Background:This study aimed to investigate the causal pathways that link obesity to the risk of gynecological diseases through specific circulating plasma metabolites. The diseases examined were endometrial cancer (EC), ovarian cancer (OC), endometriosis, and polycystic ovary syndrome (PCOS). A Mendelian randomization (MR) framework was used to identify and quantify the mediating role of metabolites.Methods:A three-stage, two-sample MR and mediation analysis was conducted. First, we estimated the causal effects of genetically predicted body mass index (BMI) and waist-hip ratio (WHR) on plasma metabolites. Second, we assessed the causal effects of the identified obesity-driven metabolites on four gynecological diseases. Finally, mediation analyses were performed to quantify the proportion of the obesity effect mediated by significant metabolites. Genetic instruments were derived from the largest available genome-wide association studies of European ancestry. The primary analytical method was inverse variance weighted (IVW), supplemented by sensitivity analyses.Results:Genetically predicted higher BMI showed evidence of causal effects for increased risks of EC, PCOS, and OC, whereas WHR showed no significant associations. BMI and WHR were associated with 218 and 172 plasma metabolites, respectively, with several metabolites identified as potential risk factors for gynecological diseases. For EC, these included androsterone sulfate and lipids within very low-density lipoprotein (VLDL), whereas for endometriosis, they included triglycerides within small VLDL and serum total triglycerides. Mediation analysis revealed that androsterone sulfate mediated 34.89% of the effect of BMI on EC risk, while serum total triglycerides mediated 22.41% of this effect.Conclusions:This study provides genetic evidence that general adiposity influences the risk of several gynecological diseases in part through specific metabolic pathways. Androgen and lipid metabolism emerged as candidate intermediate traits that explain a significant proportion of the effect of obesity on EC risk. These findings identify potential targets for risk stratification and preventive strategies.
Background:To analyze the bone mineral density (BMD) status of postmenopausal women, thereby providing a basis for precise clinical nursing interventions, an area that remains underexplored in tailored gerontological nursing practice.Methods:This was a retrospective and cross-sectional study. A total of 1375 postmenopausal women aged 45–59 years who underwent BMD examination at Jinhua Hospital of Zhejiang University from January 1, 2025, to December 31, 2025 were retrospectively enrolled. Demographic data, bone metabolism markers, sex hormones, blood lipids, and other relevant indices were collected. Participants were categorized into three groups based on BMD results: normal BMD, osteopenia, and osteoporosis. Intergroup comparisons were performed using the Kruskal-Wallis test, one-way analysis of variance (ANOVA), or the χ2 test. Independent associated factors were identified using multinomial logistic regression, and subgroup analyses were performed.Results:Subgroup analysis revealed that BMD decreased with increasing age (p < 0.001) and decreasing body mass index (BMI) (p < 0.001), and that BMD distribution also differed among occupational types (p = 0.001). Compared with the normal BMD group, univariate analysis and multinomial logistic regression showed that older age, lower BMI, lower serum calcium, and elevated alkaline phosphatase (ALP) were independently associated with osteopenia (p < 0.05 for all). Estradiol levels also showed a statistically significant but clinically negligible association (p = 0.035). Older age, lower BMI, elevated ALP, lower testosterone, and elevated lipoprotein(a) levels were identified as independent predictors for osteoporosis (p < 0.05 for all).Conclusions:Increasing age, low BMI, increased bone turnover, reduced testosterone, and elevated lipoprotein(a) were identified as factors significantly associated with reduced BMD in postmenopausal women.
Background:Giant ovarian tumors (GOTs) have become increasingly rare in the era of widespread ultrasonography and cross-sectional imaging. However, they continue to pose significant diagnostic and surgical challenges, particularly in postmenopausal women, who have a higher baseline risk of borderline or malignant disease. This review aimed to evaluate the clinicopathological characteristics and surgical management of GOTs in postmenopausal women.Methods:A systematic search of PubMed and Scopus was conducted to identify case reports and small case series (≤10 patients) published between January 1, 2010, and November 30, 2025, describing GOTs (defined as ≥20 cm and/or ≥10 kg) in postmenopausal women who underwent open surgery. Data regarding tumor size, histology, surgical management, intraoperative spillage, complications, and International Federation of Gynecology and Obstetrics (FIGO) stage were extracted. Findings were primarily synthesized qualitatively, with additional descriptive and exploratory statistical analyses performed where appropriate.Results:22 cases met the inclusion criteria. Benign tumors accounted for 68.2% (15/22), borderline lesions for 9.1% (2/22), and malignant tumors for 22.7% (5/22). The maximum reported tumor diameter, when derivable from the original reports, ranged from 20 to 58 cm. Surgical spillage was described in 36.4% of cases. No apparent association was observed between tumor size and malignancy.Conclusions:In GOTs, extreme size does not reliably predict malignancy. In the reviewed cases, preservation of capsular integrity during surgical removal appeared to be an important operative objective, particularly in mucinous lesions. However, the prognostic relevance of this observation cannot be established from the available heterogeneous case reports. As the present review included only cases managed by laparotomy, no definitive conclusions can be drawn regarding the feasibility or safety of minimally invasive surgery. The available evidence was limited to case reports and small case series, precluding formal quantitative synthesis.Registration:The study has been registered on https://www.crd.york.ac.uk/PROSPERO/ (registration number: CRD420261389870; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261389870).
Background: To compare short-term changes in fetal cardiac function following tocolytic therapy with nifedipine or magnesium sulfate (MgSO4) in pregnancies complicated by threatened preterm labor. Methods: This prospective observational study included 316 singleton pregnancies between 32–34 weeks of gestation presenting with threatened preterm labor at a tertiary perinatology clinic. Women received either oral nifedipine (n = 280) as first-line tocolysis or intravenous MgSO4 (n = 36) when nifedipine and indomethacin was contraindicated. Fetal echocardiography was performed within 2 h before initiation and 2–4 h after cessation of tocolysis. Mitral and tricuspid E and A velocities, E/A ratios, left and right myocardial performance indices (MPI), and fetal heart rate (FHR) were recorded. Pre-and post-treatment changes, as well as between-group differences, were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess the discriminative performance of cardiac indices. Results: A total of 316 pregnant women were included in the analysis, with 280 receiving nifedipine and 36 receiving MgSO4. Baseline demographic and clinical characteristics were comparable between groups, except for a slightly higher gestational age and longer duration of tocolysis in the MgSO4 group. In the nifedipine group, post-treatment mitral and tricuspid E/A ratios increased significantly, accompanied by a small but statistically significant decrease in left ventricular MPI and a significant decrease in FHR. In the MgSO4 group, E/A ratios increased significantly after treatment, whereas individual E and A wave velocities and MPI showed no significant changes. In both groups, FHR decreased significantly after treatment. ROC analyses demonstrated limited to moderate discriminative performance of individual cardiac parameters in distinguishing pre- and post-tocolysis states. Conclusions: Both nifedipine and MgSO4 were associated with short-term alterations in fetal diastolic filling parameters following tocolysis. Nifedipine additionally showed a small but statistically significant decrease in left ventricular myocardial performance index (MPI). All observed changes remained within physiologically acceptable ranges for late gestation, supporting the fetal cardiac safety of both agents when used for tocolysis. Clinical Trial Registration: The study has been registered on https://clinicaltrials.gov/ (registration number: NCT06904534; registration link: https://clinicaltrials.gov/study/NCT06904534?cond=NCT06904534&viewType=Card&rank=1).
Background:Pain and anxiety remain major barriers to the tolerability and widespread adoption of office hysteroscopy, despite advances in minimally invasive techniques and the use of nitrous oxide (N2O) analgesia. Non-pharmacological interventions targeting the clinical environment may offer a complementary strategy to improve patient experience. To evaluate the preliminary effect of a multisensory clinical setting, incorporating visual environmental distraction, on pain perception during operative office hysteroscopy.Methods:This randomized, parallel-group pilot trial enrolled 50 women undergoing operative office hysteroscopy in an outpatient setting. Participants were allocated to standard care with N2O (control group) or N2O combined with a multisensory intervention consisting of a wall-mounted virtual window displaying relaxing visual content (intervention group). The primary outcome was procedural pain assessed on a 10-point scale. Secondary outcomes included referral to the operating room and procedural feasibility. Between-group differences were analyzed using Welch’s t-test.Results:50 patients were randomized (25 per group), and all completed the study. Mean pain scores were significantly lower in the intervention group than in the control group (3.1 ± 1.5 vs. 5.8 ± 1.9; p < 0.001). The reduction in pain was observed across different hysteroscopic techniques and appeared more pronounced among multiparous women. No significant between-group differences were observed in secondary outcomes, including referral to the operating room (20% vs. 12%; p = 0.702). No adverse events related to the intervention or N2O were reported.Conclusions:In this pilot randomized trial, the addition of a simple visual environmental distraction to standard N2O analgesia was associated with reduced pain during operative office hysteroscopy. These findings suggest that non-pharmacological, environment-based strategies may complement existing analgesic approaches to enhance patient experience. Larger, adequately powered studies are needed to confirm these preliminary findings.Clinical Trial Registration:This study is registered on the ClinicalTrials.gov (registration number: NCT07473206).
Background:Emergency cesarean section is a critical intervention for maternal and fetal rescue, yet neonatal outcomes remain variable and are influenced by multiple perioperative factors. To identify and analyze factors influencing neonatal outcomes following emergency cesarean section.Methods:A retrospective analysis was conducted on 216 cases of emergency cesarean section performed at the Women and Children’s Hospital of Ningbo University from January 2016 to December 2019. Data management and statistical analyses were performed using SPSS version 20.0. Variables reaching statistical significance in the univariate analysis were subsequently assessed using a multivariate logistic regression model. A p < 0.05 was considered statistically significant.Results:Of the 216 cases, 80 (37.03%) neonates had low Apgar scores. When emergency cesarean section was initiated from the outpatient setting, the incidence of low Apgar scores (54.43%, 43/79) was significantly higher than when it was initiated from the inpatient setting (27.01%, 37/137; p < 0.001). Univariate analysis identified the following risk factors for low Apgar scores: gestational age, hypertensive disorders of pregnancy, dexamethasone use, anesthesia method, birth weight, occurrence of risk factors of maternal or fetal to decision operation interval (ORDOI), occurrence of risk factors of maternal or fetal to delivery interval (ORDI), and surgical indications (all p < 0.05). Maternal age, gestational diabetes mellitus, decision-to-delivery interval (DDI), and histological chorioamnionitis were not associated with low Apgar scores (p > 0.05). Multivariate logistic regression analyses identified the following independent risk factors for low Apgar score: general anesthesia (odds ratio [OR] = 6.930, 95% confidence interval [CI]: 2.446–19.637), placental abruption with fetal distress (OR = 5.732, 95% CI: 1.893–17.354), umbilical cord prolapse with fetal distress (OR = 17.531, 95% CI: 3.091–99.429), severe maternal complications in obstetrics with fetal distress (OR = 14.615, 95% CI: 2.036–101.888), and ORDI. Using ORDI (0–60 min) as the reference, the OR values for ORDI (61–120 min), (121–180 min), and (>180 min) were (OR = 4.399, 95% CI: 1.555–12.444), (OR = 8.748, 95% CI: 2.515–30.433), and (OR = 6.899, 95% CI: 1.816–26.215), respectively. Gestational age was identified as an independent protective factor against low Apgar score (OR = 0.827, 95% CI: 0.723–0.946).Conclusions:Timely identification of maternal and fetal risk factors and reduction of the ORDI are key strategies for improving neonatal outcomes in the emergency cesarean section.
Objectives:Premature ovarian insufficiency (POI) affects approximately 3.5% of women worldwide, and its pathogenesis is increasingly associated with the interplay of genetic, autoimmune, and environmental factors. This review aims to: (1) examine the synergistic effects of chronic inflammation and biological aging in accelerating ovarian reserve depletion; (2) evaluate the efficacy and limitations of current management strategies; and (3) explore the potential of emerging regenerative therapies, with an emphasis on integrating precision medicine frameworks in POI care.Mechanism:A systematic literature search was conducted across PubMed, Web of Science, and ClinicalTrials.gov from database inception to December 3, 2024. Search terms included combinations of “premature ovarian insufficiency”, “primary ovarian insufficiency”, “ovarian aging”, “inflammation”, “senescence”, “therapy”, and “regenerative medicine”. The review encompassed preclinical studies, clinical trials, and meta-analyses. Publications were screened by title, abstract, and full text for relevance, with a focus on human studies and high-impact translational research that elucidates pathogenic mechanisms or therapeutic innovations.Findings in Brief:The pathogenesis of POI is critically driven by a self-reinforcing cycle wherein chronic inflammation, mediated via nuclear factor kappa B (NF-κB) and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways, interacts with cellular aging to amplify oxidative stress and follicular apoptosis. This process is further exacerbated by senescence-associated secretory phenotypes (SASPs). Current standard of care, such as hormone replacement therapy (HRT), effectively manages symptoms but shows limited efficacy in restoring ovarian function or fertility. Antioxidant therapies have yielded inconsistent outcomes. Emerging regenerative strategies, including stem cell therapies, exosomal microRNA (miRNA) delivery, and platelet-rich plasma (PRP) applications, demonstrate potential for ovarian rejuvenation in preclinical and early clinical studies, yet require further validation.Conclusions:Advancing POI management requires a shift beyond symptomatic relief toward targeting the underlying inflammation aging axis. Integrating multimodal therapies with biomarker-guided precision medicine represents a feasible strategy to disrupt the self-perpetuating disease cycle. Future research should prioritize robust clinical trials to validate regenerative approaches and establish patient-specific therapeutic algorithms, aiming not only to alleviate symptoms but also to preserve or restore ovarian function.
Objective: This article reviews research advances in the management of early ambulation following female pelvic floor reconstruction surgery (PFRS), with the objective of providing a robust evidence-based foundation for the development of standardized and individualized early ambulation protocols. Mechanism: PubMed, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), and the Chinese Biomedical Literature (CBM) database were searched from 2015 to October 2025. We included studies reporting first ambulation outcomes after PFRS surgery, including both original studies and secondary resources (guidelines, consensus statements, meta-analyses). Two researchers independently extracted data and assessed the quality of each study. Findings in Brief: Fifteen publications, nine original studies and six guidance documents (consensus statements, meta-analyses, and formal guidelines), were included. All supported early ambulation after PFRS, yet none delineated procedure-specific, metric-based protocols. Two guidelines’ recommendation is for postoperative ambulation on the day of surgery for 30 minutes to 2 hours, followed by 6 hours per day thereafter, whereas the remaining four employed non-standardized terms such as “immediate” or “as soon as possible”. Nevertheless, the implementation of enhanced recovery after surgery (ERAS) principles has substantially shortened the time to first ambulation. Primary studies demonstrated that earlier ambulation accelerates gastrointestinal recovery, lowers pain scores on postoperative day 1, and reduces total hospital costs by 30%. Conclusions: Early ambulation within 24 h after PFRS may facilitate voiding, shorten hospital stay, and reduce costs, but its inclusion in ERAS protocols still needs robust evidence. Available data are of low certainty. Currently, evidence addressing different surgical approaches—especially after transvaginal mesh implantation—is lacking, and patient-centered tolerance outcomes remain unreported. Until large-scale, mesh-stratified randomized controlled trials with long-term follow-up and patient-reported tolerance as a primary outcome become available, early ambulation should be restricted to carefully selected patients and cannot yet be routinely recommended for women undergoing transvaginal mesh procedures.
Background: To investigate the clinical application of preconception expanded carrier screening (PECS) in couples undergoing assisted reproductive technology (ART) in Central China. Methods: We conducted a retrospective study at the Reproductive Medicine Center of Shiyan Renmin Hospital from August 2022 to November 2023. PECS results from infertile couples were analyzed to determine carrier rates for pathogenic single-gene variants and the proportion of at-risk couples (ARCs). Identified ARCs received genetic counseling and reproductive guidance, and pregnancy outcomes were assessed. Results: A total of 4853 patients (2082 couples) underwent PECS for 22 monogenic diseases. Among them, 81.58% (3959/4853) carried no pathogenic variants, whereas 18.42% (894/4853) carried at least one variant. The carrier rates for one, two, and three variants were 16.73%, 1.61%, and 0.08%, respectively. The genes with the highest carrier frequencies were gap junction protein beta 2 (GJB2) (3.05%), cytochrome P450 family 21 subfamily A member 2 (CYP21A2) (2.64%), hemoglobin subunit alpha 1/2 (HBA1/HBA2) (2.12%), survival of motor neuron 1 (SMN1) (2.12%), and ATPase copper transporting beta (ATP7B) (2.10%). ARCs were identified in 2.31% (48/2082) of couples. Of these, 1 couple chose preimplantation genetic testing for monogenic disorders (PGT-M), and another opted for preimplantation genetic testing for aneuploidy (PGT-A). 26 couples proceeded with routine ART, which resulted in 14 live births. Outcomes among the remaining ARCs included 4 canceled embryo transfer cycles, 3 failed pregnancies, 3 early miscarriages, and 2 elective terminations. Conclusions: PECS provides a valuable approach to identify single-gene disease risks in the infertile population of Central China. It facilitates informed reproductive decision-making and supports the prevention of affected offspring through targeted prenatal diagnosis.
Background:Hyperemesis gravidarum (HG) is a clinical condition characterized by systemic inflammation and maternal malnutrition. However, the role of a composite index integrating both inflammatory and nutritional parameters for identifying the degree of metabolic stress, as reflected by ketonuria severity, has not been investigated. This study aimed to evaluate the association between the Naples Prognostic Score (NPS), a composite index on inflammatory and nutritional biomarkers, and ketonuria severity in patients with HG.Methods:This retrospective cross-sectional study included 241 pregnant women hospitalized with a diagnosis of HG between October 2022 and October 2025. Patients were stratified into mild-to-moderate (n = 134) and severe (n = 107) ketonuria groups based on urine ketone levels. The NPS was calculated using the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin, and total cholesterol levels. Group comparisons, correlation analyses, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression analyses were performed.Results:Age, body mass index (BMI), and obstetric history were comparable between groups. Neutrophil count, NLR, and NPS were significantly higher in the severe ketonuria group. In contrast, lymphocyte count, LMR, serum albumin, and total cholesterol were significantly lower, reflecting a greater inflammatory and nutritional burden in patients in the severe ketonuria group. Among all variables tested, NPS demonstrated the strongest correlation with ketonuria severity (r = 0.845; p < 0.001). ROC curve analysis revealed that NPS had excellent discriminatory performance in identifying severe ketonuria (area under the ROC curve [AUC] = 0.939; sensitivity 90.65%, and specificity 93.28% at a cutoff value ≥3). In the multivariable logistic regression analysis, an NPS ≥3 (odds ratio [OR] = 110.261; 95% confidence interval [CI]: 42.724–284.560; p < 0.001) and total cholesterol level (OR = 0.981; p = 0.037) were independently associated with severe ketonuria. The wide CI reflects model instability and shared variance between the NPS and its components; therefore, the point estimate should not be interpreted as a stable measure of effect size.Conclusions:At admission, NPS demonstrated a strong cross-sectional association with the severity of ketonuria and excellent discriminatory performance for identifying severe ketonuria. However, because both measures were obtained simultaneously, these findings should be interpreted as reflecting a concurrent association rather than true prospective prediction.
Background:Uterine artery ligation (UAL) may reduce uterine blood flow and facilitate hemostasis during hysterectomy; however, its association with early postoperative inflammatory changes remains unclear. This study aimed to compare laboratory findings and surgical outcomes based on whether UAL was performed during robotic hysterectomy (RH).Methods:We retrospectively reviewed patients who underwent RH using the da Vinci Xi, da Vinci SP, or da Vinci 5 system at Korea University Anam Hospital between January 2022 and July 2025. Patients were divided into a UAL group and a non-UAL group according to whether UAL was performed using Hem-o-Lok® clips (Teleflex Medical) at the uterine artery origin. Postoperative white blood cell (WBC) change was further assessed using the WBC ratio (postoperative day 1 [POD 1] WBC/preoperative WBC), analyzed both as a continuous variable and categorically using an exploratory threshold of 1.3 for logistic regression analysis. Statistical analyses were performed using Student’s t-test, the chi-square test, and logistic regression analysis.Results:Among 354 patients, 146 were classified into the UAL group and 208 into the non-UAL group. Surgical time was significantly longer in the UAL group than in the non-UAL group (p < 0.001). However, pericervical bipolar coagulation time and postoperative WBC change were significantly lower in the UAL group (p = 0.017 and p < 0.001, respectively). On multivariate logistic regression analysis, UAL was independently associated with a reduced risk of greater postoperative WBC change (adjusted odds ratio [OR], 0.25; p < 0.001).Conclusions:Hem-o-Lok®–assisted UAL during RH was associated with reduced early postoperative WBC elevation and shorter bipolar coagulation time, suggesting a potential benefit in attenuating the early postoperative inflammatory response.
Background:Available treatments for endometriosis remain unsatisfactory; therefore, there is an urgent demand for novel and effective therapeutic strategies. This study focused on the therapeutic effect of cepharanthine, a monomer derived from a Chinese herb, on endometriosis in vitro, in patient-derived eutopic endometrial organoids, and in vivo.Methods:Patient-derived ectopic endometrial stromal cells were isolated from ovarian endometriomas. Organoids were generated from the eutopic endometrium of patients with endometriosis. Ectopic endometrial stromal cells, eutopic endometrial organoids, and immortalized endometrial stromal cells were used to evaluate the effects of cepharanthine on cell viability, growth, and apoptosis. Female BALB/c mice were used to develop a peritoneal endometriosis model.Results:Cepharanthine treatment decreased the viability of immortalized endometrial stromal cells, patient-derived endometriotic stromal cells, as well as eutopic endometrial organoids. It induced DNA damage, downregulated cyclin D1, and caused cell-cycle arrest at the G0/G1 phase. It also promoted apoptosis by enhancing cytochrome C release, activating caspase-9 and caspase-3, increasing the expression of proapoptotic factor Bax, and decreasing the expression of antiapoptotic factor B-cell lymphoma 2 (Bcl-2). Intraperitoneal administration of cepharanthine significantly inhibited the growth of murine peritoneal endometriosis model. The treatment significantly downregulated the protein expression of cyclin D1 and DNA repair protein RAD51 (RAD51), and increased phosphorylated histone H2AX (γ-H2AX) expression in endometriosis lesions, indicating that it induced DNA damage and impaired DNA repair. Additionally, Ki-67 expression was significantly decreased, and apoptosis was markedly increased in the lesions.Conclusions:Our results indicate that cepharanthin may represent a promising treatment option for endometriosis.
Background:The duration of infertility represents an underexplored temporal dimension of assisted reproductive technology (ART) that may capture clinically relevant patient heterogeneity beyond conventional prognostic factors. This study aimed to evaluate the associations between infertility duration and both ART treatment outcomes and psychological well-being.Methods:This retrospective cohort study analyzed 11,906 women stratified by infertility duration (<5 years, n = 9570; 5–10 years, n = 1992; ≥10 years, n = 344). Clinical pregnancy rate, early pregnancy loss, Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety, and Patient Health Questionnaire-15 (PHQ-15) somatization scores were compared using one-way analysis of variance (ANOVA) with Bonferroni correction, chi-square (χ2) tests, and multivariable regression analysis.Results:Progressive increases in maternal age and decreases in ovarian reserve markers were observed across groups (all p < 0.001). Clinical pregnancy rates declined significantly from 55.3% to 45.9% (χ2 = 15.16, p < 0.001), while rates for early pregnancy loss remained stable across groups (p = 0.175). Anxiety scores showed a significant overall decline across groups (3.33 to 3.07; p = 0.047), though no pairwise differences survived Bonferroni correction. Somatization scores increased significantly with infertility duration (4.65 to 5.00; p = 0.004), with a significant pairwise difference identified between the <5 years and the 5–10 years groups (adjusted p = 0.010). Both differences were of limited clinical magnitude (0.26 and 0.35 points, respectively), falling below established thresholds for clinically meaningful change. Multivariable analyses identified maternal age and anti-Müllerian hormone (AMH) as primary predictors of ART outcomes. Infertility duration was not an independent predictor of clinical pregnancy after multivariable adjustment (p = 0.061). AMH showed a modest but positive association with the odds of clinical pregnancy (odds ratio [OR] = 1.032 per ng/mL, p < 0.001), consistent with its established prognostic role in ART.Conclusions:Infertility duration did not independently predict clinical pregnancy after adjustment for maternal age and ovarian reserve. Although psychological differences across groups were statistically significant, their clinical magnitude was modest. Pending prospective validation, these findings suggest that infertility duration may serve as a useful descriptive variable for patient characterization. However, they should not be considered an independent prognostic factor for clinical pregnancy in ART.
Background:Ovarian torsion–detorsion injury induces ischemia–reperfusion–related oxidative stress, leading to ovarian tissue damage and impaired reproductive function. Asprosin has recently emerged as a metabolic hormone associated with oxidative stress and inflammation, but its role in ovarian ischemia–reperfusion injury remains unclear. This study aimed to evaluate the effects of N-acetylcysteine (NAC), a potent antioxidant, on reproductive capacity, as well as asprosin levels in a rat torsion–detorsion (T/D) model.Methods:35 Wistar albino rats were randomly assigned to five groups (n = 7 per group): Group I (Control), Group II (Sham), Group III (NAC), Group IV (T/D), and Group V (T/D + NAC). Ovarian tissue and blood samples were collected to assess asprosin immunoreactivity, serum asprosin levels, anti-Müllerian hormone (AMH) concentrations, and total oxidant status (TOS). Histopathological changes in ovarian tissue were evaluated using immunohistochemical techniques.Results:Serum TOS levels were higher in the T/D group than in the Control group (12.16 vs. 2.28, p = 0.016) and lower in the T/D + NAC group than in the T/D group (5.38 vs. 12.16, p = 0.032); however, neither difference remained statistically significant after Bonferroni correction. Serum asprosin levels were significantly lower in the NAC (0.81 vs. 1.39, p = 0.002) and T/D (0.47 vs. 1.39, p = 0.003) groups compared with the Control group, whereas the difference for the T/D + NAC group (0.96 vs. 1.39, p = 0.010) did not remain significant after correction. Serum asprosin levels were higher in the T/D + NAC group than in the T/D group (0.96 vs. 0.47, p = 0.008), although this difference did not persist after Bonferroni correction. In ovarian tissue, asprosin immunoreactivity was lower in the T/D group than in the Control group (p = 0.002) and higher in the T/D + NAC group than in the T/D group (p = 0.002). AMH levels did not differ significantly among groups (p > 0.05).Conclusion:NAC administration was associated with reduced oxidative stress and attenuated degenerative changes in ovarian T/D injury. Asprosin levels reflected ischemia–reperfusion–related alterations, decreasing after torsion and showing partial recovery following NAC treatment. These findings suggest that asprosin may represent a potential biomarker of metabolic and oxidative stress in ovarian ischemia–reperfusion injury; however, the underlying mechanistic relationship warrants further investigation.
Background:Premature ovarian failure (POF) refers to the loss of ovarian function in women younger than 40 years of age. Its incidence has increased annually, with a progressively younger age at onset. Women of reproductive age undergoing cancer treatments, such as radiotherapy and chemotherapy, may experience ovarian damage, leading to POF. Cyclophosphamide (CTX), a widely used chemotherapeutic agent, is a major cause of POF and severely compromises the reproductive health of female cancer survivors. However, the mechanism underlying CTX-induced ovarian damage remains not fully elucidated, and effective therapeutic strategies are lacking.Methods:Oxidative stress and cholesterol metabolism in ovarian tissues and cells following CTX treatment were assessed using enzyme-linked immunosorbent assay (ELISA), qRT-PCR, and Western blotting (WB). In vitro experiments were performed using mouse primary ovarian theca cells and granulosa cells to evaluate the impacts of CTX on oxidative stress and cholesterol metabolism, with the antioxidant lycopene (Lyc) administered as an interventional treatment. Additionally, in vivo therapeutic studies using Lyc were conducted to evaluate its regulatory effects on oxidative stress and cholesterol metabolism.Results:CTX triggers oxidative stress by enhancing reactive oxygen species (ROS) production and suppressing ROS clearance. CTX-induced ROS accumulation impairs cholesterol uptake and metabolic pathways. Specifically, CTX significantly downregulates the protein expression of low-density lipoprotein receptor (LDLR) and steroidogenic acute regulatory protein (StAR) in ovarian tissues and primary ovarian theca cells, leading to impairments in cholesterol transport and metabolism. Findings from both in vitro and in vivo assays showed that Lyc intervention markedly attenuates CTX-induced ROS accumulation, restores the expression of antioxidant enzymes and associated genes, and enhances the protein levels of LDLR and StAR in ovarian tissues and primary ovarian theca cells.Conclusions:CTX induces ovarian dysfunction by triggering ROS-mediated cholesterol metabolism disorders. Lyc exerts a protective effect against CTX-induced ovarian injury through its antioxidant activity, restoring cholesterol transport pathways and subsequent steroid hormone synthesis. Our findings provide a fresh mechanistic basis and a promising therapeutic strategy for preventing and treating chemotherapy-induced POF.
Background:In vitro maturation is a long-established technique used to obtain mature oocytes outside the human body. As an alternative to assisted reproductive technology (ART) protocols involving controlled ovarian stimulation (COS) followed by in vitro fertilization (IVF), IVM may facilitate oocyte maturation with less severe side effect and more cost effective in patients with polyendocrine metabolic ovarian syndrome (PMOS). Culture media supplemented with platelet-rich plasma (PRP) have previously shown promise in improving oocyte maturation. This study examined the potential utility of allogeneic PRP supplementation in enhancing the maturation of germinal vesicle (GV)-stage oocytes collected from patients with PMOS who underwent controlled ovarian stimulation.Methods:A prospective cohort study was conducted to determine the optimal concentration of allogeneic PRP for oocyte maturation. Subsequently, 28 GV-stage oocytes were cultured for 24 h in media supplemented with either 0% PRP (n = 14) or 5% PRP (n = 14). Oocyte maturation, total oocyte score (TOS), and fertilization rate were then assessed.Results:Supplementation with 5% PRP yielded the highest rate of oocyte maturation (66.7%) among the concentrations tested, and significantly improved maturation compared with 0% PRP (71.4% vs. 21.4%, respectively; p = 0.021). Morphological quality, as reflected by the TOS (3.9 ± 1.37), and fertilization rate (80%) were also improved following supplementation with 5% PRP, indicating support of oocyte maturation.Conclusions:Supplementation with 5% PRP was found to support oocyte maturation under controlled ovarian stimulation. Further studies are required to optimize the use of PRP without controlled ovarian stimulation in clinical in vitro maturation (IVM) protocols that may benefit patients with PMOS.Study Registration:This clinical study has been registered at https://clinicaltrials.gov/study/NCT07514234 (registration number: NCT07514234) and https://ina-crr.kemkes.go.id/en/studi/1632 (registration number: INA-F814749).
Background:Late-onset fetal growth restriction (FGR) is associated with an increased risk of adverse pregnancy outcomes (APOs). However, early identification of high-risk fetuses remains clinically challenging. This study aimed to evaluate clinical and Doppler ultrasound parameters as predictors of APOs and to develop a combined predictive model.Methods:A total of 91 cases of late-onset FGR were retrospectively evaluated. All fetuses underwent Doppler assessment of the umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV). Maternal and pregnancy characteristics, fetal biometry, and Doppler indices were analyzed for their associations with APOs. Receiver operating characteristic (ROC) curve analyses were performed to assess predictive performance, and a combined model was constructed incorporating significant clinical and Doppler variables.Results:APOs occurred in 65/91 (71.4%) cases. Maternal age was identified as an independent predictor (30.7 ± 4.5 vs. 28.1 ± 4.8 years; p = 0.023; odds ratio [OR]: 1.139, 95% confidence interval [CI]: 1.018–1.273). Gestational age (GA) at diagnosis, GA at delivery, abdominal circumference (AC), and estimated fetal weight (EFW) were also significantly associated with APOs (p < 0.05). Among Doppler parameters, only ductus venosus-pulsatility index for veins (DV-PIV) >95th percentile was significantly associated with APOs (p = 0.023; OR: 3.83; 95% CI: 1.78–10.99), whereas MCA pulsatility index (PI), UA-PI, and cerebroplacental ratio (CPR) showed no significant differences. ROC analyses indicated that individual variables demonstrated moderate predictive performance (area under the curve [AUC]: 0.613–0.663), with trade-offs between sensitivity and specificity. A combined model incorporating maternal age, gestational parameters, fetal biometry, and DV-PIV achieved superior predictive performance, with an optimal cutoff of 0.7625 (AUC: 0.747, 95% CI: 0.638–0.857), a sensitivity of 58.5% (95% CI: 0.464–0.704), and a specificity of 80.8% (95% CI: 0.656–0.959).Conclusions:In this cohort of late-onset FGR, DV Doppler findings above the 95th percentile and selected clinical parameters were associated with APOs. The combined model demonstrated moderate discriminative performance in identifying fetuses at higher risk of APOs; however, its predictive ability remains limited and requires further validation prior to clinical application. These findings suggest that integrated clinical and Doppler assessment may contribute to risk stratification in late-onset FGR.
Background:Patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) often experience negative emotions such as anxiety and stress, which may adversely affect treatment outcomes. Given that current emotional assessments rely primarily on subjective scales, identifying objective biomarkers for early intervention is crucial.Methods:A total of 236 female patients who underwent IVF/ICSI-ET treatment between March 2024 and March 2025 were enrolled in the study. Saliva samples were collected in a fasting state during the menstrual period and on the day of oocyte retrieval to measure salivary alpha-amylase (SAA) levels. Following sample collection, participants completed the Self-Rating Anxiety Scale (SAS) and the Fertility Quality of Life Questionnaire (FertiQoL). Treatment outcomes were subsequently followed up, and participants were categorized into a clinical pregnancy group and a non-clinical pregnancy group based on clinical pregnancy status. The impact of anxiety on treatment outcomes was then analyzed.Results:Menstrual SAA levels were significantly positively associated with SAS scores and significantly negatively correlated with the Social domain of fertility-related quality of life (p < 0.05). Menstrual SAS scores were significantly negatively correlated with total fertility-related quality of life (p < 0.05). Statistically significant differences were observed between the clinical pregnancy and non-clinical pregnancy groups in terms of menstrual SAA levels, age, cause of infertility, anxiety status, fertilization rate, number of available high-quality embryos, and number of transferred embryos (p < 0.05). Menstrual SAA levels, age, cause of infertility, and fertilization rate were independent factors that affected pregnancy outcomes (p < 0.05). The area under the curve (AUC) for menstrual SAA in predicting pregnancy failure was 0.719 (95% confidence interval [CI]: 0.655~0.783), with an optimal cutoff value of 58.25 IU/mL (sensitivity 68.8%, specificity 64.3%).Conclusions:SAA levels showed a significant positive association with anxiety in IVF/ICSI-ET patients. Elevated SAA levels may increase the risk of treatment failure in IVF/ICSI-ET patients. SAA may serve as a valuable objective biomarker for assessing stress-related fertility outcomes.
Objective: Obstetric anal sphincter injuries (OASIS) represent a serious complication of vaginal delivery that can result in chronic anal incontinence and reduced quality of life. Accurate diagnosis is essential for optimal repair and prevention of long-term morbidity. This review summarizes current evidence on the advantages of elastography as a diagnostic adjunct for the detection of OASIS. Mechanism: Elastography is an advanced ultrasound (US)-based imaging technique that quantifies tissue stiffness, enabling functional assessment of the anal sphincter complex beyond anatomical visualization. By distinguishing the mechanical properties of healthy muscle, acute tears, and fibrotic tissue, elastography may improve the detection of subtle or occult sphincter defects that conventional endoanal US may miss. Findings in Brief: Shear-wave elastography (SWE) has demonstrated moderate to good intraobserver and interobserver reliability, with reported intraclass correlation coefficients (ICC) that vary by measurement conditions. Preliminary studies indicate that greater sphincter stiffness may be protective against perineal tears, suggesting potential for risk stratification. Elastography is non-invasive, free of ionizing radiation, and suitable for repeated evaluation during recovery. However, its diagnostic superiority over standard US for high-grade OASIS remains unconfirmed, and correlations with functional outcomes, such as incontinence severity, are inconsistent. Key limitations include operator dependency, a steep learning curve, and a lack of standardized acquisition protocols. Integration with artificial intelligence (AI) could improve consistency and diagnostic accuracy. Conclusions: Elastography represents a promising adjunct to traditional imaging for the evaluation and management of OASIS. By providing quantitative, biomechanical insights into sphincter integrity, it holds potential to improve early diagnosis, guide rehabilitation, and support recovery monitoring. However, robust evidence demonstrating superiority over established imaging modalities for the diagnosis of OASIS remains limited. Larger, longitudinal studies are needed to validate the clinical utility of elastography and to standardize the use of this technique in obstetric practice.
