Hasil untuk "Gynecology and obstetrics"

H. Stepan, A. Galindo, M. Hund et al.

Pre‐eclampsia (PE) is characterized by placental and maternal endothelial dysfunction, and associated with fetal growth restriction (FGR), placental abruption, preterm delivery and stillbirth. The angiogenic factors soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF) are altered in pregnancies complicated by placenta‐related disorders. In this Review, we summarize the existing knowledge, examining the performance of maternal PlGF, sFlt‐1 and the sFlt‐1/PlGF ratio for screening PE, predicting development of PE in the short term, diagnosing PE, monitoring established PE and predicting other placenta‐related disorders in singleton pregnancy. We also discuss the performance of PlGF and the sFlt‐1/PlGF ratio for predicting PE in twin pregnancy. For first‐trimester screening in singleton pregnancy, a more accurate way of identifying high‐risk women than current practice is to combine maternal PlGF levels with clinical risk factors and ultrasound markers. Later in pregnancy, the sFlt‐1/PlGF ratio has advantages over PlGF because it has a higher pooled sensitivity and specificity for diagnosing and monitoring PE. It has clinical value because it can rule out the development of PE in the 1–4‐week period after the test. Once a diagnosis of PE is established, repeat measurement of sFlt‐1 and PlGF can help monitor progression of the condition and may inform clinical decision‐making regarding the optimal time for delivery. The sFlt‐1/PlGF ratio is useful for predicting FGR and preterm delivery, but the association between stillbirth and the angiogenic factors is unclear. The sFlt‐1/PlGF ratio can be used to predict PE in twin pregnancy, although different sFlt‐1/PlGF ratio cut‐offs from those for singleton pregnancy should be applied for optimal performance. In summary, PlGF, sFlt‐1 and the sFlt‐1/PlGF ratio are useful for screening, diagnosing, predicting and monitoring placenta‐related disorders in singleton and twin pregnancy. We propose that tests for these angiogenic factors are integrated more fully into clinical practice.© 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Marzieh Zamaniyan, A. Ebadi, Samaneh Aghajanpoor Mir et al.

Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran Infertility Center, Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran Department of Obstetrics and Gynecology, Medical School, Mazandaran University of Medical Sciences, Sari, Iran Student Research Committee, College of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

M. M. Tiffany A. Moore Simas, M. M. M. Camille Hoffman, M. M. Emily S. Miller et al.

PURPOSE To review evidence on the current understanding of mental health conditions in pregnancy and postpartum, with a focus on mood and anxiety disorders, and to outline guidelines for screening and diagnosis that are consistent with best available scientific evidence. The conditions or symptoms reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis. For information on psychopharmacologic treatment and management, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 5, "Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions. Onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on the screening and diagnosis of perinatal mental health conditions including depression, anxiety, bipolar disorder, acute postpartum psychosis, and the symptom of suicidality. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Wen-Hung Kuo, Li-Yun Chang, Daisy Li-Yu Liu et al.

Mohammad Afzal Shadab, Surendra Adhikari, C. Max Stevens et al.

Observations show the multidimensional dynamics of meltwater and distribution of ice layers in the firn on the Greenland Ice Sheet. However, state-of-the-art large-scale models for firn hydrology are essentially one-dimensional, limiting their ability to explain observed datasets and contributing to uncertainty in surface mass balance and sea-level rise estimates. Here, we present a large-scale, multidimensional, multiphase, and thermomechanical model for the subsurface hydrology of firn. The model is highly efficient due to a novel algorithm in which an extra equation for pressure is solved only in saturated regions. Furthermore, the model can apply spatially heterogeneous boundary conditions to the unsaturated-saturated domain and allows for the dynamic formation of fully impermeable ice layers. The numerical results show excellent comparisons against analytic solutions to one- and two-dimensional problems that involve coupled unsaturated-saturated flows, thermodynamics, and phase change. We further apply the model to investigate field data from southwest Greenland and find that lateral heterogeneities strongly influence the depth of melt percolation and ice layer formation. Improved understanding of these local, multidimensional processes will provide physics-based constraints on firn densification, reduce uncertainty in converting altimetric elevation change to mass change, and improve estimates of freshwater fluxes to the ocean under a warming climate.

Micaela Hirsch, Marina Elichiry, Blas Radi et al.

Large language models (LLMs) have been shown to exhibit biases against LGBTQ+ populations. While safety training may lessen explicit expressions of bias, previous work has shown that implicit stereotype-driven associations often persist. In this work, we examine implicit bias toward transgender people in two main scenarios. First, we adapt word association tests to measure whether LLMs disproportionately pair negative concepts with "transgender" and positive concepts with "cisgender". Second, acknowledging the well-documented systemic challenges that transgender people encounter in real-world healthcare settings, we examine implicit biases that may emerge when LLMs are applied to healthcare decision-making. To this end, we design a healthcare appointment allocation task where models act as scheduling agents choosing between cisgender and transgender candidates across medical specialties prone to stereotyping. We evaluate seven LLMs in English and Spanish. Our results show consistent bias in categories such as appearance, risk, and veracity, indicating stronger negative associations with transgender individuals. In the allocation task, transgender candidates are favored for STI and mental health services, while cisgender candidates are preferred in gynecology and breast care. These findings underscore the need for research that address subtle stereotype-driven biases in LLMs to ensure equitable treatment of transgender people in healthcare applications.

Mick Gardner, Michael L. Oelze

Three-dimensional (3D) ultrasound promises various medical applications for abdominal, obstetrics, and cardiovascular imaging. However, ultrasound matrix arrays have extremely high element counts limiting their field of view (FOV). This work seeks to demonstrate an increased field-of-view using a reduced element count array design. The approach is to increase the element size and use advanced beamformers to maintain image quality. The delay and sum (DAS), Null Subtraction Imaging (NSI), directional coherence factor (DCF), and Minimum Variance (MV) beamformers were compared. K-wave simulations of the 3D point-spread functions (PSF) of NSI, DCF, and MV display reduced side lobes and narrowed main lobes compared to DAS. Experiments were conducted using a multiplexed 1024-element matrix array on a Verasonics 256 system. Elements were electronically coupled to imitate a larger pitch and element size. Then, a virtual large aperture was created by using a positioning system to collect data in sections with the matrix array. High-quality images were obtained using a coupling factor of two, doubling the FOV while maintaining the same element count in the virtual large aperture as the original matrix array. The NSI beamformer demonstrated the best resolution performance in simulations and on the large aperture, maintaining the same resolution as uncoupled DAS for coupling factors up to 4. Our results demonstrate how larger matrix arrays could be constructed with larger elements, with resolution maintained by advanced beamformers.

M. Levy, M. Recher, H. Hubert et al.

Author Affiliations: Department of Emergency Medicine, University of British Columbia, Vancouver, Canada (Grunau); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (Goldfarb); Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada (Asamoah-Boaheng); Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada (Golding); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Kirkham, Demers); Department of Pediatrics, University of British Columbia, Vancouver, Canada (Lavoie).

R. Soslow, C. Tornos, Kay J. Park et al.

In this review, we sought to address 2 important issues in the diagnosis of endometrial carcinoma: how to grade endometrial endometrioid carcinomas and how to incorporate the 4 genomic subcategories of endometrial carcinoma, as identified through The Cancer Genome Atlas, into clinical practice. The current International Federation of Gynecology and Obstetrics grading scheme provides prognostic information that can be used to guide the extent of surgery and use of adjuvant chemotherapy or radiation therapy. We recommend moving toward a binary scheme to grade endometrial endometrioid carcinomas by considering International Federation of Gynecology and Obstetrics defined grades 1 and 2 tumors as “low grade” and grade 3 tumors as “high grade.” The current evidence base does not support the use of a 3-tiered grading system, although this is considered standard by International Federation of Gynecology and Obstetrics, the American College of Obstetricians and Gynecologists, and the College of American Pathologists. As for the 4 genomic subtypes of endometrial carcinoma (copy number low/p53 wild-type, copy number high/p53 abnormal, polymerase E mutant, and mismatch repair deficient), which only recently have been identified, there is accumulating evidence showing these categories can be reproducibly diagnosed and accurately assessed based on biopsy/curettage specimens as well as hysterectomy specimens. Furthermore, this subclassification system can be adapted for current clinical practice and is of prognostic significance independent of conventional variables used for risk assessment in patients with endometrial carcinoma (eg, stage). It is too soon to recommend the routine use of genomic classification in this setting; however, with further evidence, this system may become the basis for the subclassification of all endometrial carcinomas, supplanting (partially or completely) histotype, and grade. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.

Misa Yamaguchi, Masao Mori, Takanobu Kirihara et al.

We investigate a minor merger event in M31 that simultaneously forms the Andromeda Giant Southern Stream (AGSS), Eastern Extent (EE), North-Eastern Shelf (NES), and Western Shel (WS), offering a unified model for these substructures. By varying the scale radius and mass of the progenitor's dark matter halo (DMH), around the range predicted by the $Λ$CDM model, we successfully reproduce the spatial features of these substructures. Across the limited range of parameters considered in this study, our analysis shows that the spatial evolution of NES and WS is independent of the gravitational potential of the DMH associated with the progenitor, while a shallower potential shifts EE further north. The simulations clearly demonstrate that the progenitor with a DMH mass of $9\times10^9M_\odot$ colliding with M31 850 Myr ago could simultaneously form al thes esubstructures. The simulation results indicate that EE lies several 10kpc closer to us than the aligned Stream Cp, which is actually a metal-poor component of Stream C, whose farther distance suggests overlapping debris from distinct collision events, while both remain closely aligned in celestial coordinates. Furthermore, we predict the existence of a positive stream along the AGSS, characterized by positive line-of-sight velocities relative to M31, which complements an already observed negative stream exhibiting negative line-of-sight velocities. Finally, we propose that three objects, namely Stream B, a metal-rich component of Stream C known as Stream Cr, and EE, are components of the Andromeda Giant Southern Arc (AGSA) connected to the AGSS. Although the existence of the positive stream and a complete picture of AGSA have yet to be confirmed observationally, we anticipate that future spectroscopic observations and further advances in theoretical studies will verify their existence.

Gamze Ceylan, Ayla Kanbur

Abstract Background It is known that complaints (nausea, vomiting, frequent urination, breast tenderness, etc.) that occur during pregnancy affect anxiety and mood changes related to childbirth. Complaints may impact women’s adaptation to their new situations and roles in the postpartum period. The inability to cope with the postpartum period may cause increased complaints of obsessive-compulsive disorder in women. The present study investigated the relationship between pregnancy complaints and obsessive-compulsive behaviors during the postpartum period regarding baby care. Methods This descriptive, cross-sectional and relational study was conducted with the participation of 265 women receiving prenatal care in an urban hospital in eastern Türkiye. At the first stage of this two-stage study, pregnant women in the last trimester were recruited, and their pregnancy complaints were examined. At the second stage, women were contacted between 2 and 8 weeks postpartum, and obsessive-compulsive behaviors related to baby care were examined. Data were analyzed with the mean, Pearson’s correlation, and linear regression analyses. Results The mean score for the frequency of women’s experiencing complaints during pregnancy was 37.71 ± 12.68. The mean score for women’s postpartum obsessive and compulsive behaviors was 14.06 ± 5.60. It was found that the presence of complaints during pregnancy was a positive predictor of postpartum obsessive-compulsive behaviors and explained 15% of the variance in obsessive-compulsive behaviors (adjusted R2 = 0.015, F = 5.011, p < 0.05). Conclusion With the increased frequency of experiencing complaints during pregnancy, the rate of obsessive and compulsive behaviors of mothers toward baby care increases during the postpartum period. It is important to screen women for obsessive-compulsive disorder in the postpartum period.

Jinghui Liu, Fangli Liu, Wenqi Xu et al.

Abstract Background Ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation (COS). The main clinical manifestation of OHSS is increased ovarian volume. OHSS can cause local and systemic tissue oedema, electrolyte disturbances, cardiorespiratory dysfunction, coagulation dysfunction, and other symptoms. These symptoms greatly affect patients’ quality of life. As infertility rates rise and assisted reproductive technology (ART) becomes more common, the risk of OHSS increases. Therefore, early identification of high-risk patients and timely intervention are crucial. Methods The PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China National Knowledge Internet (CNKI), Wanfang, China Science and Technology Journal Database (VIP), and China Biology Medicine (CBM) databases were systematically searched from inception to March 30, 2025. Two researchers independently screened the literature, extracted data, and evaluated the quality of included studies using the updated prediction model risk of bias assessment tool (PROBAST + AI). We conducted a meta-analysis of predictors from the developed models using Stata 15.0 software. Results A total of 16 studies were included, comprising 29 OHSS risk prediction models. The area under the curve (AUC) ranged from 0.628 to 0.998, with 23 models demonstrating AUC > 0.700. Model calibration was performed in 10 studies, internal validation in 14 studies, and 2 studies conducted both internal and external validation. The PROBAST + AI assessment identified a high risk of bias across the included studies, primarily in the research design and statistical analysis domains. The most common predictors identified across the models included: antral follicle count (AFC), estrogen (E2) levels on the day of human chorionic gonadotrophin (hCG) injection, number of oocytes retrieved, polycystic ovary syndrome (PCOS), age, anti-mullerian hormone (AMH), gonadotropin (Gn) days, initial dose of Gn, and body mass index (BMI). Conclusions Our findings indicate substantial variation in OHSS incidence. Interpretation of the results should be with caution due to the limitations of the current evidence. Current OHSS risk prediction models remain under development and require further refinement. Future efforts to build and improve these models should focus on key areas, including research design, sample size, handling of missing data, model calibration and validation, and detailed reporting. Trial registration: PROSPERO CRD420251025876.

Houhua Guo, Nannan Luan, Jian Gao et al.

Abstract Background Lactylation, a post‐translational alteration facilitated by lactic acidderived lactyl‐CoA, has emerged as an epigenetic regulator that alters gene expression in macrophages. Emerging data situates lactylation at the nexus of metabolic flux and immune cell destiny, especially in tumor and inflammatory microenvironments. Main text Lactylation is significantly linked to tumor progression and the polarization of macrophages towards the M2 phenotype, a condition that exacerbates cancer and associated inflammation. Modulating lactylation levels can alter the M1/M2 balance, hence affecting the progression of cancer and inflammatory illnesses. These findings identify lactylation as aregulator that can either suppress or enhance tumor development and the related inflammatory response, contingent upon the context and degree of the change. Conclusion This review systematically elucidates the role of lactylation in directing macrophage polarization in the context of cancer and associated inflammation. The aggregated data suggest that targeting lactylation constitutes an innovative therapeutic strategy for regulating immune cell activity and managing the advancement of cancer and related inflammatory conditions. Key points The conversion of lactate to lactyl‐CoA facilitates enzymatic histone lactylation, transforming glycolytic byproducts into an epigenetic regulatory mechanism for gene expression. Lactylation modification influences macrophage polarization towards M1 or M2 phenotypes, affecting outcomes in infection, cancer, and fibrosis. Targeting lactylation modifiers through pharmacological means introduces a novel metabolic‐epigenetic approach for treating disorders.

K. Schulz, Douglas G. Altman, David Moher

The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience.To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.

Hong Yang, Chunjiong Wang, L. Poon

H. YANG1,2, C. WANG1,2 and L. C. POON3* 1Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China; 2Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China; 3Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR *Correspondence. (e-mail: liona.poon@cuhk.edu.hk)

L. A. Lett, Whitney U Orji, R. Sebro

Objective To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990–2016. Methods This longitudinal study of faculty diversity uses data obtained from the American Association of Medical Colleges (AAMC) Faculty Roster from US allopathic medical schools. The proportion of professors of racial minority groups and female faculty by rank was compared to the US population based on data from the US Census Bureau. The Roster includes data on 52,939 clinical medical faculty in 1990, and 129,545 in 2016, at the assistant professor level or higher. The primary measure used in this study was the S-score, a measure of representation based on the probability of the observed frequency of faculty from a racial/ethnic group and sex, given the racial and ethnic distribution of the US. Pearson correlations and 95% confidence intervals for S-score with time were used to measure trends. Results Blacks and Hispanics showed statistically significant trends (p<0.05) towards increasing underrepresentation in most specialties and are more underrepresented in 2016 than in 1990 across all ranks and specialties analyzed, except for Black females in obstetrics & gynecology. White females were also underrepresented in many specialties and in a subset of specialties trended toward greater underrepresentation. Conclusions Current efforts to improve faculty diversity are inadequate in generating an academic physician workforce that represents the diversity of the US. More aggressive measures for faculty recruitment, retention, and promotion are necessary to reach equity in academia and healthcare.

C. Ticconi, A. Pietropolli, N. Di Simone et al.

Recurrent pregnancy loss (RPL) represents an unresolved problem for contemporary gynecology and obstetrics. In fact, it is not only a relevant complication of pregnancy, but is also a significant reproductive disorder affecting around 5% of couples desiring a child. The current knowledge on RPL is largely incomplete, since nearly 50% of RPL cases are still classified as unexplained. Emerging evidence indicates that the endometrium is a key tissue involved in the correct immunologic dialogue between the mother and the conceptus, which is a condition essential for the proper establishment and maintenance of a successful pregnancy. The immunologic events occurring at the maternal–fetal interface within the endometrium in early pregnancy are extremely complex and involve a large array of immune cells and molecules with immunoregulatory properties. A growing body of experimental studies suggests that endometrial immune dysregulation could be responsible for several, if not many, cases of RPL of unknown origin. The present article reviews the major immunologic pathways, cells, and molecular determinants involved in the endometrial dysfunction observed with specific application to RPL.

D. Mutch, J. Prat

Shi Zhao MPhil, Peihua Cao, M. K. Chong et al.

Mengzhou Xue MD, PhD1, Jianbo Liu MD, PhD5 and Guang Han MD, PhD6 1Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 2Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China, 3Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, Shijiazhuang, China, 4Department of Public Health, Wuhan University, Wuhan, China, 5Department of Respiratory Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China and 6Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Sam Schulman, S. Konstantinides, Yu Hu et al.

1Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada 2Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia 3Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany 4Department of Cardiology, Democritus University of Thrace, Thrace, Greece 5 Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China