BACKGROUND:The postmenopausal period presents a significant challenge to women's health, characterised by vasomotor, psychological, and sleep disturbances. This systematic review and meta-analysis synthesised evidence on aromatherapy for menopausal symptoms. METHODS:We searched Cochrane Library, Web of Science, ScienceDirect, PubMed, Scopus, SID, and Google Scholar until January 2, 2026. The protocol was registered (PROSPERO: CRD420261303084). Randomised controlled trials and quasi-experimental studies were included. The Cochrane Risk of Bias tool and GRADE approach were used for quality assessment and certainty of evidence. Meta-analyses were performed using RevMan 5.3. RESULTS:Of 4435 records, 21 articles from 17 studies (n = 1347) were included. Aromatherapy significantly improved sexual function (MD: 7.05, 95% CI: 3.64-10.45), sleep quality (MD: -3.95, 95% CI: -5.94 to -1.97), overall menopausal symptoms (SMD: -1.00, 95% CI: -1.43 to -0.58), vasomotor symptoms (SMD: -0.79, 95% CI: -1.11 to -0.47), physical symptoms (SMD: -0.78, 95% CI: -1.10 to -0.46), somatic symptoms (MD: -1.34, 95% CI: -2.46 to -0.23), psychological symptoms (SMD: -0.59, 95% CI: -0.96 to -0.23), anxiety (SMD: -0.63, 95% CI: -1.10 to -0.16), and depression (SMD: -0.57, 95% CI: -0.85 to -0.28). No significant effect was found for urogenital symptoms. GRADE certainty was 'Very Low' for sexual function and sleep quality, and 'Low' for other outcomes. CONCLUSIONS:Preliminary evidence suggests that aromatherapy may be a beneficial complementary therapy for alleviating some menopausal symptoms. However, given the substantial heterogeneity, methodological limitations, and limited number of studies for subgroup analyses, firm clinical recommendations cannot be made at this time. More rigorous, large-scale, multi-centre randomised controlled trials with standardised interventions and consistent adverse event reporting are required before definitive clinical recommendations can be made.
BACKGROUND:Complex Decongestive Therapy (CDT) is the non-operative standard for breast cancer-related lymphedema (BCRL), but many patients experience persistent subcutaneous stiffness, pain, and restricted mobility. This study systematically reviews the safety and clinical efficacy of Meridian Sinew Tuina (MST) protocols for BCRL. METHODS:Global and regional databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP) were searched from inception to January 15, 2026, with alerts monitored through April 30, 2026. Randomised controlled trials (RCTs) evaluating MST (deep tissue mobilisation along the six-hand meridian sinew [Jingjin] lines via plucking, kneading, and pressing) were included. Two reviewers independently extracted data, evaluated risk of bias using Cochrane RoB 2, and assessed evidence certainty via GRADE using a random-effects model. RESULTS:Fifteen RCTs were included. For the primary anthropometric outcome, MST significantly reduced upper limb circumference compared to controls (SMD = 1.59; 95% CI: 1.44 to 1.74; Z = 20.81; p < 0.0001; I2=0.0%; N = 924; GRADE: Moderate certainty). The Clinical Response Efficacy Rate (≥ 30% swelling reduction and symptom relief) favoured MST (RR = 1.69; 95% CI: 1.54 to 1.87; Z = 10.62; p < 0.0001; I2=0.0%; N = 1,114; GRADE: Moderate certainty). Trial Sequential Analysis confirmed sample size sufficiency. For secondary outcomes (N = 924; GRADE: Low to Very Low certainty due to performance bias and clinical heterogeneity), MST showed favourable 3-month improvements in DASH functional scores (SMD = -1.81; 95% CI: -2.11 to -1.51; I2=45.1%), pain intensity (SMD = -2.44; 95% CI: -2.93 to -1.95; I2=50.4%), and quality of life (SMD = 1.04; 95% CI: 0.79 to 1.29; I2=0.0%). No serious adverse events occurred. CONCLUSIONS:MST protocols are associated with favourable short- and mid-term reductions in upper limb swelling. However, confidence is tempered by unblinded performance bias and control group variations. MST cannot be unconditionally recommended for standalone implementation but represents a promising, optional supportive adjunctive intervention within oncological rehabilitation.
BACKGROUND:This study aimed to identify predictors and develop a multivariable prediction model for Category II and III foetal heart rate (FHR) patterns in parturients undergoing labour epidural analgesia (LEA). METHODS:A retrospective cohort study of 237 parturients receiving LEA was conducted. To address the multicollinearity of 18 intrapartum variables, least absolute shrinkage and selection operator (LASSO) regression and cross-validation were used for feature selection. A predictive nomogram was constructed and internally validated. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration plots, and Decision Curve Analysis (DCA). RESULTS:Abnormal FHR patterns (Category II and III) occurred in 168 (70.9%) parturients. The LASSO algorithm identified 11 predictors. Multivariable logistic regression demonstrated that maternal intrapartum temperature (OR = 3.518), initial LEA bolus count (OR = 3.625), body mass index (BMI), and oxytocin dosage were independent predictors associated with abnormal FHR patterns. The constructed nomogram demonstrated good discrimination (AUC = 0.800) and good calibration. DCA demonstrated potential clinical net benefit across a wide range of threshold probabilities (0.02-0.99). CONCLUSIONS:We developed and internally validated an 11-variable nomogram (AUC = 0.800) to predict abnormal FHR patterns during LEA. By integrating routinely available clinical variables, the nomogram facilitate early risk stratification and support individualised intrapartum management. TRIAL REGISTRATION:Clinical trial registration: (https://www.chictr.org.cn ChiCTR2300073493; registered 12th July 2023).
BACKGROUND:Functional constipation (FC) is a common complaint during pregnancy and has been reported to be associated with physical activity and dietary intake. However, previous studies have reported inconsistent findings. Therefore, this study aimed to determine the prevalence of FC and examine its association with physical activity and dietary intake among pregnant women. METHOD:In this cross-sectional study, 381 healthy pregnant women attending urban health centres in Tabriz, Iran, between January 2024 and February 2025, were selected using a multistage cluster sampling method. FC was diagnosed according to the Rome IV criteria. Data were collected through face-to-face interviews using the International Physical Activity Questionnaire (IPAQ) and the Food Frequency Questionnaire (FFQ). Multivariable Generalised Estimating Equations (GEE) analysis was performed to identify factors associated with FC. RESULTS:The overall prevalence of FC throughout pregnancy was 37%. In the first trimester, 41 out of 73 women (56%) had FC, while in the second trimester 53 out of 146 women (36%), and in the third trimester 47 out of 162 women (29%) were affected. Multivariate GEE indicated that both higher dietary fibre intake (aOR= 0.88, 95%CI 0.86-0.91, p < 0.001) and higher fluid intake (aOR= 0.59, 95%CI 0.52-0.67, p < 0.001) were associated with a reduced risk of FC. A normal BMI was associated with a lower risk of FC (aOR= 0.35, 95% CI 0.16-0.77, p = 0.009), whereas, secondary education was associated with a higher risk (aOR= 2.81, 95%CI 1.33-5.95, p = 0.007). Physical activity (aOR= 1.00; 95%CI 1.00 to 1.01; p = 0.168), and other demographic characteristics (p > 0.05) were not independently associated with FC after adjustment. CONCLUSION:FC is highly prevalent during pregnancy and may adversely affect women's quality of life. Higher dietary fibre and fluid intake were associated with lower odds of FC, highlighting the importance of healthy lifestyle behaviours during pregnancy. Prospective longitudinal studies are warranted to confirm these findings.
BACKGROUND:Platelet-rich plasma (PRP) has been proposed as an adjuvant treatment in reproductive medicine. While most evidence refers to blind intrauterine instillation, subendometrial administration under hysteroscopic guidance allows targeted delivery under direct visualisation. This systematic review aimed to synthesise the available evidence on hysteroscopic PRP administration and its impact on clinical medically assisted reproduction (MAR) outcomes. METHODS:A systematic search was conducted from inception to December 2025 across major databases. Studies were included if they evaluated hysteroscopic PRP administration in women undergoing MAR, comparing reproductive outcomes between treated and control groups. RESULTS:Out of 142 records, 3 studies met the inclusion criteria. Study populations were heterogeneous and included women with refractory thin endometrium and/or a history of implantation failure. Hysteroscopic PRP administration protocols varied in timing, technique, and dosage. In a prospective case-control study, hysteroscopic intraendometrial PRP injection at a depth of 2-3 mm in the four uterine walls, using an ovum aspiration needle, on days 11-13 of the cycle prior to euploid frozen embryo transfer (ET), was associated with higher implantation (IR), clinical pregnancy (CPR), and live birth rates (LBR) compared with standard therapy. Conversely, no significant differences in CPR, miscarriage rate, or LBR were observed in an observational study evaluating a single intraendometrial PRP injection (35-40 mL, 2-3 mm depth), administered via endoscopic needle on days 6-8 of the menstrual cycle preceding frozen ET, alone or after electrical impulse therapy. A randomised controlled trial in women undergoing intrauterine insemination reported a significant improvement in CPR following hysteroscopic subendometrial PRP instillation in the four uterine walls (1.0 mL each). CONCLUSIONS:Current literature on hysteroscopic PRP administration in reproductive medicine is limited, and robust conclusions cannot yet be drawn. Well-designed randomised controlled trials with standardised protocols are needed to clarify its clinical role.
BACKGROUND:Pain control during operative outpatient hysteroscopy remains a clinical challenge, with the paracervical block (PCB) showing inconsistent efficacy. The King's Mill Anterior-Posterior and Transverse (KAPT) block targets the Lee-Frankenhauser plexus within the uterosacral ligament complex, where the highest density of uterine and cervical sensory fibres lies. We compared the KAPT block with the PCB in operative outpatient hysteroscopy. METHODS:Single-centre, participant- and outcome assessor-blinded randomised controlled trial in a UK district general hospital. Forty-eight women undergoing operative outpatient hysteroscopy were randomised 1:1 to the KAPT block or the PCB, each delivered with 10 ml of prilocaine. Pain was measured on a 10-point Visual Analogue Scale (VAS) during the procedure and 10 minutes post-procedure (co-primary endpoints), and during cervical dilatation (exploratory). Analyses used the Mann-Whitney U test on an intention-to-treat basis, with Hodges-Lehmann median differences, percentile bootstrap 95% confidence intervals, and a hierarchical fixed-sequence testing strategy. RESULTS:Median intra-procedural VAS was 1 (IQR 0 to 3) with the KAPT block versus 2 (IQR 1 to 6) with the PCB (Hodges-Lehmann median difference -1.00, 95% CI -3.00 to 0.00; p = 0.040). At 10 minutes post-procedure, median VAS was 0 (IQR 0 to 1.25) versus 2 (IQR 0 to 3.25) (median difference -1.00, 95% CI -2.00 to 0.00; p = 0.011). Both co-primary endpoints reached significance under hierarchical testing. Cervical dilatation pain did not differ significantly (p = 0.146). Satisfaction was 100% in both arms; willingness to recommend was 100% (KAPT) versus 95.8% (PCB). No serious adverse events occurred. CONCLUSIONS:The KAPT block was associated with lower intra-procedural and post-procedural pain than the PCB, with effect sizes consistent with a clinically meaningful difference. These findings support the KAPT block as a superior, anatomically targeted alternative to the PCB and justify evaluation in a larger multicentre trial.Trial registration: ISRCTN15619382.
BACKGROUND:Human papillomavirus (HPV) infection represents a major public health concern worldwide. Inflammatory indicators have been associated with various disease conditions. However, the associations of platelet-to-lymphocyte ratio (PLR), platelet (PLT), and lymphocyte (LYM) with HPV infection remain unclear. This study aimed to investigate the relationships between PLR, PLT, LYM, and HPV infection. METHODS:This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. PLR was calculated as PLT/LYM. Multivariable logistic regression was performed to evaluate the associations between PLR and HPV infection. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC). Restricted cubic spline (RCS) analysis was applied to assess the association between LYM and HPV infection, and subgroup analyses with interaction tests were conducted. RESULTS:Among 5,415 adult females included in this study, 2,301 had HPV infection, and 3,114 did not. When PLR was analysed as a continuous variable, multivariable logistic regression showed a significant inverse association with HPV infection (odds ratio [OR] = 0.99). After categorising PLR into quartiles, participants in the highest PLR quartile (Q4: 143.70-477.14) showed lower odds of HPV infection compared with those in the lowest quartile (Q1: 12.86-92.60). The AUC values were 0.53, 0.64, and 0.72 for models I, II, and III, respectively. No significant association was observed between PLT and HPV infection. In contrast, LYM showed a significant positive association with HPV infection, with RCS analysis indicating a linear relationship. Interaction analysis suggested that this association varied according to PIR. CONCLUSION:Higher PLR was associated with lower odds of HPV infection, whereas higher LYM levels were associated with higher odds of HPV infection. These findings provide additional evidence regarding the associations between inflammatory indicators and HPV infection.
BACKGROUND:Cross-sectional associations of high-density lipoprotein-related inflammatory indices (HIRIs) - white-blood-cell-, lymphocyte-, monocyte-, neutrophil-, and platelet-to-high-density lipoprotein cholesterol (HDL-C) ratios (WHR, LHR, MHR, NHR, and PHR) - with self-reported gynaecological cancer (GC) history are unclear. METHODS:We analysed 12,955 women from six National Health and Nutrition Examination Survey cycles (2007-2008 to 2017-March 2020 pre-pandemic), including 369 with GC history; cervical cancer (CC), 184; uterine cancer (UC), 127; and ovarian cancer (OC), 70. Primary analyses used survey-weighted logistic regression and restricted cubic spline (RCS) models with Benjamini-Hochberg false discovery rate (BH-FDR) correction; component-resolved and sensitivity analyses were supportive, and other secondary analyses were exploratory. RESULTS:In fully adjusted models, overall GC history was nominally associated with PHR (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.01-1.59; p = 0.045), the highest NHR tertile (OR 1.67, 95% CI 1.12-2.50; p = 0.013), and the highest WHR tertile (OR 1.56, 95% CI 1.04-2.34; p = 0.032). Subtype analyses showed selected nominal patterns, including an NHR tertile gradient for CC and WHR/LHR/PHR associations for UC; OC estimates were less stable. No primary logistic or RCS result survived BH-FDR correction. In supportive component-resolved analyses, the OC WHR white-blood-cell component met the BH-FDR threshold within the prespecified WHR-specific eight-test family (OR 2.40, 95% CI 1.35-4.25; p = 0.003; q = 0.025). CONCLUSIONS:HIRIs showed modest, heterogeneous cross-sectional associations with self-reported GC history, but the primary findings were not retained after multiplicity correction. These ratios appear to reflect both shared HDL-C and numerator-cell information and should be interpreted as descriptive, hypothesis-generating phenotypes rather than diagnostic, prognostic, or causal markers.
BACKGROUND:Endometrial carcinoma (EC) presents commonly with abnormal uterine bleeding, and definitive diagnosis requires invasive endometrial biopsy. Haematological inflammatory markers-including the neutrophil-to-lymphocyte ratio (NLR), platelet distribution width (PDW), and the systemic immune-inflammation index (SII)-have been proposed as adjuncts in the differential diagnosis of endometrial pathologies. We evaluated whether these markers can independently discriminate EC from endometrial hyperplasia with atypia/endometrial intraepithelial neoplasia (EHA/EIN), endometrial hyperplasia without atypia (EH), and normal endometrium, after adjustment for age and other confounders. METHODS:Data from 238 patients who underwent endometrial biopsy for abnormal uterine bleeding between 2015 and 2020 were retrospectively analysed. Patients were categorised as EC (n = 74), EHA/EIN (n = 28), EH without atypia (n = 66), and controls with normal endometrium (n = 70). Haematological parameters, NLR, platelet-to-lymphocyte ratio (PLR), and SII were derived from preoperative complete blood count results. Univariable comparisons used the Kruskal-Wallis test with Dunn's post-hoc pairwise comparisons. Hierarchical multivariable logistic regression models were fitted, adjusting sequentially for age, menopausal status, and (where available) diabetes mellitus and hypertension. Receiver operating characteristic (ROC) analysis was performed for markers showing significant univariable discrimination, and PDW was analysed in inverted form (1-PDW direction) to reflect its inverse association with malignancy. RESULTS:NLR and SII were significantly elevated, and PDW was significantly reduced, in EC patients compared with controls (all p < 0.05). After adjustment for age and menopausal status, NLR (adjusted OR [aOR] 2.06, 95% CI 1.04-4.09; p = 0.037), SII per 100 units (aOR 1.49, 95% CI 1.09-2.04; p = 0.014) and PDW (aOR 0.93, 95% CI 0.89-0.96; p < 0.001) remained independently associated with EC versus controls. By contrast, after adjustment for age, NLR and SII no longer independently discriminated EC from EH (NLR aOR 1.27, p = 0.245; SII aOR 1.14, p = 0.165), suggesting that age accounts for a substantial proportion of the apparent univariable differences. In ROC analysis with PDW values inverted, AUCs were 0.79 (95% CI 0.72-0.87) for PDW, 0.68 (95% CI 0.59-0.76) for NLR, and 0.62 (95% CI 0.52-0.70) for SII against the control group. No marker-adjusted or unadjusted-significantly distinguished EC from EHA/EIN. CONCLUSIONS:NLR, SII, and (low) PDW are independently associated with EC compared with normal endometrium, even after age and menopausal status adjustment, but their performance is modest and they do not independently discriminate EC from premalignant endometrial lesions. Histopathological evaluation remains indispensable. These markers may inform risk stratification but are not sufficient as standalone tests.
Pregnancy is now recognised as a dynamic gestational ecosystem where maternal microbial communities influence maternal physiology, obstetric outcomes, and offspring health. This review synthesises recent advances in understanding the maternal microbiome’s role in this process.We examine the spatial and temporal dynamics of the maternal microbiome, highlighting niche-specific remodelling in the gut, vagina, and oral cavity, and critically appraise the controversial evidence for a placental microbiome. We explore cutting-edge mechanistic pathways, including immunomodulation via short-chain fatty acids (SCFAs) and histamine, metabolic cross-talk through bile acids and neurotransmitters, vascular disruption via metabolites like trimethylamine N-oxide (TMAO), and the role of biofilm-associated infection. These pathways link microbial dysbiosis to adverse outcomes such as preterm birth, preeclampsia, and gestational diabetes. Furthermore, we detail how maternal microbes program offspring metabolic, immune, and neurodevelopmental trajectories through vertical transmission and metabolite-mediated epigenetic regulation.This review shows that the maternal microbiome is a modifiable axis that influences pregnancy outcomes and offspring health through immune, metabolic, and epigenetic pathways. Translation to practice will require stronger causal evidence, contamination-aware low-biomass methods, and carefully designed intervention trials, including next-generation probiotics, postbiotics, and precision lifestyle strategies.
BACKGROUND:Vaginitis is a common gynaecologic condition in patients assigned female at birth in the United States, most often caused by bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or trichomoniasis vaginalis (TV). Symptoms such as discharge, irritation, and burning often overlap. Symptom-based diagnosis is frequently inaccurate, with correct identification in only about half of cases. Empiric treatment without confirmatory testing remains common and can drive inappropriate therapy and antimicrobial resistance. Uninsured populations face higher infection burdens and barriers to care, yet data on vaginitis testing outcomes in student-run free clinics (SRFCs) are limited. METHODS:We conducted an IRB-approved retrospective chart review of patients receiving vaginitis testing at a no-cost SRFC affiliated with a Midwestern academic medical centre between October 2019 and November 2023. 104 testing encounters met inclusion criteria for BV, VVC, or TV testing. Demographics, age, and symptom status were extracted from the electronic medical record. Encounters were categorised as having documented vaginitis symptoms or no documented symptoms at the time of testing. All tests used transcription-mediated amplification. Proportional-difference chi-square tests compared results by symptom status, and logistic regression assessed associations between age and positive test results. RESULTS:The sample was predominantly comprised of patients assigned female at birth with a mean age of 31.1 years; 38% identified as Black. No significant differences were observed in positive or negative BV, VVC, or TV test results between encounters with and without documented vaginitis symptoms. Comparisons of positive VVC and TV results were limited by the small number of positive cases. Age was not associated with testing positive for BV, VVC, or TV. CONCLUSIONS:Documented symptom status did not consistently correspond with organism-specific test results in this uninsured clinic population. Findings among patients without documented symptoms should be interpreted cautiously because testing was frequently bundled and symptom status was determined retrospectively.
BACKGROUND:We aimed to investigate the influencing factors for recurrence of International Federation of Gynaecology and Obstetrics (FIGO) type II submucosal myoma with a diameter of 4-5 cm following hysteroscopic myomectomy, and to establish an individualised prediction model for the risk of postoperative 3-year recurrence. METHODS:In this single-centre retrospective cohort study, patients undergoing hysteroscopic myomectomy between January 2017 and June 2025 were included. Recurrence-free survival was assessed using the Kaplan-Meier method. Candidate variables were initially screened using LASSO-Cox regression with 10-fold cross-validation for λ selection, followed by multivariable Cox regression. Multicollinearity among candidate predictors was assessed using variance inflation factors. A nomogram was constructed to predict 3-year recurrence risk. Model performance was evaluated by bootstrap validation, including discrimination (C-index), calibration (calibration curve and Brier score), and clinical utility (decision curve analysis). RESULTS:A total of 120 patients were included, and 30 recurrences occurred, mainly within 24 months after surgery. Multivariate Cox analysis identified larger myoma diameter, multiple myomas, staged operation, and longer operation time as independent risk factors, whereas older age and postoperative gonadotropin-releasing hormone agonist (GnRHa)/dienogest therapy were protective factors (P < 0.05). The nomogram showed favourable discrimination, calibration, and clinical net benefit. CONCLUSIONS:Recurrence after hysteroscopic myomectomy was associated with tumour characteristics, surgical complexity, and postoperative hormonal therapy. The nomogram showed favourable performance, with a bootstrap-corrected C-index of 0.811, a 3-year Brier score of 0.099, and clinical net benefit across threshold probabilities of approximately 0.05-0.45. This exploratory model may support individualised 3-year recurrence risk stratification and guide follow-up and adjuvant treatment planning.
Pregnancy provides a unique opportunity for early cardiovascular prevention by revealing maternal vascular and cardiometabolic vulnerability. Placental growth factor (PlGF), uterine artery Doppler and emerging inflammatory biomarkers may improve the identification of placental dysfunction and adverse pregnancy outcomes. However, their ability to predict long-term maternal cardiovascular risk remains uncertain. PlGF performance varies according to gestational age, clinical setting, population and assay platform, while inflammatory biomarkers such as S100A8/A9 remain investigational. Importantly, detecting placental dysfunction, recognising an adverse pregnancy outcome as a cardiovascular risk marker and demonstrating incremental long-term prognostic value are distinct concepts. Current evidence does not support biomarker-guided postpartum cardiovascular management. Obstetric history should therefore remain the principal trigger for cardiovascular counselling and follow-up. Prospective studies should determine whether standardised angiogenic and inflammatory biomarkers improve prediction beyond clinical and obstetric characteristics and whether their use translates into better cardiovascular outcomes.
BACKGROUND:Adenomyosis causes severe dysmenorrhoea and menorrhagia. While the Levonorgestrel-Releasing Intrauterine System (LNG-IUS) is a highly effective conservative treatment, its success is frequently compromised by high expulsion rates (15%-37.5%) caused by uterine enlargement and cavity distortion. This review evaluates the principles, clinical efficacy, and safety of emerging intrauterine fixation techniques designed to prevent LNG-IUS downward displacement and expulsion. METHODS:A comprehensive literature search was conducted across PubMed, Web of Science, and Google Scholar for articles published between January 2000 and February 2026. The review synthesised data from observational studies, retrospective cohorts, and controlled trials focusing on the surgical modification and stabilisation of the LNG-IUS in patients with adenomyosis. RESULTS:Current intrauterine fixation strategies are broadly classified into hysteroscopic suture fixation (utilising non-absorbable sutures to anchor the device to the myometrium) and non-suture fixation (encompassing combined frameless IUD fixation, device-modified anchoring, and direct tail-embedding). Current literature indicates that these techniques significantly reduced expulsion rates, generally to below 7%, compared to conventional placement failure rates that can exceed 30%. This mechanical stabilisation maintains the device's pharmacological efficacy, yielding sustained improvements in dysmenorrhoea and reducing menstrual blood loss. Nonetheless, these procedures introduce new clinical and safety challenges. Key concerns include off-label regulatory issues regarding manual device modification, altered sonographic imaging profiles, increased removal complexity requiring secondary hysteroscopic intervention, and theoretical long-term risks associated with myometrial micro-scars. CONCLUSION:Intrauterine fixation significantly mitigates LNG-IUS expulsion in adenomyosis. While highly effective, the manual and invasive nature of these techniques necessitates careful patient selection and rigorous safety monitoring. Future research must prioritise large-scale randomised controlled trials. Ultimately, clinical practice should transition from manual surgical modifications towards the standardised industrial development of next-generation LNG-IUS devices equipped with inherent anti-expulsion features.
The authors present a case of a successful two-stage hysteroscopic resection of a submucosal fibroid and share helpful hints and tips for a successful procedure.A 41 year old female presented with subfertility and heavy, prolonged periods. An MRI scan confirmed a submucosal fibroid measuring 40 mm arising from the posterior wall and projecting in the endometrial cavity by more than 50% (FIGO type 1). A hysteroscopic resection removed approximately 70% of the fibroid. The procedure had to be stopped due to loss of pressure and suboptimal view. Following a course of Prostap, a second hysteroscopic procedure was undertaken 3 months later successfully resecting the remainder of the fibroid.The video demonstrates the importance of case selection with good preoperative planning and imaging, e.g., MRI, to assess the feasibility of resection. Large fibroids extending towards the serosa of the uterus may not be suitable cases for hysteroscopic resection. There is discussion about optimal dilation of the endocervical canal, improving visualisation and trouble shooting techniques if this is suboptimal during the operation. Attention is also given to safe surgical technique and the use of a post-surgical adhesion prevention barrier. Reference is made to the BSGE/ESGE guidance on fluid management and systems to prevent overload, as well as consideration of a two-step procedure should be considered for larger fibroids if necessary.
BACKGROUND:Ovarian tumours are common among women, with ultrasound serving as the primary diagnostic tool. The O-RADS system classifies tumours into categories 1-5 based on malignancy risk. Category 4 tumours are the most challenging to diagnose, as they may be either benign or malignant, often leading to unnecessary surgery. METHODS:This prospective study enrolled 723 patients with pathologically confirmed adnexal masses from July 2023 to May 2026. A total of 805 masses were included. All underwent standardised ultrasound with dynamic cine loop storage. Category 4 masses were subclassified into 4a (low-risk) and 4b (high-risk) based on locule count (>10 as high-risk) and colour score. Pathological results served as the gold standard. RESULTS:Among 225 O-RADS Category 4 masses, the malignancy rate was 19.1% (43/225). The 4b subclass (86 masses) had a malignancy rate of 45.3% (39/86), significantly higher than the 4a subclass (139 masses, 2.9% (4/139)). Masses with >10 locules showed a 53.3% malignancy rate, while those with colour score 3-4 had a 38.6% malignancy rate. The combined model achieved an area under the curve of 0.956, significantly outperforming single predictors. Decision curve analysis indicated that this model could reduce unnecessary surgeries by approximately 18%. CONCLUSION:The modified O-RADS model effectively stratifies malignancy risk in adnexal masses, improving diagnostic accuracy and potentially reducing unnecessary surgical interventions.
Background Observational studies have established a strong epidemiological connection between obesity and an increased risk of pre-eclampsia (PE). However, the genetic mechanisms underlying this comorbidity remain largely unexplored. In this study, we conducted a comprehensive cross-trait analysis to elucidate the shared genetic architecture between various adiposity-related traits and PE.Methods Using the genome-wide association study (GWAS) statistics, we first evaluated the overall genetic overlap between adiposity-related traits and PE through multiple approaches, including linkage disequilibrium score regression (LDSC), high-definition likelihood inference (HDL), genetic covariance analysis, and pleiotropy and annotation methods. Causal relationships were then evaluated through bi-directional Generalised Summary-data-based Mendelian Randomisation (GSMR). Candidate pleiotropic loci were identified using a robust suite of analytical tools, including cross-phenotype association analysis, Multi-Trait Analysis of GWAS (MTAG), pleiotropic analysis under a composite null hypothesis, a pleiotropy-informed conditional false discovery rate (pleioFDR) framework, and Functional Mapping and Annotation (FUMA). Bayesian colocalisation (COLOC) was subsequently applied to these loci to pinpoint independent, significant causal single nucleotide polymorphisms (SNPs). To identify and validate shared genes, we performed tissue enrichment analysis, using Multi-marker Analysis of Genomic Annotation, and integrated SPrediXcan with COLOC. Finally, gene functional enrichment was characterised via Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) enrichment analyses.Results We identified significant positive genetic correlations and robust causal associations between adiposity-related traits and PE-related diseases. Our analyses revealed 35 independent significant causal SNPs, 32 enriched tissues, and 7 shared high-confidence genes supported by COLOC analysis.Conclusions Collectively, our study indicates a genetic correlation and common risk genes, linking adiposity-related traits to PE-related diseases. These findings offer novel insights into the biological mechanisms underlying this comorbidity, highlighting promising targets for future mechanistic studies and stratified preventative strategies.
Background Recurrent missed miscarriage (RMM) is heterogenous and emotionally burdensome. Low-molecular-weight heparin (LMWH) plus low-dose aspirin improves live-birth rates in women with obstetric antiphospholipid syndrome (APS), but the value of the use of LMWH in APS-negative RMM with and without confirmed coagulation disorders remains controversial, and optimal dosing frequency is uncertain.Methods We performed a narrative synthesis of randomised controlled trials (notably ALIFE and ALIFE2), Cochrane systematic reviews, pharmacokinetic studies, and national/international guidelines (RCOG, ESHRE). Emphasis was placed on live-birth outcomes, trial design limitations (including inclusion of chromosomally abnormal losses), pharmacokinetics relevant to once-daily (OD) versus twice-daily (BD) regimens, and safety/tolerability data.Results Robust evidence supports LMWH plus low-dose aspirin in improving live-birth rates in women with APS. In APS-negative populations, randomised controlled trials and meta-analyses show no reproducible live-birth benefit; interpretation is limited by clinical heterogeneity, underpowering and failure to exclude chromosomally abnormal losses, which account for up to half of early miscarriages. Notably, these trials almost exclusively used once-daily LMWH. Pharmacokinetic data indicate that twice-daily dosing yields more stable anti-Xa levels than once-daily dosing; however, this is a pharmacokinetic rationale only, and no adequately powered trial has tested whether it improves clinical outcomes.Conclusions Routine LMWH for APS-negative RMM is not supported outside clinical trials. Key knowledge gaps include the effect of pre-randomisation genetic stratification (euploid-only cohorts), directly comparing OD vs BD LMWH regimens, and incorporation of patient-centred and health-economic outcomes. Well-designed, adequately powered trials with genetic and phenotypic enrichment and embedded pharmacokinetic sub-studies are required to resolve clinical equipoise.
Background To compare sleeve gastrectomy, semaglutide therapy, and the Diet, Exercise, Accompany and Refresh (DEAR) weight management programme for weight control, metabolic improvement, and oncological outcomes in patients with endometrial cancer receiving fertility-sparing treatment.Methods In this prospective observational study, 53 patients received sleeve gastrectomy (n = 10), semaglutide therapy (n = 23), or the DEAR programme (n = 20) after multidisciplinary assessment and shared decision-making. Anthropometric and metabolic measures and tumour response were assessed over two years.Results At 1 year, all groups lost weight; the sleeve gastrectomy group had the largest body mass index reduction compared with the semaglutide group (difference = 4.04 kg/m2, p < 0.05) and the DEAR group (difference = 2.12 kg/m2, p < 0.05). By 2 years, weight regain was less frequent in the DEAR group (14.3%) than in the semaglutide (55.6%) and sleeve gastrectomy (66.7%) groups (p = 0.037). The DEAR group showed more stable metabolic improvements and the highest complete tumour remission rate (85.0%), followed by the semaglutide group (73.9%) and the sleeve gastrectomy group (60.0%).Conclusion Sleeve gastrectomy produced rapid short-term weight loss, whereas the DEAR programme showed better medium-term weight maintenance, metabolic stability, and tumour response. Integrated lifestyle support may be a useful medium-term strategy for patients seeking fertility preservation.
