Medicine and Pharmacology

Abstract: Background: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common pelvic floor disorders with multifactorial etiology. This study aimed to identify demographic, anthropometric, and obstetric factors associated with POP and SUI. Methods: A retrospective cross-sectional study was conducted among 5,477 women attending a tertiary urogynecological outpatient clinic between 2016 and 2025. The study group included 4,333 women diagnosed with POP or SUI, while 1,144 women with other gynecological conditions served as controls. Associations between age, body mass index (BMI), smoking, and obstetric history were evaluated using multivariable logistic regression and the U-Smile predictive method. Results: Increasing age was independently associated with a higher risk of pelvic floor disorders (OR = 1.02; 95% CI: 1.01–1.02; p < 0.0001). Overweight was associated with a reduced likelihood of POP/SUI compared with normal BMI (OR = 0.85; 95% CI: 0.73–1.00; p = 0.0444). Each additional full-term pregnancy was associated with a 35% reduction in the odds of pelvic floor disorders (OR = 0.65; 95% CI: 0.60–0.69; p < 0.0001). Underweight, obesity, preterm birth, miscarriage, and smoking were not independent predictors. Conclusions: Age, overweight status, and the number of full-term pregnancies were the strongest independent predictors of POP and SUI. Further studies are needed to clarify the unexpected protective associations observed for overweight and term pregnancies.

Abstract: Background/Objectives: Persistent infection with high-risk HPV genotypes accounts for the development of a substantial portion of anogenital and oropharyngeal malignancies. Patients with primary and secondary immunodeficiency or those receiving immunosuppressive therapy, including transplant recipients and patients affected by rare diseases, are vulnerable to particularly severe clinical manifestations of infection. While HPV vaccination constitutes primary prevention, patients with HPV-associated disease remain at risk of reinfection or subsequent infection with alternative genotypes following surgical treatment and may benefit from peri-operative vaccination regimens. This study aimed to evaluate long-term outcomes of HPV vaccination following surgical management of condyloma acuminata in patients with concurrent high-risk genotype infection. Methods: 350 patients with condyloma acuminata and HPV-16 or -18 co-infection confirmed by histopathological examination and PCR genotyping (oral cavity, vulva, vagina, penis, anoderma), including a subgroup with primary or acquired immunodeficiency or chronic immunosuppressive regimens, underwent surgical treatment, receiving simultaneous immunization with the first dose (subsequent completion of full regimen over 12 months) of the bivalent Cervarix vaccine (170 patients) or the quadrivalent Gardasil vaccine (180 patients). A follow-up examination including HPV genotyping (16/18/31/35) was performed after 6 and 12 months following regimen completion. After 36 months a standard clinical examination was performed, and in doubtful cases, supplemented with genotyping with biopsy/cytology. Observation was continued in subsequent years (5, 10, and >15 years). Results: Condyloma acuminata requiring removal were observed in 5% of the patients in follow-up at 36 months, with no significant statistical difference between vaccine groups. No cellular atypia or malignant transformation in the form of squamous cell carcinoma was observed. Genotyping did not detect HPV-16/18/31/35 infection in the follow-up examinations. Conclusions: In this uncontrolled, single-arm cohort, peri-operative initiation of either the bivalent or quadrivalent HPV vaccine was associated with a low rate of clinically apparent condyloma acuminata recurrence and no detectable HPV-16/18/31/35 infection during follow-up.

Abstract: Purpose: To review how standardized ultrasound-based risk stratification and artificial-intelligence (AI) governance have reshaped early diagnostic pathways for ovarian cancer. Materials and Methods: We performed a critical narrative review of milestones in transvaginal ultrasound, IOTA descriptors, ADNEX, O-RADS US/MRI, population screening trials and AI reporting/governance standards. Priority was given to evidence that used external validation, calibration or explicit links between risk categories and clinical management. Results: Population screening with CA-125 and ultrasound has not reduced mortality in average-risk women; therefore, the highest near-term value lies in triage once an adnexal lesion is detected. IOTA/ADNEX and O-RADS translate sonographic descriptors into reproducible probabilities and management categories; O-RADS MRI is useful for sonographically indeterminate lesions. AI may support segmentation, structured reporting and triage, but high discrimination is insufficient without external validation, calibration, transportability testing, decision-curve analysis and subgroup monitoring. Conclusion: Earlier and safer decisions are more likely to come from living standards - structured ultrasound reporting, calibrated risk models, MRI arbitration, auditable AI updates and equity-aware monitoring - than from population screening alone.

Abstract: Prenatal detection of agenesis of corpus callosum (CC) anomalies is a challenge. Although a correct diagnosis of anomalies of the CC requires direct examination of the CC in the mid-sagittal plane of the fetal brain, the international guidelines on mid-trimester morphology scan do not recommend such direct examination of the CC in low-risk populations because of the associated technical difficulties. Recently, routine direct assessment of the CC with the mid-sagittal view has been recommended by several international experts in a consensus statement. The implementation of such routine direct assessment is not easy given the difficulties encountered in obtaining the mid-sagittal view of the CC. As such, it is the time to revisit the various two-dimensional and three-dimensional ultrasound techniques with a view to improve visualisation of the CC. The aim of this narra-tive review article is to discuss the use of various prenatal ultrasound screening methods of CC anomalies in-cluding standard axial views, a more detailed axial views, the mid-sagittal view, transvaginal approach, and 3D reconstruction. New insights on screening methods, and a pragmatic approach are also shared.

Abstract: Objective: To determine whether a high concentration of oxygen and hyaluronic acid applied vaginally in the two weeks preceding embryo transfer may increase implantation rates in human IVF. Design: Oxygen was applied vaginally in 3 x 15 minute sessions in the two weeks prior to embryo transfer at a pressure of 1bar at a flow of 2 litres /minute containing 0.2% of sodium hyaluronate. Subjects: 377 women (average age in the control group 38.0yrs and 37.5 yrs in the treated group) with a history of infertility or previous IVF failure undergoing frozen blastocyst transfer. Main Outcome Measures: Implantation rates after homologous and heterologous frozen blastocyst transfer. Results: The treated patients (n = 161) showed a significant increase in implantation rate compared to the control group (n = 216), with the highest significance in the heterologous population. Conclusions: Pre-treating IVF patients with high concentrations of O₂ and hyaluronic acid delivered vaginally in the two weeks preceding transfer statistically improved implantation rates in human IVF following frozen-thawed single blastocyst transfer.

Abstract:

Background/Objectives: Sacrocolpopexy (SP) remains the gold standard for apical pelvic organ prolapse (POP) repair; however, promontory-sparing techniques such as laparoscopic lateral suspension (LLS) and pectopexy (PP) have emerged as alternatives to reduce surgical complexity and potential complications. Comparative evidence among these techniques remains limited. Methods: Single-center prospective cohort study including 312 women undergoing laparoscopic apical POP repair. The primary endpoint was apical recurrence, defined as POP-Q stage ≥ II, point C > 0, or reintervention. Secondary endpoints included compartment-specific recurrence, operative time, and perioperative complications. Anatomical outcomes were assessed using both POP-Q staging and individual POP-Q measurements. Results: Anatomical preoperative heterogeneity reflecting routine clinical practice due to the non-randomized design. No significant differences were observed in apical recurrence rates (p=0.779), point C > 0 (p=0.696) or reintervention rates (p=0.719) between techniques. Anterior compartment outcomes were comparable, although Ba > 0 was more frequent in PP (p=0.005). Posterior compartment recurrence differed, with higher rates in PP compared to SP (p=0.007). Operative time was significantly longer in SP (202.5 ± 61.2 min) than in LLS (113.0 ± 40.3 min) and PP (168.0 ± 48.8 min) (p<0.001). Overall complication rates were similar (p=0.152), although major complications occurred in SP. Conclusions: SP remains the gold standard laparoscopic technique for apical prolapse but entails greater surgical complexity and increased operative time, whereas LLS and PP could be other options to correct the apical defect. Future multicenter randomized trials with long-term follow-up are required to determine definitive equivalence among techniques. Surgical planning should be individualized based on patient risk profile and anatomical considerations.

Abstract: Objective: To assess gut and endometrial microbiota simultaneously in women with unexplained recurrent implantation failure (RIF) and explore the hypothesis of a gut-endometrium microbial axis. Study design: This monocentric observational pilot study included women aged 38 years or younger with RIF and a normal uterine cavity. Paired fecal and endometrial samples were collected on the same day and analyzed by 16S rRNA gene sequencing. Relative abundances of major phyla and alpha-diversity indices were compared between compartments. Results: Twenty-one women were included. Chronic endometritis was documented hysteroscopically in all cases. Gut dysbiosis was observed in 20/21 patients (95.2%), whereas endometrial dysbiosis was found in 16/21 (76.2%); crude agreement between compartments was 71.4%. The intestinal microbiota was dominated by Bacteroidetes (52.8% ± 14.9%) and Firmicutes (33.3% ± 11.0%), whereas the endometrial microbiota was enriched in Firmicutes (64.5% ± 33.5%) and Proteobacteria (30.9% ± 32.3%). Bacteroidetes were significantly more abundant in fecal than endometrial samples (p < 0.001), while Firmicutes were significantly enriched in the endometrium (p = 0.001). All alpha-diversity indices were significantly higher in feces, indicating greater microbial richness and complexity in the gut. Conclusions: In women with RIF, gut and endometrial dysbiosis frequently coexist and show relevant concordance. These data support the hypothesis that endometrial dysbiosis may reflect a broader systemic microbial imbalance rather than an isolated uterine disorder.

Abstract: Objective: To analyze the clinical and sociodemographic profile of patients un-dergoing assisted reproductive techniques (ART) and to assess whether sociodemo-graphic or clinical factors influence access to the different therapeutic modalities available in a public assisted reproduction unit. Materials and Methods: A retrospective study was conducted including 222 pa-tients treated at the Maternal and Child Hospital of Málaga (January–June 2025). So-ciodemographic and clinical variables were analyzed using multivariate models. Results: The mean age was 34.7 years, with a predominance of women aged 35–39 years (46.85%). Most patients were of normal weight (59.17%), non smokers (74.77%), and employed (88.68%). New family models accounted for 23.6% of the co-hort, including 16.67% single mothers by choice (SMC) and 6.94% female couples, high-lighting diversity and equity in reproductive access. Infertility diagnosis and marital status were significantly associated with the technique used (p < 0.001), whereas edu-cational level showed no association. Among clinical diagnoses, structural uterine pa-thology was one of the most frequent (23.02% of valid gynecological histories), together with diminished ovarian reserve and other factors guiding referral to IVF/ICSI and other high complexity techniques. In the multivariate analysis, structural uterine pa-thology showed a trend toward greater use of high complexity techniques without reaching statistical significance (adjusted OR 1.16; 95% CI: 0.48–2.77; p = 0.742), likely due to limited statistical power and a high proportion of missing data (36.94% for infertility diagnosis/duration). Conclusions: In this cohort, the public health system ensured equitable access to ART based on clinical criteria and family models, suggesting that the socioeconomic variables evaluated did not determine the type of treatment received. Access was pri-marily driven by clinical need, underscoring the relevance of the uterine factor as a functional determinant of implantation and therapeutic personalization. Multicenter studies are warranted to evaluate reproductive outcomes and potential hidden inequities.

Abstract: Background and Objectives: High-risk pregnancy is associated with increased vulnerability to psychological distress, yet the protective mechanisms that may buffer this vulnerability remain insufficiently understood. This study examined differences in emotional distress and coping strategies between women with high-risk and low-risk pregnancies and investigated whether active coping and marital satisfaction attenuate associations between negative pregnancy experiences, prenatal depression and perceived stress. Materials and Methods: A cross-sectional study was conducted among 195 pregnant women aged 18–51 years (M = 31.76, SD = 5.32), including 102 women with high-risk pregnancies and 93 women with low-risk pregnancies. Participants completed measures of prenatal depression (EPDS), state anxiety (STAI), perceived stress (PSS-10), pregnancy-related anxiety (PRAS), pregnancy experiences (PES), coping strategies (COPE), and marital satisfaction (CSI). Independent-samples t tests, correlation analyses, partial correlations and moderation analyses were conducted. Results: Women with high-risk pregnancies reported significantly higher levels of prenatal depression (p = 0.032) and pregnancy-related anxiety (p < 0.001) than women with low-risk pregnancies. They also reported lower use of socio-emotional support (p = 0.036) and mental disengagement coping strategies (p = 0.022). Negative pregnancy experiences were positively associated with state anxiety, pregnancy-related anxiety, prenatal depression, and perceived stress after controlling for pregnancy risk status (all p < 0.001). Maladaptive coping strategies were generally associated with higher emotional distress, whereas adaptive coping strategies, particularly positive reinterpretation and planning, were associated with lower levels of prenatal depression and anxiety. Active coping moderated the association between negative pregnancy experiences and perceived stress (β = −0.16, p = 0.016). Marital satisfaction moderated the association between prenatal depression and perceived stress among women with high-risk pregnancies (β = −0.21, p = 0.016). Conclusions: Active coping and marital satisfaction emerged as modifiable protective factors that may attenuate psychological distress during pregnancy. These findings support the integration of psychological screening, coping-focused interventions, and partner involvement into prenatal care, particularly for women experiencing high-risk pregnancies.

Abstract: Background: Idiopathic intrauterine growth restriction (IUGR) is strongly associated with placental dysfunction, impaired spiral uterine artery remodeling, and adverse perinatal outcomes. Although insulin-like growth factor-1 (IGF-1) signaling is essential for placental and fetal development, the role of specific IGF-1 isoforms remains unclear. This study investigated placental IGF-1Eb expression in idiopathic IUGR and its potential as a biomarker of placental dysfunction. Methods: A total of 62 third-trimester human placentas were analyzed, including 47 from pregnancies complicated by idiopathic intrauterine growth restriction (IUGR) and 15 from pregnancies with appropriate-for-gestational-age (AGA) fetal growth, which served as the control group. The mRNA expression levels of the IGF-1Eb isoform were assessed by reverse transcription quantitative PCR in a subset of 28 fresh placental samples. The immunoexpression of IGF-1Eb protein was assessed in paraffin-embedded tissue sections. Histopathological lesions were classified according to the Amsterdam criteria, and correlations with clinical, demographic and pathological parameters were assessed using appropriate statistical analyses. Results: The mRNA expression of the IGF-1Eb isoform in placentas did not differ significantly between the IUGR and AGA groups. In contrast, immunohistochemical analysis revealed statistically significant differences in IGF-1Eb protein expression. The protein localization was cytoplasmic, perimembranous and occasionally nuclear, expressed in the perivillous and extravillous trophoblast, and the endothelium of fetal and maternal vessels. Moderate IGF-1Eb immunoexpression in the perivillous syncytiotrophoblast was observed significantly more frequently in IUGR placentas compared with the AGA group and was associated with histological changes of maternal vascular malperfusion, and with clinical parameters, including gestational age, neonatal birth weight, placental weight, maternal body mass index, and fetal sex. Furthermore, a significant increase in IGF-1Eb immunopositivity was observed in the endothelium of maternal decidual and fetal villous vessels in IUGR placentas. In contrast, no statistically significant differences were recorded in the scores or intensity of IGF-1Eb immunoexpression in the extravillous trophoblast between the two groups. Conclusions: Although total IGF-1Eb mRNA levels remained unchanged, increased protein immunoexpression was associated with idiopathic IUGR in distinct parts of the placenta. In association with histological changes of maternal vascular malperfusion, these findings suggest that IGF-1Eb may serve as a potential marker of placental dysfunction in IUGR pregnancies.

Abstract: Preterm labor is a leading cause of neonatal morbidity and mortality, with inflammation playing a central role in its pathogenesis. This structured literature review summarizes the role of the nuclear factor kappa B (NF-κB) signaling pathway in term and preterm labor and critically evaluates current evidence on natural and synthetic NF-κB modulators as potential therapeutic approaches. To ensure comprehensive identification of relevant studies, a structured literature search informed by PRISMA 2020 reporting recommendations was performed, including studies published through August 2025. Experimental, translational, and review studies were synthesized narratively. NF-κB integrates hormonal, mechanical, infectious, and sterile inflammatory signals in gestational tissues, promoting the expression of pro-inflammatory cytokines, cyclooxygenase-2, prostaglandins, chemokines, and contraction-associated proteins that drive uterine activation. While tightly regulated NF-κB activation is essential for physiological term labor, its premature or excessive activation contributes to inflammation-associated preterm labor. Natural compounds and synthetic agents consistently attenuate excessive NF-κB signaling and downstream inflammatory responses in preclinical models, supporting their potential as candidate therapeutic strategies. However, clinical evidence remains limited. Future research should prioritize tissue-specific, context-dependent modulation of NF-κB and establish the safety, optimal therapeutic windows, and clinical efficacy of NF-κB-targeted interventions during pregnancy.

Abstract: Recent advances in artificial intelligence (AI), especially machine learning (ML), deep learning (DL), natural language processing (NLP) and computer vision have rapidly impacted obstetric care. Key applications include automated ultrasound interpretation (biometry, anomaly detection), AI-enhanced fetal monitoring (cardiotocography), risk stratification (preeclampsia, preterm birth, hemorrhage), labor management (delivery mode prediction), genomic screening (NIPT interpretation), and remote/telehealth tools for monitoring especially in underserved areas. For example, DL models now attain accuracy comparable to experts for fetal ultrasound biometry[1], and FDA-cleared AI tools have achieved >97% detection of congenital heart defects during prenatal screening[2]. However, clinical readiness varies: some technologies (e.g. ultrasound AI tools) are already FDA-cleared[2,3], whereas others remain at proof-of-concept. Across studies, performance metrics (AUC, R2, accuracy) are generally high (often >0.85) but depend on data quality and label definitions[4,5]. Crucial issues include dataset biases, lack of standardization, explainability, and regulatory oversight. This review synthesizes AI technologies, applications, validation (metrics, datasets), deployment (trials, approval, integration), and ethical considerations, and identifies knowledge gaps. Overall, AI shows promise to improve prenatal diagnosis and individualized care, but requires rigorous validation, transparent algorithms, and clinician oversight to ensure safety, equity and trust.

Abstract: Background: Vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection are among the most frequent infectious conditions encountered in gynecological practice and are commonly associated with substantial impairment in quality of life, sexual health, emotional well-being, and daily functioning. Dequalinium chloride is a locally administered broad-spectrum anti-infective agent with activity against bacterial and fungal pathogens; however, longitudinal real-world data integrating clinical, physiological, and fresh microscopic evolution across heterogeneous infectious phenotypes remain limited, particularly in Latin American populations Objectives: To evaluate the longitudinal clinical, physiological, and fresh microscopic evolution associated with intravaginal dequalinium chloride therapy in women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection during routine gynecological practice. Methods: A retrospective longitudinal real-world study was conducted in non-pregnant women diagnosed with vulvovaginal candidiasis, bacterial vaginosis, or mixed vaginal infection who received intravaginal dequalinium chloride therapy. Patients were evaluated at baseline, treatment completion, and post-treatment follow-up. Longitudinal assessment integrated patient-reported symptoms, physician-assessed gynecological findings, vaginal pH, and direct fresh wet-mount microscopic examination. Exploratory integrated clinical–microscopic assessment frameworks were used to characterize multidimensional longitudinal therapeutic evolution. Repeated-measures non-parametric analyses were performed across follow-up evaluations. Results: A total of 69 women were included in the final longitudinal analysis, including vulvovaginal candidiasis (n = 24), bacterial vaginosis (n = 31), and mixed vaginal infection (n = 14). Significant longitudinal improvement was observed across all evaluated clinical, physiological, and fresh microscopic domains throughout follow-up (all p < 0.0001). Median integrated clinical–microscopic assessment values decreased from 8 (IQR 6–10) at baseline to 3 (IQR 1–5) at treatment completion and to 1 (IQR 0–3) during post-treatment follow-up. Progressive normalization of vaginal pH occurred concomitantly with reduction of inflammatory-suggestive microscopic findings, improvement of infectious microscopic markers, and partial restoration of Döderlein bacillary predominance. Patients with mixed vaginal infection demonstrated the greatest baseline multidimensional disease burden but also exhibited substantial longitudinal improvement throughout follow-up. Clinically meaningful longitudinal therapeutic response was observed in 95.7% of patients at treatment completion and in 100% during post-treatment evaluation. Intravaginal dequalinium chloride demonstrated favorable overall tolerability, with only mild transient adverse events reported and no severe treatment-related complications identified Conclusions: Intravaginal dequalinium chloride therapy was associated with consistent longitudinal clinical, physiological, and fresh microscopic improvement across women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection in a real-world gynecological setting. The observed concordance between clinical symptom improvement, vaginal physiological normalization, and objective fresh microscopic evolution supports the potential clinical utility of dequalinium chloride as a locally administered therapeutic approach in heterogeneous vulvovaginal infectious disorders. Larger prospective controlled studies incorporating molecular microbiological evaluation and longer-term follow-up remain necessary to further validate these findings.

Abstract: Background: The incidence of placenta accreta spectrum (PAS) with placenta previa has been previously reported. However, the incidence varies across reports, suggesting that unknown risk factors may be involved. This study aimed to reevaluate the risk of PAS in patients with placenta previa. Methods: This multicenter retrospective study was conducted from 2015 to 2024 in patients with placenta previa who underwent cesarean section (CS). PAS was defined based on pathological or clinical findings, such as manual removal of the placenta or obvious retention of the placenta if a hysterectomy was not performed. The incidence of PAS and associated risk factors were analyzed using multivariable logistic regression. Results: PAS was observed in 26% of women with placenta previa. The incidence of PAS increased significantly with the number of prior CSs: 13.2% in women with no prior CS, 41.9% in those with one prior CS, and 66.7% in those with two or more prior cesarean sections. Multivariate analysis identified major placenta previa (aOR 2.69, 95% CI 1.11–6.54), including complete and partial placenta previa, and number of prior CSs (one prior: aOR 4.35, 95% CI 1.94-9.73; two or more prior: aOR 9.48, 95% CI 2.55-35.2) as independent risk factors. Conclusions: The incidence of PAS with placenta previa was higher than that previously reported, and major placenta previa was shown to be an independent risk factor, regardless of prior CS history. Comprehensive evaluation, including prior CS and placenta previa classification, is crucial for accurate risk stratification and perinatal management.

Abstract: Pregnancy involves profound metabolic, hormonal, and immunological adaptations essential for fetal development; however, disturbances may lead to complications such as preeclampsia (PE), pre-gestational diabetes, and gestational diabetes mellitus (GDM). These conditions are closely linked to oxidative stress, inflammation, endothelial dysfunction, impaired placentation, and metabolic dysregulation. Consequently, dietary strategies capable of modulating these pathways are of increasing interest. Edible and medicinal mushrooms have emerged as functional foods rich in bioactive compounds with antioxidant, anti-inflammatory, immunomodulatory, and metabolic regulatory effects. This review summarizes the nutritional composition of mushrooms and highlights key bioactive constituents, such as ergothioneine, which may influence redox balance, immune responses, glucose metabolism, endothelial function, and placental development. Experimental evidence suggests that these compounds modulate pathways involved in PE and GDM pathogenesis. Mushroom consumption has additionally been associated with improved glycemic control, enhanced antioxidant defenses, and reduced risk of hypertensive and metabolic pregnancy complications. Although preclinical findings are promising, clinical evidence remains limited. Further well-designed prospective studies and randomized controlled trials are required to determine efficacy, safety, optimal intake, and active compounds responsible for these effects. Nevertheless, current evidence supports edible and medicinal mushrooms as potential dietary modulators of key mechanisms involved in PE and GDM, with relevance for improving maternal-fetal health outcomes.

Abstract: Stress urinary incontinence (SUI) is conventionally viewed as a peripheral mechanical disorder, but the growing evidence has highlighted the significant psychological burden. This kind of narrative integrative review has examined SUI through a chronic stress framework and this has linked clinical outcomes with epigenetic and neuroendocrine mechanisms. Evidence has suggested that SUI-related experiences can activate the HPA axis and contribute to allostatic load, and might also induce an epigenetic alteration in stress-related genes such as FKBP5 and NR3C1. These are linked with consistent effective symptoms even after the treatment. In addition to this, the review has highlighted the important function of anticipatory anxiety, behavioural avoidance, and social evaluative threat in the sustenance of chronic stress exposure among individuals who have SUI. These psychosocial mechanisms have interacted dynamically with other biological processes, and it has reinforced a feedback loop which has contributed to psychological vulnerability and persistence. The evidence has highlighted the heterogeneity of patient outcomes, and it has suggested the presence of distinctive vulnerability and resilience profiles which are shaped by individualistic differences in the responsivity to stress and coping strategies. Collectively, this thorough integrative perspective has highlighted the requirement of moving beyond solely biomedical models towards a more interdisciplinary approach that can incorporate biological and psychological assessment. Such a framework has crucial implications for targeted interventions, early identification, and the development of more exhaustive management strategies for SUI. This review has proposed a stress-epigenetic model which integrates psychosocial and biological pathways, thereby offering new types of insights into SUI as a condition with translational and systemic relevance to psychiatry.

Abstract: Background/Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder, and Rotterdam-defined phenotypes may require more refined non-invasive adjunctive signals for phenotypic stratification. Saliva is a practical diagnostic matrix, but genus-level qPCR findings must be interpreted cautiously. This study evaluated whether salivary qPCR signals for Lactobacillus, Prevotella, and Bifidobacterium differ across Rotterdam-defined PCOS phenotypes and controls, with emphasis on the exploratory diagnostic relevance of Prevotella. Methods: This cross-sectional study included 110 women: 87 with PCOS and 23 controls. PCOS phenotypes were classified according to the Rotterdam criteria. Salivary microbial targets were assessed using SYBR Green-based genus-specific qPCR on a MyGo Mini S platform. Because the available standard-curve outputs did not support robust absolute CFU/mL conversion across all targets, inferential analyses were reported using Cq-based microbial signals; lower Cq values indicate higher target DNA signal. Group differences were evaluated using non-parametric tests, followed by Bonferroni-corrected post-hoc comparisons. Exploratory ROC and correlation analyses were retained only as hypothesis-generating diagnostic adjunct analyses. Results: Prevotella Cq values differed significantly across groups (p < 0.001), with lower median Cq values in selected hyperandrogenic and PCOM-related PCOS phenotypes compared with phenotype D and controls. Lactobacillus Cq values did not differ significantly across groups (p = 0.249), whereas Bifidobacterium showed an overall between-group difference (p < 0.001) with a less consistent post-hoc pattern. Among women with PCOS, Prevotella Cq values were associated with Ferriman-Gallwey score and polycystic ovarian morphology. Conclusions: Salivary Prevotella showed the clearest exploratory genus-level qPCR signal across Rotterdam-defined PCOS phenotypes. The findings support further evaluation of saliva-based microbial profiling as a non-invasive diagnostic adjunct for PCOS phenotype stratification, but they do not establish Prevotella as a validated standalone diagnostic biomarker or absolute bacterial load estimate.

Abstract: Background: Endometriosis is a chronic inflammatory disease commonly associated with pelvic pain and infertility. Increasing evidence suggests that women with endometriosis may also experience lower urinary tract symptoms (LUTS), even without direct urinary tract involvement. Aim: This study aimed to evaluate LUTS in women with endometriosis and determine whether these symptoms are associated with urethral ultrasonographic parameters or the localization of endometriotic lesions. Materials and Methods: This prospective case–control study included 166 women aged 17–49 years: 83 with confirmed endometriosis and 83 controls without endometriosis. Endometriosis was confirmed laparoscopically, except in patients with cesarean scar endometriosis, where diagnosis was based on imaging and histopathological confirmation. Clinical assessment included standardized questionnaires and transvaginal pelvic floor sonography. Urinary symptoms were assessed using the Urogenital Distress Inventory short form (UDI-6). Urethral length and mobility were evaluated at rest, during contraction, and during the Valsalva maneuver. Results: Women with endometriosis demonstrated significantly higher total UDI scores than controls (27.8 vs. 16.7; p = 0.002), with the greatest differences in pain/discomfort and urine leakage symptoms. No significant differences in urethral anatomy were observed. Among symptomatic patients, urethral mobility during Valsalva was significantly lower in the endometriosis group (p = 0.041). Lesion localization was not associated with symptom severity. Conclusions: Women with endometriosis experience a greater burden of LUTS, particularly bladder storage dysfunction and pain, likely related to functional and neuroinflammatory mechanisms rather than structural abnormalities.

Abstract: We report a rare case of simultaneous well-differentiated papillary mesothelial tumor (WDPMT) and multicystic mesothelioma. The concurrent occurrence of these entities is exceptionally uncommon and may pose challenges during surgical intervention. Both tumors are variants of epithelioid mesothelioma and are most frequently identified incidentally during surgical procedures. A 41-year-old patient was admitted for laparoscopic surgery due to a left adnexal mass. Ultrasound examination revealed a 5 cm lesion adjacent to the left ovary, exhibiting central vascularization. Intraoperatively, the mass appeared as a solid, soft, and nodular tumor. Frozen section analysis confirmed the diagnosis of WDPMT involving the left adnexa. Recognition of well-differentiated papillary mesothelial tumor and multicystic mesothelioma is critical for accurate differential diagnosis from malignant mesothelioma. Awareness of these entities informs appropriate surgical management and follow-up protocols.

Abstract: Background/Objectives: Electromagnetic pelvic floor stimulation is an emerging non-invasive treatment for urinary incontinence (UI), yet direct comparisons between devices of differing magnetic field strengths are lacking. This quality improvement study compared the clinical effectiveness of a 3 Tesla and an 8 Tesla electromagnetic device for the treatment of stress and mixed UI. Methods: In this prospective, single-blinded comparative quality improvement study with randomized allocation, 103 women (aged 35–77) with stress or mixed UI were randomly allocated to treatment with either a 3 Tesla device (Chair A, n = 52) or an 8 Tesla device (Chair B, n = 51). Each participant received six sessions over three weeks. Symptoms were assessed using a modified International Consultation on Incontinence Questionnaire (ICIQ) instrument at baseline, after each session, and at 2- and 4-week follow-up. Statistical analysis was performed independently by a biostatistician using SPSS v30. Results: Both devices produced statistically significant within-group improvements across all ICIQ domains (p < 0.001 to p < 0.05). Chair B demonstrated earlier onset of significant improvement (after 2 sessions vs. 3 sessions for Chair A) and significantly greater reduction in leakage frequency at 4-week follow-up (mean 1.02 ± 0.96 vs. 1.54 ± 1.19; p = 0.020; Cohen’s d = 0.48). One minor, self-limited adverse event was reported (transient low back pain, Chair A group). Conclusions: Both electromagnetic devices effectively reduced UI symptoms. The 8 Tesla device showed faster onset and greater sustained symptom reduction at 4 weeks, suggesting that higher magnetic field strength may enhance clinical outcomes for pelvic floor rehabilitation. Findings are reported in alignment with SQUIRE 2.0 guidelines for quality improvement research.