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Ovarian cancer, one of the most lethal gynecological cancers, metastasizes into skin in 0.9%-5.8% of cases. Cutaneous metastases severely affect the quality of life of ovarian cancer patients. Although cutaneous metastases are rare, a therapeutic option for affected patients is needed. Herein, we present a combination therapy comprising radiation and mild hyperthermia with parallel chemotherapy as a treatment modality. A woman with extensive skin metastases of a high-grade, serous ovarian carcinoma on the thigh was treated with a combination of mild hyperthermia (39-43 °C) immediately followed by low-dose hypofractionated radiotherapy and parallel systemic treatment with carboplatin/gemcitabine. Mild hyperthermia, a strong radiosensitizer, was induced through water-filtered infrared A radiation (wIRA). The patient responded well and remained tumor free in the treatment area for more than 1 year. Radiotherapy combined with mild hyperthermia in addition to systemic treatment allows for tumor control in the treated area, even with a reduced total radiation dose. To the best of our knowledge, this is the first report of a long-term tumor-free situation in the treatment area of skin metastases of ovarian cancer. This novel treatment might also be beneficial for skin metastases from other malignancies.

The dissemination of robotic-assisted surgery (RAS) for benign gynaecological conditions may be delayed due to concerns about incremental system and instrument costs, without considering associated potential efficiencies and cost savings. This retrospective, single-centre study aims to analyse the feasibility, safety, and potential intraoperative financial savings of omitting the assisting physician (AP) and the fourth EndoWrist&#xa9;-arm (FEWA). Consecutive patients are enrolled and stratified in terms of the omission of AP and FEWA. Console time, cut-seam time, theatre-block time, complications, and the duration of hospitalisation are used to prove feasibility and safety. The personnel and material costs are calculated and interpreted via the InEK (Institut f&#xfc;r das Entgeltsystem im Krankenhaus) cost matrix of the Diagnosis-Related Group (DRG). The data of 55 consecutive women were analysed. No differences in terms of feasibility or safety were detected (all p values&#x2009;>&#x2009;0.05). Omitting the AP results in a significant staff cost reduction of &#x20ac;0.84 (19.1%) per operating room minute (p&#x2009;<&#x2009;0.001). These savings translate into a total amount of &#x20ac;79.12 per procedure (12.5% of personnel costs of &#x20ac;633.47 within the InEK). The omission of the FEWA saves &#x20ac;115.16 per procedure (23.04% of the material costs of &#x20ac;499.63 within the InEK). The omission of AP and FEWA in RAS for benign gynaecological conditions appears feasible without an immediately detectable signal of harm in this small cohort, justifying a larger prospective evaluation. The potential savings in terms of personnel and material costs represent a relevant portion of the provided amount within the InEK and should thereby facilitate the further dissemination of RAS in this field of gynaecology.

To examine associations between maternal-paternal racial pairings and adverse perinatal outcomes in the United States. We conducted a retrospective population-based cohort study using 2016-2023 U.S. birth certificate data from the CDC National Vital Statistics System. Singleton live births with complete data on maternal and paternal race were included. Parental race was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian, resulting in 16 racial dyads. Outcomes included preterm birth (PTB, <37 weeks), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and small for gestational age (SGA, <10th percentile). Adjusted relative risks (aRRs) were estimated using multivariable Poisson regression with robust error variance, adjusting for maternal age, body mass index, parity, insurance status, nativity, chronic hypertension, pregestational diabetes, smoking, and social vulnerability index. Of 26,284,090 births, 12,595,260 (47.9%) had White fathers, 9,147,469 (34.8%) Hispanic, 3,131,956 (11.9%) Black, and 1,409,405 (5.4%) Asian fathers. Compared to White fathers, PTB risk was higher with Black (aRRs 1.09-1.21) and Hispanic fathers (1.14-1.31), and lower among Asian fathers (0.84-0.93) regardless of maternal race. HDP risk was consistently lower among Asian (0.72-0.87) and Black fathers (0.86-0.93), while associations with Hispanic fathers were inconsistent. GDM risk was lower among Black fathers (0.87-0.94). For Hispanic fathers, GDM risk decreased among White and Black mothers but increased in Hispanic mothers. Asian fathers were associated with higher GDM risk compared to White fathers only among Asian mothers. SGA risk was higher for all non-White paternal groups, highest with Asian fathers (1.40-1.86). Conclusion Paternal race was associated with perinatal risk. Non-White paternal race was associated with higher risks of PTB and SGA, whereas risks of HDP and GDM varied according to the specific maternal-paternal racial pairing.

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This study explored the association between the composite dietary antioxidant index (CDAI) and cardiovascular-kidney-metabolic (CKM) progression in an older population. Using data from NHANES 2001-2020, we analyzed 4974 adults aged &#x2265;&#x2009;60&#x2009;years with CKM syndrome. The CDAI was calculated from the intake of six dietary antioxidants. Associations between the CDAI and its components and advanced CKM syndrome (Stages 3-4) were assessed using multivariable logistic regression, restricted cubic splines, piecewise logistic regression, and weighted quantile sum (WQS) regression. Participants in the highest CDAI quartile had lower odds of advanced CKM syndrome than those in the lowest quartile (OR&#x2009;=&#x2009;0.728, 95% CI: 0.594-0.893). Restricted cubic spline analysis showed an L-shaped association between CDAI and odds of advanced CKM syndrome, with an inflection point at 5.857; the inverse association was evident below this threshold and plateaued above it. Furthermore, the WQS regression model identified a protective combined effect of the six dietary antioxidants against advanced CKM syndrome, with vitamin A and vitamin C contributing the largest weights. Higher CDAI levels were associated with a lower risk of advanced CKM syndrome in older adults, with vitamins A and C emerging as the most influential components.

Occupational burnout threatens care quality, workforce retention, and physician health. Childbearing physicians in training are at high risk due to stigma, low workplace support, and physical challenges compounding role transitions and increased home responsibilities, yet evaluations of mitigation strategies remain scarce. To assess the efficacy of a parental support package targeting perinatal stressors in reducing burnout and distress among childbearing physicians in training. Pragmatic, randomized, controlled, parallel-group clinical trial. Pregnant (&#x2265;12 weeks' gestation) residents and fellows were enrolled across 7 training institutions in the northeastern US from May 2023 to July 2024. Nonbirthing parents were excluded. Follow-up concluded in May 2025. Participants were randomized 1:1, stratified by site and specialty type (procedural vs nonprocedural), to receive a parental support package (n&#x2009;=&#x2009;78) or usual support (n&#x2009;=&#x2009;78) from early pregnancy through 24 weeks post partum. The parental support package included a smart bassinet, wearable breast pump, virtual perinatal support, and formal faculty mentorship. The primary outcome was change in burnout (Stanford Professional Fulfillment Index; score range, 0-10; and the emotional exhaustion and interpersonal disengagement subscales), from enrollment during pregnancy to 24 weeks post partum. Secondary outcomes included changes in professional fulfillment, organizational and personal values alignment, relationship strain, career dissatisfaction, and sleep-related impairment. Mixed-effects models analyzed outcomes. Effect sizes were standardized using the Cohen d (0.2: small; 0.5: medium; 0.8: large). Of 156 randomized participants, 143 were included in the primary analysis (median age, 32 [IQR, 31-34] years; 71 in the parental support package group and 72 in the usual support group). From enrollment during pregnancy to 24 weeks post partum, mean burnout scores increased from 2.96 to 3.03 in the parental support package group and from 3.13 to 3.79 in the usual support group (adjusted between-group difference in change, -0.58; 95% CI, -1.10 to -0.07; P&#x2009;=&#x2009;.03; d&#x2009;=&#x2009;0.65). Differences were driven by interpersonal disengagement (adjusted between-group difference in change, -0.70; 95% CI, -1.24 to -0.15; P&#x2009;=&#x2009;.01; d&#x2009;=&#x2009;0.57). Emotional exhaustion scores were not statistically different between groups. Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout. ClinicalTrials.gov Identifier: NCT06014892.

We aimed to investigate associations between newborn metabolite concentrations and the development of early-life wheezing and asthma. Our goal was to advance understanding of pathways involved in childhood asthma pathogenesis and identify potential targets for disease prevention. Our study populations included children enrolled in two Environmental influences on Child Health Outcomes (ECHO) cohorts (INSPIRE, discovery; Healthy Start, replication) with linked newborn screening metabolic and outcome data (4-year recurrent wheeze and 5-year current asthma). We used elastic net penalized regression, followed by multivariable logistic regression, to determine metabolite-wheeze and metabolite-asthma associations. We secondarily assessed whether metabolite-asthma associations differed by asthma phenotype in the discovery cohort. Among 1554 INSPIRE children, the prevalence of recurrent wheeze and current asthma is 11% and 18%, respectively. Newborn concentrations of butyrylcarnitine + isobutyrylcarnitine (C4) and decenoylcarnitine (C10:1) are associated with recurrent wheeze (C4: aOR 0.75 [95% CI 0.59, 0.95]; C10:1: aOR 1.42 [95% CI 1.13, 1.78]), while linoleoylcarnitine (C18:2) and citrulline (CIT) are associated with current asthma (C18:2: aOR 1.20 [95% CI 1.02, 1.41]; CIT: aOR 0.74 [95% CI 0.58, 0.93]). The effect size and directionality of the association between C18:2 and childhood asthma is similar in Healthy Start (n&#x2009;=&#x2009;518), although the relationship is not statistically significant. C18:2 is additionally associated with increased odds of non-allergic asthma compared to no asthma in INSPIRE. These findings suggest biologic pathways that may be involved in childhood asthma pathogenesis and support investigation of the mechanisms underlying these relationships given the potential for targeted prevention strategies. Childhood asthma results in significant morbidity and costs, but prevention strategies remain elusive due to limited understanding of its underlying preventable causes. As the development of asthma is influenced by genetic and environmental factors, assessment of metabolic profiles reflects both and can improve our understanding of disease development. This study examines newborn metabolic profiles from two birth cohorts and finds links to early-life wheezing and asthma. Results highlight potential pathways for asthma development and may inform future prevention efforts.

Ovarian cancer is the deadliest gynecological malignancy, with platinum-based chemotherapy being the standard treatment. However, most patients develop resistance to platinum treatment, making it essential to evaluate chemotherapy sensitivity. Patient-derived ovarian cancer organoids (OCOs) from primary or metastatic tumor tissues and malignant effusions were validated by histopathological and molecular profiling. The correlation between organoid drug sensitivity test results and clinical outcomes was evaluated based on longitudinal follow-up data. An AI model integrating multimodal omics data and treatment trajectories was developed to predict platinum-sensitive versus resistant recurrence following therapy. Aldehyde Dehydrogenase 1 Family Member A1 (ALDH1A1) -related analysis identified genes associated with chemotherapy prognosis, and these findings informed AI-assisted high-throughput screening of candidate inhibitors, which were subsequently validated in cell lines and OCOs. A total of 191 patient-derived organoid models were generated from 123 ovarian cancer patients, including those from primary tumors, metastatic lesions, and malignant effusion. In vitro sensitivity testing with platinum-based chemotherapy agents was conducted with follow-ups. Organoids derived from primary tumors showed the highest predictive accuracy, followed by metastatic lesions, while ascites-derived organoids demonstrated lower predictive ability. Additionally, long-term organoid culture and chemotherapy resistance were strongly associated with tumor stem cell ALDH1A1 expression, then inhibitors against ALDH1A1 were screened and validated in ovarian cancer cells and organoids. Ovarian cancer organoid drug sensitivity testing represents a potential precision medicine tool for predicting platinum response in patients, which could serve as a preclinical model for drug screening and validation. ALDH1A1, a key molecular marker of cancer stem cells, presents a viable therapeutic target; its inhibitors demonstrate potential efficacy against platinum-resistant ovarian tumors.

To investigate associations of perinatal and lifestyle factors with alanine aminotransferase (ALT) levels as an early indicator of metabolic dysfunction-associated steatotic liver disease (MASLD). Data from the population-representative longitudinal PANIC study, conducted among Finnish schoolchildren (n=736), were utilized. Three visits during childhood included comprehensive assessments of metabolic biomarkers, body composition, and lifestyle factors. Perinatal data were obtained from registries and questionnaires. Altogether, 488 children were included in mid-childhood (ages 7-8), 421 in late childhood (9-11), and 255 in adolescence (15-17). The predefined primary outcome was plasma ALT level, used as a biomarker of early-stage MASLD. In mid-childhood and adolescence, significant associations (P <0.05) between the children's ALT were detected for pre-pregnancy hypertension (&#x3b2;=0.155-0.157). In late childhood, higher waist-to-height ratio and visceral adiposity by DXA became positively associated with ALT independent of body mass index standard deviation score (&#x3b2;=0.246-0.377). In adolescence, higher insulin levels and dyslipidemia (0.184-0.378) were positively associated with ALT. In late childhood, intake of protein, and animal and dairy products (&#x3b2;=0.121-0.184), and in adolescence, intake of protein and fish (&#x3b2;=0.154-0.280) were positively associated with ALT, and intake of vegetables, fruit and berries and fructose (&#x3b2;=-0.135 to -0.141) showed a negative association. In mid- and late childhood, levels of phenylalanine and branched-chain amino acids (&#x3b2;=0.131-0.248), and in adolescence, those of omega-3/6 (&#x3b2;=-0.103 to 0.198) and all fatty acids (&#x3b2;=0.197-0.228) were all positively associated with ALT. Sleep or measured physical activity were not associated with ALT. Several associations attenuated after multiple-testing correction for false discovery rate. Maternal hypertension, offspring intake of protein, animal and dairy products, levels of phenylalanine, branched-chain amino acids and fatty acids, and offspring cardiometabolic risk factors correlated with elevated ALT as an indicator of MASLD. The findings underscore the importance of pre- and post-natal influences and support early prevention, although caution is warranted as associations were modest and reduced after adjustment for false discovery rate.

Schistosomiasis presents a major public health problem for women and adolescent girls in endemic areas, particularly tropical and subtropical regions. Many sex-specific effects of schistosomiasis are due to Schistosoma haematobium, which primarily affects the genitourinary tract. Deposition of schistosome eggs in genital tissue causes female genital schistosomiasis (FGS), a chronic gynaecological condition that affects over 40 million women and girls. Women and girls living with FGS face intersecting challenges that compound its adverse effects. Disabling genital symptoms include pain, abnormal discharge, menstrual irregularities, and subfertility. These symptoms affect daily activities, impose financial burdens, and harm intimate relationships. Women and girls face stigma and isolation due to the similarity of FGS symptoms to sexually transmitted infections. Health systems in endemic areas are poorly equipped to consider, diagnose, and treat FGS, and women and girls are often excluded from schistosomiasis control strategies. Multifaceted approaches targeting schistosomiasis in women and girls are urgently needed.

Cancer treatments can deplete the ovarian follicle reserve causing infertility and early menopause, with subsequent decline in cardiovascular, cognitive, and overall health. Medical measures to prevent this chemotherapy-induced ovarian damage are currently not available. Anti-M&#xfc;llerian hormone (AMH) is important for preserving the ovarian follicle pool via downregulation of granulosa cell replication and function. Despite proven therapeutic ability to protect the ovarian follicle number in mice exposed to chemotherapy, AMH is not approved for human use. To overcome this gap, we created and patented a peptide designed to specifically bind to the AMH receptor, AMHR2 binding peptide (AMHR2BP), that could serve as an alternative therapeutic treatment. By activating the same downstream signaling and replicating the biological effects of natural AMH, we sought to investigate whether AMHR2BP could protect the follicle pool in both natural and accelerated ovarian aging mouse models. Here, we present a series of in vitro and in vivo translational studies to verify AMHR2BP's affinity, specificity, mechanism of action, stability, and in vivo toxicity and efficacy. We performed immunofluorescence, immunoprecipitation, real-time RT-PCR, mass spectrometry, histological, and immunohistochemistry testing to validate our findings on two levels, gene activation and protein translation. We found that AMHR2BP activates the same SMAD signaling pathways as AMH and ultimately preserves the ovarian follicle pool by preventing the progression of primordial to antral follicles in naturally aging mice. Additionally, we demonstrated that AMHR2BP prevents follicle loss in an accelerated, chemotherapy-induced ovarian aging model, thereby effectively preventing identifiable ovarian damage. Importantly, AMHR2BP also portrays excellent plasma stability with no detectable toxicity. By mimicking the function of AMH, AMHR2BP represents a new medical therapeutic strategy to preserve fertility and reduce long-term reproductive and health risks from chemotherapy treatments.

This cross-sectional study aims to screen for eating disorders and low energy availability, as well as identify associated factors among female trail runners. An online survey was used, collecting participants' sociodemographic data, trail running habits, medical indicators, and screening questionnaires for eating disorders (BEDA-Q) and low energy availability (LEAF-Q). A total of 276 female trail runners were included in the analysis. The mean age was 36.2 (&#xb1; 8.1) years and body mass index (BMI) was 22.0 (&#xb1; 2.5) kg/m2. They reported 6.2 (&#xb1; 5.0) years of trail running experience and 7.7 (&#xb1; 4.3) hours of training per week. Statistical analysis was conducted to analyse the frequency of positive screening based on the sociodemographic characteristics, trail running habits, and medical indicators. Multivariate logistic regression was used to analyse factors associated with a positive screening for eating disorders and low energy availability. A total of 53.6% participants had a positive BEDA-Q score (defined as a score&#x2009;&#x2265;&#x2009;0.27), screening positive for eating disorders. Independent risk factors associated with a positive screening for eating disorders were BMI above 24&#x2009;kg/m2 (p&#x2009;=&#x2009;0.001), high school education (p&#x2009;=&#x2009;0.049), doctoral degree (p&#x2009;=&#x2009;0.023) and a positive screening for depression (p&#x2009;<&#x2009;0.001). Overall, 55.1% participants had a positive LEAF-Q score (defined as a score&#x2009;&#x2265;&#x2009;8), indicating a risk of low energy availability. Associated factors were a decrease in libido (p&#x2009;=&#x2009;0.043) and a positive screening for depression (p&#x2009;=&#x2009;0.027). Trail running more than 3 years (p&#x2009;=&#x2009;0.020) was the only independent risk factor for low energy availability. The independent protective factors for low energy availability were BMI above 24&#x2009;kg/m2 (p&#x2009;=&#x2009;0.047) and doctoral degree (p&#x2009;=&#x2009;0.014). An association between eating disorders and low energy availability was also demonstrated. We present novel data on eating disorders and low energy availability in female trail runners. The elevated rates of these conditions highlight the importance of creating awareness, screening, and early interventions in this population.

To summarize the role of antenatal risk factors for infant cerebral palsy (CP) by un umbrella review. Pubmed, Cochrane list of trials, Medline and Google Scholar were searched for meta-analyses and systematic reviews, published between September 2009 and August 2025. In all the studies included, the diagnosis of CP was made according to standard definitions after a minimum of two-year follow-up (PROSPERO N.XXXXXXXXXX). Results from primary studies were re-analyzed with dedicated software (Metaumbrella). The AMSTAR 2 checklist was used to determine the level of confidence in the meta-analyses' findings. Evidence strength was stratified into five categories: convincing, highly suggestive, suggestive, weak, and non-significant. A total of 35 meta-analyses, 16 systematic reviews, and 261 primary investigations, predominantly from developed countries, were included. The analysis assessed 54 antenatal, pregnancy, and delivery-related risk and protective factors, identifying 43 significantly associated with infant CP. Key antenatal risk factors included pre-pregnancy obesity (eOR=1.36, 95% CI=1.28-1.45, convincing evidence), smoking during pregnancy (eOR=1.32, 95% CI=1.22-1.44, convincing evidence), and singleton pregnancies from assisted reproductive technology (suggestive evidence). Among delivery-related factors, prematurity was the strongest risk, with odds inversely correlated with gestational age. Infants born before 32 weeks had the highest risk (eOR=40.8, 95% CI=32.3-51.6, highly suggestive evidence). Risk progressively decreased for infants born at 32-33 weeks (eOR=14), 34-36 weeks (eOR=3.49), and 37-38 weeks (eOR=1.62). Additional significant risks included a male fetus, maternal age >39 or <20, preexisting diabetes, alcohol exposure, low socioeconomic status, consanguinity, infections, twin pregnancies, preeclampsia, very-low birthweight, congenital anomalies, emergency cesarean section, operative vaginal delivery, and abnormal placental pathology. Protective factors included a single course of corticosteroids in preterm pregnancies (eOR=0.70, 95% CI=0.61-0.79, convincing evidence) and magnesium sulfate prophylaxis in very preterm deliveries (eOR=0.56, 95% CI=0.40-0.78, weak evidence). Indicated preterm delivery, rather than spontaneous, was also associated with reduced CP risk. This analysis highlights the critical role of modifiable factors such as maternal obesity, smoking, alcohol use, and perinatal care in reducing the prevalence of CP. Prematurity remains a predominant risk, emphasizing the need for targeted prevention strategies.

In sub-Saharan Africa, adult women and adolescent girls face a high burden of genital tract co-infections, either by sexual or non-sexual transmission route. Distinguishing between these modes of transmission has important implications for diagnosis and treatment and is particularly relevant for community perceptions and associated stigma. Causative pathogens and parasites include a wide spectrum of organisms, including bacteria, viruses, fungi, protozoans, and helminths. Understanding shared risk factors, overlapping geographical distribution, and potential biological interactions between these infections is paramount for an integrated approach to prevention, management, and control of genital co-infections in African women. This Series paper assesses one of the most neglected and least understood genital infections, female genital schistosomiasis (FGS), mainly caused by the waterborne parasitic helminth Schistosoma haematobium. We explore current evidence on its interactions with other genital infections, including those acquired by sexual transmission (HIV and human papillomavirus) and non-sexual transmission (bacterial vaginosis and vulvovaginal candidiasis). We highlight the emerging role of zoonotic and hybrid Schistosoma species in FGS and consider their potential clinical implications. Opportunities to integrate FGS into broader sexual and reproductive health frameworks are explored within shared diagnostic tools and combined treatment strategies, with the ultimate goal of improving clinical care for affected women.

As a routine component of antenatal care, hemoglobin (Hb) testing can detect underlying abnormalities in pregnant women, thereby guiding clinical interventions. However, Hb concentration levels and trajectories during pregnancy and the association with preterm birth remain contentious owing to the unclear mechanisms involved. We aimed to evaluate the association between Hb concentration levels and preterm birth clinical subtypes in each trimester, and to assess the association between Hb trajectories and preterm birth clinical subtypes in pregnancy. This is a secondary analysis of a previously conducted cohort which is a retrospective, observational, multicenter study. The study included women with singleton live births between 28 and 45 gestational weeks from 2012 to 2021 who had undergone at least one Hb test before 37 weeks. Poisson regression with a robust variance estimator was used to estimate the association between preterm birth and Hb concentration levels measured at a given time. We included women from the overall sample who initiated antenatal care before 14 weeks and who had at least one Hb test in each trimester for analysis of their Hb trajectory. Multivariable logistic regression was used to estimate the association between preterm birth and Hb trajectories. Outcome measurements included preterm birth and clinical subtypes. We included 72,139 women in this analysis, the preterm rate, spontaneous preterm rate and iatrogenic preterm rate were 6.73%, 4.12% and 2.50% respectively. In relation to an Hb cutoff value of 110 g/L in the third trimester, a "L" shape of curve was observed in the association between spontaneous preterm and Hb concentration, and a "U" shape of curve was observed in the association between preterm, iatrogenic preterm and Hb concentration. 17,101 women were enrolled in the trajectory analysis. A constant high Hb concentration trajectory was associated with an increased risk of preterm and iatrogenic preterm (odds ratio with its 95% Confidence Interval, OR[95%CI] were 1.22[1.05,1.42] and 1.35[1.03,1.78] respectively), and a constant low Hb concentration trajectory was associated with an increased risk of spontaneous preterm (OR[95%CI], 1.30[1.03,1.64]). The association between preterm birth and both low and high Hb levels should not be ignored. Women with anemia in late pregnancy should be aware of iatrogenic and spontaneous preterm birth, and women with high Hb concentrations should be aware of iatrogenic preterm birth. Constantly high Hb level may warrant an alert for iatrogenic preterm birth, and constantly low Hb level may warrant an alert for spontaneous preterm birth.

Cardiovascular disease (CVD) is a leading and preventable cause of maternal mortality in low and middle-income countries (LMICs), yet most management guidelines rely on data from high-income countries. Robust, nationally representative data on pregnant women with heart disease (PWHD) are limited in India, underscoring the need for locally relevant evidence to guide clinical practice and policy. The National Pregnancy and Cardiac Disease Study in India (NPAC-India) is a multi-phase national initiative, and this paper describes the protocol for Phase 1, a prospective multicenter observational study initiated at 56 sites across India. All consecutive pregnant women presenting for antenatal care with known or newly diagnosed cardiovascular diseases, including congenital or acquired structural heart disease, cardiac arrhythmia, ischemic heart disease, aortopathies, or pulmonary vascular disease, will be enrolled from July 2024. Clinical details related to antenatal, intranatal, and postnatal care will be systematically documented. All study participants will be followed up for six months after the end of their pregnancy. The primary outcome is a composite of maternal cardiac events during pregnancy and up to six weeks postpartum. The secondary outcomes cover obstetric and fetal parameters. The study will evaluate the predictive accuracy of widely used general and lesion-specific risk assessment tools in the Indian population and explore the development and validation of a population-specific risk stratification model. The NPAC-India study is expected to facilitate the development of evidence-based, locally tailored guidelines for managing heart disease in pregnancy, thereby reducing maternal and fetal risks in India. The generation of national data may strengthen clinical care, improve resource allocation, and inform public health policy.

To evaluate prevalence of sugar dating among undergraduate students and assess the demographics and motivations of sugar babies. This study included 1582 undergraduate students 18&#x2009;years or older in an urban, private university in the U.S. (82 sugar participants and 1500 controls). From October 2019 to May 2020, a cross-sectional, online survey asked participants about sugar dating experiences, substance use history, and childhood traumas. Prevalence of sugar dating was 5.2%. Sugar babies were 2 to 5 times more likely to have experienced childhood trauma defined by the 10 item ACE questionnaire. Sugar babies were more likely to have financial support (loans, scholarships, Federal Pell grants, work-study), use illegal drugs, and have greater daily alcohol consumption. Many sugar babies have experienced vulnerabilities (financial need, childhood traumas) that could heighten their risk of exploitation by sugar sponsors. Future studies should explore the dynamics of sugar relationships among undergraduate students and the risks accompanying these relationships.

Enhanced Recovery After Surgery (ERAS) protocols have increasingly been adopted in gynecologic oncology. This study evaluates their effectiveness in patients undergoing endometrial cancer surgery, focusing on length of hospital stay (LOS), postoperative pain, and complications. A retrospective case-control study was conducted on patients treated between January 2019 and December 2024. Fifty patients managed with ERAS (Group 1) were compared with fifty patients treated with traditional care (Group 2). Groups were matched considering the American Society of Anesthesiologists physical status (ASA-PS) score, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, and age. Key outcomes analyzed were LOS, postoperative pain, analgesic use, and complications. Patients in the ERAS group had a significantly shorter length of stay (LOS) (p < .001), lower pain scores on the numeric rating scale (NRS) at 8, 16, 32, and 48&#x2009;hours (p < .01-.001), but not at 40&#x2009;hours (p = .13) at rest, and required fewer opioids (p&#x2009;<&#x2009;0.001). Additionally, they experienced fewer nausea/vomiting episodes (p = .05). ERAS implementation in endometrial cancer surgery appears to improve recovery, reduce opioid use, and shorten hospitalization without compromising safety. These findings may support ERAS for optimizing perioperative outcomes, especially in overweight patients undergoing endometrial cancer surgery.

To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy. This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve >&#x2009;0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise. While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR. &#xa9; 2026 International Society of Ultrasound in Obstetrics and Gynecology.