The objectives of this study were to determine 1) the prevalence of perceived mistreatment, 2) the source of mistreatment, and 3) the location where mistreatment occurred among obstetrics and gynecology residents. We conducted a national survey of obstetrics and gynecology residents using an adapted validated questionnaire. Over half of participating obstetrics and gynecology residents reported mistreatment. The most common type of mistreatment reported was verbal or emotional abuse (57%). Patients/patients' families, attendings, nurses, and other residents were all common sources of mistreatment. The most frequent location was labor and delivery. Female, gender-diverse, Black, and lesbian, gay, bisexual, queer+ (LGBQ+) residents experienced mistreatment at higher rates. Obstetrics and gynecology residents report a high prevalence of mistreatment. Interventions to reduce mistreatment, especially on labor and delivery, will prove important to promote the respectful work environment necessary for optimal learning and patient care.
This study aimed to examine associations between mental health symptoms and several pandemic-related experiences specifically online education, social isolation, financial concerns, and health anxieties among medical students during the coronavirus disease-2019 (COVID-19) pandemic. Due to the cross-sectional design and the absence of a pre-pandemic or contemporaneous in-person comparison group, causal relationships cannot be established, and the associations of online education cannot be isolated from the broader pandemic context. This cross-sectional study was conducted at Tehran University of Medical Sciences during the COVID-19 pandemic. The sampling frame comprised all basic sciences and physiopathology medical students (N = 1247). A simple random sample of 400 students was drawn; 330 completed the online questionnaire (response rate: 82.5%). The questionnaire included the Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS-10), and researcher-developed items on pandemic-related experiences. Data were analyzed using SPSS-24. Potential selection and non-response biases are discussed in the limitations. 330 medical students participated in the study, of whom 137 (41.5%) were female and 193 (58.5%) were male. Clinical screening revealed that 26.5% of participants had minimal or no symptoms, while 46.8% had mild depression, 17.3% had moderate depression, and 9.4% had severe depression. For analytical comparison, when combining minimal and mild severities, 73.3% presented with minimal/mild depression. Additionally, 4.2% had mild stress, 91.5% had moderate stress, and 4.2% had severe anxiety. Several factors, including a history of psychiatric illness, lack of private study space, fear of social isolation, health-related anxiety, dissatisfaction with virtual classes, poor internet access, and financial concerns, were significantly associated with depression and/or perceived stress among medical students during the COVID-19 pandemic. Given the cross-sectional design and the absence of multivariable adjustment, these findings should be interpreted strictly as descriptive, unadjusted associations rather than independent predictors. The results highlight exploratory areas that may warrant further confirmatory investigation.
Are higher ambient temperatures before oocyte retrieval associated with adverse oocyte-related outcomes in women undergoing their first IVF or ICSI cycle? Higher pre-retrieval temperatures are associated with reduced oocyte yield, an effect partially mediated through LH and partially counteracted by compensatory increases in FSH and estradiol (E2). Evidence on the impact of ambient temperature on IVF/ICSI outcomes is emerging but limited. A recent study reported weak negative associations between higher ambient temperatures during folliculogenesis and oocyte yield, though the effect was modest and findings across populations remain inconsistent. However, these findings are further limited by small sample sizes, specific clinical subpopulations or geographic regions, which prevents the establishment of a generalizable dose-response relationship and leaves the underlying biological mechanisms largely unexplored. A retrospective cohort study of 58 468 women undergoing their first IVF/ICSI cycle with oocyte retrieval between 1 January 2018 and 31 May 2024. Women undergoing their first IVF/ICSI cycle were included. The primary outcomes were total oocytes retrieved, mature oocytes retrieved, and 2PN (two pronuclei) fertilized oocytes. Secondary outcomes included rates of oocyte maturation, normal fertilization, and blastocyst formation. Basal sex hormone levels were measured during the early follicular phase (cycle days 2-4). Environmental exposure data, including both ambient temperature and apparent temperature (integrating air temperature and humidity), were assessed over biologically relevant exposure windows. Generalized linear mixed-effects models were used to estimate associations between temperature exposures and oocyte-related outcomes. Restricted cubic spline models assessed nonlinearity. A counterfactual causal mediation analysis examined the roles of basal sex hormones. Stratified analyses by age, BMI, antral follicle count, anti-Müllerian hormone, season, COVID-19 period, and the distance to ART center, along with sensitivity analyses, were performed to evaluate robustness. Each 1°C increase in apparent temperature was associated with significant decreases in total oocytes retrieved (-0.20%; 95% CI: -0.28%, -0.12%), mature oocytes retrieved (-0.17%; 95% CI: -0.26%, -0.09%), and 2PN fertilized oocytes (-0.19%; 95% CI: -0.28%, -0.09%); consistent associations were observed for ambient temperature (-0.25%, -0.22%, and -0.22% per 1°C, respectively). For rate-based outcomes, no significant associations were observed for the normal fertilization rate or blastocyst formation rate; the mature oocyte rate showed small positive associations in longer-term exposure windows (3-week and 90-day). Mediation analyses indicated that LH partially mediated these associations, accounting for up to 5.23% of the total effect, while both FSH and E2 exhibited suppression effects. The observational design cannot definitively establish causality. Unmeasured confounding (e.g. individual indoor climate control, occupational heat exposure) and residential address-based exposure assessment are potential sources of bias. Restricting the primary analysis to completed cycles may introduce selection bias, although sensitivity analyses incorporating canceled cycles yielded consistent estimates. Higher ambient temperatures represent a modifiable environmental risk factor for oocyte yield in ART treatment, with basal sex hormone pathways, including LH as a partial mediator and compensatory shifts in FSH and E2, providing a plausible biological basis for this effect. In the context of rising global temperatures, these findings suggest that ambient thermal exposure during the peri-folliculogenesis period warrants clinical attention, and that monitoring basal sex hormone levels may help identify patients at risk of a suboptimal ovarian response in high-temperature settings. This study was supported in part by the Technology Innovation and Research & Development Project of the Chengdu Science and Technology Bureau (No. 2024-YF05-02159-SN), the Open Fund of Chongqing Maternal and Child Disease Control and Public Health Research Center (No. CQFYSJ01001), the Program of Inheritance and Innovation of Traditional Chinese Medicine in Chongqing (Chongqing Traditional Chinese Medicine [2022] No. 33), and Chongqing Yuzhong District Natural Science Foundation Project (No. 20240118). All authors declare that they have no conflicts of interest related to this study. N/A.
Pseudoamniotic band syndrome (PABS) is an iatrogenic amniotic disruption sequence that may occur after invasive fetal procedures, including fetoscopic laser therapy and amniocentesis. Fetoscopic release of the bands has been reported in singleton pregnancies, but it remains rare in twin pregnancies after intrauterine fetal surgery. This study aimed to report two rare cases of PABS occurring after invasive fetal interventions-one for twin-to-twin transfusion syndrome (TTTS) and one for twin reversed arterial perfusion (TRAP) sequence-both of which were successfully managed by fetoscopic band release, and to review the clinical characteristics of PABS in TTTS. We describe one rare case off fetal abdominal constriction caused by amniotic bands following TTTS fetoscopic surgery, and one case of PABS in TRAP sequence after microwave ablation and amniocentesis. Both cases were successfully treated in utero via subsequent fetoscopic band release later. A literature review was conducted on PABS cases after TTTS intervention, comparing cases managed expectantly versus those treated with fetoscopic release. We reported two cases of PABS with constriction of the fetal abdomen and ankle, respectively, treated by fetoscopic band release, and both cases achieved successful outcomes after fetoscopic band release. A literature review identified 50 reported PABS cases after TTTS treatment. PABS occurred predominantly in recipients (78.0%, 39/50 cases), primarily affecting fetal limbs (88.2%, 45/51 fetuses). Antenatal detection was low (20.0%, 10/50 cases), and without intervention, 9.5% (4/42 fetuses) developed fetal limb amputation. Including our case, only 8 PABS cases in TTTS have undergone fetoscopic release, with a median interval of 4.3 weeks post-TTTS fetoscopic laser. The median GA at fetoscopic release surgery was 23.5 (range, 21-27.4) weeks, with a median interval of 5.6 (range, 0.8-11.9) weeks between fetoscopic release and delivery (at 30.7 weeks; range, 24.7-34.9). Of these, 37.5% (3/8) of the newborns required further plastic surgery after birth, but all fully recovered functionally without amputation. Serial ultrasound surveillance after fetal interventions should include PABS assessment, particularly 4 weeks post-procedure. Although antenatal diagnosis remains challenging, fetoscopic band release appears technically feasible in twin pregnancies and potentially beneficial in carefully selected, antenatally diagnosed cases, but the evidence remains limited and vulnerable to publication bias.
Our recent large-scale population study demonstrated that several per- and polyfluoroalkyl substances (PFAS) are potential risk factors for sperm quality-with perfluorohexane sulfonate (PFHxS) and 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA) emerging as the strongest effect contributors to asthenospermia, yet their causal relationships remain unclear. Here, we provide in vivo experimental evidence and evaluation of the combined effects of 6:2 Cl-PFESA and PFHxS under human-relevant exposure. Male ICR mice were orally exposed to each compound alone or in combination for 35 days, covering one full spermatogenic cycle. Both single and combined exposures were associated with alterations of the male reproductive axis, including reduced serum testosterone and elevations in the gonadotropins luteinising hormone (LH) and follicle-stimulating hormone (FSH), and in sex hormone-binding globulin (SHBG). Testicular injury included disturbed seminiferous architecture, decreased sperm motility, and increased germ-cell apoptosis. Transcriptomics highlighted pathways related to cell adhesion, junctional integrity, and apoptosis, and Western blotting and TUNEL confirmed blood-testis barrier (BTB) protein disruption and increased germ-cell apoptosis. Toxic potency differed by endpoint, with endpoint-specific patterns across endocrine, BTB, and motility outcomes. Combined-effect analysis identified a positive non-additive interaction for LH, whereas most BTB-associated proteins showed no statistically significant interaction despite endpoint-specific deviations from the concentration-addition expectation. Collectively, these findings indicate that human-relevant co-exposure to 6:2 Cl-PFESA and PFHxS is associated with asthenospermia-related sperm and testicular alterations. The converging phenotypic, molecular, and functional findings support BTB impairment and germ-cell apoptosis as plausible contributing processes, yet the precise mechanisms still need further investigation.
Investigating the molecular mechanism of granulosa cell dysfunction is vital to understand the pathogenesis of polycystic ovary syndrome (PCOS). Based on bioinformatics analysis, we analyzed the differentially expressed genes and their enrichment pathways between PCOS patients and normal samples. We also analyzed the levels of CD14 and miR-296-3p in PCOS patients. Pearson correlation coefficient was used to analyze the correlation between CD14 expression and PCOS-related inflammatory factors. CCK-8 assay, flow cytometry, qRT-PCR and western blotting were performed to explore the mechanism of CD14 modulated via miR-296-3p in KGN cells in vitro. The gene expression data of PCOS and normal individuals in the GEO database, as well as the experimental data in KGN cells. KGN cells were subjected to the following interventions: Transfection with miR-296-3p inhibitor to suppress miR-296-3p expression; Transfection with small interfering RNA targeting CD14 (si-CD14) to knock down CD14; Co-transfection with si-CD14 and miR-296-3p inhibitor to evaluate the rescue effect. The detections included CCK-8, flow cytometry, qRT-PCR and Western blotting. The expression of CD14 in patients with PCOS and KGN cells, and its correlation with inflammatory factors; The expression of MiR-296-3p in patients with PCOS, and its regulatory relationship with CD14; The effect of MiR-296-3p/CD14 on the viability and apoptosis of KGN cells; The influence of MiR-296-3p/CD14 on the NF-κB pathway. CD14 was up-regulated in PCOS patients and KGN cells, and the expression of CD14 was positively correlated with the expression of inflammatory factors (CAT, CCL2, ICAM1, IL10, MMP9 and TGFB1) related to PCOS. miR-296-3p was the upstream regulatory factor of CD14, and miR-296-3p inhibitor could promote cell apoptosis and inhibit cell viability. On the contrary, knockdown of CD14 in KGN cells inhibited apoptosis and promoted cell viability. Importantly, KGN cells co-transfected with si-CD14 and miR-296-3p could reverse the effects of miR-296-3p inhibitor and si-CD14 on the biological behavior of KGN cells. Moreover, miR-296-3p/CD14 axis mediated activation of NF-κB pathway in KGN cells. Down-regulation of CD14 attenuated the miR-296-3p inhibitor-induced increase in apoptosis and decrease in cell viability by suppressing NF-κB signaling pathway. Our findings contribute to further understanding of the pathogenesis of PCOS and provide potential biomarkers for PCOS.
Cancer survivors face unique and persistent health-related quality of life (HRQoL) challenges. Existing HRQoL questionnaires for survivors lack content regarding chronic physical issues and have typically included limited cancer types and languages/cultures, affecting breadth of content and generalisability. We developed and validated the EORTC QLQ-SURV100, a questionnaire to assess HRQoL in disease-free survivors of diverse cancers. A conceptual framework of HRQoL in cancer survivors, developed in previous study phases and conceptualised as survivors' self-reported physical, mental and social functioning and well-being, formed the basis for questionnaire content. The QLQ-SURV100 was administered to 1480 participants across 46 centres in 21 countries (31% breast cancer, 23% colorectal, 22% prostate, 24% other cancers), who had completed primary treatment 1-10 years earlier and had no evidence of active disease. Structural validity of the 21 multi-item questionnaire scales was assessed via confirmatory factor analysis; test-retest reliability via intraclass correlation coefficients (ICCs); construct validity through known-group comparisons; and cross-cultural validity and sex invariance through differential item functioning (DIF). Item response theory (IRT) analyses evaluated item redundancy and performance. The QLQ-SURV100 showed strong structural validity (Comparative Fit Index = 0.951; Tucker-Lewis Index = 0.944; Root Mean Square Error of Approximation = 0.046), with most standardised factor loadings > 0.7. Test-retest ICCs exceeded 0.7 for 27 of 35 scales and 0.6 for 34 scales. Known-groups analyses supported most hypotheses, confirming sensitivity to treatment, comorbidity, age, sex, and education. DIF analysis indicated minor cross-cultural item bias, but no sex-related DIF. IRT analysis found no redundant items. The EORTC QLQ-SURV100 showed satisfactory structural validity, test-retest reliability and construct validity; limited item redundancy; and measurement invariance across the sex and language groups examined.
To examine the intersectionality of three frequently measured neighborhood social determinants during pregnancy-socioeconomic disadvantage, food access, and walkability-and their collective association with nulliparous term, singleton, vertex (NTSV) cesarean delivery. This was a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be observational cohort. Home addresses in the first trimester were geocoded at the census-tract level to define three adverse neighborhood measures: 1) socioeconomic disadvantage by the Area Deprivation Index (in tertiles), 2) low food access by the U.S. Department of Agriculture Food Access Research Atlas (yes/no), and 3) low walkability by the Environmental Protection Agency National Walkability Score (yes/no). The exposure was the number of neighborhood adverse social determinants and was assessed by number (0, 1, 2 or more) and specific combinations. The outcome was NTSV cesarean delivery. Multivariable modified Poisson regression with robust error variance was used. We secondarily assessed the distribution of clinical indications for cesarean delivery and whether associations between neighborhood social determinants and cesarean delivery varied by self-reported race and ethnicity. Among 8,010 nulliparous individuals with NTSV deliveries, 27.3% lived in a neighborhood in the top tertile of socioeconomic disadvantage, 24.5% with low food access, and 66.4% with low walkability. The risk of NTSV cesarean delivery was higher only among individuals living in neighborhoods with low walkability (adjusted relative risk [RR] 1.17, 95% CI, 1.06-1.28). Individuals exposed to one (adjusted RR 1.14, 95% CI, 1.01-1.27) or two or more (adjusted RR 1.19, 95% CI, 1.06-1.34) compared with no adverse neighborhood social determinants had a higher risk of cesarean delivery. Individuals living in neighborhoods with low walkability and high socioeconomic disadvantage (adjusted RR 1.21, 95% CI, 1.03-1.41) or low walkability and low food access (adjusted RR 1.20, 95% CI, 1.05-1.37) had a higher risk of cesarean delivery. The frequency of all three adverse neighborhood social determinants was higher for non-Hispanic Black and Hispanic individuals compared with non-Hispanic White individuals (P<.05), but the above association between neighborhood social determinants and cesarean delivery did not vary by self-reported race and ethnicity (adjusted interaction P=.6). In a prospective U.S. cohort, living in a neighborhood with low walkability, alone and in combination with socioeconomic disadvantage and food access, was associated with an increased risk of NTSV cesarean delivery.
The United States lags peer nations in infant mortality, with persistent racial and geographic inequities. In Missouri, Black infants experience mortality rates more than double those of White infants. Addressing these disparities requires community-driven interventions beginning before conception and extending beyond routine perinatal care. We describe the development and feasibility of Women & Person-Empowered Community Access for Reproductive Equity (WE CARE)-Jackson County (JC), a reproductive justice-informed intervention adapted from the Detroit WE CARE model to address reproductive health and infant mortality disparities. WE CARE-JC used a two-phase, mixed-methods design. Phase 1 included listening sessions with advocacy groups and reproductive-age women, and a community survey (N = 537) to identify needs, barriers, and engagement strategies. Phase 2 piloted the intervention in a safety-net hospital's emergency department. Intervention components included the "One Key Question," MyPath decision-support tool, community health worker-led counseling, and follow-up care navigation. Listening sessions identified trusted providers as preferred sources of family planning guidance, while stigma, limited provider access, and knowledge gaps were key barriers. Survey data showed social (13% housing, 22% food, and 35% transportation insecurity) and medical (51% comorbid condition) vulnerability. In the pilot, 45 women were enrolled (85% of those approached), of whom 58% scheduled follow-up care and 10 (39%) attended appointments. Feedback from eight attendees showed high acceptability of the MyPath tool, counseling, and navigation support. WE CARE-JC demonstrated feasibility and acceptability of a reproductive justice-informed, community-engaged model to reduce barriers and improve equitable access to reproductive health care. This model provides a scalable framework for addressing upstream drivers of infant mortality inequities.
Elective Cesarean surgeries (CSs) rates continue to rise worldwide, prompting renewed interest in predictors of prenatal biometrics, which have a central role in recommendations for elective CS. To develop machine learning (ML) models for predicting neonatal anthropometric measures such as head circumference (HC), birth weight, and the mode of delivery, either vaginal or CS. A retrospective single-center longitudinal cohort cross-sectional study conducted at a big public hospital. Data were drawn from 5375 pregnant women who underwent routine prenatal ultrasound examinations within 2 weeks of delivery. Dataset curation included exclusion criteria and handling of missing data prior to model development. Formal feature selection for the most predictive variables resulted in the final dataset of 3447 subjects. Four supervised ML algorithms were implemented: stochastic gradient descent, random forest, K-nearest neighbors, and stacking ensemble (SE). The models were trained and evaluated on clinical and ultrasonographic data. The predicted newborn weight (NBW) was of comparable accuracy to the commonly used Hadlock IV formula for the estimated fetal weight. The predicted newborn head circumference (NBHC) was of superior accuracy compared to the last prenatal ultrasound measurement. The classification of the delivery mode revealed a very close association between the predicted CSs and high values of NBHC and NBW. We developed highly accurate ML-based models for prediction of NBHC, NBW, and the mode of delivery using only the three last prenatal ultrasound measurements: biparietal diameter, abdominal circumference, and HC. The predicted mode of delivery demonstrated a very good association between CSs and high values of NBHC and NBW. Future implementation of ML algorithms in risk-based obstetric management will benefit both maternal and fetal health and wellbeing.
Preeclampsia is a pregnancy-related hypertensive disorder with long-term cardiovascular risks. The aim of this study was to explore the factors influencing hypertension progression in preeclampsia patients within 5 years postpartum, and to construct a nomogram. A retrospective study of 280 preeclampsia patients, grouped by hypertension progression status within 5 years postpartum, was performed. Differential analyses compared: 1) demographic/pregnancy characteristics, and 2) late-pregnancy, 1-week-postpartum, and 6-week-postpartum blood indicators between groups. Multiple logistic regression and generalized estimating equations (GEE) identified hypertension progression factors. Significant factors used to construct the nomogram were evaluated via calibration and receiver operating characteristic (ROC) curves in training/test sets. Patients who progressed to hypertension had higher pre-pregnancy and postpartum body mass index (BMI), a greater proportion of early-onset and severe preeclampsia, and a higher incidence of adverse pregnancy outcomes compared to those who did not progress to hypertension. Additionally, they had lower platelet levels during late pregnancy and postpartum, while levels of aspartate aminotransferase, alanine aminotransferase, 24-hour urinary protein, uric acid, and C-reactive protein were higher in patients who did not progress to hypertension. Multivariate logistic regression identified placental abruption, oligohydramnios, and umbilical artery pulsatility index as significant factors, while the generalized estimating equation highlighted uric acid (UA), platelet (PLT), and alanine aminotransferase (ALT) as key predictors. The nomogram demonstrated good predictive performance, as shown by calibration and ROC curves. Hypertension progression correlates with placental abruption, oligohydramnios, elevated umbilical artery pulsatility index (UA-PI), elevated UA, decreased PLT, elevated ALT, and specifically aspartate aminotransferase at 1-week postpartum. The nomogram aids early identification of high-risk patients.
Objective The primary objective of this retrospective cohort study was to explore the associations between cervical anatomical features and gestational age at delivery in high-risk asymptomatic singleton pregnancies. A secondary exploratory objective was to evaluate gestational age at delivery according to preventive intervention strategy (Arabin pessary, cervical cerclage, or no intervention). Study design This retrospective cohort study included singleton pregnancies managed at a tertiary hospital between December 2019 and December 2024. Eligible pregnancies had documented cervical evaluation (length, diameter, and funneling), intervention status, and gestational age at delivery. The first available cervical measurement was analyzed. Very early preterm birth was defined as delivery before 33+0 weeks to focus on clinically significant prematurity associated with intensive neonatal care. Methods Categorical variables (cervical length: ≤2.4 cm vs. >2.4 cm, diameter: ≤10 mm vs. >10 mm, funneling yes/no, and intervention type) were compared using chi-square or Fisher's exact tests. Gestational age distributions among intervention groups were assessed using kernel density plots and boxplots. Time-to-delivery was evaluated using Kaplan-Meier curves and log-rank testing. Multivariable Cox proportional hazards models included intervention type (reference: cerclage), cervical length, diameter, and funneling. Given the limited number of events, multivariable estimates were interpreted cautiously because of potential overfitting and type II error. Results Among 174 singleton pregnancies, 30 (17.2%) delivered before 33 weeks, whereas 144 (82.8%) delivered at ≥33 weeks. Cervical diameter >10 mm was less frequent among pregnancies delivering before 33 weeks (3/30, 10%) compared with those delivering at ≥33 weeks (63/144, 43.8%; p<0.001). Funneling was more frequent in the <33-week group (15/30, 50.0%) than in the ≥33-week group (51/144, 35.4%), although this association did not reach conventional statistical significance in multivariable modeling (p=0.107). Kaplan-Meier analyses suggested longer gestation in the pessary and cerclage groups compared with no intervention, but between-group differences were not statistically significant (log-rank p=0.08). In adjusted Cox models, diameter ≤10 mm was associated with a lower hazard of delivery (HR: 0.398, 95% CI: 0.205-0.433; p<0.001). Other covariates were not statistically significant. Conclusion Cervical diameter was associated with gestational age at delivery in this cohort and may represent a candidate marker for risk stratification in high-risk singleton pregnancies. Because of the retrospective design, limited event numbers, and potential indication bias in intervention assignment, these findings should be interpreted as hypothesis-generating rather than definitive evidence of intervention effectiveness or equivalence. Larger prospective and multicenter studies are needed.
 Spontaneous abortion (SAB, miscarriage) affects and may influence outcomes in subsequent pregnancies. This study aimed to assess maternal and fetal outcomes in women with a history of SAB who conceived a subsequent pregnancy.  A hospital‑based observational study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, over 18 months. Ninety‑six women aged 18-35 years with at least one previous SAB were enrolled. Maternal outcomes (gestational hypertension, diabetes mellitus, placental complications, and mode of delivery) and fetal/neonatal outcomes (fetal growth retardation, birth weight, Apgar score, and neonatal intensive care unit (NICU) admission) were recorded. Comparisons were made between single (82, 85.4%) and recurrent (≥2 abortions; 14, 14.6%) subgroups.  A total of 96 pregnant women with a history of SAB were included. The mean maternal age was 27.74 ± 4.81 years, and most participants were aged <30 years (65, 67.7%) and had conceived spontaneously (88, 91.7%). Recurrent SAB was present in 14 (14.6%) women. Gestational diabetes mellitus and gestational hypertension were observed in 17 (17.7%) and 12 (12.5%) women, respectively. Preterm delivery occurred in 12 (12.5%) pregnancies, while 58 (60.4%) women underwent cesarean section. Fetal growth restriction was identified in 12 (12.5%) cases, and NICU admission was required in 18 (18.8%) neonates. Low birth weight, low APGAR score, and meconium aspiration syndrome were each observed in 1 (1.0%) neonate, with no intrauterine deaths recorded. Recurrent abortion was associated with higher rates of preterm birth (21.4% vs. 11.0%; P = 0.375) and NICU admission (28.6% vs. 17.1%; P = 0.291), although these associations were not statistically significant. Preterm delivery was significantly associated with NICU admission (41.7% vs. 15.5%; P = 0.043).  Pregnancy after SAB generally results in favorable outcomes with no intrauterine deaths and high rates of normal birth weight and Apgar scores. However, clinically significant risks of gestational diabetes, hypertension, fetal growth retardation, high cesarean section rates, and NICU admissions persist. Structured antenatal surveillance and individualized care are recommended for this population.
and Hypothesis: Endometriosis often causes pelvic pain, limiting movement and physical function. Performance-based tests are fundamental to measure functional status among these women. This study aimed to evaluate the reliability and validity (cross-sectional and longitudinal) of the 30-Second Chair-Stand Test (30CST) in women with endometriosis. Observational longitudinal study from a specialized unit of a hospital. Participants completed a sociodemographic and clinical questionnaire. Functional performance was assessed using the 30CST at three time points: T1: In-clinic, baseline; T2: At home, pre-menstruation; T3: At home, during menstruation. Reliability was assessed via intraclass correlation coefficients (ICC) using a 2-way mixed-effects model. Minimal Detectable Change (MDC) was also calculated. Longitudinal validity was tested via two hypotheses supported by the fact that functional performance in women is significantly worse on menstrual phase, when compared to the premenstrual phase, through paired t-tests and standardized response means (SRM). Cross-sectional validity was assessed by comparing 30CST performance between pain groups (cut-off: 7). 54 women participated with mean baseline pain 3.52 ± 3.21, and average 30CST performance ∼15 repetitions. Reliability was high across all contexts (ICC: 0.985, 0.975, and 0.981 at T1, T2, and T3, respectively). Performance during menstruation (T3) was significantly lower than pre-menstruation (T2) (mean difference=-1.22 repetitions, p<0.001; SRM=-0.436). Cross-sectional validity showed that women with high baseline pain (≥7) performed significantly fewer repetitions than those with lower pain scores (p<0.001), with a large effect size (Cohen's d=1.59). The 30CST is a simple and reliable test with strong validity for women with endometriosis.
To evaluate the clinical characteristics, metastatic patterns, and treatment outcomes of gestational choriocarcinoma in Mongolia, with a particular focus on the impact of etoposide-methotrexate-actinomycin D/cyclophosphamide-vincristine (EMA/CO) chemotherapy implementation. A retrospective cohort study was conducted including 66 patients diagnosed with gestational choriocarcinoma between 2011 and 2025. Patients were stratified based on FIGO stage and metastatic status. Clinical features, antecedent pregnancy, and treatment outcomes were analyzed. Comparisons between pre-implementation (2011-2017) and post-implementation (2018-2025) cohorts were performed using independent t-test, chi-square test, or Fisher's exact test as appropriate. Of the 66 patients, 45.5% (n = 30) had non-metastatic disease (FIGO stage I-II), while 54.5% (n = 36) presented with metastatic disease (FIGO stage III-IV). Vaginal bleeding was the most common presenting symptom (84.8%). The lungs were the most frequent site of metastasis. Following implementation of the EMA/CO chemotherapy regimen in 2018, higher complete remission rates and lower observed mortality were observed in the post-implementation cohort. Complete remission increased from 69.7% (23/33) to 97.0% (32/33) (p = 0.006), while disease-related mortality decreased from 30.3% (10/33) to 3.0% (1/33) (p = 0.006). Chemoresistance and relapse rates also decreased, although these differences were not statistically significant. Additional interventions, including surgery for residual disease and radiotherapy for brain or lung metastases, were applied when indicated. Despite overall improvements, metastatic disease remained a key determinant of prognosis. Patients treated after 2018 demonstrated higher complete remission rates and lower observed mortality compared with those treated before 2018. However, due to the retrospective design, absence of adjusted outcome analysis, and baseline differences between treatment-era cohorts, these findings should be interpreted cautiously. Early diagnosis, routine serum β-hCG surveillance, timely referral, and standardized management remain essential for optimizing outcomes in gestational choriocarcinoma.
The purpose of this study was to determine if urine epidermal growth factor (EGF) levels can be used to distinguish between overactive bladder (OAB) and recurrent lower urinary tract infection (UTI). This was a prospective study conducted at a single tertiary medical center, using medical records and biospecimens collected from premenopausal women with OAB, recurrent lower UTI, and healthy controls without urinary tract conditions. Patients with OAB were treated with either mirabegron (Betmiga®) or solifenacin succinate (Vesicare®) for 3 months. Urinary EGF and creatinine levels were measured at baseline and posttreatment. Symptom changes were assessed using voiding diaries and the OAB Symptom Score (OABSS) questionnaire. A total of 61 women were included in the study: 21 with OAB, 20 with recurrent lower UTI, and 20 healthy control women. There was no significant difference in the urine EGF/creatinine ratio between the OAB, recurrent lower UTI, and control groups (3212.7 [2592.2, 3909.6] and 3362.3 [2374.7, 4632.3] vs. 3402.3 [2700.1, 4568.9], P = 0.895). Both medications were effective in relieving symptoms of OAB, but solifenacin was associated with a significantly higher rate of dry mouth (60% vs. 0%, P = 0.045). No significant difference in urine EGF/creatinine ratio was observed between control subjects and patients with OAB or recurrent lower UTI. Thus, urine EGF is not likely a useful marker for distinguishing between OAB and recurrent lower UTI.
Evidence on the clinical utility of baseline human epididymis protein 4 levels and their kinetics in recurrent ovarian cancer remains limited. This study evaluated longitudinal human epididymis protein 4 dynamics in real-world patients treated with platinum-based chemotherapy, aiming to determine the prognostic significance of human epididymis protein 4 kinetic parameters compared with CA125 response and established prognostic factors for progression-free and overall survival. This retrospective analysis included 220 patients with recurrent epithelial ovarian cancer treated with second-line platinum-based chemotherapy between 2000 and 2020. Four mathematical models were tested to describe human epididymis protein 4 kinetics, with model selection based on goodness of fit, visual predictive checks, and prognostic performance. The prognostic value of the most informative human epididymis protein 4 kinetic parameter (the modeled residual human epididymis protein 4 level), was assessed in univariable and multi-variable analyses. Among the 93 assessable patients, no clear associations were observed between baseline human epididymis protein 4 levels and disease characteristics. Longitudinal human epididymis protein 4 kinetics differed from those of CA125 and showed an initial decline followed by a plateau at approximately 40 days. The best-fitting model was a mono-exponential decline incorporating the modeled residual human epididymis protein 4 parameter, which was subsequently evaluated as a prognostic factor. Baseline human epididymis protein 4 levels lacked prognostic significance for progression-free or overall survival. In contrast, a higher modeled residual human epididymis protein 4 level was significantly associated with shorter progression-free and overall survival in univariable analyses (residual human epididymis protein 4 ≥median vs <median; median progression-free survival: 7.2 vs 12.6 months, p =.002; median overall survival: 16.5 vs 34.9 months; p =.001) and in multi-variable models (overall survival: hazard ratio 2.65; 95% confidence interval 1.23 to 5.71, p =.012) alongside CA125 response. In this study, we identified residual HE4 levels in patients treated with second-line platinum-based chemotherapy as an independent dynamic marker of overall survival, with higher levels indicating poorer outcomes and potential chemoresistance.
Lactoferrin (LF), a multifunctional glycoprotein of the transferrin family, exhibits anti-inflammatory and immunomodulatory properties. Endometriosis is an estrogen-dependent chronic inflammatory disease commonly treated with progesterone therapy; however, progesterone receptor (PGR) resistance in endometriotic lesions has increased interest in immunomodulatory approaches. To evaluate the effects of LF alone and combined with progesterone on endometriotic lesions in a rat model. An endometriosis model was induced in female Wistar Albino rats. Rats with confirmed endometriotic lesions were randomly divided into 4 equal groups and received the following oral treatments: Control (0.5% carboxymethylcellulose), bovine LF (bLF) (100 mg/kg/d), progesterone (0.3 mg/kg/day), combination therapy (bLF [100 mg/kg/d] + progesterone [0.3 mg/kg/d]). After treatment, the rats were euthanized, histopathological and biochemically anayses were done. No statistically significant differences were observed in volume and adhesion scores of endometriotic lesions before and after treatment (P = 0.653, P = 0.413, P = 0.890, respectively). However, PGR and inflammatory cytocine levels were decreased in all treatment groups (P = 0.001). Although serum progesterone levels did not differ between groups (P = 0.06), serum LF levels were lower in the progesterone-only group (P = 0.001). Total antioxidant status (TAS) and Plasma total oxidant status (TOS) showed no significant differences among groups (P = 0.623 and P = 0.318, respectively). LF, alone or combined with progesterone, reduced inflammatory cytokine levels associated with endometriosis-related pain, suggesting potential therapeutic value. Further studies are needed to clarify its role in progesterone resistance and the clinical management of endometriosis.
Angiomyofibroblastoma (AMFB) of the vulva is a rare benign mesenchymal tumor of the vulva that affects the vulva and vagina of adult women. Often mimicked by other vulvar masses such as vestibular macrocystic glands, subcutaneous lipomas, and dermoid cysts, AMFB can be detected by histopathology. Here, we present a case where AMFB was initially misdiagnosed as a subcutaneous lipoma. By highlighting the role of preoperative pathology and imaging in the diagnostic and treatment process, we aim to improve AMFB recognition and better management. A 59-year-old woman, postmenopausal for 10 years, reported that she first saw a vulvar mass 14 years ago, and it has gradually grown since then. A color Doppler ultrasound at another hospital detected a slightly hyperechoic mass in the fat of the left perineum measuring 7.2 × 3.0 × 4.5 cm, 36 mm from the body surface. The lesion was well circumscribed but internally heterogeneous; no intralesional blood flow was detected. No preoperative biopsy was obtained. The lesion was excised surgically. Intraoperatively, the surgeons identified a cystic mass on the lateral side of the left labium majus, measuring approximately 7.0 × 4.0 × 4.0 cm, soft, irregularly shaped, encapsulated, and clearly distinguished from adjacent tissues. Histopathological examination of the resection specimen from the left labia majora confirmed angiomyofibroblastoma. At the 3-month follow-up, no tumor recurrence was observed. This case confirmed that AMFB is prone to misdiagnosis. Before the operation, imaging examinations should be combined, and surgical resection should be performed after a confirmed diagnosis based on pathological and immunohistochemical examinations.
The scale of IVF centres currently ranges from small, stand-alone units to large networked organizations operating across multiple regions or countries. This diversity in organizational models may influence clinical outcomes, patient experience, professional practice, innovation and long-term sustainability. In parallel with broader healthcare trends, the fertility sector has undergone rapid consolidation over the last decade, prompting renewed debate regarding the relationship between centre size, governance structures, quality of care and efficiency. This opinion paper critically examines the strengths and limitations of both small and large IVF centres, with particular attention to the concepts of critical mass, technology adoption, human resources, quality management and professional autonomy. Beyond size alone, the discussion also covers how evolving governance models, particularly the growing influence of managerial and financial decision making, may reshape scientific leadership and clinical practice within fertility centres. Importantly, the authors acknowledge the scarcity of high-quality comparative evidence linking organizational scale to live birth outcomes or patient-reported measures. Rather than advocating for a single optimal size, they propose the concept of a 'sustainable or balanced scale', defined as an organizational equilibrium where operational robustness, leadership, science and innovation coexist with uncompromising personalized, patient-centred care.