Ny forskning om jente- og kvinnehelse

Cervical cancer continues to be a major cause of morbidity and mortality among women in Africa. Screening coverage across the continent remains significantly below the World Health Organization's 90-70-90 targets. Mobile health (mHealth) technologies offer a scalable solution to improve outreach, screening, vaccination, and follow-up in resource-limited settings. Thus, this scoping review aims to systematically map the existing evidence on mHealth interventions for the prevention and control of cervical cancer in Africa. This scoping review adopted the methodological framework developed by Arksey and O'Malley and refined by Levac et al. A systematic search was conducted across CINAHL, MEDLINE, Scopus, and Web of Science, complemented by manual searches. Studies published in English between 2016 and 2026 were eligible. From an initial set of 550 records, 32 studies met the inclusion criteria and underwent subsequent data extraction and thematic analysis. mHealth interventions included messaging, voice communication, and awareness-raising ( n = 14), image-based diagnosis with tele-expert review ( n = 11), digital apps for decision-making and support ( n = 3), baseline and feasibility studies ( n = 3), and provider education and training ( n = 5). Stages of the cervical cancer care continuum were not mutually exclusive: studies addressed screening ( n = 22), diagnosis and treatment ( n = 9), primary prevention/HPV vaccination ( n = 3), post-treatment follow-up ( n = 1), and workforce and system-capacity interventions ( n = 2). Electronic devices used included smartphones ( n = 12), basic mobile phones ( n = 13), computer- and cloud-based devices ( n = 3), a digital camera ( n = 1), a tablet ( n = 1), and unspecified mobile phones ( n = 2). Outcomes included diagnostic accuracy, feasibility and acceptability, treatment uptake, provider competence, and vaccination uptake. Facilitators included high mobile phone ownership and real-time expert support, while challenges involved sustainability, health systems, connectivity, privacy and confidentiality concerns, low literacy, and language barriers. mHealth shows promise for cervical cancer prevention and control in Africa. Realizing this potential at scale requires investing in underrepresented care stages, addressing connectivity and health-system barriers, and conducting rigorous multi-country research beyond pilot evidence.

During perimenopause and postmenopause, changes in estrogen exposure may alter mucosal barriers, microbial ecosystems, and inflammatory responsiveness across the oral and genitourinary tracts. These stages differ in their hormonal patterns, and much of the available evidence comes from postmenopausal women or experimental models of estrogen deficiency. In the oral cavity, altered salivary function, gingival immunity, epithelial integrity, and alveolar bone metabolism may increase the inflammatory potential of established biofilms without generating a uniform menopause-associated microbial signature. When periodontitis develops, disruption of the gingival barrier can promote repeated exposure to microbial products, cytokine spillover, hepatic acute-phase responses, endothelial activation, and myeloid activation, thereby adding to systemic inflammatory burden. In parallel, hypoestrogenism can weaken vaginal, urethral, and bladder epithelial resilience, reduce Lactobacillus-associated colonization resistance, and impair tissue repair. The association between hypoestrogenism and recurrent urinary tract infection is better supported than corresponding associations with bacterial vaginosis or vulvovaginal candidiasis. Genitourinary syndrome of menopause may cause overlapping symptoms and coexist with infection. In this narrative review, we propose an estrogen-sensitive oral-systemic-genitourinary axis in which periodontal inflammation may amplify genitourinary susceptibility through systemic inflammatory signals and possibly through changes in intestinal and vaginal ecosystems. Hypoestrogenism may provide a permissive background, while local microbial or inflammatory challenges contribute to clinical disease. This proposed interaction does not require direct bacterial dissemination to the genitourinary tract. Evidence supporting the individual components is stronger than direct human evidence for the complete pathway, and a contribution from persistent myeloid reprogramming remains unproven. Longitudinal multisite studies integrating hormonal trajectories, periodontal status, systemic immune markers, and microbiologically confirmed genitourinary outcomes, together with combined periodontal and local estrogen interventions, are required to test this hypothesis in perimenopausal and postmenopausal women.

Postpartum psychosis is a rare but severe psychiatric emergency in which infant-directed violence, although uncommon, is best understood as a manifestation of acute psychotic illness rather than enduring maternal hostility or conventional criminal intent. The psychotic content of postpartum psychosis is often infant focus, with profound disturbances in reality testing that transform the mother's perception of her infant, framing the child through delusions and hallucinations as an object of danger, salvation, contamination, or divine significance. In the cases of infanticide or filicide, the violence directed at the child, although objectively tragic are subjectively protective or morally necessary. Drawing on the existing literature on postpartum psychotic phenomenology, this conceptual analysis uses two contrasting clinical cases as illustrative examples-one involving infanticide and one without infant-directed violence-to examine how infant-focused delusions can shape perception and behavior. By contrasting these cases, the article demonstrates how infant-focused delusions directly dictate behavior and explores why the infant becomes the primary object of the mother's psychotic experience. Finally, the paper discusses the implications of this comparative framework for forensic assessment, criminal responsibility, violence risk evaluation, and clinical intervention.

Placental growth factor (PlGF) contributes to first-trimester screening algorithms for preeclampsia, but its prognostic performance as an isolated biomarker in routine Chinese care is uncertain. We performed a retrospective, single-centre cohort study among pregnancy episodes recorded in a hospital PlGF workbook. Pregnancy episodes were deduplicated, PlGF values were traced to source laboratory cells, and hypertensive disorders of pregnancy (HDP) were ascertained using unvalidated free-text discharge-diagnosis keywords. The primary operational window was 9 + 0 to 13 + 6 weeks; 11 + 0 to 13 + 6 weeks was evaluated separately. We compared PlGF with a parsimonious maternal-characteristics model containing age, pre-pregnancy body mass index (BMI), and nulliparity. From 405 source rows, 380 pregnancy episodes were resolved; 310 met the primary criteria, including 27 HDP events (11 cases of preeclampsia and 16 of gestational hypertension). PlGF alone had an area under the curve (AUC) of 0.633 (95% bootstrap CI 0.523-0.738), and internally derived PlGF multiple of the median (MoM) had an AUC of 0.636 (0.533-0.740). In 308 complete records, the maternal-characteristics model had an apparent AUC of 0.740 (0.635-0.837), while adding log10(PlGF) yielded an AUC of 0.748 (0.638-0.849); paired ΔAUC was 0.009 (95% CI -0.019 to 0.037). The findings are consistent with a modest association between lower first-trimester PlGF and subsequent HDP, but they do not support isolated clinical use or a deployable prediction model.

Direct comparative evidence between taxane plus trastuzumab plus pyrotinib (THPyro) and taxane plus trastuzumab plus pertuzumab (THP) as first-line therapy for HER2-positive advanced breast cancer remains limited. This multicenter retrospective real-world cohort study included 181 female patients in Xinjiang, China who initiated first-line THP or THPyro between 1 January 2020 and 30 September 2025. Propensity score matching generated 60 matched pairs. The primary endpoint was progression-free survival (PFS). Median follow-up in the matched cohort was 28.4 months. After matching, baseline characteristics were well balanced. THPyro showed numerically longer median PFS than THP (20.1 vs. 17.6 months; log-rank P = 0.086), and the stratified Cox model showed a non-significant trend toward reduced progression risk (hazard ratio, 0.478; 95% confidence interval, 0.216-1.061). Restricted mean survival time (RMST) analysis demonstrated a significant 24-month PFS gain with THPyro (absolute difference, 2.41 months; P = 0.007). Objective response and disease control rates were comparable. Brain metastasis status was the most prominent potential effect modifier, with an exploratory signal observed in patients with baseline brain metastases. THPyro was associated with more diarrhea, and higher albumin level and prophylactic loperamide use were associated with a lower observed risk of grade ≥2 diarrhea. First-line THPyro was associated with a non-significant trend toward longer PFS and a significant 24-month RMST gain compared with THP in this retrospective matched cohort. An exploratory signal was observed among patients with baseline brain metastases, while diarrhea was more frequent and required proactive management.

Breast cancer is a frequent female malignancy worldwide. Central Saudi women can benefit from breast cancer screening. This study examines adult women's adherence to breast cancer screening standards and the main impediments to participation. A cross-sectional online survey was conducted in the Central Region (Riyadh) of Saudi Arabia from 13 September 2025 to 28 February 2026. 404 people took the survey. The majority of participants were younger than 30 years (37.9%), followed by participants aged 40-49 (23.8%). Most participants (96.5-99.5%) endorsed the listed benefits of breast cancer screening, whereas 66.1% reported knowing how to screen for breast cancer. Most participants supported screening even in the absence of symptoms (86.4%) and reported that they would follow a doctor's recommendation (84.9%). Regular mammography was reported by 21.5% of the full sample and by 43.1% of participants aged ≥40 years. The most frequently reported barrier was believing that screening was unnecessary in the absence of symptoms (69.8%), followed by fear of examination (55.2%), time constraints (49.0%), and fear of the results (48.8%). Participants generally recognized the importance of breast cancer screening, but screening practices remained limited. Commonly reported concerns included the belief that screening was unnecessary without symptoms, fear of examination and results, and time constraints. These findings suggest that awareness alone may not be sufficient to improve screening uptake.

To assess the diagnostic accuracy of machine learning (ML) and deep learning (DL) models for endometriosis. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251231469). Databases were searched through November 24, 2025. Twenty-two eligible studies were included. Risk of bias was assessed using QUADAS-2. Pooled analysis was conducted in Stata 18.0. Pooled sensitivity was 0.90 (95% CI 0.86-0.93), specificity 0.75 (95% CI 0.64-0.84), and SROC-AUC 0.92 (95% CI 0.89-0.94). A positive prediction increased disease probability from 10% to 29%, whereas a negative prediction reduced it to 1%. Multicenter design and DL were associated with lower sensitivity. Results were robust. ML/DL models demonstrate high diagnostic performance and are promising for non-invasive auxiliary diagnosis. Large multicenter prospective studies and multimodal models are needed to enable clinical translation. Systematic Review Registration : https://www.crd.york.ac.uk/PROSPERO/view/CRD420251231469, identifier CRD420251231469.

The high incidence of distant metastasis in triple-negative breast cancer (TNBC) remains the principal driver of disease-related mortality, highlighting an urgent clinical need for novel therapeutics to restrict tumor progression and dissemination. We investigated the anti-tumor potential and underlying molecular mechanisms of MHO7 (6-epi-ophiobolin G), a structurally unique sesterterpenoid derived from a marine fungus, using MDA-MB-231 cells in vitro and a subcutaneous xenograft model in vivo . Transcriptomic profiling and biochemical analyses were performed to elucidate the underlying signaling alterations. Both in vitro and in vivo evaluations demonstrated that MHO7 profoundly curtails MDA-MB-231 cell migration and invasion, strengthens adherens junctions, and exhibits robust primary tumor growth inhibition without inducing overt systemic toxicity in preclinical mouse models. Mechanistically, transcriptomic profiling coupled with biochemical analyses revealed that MHO7 exerts inhibitory effects on cell migration and invasion primarily by attenuating the Focal Adhesion Kinase (FAK) signaling pathway. Specifically, MHO7 treatment remarkably suppressed the autophosphorylation of FAK (Y397) and the subsequent recruitment of p-Src (Y419). This pathway suppression consequently altered cytoskeletal architecture, attenuated the downstream PI3K/AKT signaling cascade, and curtailed tumor angiogenesis. Furthermore, we identified a dual inhibitory mechanism wherein MHO7 successfully dismantled the oncogenic crosstalk between FAK and the canonical Wnt/β-catenin pathway by significantly downregulating nuclear β-catenin accumulation. MHO7 exerts tumor-suppressive and anti-migratory effects in TNBC primarily by attenuating FAK signaling and its downstream pathways, supporting its potential as a promising therapeutic candidate for highly aggressive TNBC.

The vaginal discharge is a common clinical presentation associated with diverse infectious and microbiota-related conditions. Existing artificial intelligence (AI)-based diagnostic approaches have predominantly focused on detection of individual pathogens and have rarely integrated microbiota-associated conditions within a diagnostic framework. We developed an explainable deep learning framework for automated analysis of Gram-stained vaginal smear images acquired using handheld smartphones or tablets positioned over a conventional light microscope eyepiece. The framework integrates object detection with image-level classification, termed detection-based image classification, to identify diagnostically relevant microscopic structures without requiring exhaustive enumeration of all objects. Five diagnostic categories included vulvovaginal candidiasis (VVC), bacterial vaginosis (BV), trichomoniasis (TV), gonococcal urethritis/cervicitis (GU), and healthy vaginal condition (HL). YOLOv26, RT-DETR and EfficientDet0 were independently trained and evaluated using 1,966 microscopic images comprising 11,069 annotated diagnostic objects. Model explainability and computational benchmarking were assessed. The localization quality was independently evaluated by eight clinicians and microbiologists. Class-specific analysis demonstrated that TV and GU consistently achieved the highest detection performance across all models (mAP50 = 0.622-0.752), whereas RT-DETR demonstrated superior performance for VVC, BV, and HL. Expert evaluation showed favorable localization, with Good/Excellent ratings in 84.8 and 85.1% of valid evaluations for YOLOv26 and RT-DETR, respectively, with no significant difference between models (OR = 0.97; 95% CI, 0.58-1.61; p = 0.895). This study presents an accurate and clinically interpretable framework that integrates microbiota-associated conditions and sexually transmitted infections for differential diagnosis of vaginal discharge using conventional light microscopy. By linking image-level predictions to localized diagnostic morphology, the framework provides human-verifiable AI evidence as a proof-of-concept prototype. While promising for low-cost implementation, rigorous prospective multi-center validation is required before broad clinical deployment or autonomous diagnosis.

Immune checkpoint inhibitors (ICIs) are associated with a wide spectrum of immune-related adverse events (irAEs), reflecting enhanced immune activation. Pancreatic involvement is rare and typically presents as asymptomatic hyperlipasemia or diffuse inflammatory changes. Focal or multifocal mass-like presentations are uncommon and may mimic pancreatic malignancy, posing a significant diagnostic challenge. We report the case of a 48-year-old woman treated with Pembrolizumab and Paclitaxel for axillary recurrence of triple-negative breast cancer. After four cycles, FDG PET/CT demonstrated a complete metabolic response at the initial tumor site but revealed new multifocal hypermetabolic pancreatic lesions. Magnetic resonance imaging confirmed multiple pancreatic masses, raising suspicion of metastatic disease or dissociated response. Endoscopic ultrasound-guided fine-needle aspiration at two concordant pancreatic sites showed neutrophil-predominant inflammatory infiltration without malignant cells, consistent with immune-related pancreatic injury. The patient subsequently developed symptoms of exocrine pancreatic insufficiency, which improved after concomitant initiation of pancreatic enzyme replacement therapy and corticosteroid tapering, with the relative contribution of each not clearly distinguishable. Follow-up imaging demonstrated complete resolution of pancreatic lesions. This case highlights a rare mass-forming (pseudotumoral) phenotype of ICI-related pancreatic injury (ICI-PI), presenting as multifocal FDG-avid pancreatic pseudomasses. Such findings may represent a major pitfall in PET/CT interpretation under immunotherapy, particularly in the context of otherwise favorable oncologic response. Histopathological confirmation is critical to distinguish immune-mediated inflammation from metastatic disease. This observation supports the concept of organ-specific immune dysregulation driven by ICIs and expands the radiological spectrum of pancreatic irAEs. Multifocal FDG-avid pancreatic lesions occurring during immunotherapy should raise suspicion for immune-related pancreatic injury (ICI-PI), especially in the absence of systemic progression. Early recognition is essential to avoid misdiagnosis and inappropriate treatment decisions.

Existing evidence regarding the association between sleep patterns and breast cancer development remains inconsistent. This study aimed to investigate the relationship between sleep patterns and breast cancer risk while examining the potential mediating effects of sleep score-related metabolic signatures. A total of 220,089 participants from the UK Biobank study were analyzed. Cox proportional hazards models were used to examine the relationships among the sleep score (based on 5 sleep factors), genetic risk (based on 22 variants), metabolic signature (derived from 251 metabolites), and breast cancer incidence, adjusting for age, BMI, sociodemographic, and lifestyle factors. Mediation analysis was used to test whether the metabolic signature mediated the association between the sleep score and breast cancer risk. A total of 8459 incident breast cancer cases (3.84% of the cohort) were identified during a median follow-up of 11.6 years. Compared with individuals with a sleep score of 5 points, those with a score of 0-1 points had a significantly greater risk of developing breast cancer (HR = 1.30, 95% CI = 1.11-1.52). The sleep-related metabolic signature was also associated with elevated breast cancer risk (HR = 1.62, 95% CI = 1.32-1.99). Mediation analysis revealed that the metabolic signature accounted for 13.5% of the observed association between the sleep score and the incidence of breast cancer. Maintaining healthy sleep patterns may lower the risk of breast cancer irrespective of genetic predispositions. The metabolic signature partially mediated the association between the sleep score and breast cancer development.

Background Unexplained infertility is a couple-level diagnosis made after standard female and male investigations do not identify a specific cause. Subtle cross-partner reproductive patterns may nevertheless be present. This exploratory secondary analysis assessed associations between female reproductive hormones and partner semen parameters in couples with unexplained infertility. Methods This cross-sectional secondary analysis used paired data from 70 couples with unexplained infertility from a previously published case-control study conducted at Ain Shams University Maternity Hospital in Cairo, Egypt, from October 2018 through April 2019. The original study evaluated vitamin D and reported descriptive hormone and semen data; the cross-partner analyses reported here are new. Female follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol (E2), and thyroid-stimulating hormone (TSH) were correlated with partner semen volume, concentration, total count, total motility, progressive motility, and normal morphology using Spearman correlation. Thirty correlations were screened with Benjamini-Hochberg false-discovery-rate (FDR) adjustment. Targeted linear models were adjusted for female age and body mass index (BMI), with 5,000-resample bootstrap confidence intervals. Results Female prolactin was inversely correlated with partner progressive motility (rho = -0.472, FDR q < 0.001) and normal morphology (rho = -0.595, FDR q < 0.001). TSH correlated positively with progressive motility (rho = 0.331, FDR q = 0.038) and morphology (rho = 0.419, FDR q = 0.003). E2 was nominally correlated with sperm concentration (rho = 0.284, p = 0.017) but did not survive FDR adjustment (q = 0.103). In age- and BMI-adjusted models, prolactin remained inversely associated with progressive motility (B = -0.401, bootstrap 95% CI -0.687 to -0.147) and morphology (B = -0.929, bootstrap 95% CI -1.282 to -0.620). The adjusted TSH association with morphology persisted (B = 4.076, bootstrap 95% CI 0.250 to 8.016), whereas the bootstrap interval for progressive motility included the null. Conclusions Female prolactin showed the most consistent inverse couple-level association with partner progressive motility and normal morphology. These cross-sectional findings do not establish biological effects of female hormones on male semen quality and should be regarded as hypothesis-generating pending independent prospective replication.

Exploring health-care providers' perspectives on cannabis use during pregnancy and breastfeeding is essential for improving patient-provider communication on these topics. Twenty medical providers caring for pregnant individuals were recruited to participate in semi-structured key informant interviews, which asked about strategies and challenges caring for pregnant individuals using cannabis. Health-care providers worried about the harmfulness of cannabis during the perinatal period, short appointment times, and having limited evidence-based guidance. In contrast to these concerns, participants worked with their patients to avoid potential punitive actions and reported supporting patient decisions when discussing cannabis use and breastfeeding. More provider-focused evidence-based resources about the health effects of cannabis use during and after pregnancy may strengthen clinical counseling and support patient cessation when appropriate or desired.

Perinatal loss is a profound experience that can lead to lasting emotional distress, including anxiety, depression, and posttraumatic stress disorder. Women with a history of perinatal loss often require increased medical attention and emotional support during subsequent pregnancies. Limited resources were available for these women at a West Texas hospital. Our aim was to implement and evaluate a structured prenatal class tailored to their needs, incorporating education, mental health support, and staff training. The class was offered virtually and face-to-face. Although participation was limited, qualitative feedback suggested the women valued the emotional and informational support. The findings suggest that ongoing support and education focused on addressing the stressful challenges following a maternal experience of perinatal loss are essential.

The purpose of this study was to explore associations between retinal parameters and selected systemic markers in hypertensive disorders of pregnancy (HDP). Retinal imaging was used to measure vessel diameter/tortuosity and thickness of the retinal nerve fiber layer (RNFL) and retina in participants. Uric acid (UA), aspartate aminotransferase (AST), 24-hour urine protein levels, and mean ocular perfusion pressure (MOPP) were assessed. Intergroup comparisons were performed using 1-way analysis of variance/nonparametric tests; correlations were analyzed using linear regression. In total, 150 pregnant women were included: 87 normotensive controls, 32 with gestational hypertension (GH), and 31 with preeclampsia (PE). Across groups, arteriolar diameter decreased, temporal venular diameter and inferonasal arteriolar tortuosity increased (P < 0.001), and inferotemporal venular tortuosity decreased (P = 0.017). Nasal RNFL thickness increased (P < 0.001), with nonsignificant changes in other quadrants. No significant trends were noted for retinal thickness. MOPP interacted with nasal RNFL thickness (P < 0.05), but not with retinal thickness. The 24-hour urine protein and UA were associated with superotemporal venular and arteriolar diameters, respectively. MOPP was associated with inferotemporal, superonasal, and inferonasal arteriolar diameters, inferonasal arteriolar tortuosity, and central retinal arteriolar equivalent (P < 0.05). AST was not significantly associated with any retinal parameter. UA and 24-hour urine protein were associated with retinal vascular parameters, whereas AST was not significantly associated with any retinal parameter. These exploratory associations warrant prospective validation.

Breast cancer is the most common malignant disease among women worldwide. With improved treatment, 5-year survival has increased leading to increasing number of survivors reporting chronic persistent post-surgical pain (CPPP). Hence this systematic review and meta-analysis was conducted to analyse preventive strategies in chronic persistent postsurgical pain following breast cancer surgery. Electronic databases were searched for randomized controlled trials that allocated patients undergoing breast cancer surgery to receive any intervention to prevent postsurgical pain. Data extraction was conducted by two reviewers and any discrepancy was resolved by third independent reviewer. The quality of study was assessed using the Pedro scale and risk of bias was assessed using Cochrane risk of bias. The primary outcomes of interest were patient-reported pain intensity as by the verbal rating scale (VRS), Visual analogue scale (VAS), and numerical rating scales (NRS), and incidence of chronic pain. This was assessed at 3 months and 6 months after the surgery. The association between the primary outcome and preventive strategies was analyzed using relative risk. Twenty-seven studies were included. The intervention reduces the CPPP at 3-month by 36% as compared to the control group and this reduction was statistically significant [RR: 0.64: 0.54-0.75; P < 0.001; I 2 = 24.2%]. The heterogeneity between them was quite low I 2 = 24.2% with P = 0.158. Intervention group reduces the incidence of CPPP at 6 months by 40% which was also statistically significant [RR: 0.60: 0.41-0.87; P = 0.007; I 2 = 36.9%; P = 0.125]. Either of the pain preventive strategies that is, pharmacotherapy and regional blocks led to a significant reduction in the incidence of CPPP at 3 months as well as 6 months.

To investigate the mechanisms by which Xuandan Sanjie decoction (, XSD) inhibits angiogenesis in adenomyosis (AM), using both AM-derived primary endometrial stromal cells (ESCs) and a mouse model. Core components and targets of XSD for AM treatment were predicted using multiple databases. Gene ontology and kyoto encyclopedia of genes and genomes pathway analyses were used to elucidate the potential mechanisms. Ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was applied to identify chemical constituents of XSD. A cobalt (II) chloride (CoCl 2 )-induced hypoxia-mimicking ESC model and an AM mouse model were established to experimentally validate the anti-angiogenic effects of XSD. According to bioinformatics analysis, hypoxia signaling and angiogenesis are crucial for AM progression. Twenty chemical constituents of the 106 compounds identified from the Traditional Chinese Medicine systems pharmacology database and analysis platform database were validated by UHPLC-MS/MS. Network pharmacology identified protein kinase B alpha, epidermal growth factor receptor, hypoxia inducible factor-1α (HIF-1α), and estrogen receptor 1 (ESR1) as core targets. According to in vitro and in vivo experiments, XSD exhibits anti-angiogenic properties through ESR1/G protein-coupled estrogen receptor (GPER)-mediated HIF-1α signaling. Our study confirms that XSD inhibits angiogenesis in AM via ESR1/GPER-mediated HIF-1α signaling. These findings elucidate the molecular mechanisms underlying XSD's therapeutic effects for abnormal uterine bleeding associated with adenomyosis, offering new therapeutic strategies for this condition.

Breast malignancies can be difficult to assess on conventional imaging, particularly in patients with heterogeneous or dense breast tissue. We report the case of a woman in her early 70s with a biopsy-confirmed right breast malignancy who underwent contrast-enhanced spectral CT with both standard MonoE40 reconstruction and a dedicated breast spectral CT protocol. The dedicated reconstruction improved visualization of the primary lesion, associated dermal changes, ipsilateral axillary nodal abnormalities, and tumor vascularity, while also providing additional iodine-based enhancement information. These reconstructions were generated from the same CT acquisition and therefore required no additional radiation exposure or image acquisition. Subsequent surgical pathology confirmed locally advanced breast carcinoma with skin and regional nodal involvement, providing correlation with several of the imaging abnormalities. This case demonstrates the technical feasibility and qualitative added imaging information of dedicated breast spectral CT reconstruction in the assessment of a known breast malignancy undergoing preoperative staging.

Autoimmune polyglandular syndrome type 3c (APS3c), characterized by autoimmune thyroid disease with another organ-specific autoimmune disorder in the absence of adrenal insufficiency, is an uncommon presentation. Its coexistence with Graves' disease and myasthenia gravis (MG) is rare and poses additional diagnostic and therapeutic challenges, particularly when complicated by thyroid storm and pregnancy. We report the ongoing management of a 22-year-old woman with this combination of autoimmune disorders. She was admitted with thyroid storm diagnosed using the Burch-Wartofsky Point Scale and Japan Thyroid Association criteria after a 15-month history of weight loss, heat intolerance, diaphoresis, anxiety, palpitations, unilateral ptosis, and fatigable proximal upper-extremity weakness. Graves' disease and MG were diagnosed based on clinical findings, positive thyroid-stimulating immunoglobulin and acetylcholine receptor antibodies, and electrophysiological evidence of a postsynaptic neuromuscular junction disorder. In the absence of clinical or biochemical evidence of primary adrenal insufficiency, the coexistence of autoimmune thyroid disease and MG supported a diagnosis of APS3c on the Neufeld and Blizzard classification. Despite methimazole (15 mg/day) and pyridostigmine (600 mg/day) therapy, and good adherence to treatment, biochemical hyperthyroidism persisted and progressed to thyroid storm. During outpatient follow-up, an intrauterine pregnancy was confirmed. Methimazole was withheld during the first trimester while the patient remained clinically stable despite persistent biochemical hyperthyroidism, and it was resumed thereafter. At the time of writing, the pregnancy remains ongoing under multidisciplinary care involving endocrinology, neurology, internal medicine, and maternal-fetal medicine, with serial maternal monitoring, planned third-trimester antibody reassessment, targeted fetal ultrasonography, perinatal planning, and neonatal surveillance. This case highlights APS3c as an important diagnostic framework for the coexistence of Graves' disease and MG and illustrates how management must be continually reassessed in the setting of thyroid storm and pregnancy. Maternal, fetal, and neonatal outcomes remain pending.

Thyroid metastases from breast cancer are uncommon, and their coexistence with primary thyroid neoplasms as collision tumors is even rarer, posing important diagnostic and therapeutic challenges. We report the case of a 57-year-old woman with hormone receptor-positive, HER2-negative breast cancer who developed disease recurrence 13 years after initial treatment, presenting with a cervical mass, persistent dry cough, and dysphagia. Evaluation revealed an intermediate-suspicion thyroid nodule according to the American Thyroid Association (ATA) classification, with successive fine-needle aspiration biopsies categorized as Bethesda III and IV. Right hemithyroidectomy demonstrated poorly differentiated metastatic breast carcinoma, confirmed by immunohistochemistry, coexisting within the same thyroid specimen with a 1.8-mm papillary thyroid microcarcinoma (PTMC) and a 7-mm oncocytic adenoma, constituting an exceptionally rare thyroid collision tumor. Staging studies subsequently revealed systemic metastatic disease, and treatment with ribociclib plus fulvestrant was initiated according to the phase III MONALEESA-3 regimen. This case highlights the possibility of very late recurrence of hormone receptor-positive breast cancer presenting as thyroid metastasis, illustrates the diagnostic complexity of thyroid collision tumors, and emphasizes the importance of considering metastatic disease in the differential diagnosis of thyroid nodules in patients with a history of breast cancer. Although current evidence does not support routine thyroid screening, this case raises the question of whether targeted thyroid evaluation in selected patients at high risk of late recurrence warrants further prospective investigation.

What are the perceptions and recommendations of reproductive endocrinology and infertility (REI) patient care team members regarding best communication and support strategies for fertility patients experiencing pregnancy loss? This qualitative case study utilized a phenomenological approach to understand the lived work experiences and recommendations of REI professionals, with purposive sampling of physicians, nurses and social workers, at a US Midwest academic health system. Twelve semi-structured interviews were conducted, transcribed and analysed using Braun and Clarke's six-phase framework. The findings include five major themes and two subthemes, with the theme 'pregnancy loss in the context of infertility' or the 'patient journey' being most referenced by participants in representing the patient experience. Within this patient journey, the findings discuss how participants navigate highly desired pregnancies compounded by pregnancy loss, creating varying patient experiences and responses. Based on this variability, changes to operational management are indicated. The participants/providers primarily highlight the value of an integrated team and a call for improved communication and support strategies. The study findings suggest prioritizing face-to-face communication with fertility patients when discussing pregnancy loss. This may give REI professionals and patients greater opportunity to better assess and express needs, and tailor resources specific to pregnancy loss within the context of the infertility journey.

Thyroid dysfunction during pregnancy is an important endocrine concern because untreated disease may adversely affect maternal health, pregnancy outcomes, and fetal neurodevelopment. Public awareness is particularly relevant in Saudi Arabia, where historical iodine deficiency, regional variation in dietary iodine intake, and differences in health literacy may influence preventive behaviors. This study assessed knowledge, attitudes, and preventive practices regarding thyroid disorders during pregnancy among Saudi adults of reproductive age. A nationwide online cross-sectional survey was conducted among 1,053 Saudi adults aged 18-45 years from the five major geographical regions of Saudi Arabia. Participants completed a structured self-administered questionnaire assessing sociodemographic characteristics, knowledge of thyroid disorders in pregnancy, attitudes toward screening and treatment, preventive practices, and sources of health information. Knowledge, attitude, and practice scores were summarized using descriptive statistics. Group differences were examined using independent-samples t-tests or one-way analysis of variance, as appropriate. The mean knowledge score was moderate at 5.9 ± 2.4 out of 10. Although most participants recognized that thyroid disorders can be diagnosed using blood tests (84.2%) and may affect fetal brain development (76.1%), only 52.1% knew that thyroid disorders during pregnancy may be asymptomatic. Attitudes were generally favorable, with a mean score of 26.9 ± 4.5 out of 35; 82.9% agreed or strongly agreed that thyroid screening is important in prenatal care, and 96.0% recognized the importance of management for fetal health. Preventive practices were less optimal, with a mean score of 5.4 ± 2.3 out of 10. Only 44.1% had previously undergone thyroid function testing, and 30.1% regularly consumed iodine-rich foods. Saudi adults of reproductive age demonstrated favorable attitudes but only moderate knowledge and suboptimal preventive practices regarding thyroid disorders during pregnancy. These findings support targeted public health education, improved preconception counseling, and clearer clinical communication regarding thyroid screening and treatment safety during pregnancy.

Interstitial ectopic pregnancy is an uncommon form of ectopic pregnancy and can be associated with a high risk of rupture and hemorrhagic death due to its deep myometrial location. Diagnosis can be challenging because transvaginal ultrasonography (TVUS) may fail to initially identify the implantation site until late in gestation, and the presentation can closely mimic that of an early intrauterine pregnancy or spontaneous abortion. We report the case of a 27-year-old gravida 2 para 1 (G2P1) woman who presented to the emergency department (ED) with vaginal spotting and pelvic cramping at an estimated seven weeks gestational age. Serial serum beta-human chorionic gonadotropin (β-hCG) measurements demonstrated an initial suboptimal rise followed by a plateau and subsequent decline (3,954 → 6,136 → 5,863 → 5,028 mIU/mL). Repeat TVUS identified no intrauterine pregnancy and no discrete adnexal mass, constituting a pregnancy of unknown location (PUL). Following stabilization in the Rapid Decision Unit, the patient was discharged with urgent outpatient obstetrics and gynecology (OB/GYN) follow-up. Interval repeat TVUS raised concern for a left interstitial ectopic pregnancy, prompting hospital readmission for diagnostic laparoscopy, which confirmed a 3-4 cm unruptured left interstitial ectopic pregnancy. Given hemodynamic stability and the high vascularity of the interstitial mass, intraoperative conservative management was elected in lieu of immediate wedge resection. Postoperatively, she received multi-dose systemic methotrexate with leucovorin rescue under co-management with maternal-fetal medicine and was discharged in stable condition. Although β-hCG declined to undetectable levels, interval imaging identified a persistent adnexal mass and a newly developed left hydrosalpinx. Given the patient's desire for future fertility, she underwent laparoscopic left salpingectomy with wedge resection of the left uterine cornu as uterus-conserving definitive management. This case illustrates the diagnostic limitations of TVUS and the critical role of serial β-hCG kinetics in PUL, as well as the feasibility and limitations of uterus-conserving medical and surgical management for interstitial ectopic pregnancy, including the need for long-term surveillance and the role of definitive surgery when resolution after methotrexate is incomplete.

Receptor activity-modifying protein 3 (RAMP3) has been implicated in stromal regulation in cancer. However, its role in tumor microenvironment (TME) remodeling and immune checkpoint resistance remains unclear. In this study, we aimed to define the role of RAMP3 in shaping the immunosuppressive TME and evaluate its potential as a therapeutic target to enhance immunotherapy responses. We used syngeneic mouse models of breast cancer with genetic manipulation of RAMP3 to investigate tumor progression, immune remodeling, and response to immune checkpoint blockade in vivo. Tumor growth, metastasis, and survival were evaluated. Single-cell RNA sequencing was performed on murine tumor tissues, and a publicly available spatial transcriptomic dataset was analyzed to characterize immune cell states and spatial organization within the TME. Human breast cancer datasets from The Cancer Genome Atlas were analyzed to assess the clinical relevance of RAMP3-associated immune signatures. Our results suggest that RAMP3 contributed to the establishment of an immunosuppressive TME. In mouse models, RAMP3 deletion suppressed primary tumor growth, reduced lung metastasis, and improved survival. These effects were associated with a shift from M2-like tumor-associated macrophages to antigen-presenting macrophage states, increased CD8 + T cell infiltration, and reduced T cell exhaustion. Mechanistically, RAMP3 deficiency was associated with reduced IL-4/STAT6 signaling in macrophages and decreased expression of immunosuppressive genes, including the chemokine CCL8. Pharmacological inhibition of CCL synthesis phenocopied the effects of RAMP3 deficiency, and RAMP3 deficiency enhanced the efficacy of PD-1 blockade. Spatial transcriptomic analysis demonstrated co-localization of RAMP3 and CCL8 within the TME. In the TCGA-BRCA cohort, a higher weighted RAMP3/CD163/CD8A risk score was associated with poorer overall survival and remained significantly associated with overall survival in complete-case multivariable Cox models adjusted for clinicopathological variables. RAMP3 was identified as a potential regulator of the immunosuppressive TME and its functional impact was demonstrated in vivo. Integration with human clinical datasets supports further investigation of RAMP3 as a potential therapeutic target for overcoming resistance to immune checkpoint therapy in breast cancer.

In recent years, there has been rapid development of minimally invasive cardiovascular procedures, such as atrial septal defect (ASD) transcatheter closure. Many female patients of reproductive age have undergone this procedure, but evidence regarding pregnancy outcomes after transcatheter closure of ASD remains limited. Our aim was to assess maternal and fetal outcomes and investigate the magnitude and determinants of obstetric complications in patients after transcatheter closure of an ASD. We analyzed 130 women with an average age of 28.6 ±9.1 years (19-44) who underwent ASD transcatheter closure using the Amplatzer Septal Occluder. Detailed records of each pregnancy ( n = 130), occurring an average of 18.2 ±4.1 months (11-35) after transcatheter closure, were analyzed. Cardiac events were defined as heart failure exacerbation, stroke, transient ischemic attack (TIA), arrhythmias, or endocarditis; obstetric events as pregnancy-induced hypertension (PIH), preeclampsia, HELLP syndrome, premature labor, or postpartum hemorrhage; neonatal events as premature delivery, small-for-gestational age, or fetal or neonatal morbidity or mortality. Cardiac events were observed during 20.8% ( n = 27) of pregnancies and included supraventricular arrhythmias ( n = 24, 18.5%) and severe peripheral edema ( n = 3, 2.3%). Obstetric events occurred in 22 (16.9%) patients. Neonatal events complicated only 2 (1.5%) pregnancies. Most pregnancies after transcatheter ASD closure with the Amplatzer Septal Occluder were completed successfully, with favorable obstetric and neonatal outcomes. Maternal complications were more common among women aged over 30 years.

Maternal serum alpha-fetoprotein (AFP) is related to placental dysfunction, whereas aminotransferases are routinely available biochemical measures. We evaluated an empirically constructed AFP/(AST×ALT) index measured during second-trimester screening as an exploratory marker associated with subsequent preeclampsia. We specifically examined whether the index showed a consistent severity gradient and whether it provided clinically meaningful discrimination. This retrospective cohort study included 164 singleton pregnancies followed at a tertiary referral center between January 2022 and June 2024: 81 pregnancies without preeclampsia, 42 with preeclampsia without severe features, and 41 with preeclampsia with severe features. AFP, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) measured at 16-18 weeks were retrieved. The AFP/(AST×ALT) index was calculated. Group comparisons were performed using variance-robust methods with post-hoc pairwise testing. Candidate diagnostic performance was explored using receiver-operating-characteristic analysis, and logistic regression was scaled per 0.1-unit increase in the index. Multivariable models included maternal age, body mass index, parity, and gestational age at sampling. The index showed a non-monotonic pattern across groups: 0.200 ± 0.188 in pregnancies without preeclampsia, 0.801 ± 0.422 in preeclampsia without severe features, and 0.229 ± 0.239 in preeclampsia with severe features. The comparison between pregnancies without preeclampsia and preeclampsia with severe features was not significant, whereas both comparisons involving preeclampsia without severe features were significant. This pattern was driven largely by lower second-trimester AST and ALT values in the group without severe features. For preeclampsia presence, ROC analysis yielded an AUC of 0.738 (95% CI 0.654-0.812). A cutoff of 0.328 provided 61.4% sensitivity and 86.4% specificity. In multivariable analysis adjusted for maternal age, BMI, parity, and gestational age at sampling, the adjusted OR was 1.46 (95% CI 1.25-1.71) per 0.1-unit increase in the index. AFP/(AST×ALT) demonstrated an association with preeclampsia in this retrospective cohort, but the relationship was non-monotonic across clinical phenotypes and appeared strongly influenced by low transaminase values in the group without severe features. The index should therefore be regarded as exploratory rather than as a validated severity biomarker or stand-alone clinical test. Independent prospective validation is required.

Since surgery can only remove lesions of a larger size visible to the naked eye, the recurrence rate of uterine fibroids after surgery is high. In recent years, numerous scholars have found that traditional Chinese medicine (TCM) treatment is effective in reducing the recurrence rate of postoperative fibroids, as well as improving the clinical treatment rate, regulating serum hormone levels, reducing plasma viscosity, and promoting the restoration of uterine volume following surgery. Several randomized controlled trials have been undertaken on the prevention and treatment of postoperative recurrence of uterine fibroids using patented Chinese medicines and self-proposed formulations, such as Guizhi Fuling Pill, Xiaozheng decoction, Xiangleng pill, Zhengjia decoction, Xiaoliu decoction, Guizhi Jiliu pill, Huoxue Huayu formula, Huoxue Xiaozheng decoction, Shugan Sanjie decoction, Gongliuxiao capsule, Hongjin Xiaojie concentrated pill, and Jiawei Guizhi Fuling decoction. However, no study has systematically evaluated Chinese herbal medicine (CHM) in reducing the recurrence rate of uterine fibroids after surgery. This study aimed to conduct a meta-analysis of randomized controlled trials of CHM for the prevention of postoperative recurrence of uterine fibroids, evaluating its efficacy and safety. A comprehensive search was conducted on PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP Information Database (VIP), WanFang Database, and China Biomedical Database (CBM) to identify randomized controlled clinical studies conducted up to March 2025 that examined the efficacy of CHM in treating patients with postoperative uterine fibroids. Two institutes were independently under-selected, and data were extracted and quality assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were performed using Review Manager software 5.4, and forest plots were generated. The quality of evidence was assessed using GRADEpro 3.2.2. This study was registered in PROSPERO (CRD420251000288). 16 trials were included in this study, and the postoperative recurrence rate after treatment was mainly analyzed. CHM treatment reduces postoperative recurrence rates in patients with uterine fibroids compared to the blank (6 trials, n = 588; OR (odds ratio) = 0.22; 95% CI (95% confidence intervals) = 0.14-0.34; I 2 = 0%, p < 0.00001), conventional western medicine (CWM) (1 trial, n = 80; OR = 0.30; 95% CI = 0.09-0.93, p = 0.04), and combined CHM with CWM (9 trials, n = 959; OR = 0.29; 95% CI = 0.19-0.46; I 2 = 0%, p < 0.00001). In addition, CHM is also effective in improving clinical efficiency, restoring serum sex hormone levels, lowering plasma viscosity, and reducing uterine volume. CHM is generally considered safe, with a low incidence of adverse reactions. CHM is effective in avoiding recurrence of uterine fibroids after surgery, excelling in terms of overall effectiveness, restoring female hormone levels, improving hemorheological indices, and promoting uterine recovery and safety. However, these findings are preliminary and still need to be validated by higher-quality studies.

Endometriosis is a chronic inflammatory condition and is one of the leading causes of infertility. The role of T helper (Th) cytokines in infertility remains largely unexamined, despite their recognized importance in endometriosis. To investigate the serum and peritoneal fluid levels of IL-4, IL-5, IL-10, IL-17A, IL-17F, and IFN-γ in women with endometriosis and to explore their correlations with disease severity. Eighty-seven infertile women undergoing diagnostic laparoscopy were included, comprising 44 endometriosis patients and 43 controls with benign gynecologic disorders. Serum and peritoneal cytokines were measured using Enzyme-linked immunosorbent assay. Statistical analyses assessed differences and correlations with clinical parameters. Both serum and peritoneal fluid levels of IL-4 and IL-5 were markedly higher in endometriosis patients compared to controls ( P < 0.001). Although serum IL-10 levels did not show significant differences, there was an increase in peritoneal fluid ( P < 0.001). Among those with endometriosis, serum levels of IL-4, IL-10, IL-17A, and IL-17F exhibited a positive correlation with the revised American Society for Reproductive Medicine score, while IL-17F indicated an inverse correlation with the Endometriosis Fertility Index (EFI) scores ( r = -0.422, P = 0.004). Receiver operating characteristic curve analysis demonstrated that IL-4 and IL-5 effectively distinguished endometriosis cases from controls, with IL-17F also providing significant predictive value for EFI scores ( P = 0.015). Elevated IL-4 and IL-5 levels in endometriosis suggest a Th2-skewed immune response. Meanwhile, the correlation of IL-17A with disease severity and the inverse relationship of IL-17F with fertility scores highlight the complex role of the Th17 response. These findings enhance understanding of cytokine dysregulation in endometriosis and may guide future therapeutic strategies.

Abnormal uterine bleeding (AUB) is a highly prevalent clinical condition affecting women of reproductive age. Beyond causing severe secondary complications such as iron-deficiency anemia and infertility, AUB profoundly impairs women's emotional well-being, social functioning, and overall quality of life. Current mainstream guidelines typically recommend conventional treatments as first-line strategies; however, these approaches face significant challenges regarding long-term efficacy and patient tolerability. This unmet need has prompted both patients and clinicians to seek safer and more effective alternative therapies. Chinese Herbal Medicine (CHM) is widely utilized in the management of gynecological disorders, demonstrating remarkable clinical advantages in alleviating AUB symptoms, reducing recurrence rates, and improving patient tolerability. This review provides a comprehensive synthesis of the molecular mechanisms underlying CHM formulas and plant-derived bioactive monomers for the treatment of AUB, based on a three-tiered body of evidence encompassing clinical studies, animal models, and in vitro experiments. Current evidence indicates that classical CHM prescriptions and Chinese patent medicines primarily exert their therapeutic effects by rectifying endocrine imbalances, promoting structural repair of the endometrium, regulating systemic metabolism, and restoring coagulation homeostasis. Regarding CHM-derived bioactive monomers (eg alkaloids and flavonoids), their principal mechanisms are characterized by the inhibition of inflammatory cell infiltration, attenuation of oxidative stress, and suppression of pathological angiogenesis. Furthermore, they contribute to endometrial tissue remodeling through the regulation of abnormal cellular proliferation and the induction of apoptosis. It should be emphasized, however, that the mechanistic evidence summarized herein originates primarily from preclinical investigations. Robust clinical evidence targeting specific PALM-COEIN subtypes is still lacking and does not yet permit firm subtype-specific therapeutic recommendations. Moreover, available clinical evidence is unevenly distributed across AUB etiologies, and safety reporting remains inconsistent; these limitations should be considered when interpreting the clinical relevance of findings derived from animal, cellular, omics, or computational studies. Notwithstanding these limitations, the present review offers a coherent scientific framework for deciphering the "multi-component, multi-target" pharmacological paradigm of CHM against AUB and identifies critical avenues for subsequent research endeavors.

[This corrects the article DOI: 10.3389/fimmu.2026.1927103.].