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Uterine rupture (UR) is a rare but life-threatening obstetric emergency associated with high maternal and perinatal morbidity and mortality, particularly in low-resource settings. Delayed diagnosis and management significantly worsen outcomes. This study aimed to describe the epidemiological characteristics, risk factors, management, and maternal and perinatal outcomes of uterine rupture, with particular emphasis on distinguishing neglected from non-neglected cases. A retrospective descriptive study was conducted at Mohammed VI University Hospital, Marrakesh, Morocco, between January 2017 and December 2024. All confirmed cases of uterine rupture were included. Demographic, obstetric, clinical, and surgical data were collected from medical records. Maternal and perinatal outcomes were compared according to uterine scar status and delay in management. Among 115,121 deliveries, 74 cases of uterine rupture were identified, corresponding to an incidence of 0.06%. Rupture occurred in unscarred uteri in 57% of cases and in scarred uteri in 43%. Inadequate or absent antenatal care was reported in 81% of patients. Hysterectomy was required in 23% of cases, predominantly in neglected ruptures. Maternal mortality was 1.4%, while perinatal mortality reached 35.1%, occurring mainly in neglected and unscarred uterine ruptures. Uterine rupture remains a severe and largely preventable obstetric emergency in low-resource settings. Strengthening antenatal care, eliminating harmful obstetric practices, and ensuring timely referrals and intervention are essential to reduce preventable morbidity and mortality.

The tumor shrinkage rate in patients with locally advanced cervical cancer after external beam radiotherapy varies widely, and simple pretreatment predictors are lacking. The lymphocyte-to-monocyte ratio (LMR) is a routine blood marker reflecting inflammatory and immune status; however, its association with short-term radiotherapy response in cervical cancer remains unclear. We retrospectively enrolled 247 patients with locally advanced cervical cancer who underwent radical external-beam radiotherapy between April 2020 and April 2025. LMR was calculated from pretreatment blood counts, with extreme values winsorized. The primary outcome was the continuous tumor shrinkage rate and the secondary outcome was a marked response (≥70% shrinkage). Multivariable linear and logistic regressions were used to assess the LMR-shrinkage association, adjusting for age, body mass index, International Federation of Gynecology and Obstetrics stage, pretreatment maximum tumor diameter, lymph node metastasis, concurrent chemoradiotherapy, and radiotherapy dose. Subgroup and sensitivity analyses were also performed. In the multivariate analysis, each unit increase in LMR was associated with a 0.018 absolute increase in shrinkage rate (95% confidence interval (CI)], 0.001-0.036; P = 0.0477). The odds ratio for achieving a marked response was 1.117 per unit increase in LMR (95% CI: 1.002-1.356, P = 0.0241). The LMR effect was consistent across subgroups and remained significant after adjusting for nutritional and oxidative stress markers. The restricted cubic splines exhibit linearity (P for nonlinearity = 0.098). A higher pretreatment LMR was independently associated with better tumor shrinkage after external beam radiotherapy in patients with locally advanced cervical cancer. This readily available hematological marker may help identify patients who are likely to benefit from radiotherapy, although prospective validation is warranted.

Diffuse capillary-malformation-like cutaneous lesions are uncommon during pregnancy, and their clinical implications become more complex when they coexist with focal neurological symptoms or cerebrovascular malformation. This case report describes a 25-years-old primigravida admitted at 36 + 6 weeks of gestation with diffuse congenital capillary-malformation-like skin lesions, a documented history of cerebrovascular malformation diagnosed 10 years earlier, obesity, and hypothyroidism. Physical examination revealed extensive dark red to violaceous patches over the face, trunk, back, buttocks, and extremities. Brain imaging showed mild volume reduction and sulcal widening in the left temporoparietal-occipital region, a left frontal ischemic lesion, and non-visualization of most of the left posterior cerebral artery, whereas magnetic resonance venography revealed no obvious abnormality. After multidisciplinary assessment by obstetrics, anesthesiology, neurology, neurosurgery, and endocrinology, the patient underwent elective cesarean delivery at 37 + 0 weeks under an individualized staged anesthetic strategy. Maternal oxygenation and hemodynamics were maintained within an acceptable range, fetal exposure to general anesthetic agents before delivery was minimized, and no perioperative neurological event occurred. A healthy female neonate was delivered with Apgar scores of 10 at 1, 5, and 10 min. This case illustrates that diffuse capillary-malformation-like cutaneous lesions may serve as a clinical clue prompting broader vascular and neurological assessment when they coexist with neurological symptoms, documented cerebrovascular malformation, or abnormal neuroimaging. It also highlights the importance of descriptive terminology, individualized peripartum risk assessment, and multidisciplinary planning under diagnostic uncertainty.

This simulation is intended for emergency medicine residents, PGY 1-4. Postpartum hemorrhage (PPH) is defined as cumulative blood loss &#x2265;1000 mL or any postpartum bleeding with signs of hypovolemia within 24 hours of delivery. Post-abortion hemorrhage (PAH) has no single universally adopted numeric definition but clinically is defined as excessive bleeding following spontaneous or induced abortion that results in hemodynamic instability, need for transfusion, hospital admission, or procedural intervention. Due to its rarity, PAH may be underrecognized and thus is the target of this simulation. The emergency department is the country's reproductive health safety net. With the decline of labor and delivery units and on-call, in-house OB/GYN consultants, emergency clinicians must be equipped to recognize and manage these cases.1 Effective management of these cases includes uterotonic medications and uterine tamponade devices like the Bakri balloon.2 There is mixed evidence on the use of Bakri balloons for post-abortion hemorrhage, with some hospitals moving towards vacuum-assisted devices (e.g. JADA).3 However, they have remained relevant in non-OB settings and institutions with limited obstetrical support.4-6 This simulation aims to address a gap in training for PAH for emergency medicine residents, focusing on the placement of the Bakri balloon. By the end of this simulation, learners should be able to: 1) recognize signs of post-abortion hemorrhage, 2) manage hemorrhage using appropriate physical maneuvers, uterotonic medications, and specialist consultation, 3) demonstrate proper placement of a Bakri balloon. This single-center, high-fidelity simulation was conducted at a tertiary care academic center. Simulation was chosen as the best way to teach this topic because it allows a psychologically safe environment to practice a scenario which involves high-level critical thinking and fine-motor skills that would otherwise degrade under stress during a real patient encounter. Pre- and post-simulation surveys were administered, including Likert-scale questions on comfort with the management and procedures included, and a multiple-choice knowledge assessment. Twenty-eight individuals completed the pre-simulation learner evaluation, and 31 completed the post-simulation learner evaluation. Likert-scale data was treated as ordinal (1 = strongly disagree, 5 = strongly agree) and analyzed using the Mann-Whitney U Test. The multiple-choice knowledge assessment was analyzed using a paired T-test. The simulation included 29 emergency medicine residents, four MS3 students, four MS4 students, and three junior EM PA fellows. This case was used eight times during the session. The simulation lasts approximately 20 minutes. There were statistically significant improvements across all measures. On a 5-point Likert scale, comfort in placing a Bakri balloon increased from 2.35 to 3.97 (U = 82, z = 5.34, P < 0.01); comfort in managing postpartum/abortion hemorrhage rose from 3.11 to 3.90 (U = 197, z = 3.59, P < 0.01), and recognition of hemorrhage signs increased from 3.96 to 4.39 (U = 278, z = 2.36, P = 0.02). Mean scores on the multiple-choice knowledge assessment improved from 55.79% to 90.52% (t(18) = -5.23, P < 0.001) pre- and post-intervention. This simulation successfully addressed the gap in the educational materials available to address the learning of the recognition and management of PPH/PAH, including the placement of intrauterine balloon devices. The simulation increased learners' comfort in managing PAH and placing Bakri balloons. While effective for immediate skills/knowledge acquisition, this is a high-acuity, low-occurrence procedure that requires repetition and deliberate practice for more durable learning. Postpartum hemorrhage, post-abortion hemorrhage, Bakri balloon, uterine tamponade, simulation training.

In Japan, a version of the Japanese Food Guide, specifically developed for pregnancy and lactation (JFGST-P/L), promotes healthy dietary habits. In the mid- to-late stages of pregnancy, it is especially important to consume the recommended additional calories and nutrients. Adherence to these guidelines also plays a key role in achieving appropriate gestational weight gain (GWG). This study investigated the relationship between adherence to these guidelines and GWG among women in the mid- to late stages of pregnancy. Data were obtained from the Maternal and Child Cohort Study, conducted at the National Center for Child Health and Development (Setagaya-ku, Tokyo, Japan). The degree of adherence to the JFGST-P/L was evaluated using scores calculated from responses to a semi-quantitative food frequency questionnaire. The participants were classified into quartiles (Q1-Q4) based on their adherence scores. GWG was classified as inadequate, adequate, or excessive according to the Ministry of Health, Labour and Welfare guidelines. The degree of JFGST-P/L adherence was divided into quartiles, and a multinomial logistic regression analysis was performed. Furthermore, the Q1 group was compared with the Q2-Q4 groups to examine the association with the risk of insufficient GWG. In the quartile analysis, no clear dose-response relationship was observed between JFGST-P/L adherence and GWG. Conversely, among Q1, an increased risk of insufficient GWG was noted compared to the Q2-Q4 group (Unadjusted OR 1.389, 95%CI 1.008-1.913). In this study, the lowest degree of adherence to the JFGST-P/L among pregnant women was associated with inadequate GWG.

The significant risk associated with treatment for cesarean scar pregnancy (CSP) is the potential for severe hemorrhage at termination, resulting in controversy over optimal treatment and no international standards. Our previous study proposed that estimating intraoperative blood loss from ultrasound findings, called quantitative risk-scoring (QRS), may help select the optimal treatment. In this study, we analyzed the success rate in selecting the optimal treatment for CSP based on QRS. A total of 318 CSP cases were included, and the initial treatment, including suction evacuation or uterine artery embolisation (UAE), was selected based on intraoperative blood loss estimates. Failure and intraoperative blood loss were measured. The mean intraoperative blood loss in CSP cases with QRS&#x2009;<&#x2009;3 who underwent suction evacuation were not statistically different from CSP cases with UAE. In CSP cases with QRS&#x2009;&#x2265;&#x2009;3, there were 14 (10%) or 6 (8%) unsuccessful cases with suction evacuation or UAE. The mean intraoperative blood loss after excluding failure was not statistically different between the two groups. Additionally, type 2 CSP cases with QRS&#x2009;&#x2265;&#x2009;3 and UAE had lower intraoperative blood loss than those who initially underwent hysteroscopy or laparoscopy, with 5 (8%) cases being unsuccessful. Our study suggested that suction evacuation is safe, with a higher success rate and minimal blood loss for cases with QRS&#x2009;<&#x2009;3. Similarly, the UAE is safe with minimal blood loss for CSP cases with QRS&#x2009;&#x2265;&#x2009;3, although the unsuccessful rate was slightly higher. Our study suggests that QRS can be a tool for selecting initial treatment for CSP in clinical practice.

Early-life gut microbiome assembly is a pivotal determinant of lifelong health; however, the integrated frameworks governing this process across developmental milestones remain insufficiently defined. This review establishes a multidimensional framework by delineating the crosstalk between the gut microbiome and the host throughout the preconception, prenatal, postpartum, and early childhood stages. We first highlight the emerging paradigm of biparental microbial contributions during the preconception period, detailing how paternal and maternal niches jointly prime offspring development. Moving into pregnancy, we examine the maternal reservoir, integrating the role of gut microbiota-derived metabolites across multiple trimesters in prenatal priming and vertical transmission. For the postpartum period, we discuss the development of the multikingdom gut microbiome and address the impacts of delivery modes and clinical interventions. Here, we articulate a critical knowledge gap: the discrepancy between taxonomic "catch-up" and true functional restoration, particularly in vulnerable cohorts such as preterm infants. Furthermore, we propose a "developmental synchronization" model within the maternal-infant-microbiome continuum. This model posits that early-life "windows of opportunity" are defined by the obligate temporal coupling of host physiological maturation with stage-specific microbial metabolic signals. From a translational perspective, we discuss how this framework informs the development of precision interventions, such as stage-specific probiotics, prebiotics, or metabolic modulators. These therapies aim to restore not only the microbial composition but also the synchronized functional dialog between the microbiome and host development. By mapping the "microbiota-metabolite-host target-physiological phenotype" network, we provide a systematic roadmap for precision-targeted interventions during the first 1000 days of life.

Uterine corpus endometrial carcinoma (UCEC) ranks as the 6th most common malignancy among women. Emerging evidence indicates that the dysregulation of tRNA-derived fragments (tRFs) is involved in the pathogenesis of multiple cancer types, including UCEC; however, the molecular mechanisms underlying the roles of tRFs in UCEC remain poorly characterized. Desmocollin3 (DSC3), a transmembrane protein, is predominantly expressed in the basal and suprabasal layers of normal stratified epithelia. While accumulating evidence has implicated DSC3 in the pathogenesis of multiple disease entities, its functional role in UCEC remains elusive. The present study is designed to investigate the functional significance and underlying molecular mechanisms of tRF-19-79MP9PJZ in the progression of&#xa0;UCEC. In this study, tRF-19-79MP9PJZ was found to be significantly upregulated in UCEC tissues and cell lines, with its elevated expression correlating with unfavorable prognostic outcomes in UCEC patients. Furthermore, tRF-19-79MP9PJZ knockdown was observed to suppress the proliferative and migratory capacities of UCEC cells, while concurrently enhancing apoptotic processes. At the mechanistic level, tRF-19-79MP9PJZ was demonstrated to facilitate UCEC progression through targeted regulation of&#xa0;DSC3. Collectively, this study elucidates a previously uncharacterized mechanism whereby tRF-19-79MP9PJZ drives UCEC development, thereby highlighting the potential of the tRF-19-79MP9PJZ/DSC3 axis as a therapeutic target for UCEC intervention.

This study aimed to assess the current status of oral health-related quality of life (OHRQoL) and to identify associated factors among older adults receiving maintenance hemodialysis (MHD). Between September 2024 and September 2025, a total of 107 older adults receiving MHD were recruited from a Grade A tertiary hospital in Guangdong Province using a convenience sampling method. Data were collected using a general information questionnaire, the Oral Health Impact Profile-14 (OHIP-14), and the Self-Efficacy Scale for Oral Self-care (SESS). Univariate analyses and stepwise multiple linear regression were performed to determine factors associated with OHRQoL. The mean OHIP-14 score was 18.97&#x202f;&#xb1;&#x202f;8.00, and the mean SESS score was 43.52&#x202f;&#xb1;&#x202f;12.98. A statistically significant negative correlation was observed between OHIP-14 and SESS scores (r&#x202f;=&#x202f;-0.736, p&#x202f;<&#x202f;0.01). Multivariate analysis identified dialysis frequency, dialysis duration, tooth brushing frequency, tooth brushing duration, pre-dialysis blood urea nitrogen, pre-dialysis serum creatinine, SESS score, and comorbid diabetes mellitus as independent factors associated with OHRQoL (p&#x202f;<&#x202f;0.05). Older adults receiving MHD demonstrated relatively low levels of both OHRQoL and oral self-efficacy. Enhanced clinical attention and the development of targeted interventions addressing the identified influencing factors may contribute to improvements in OHRQoL in this population.

LBN is a rare variant of uterine smooth muscle tumors. Although LBN is a benign variant of leiomyoma, recurrent cases have been reported. In our study, we aimed to evaluate the clinicopathological features of LBN cases and to define the characteristics of recurrent cases. Seventy-six cases with LBN identified in the final pathology were included in the study. The patients' physical examination findings, imaging reports, postoperative complications, and medical data related to recurrence, metastasis, disease-free survival, and overall survival after LBN diagnosis were retrospectively evaluated. An immunohistochemical evaluation of the cases was conducted. Average patient age: 42.3 years. Myomectomy: 46.1%; hysterectomy: 53.9%. Mean follow-up: 40.4 months. Recurrence: 2 cases (2.6%), both in the uterus and myomectomy group. Post-myomectomy pregnancies: 8 out of 35 cases (22.9%). Mitotic count: 2.7. ER positivity: 30%; PR positivity: 33.8%. Ki-67: negative in 56.6%, focal positivity in 42.1%, diffuse positivity in 1.3%. p16 positivity: 14.5%; p53 positivity: 22.4%. PHH3 distribution: various levels from 0/10 to 9/10 BBA. Both recurrences managed with myomectomy, identified as LBN recurrences. LBN is a rare type of uterine smooth muscle tumor with a low recurrence rate, primarily affecting women of reproductive age, making conservative treatments like myomectomy appropriate. However, concerns about morcellation remain. While immunohistochemistry markers and the mitotic index help differentiate between LBN and LMS, their effectiveness in predicting recurrence and prognosis in LBN is limited.

Mitotane remains the cornerstone of adrenocortical carcinoma. However, its real-world safety profile is poorly defined. This study systemically evaluated mitotane-associated adverse events (AEs) and characterized multivariable patterns of serious outcomes using a combined pharmacovigilance and machine learning approach. Mitotane-related AE reports (2004-2025) were extracted from the FDA Adverse Event Reporting System (FAERS). Disproportionality analyses were performed via four algorithms. Detected signals were categorized using a clinical priority scoring system based on signal strength, mortality, seriousness, and existing evidence. Time-to-onset was evaluated utilizing Kaplan-Meier methods. Elastic net logistic regression and Extreme Gradient Boosting (XGBoost) models characterized features associated with serious outcomes, with performance assessed by the area under the receiver operating characteristic curve (AUROC). Among 870 identified reports, 45.7% involved serious outcomes. We detected 75 safety signals, predominantly involving gastrointestinal, neurological, endocrine, and metabolic systems. Notably, 21 signals (28.0%) were assigned moderate clinical priority, with adrenal insufficiency as the highest-priority signal. Time-to-onset analysis showed that endocrine AEs had a significantly longer onset time than non-endocrine AEs. Both models demonstrated consistent characterization of multivariable patterns associated with serious outcomes (elastic net AUROC&#xa0;=&#xa0;0.830, XGBoost AUROC&#xa0;=&#xa0;0.869). Key contributors to serious outcomes included reporting country, medical event designation, organ system involvement, and medication complexity. This large-scale study provides a real-world safety assessment of mitotane. Integrating signal detection, clinical prioritization, and interpretable machine learning reveals multivariable patterns underlying serious AEs. These findings support a risk-stratified monitoring approach to enhance the clinical safety of mitotane therapy.

Early infancy represents a critical window of immune system maturation during which transient dysregulation may result in atypical inflammatory or autoimmune-like phenotypes. Distinguishing such self-limited processes from true systemic autoimmune disease remains a major clinical challenge. We report an infant presenting with prominent cutaneous manifestations, markedly elevated inflammatory markers, hypocomplementemia, and broad high-titer autoantibody positivity including antinuclear, anti-dsDNA, extractable nuclear antigen, and antineutrophil cytoplasmic antibodies. Despite a laboratory profile strongly suggestive of systemic autoimmune disease, the patient remained clinically stable without evidence of organ involvement, including renal, neurological, or cardiopulmonary systems. Immunophenotyping demonstrated lymphocytosis with expansion of CD19+ B cells, while T-cell subsets and natural killer cells remained within expected ranges. Interferon signature analysis was negative, and whole-exome sequencing did not identify a causative monogenic disorder. All immunological abnormalities resolved spontaneously without immunosuppressive therapy. During follow-up, the patient developed transient neutropenia and atopic dermatitis, both with a self-limited course. This case highlights a transient systemic immune phenotype characterized by expansion of the CD19+ B-cell compartment, broad humoral immune activation and complement consumption in early infancy, followed by complete restoration of immune homeostasis. Recognition of such self-limited immune dysregulation is essential to avoid unnecessary immunosuppressive therapy and provides insight into mechanisms of immune tolerance during early human development.

This systematic review aimed to synthesize the available scientific evidence on the relationship between psychopathy and sadism. It was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD420261394636). Included studies had to assess both constructs using validated instruments such as the Psychopathy Checklist-Revised (PCL-R), the Self-Report Psychopathy Scale (SRP), the Levenson Self-Report Psychopathy Scale (LSRP), the Psychopathic Personality Inventory-Revised (PPI-R), or the Triarchic Psychopathy Measure (TriPM) for psychopathy and clinical or behavioral scales for sadism or sexual sadism. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science using terms related to psychopathy, sexual violence, sexual aggression, and sadism, combined with Boolean operators. Two reviewers independently performed study selection and data extraction, while methodological quality was assessed using the Newcastle-Ottawa Scale (NOS), Cochrane Risk of Bias version 2 (RoB 2), and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) tools. The certainty of the evidence was evaluated using the GRADE framework. According to the PRISMA flowchart, 1,061 records were identified. After removing 239 duplicates and applying the selection criteria, 18 studies (19 reports) involving 12,302 participants with a mean age of 34.01 &#xb1; 9.98 years were included. The evidence consisted of 16 observational studies and two meta-analyses. The studies primarily focused on forensic, clinical, and prison populations, and there was a predominant representation from Europe and the Americas (42.11% each). The studies used validated instruments, such as the PCL-R, LSRP, SRP, and TriPM, as well as specific scales for sexual and everyday sadism. Meta-analyses identified moderate to significant positive correlations between global psychopathy and sadism (r = 0.24, 95% CI: 0.16-0.34, p < 0.001) and between psychopathy and sexual sadism (r = 0.33, 95% CI: 0.21-0.44, p < 0.001). However, there was high heterogeneity (I&#xb2; = 84.5-92.3%). Individual studies revealed positive correlations between psychopathy and sadism ranging from low to moderate (r = 0.16-0.53). However, some studies found no significant associations. Individuals with sadistic characteristics generally had higher psychopathy scores than non-sadistic subjects. Significant differences in PCL-R scores were observed between sadistic and non-sadistic groups (21.49 vs. 17.12; p = 0.004; d = 0.59) and between sexual offenders with and without sadism (27.0 vs. 19.0; p = 0.01). Nevertheless, some findings were contradictory, with studies failing to identify a specific relationship between psychopathy and sexual sadism. Analysis of the psychopathic dimensions revealed that the antisocial, impulsive, and affective components exhibited the strongest associations with sadism. The antisocial facet predicted sexual aggression (r = 0.48, &#x3b2; = 0.26, p < 0.001), and the affective dimension showed significant associations with sexual sadism (&#x3b2; = 0.27). In dimensional models, "malice" and disinhibition were the components most strongly related to sadism, while audacity showed weak associations. Among a non-forensic population, latent correlations between psychopathy and everyday sadism were very high (&#x3c1; = 0.94-0.98), suggesting a possible conceptual overlap between the two constructs.

Air pollution is a major contributor to mortality and adverse health outcomes, particularly in pregnant women and children, with vehicular emissions as a key source. This study aimed to characterize long-term exposure to fine particulate matter (PM2&#xb7;5), evaluate potential health risks, and quantify the contribution of road transport and proximity to roads in The Gambia, Kenya, and Mozambique. Multi-temporal personal exposure data were interpolated into continuous spatial surfaces and aggregated into daily averages, which were then compared with World Health Organization (WHO) guidelines to assess potential health impacts. Multi-distance buffers at 10 m intervals up to 1000m from major roads were created to examine pollutant variation with road proximity. Overlay analyses and linear regression models were applied to quantify the road-edge effect on pollution exposure. The Inverse Distance Weighting interpolation technique produced accurate PM2&#xb7;5 field in all sites (R2>0.55, MAE<4 &#x3bc;g/m3 and RMSE<10 &#x3bc;g/m3) based on leave-one-out cross-validation. PM2&#xb7;5 concentrations were highest in The Gambia across all land use and land cover (LULC) types, reflecting localized industrial and vehicular emissions. Elevated pollutant levels were observed in herbaceous wetlands, bare land, and built-up areas. Most sites across all three countries exceeded WHO recommended thresholds, indicating significant health risks. PM2&#xb7;5 decreased with distance from roads in Rabai (Kenya) and Mozambique, while in other sites it increased away from roads. These findings highlight the combined influence of multiple local sources, including traffic, fire smoke, wetlands, and industry, on pollutant exposure. The study demonstrates the utility of WHO thresholds for health risk assessment and shows how road proximity affects pollutant dispersal. The results provide critical insights for modeling air pollution exposure and informing mitigation strategies in sub-Saharan Africa.

Endometriosis is a common, chronic, estrogen-dependent gynecological disorder characterized by the growth of endometrial-like tissue outside the uterus and frequently associated with pelvic pain and infertility. Despite its high prevalence, the molecular mechanisms underlying lesion persistence and inflammation remain poorly understood, limiting the development of reliable non-surgical diagnostic tools and targeted therapies. A case-control study included 176 women with endometriosis and 124 controls. Salivary microRNA (miRNA) expression was analyzed using next-generation sequencing. Patients were stratified into untreated and treated groups (pharmacological or surgical therapy), while controls included healthy individuals and a technical control group of women with benign gynecological conditions to reduce potential confounding factors. Ten salivary miRNAs were associated with disease activity. Seven (hsa-miR-130a-3p, hsa-miR-130b-3p, hsa-miR-141-3p, hsa-miR-200b-3p, hsa-miR-200c-3p, hsa-miR-203b-5p, and hsa-miR-29c-3p) had previously been linked to endometriosis, while three were associated with inflammatory or cancer-related pathways. Expression levels showed a gradient across clinical groups, with intermediate levels in treated patients, suggesting therapeutic modulation. Target analysis identified PTEN as a key regulated gene, implicating the PI3K/AKT/mTOR pathway. These findings support salivary miRNAs as promising non-invasive biomarkers for the diagnosis and monitoring of endometriosis and provide further insight into the molecular pathways involved in disease pathogenesis.

In 2023, the WHO and CDC updated HIV infant feeding guidelines, emphasizing the role of antiretroviral therapy (ART) in reducing breastfeeding/chestfeeding transmission risk among birthing people living with HIV (BPLWH). Despite this update, clinical integration remains inconsistent, shaped by provider knowledge, bias, patient engagement, and systemic barriers. Between August 2025 and January 2026, we conducted 10 semi-structured, in-depth interviews with healthcare workers (HCWs) to assess their understanding of and engagement with updated HIV breastfeeding/chestfeeding guidelines. The Normalization Process Theory (NPT) informed the development of the interview guide and the thematic analysis. Transcripts were double-coded in Dedoose and thematic analysis was conducted deductively. Healthcare workers generally accepted the guidelines as evidence-based, but their implementation varied across the four NPT constructs. While the guidelines were seen as logically coherent, OB-GYNs highlighted reproductive autonomy, whereas infectious disease and pediatric providers prioritized infant HIV susceptibility. Uncertainty about viral load thresholds led to variability among providers. Ethical motivation strongly supported implementation, but inconsistent training and low patient volumes reduced confidence. Institutional leaders and interdisciplinary workflows were identified as vital facilitators. Major obstacles included fragmented OB-GYN-to-pediatrics handoffs, services located in different areas, and structural patient burdens such as monitoring requirements and insurance issues, which the guidelines did not specifically address. Systematically identifying how new breastfeeding/chestfeeding practices become embedded in healthcare among HCWs, and assessing where knowledge gaps, misunderstandings, and engagement barriers exist regarding the guidelines, will inform the development of a decision-making guide to enhance implementation of HIV breastfeeding/chestfeeding guidelines for pregnant people.

To evaluate whether preoperative clinical Enzian scoring and digital rectal examination improve accuracy of operative time prediction and surgical outcomes in women undergoing surgery for endometriosis. Prospective, randomized, multicenter pilot trial. Three urban teaching hospitals certified as endometriosis centers. A total of 107 women undergoing surgery for endometriosis. The participants were randomly assigned to three groups: Group 1 underwent clinical Enzian scoring combined with digital rectal examination (DRE); Group 2 underwent clinical Enzian scoring only; and Group 3 underwent digital rectal examination only. All patients received standard transvaginal ultrasound examinations. The primary endpoint was defined as an absolute difference of&#x2009;&#x2264;&#x2009;10&#xa0;min between the estimated and the actual operative time. Secondary end points included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, correspondence between the preoperative Enzian assessment and intraoperative findings, and postoperative pain (visual analog scale) and patient satisfaction. The primary endpoint was achieved in 9 patients (23.7%) in Group 1, 16 patients (47.1%) in Group 2, and 15 patients (42.9%) in Group 3. Exploratory comparison of the three groups did not demonstrate a statistically significant difference in the proportion of accurate operative time estimations. Secondary endpoints, including conversion rate, abandonment of the operation, complete resection rate, reoperation rate, and patient-reported outcomes, were also comparable across the groups. The results demonstrate that neither diagnostic strategy provided a measurable advantage in predicting operative time or improvement of surgical outcome parameters. DRKS00040760.