI to predict the risk of PE on the day of hCG administration. This tool provides clinicians a simple, evidence-based method to identify high-risk patients before starting their IVF/ICSI cycles, potentially enabling proactive interventions to improve pregnancy outcomes.

Cesarean section (CS) is a key obstetric surgery, postoperative wound, uterine incision, and pelvic infections are relatively common, so clinicians must pay close attention to the prevention and early detection of surgical site infections. To investigate the risk factors and management strategies for severe uterine incision infections with pelvic abscesses following CS.

We conducted a retrospective study of CS cases performed at our hospital from January 2018 to December 2023. The observation group included 27 patients who developed severe uterine incision infections and pelvic abscesses postoperatively. Each case was matched with 3 controls (total number = 108) who did not develop these complications, selected from the same source population during the study period.

Univariate logistic regression analysis demonstrated a statistically significant difference in the incidence of chorioamnionitis, premature rupture of membranes, and preterm delivery between the two groups (p < 0.05). Multivariate stepwise logistic regression further identified preterm delivery (odds ratio [OR] = 4.084, 95% confidence interval [CI] = 1.261–13.224) and chorioamnionitis (OR = 4.388, 95% CI = 1.370–14.058) as independent risk factors for severe pelvic abscess.

Chorioamnionitis and preterm delivery are independent risk factors for severe uterine incision infection with pelvic abscess following CS, underscoring the need for heightened perioperative vigilance and targeted preventive strategies in at-risk patients.

Gestational diabetes mellitus (GDM) elevates the risk of neonatal respiratory distress syndrome (NRDS), highlighting the need for robust predictive tools. Current assessments of fetal lung maturity assessments are invasive, creating a clinical demand for non-invasive alternatives. This study presents a dual-parameter framework that combines artificial intelligence (AI)-derived fetal lung texture signatures with uterine artery pulsatility index (PI) to predict NRDS risk in GDM pregnancies.

A prospective cohort of 50 patients with GDM patients was enrolled. Standardized four-chamber view ultrasound images were processed using a TensorFlow-based framework to extract 342 gray-level co-occurrence matrix (GLCM) texture features from the fetal lungs. A support vector machine (SVM) classifier was then employed for NRDS risk stratification. Concurrently, uterine artery PI was measured transvaginally following International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. The predictive performance of the AI model, uterine artery PI, and their combination was evaluated for predicting NRDS.

The uterine artery PI was significantly elevated in the NRDS group (n = 22) compared with controls (n = 28) (median 1.52 [interquartile range, IQR: 1.35–1.70] vs. 1.16 [IQR: 0.95–1.30]; p < 0.001). The standalone AI-based pulmonary texture analysis achieved 86.4% sensitivity and 78.6% specificity for NRDS prediction, with substantial agreement with clinical diagnosis (κ = 0.67). The synergistic integration of an AI-based high-risk classification with a uterine artery PI ≥1.28 yielded superior predictive performance, attaining 92.0% overall accuracy (46/50). Decision curve analysis confirmed that the combined model provided a superior net benefit across clinically relevant threshold probabilities (10%–50%).

The integration of AI-quantified fetal lung texture analysis with uterine artery Doppler hemodynamics provides a refined, non-invasive tool for NRDS risk stratification in pregnancies complicated by GDM. This dual-pathway framework effectively captures the interplay between placental vascular insufficiency and pulmonary immaturity, offering high diagnostic accuracy and clinical utility to guide perinatal management decisions.

Adenomyosis involves epithelial-mesenchymal transition (EMT), yet the role of mitochondrial regulator Mitofusin 2 (Mfn2) remains unclear. This study investigated the role of Mfn2 in adenomyosis-related EMT and evaluated its potential as a therapeutic target.

Mfn2 expression was compared between human adenomyotic and normal endometrial tissues using immunohistochemistry. Transforming growth factor-beta 1 (TGF-β1)-induced EMT was established in Ishikawa cells, and Mfn2 was overexpressed to assess EMT markers using quantitative polymerase chain reaction (qPCR) and Western blot, as well as cell migration and invasion (via scratch and Transwell assays). A neonatal mouse model of tamoxifen-induced adenomyosis received intrauterine lentiviral Mfn2 overexpression. Uterine morphology, fibrosis, and EMT markers were evaluated after 20 days.

Mfn2 was significantly downregulated in adenomyosis (p < 0.05). Overexpression of Mfn2 reversed EMT, evidenced by increased E-cadherin and decreased N-cadherin and Vimentin (p < 0.05), suppressed cell migration and invasion in vitro (p < 0.05), improved uterine morphology (p < 0.05), reduced fibrosis (p < 0.05), and inhibited EMT in vivo.

Mfn2 suppresses EMT in adenomyosis, suggesting its protective role and potential as a therapeutic target.

Endometrial cancer (EC) is the second most common gynecological malignancy and remains a major contributor to morbidity and mortality among women worldwide. Current diagnostic and prognostic tools have limited accuracy, highlighting the need for reliable, non-invasive biomarkers. Non-coding RNAs (ncRNAs), including long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), have emerged as promising candidates. This study aimed to investigate serum lncRNA HOXA transcript antisense RNA myeloid-specific 1 (HOTAIRM1) and miR-182-5p expression levels in EC and evaluate their diagnostic value and association with clinicopathological features.

This prospective cohort study analyzed serum samples that were prospectively collected from 73 women with histologically confirmed EC and 76 controls with non-malignant gynecological conditions. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to quantify serum lncRNA HOTAIRM1 and miR-182-5p expression levels. Associations with clinicopathological parameters and diagnostic performance were evaluated.

Serum expression levels of lncRNA HOTAIRM1 were significantly higher in EC patients (median [interquartile range (IQR)]: 1.36 [0.74–3.37]) than in controls (1.03 [0.58–2.03]; p = 0.043), whereas miR-182-5p levels showed no significant difference (p = 0.327). Receiver operating characteristic (ROC) curve analysis demonstrated that serum lncRNA HOTAIRM1 had high specificity (93.2%) but low sensitivity (29.6%) for EC diagnosis. No significant associations were identified between either biomarker or clinicopathological variables (p > 0.05).

This study provides one of the first evaluations of circulating lncRNA HOTAIRM1 and miR-182-5p in serum samples from patients with EC. Our findings suggest that serum lncRNA HOTAIRM1, but not miR-182-5p, may serve as a potential non-invasive biomarker for EC. Although its limited sensitivity restricts its role as a standalone diagnostic tool, its high specificity supports potential clinical relevance. These preliminary results should be interpreted with caution, as they represent an initial exploratory analysis of circulating lncRNA HOTAIRM1 and miR-182-5p in EC.

The coronavirus disease-2019 (COVID-19) epidemic has emerged as a significant threat to global maternal health, especially with the increasing risk of serious consequences among a vulnerable population, including admission to the intensive care unit (ICU). Therefore, understanding the nature of outcomes in various populations is crucial for developing effective healthcare strategies. Thus, this study aimed to investigate the epidemiology, risk factors, and acute and long-term outcomes of COVID-19 among pregnant women in Bisha Province, Saudi Arabia. Our specific focus was on the determinants of ICU admission to ensure a thorough understanding of the impact of the disease.

This cohort study was conducted at King Abdalla Hospital from February 2020 to January 2023. This study included 88 pregnant women with COVID-19 admitted to the ICU (cases) and 120 pregnant women with COVID-19 not admitted to the ICU (controls). Electronic medical records (EMRs) were extracted for sociological, maternity, and clinical characteristics, as well as the results. A multivariable logistic regression model was used to identify independent risk factors for ICU admission and adverse outcomes.

This indicated that advanced maternal age [>35 years; odds ratios (ORs) = 2.5; p < 0.003], third-trimester gestation (ORs = 3.1; p < 0.010), low income (ORs = 2.9; p < 0.010), pre-existing hypertension (ORs = 4.8; p < 0.010), and lower educational level (ORs = 3.6; p < 0.010) were significant independent predictors of ICU admission. Furthermore, survivors of ICU admission experienced 2.5 to 3.2 times greater persistence of cardiovascular, respiratory, neurological, and mental health symptoms at 12 months post-infection compared to non-ICU patients.

This research has revealed a convergence of clinical and socioeconomic factors that significantly increases the likelihood of severe COVID-19 during pregnancy. The significant long-term morbidity among ICU survivors highlights the essential requirement for a comprehensive strategy. These findings can specifically help reduce risk for targeted delivery, improve healthcare access, particularly in post-COVID recovery clinics, and increase outcomes for this risk population in future epidemic responses.

Maternal ambivalence—conflicting emotions toward motherhood—can affect psychological well-being; however, the longitudinal course of maternal ambivalence remains poorly understood.

A three-wave study included 1242 Spanish women who completed the Maternal Ambivalence Scale at baseline (T1), with follow-ups at 3 months (T2, n = 182) and ~3 years (T3, n = 23). Doubts, rejection, and suppression comprised the assessed dimensions. Linear mixed-effects models (LMMs), adjusted for age, parity, education, and perinatal status, were used to examine changes over time, complemented by repeated-measures analysis of variance (RM-ANOVA). Attrition bias was evaluated via Little’s Missing Completely at Random (MCAR) test, logistic regression, and inverse-probability weighting.

Short-term changes (T1–T2) were negligible across subscales (|β| ≤ 0.07; g = –0.03 to 0.09; partial η² = 0.003–0.015). Rank-order stability was high for doubts (r = 0.78) and rejection (r = 0.83), moderate for suppression (r = 0.67). Long-term trajectories suggested stable doubts and rejection, whereas suppression increased moderately [β = 0.16, 95% CI (0.14, 0.19); p < 0.001]. Given the extremely low T3 retention (n = 23), these findings are exploratory; negative rank-order correlations suggest potential reversals or selective retention.

Findings underscore the importance of longitudinal assessment and interventions promoting adaptive emotional expression.

The selection of an optimal thawing and transfer strategy is a critical determinant of success in frozen embryo transfer (FET) cycles. To investigate the optimal FET strategy, this study analyzed the effects of extended culture duration after warming on clinical outcomes following embryo transfer.

We retrospectively analyzed 9981 FET cycles following either an unsuccessful fresh embryo transfer or cycle cancellation. In these cycles, embryos were warmed and transferred on varying days, spanning from Day 2 to Day 5. We compared baseline characteristics, thawing recovery, and embryo development across groups. Additionally, we performed regression analyses to examine the relationship between clinical outcomes and in vitro culture conditions.

The post-warming embryo survival rate was 98.60%, with an available embryo rate of 86.88%. For warmed Day 2 embryos, extending culture to Day 3 was significantly associated with higher clinical pregnancy and live birth rates. Similarly, Day 3 warmed embryos cultured to Day 4 or Day 5 were associated with better outcomes compared with Day 3 transfer. However, there was no significant difference between transferring embryos on Day 4 or Day 5 after warming on Day 4. Likewise, no significant differences were observed when all embryos were cultured to Day 5, regardless of the initial warming day.

Tailoring FET strategies with an optimized post-warming culture duration is associated with improved clinical outcomes in assisted reproductive technology. Direct transfer of frozen-warmed blastocysts yielded similar success rates to those undergoing extended culture to the blastocyst stage.

This study aimed to analyze the clinical and ultrasonographic features of 6 pathologically confirmed cases of uterine inflammatory myofibroblastic tumors (UIMT) and to enhance clinicians’ ability to achieve timely diagnosis and treatment.

This retrospective case series included 6 patients with pathologically confirmed UIMT who were admitted to our hospital between January 2019 and January 2025. Clinical, ultrasonographic, and pathological data were collected and analyzed retrospectively.

All 6 tumors were solid and originated from the myometrium. 3 were confined to the myometrium, 2 extended toward the submucosa, and 1 toward the subserosa. 5 lesions were hypoechoic and 1 was hyperechoic, all showing heterogeneous internal echoes and a characteristic “blurred halo sign”. The median maximum diameter was 6.9 cm. Color Doppler flow imaging (CDFI) showed an Adler grade ≥2, demonstrating a “colorful mosaic sign”. During follow-up, 2 lesions increased in size by 1 cm and 2 cm, respectively, within 2–4 months. No extrauterine metastasis was observed. All cases were positive for anaplastic lymphoma kinase (ALK), as confirmed by fluorescence in situ hybridization (FISH). All patients underwent surgical treatment, including 1 total hysterectomy and 5 local resections. No recurrence or metastasis was observed during 21–57 months of follow-up.

UIMT exhibits characteristic sonographic features, including solid masses with heterogeneous internal echoes (“blurred halo sign”) and abundant blood flow signals (“colorful mosaic sign”). Recognizing these distinctive imaging patterns is critical for improving diagnostic accuracy and guiding appropriate clinical management.

This research sought to examine alterations in plasma circular RNA (circRNA) expression in women with postpartum depression (PPD), assessing its potential utility as an auxiliary diagnostic biomarker for this condition.

Women examined at 42 days postpartum were recruited between June 2024 and December 2024, during which plasma samples and relevant data were collected. A discovery cohort was established, consisting of 3 women with PPD and 3 control participants. This was followed by a validation cohort of 50 women with PPD and 50 controls, identified using the Structured Clinical Interview. The discovery cohort underwent plasma circRNA microarray analysis, whereas the validation cohort used reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to quantify candidate circRNAs and five circRNAs previously associated with major depressive disorder (MDD).

Plasma levels of circRNA derived from the Interferon Gamma Receptor 2 gene (circIFNGR2), circRNA derived from the ATP-Binding Cassette Subfamily C Member 5 gene (circABCC5), circRNA derived from the Activating Transcription Factor 7 Interacting Protein gene (circATF7IP) were significantly upregulated in the PPD group, whereas circRNA derived from the Dystrophia Myotonica Protein Kinase gene (circDYM) was significantly downregulated (p < 0.05). The area under the curve (AUC) of the four circRNAs, circIFNGR2, circABCC5, circDYM, and circATF7IP, was 0.62 (sensitivity 28%, specificity 96%), 0.64 (sensitivity 36%, specificity 96%), 0.69 (sensitivity 54%, specificity 84%), and 0.65 (sensitivity 62%, specificity 72%), respectively. The joint AUC of circIFNGR2, circABCC5, circDYM, and circATF7IP was 0.80 (sensitivity 78%, specificity 70%). After adjustment for covariates, circIFNGR2, circABCC5, and circATF7IP remained independent predictive factors.

Changes in the levels of circIFNGR2, circABCC5 identified by microarray analysis, as well as circDYM, and circATF7IP associated with MDD, were associated with the occurrence of PPD. These findings support the potential utility of circRNAs as adjunct diagnostic biomarkers for PPD and offer valuable insights into the molecular mechanisms underlying the disorder.

The study has been registered on https://zenodo.org/ (registration number: zenodo. 17906223; registration link: https://zenodo.org/records/17906223).

Primary ovarian insufficiency (POI) is a heterogeneous disorder with multifactorial etiologies. Accurate diagnosis requires an integrated clinical, hormonal, and genetic evaluation, yet data from Pakistan are limited, and the burden of idiopathic and genetically predisposed cases remains largely unknown.

A total of 345 women under 40 years presenting with amenorrhea or menstrual irregularities were screened. After excluding pregnancy, cases not meeting the European Society of Human Reproduction and Embryology (ESHRE) diagnostic criteria, and incomplete records, 290 women were included. Comprehensive clinical, hormonal, and genetic investigations were performed according to ESHRE guidelines to determine underlying etiologies.

The mean age at presentation was 33 ± 4.5 years, with a median symptom duration of 6 months. The mean age at menarche was 13 ± 1 years, and the mean body mass index (BMI) was 24.5 ± 3.4 kg/m². Most women presented with amenorrhea (80%) or oligomenorrhea (20%). Secondary infertility was reported in 72.8% and primary infertility in 2.4%. A history of miscarriage was documented in 5.9% of participants. Common clinical features included hot flushes (75.9%), depression (72.4%), high stress (65.5%), mood changes (62.1%), vaginal dryness or dyspareunia (55.2%), and night sweats (54.5%). Coexisting comorbidities were observed in 12.4%, most frequently migraines (4.1%). Hormonal evaluation confirmed elevated follicle-stimulating hormone (FSH) levels (>25 IU/L) and low estradiol (<50 pg/mL) in all participants. Etiological classification identified iatrogenic causes in 7.2%, genetic causes in 3.8% (confirmed in women with suggestive genetic features or isolated POI), autoimmune causes in 6.6%, and idiopathic POI in 82.4%. Statistically significant differences in confirmed diagnoses were observed among most etiological groups (p < 0.0001), except for women with features suggestive of a genetic cause (p ≈ 0.8500).

POI presents with diverse clinical features. Evaluation based on ESHRE guidelines enables identification of iatrogenic, autoimmune, and genetic contributors, and highlights the high prevalence of idiopathic cases, which may have an underlying genetic predisposition.