Abstract: Background: The importance of integrating enhanced recovery after surgery (ERAS) protocols in gynecologic oncology has been proven in numerous studies. However, the actual adherence to protocol among institutions remains inconsistent in clinical practice, particularly among those without prior structured implementation. This pragmatic multicenter study provides a preliminary report from the ongoing ERGO (Enhanced Recovery in Gynecologic Oncology) cohort study (ClinicalTrials.gov: NCT06655506) and aims to evaluate adherence to ERAS protocols during the early phases of its adoption as well as to determine factors determining low uptake. Methods: Overall, 300 consecutive patients undergoing gynecologic oncology surgery across five institutions were included in the present study. Adherence to preoperative, intraoperative, and postoperative ERAS elements was documented using standardized forms. Optimal adherence was predetermined as fulfillment of more than 70% of the ERAS components included in the pathway. Multinomial analysis was used to identify predictors of adherence. Results: Overall, 70.3% of patients achieved optimal adherence; however, rates varied across centers (26.9%–84.4%), reflecting the limited institutional familiarity with ERAS pathways in most participating centers. The actual volume of cases handled was as an important determinant of adherence, with high-volume units consistently demonstrating substantially higher compliance compared with lower-volume hospitals. Routine preoperative items demonstrated high uptake, whereas several intraoperative and early postoperative components showed low and heterogeneous implementation, that might be the result of anesthesiology-driven practices. Higher surgical complexity and poorer ECOG performance status independently predicted reduced adherence. Visual mapping confirmed that complex procedures resulted in lower adherence. Conclusion: The significant variability in ERAS adherence that was observed in our study indicates the need to institute structured workflows that help increase team familiarization, particularly in high-complexity cases and centers new to ERAS.

Abstract: Background: 22q11.2 deletion syndrome (22q11.2DS), also known as Di-George/velocardiofacial syndrome is the most common chromosomal microdeletion and is frequently associated with conotruncal congenital heart defects (CHD). A novel protocol for 22q11.2 deletions detection using conventional PCR and agarose gel electrophoresis was developed, and seven primer pairs targeting six 22q11.2 genes (HIRA, TBX1, DGCR8, ZNF74, CRKL, MAPK1) plus the reference gene RPP30 were evaluated. Methods: DNA from eight CHD cases (four 22q11.2 deletions confirmed by FISH (P1–P3) or BOBs (P4), and four cases with unknown status (U1–U4)) and two controls was amplified un-der optimized PCR conditions. The PCR products were analyzed on 2.5% agarose gels to assess band presence, intensity, and expected size for primer validation and potential 22q11.2 deletions detection. Results: All seven primer pairs produced expected sizes bands in two normal controls, with no target-size bands in the no template control (NTC), indicating adequate amplification performance. Among deletion confirmed cases, concordant multi-locus loss was observed—most notably at TBX1, DGCR8 and ZNF74, with MAPK1 additionally reduced in P4 sample. In the unknown group, U1 and U3 showed normalized band-intensity ratios above the 0.6 cut-off at all loci, indicating no evidence of 22q11.2 deletions, whereas locus-specific partial loss at ZNF74 was detected in U2 and U4; none of the unknown samples exhibited the broad multi-gene loss pattern observed in the confirmed 22q11.2 deletion cases. Conclusions: This study has developed and val-idated a novel 22q11.2 deletions detection protocol using conventional PCR with agarose gel electrophoresis. The assay is rapid and inexpensive, suitable for basic molecular laboratories, while confirmation still relies on standard clinical genetic tests such as CMA, FISH or BOBs, particularly in resource-limited settings.

Abstract:

Background And Objective: Changes in female sex hormone levels are closely linked to the development and progression of uterine fibroids (UFs). Clinical approaches to fibroid management vary according to guidelines and depend on patient symptoms, fibroid size, and clinician judgment. Despite available diagnostic tools, surgical decisions remain largely subjective. With the advancement of artificial intelligence (AI) and clinical decision support technologies, clinical experience can now be transferred into data-driven computational models trained with hormone-based parameters. To develop a clinical decision support algorithm that predicts surgical necessity for uterine fibroids by integrating fibroid characteristics and female sex hormone levels. Methods: This multicenter study included 618 women with UFs who presented to three hospitals; 238 underwent surgery. Statistical analyses and artificial intelligence–based modeling were performed to compare surgical and non-surgical groups. Training was conducted with each hormone—follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and anti-Müllerian hormone (AMH)—and with 126 input combinations including hormonal and morphological variables. Five supervised learning algorithms—support vector machine, decision tree, random forest, and k-nearest neighbors—were applied, resulting in 630 trained models. In addition to this retrospective development phase, a prospective validation was conducted in which 20 independent clinical cases were evaluated in real time by a gynecologist blinded to both the model predictions and the surgical outcomes. Agreement between the clinician’s assessments and the model outputs was measured. Results: FSH, LH, and PRL levels were significantly lower in the surgery group (p < 0.001, 0.009, and < 0.001, respectively), while E2 and AMH were higher (p = 0.012 and 0.001). Fibroid volume was also greater among surgical cases (90.8 cc vs. 73.1 cc, p < 0.001). The random forest model using LH, FSH, E2, and AMH achieved the highest accuracy of 91 percent. In the external validation phase, the model’s predictions matched the blinded gynecologist’s decisions in 18 of 20 cases, corresponding to a 90% concordance rate. The two discordant cases were later identified as borderline scenarios with clinically ambiguous surgical indications. Conclusion: The decision support algorithm integrating hormonal and fibroid parameters offers an objective and data-driven approach to predicting surgical necessity in women with UFs. Beyond its strong internal performance metrics, the model demonstrated a high level of clinical concordance during external validation, achieving a 90% agreement rate with an independent, blinded gynecologist. This alignment underscores the model’s practical reliability and its potential to reduce subjective variability in surgical decision-making. By providing a reproducible and clinically consistent framework, the proposed AI-based system represents a meaningful advancement toward the validated integration of computational decision tools into routine gynecological practice.

Abstract: High-risk human papillomavirus (HPV), including types 16-18, is the established cause of cervical intraepithelial neoplasia (CIN) and invasive carcinoma of the cervix. While preventive vaccination is highly effective in preventing infection from becoming re-constituted following treatment of existing disease, its use among cervical intraepithelial neoplasia (CIN)-positive females has remained sporadic. The following review provides an update on the current state of evidence about the acceptance, awareness, or perception of HPV vaccination by women following a diagnosis or treatment of CIN.Methods:A narrative synthesis of literature from the publication period of 2010 to 2025 was done on both PubMed, Scopus, and Google scholar. Surveys that quantified literature on post-CIN vaccination attitudes, risk perceptions, or behavioural factors were consid-ered.Results:Acceptance levels varied from 20–95% across all continents. The highest acceptance levels (≥80%) among the populations belong to the European and Oceanian groups, followed by moderate acceptance among the North Americans (60–80%), which was influenced by financial costs, misconceptions, and sociocultural stigmas. The lowest levels (20–70%) of awareness of HPV diseases and vaccination programs among Asians and Africans can be attributed to obstacles that include misconceptions about fertility concerns. The key determinant of acceptance levels was physician endorsement, lack of knowledge of the association of HPV-CIN, or the belief that there is no need for vaccination after treatment.Conclusion:The acceptance of HPV vaccination among women following CIN is influenced by educational level, the structure of the healthcare system, and so-ciocultural factors. Incorporating evidence-based cervical vaccination counselling into follow-up care after biopsy could help increase its acceptance and prevent recurrent high-grade lesions. Keywords: Human papillomavirus (HPV); Cervical intraepithelial neoplasia (CIN); HPV vaccination; Adjuvant immunization; Vaccine acceptance; Patient perception; Secondary prevention; Gynecologic oncology; Behavioral determinants; Physician recommendation.

Abstract: Endometriosis is an inflammatory estrogen-dependent disorder characterized by pain, dyspareunia, dysmenorrhea, and infertility. This is due to the invasion of different organs by endometrial tissue that cause inflammation, angiogenesis, and fibrosis. The ion channels Piezo1 and Piezo2 primary work as mechanosensors and mechanotransducers but also have functions that could participate in the clinical hallmarks of the endometriosis. Thus, we investigated the occurrence and localization of Piezo1 y Piezo2 in the healthy human endometrium and in endometriosis using immunohistochemistry. In healthy endometrium Piezo1 immunoreactivity was detected in the glands and to a lesser extent in the stroma; Piezo2 was present in the same locations but at low or residual levels. In ectopic endometriosis, there was an increase in the intensity of Piezo1 regardless of their location; Piezo2 only showed a net increase in the ovary and vagina endometriosis foci. Present results demonstrate for the first time the occurrence of Piezo ion channels in the healthy human endometrium, as well as an increase in Piezo1 in ectopic endometriosis, and no changes in Piezo2 with the exception of the ovary and vagina. The role of these ion channels in the endometrium and in the pathogenesis of the endometriosis remains to be elucidated.

Abstract: Assisted reproductive technologies (ART) and, in particular, intracytoplasmic sperm injection (ICSI) transformed the management of male infertility by making fertility possible in previously untreatable cases. However, the bypassing of natural selection mechanisms at fertilization is fraught with the danger of transmission of genetic and epigenetic abnormalities. Male infertility is now a multifactorial disorder with notable contributions from single-gene defects, chromosomal abnormalities, and Y-chromosome microdeletions. The recent advances in next-generation sequencing and sperm omics have identified mutations and copy-number variations in genes crit-ical for spermatogenesis, flagellar structure, and endocrine regulation. Along with these findings, an increasing body of evidence suggests that ART procedures can lead to a disruption of epigenetic reprogramming during gametogenesis and early embryo-genesis, resulting in imprinting disorders and altered patterns of gene expression in the offspring. This review synthesizes recent progress in the molecular underpinnings of genetic and epigenetic hazards of ART, with an emphasis on clinical significance for reproductive counselling and ethical considerations for future generations.

Abstract: Uterine fibroids are among the most common benign tumors affecting women of reproductive age. Traditional treatment has often involved surgical removal, including hysterectomy, but minimally invasive alternatives such as radiofrequency ablation (RFA) have emerged. We report the case of a 41-year-old woman with symptomatic uterine fibroids (FIGO type 2–5, size of 5 cm) treated with transvaginal RFA. One month post-treatment, the fibroid showed partial volume reduction. Two months after the procedure, the patient presented with foul-smelling discharge and heavy bleeding. Ultrasound confirmed complete fibroid migration into the cervical canal. Vaginal removal was performed without complications. This case highlights a rare but notable outcome of RFA treatment. Transvaginal fibroid expulsion may be viewed as either a treatment-related complication or a spontaneous therapeutic result. To our knowledge, only one other case has been reported in the literature. Further studies are needed to assess the prognostic and clinical significance of this occurrence.

Abstract: Breastfeeding is the only appropriate way to feed healthy newborns. A shortened lingual frenulum in newborns is considered one of the main causes of difficulties in effective breastfeeding, sore nipples, and breastfeeding discontinuation. In recent years, there has been an increasing incidence of diagnosed shortened lingual frenulum in newborns, with this clinical condition being considered the sole cause of breastfeeding difficulties. At the same time, the frequency of frenulum cutting procedures has recently increased dramati-cally and is becoming an increasingly common procedure in newborns. This raises con-cerns among both mothers and physicians. Our paper aims to answer whether a frenoto-my is always necessary and justified, and whether it has advantages over simple, non-invasive conservative methods.

Abstract:

Background/Objectives: Tumour-infiltrating lymphocytes (TILs) significantly influence the prognosis of epithelial ovarian cancer (EOC). Advanced EOCs often cause neutrophilia, ascites, and malnutrition. The neutrophil-to-lymphocyte ratio (NLR) serves as a marker of systemic inflammation. This study investigated the prognostic significance of pre-treatment NLR and TILs in advanced EOCs. Methods: Overall, 101 advanced EOCs (stages III–IV, FIGO 2014) were treated between 2005 and 2020. Based on pathological findings, advanced EOCs were classified as having high or low TIL density using CD8 immunostaining. The number of marker-positive cells was counted using HALO. Progression-free survival and overall survival (OS) were compared between the high- and low-NLR groups based on CD8+ TIL levels. Results: Clinicopathological characteristics, including age, FIGO stage, histological subtype, and postoperative residual disease, did not significantly differ among the four groups defined by NLR and intra-epithelial CD8+ TILs (CD8+ iTILs). Multivariate Cox regression analysis of OS revealed that NLR and CD8+ iTILs were independent prognostic factors. The 5-year OS rates (Kaplan–Meier estimates) were 82.2% (median survival time not reached; range, 8–163 months) in the low NLR–high CD8+ iTIL group (n=25); 41.7% (46 months; range, 2–109 months) in the low NLR–low CD8+ iTIL group (n=16); 47.2% (52 months; range, 1–181 months) in the high NLR–high CD8+ iTIL group (n=34); and 26.0% (24 months, 2–106 months) in the high NLR–low CD8+ iTIL group (n=26) (p<0.001). Conclusions: In advanced EOCs, the status of tumour-localised immunity and pre-treatment systemic inflammation influenced long-term prognosis.

Abstract: Background: Recurrent pregnancy loss (RPL) is a multifactorial condition in which genetic variants associated with thrombophilia may contribute to altered coagulation and adverse pregnancy outcomes. Objective: This study aimed to investigate the association between thrombophilia-related single nucleotide variants (SNVs) and coagulation-related metabolites in a cohort of Mexican women with RPL. Methods: A retrospective and descriptive design was conducted including 105 women with at least two consecutive miscarriages. Peripheral blood samples were collected after fasting for biochemical and molecular analyses. Genotyping of thrombophilia-associated SNVs was performed using real-time PCR with custom-designed TaqMan probes on a Rotor-Gene Q platform, including variants in AGT (rs4762, rs699), F7 (rs6046), FGB (rs1800790), MTR (rs1805087), MTRR (rs1801394), MTHFR (rs1801133, rs1801131), F2 (rs1799963), F5 (rs6025), SERPINE1 (rs1799889), F12 (rs1801020), and F13A1 (rs5985) genes. Coagulation parameters evaluated were folic acid, cobalamin, fibrinogen, D-dimer, homocysteine, antithrombin III activity, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and Factor XII activity. Results: Significant differences were found in INR values across F7-rs6046 genotypes (p = 0.006), with an additive model showing a mean difference of 0.05 (p = 0.0009). The F12-rs1801020 variant was strongly associated with Factor XII activity (p = 0.002) and aPTT (p = 0.045). Conclusions: These findings indicate that F7-rs6046 and F12-rs1801020 genotypes influence specific coagulation parameters, suggesting that certain thrombophilia-associated SNVs may modulate the hemostatic profile in Mexican women with RPL and contribute to personalized risk assessment in reproductive medicine.

Abstract:

Introduction: Preterm birth (PTB) (delivery< 37 completed weeks of gestation) is one of the leading causes of neonatal mortality and morbidity. Its aetiology is multifactorial but is unknown in many cases. Worldwide about 15 million babies are born preterm annually. Rates are higher in low and middle-income countries where several social, environmental and health factors interact. Objectives: The aim of this study was to identify factors associated with PTB in a metropolitan area of a low middle income country- Sudan. Method: This was a prospective cross-sectional hospital-based study carried out at Omdurman Maternity Hospital over a period of six months on women who received antenatal care and delivered at the hospital over the study period. After delivery, the cohort was then divided into those who delivered preterm and those who delivered at term, and a multivariate analysis performed to identify factors associated with PTB. Those who had elective CS were excluded from the study. Result: A total of 411 women received antenatal care and delivered over the study period and 384 formed the subjects of the study. The PTB rate was 7.4%. Factors identified that were associated with PTB included maternal age <20 years old (P=0.017), low family income (P=0.005), rarely receiving iron and folic acid supplementation (P=0.00001), infrequent antenatal care attendance (P=0.013), poor nutritional status (P=0.0000001), low maternal education (P=0.04) and short inter-pregnancy interval (<6 months) (P=0.04). Other factors included multiple birth (P=0.001), diabetes mellitus (P=0.004), antepartum haemorrhage (P=0.002), hypertension (P=0.004), previous PTB (P=0.0001) and urinary tract infections (P= 0.004). Conclusion: Various sociodemographic factors and complications during pregnancy increased the risk of PTB in this population. To reduce the risk, an interdisciplinary approach must be adopted. This should tackle factors pre-pregnancy and improve access. Healthcare providers should ensure folate and iron supplementation and identify complications such as diabetes and hypertensive disorders in pregnancy early and manage appropriately.

Abstract: Background and Aim: Adverse pregnancy outcomes (APOs) such as prematurity, low birth weight, stillbirth, and birth defects remain significant global health challenges. While many risk factors are known, APOs encompass a wide range of outcomes with di-verse, sometimes poorly understood etiologies. Pregnancy-related acute kidney injury (PR-AKI) and liver injury are particularly associated with increased maternal and fetal mortality. This study investigated the association between hematological parameters, kidney and liver injury markers and adverse pregnancy outcomes. Materials and Meth-ods: This cross-sectional study involved 714 pregnant women aged 18-40 years, conduct-ed between August 2021 and August 2022. Maternal blood samples were collected before and after delivery to compare hematological parameters. Kidney and liver injury markers were measured using standard methods. The study analysed the association of these pa-rameters with adverse pregnancy outcomes. Results: The median age of participants was 24 years (Q1, Q3: 21, 26). Women with adverse pregnancy outcomes had statistically sig-nificant serum creatinine levels [0.52 mg/dL (0.45, 0.58)] compared to those without [0.50 mg/dL (0.44, 0.56)], although the difference was not clinically significant. Elevated AST levels (>90th percentile) were statistically associated with adverse pregnancy outcomes. Pairwise comparisons with Bonferroni corrections revealed significant differences in Hb, WBC, RBC, platelet, and PCV levels before and after delivery (p< 0.05) in both groups. Con-clusion: The study revealed a statistically significant yet clinically negligible difference in creatinine levels between women with and without adverse pregnancy outcomes. Elevat-ed AST levels showed an associated with APOs, whereas other biochemical markers showed no association.

Abstract: Brazil recently implemented a national menstrual health program within its Public Health System (Sistema Único de Saúde, SUS), representing a significant policy shift toward recognizing menstrual dignity as a public health and human rights issue. The distribution of menstrual products has expanded rapidly; however, this alone is insufficient to address the structural inequalities affecting menstrual health. This article aims to analyse the implementation of the menstrual health program in Brazil, identify existing inequalities and operational barriers, and propose a research and data framework capable of strengthening monitoring, policymaking, and global collaboration. The study is part of the PLATO project (Work Package 1), integrating public health, gender equality, and implementation science. A narrative analysis was conducted using government and legal documents, demographic and WASH data, and international literature on menstrual equity. Despite strong legislation and intersectoral governance, substantial gaps remain in access, digital inclusion, infrastructure, and participation of marginalized groups. Brazil lacks standardized indicators, interoperable data systems, and monitoring strategies to assess real outcomes. A logic model and equity-centered research architecture are proposed to address these gaps by integrating product provision, WASH, data systems, community participation, and global integration. Brazil has made fundamental progress in menstrual health policy. However, achieving menstrual dignity requires moving beyond product distribution to integrated data collection, infrastructure, equity monitoring, and participatory governance. This framework offers a model applicable to Brazil and other low- and middle-income countries.

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Background: The popularity of wearable health monitoring devices, such as Fitbits, is on the rise. However, their applicability in various research demographics remains uncertain, particularly among postpartum women facing significant sleep challenges. Objective: This study aimed to evaluate the consistency between Fitbit Charge 6 and structured interview questions in measuring sleep quality among breastfeeding mothers. Methods: A cross-sectional study utilizing random convenience sampling was conducted in Ho Chi Minh City, Vietnam, involving 208 breastfeeding women one month postpartum. The participants used the Fitbit Charge 6 device continuously for four days and three nights to gather daily sleep information; then, they were administered a structured sleep questionnaire via home interviews. Results: The correlation between the total sleep time (TST) recorded by both the device and interview was weak (r = 0.28), as was the correlation for short nap duration (r = 0.25). The agreement between the Fitbit Sleep Score and sleep satisfaction from the questionnaire was 79.9%, with a notably low Kappa index (0.02), indicating a lack of strong agreement. Conclusion: The Fitbit Charge 6 did not show reliable correlation with the subjective sleep data reported by one-month postpartum breastfeeding women. Further research employing rigorous comparative studies is necessary to assess the validity and reliability of sleep data collection methods for this demographic.

Abstract: Background: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes. Simple prognostic biomarkers are needed for risk stratification. The Albumin-Bilirubin (ALBI) score and Aspartate Aminotransferase to Alanine Aminotransferase ratio (De Ritis) are established liver function indices, but their comparative utility for predicting adverse perinatal outcomes in ICP remains inadequately explored.This study aimed to evaluate and compare the prognostic performance of the ALBI score and the De Ritis ratio for predicting ICP and adverse perinatal outcomes.Methods: A retrospective study was conducted utilizing a publicly available dataset comprising 100 pregnant women with a diagnosis of ICP. The ALBI score and De Ritis ratio were calculated from serum biomarkers. Univariate and multivariable logistic regression were used to assess associations, presented as odds ratios (OR) with 95% confidence intervals (CI). Predictive performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis, reporting the area under the curve (AUC), sensitivity, and specificity.Results: In univariate analysis, the ALBI score was a significant predictor of adverse outcomes (OR=20.54, p<0.001), while the De Ritis ratio was not (OR=0.78, p=0.42). The ALBI score demonstrated significantly superior discriminatory power (AUC=0.712). In multivariable models adjusting for gestational age, maternal age, ALP, and GGT, the ALBI score remained a strong, independent predictor (fully adjusted OR=21.65, p=0.006), whereas the De Ritis ratio was consistently non-significant. A model combining both scores showed good predictive performance (AUC=0.714), which was significantly enhanced to an excellent level (AUC=0.845) after full adjustment for clinical covariates.Conclusion: The ALBI score is a significant and independent predictor of ICP and adverse perinatal outcomes in the pregnancy, demonstrating good prognostic utility. In contrast, the De Ritis ratio showed no meaningful predictive value. The ALBI score could serve as a useful clinical tool for risk assessment in this patient population.

Abstract: We present the open-source development and application of a novel, custom-engineered vaginal dilator for the post-surgical management of vaginal stenosis in a 29-year-old patient with congenital adrenal hyperplasia. This methodology highlights a collaborative approach between surgical teams and biomedical engineers, addressing limitations in traditional dilators by designing patient-specific molds based on MRI measurements. The dilator, made of biocompatible silicone elastomer and created using a simple 3D-printing process, demonstrated superior patient comfort and compliance in this patient. The use of this innovative device could improve surgical outcomes, reduced re-stenosis rates, and enhanced patient quality of life. Additionally, the surgical approach for clitoral reduction is described, emphasizing its complexity and the importance of preserving neurovascular integrity to avoid complications such as pain or sensory loss. The case underscores the importance of tailored interventions, as well as interdisciplinary collaboration and the potential of this for broader application of novel methodologies in similar clinical contexts.

Abstract:

Background: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) represents a novel evolution in minimally invasive gynecologic surgery, combining endoscopic visualization with a transvaginal access route. Although its safety and efficacy in benign conditions and endometrial cancer have been well established, evidence regarding its role in ovarian malignancies remains limited. Objective is to evaluate the feasibility, perioperative safety, and oncologic adequacy of vNOTES for the surgical management and staging of apparent early-stage ovarian cancer.Methods: A narrative literature review was performed following a PICO-driven framework. Databases including PubMed, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar were searched up to September 2025. Eligible studies included case reports, series, and comparative analyses reporting outcomes of vNOTES in early-stage ovarian cancer or borderline ovarian tumors. Data on feasibility, intra- and postoperative complications, tumor spillage, conversion rates, and oncologic outcomes were synthesized descriptively.Results: The current evidence base comprises several case reports and small series (totaling approximately 50 reported patients). Across studies, vNOTES enabled completion of standard staging steps—oophorectomy, hysterectomy, omentectomy, peritoneal biopsies, and selective lymphadenectomy—entirely via the transvaginal route in nearly all cases, with conversion rates approaching zero. Estimated blood loss was minimal (≤150 mL), median operative times ranged from 45–90 minutes, and hospital stay was typically ≤2 days. Complication rates were low, and intraoperative tumor spillage was rare (<5%). Short- to medium-term follow-up (≤3 years) revealed recurrence rates consistent with expected outcomes for early-stage disease and no disease-related deaths.Conclusions: Early evidence indicates that vNOTES is a technically feasible and safe approach for carefully selected patients with apparent early-stage ovarian cancer, achieving oncologically sound procedures with reduced postoperative pain, minimal morbidity, and excellent cosmetic outcomes. Nevertheless, its use should currently be limited to specialized centers with vNOTES expertise, pending confirmation of long-term oncologic equivalence through multicenter prospective studies.

Abstract:

Background: Thyroid autoimmunity, particularly anti-thyroid peroxidase antibodies (anti-TPO), has been implicated in reduced fertility and diminished ovarian reserve. However, the stratified effects of anti-TPO across age groups, body mass index (BMI) categories, and polycystic ovary syndrome (PCOS) status remain unclear. This study aims to investigate the association between anti-TPO positivity and ovarian reserve markers—antral follicle count (AFC), anti-Müllerian hormone (AMH), and follicle-stimulating hormone (FSH)— in euthyroid infertile women. Methods: This retrospective study included 1,460 infertile women aged 18–45 years, evaluated between 2022 and 2025. Participants were categorized based on anti-TPO levels (≥9 vs. <9 IU/mL) using Beckman Coulter-DXI 800 analyzer, which uses chemiluminescent immunoassays to measure results. BMI (<30 vs. ≥30 kg/m²), and PCOS status. Age was categorized into five strata (18–25, 25–30, 30–35, 35–40, and 40–55 years), and (<35 vs. ≥35 years). Linear regression models were used to assess the impact of anti-TPO on AMH and AFC within each subgroup. Additional logistic regression was performed to evaluate the odds of diminished ovarian reserve (DOR: AMH <1 ng/mL or AFC <5) after adjusting for age, BMI, and TSH. Results: Anti-TPO positivity (17.6% prevalence) was significantly associated with reduced AMH (1.47 ± 1.52 vs. 3.33 ± 3.03 ng/mL, p < 0.0001), reduced AFC (8.18 ± 5.06 vs. 15.88 ± 8.18, p < 0.0001), and elevated FSH (9.40 ± 6.21 vs. 8.06 ± 4.79 mIU/mL, p = 0.001). These associations remained significant in non-obese and PCOS-negative subgroups. Regression models revealed stronger associations in younger women (<35 years) and showed significant Anti-TPO × Age and Anti-TPO × BMI interactions. Logistic regression confirmed Anti-TPO ≥9 IU/mL as a strong predictor of diminished ovarian reserve (AMH <1 ng/mL: OR = 3.13; AFC <5: OR = 6.48). ROC analysis indicated modest predictive ability (AUC: 0.665–0.694), and path modeling confirmed direct effects of Anti-TPO on AMH and AFC independent of TSH or BMI. Conclusion: Elevated Anti-TPO levels are independently associated with diminished ovarian reserve in euthyroid women, particularly in younger, non-obese, and PCOS-negative individuals. Anti-TPO may serve as a useful biomarker in fertility risk assessment and personalized reproductive counseling, even in the absence of overt thyroid dysfunction.

Abstract: Introduction: It is unclear in which patients’ bleomycin-induced pulmonary toxicity oc-curs at an increased rate in testicular cancer (TC). Objective: The aim of this study was to analyze the prognostic significance of lympho-cyte-associated inflammation markers that may predict bleomycin-related pulmonary toxicity in TC. Results: Clinical and laboratory data were recorded for 118 patients diagnosed with TC who received bleomycin, with a median age at diagnosis of 32.19±9.62. Symptomatic pulmonary toxicity was present in 19.49% (n=23) of patients. Of these, 66.67% had a DLCO decrease of more than 10%. When comparing patients with and without pulmo-nary toxicity, there were no differences in terms of age at diagnosis, performance status, histopathological subgroup, tumor size, lymphovascular invasion, diagnostic symptom, stage, number of adjuvant treatment cycles, and tumor marker levels. Patients with pul-monary toxicity were more likely to be active smokers than those without pulmonary tox-icity, and NLR>1.64, PLR>93.92, CLR>0.49, SII>444.25, and SIRI>0.66 were found to be statistically significant. Lymphocyte-related inflammation markers (NLR, PLR, LMR, CLR, SII, and SIRI) were found to be prognostic for pulmonary toxicity. There was 5.2 times more pulmonary toxicity in smokers than in non-smokers. The prognostic inflammation markers that enable us to predict pulmonary toxicity are TC. Conclusion: The employment of lymphocyte-related inflammation biomarkers at the commencement of treatment offers a means of predicting bleomycin-related pulmonary toxicity in TC.

Abstract: Congenital anomalies are an important cause of infant morbidity and mortality and have a high prevalence, especially in low- and middle-income countries. This retrospective cohort study evaluated the prevalence, distribution, and outcomes of congenital anomalies in Southeast Turkey over a 10-year period and investigated prognostic factors affecting survival. A total of 956 pregnant women referred to a tertiary care centre with suspected or confirmed fetal anomaly between January 2015 and December 2024 were included in the study. Maternal demographic, obstetric and clinical data and fetal characteristics were obtained from hospital records. Anomalies were classified according to organ systems and birth weights were categorised according to World Health Organization definitions. Congenital anomalies were observed in 956 (7.3%) of 13,089 births. Central nervous system anomalies were the most common (44.2%), followed by cystic hygroma (10.3%), cardiac (9.4%) and urinary system anomalies (8.7%). Neural tube defects were present in 31.8% of cases and spina bifida was the dominant type (51.0%). Survival was 89.9% at ≥24 weeks compared to only 1% at less than 24 weeks (p&lt;0.001). Logistic regression identified gestational age as the only independent predictor of survival (OR=0.744, 95% confidence interval:0.555-0.997, p=0.048). These findings emphasise the importance of early diagnosis, prenatal screening and region-specific preventive strategies.