مامایی و بارداری
مقالهها، منابع و پژوهشهای تازه حوزه مامایی و بارداری
ورود به زیرشاخهنقشه موضوعی
جستوجوی دقیقزنان، زایمان و کودکان
سلامت مادر، جنین، نوزاد، کودک و نوجوان
زیرشاخهها
برای رسیدن به فهرست متمرکزتر، یک مسیر تخصصی را انتخاب کنید.
بیماریهای زنان
مقالهها، منابع و پژوهشهای تازه حوزه بیماریهای زنان
ورود به زیرشاخهپزشکی تولیدمثل و ناباروری
مقالهها، منابع و پژوهشهای تازه حوزه پزشکی تولیدمثل و ناباروری
ورود به زیرشاخهطب مادر و جنین
مقالهها، منابع و پژوهشهای تازه حوزه طب مادر و جنین
ورود به زیرشاخهنوزادان
مقالهها، منابع و پژوهشهای تازه حوزه نوزادان
ورود به زیرشاخهکودکان
مقالهها، منابع و پژوهشهای تازه حوزه کودکان
ورود به زیرشاخهطب نوجوانان
مقالهها، منابع و پژوهشهای تازه حوزه طب نوجوانان
ورود به زیرشاخهجراحی کودکان
مقالهها، منابع و پژوهشهای تازه حوزه جراحی کودکان
ورود به زیرشاخهتازهترین رکوردها
شواهد زنان، زایمان و کودکان
PubMed2026
[THE CENTERS OF FEMALE HEALTH: INTERNATIONAL EXPERIENCE AND THE MOSCOW INNOVATIVE MODEL].
The global transformations in health care system, directed from reactive medicine to proactive and preventive model bring to the forefront issues of protection of female health. The health of woman is not only fundamental basis, but also key factor of social economic well-being of society, demographic stability and health of future generations. The traditional fragmented model of provision of obstetric gynecological care, focused mainly on treatment of already occurred pathologies and pregnancy management, demonstrates its inefficiency in the context of modern challenges: increase of chronic noncommunicable diseases, psycho-emotional loads and need of integration of reproductive health into general context of well-being of woman at all stages of her life. In the Russian Federation, the problem of modernization of obstetric gynecological service and, in particular, women consultations, is especially acute. Historically, The historically established system is often criticized for bureaucratization, insufficient focus on prevention and disparity between various levels of medical care. In this regard, emergence and implementation of new regional standards, in particular, metropolitan standard of obstetric gynecological care and Centers of Female Health is unique case requiring detailed scientific analysis and comparison with international advanced experience. The actuality of the study is conditioned by increasing need in developing new paradigm of medical care support of women, built on principles of complexity, continuity, personalization and orientation on prevention. The Centers of Female Health, integrating large spectrum of services, from screenings and diagnostics to psychological support and training programs, are considered by world community as gold standard of organization of such care.
PubMed2026
[THE CHARACTERISTICS OF COURSE OF PREGNANCY RESULTED FROM EXTRA-CORPOREAL IMPREGNATION AGAINST THE BACKGROUND OF GESTATIONAL DIABETES MELLITUS DEPENDING ON TERMS OF MANIFESTATION].
The pregnancy that occurred due to in vitro fertilization is characterized by higher risk of development of gestational diabetes mellitus. The purpose of the study was to investigate course and outcomes of pregnancy resulted from in vitro fertilization in women with gestational diabetes mellitus, depending on time of its manifestation. The analysis of course of pregnancy, childbirth and condition of newborns in 179 women with gestational diabetes mellitus under pregnancy resulted from in vitro fertilization was carried out. It is established that early manifestation of gestational diabetes mellitus is associated with older age of pregnant women, higher rate of birth of large fetus in anamnesis, higher body mass index, more frequent prescription of insulin therapy to treat gestational diabetes mellitus, higher rate of development of early threatened miscarriage, isthmic cervical insufficiency, anemia, chronic arterial hypertension, gestational arterial hypertension, moderate preeclampsia, severe preeclampsia, premature normally placed placenta detachment, fetal growth retardation, chronic intrauterine fetal hypoxia, diabetic fetopathy, prenatal rupture of amniotic fluid, premature birth, more frequent birth of large fetus, development of fetal renal pyelectasia. The female patients with late manifestation of gestational diabetes mellitus had higher level of fasting plasma glycemia, frequent development of placenta previa, polyhydramnios, pathological and insufficient gain of body mass during pregnancy, dis-coordination of labor and clinically narrow pelvis during labor, more frequent operative delivery and early delivery. The gestational diabetes mellitus, developed both in early and late periods, complicates the course and childbirth under pregnancy resulted from in vitro fertilization, adversely affects state of the newborn. The study in depth is needed to establish possible mechanisms of development of gestational diabetes mellitus in this cohort of women with implementation of screening examinations and determination of further tactics of management of pregnancy depending on time of its manifestation.
PubMed2026
[The Legal Regulation of Refusal of Medical Organizations and Physicians From Giving Service of Interruption of Pregnancy (Abortion) to Women in Countries of World Community].
The problem of availability of abortion services for women in countries of world community is not only not losing its importance, but is undergoing new stage of actualization, since it has no clear understanding and is often raised in the context of solving demographic problems of aging society. At the same time, analysis reveals vulnerability of position of those using religious context in womans self-determination regarding disposal of her own body and right to refuse compulsion to terminate her pregnancy by physiological childbirth without her psychological, social and economic readiness and public support. Referring to various testimonies and sources, we appeal to necessity of working out common criteria to ensure womens access to medical care related to procedure of abortion in order to reduce mortality from diseases associated with self-abortions menacing live and health of women. The issues considered in the study may affect various spheres of social, medical and legal field and have wide area of practical implementation. The purpose of the study is to identify causes and to establish consequences of womens limited access to abortion services, as well as legal and ethical aspects of overcoming these restrictions.
PubMed2026
Clinical efficacy and safety of indomethacin-gyneFix IUD combined with a levonorgestrel-releasing intrauterine system in patients with adenomyosis and different uterine cavity depths.
BACKGROUND: Adenomyosis is commonly associated with dysmenorrhea and heavy menstrual bleeding. Although the levonorgestrel-releasing intrauterine system (Mirena, LNG-IUS) is recommended as a first-line conservative treatment, device displacement or expulsion remains a major limitation, especially in patients with enlarged uteri or deep uterine cavities. OBJECTIVES: To evaluate the clinical efficacy and safety of the Indomethacin-GyneFix IUD (GyneFix IUD) combined with LNG-IUS in patients with adenomyosis and to assess whether uterine cavity depth influences device stability. METHODS: In this single-center prospective randomized controlled trial, 270 patients with adenomyosis were randomly assigned in a 1:1:1 ratio to the GyneFix IUD + LNG-IUS group, the ring IUD + LNG-IUS group, or the LNG-IUS-alone group (90 patients each). The primary endpoint was the rate of device displacement/expulsion at 6 months. Secondary endpoints included changes in visual analogue scale (VAS) scores, pictorial blood loss assessment chart (PBAC) scores, uterine volume, hemoglobin (Hb), serum CA125, adverse events and patient acceptance. Subgroup analysis was performed according to uterine cavity depth (≤ 9cm vs. >9 cm). RESULTS: At 6 months, the displacement/expulsion rate was significantly lower in the GyneFix IUD + LNG-IUS group (2.22%) than in the ring IUD + LNG-IUS group (10.00%) and the LNG-IUS-alone group (18.89%) (χ2=13.468, P<0.001). All three groups showed significant improvement in dysmenorrhea, menstrual blood loss, Hb and CA125 compared with baseline, without significant between-group differences (all P>0.05). Adverse event rates were comparable among groups (all P>0.05). Patient willingness to choose the same treatment again (95.12%) and willingness to recommend it (90.24%) were significantly higher in the GyneFix IUD + LNG-IUS group. In patients with uterine cavity depth >9 cm, the stability advantage of this strategy was more pronounced. CONCLUSION: GyneFix IUD combined with LNG-IUS significantly reduces device displacement/expulsion in adenomyosis, particularly in patients with deeper uterine cavities, while maintaining comparable symptom relief and safety. It may represent a more stable and acceptable long-term conservative treatment option.
PubMed2026
Effect of SJAMP on mTOR/p70S6K signaling pathway and invasion and migration ability of HeLa cells in cervical cancer.
BACKGROUND: SJAMP, a natural polysaccharide compound, has demonstrated significant inhibitory effects on various tumor models. Whether it plays a role in cervical cancer is unclear. OBJECTIVES: To explore the effects of SJAMP on the mTOR/p70S6K signaling pathway and the invasion and migration abilities of cervical cancer HeLa cells. METHODS: The HeLa cells were divided into blank/solvent/polymer control groups and 1.2, 3.2 and 6.4 g/L SJAMP treatment groups. The cell proliferation, migration, invasion abilities, as well as the expression of mTOR/p70S6K protein and mRNA were detected. RESULTS: As the concentration of SJAMP increased, the proliferation, migration and invasion abilities of HeLa cells were significantly reduced (all P < 0.05) and the protein and mRNA expressions of mTOR and p70S6K also decreased in a concentration-dependent manner (all P < 0.05). CONCLUSION: SJAMP can effectively inhibit the proliferation, migration and invasion of cervical cancer HeLa cells and this inhibitory effect is strongly dose-dependent and correlates with the downregulation of the mTOR/p70S6K signaling pathway.
PubMed2026
Fertility challenges: Interplay between visfatin and silent information regulator 1 (SIRT1); A cross-sectional study.
BACKGROUND: Maintenance of a normal redox balance is essential for optimal ovarian function and fertility. Reduction in silent information regulator1 (SIRT1) can potentiate inflammatory pathways, mitochondrial dysfunction and ultimately programmed cell death via "hypothalamic-pituitary-ovarian axis", developing 'low-grade oocytes', potentiating obesity related problems. Current hypothesis that a reduction in antioxidant levels (measured by SIRT1, visfatin, Manganese Superoxide dismutase (MnSOD), and Glutathione reductase (GR) with increased BMI is associated with decreased fertility. OBJECTIVES: The study aimed to evaluate the relationship between obesity and OS markers and to compare their levels between fertile and infertile women, thereby elucidating the potential role of redox imbalance in obesity-associated subfertility. METHODS: A cross-sectional study comprised of 207 fertile and 135 infertile females were recruited. Body mass index (BMI) determines obesity with the formula: weight in kilograms (kg)/height in meters (m2). Women's stratification was according to the South-Asian criteria (normal=18-22; overweight =23-24; obese >25 kg/m2). The enzyme-linked immunosorbent assay (ELISA) kits measured serum levels of MnSOD, GR, visfatin and SIRT1. Pearson chi-square and ANOVA were used; study variable association was calculated by Spearman's correlation, where p<0.05 was significant. RESULTS: The mean BMI was 25.94 ± 5.1 kg/m2; normal weight females were 27.5%, overweight 22.8% and obese 40.9% and infertile females had significantly increased BMI (p<0.001). The antioxidant levels of MnSOD, GR, SIRT1 and visfatin were significantly lower in infertile females (p value =0.049, 0.027, 0.027 and 0.034, respectively). Infertile women had decreased MnSOD and visfatin, decreasing from normal weight to obese (p=0.00 and 0.04). BMI was inversely related to SIRT1 and studied antioxidant concentrations. CONCLUSION: Continuous reduction in antioxidant levels in association with increased BMI indicates that obesity contributes to oxidative stress attributed by reducing antioxidant levels, which may lead to female infertility.
PubMed2026
Caregiver and Care Recipient Perspectives on Paediatric ED Mental Health Presentations: A Qualitative Study.
OBJECTIVE: To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. METHODS: Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. RESULTS: A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. CONCLUSIONS: Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.
PubMed2026
Evaluating the Scale-Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi-Methods Study.
OBJECTIVE: To identify factors influencing implementation and integration of the paediatric ESCALATION system in country Western Australia. SETTING AND PARTICIPANTS: Health professionals (nurses and doctors) working in country Western Australia. DESIGN AND METHODS: A multi-methods study using an interpretive descriptive approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) and Normalisation Process Theory (NPT). Data collection across six sites included patient chart audit, health professional survey and focus groups/interviews. Data were analysed descriptively (audit and survey) and thematically (focus groups/interviews). RESULTS: An audit of 94 patient charts showed 61.7% met escalation of care criteria, while 69.0% of cases were escalated per policy. Among 114 survey responses, findings indicated system integration, with 95.6% reporting ESCALATION was part of their role, 93.5% agreeing it supported early detection of clinical deterioration and 93.8% reporting ease of use. Fewer identified local champions (66.7%), had confidence in others' use of the system (61.1%), reported sufficient training (69.0%), or were aware of reports demonstrating system effectiveness (55.0%). Seventy-eight health professionals participated in focus groups/interviews. Three themes were interpreted through the PRISM and NPT frameworks: (i) Enhanced patient safety (intervention characteristics and participants' perspectives; coherence; cognitive participation), (ii) Strengthening clinical decision-making (implementation and sustainability infrastructure; cognitive participation; collective action), (iii) Monitoring and fidelity (implementation and sustainability infrastructure, external; collective action; reflexive monitoring). CONCLUSION: The paediatric ESCALATION system is embedded and valued, but sustaining fidelity through scale-up requires ongoing training, teamwork, confident communication and organisational support across regional, rural and remote WA health services.
PubMed2026
Orthodontics-Assisted Autogenous Tooth Transplantation for Maxillary Incisor Injury in Pediatric Patient With Crowding and Class II Malocclusion: A Case Report.
OBJECTIVES: This case report describes orthodontics-assisted autogenous tooth transplantation for a maxillary incisor injury in a pediatric patient with crowding and Class II malocclusion. MATERIAL AND METHODS: A 10-year-old boy presented with a compromised maxillary left central incisor with a periapical lesion after failed endodontic treatment, together with bimaxillary crowding and Class II malocclusion. The mandibular right second premolar was transplanted to replace the maxillary incisor and was integrated with comprehensive orthodontic treatment. RESULTS: After transplantation, endodontic treatment was completed when pulp vitality could not be maintained. During long-term follow-up, the transplanted tooth remained clinically stable, with healthy periodontal tissues and no progressive root resorption or bone loss. Orthodontic treatment achieved stable occlusion, improved function, and satisfactory smile esthetics. CONCLUSIONS: Orthodontics-assisted autogenous tooth transplantation may be a biologically favorable option for replacing a traumatized maxillary incisor in growing patients with crowding and malocclusion. Careful donor selection, coordinated orthodontic timing, and long-term follow-up are essential for stable functional and esthetic outcomes.
PubMed2026
Sleep Disturbances and Male Reproductive Dysfunction: Pathophysiological Mechanisms Linking Obstructive Sleep Apnea and Sleep Deprivation.
BACKGROUND: Sleep disturbances, particularly obstructive sleep apnea (OSA) and sleep deprivation, are critical yet underrecognized contributors to male reproductive dysfunction. Both conditions disrupt endocrine homeostasis, reducing testosterone and luteinizing hormone levels, which are central regulators of spermatogenesis. OBJECTIVE: This review aimed to synthesize current evidence on the mechanisms linking OSA and sleep deprivation to impaired male fertility, with emphasis on endocrine, oxidative, and inflammatory pathways. METHODS: We conducted a structured, non-systematic narrative review using PubMed/MEDLINE, Scopus, and Web of Science databases, focusing on clinical and experimental studies evaluating the effects of sleep disturbances on male reproductive health. RESULTS: Disrupted sleep and OSA-related intermittent hypoxia trigger oxidative stress, systemic inflammation, and testicular dysfunction, leading to impaired sperm motility, abnormal morphology, and genomic instability. In OSA, the severity of reproductive disruption correlates with apnea-hypopnea index and nocturnal oxygen desaturation. Despite extensive evidence implicating metabolic and endocrine factors in male infertility, the role of sleep disturbances remains overlooked in clinical practice. CONCLUSIONS: Emerging evidence suggests that sleep disturbances may represent a relevant and potentially modifiable factor in male reproductive health. Interventions targeting sleep disorders and oxidative stress pathways have shown potential benefits on hormonal and physiological parameters; however, their direct impact on fertility outcomes remains to be established. Further longitudinal and interventional studies are needed to clarify causality and clinical applicability.
PubMed2026
Multiomics integrative bioinformatics analysis of gene expression characteristics and molecular mechanisms in preeclampsia placental tissue.
Preeclampsia (PE) is a severe pregnancy-specific complication characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, which can cause multi-organ damage and life-threatening outcomes for both mothers and foetuses. Its pathogenesis remains incompletely elucidated, with placental dysfunction widely recognized as a core pathogenic factor. This study integrated multiple placental transcriptome and single-cell sequencing datasets from the Gene Expression Omnibus (GEO) database, employing a multi-dimensional bioinformatics approach - including differential expression analysis, Weighted Gene Co-expression Network Analysis (WGCNA), machine learning, molecular subtype clustering, single-cell resolution analysis, and intercellular communication analysis - to systematically identify PE-related key genes, construct a diagnostic model, define molecular subtypes, and explore potential molecular mechanisms. Results showed 10 differentially expressed genes (DEGs) were identified in PE placental tissues; WGCNA pinpointed the turquoise module as the core PE-associated module. Further screening using 11 machine learning algorithms identified 9 feature genes with high diagnostic value (DDR1, DIO2, FSTL3, HK2, HTRA4, LEP, SERPINA3, TMEM45A, TREM1). A diagnostic model built with the 'Stepglm[forward]' algorithm exhibited excellent performance in both training and validation sets (average AUC = 0.865). Molecular subtype analysis classified PE samples into two subtypes (C1, C2) with significantly distinct immune infiltration profiles, where the C1 subtype showed higher immune cell infiltration. Single-cell analysis identified 11 cell types in PE placental tissue and highlighted TMEM45A as a key DEG. Intercellular communication analysis revealed the VEGF signalling pathway as the core driver of abnormal cellular crosstalk in PE, primarily mediating signal transduction between villous cytotrophoblast cells (VCT), extravillous trophoblast cells (EVT), and endothelial cells. Hypoxia scoring analysis demonstrated significantly higher hypoxia levels in the PE group compared to normal controls, with TMEM45A expression positively correlated with hypoxia scores. This study provides novel insights into the molecular pathogenesis of PE and offers potential biomarkers and a theoretical basis for its early diagnosis and targeted therapy.
PubMed2026
[Current issues in obstetrics and gynecology residency training].
The aim of this paper is to present the current status, challenges, and development directions of obstetrics and gynecology residency training in the Southern Great Plain region, in the context of the ongoing transformation of the Hungarian healthcare system. Obstetrics and gynecology represent one of the most complex fields of clinical medicine, where decision-making, ethical sensitivity, psychological resilience, and technical proficiency together define professional competence. Over the past decade, Hungarian postgraduate medical education has undergone significant reforms: the introduction of the healthcare service relationship, the elimination of informal gratuities, and the implementation of a competency-based educational framework have resulted in a more transparent and objective system. This paper draws attention to regional residency data, presenting trends in trainee distribution, the main structural elements of the program, and key areas of modernization - including digitalization, simulation-based training, the strengthening of research activity, and international mobility. The authors emphasize that high-quality residency training program requires structured competency assessment, modern infrastructure, the integration of international experience, and adequate mental support for trainees. The obstetrician-gynecologist of the future should not only be technically proficient but also reflective, empathetic, and responsible - a physician whose training is built on both professional excellence and the preservation of humanistic values and vocation. Orv Hetil. 2026; 167(29): 1159-1163.
PubMed2026
Critical care level admissions and transfers of preterm births in England.
AIM: Preterm birth, defined as delivery at gestational age less than 37 weeks, is a major contributor to neonatal morbidity, placing a significant burden on healthcare resources. This analysis explores the prevalence and patterns of critical care admissions among preterm neonates in England. METHODS: Hospital-level data were obtained from the Hospital Episode Statistics Data-NHS England 2022-2023 database. Data were analyzed for newborns in England for April 2022-March 2023, focusing on gestational age categories and the care level of facilities managing these infants. RESULTS: Among all 541,765 singleton births in England during the examined interval, 7.0% (37,815) were preterm. Of these preterm infants, 71.3% (26,965) had a recorded gestational age. Of those with recorded gestational ages, 0.6% (149) were born <28 weeks (extremely preterm), 10.5% (2,844) at 28-32 weeks (very preterm), and 88.9% (23,972) at 33-37 weeks (moderate and late preterm). While 58.4% (87) of extremely preterm neonates were delivered in a hospital with appropriate facilities, 32.2% (48) of extremely preterm neonates, and 4.3% (121) of very preterm neonates were born in hospitals without neonatal intensive care facilities. CONCLUSION: Persistent gaps in triage for women at risk of preterm birth highlights the need for improved early risk recognition and in utero referral systems to ensure appropriate delivery in recommended critical care facilities and to reduce postnatal transfers for babies.
PubMed2026
Feasibility and acceptability of a novel forehead-mounted wireless heart rate monitoring device in preterm infants: a prospective multicenter observational cohort study.
BACKGROUND: Wireless monitoring technologies may offer practical advantages over conventional monitoring approaches in neonatal care. We aimed to evaluate the feasibility and acceptability of a wireless heart rate monitoring device in preterm infants across different neonatal clinical settings. METHODS: Between January 2022 and August 2023, we prospectively evaluated the SurePulse VS wireless heart rate monitoring device (SurePulse Medical Ltd, Nottingham, UK) in 62 preterm infants at birth and during postnatal care in two UK tertiary neonatal intensive care units. Staff completed structured questionnaires assessing the device feasibility and acceptability in this preterm population. Downloaded device data were analyzed as exploratory operational metrics and compared with contemporaneously collected staff assessments of signal availability and heart rate acquisition time. RESULTS: Staff reported device cap fitting as "Easy" or "Very Easy" in 88% (45/51) of deployments. Heart rate visibility was reported as available for "All" or "Most" of the monitoring period in 82% (42/51) of cases, and heart rate acquisition within 60 s was reported in 69% (35/51) of cases. Downloaded data were available for 51 infants and provided exploratory operational measures of signal availability and acquisition time that broadly aligned with staff-reported assessments. CONCLUSIONS: The SurePulse VS device demonstrated a high level of feasibility and acceptability among clinical staff across a range of neonatal care settings. These findings support the feasibility of wireless heart rate monitoring in preterm infants and provide insight into practical considerations and challenges for implementation in routine clinical care.
PubMed2026
Immune-guided calibration of metagenomic next-generation sequencing (mNGS) results in a pregnant patient with Listeria infection: a case report.
BACKGROUND: Listeriosis during pregnancy is a rare but life-threatening infection that often presents with nonspecific symptoms, making timely diagnosis difficult. This article reports a case in which the clinical presentation and immune profile were highly consistent with Listeria monocytogenes infection, leading to a presumptive clinical diagnosis. The patient was successfully treated following a diagnostic approach that integrated host immune profiling with AI-assisted decision-making, despite dual interference from Ureaplasma urealyticum detected by metagenomic next-generation sequencing (mNGS) and Staphylococcus capitis detected by blood culture. CASE PRESENTATION: A 25-year-old female patient, at 37+6 weeks of gestation, presented with persistent high fever following induced labor due to intrauterine fetal death. External hospital blood culture and our hospital's reproductive tract mNGS suggested Staphylococcus capitis and Ureaplasma urealyticum, respectively. However, intensified treatment targeting these pathogens was ineffective. DIAGNOSTIC PROCESS: Further investigation revealed a characteristic immune imbalance in the patient: a concurrent significant elevation of IFN-γ and IL-10, accompanied by activated CD8+ T cells. With AI-assisted analysis, this immune profile was found to be highly consistent with Listeria monocytogenes infection. TREATMENT AND OUTCOME: After switching to ampicillin combined with gentamicin, the patient's body temperature rapidly normalized, and she recovered and was discharged. CONCLUSION: When etiological diagnosis reaches an impasse, integrating host immune characteristics with AI-assisted decision-making can provide crucial diagnostic clues for infections caused by rare pathogens when microbiological confirmation is unavailable.
PubMed2026
miR-145-5p in predicting caesarean section postoperative complications in scarred uterus cases: a prospective cohort study.
BACKGROUND: To investigate whether serum micro (miR)-145-5p for postoperative complications in patients with scarred uterus undergoing caesarean section, suggesting its potential as an adjunctive molecular biomarker for clinical preoperative risk assessment. METHODS: A total of 198 women were divided into high-expression and low-expression groups based on the mean relative serum miR-145-5p level. Pelvic floor function, vaginal microecology, and abdominal adhesion status were assessed, and postoperative complications were monitored. Spearman's rank correlation was used to analyse the correlation between miR-145-5p expression and scar scores, while Receiver operating characteristic (ROC) curves were employed to evaluate its predictive efficacy for complications. RESULTS: Serum miR-145-5p was negatively correlated with abdominal scar Patient-Observation Scar Assessment Scale (POSAS) scores. The level of miR-145-5p was lower in the moderate-to-severe pelvic floor dysfunction (PFD) group, vaginal microecological disorder group, abdominal adhesion group, and postoperative complication group compared with the corresponding control groups. ROC curve analysis showed that miR-145-5p had good predictive value for these complications. CONCLUSIONS: miR-145-5p is closely correlated with abdominal scar, PFD, vaginal microecological disorders, abdominal adhesions, and other postoperative complications in patients with scarred uterus after caesarean section, which may serve as a potential molecular biomarker for preoperative risk assessment.
PubMed2026
Prospective observational study of the association between tear and serum CHI3L1 and PTX3 levels and the severity and prognosis of retinopathy of prematurity.
BACKGROUND: To investigate the independent and combined associations of tear-fluid and serum chitinase-3-like protein 1 (CHI3L1) and pentraxin-3 (PTX3) with retinopathy of prematurity (ROP) severity and long-term neurovascular outcomes, and to evaluate their incremental predictive value beyond conventional risk factors. METHODS: This prospective cohort study enrolled 235 premature infants with ROP (diagnosed January 2024-May 2025) and 110 gestational-age-matched controls. ROP infants were stratified into poor-outcome (n = 34) and favorable-outcome (n = 201) subgroups based on treatment response and longitudinal neurovascular findings. Poor outcome was defined as posterior pole retinal fold involving the macula, retinal detachment, or posterior pole obscuration by fibrous tissue or a "white mass" at ≥6 months after intravitreal anti-VEGF therapy. Tear fluid and venous blood were collected within 24 h of the first ROP diagnosis; CHI3L1 and PTX3 were measured by enzyme-linked immunosorbent assay. Spearman correlation, multivariable logistic regression, and receiver operating characteristic (ROC) curves were employed to examine the associations. RESULTS: Tear and serum CHI3L1 and PTX3 concentrations increased stepwise across control, mild-ROP, and severe-ROP groups (all p < 0.05), correlating positively with fundus stage (Spearman r = 0.610-0.779). Infants with unfavorable neurovascular outcomes had higher baseline levels than those with favorable outcomes (p < 0.05). Multivariable analysis identified gestational age, birth weight, severe ROP, bronchopulmonary dysplasia, tear CHI3L1, tear PTX3, serum CHI3L1, and serum PTX3 as independent predictors of poor outcome (p < 0.05). The four-biomarker panel predicted progression with an area under the curve of 0.847 (95% CI 0.775-0.919), outperforming individual markers (p < 0.05). CONCLUSION: Tear and serum CHI3L1 and PTX3 are associated with ROP severity and may serve as a noninvasive early biomarker panel for risk assessment.
PubMed2026
Weight-gain-for-gestational-age z-score in twin pregnancies in China and its association with preterm birth: a retrospective cohort study.
BACKGROUND: To evaluate the association between the weight-gain-for-gestational-age z-score and preterm birth (PTB) in a large Chinese twin pregnancy cohort. METHODS: A hospital-based retrospective study included 2832 twin pregnancies between January 1, 2015, and December 31, 2019. The primary composite outcome was defined as PTB. The total gestational weight gain was converted into z-score, and logistic regression models were used to examine the associations between z-scores and PTB. RESULTS: We developed a weight-gain-for-gestational-age z-score to determine the gestational weight gain during twin pregnancies in Chinese women. Low (<P25) and high (≥P75) z-scores were associated with a higher risk for spontaneous PTB (SPTB) than scores between the 25th and 75th percentiles (adjusted odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.05-1.74; 1.28, 0.99-1.66; respectively). Similarly, low z-scores (1.40, 1.12-1.76) and high z-scores (1.97, 1.57-2.47) were also associated with an increased risk for iatrogenic PTB (IPTB). Normal weight subgroups exhibited comparable outcomes. In addition, z-scores between the 25th and 75th percentiles indicated an equivalent total gestational weight gain at 37 weeks of 15.8-20.9 kg for underweight, 14.6-20.3 kg for normal weight, and 11.8-18.6 kg for overweight or obese women, which are narrower than the 2009 IOM recommendation. CONCLUSIONS: Our findings indicate that inadequate gestational weight gain, as evaluated by the z-score, is associated with a significantly increased risk for SPTB, whereas inadequate and excessive gestational weight gain are associated with a significantly increased risk for IPTB, in a large Chinese twin pregnancy cohort.
PubMed2026
Investigating the effects of nicotinamide mononucleotide administration on testicular apoptosis, and mitochondrial function in doxorubicin-treated rats.
BACKGROUND: Male infertility is one of the most important side effects of chemotherapy that can seriously compromise the quality of life of cancer patients. Doxorubicin, a widely used chemotherapy drug in the treatment of cancer patients, is known to cause testicular toxicity. Nicotinamide mononucleotide (NMN) has recently received attention due to its potential role in improving mitochondrial function and cellular resistance to oxidative stress. The aim of the present study was to investigate the protective effects of NMN on testicular apoptosis, inflammatory changes, oxidative stress, and mitochondrial function in rats treated with doxorubicin. MATERIAL AND METHOD: Thirty-two male Wistar rats were randomly assigned into four groups: control, NMN, doxorubicin, and NMN + doxorubicin. NMN (100 mg/kg) was administered intraperitoneally for 28 days, whereas doxorubicin was injected intraperitoneally at a dose of 2 mg/kg every 48 h for 12 days (six injections; cumulative dose 12 mg/kg). Histopathological evaluation was performed using Johnson's scoring system and morphometric analysis of seminiferous tubules. Oxidative stress markers (MDA, SOD, and GPx), intracellular ROS levels, and mitochondrial membrane potential were assessed. In addition, Bax and Bcl-2 gene and protein expression were examined using RT-qPCR and Immunohistochemistry staining. RESULTS: Doxorubicin administration significantly decreased Johnson's score, seminiferous tubule diameter, epithelial thickness, antioxidant enzyme activity, and mitochondrial membrane potential, while markedly increasing ROS levels, lipid peroxidation, and Bax expression (p < 0.05). NMN treatment significantly attenuated these alterations by reducing oxidative stress and apoptosis while improving mitochondrial function and histological architecture of the testes. CONCLUSION: NMN exerts significant protective impact against testicular damages related to doxorubicin via antioxidant, anti-apoptotic, and mitochondrial-protective mechanisms. These findings indicate that NMN attenuates structural and molecular indices of testicular injury induced by doxorubicin, although preservation of endocrine function and fertility potential remains to be established.
PubMed2026
Genetic determinants of gestational diabetes mellitus in thai pregnant women: role of GCKR, CDKAL1, TCF7L2, NEDD1, and CMIP variants.
BACKGROUND: Gestational diabetes mellitus (GDM) has a high global prevalence and arises from complex interactions between genetic predisposition and environmental factors. GDM is associated with metabolic disturbances and chronic low-grade inflammation, both of which contribute to its pathogenesis. This study aimed to investigate the association between GDM and 135 single-nucleotide polymorphisms (SNPs) across 20 genes related to metabolic traits. METHODS: In this case-control study, 152 pregnant women with GDM and 684 pregnant women with normal glucose tolerance (NGT) who underwent antenatal examination at Siriraj Hospital, Bangkok, were enrolled. Clinical data and blood samples were collected from all participants. Genomic DNA was isolated and subjected to whole-genome sequencing using the DNBSEQ-T7RS high-throughput sequencing platform. Genotype analyses were performed using R software, and haplotype analyses were conducted using the online SNPStats software. RESULTS: After adjusting for maternal age and pre-pregnancy body mass index, polymorphisms in TCF7L2 (rs34872471, rs7901695, rs4506565, rs7903146, rs12243326, and rs12255372), NEDD1 (rs10431408, rs11830756, rs249579, rs249585, and rs4762339), CMIP (rs2306115 and rs201681534), CDKAL1 (rs4710942), GCKR (rs2293572 and rs2293571), and GCK (rs5883890) were significantly associated with the risk of GDM. Haplotype analysis demonstrated that the TCF7L2 rs12243326-rs12255372 CA haplotype was associated with a decreased risk of GDM (OR = 0.44, 95% CI: 0.23-0.81), while the NEDD1 rs249579-rs249585-rs4762339 GGT haplotype was associated with an increased risk of GDM (OR = 1.40, 95% CI: 1.08-1.82). CONCLUSIONS: These findings suggest that genetic variations in TCF7L2, NEDD1, CMIP, CDKAL1, GCK, and GCKR contribute to GDM susceptibility in the Thai population.
PubMed2026
Psychometric properties of the City Birth Trauma Scale in Black trauma-exposed women.
Background: Black women in the USA, who face disproportionate risks of obstetric complications and adverse birth outcomes, may be at heightened risk of birth-related post-traumatic stress symptoms. However, the City Birth Trauma Scale (BiTS) has not yet been psychometrically evaluated in this population.Objective: This study examined the psychometric properties of the BiTS, including internal consistency, convergent and divergent validity, and factor structure, among Black postpartum trauma-exposed women.Method: In total, 130 women who were 6-8 weeks postpartum completed the BiTS, along with validated measures of post-traumatic stress disorder (PTSD), depression, and anxiety. Confirmatory factor analysis (CFA) was conducted to assess BiTS factor structure. Internal consistency, convergent and divergent validity, and PTSD diagnostic prevalence were also examined.Results: The BiTS demonstrated excellent internal consistency (α = 0.91) and strong convergent and divergent validity with PTSD, depression, and anxiety measures. CFA supported a two-factor model (birth-related symptoms and general symptoms subscales) with good model fit. One-third (33.6%) of women reported their birth as traumatic and met criterion A (e.g. the belief that she or her baby would die during childbirth). Using the BiTS, 4.6% of women met full DSM-5 diagnostic criteria for PTSD, while 7.6% were above the established BiTS diagnostic cut-off for probable PTSD diagnosis.Conclusion: The BiTS demonstrates strong psychometric properties in Black postpartum trauma-exposed women.
PubMed2026
Voices from the neonatal unit: Mothers' and healthcare workers' perspectives on respectful and collaborative care for small and sick newborns in rural districts in KwaZulu-Natal, South Africa.
Neonatal care increasingly emphasizes improving the experience of care by engaging mothers as active partners alongside health workers providing clinical care for newborns. Guided by the World Health Organization's Standards for improving the quality of care for small and sick newborns, this study focuses on Standard 4, which promotes care that is respectful, responsive, and supportive of families' needs and preferences. We conducted a concurrent triangulation mixed-methods study among health workers and mothers of small and sick newborns admitted to neonatal units in two rural districts of KwaZulu-Natal, South Africa. Effective communication emerged as a foundational factor shaping mothers' experiences of care. Many mothers reported frustration due to inadequate, unfriendly communication and exclusion from clinical decision-making, resulting in limited collaboration and lack of informed consent. Health workers, in turn, described barriers to providing respectful, family-centred care, citing overcrowding, staff shortages, fatigue, and lack of space for mothers to participate. Findings reveal persistent gaps in the implementation of Standard 4 within rural neonatal units. Strengthening communication and integrating family-centered newborn care in rural settings requires investment in health workers' communication training, facility infrastructure that enables maternal presence, and policy adaptations that promote shared caregiving and decision-making.
PubMed2026
Medical Child Abuse Module in the Child Abuse Pediatrics Curriculum for Physicians (CAP-CuP).
INTRODUCTION: Medical child abuse is an underrecognized and undertaught condition with potentially fatal consequences. Clinicians must learn to recognize and manage harmful overmedicalization of children. METHODS: We developed a 2-part interactive workshop on medical child abuse for pediatric clinicians. We evaluated part 1, an interactive high-yield lecture, using a pre- and postmodule assessment of self-rated confidence and knowledge in 1 resident conference and 3 multidisciplinary grand rounds settings across 2 institutions. We evaluated part 2, a popcorn-style role-play, with an additional postmodule confidence assessment at 2 resident conferences. We excluded duplicate participants. Part 1 duration was 45 minutes and part 2 was 60 minutes. We summarized results using descriptive statistics and analyzed paired data using paired t tests for knowledge (mean ± SD), and Wilcoxon signed-rank tests for confidence (median and interquartile range [IQR]). RESULTS: A total of 203 and 36 unique participants participated in part 1 and part 2, respectively. Participant confidence in recognizing and managing medical child abuse increased from a median of 5 (IQR 4-6; n = 124) to 7 (IQR 6-8) after part 1 (P < .001). Among participants completing part 2 (n = 20), confidence increased further to 8 (IQR 8-9; P <.001). Knowledge scores increased from 66% (SD = 29%) premodule to 88% (SD = 20%) postmodule (n = 119; P < .001). DISCUSSION: This interactive 2-part workshop was adaptable across clinical audiences and settings and improved confidence and knowledge in recognition and management of medical child abuse.
PubMed2026
Stability of first twin presentation in the late third trimester and its implications for delivery planning: a retrospective cohort study.
INTRODUCTION: Fetal presentation of the first twin plays a key role in delivery planning. While vertex presentation is considered favorable for vaginal delivery, presentation changes may occur during the third trimester. However, the factors influencing these changes-particularly in relation to chorionicity-remain poorly defined. MATERIAL AND METHODS: This was a retrospective cohort study including 263 twin pregnancies (166 dichorionic diamniotic (DCDA), 97 monochorionic diamniotic (MCDA)) followed at a tertiary center between 2000 and 2025. Third-trimester ultrasounds were performed at 32 weeks and prior to delivery. We evaluated changes in the presentation of the first twin and analyzed variables that may be associated with fetal dynamics or stability, including parity, amniotic fluid volume, placental location, estimated fetal weight, and second twin presentation. RESULTS: The first twin maintained the same presentation in 53.6% of DCDA and 57.7% of MCDA pregnancies. Among those initially non-vertex, a spontaneous change to vertex presentation occurred in 53.4% of DCDA and 71.4% of MCDA cases. No statistically significant associations were found between presentation changes and the maternal or ultrasound-related variables studied. When vertex presentation was observed in the third trimester, it remained stable in over 95% of cases. CONCLUSIONS: The presentation of the first twin remains dynamic throughout until delivery, especially in non-vertex cases. However, a vertex presentation after 32 weeks is highly predictive of stability until delivery. Serial third-trimester ultrasound are essential for accurate delivery planning and should guide shared decision-making with expectant parents.
PubMed2026
Health advocates to address social adversity in pediatric liver transplantation: A clinical trial.
BACKGROUND: Children undergoing liver transplantation experience socioeconomic disparities in long-term outcomes, partly due to unaddressed material economic hardships such as food insecurity and housing instability. Health Advocates-trained lay health workers who assist families in navigating social and medical systems-may mitigate these disparities. We pilot-tested a Health Advocate intervention (NCT05700799) to assess feasibility, acceptability, and preliminary effects on caregiver experience and clinical outcomes in pediatric liver transplant recipients. METHODS: In this single-center study, 18 caregivers/child dyads participated in a 90-day Health Advocate program; they were provided weekly support from trained navigators. Navigators helped to identify and connect participants with community-based resources and communicated reported social risks to the transplant team. RESULTS: The patients' median age at transplant was 1.1 (0.7, 4.6) and the median age at study enrollment was 8.6 (4.3, 13.1) years; 83% remained in the intervention until their needs were met or the end of the 12-week intervention. Caregivers reported improvement in comfort discussing social risks with the transplant team and improved overall care experience (both median 1-point change). Clinical parameters, including the Medication Level Variability Index, trended toward improvements. Qualitative analysis demonstrated high enthusiasm for the intervention, with themes of enhanced communication, reduced stress, and practical assistance addressing diverse social needs. CONCLUSIONS: A Health Advocate intervention for pediatric liver transplant families was feasible, acceptable, and associated with improved caregiver experiences. These preliminary findings support testing this intervention in a multi-center effectiveness and implementation trial to evaluate its impact on improving longer-term transplant outcomes.
PubMed2026
Innovative treatment approaches for azoospermia: causes, emerging techniques, and future directions.
Azoospermia, particularly non-obstructive azoospermia (NOA), is a major cause of male infertility and remains difficult to treat due to its complex hormonal, genetic, and immunological etiologies. The purpose of this review is to examine the biological, hormonal, genetic, and immunological mechanisms underlying azoospermia, with a specific focus on recent advances in regenerative and genetic therapies aimed at restoring spermatogenesis and fertility.This narrative review summarizes and analyzes published experimental, preclinical, and clinical studies focusing on the biological, hormonal, genetic, and immunological aspects of azoospermia, with particular emphasis on emerging regenerative and genetic therapeutic approaches.The reviewed highlights that non-obstructive azoospermia results from multifactorial disturbances involving hormonal imbalance, genetic defects, immune dysregulation, and disruption of the testicular microenvironment. The literature discussed in this review indicates that regenerative strategies such as platelet-rich plasma, stem cell-based approaches, and extracellular vesicles may contribute to testicular repair and support spermatogenic processes through modulation of cellular signaling and inflammatory pathways. In parallel, advances in genetic technologies, particularly CRISPR-based gene-editing tools, are presented as emerging strategies for targeting genes essential for spermatogenesis.Although clinical application remains early, these strategies show strong potential in reversing testicular damage. Continued research and clinical trials are essential to confirm safety, optimize protocols, and expand therapeutic use.
PubMed2026
Longitudinal modelling of microbiome subcommunities reveals parity-dependent dynamics during pregnancy and postpartum.
BACKGROUND: Dysregulation of maternal adaptations to pregnancy due to high pre-pregnancy BMI (pBMI) is associated with worsened health outcomes for mothers and children. The role of the gut microbiome in these adaptations remains unclear. METHODS: Stool samples were collected from pregnant participants (n = 52) enrolled in the Be Healthy in Pregnancy study (NCT01689961) during first, second, and third trimesters, and 6-months postpartum, along with samples from their infants at 6 months of age. Following 16S rRNA gene sequencing, we implemented time-aligned LDA (TALDA) using a time-weighted sampling strategy with exponentially decaying weights to construct time-proximal cohorts, applied LDA to each cohort independently, and aligned resulting topics using the alto R package. Infant samples were analyzed using standard LDA. RESULTS: Seven distinct subcommunities were identified, one of which represented perineal contamination and was excluded from further analysis. Remaining subcommunities had distinct taxonomic definitions which remained stable throughout pregnancy (mean cross-cohort stability 0.899) while subcommunity proportions within individuals varied. Multiparous individuals showed greater shifts in subcommunity proportions during early pregnancy, while primiparous individuals displayed progressively increasing shifts with the largest changes during the transition from pregnancy to postpartum. High pBMI was associated with reduced microbiome remodelling, particularly among multiparous individuals. In exploratory analyses, maternal SCFA-producing subcommunity abundance at late pregnancy was positively associated with infant Bifidobacterium-dominated subcommunity proportions at 6 months, while pBMI > 25 was independently associated with lower infant Bifidobacterium. CONCLUSION: TALDA effectively distinguished between stable subcommunity definitions and dynamic subcommunity proportions, revealing that the microbiome maintains functional organization while subcommunity proportional contributions shift over the course of pregnancy and postpartum. These maternal dynamics may have intergenerational consequences through their influence on infant gut colonization. This work demonstrates that maternal factors modify microbiome trajectories and supports the existence of an ecological memory of pregnancy history within the maternal gut microbiome.
PubMed2026
Maternal and neonatal predictors of high Edinburgh Postnatal Depression Scale score on postpartum day 7: a retrospective cohort study.
OBJECTIVE: To evaluate the association between Edinburgh Postnatal Depression Scale (EPDS) scores on postpartum day 7 and maternal demographic, sociodemographic, obstetric, complication-related, and neonatal factors. METHODS: This retrospective cohort study included 1,032 women who delivered at a tertiary referral hospital in 2025. Patients were stratified into low-risk (EPDS <13, n = 893) and high-risk (EPDS ≥13, n = 139) groups. Demographic, sociodemographic, obstetric, neonatal, and laboratory variables were compared, and independent predictors of high-risk status were identified by multivariable logistic regression. RESULTS: Of 1,032 patients, 13.5% (n = 139) screened high-risk. On univariable analysis, any prior abortion was significantly less frequent in the high-risk than in the low-risk group (5.0% vs 11.5%, p = 0.020).Higher education (university 30.2% vs 21.6%, p = 0.041) and employment (41.7% vs 26.9%, p < 0.001) were more frequent in the high-risk group. On multivariable analysis, prior abortion count was the only independent inverse predictor (aOR = 0.536, 95% CI 0.299-0.959, p = 0.036); gestational diabetes did not reach significance (aOR = 0.311, p = 0.053). Sociodemographic variables were analyzed univariately and were not entered into the multivariable model. No other variables differed significantly. CONCLUSIONS: In this Turkish obstetric population, a higher prior abortion count was independently associated with a lower likelihood of high EPDS risk on postpartum day 7. This unexpected inverse association is hypothesis-generating and should be interpreted with caution, given the small number of events, the inability to distinguish loss subtypes, and the multiple comparisons performed. Univariate associations of higher education and employment with EPDS risk diverge from Western literature and warrant prospective multicenter confirmation.
PubMed2026
Reducing Low Value Care Through Implementation of a Clinical Decision Support Tool Addressing Urine Culture in a Paediatric Emergency Department.
An interruptive alert as a clinical decision support tool has been implemented to reduce the ordering of unnecessary urine cultures in a tertiary paediatric emergency department. Following its introduction, there was an immediate and sustained reduction in urine culture ordering rates of 25%, with a small increase in cultures with pure growth over a twelve-month period.
PubMed2026
Reproductive healthcare use before and after infertility diagnosis: a population-based study in South Korea.
OBJECTIVES: This study examines heterogeneity in women's use of reproductive healthcare services before and after receiving an infertility diagnosis and its association with pregnancy identified without recorded loss within one year following the first infertility diagnosis. Reproductive healthcare use was operationalised as care-seeking history, utilisation intensity and subsequent engagement with assisted reproductive technology (ART) and financial support. DESIGN: Population-based retrospective cohort study. Multivariate logistic regression analyses were performed. SETTING: Korean National Health Insurance Service nationwide claims database. PARTICIPANTS: Women aged 20-49 years with a first recorded infertility diagnosis in 2019-2020 (n=151 570). OUTCOME MEASURES: Pregnancy identified without recorded loss within 1 year after infertility diagnosis. RESULTS: Differences between women who did and did not have a pregnancy identified without recorded loss were more pronounced in pregnancy-related diagnostic codes recorded prior to infertility diagnosis than in classical genitourinary disorders. ART use (OR: 1.66; 95% CI 1.60 to 1.72) and financial support (OR: 1.60; 95% CI 1.54 to 1.67) were positively associated with pregnancy; however, these associations were modest relative to age and socioeconomic gradients. Greater postdiagnostic healthcare utilisation was associated with lower odds of pregnancy identification. CONCLUSIONS: Women diagnosed with infertility exhibit heterogeneous patterns of prediagnostic and postdiagnostic healthcare engagement. Our findings suggest that infertility diagnosis is situated within women's broader reproductive healthcare engagement, highlighting the need for a patient-centred monitoring and evaluation system for women's health.