Search Results (19,420)

Ovarian cancer (OC) is the second most common gynecological malignancy and remains one of the leading causes of gynecological cancer-related mortality worldwide. A major clinical challenge is the lack of an accurate and widely applicable strategy for identifying patients at high risk of malignancy at an early stage. In this context, artificial intelligence (AI) has emerged as a promising tool to improve diagnostic performance. Among AI technologies, large language models (LLMs) have recently shown considerable potential in healthcare applications. In this study, we evaluated the diagnostic performance of ChatGPT (GPT-5) in classifying 300 adnexal masses as benign or malignant and compared its performance with that of the IOTA Simple Rules, the ADNEX model, and expert subjective assessment. We also assessed ChatGPT’s ability to predict the most likely histological diagnosis for each lesion. All adnexal masses were described using the International Ovarian Tumor Analysis (IOTA) terminology, and histopathological examination served as the reference standard. Our findings showed that expert subjective assessment achieved the highest overall diagnostic performance for both benign/malignant classification (accuracy 87.3%; 95% CI, 83.0–90.9%) and prediction of the presumed histological diagnosis. ChatGPT A and ChatGPT B reached a sensitivity of 72.3% and 73.5%, a specificity of 74.5% and 75.9%, a positive predictive value of 75.2% and 76.5%, and a negative predictive value of 71.5% and 72.8%, respectively (inconclusive responses counted as misclassifications), with an overall accuracy of 73.3% and 74.7%. After adequate validation, large language models might complement existing decision-support tools for less experienced examiners, without replacing expert evaluation. Their ease of use and reliance on standardized ultrasound descriptors make them accessible to ultrasonographers with varying levels of expertise. Full article

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but may cause immune-related kidney injury, and their association with glomerular disease remains incompletely understood. We evaluated the risk of incident glomerular disease following ICI therapy using the TriNetX U.S. Collaborative Network. Adult patients with cancer treated between January 2014 and March 2025 who received ICIs were compared with those receiving conventional antineoplastic therapies after 1:1 propensity score matching for demographics, cancer type, comorbidities, medications, and baseline kidney function. The index date was constrained to an eligibility window ending 1 March 2024, and identical exposure requirements were applied to both cohorts. The primary outcome was incident glomerular disease (ICD-10-CM codes N00, N01, N02, N04, N05 and N08), and hazard ratios (HRs) were estimated using Cox proportional hazards models. The proportional hazards assumption was tested for every outcome, death was additionally modelled as a competing event, and subgroup heterogeneity was assessed by formal tests of interaction. Among 71,354 matched patient pairs, glomerular disease occurred in 2.5% of ICI-treated patients and in 2.4% of controls. ICI therapy was associated with a higher hazard of glomerular disease (HR 1.492, 95% CI 1.392–1.599). The excess hazard was concentrated in the first 500 days after initiation (interval HR 1.68); beyond approximately 1000 days, the interval point estimates approached unity. In a supporting analysis in which death was modelled as a competing event, the estimated 5-year cumulative incidence was 4.5% with ICI therapy and 3.2% with comparator therapy, an absolute difference of approximately 1.2 percentage points, and the corresponding difference in restricted mean time free of glomerular disease was about 20 days. These absolute estimates were derived from the survival functions of the matched cohort rather than from patient-level competing-risk regression and should be read as approximations. In exploratory analyses, heterogeneity was demonstrated by race, cancer type and ICI agent. Renal biopsy and urine protein testing were performed at indistinguishable rates in the two cohorts, arguing against differential detection. ICI therapy is associated with a modest absolute increase in the risk of coded incident glomerular disease, concentrated in the first 18 months, which may support targeted rather than indefinite renal surveillance. Full article

Background/Objectives: Clostridioides difficile colonization is common among hospitalized onco-hematological patients, yet its clinical significance and risk factors in this population remain incompletely characterized. This study aimed to determine the prevalence, risk factors, and genomic characteristics of C. difficile colonization among oncology and hematology inpatients, and to assess its relationship with progression to symptomatic infection. Methods: We conducted a prospective cohort study of patients admitted to the oncology and hematology departments of a tertiary-care hospital in the Canary Islands, Spain, between March and October 2025. Weekly active screening for C. difficile colonization was performed on stool samples throughout hospitalization. Risk factors were assessed using multivariable logistic regression, and whole-genome sequencing was performed on 16 of the 23 recovered isolates (after excluding 3 non-recoverable and 4 contaminated isolates) to characterize sequence types, ribotypes, and antimicrobial resistance determinants. Results: Among 215 patients (262 admission episodes), colonization was detected in 23 episodes (8.8%), with higher rates in oncology (10.9%) than hematology (7.2%; adjusted OR 0.37, 95% CI 0.14–0.96, p = 0.042). Chemotherapy administered during hospitalization was the strongest independent risk factor for colonization (adjusted OR 4.16, 95% CI 1.56–11.10, p = 0.004). Only 4.3% of colonizations were classified as truly community-associated, with 95.7% of patients showing documented healthcare contact. Sequencing of 16 isolates identified nine sequence types, including ST11 (ribotype 078, of zoonotic origin) and rare ribotypes (RT010, RT451); four isolates (36%) exhibited moxifloxacin resistance linked to gyrA/gyrB mutations, while all remained susceptible to vancomycin and metronidazole. No colonized patient progressed to symptomatic infection; the single CDI case in the cohort occurred in a non-colonized patient. Conclusions: These findings support current recommendations against isolating or treating asymptomatically colonized patients, while underscoring the need for continued genomic surveillance and reinforced environmental hygiene and antimicrobial stewardship in this high-risk population. Full article

Background: Endometrial intraepithelial neoplasia/atypical endometrial hyperplasia (EIN/AEH) carries a substantial risk of concurrent endometrial carcinoma at hysterectomy. Sentinel lymph node (SLN) mapping requires cervical injection into an intact uterus, so the decision to map must be made before uterine pathology is known. A strategy that defers that decision to intraoperative frozen section therefore does not choose between mapping and no mapping; it forecloses mapping altogether. We evaluated the technical feasibility and diagnostic yield of SLN mapping performed without frozen section in patients with preoperative EIN/AEH and estimated how much of the nodal disease identified might not have been detected under a frozen-section-guided pathway. Methods: In this retrospective single-center study, 86 patients with a preoperative diagnosis of EIN/AEH underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping with methylene blue between November 2021 and May 2026. No patient underwent intraoperative frozen section, and all SLNs underwent ultrastaging. Patients were grouped by final histopathology, and carcinomas were staged according to FIGO 2023. A counterfactual analysis applied the Mayo intraoperative triage criteria to the final uterine pathology and considered two mechanisms separately: patients who would not have undergone nodal assessment at all, and patients who would have undergone lymphadenectomy but whose disease volume might not have been detected by conventional nodal pathology. Results: Final pathology showed persistent EIN/AEH in 37 patients (43.0%) and endometrial carcinoma in 49 (57.0%). Patients upgraded to carcinoma were older (60.3 ± 9.5 vs. 53.1 ± 10.4 years, p = 0.001), more often postmenopausal (87.8% vs. 54.1%, p = 0.001), and had greater endometrial thickness (18.6 ± 8.7 vs. 13.5 ± 5.4 mm, p = 0.004). At least one SLN was retrieved in 82 of 86 patients (95.3%) and bilaterally in 76 (88.4%); bilateral detection did not differ significantly between groups (94.6% vs. 83.7%, p = 0.177). SLNs lay in the obturator region in 62.2% of hemipelves and in the external iliac region in 26.3%, together accounting for 88.5%. Nodal involvement was identified in 11 patients (12.8% of the cohort; 22.4% of carcinomas): isolated tumor cells in two, micrometastasis in six, and macrometastasis in three. Among the patients who underwent additional non-sentinel nodal assessment, no metastatic non-SLN was identified in the presence of negative SLNs; no reference standard was applied to the remaining SLN-negative patients, so a false-negative rate cannot be estimated. No patient with EIN/AEH-only pathology had nodal involvement. Under simulated frozen-section triage, 2 of the 11 node-positive patients (18.2%) would not have undergone nodal assessment at all; a further 6 had low-volume disease that might not have been identified by conventional nodal pathology. Taken together, up to 8 of 11 (72.7%), and up to 6 of the 9 with micro- or macrometastasis (66.7%), might have remained undetected under the specified hypothetical pathway. Conclusions: SLN mapping performed before hysterectomy and without intraoperative frozen section was technically feasible with methylene blue alone and identified occult nodal disease, a substantial part of which might not have been detected under a frozen-section-guided pathway. These findings establish feasibility and diagnostic yield only: the study has no comparison group and supports no conclusion about survival, morbidity, or cost-effectiveness. Because 43.0% of patients had EIN/AEH-only pathology, mapping should form part of individualized preoperative counseling rather than be applied universally. Full article

Background/Objectives: Artificial intelligence (AI)-assisted automatic fetal measurements during ultrasound evaluation have become a major subject of interest. Most publications include systems developed and tested for a single anatomical component. In routine clinical practice, multiple biometric parameters are required for fetal weight estimation. Our objective is to assess the studies that incorporated three or more standard plane fetal automatic measurements with the help of AI systems in the second and third trimesters. Methods: We performed a systematic review of the published research focusing on automated AI systems analyzing at least three standard fetal biometric parameters or their corresponding standard ultrasound planes for fetal biometric, gestational-age, or fetal-growth assessment. The literature screening had to meet the predefined inclusion and exclusion criteria. Results: Nineteen studies, comprising more than 730,000 ultrasound images, met the inclusion criteria, and eighteen studies compared automated measurements with manual reference measurements. Overall, the included studies reported favourable performance for automated assessment of biparietal diameter, head circumference, abdominal circumference, and femur length, although substantial heterogeneity was observed in study design, AI architecture, validation methodology, and reported performance metrics. Conclusions: Automated AI systems show promising performance for assessing multiple standard fetal biometric parameters and may improve measurement consistency and examination efficiency. However, substantial heterogeneity in datasets, model architectures, and outcome reporting restricts direct comparison and the certainty of the evidence. Standardized reporting and prospective multicentre evaluation across gestational ages (GA), ultrasound systems, and operators are needed before these systems can be recommended for routine clinical use. Full article

Background/Objectives: Despite the gradual waning of global interest in SARS-CoV-2, the continued evolution and emergence of viral variants underscore the need for broadly protective vaccines. Vaccines targeting the highly mutable S1 subunit of the spike protein have shown limited breadth of protection, whereas conserved regions within the S2 fusion machinery remain critical targets for the development of vaccines effective against future variants. This study evaluated two mRNA-lipid nanoparticle (mRNA-LNP) vaccines encoding HR121, a conserved HR1-HR2-HR1 fusion-intermediate immunogen, in comparison with a recombinant HR121 protein vaccine. Methods: Two mRNA vaccine candidates, TM-HR121 and Fc-HR121, were designed to present HR121 through distinct antigen presentation strategies by incorporating a transmembrane anchor or an IgG Fc domain, respectively. Immunogenicity and protective efficacy were assessed in New Zealand White rabbits, BALB/c mice, and Golden Syrian hamsters. Results: Both mRNA vaccines elicited robust HR121-specific binding antibody responses and broad neutralizing activity against seven SARS-CoV-2 pseudoviruses in rabbits. In mice, the mRNA vaccines induced higher peak IgG titers, a more balanced IgG1/IgG2a profile, stronger antigen-specific IFN-γ responses, and enhanced T-cell responses compared with the recombinant protein vaccine, while maintaining detectable IL-4 responses. In hamsters, immunization with the HR121 mRNA vaccines significantly reduced lung viral RNA levels and attenuated pulmonary pathology and nucleocapsid antigen expression following authentic SARS-CoV-2 challenge. Conclusions: HR121-based mRNA-LNP vaccines successfully elicited cross-variant humoral and cellular immune responses and conferred protective efficacy in small-animal models. These findings support HR121 mRNA-LNP vaccines as a promising strategy for the development of broadly protective coronavirus vaccines targeting conserved S2 fusion epitopes. Full article

Background/Objectives: Universal surgical risk calculators are not validated for use and poorly predict postoperative morbidity and mortality for women undergoing gynaecological oncology surgery. This adversely affects communication of risk resulting in poorly informed decisions and missed opportunities for medical optimization to mitigate risk preoperatively. We present the development and external validation of our novel GO SOAR surgical risk calculator for use to preoperatively predict postoperative thirty-day surgical morbidity and mortality in relation to gynaecological oncology surgeries. Methods: New logistic regression models were developed using the GO SOAR1 training cohort (n = 1811) and externally validated in an independent prospective cohort (n = 416) for two outcomes: thirty-day postoperative mortality (alive versus dead) and thirty-day postoperative morbidity (any complication (Clavien–Dindo I–V) versus none). Performance of the GO SOAR models was compared against established all-purpose surgical risk calculators (SORT/POSSUM/P-POSSUM/NSQIP). Model discrimination was assessed with sensitivity calculated at a clinically significant prespecified specificity threshold of 90%. Results: For mortality, AUROC was 0.752 (95% CI 0.570–0.935) for GO SOAR full and 0.795 (95% CI 0.660–0.930) for GO SOAR condensed; corresponding sensitivities at 90% specificity were 57.1% and 42.9%. For morbidity, AUROC was 0.698 (95% CI 0.641–0.755) and 0.703 (95% CI 0.646–0.760) for the full and condensed models, respectively, with sensitivities of 30.4% and 32.1% at 90% specificity. Conclusions: The GO SOAR model using a data-driven, gynaecological-oncology-specific approach at 90% specificity, achieved the highest observed sensitivity among the evaluated calculators. Accurate surgical risk predictions are crucial for major oncological surgery, where complications can diminish quality of life and affect long-term cancer survival. A model such as the GO SOAR surgical risk calculator that uses readily available preoperative data, regardless of income setting, is essential in reducing global disparities in surgical outcomes. Full article

Background/Objectives: Evidence regarding sustained changes in ambulance utilization during the COVID-19 pandemic is inconsistent, and long-term national evidence from Saudi Arabia is limited. This study assessed changes in the level and weekly trend of eligible non-COVID-19 mid-priority, potentially life-threatening, and life-threatening ambulance activations and EMS time intervals recorded by the Saudi Red Crescent Authority (SRCA) during the COVID-19 period relative to the pre-pandemic period. Methods: We retrospectively analyzed eligible SRCA activations recorded between 1 March 2018 and 28 February 2022. Weekly counts were evaluated using segmented negative-binomial interrupted time-series models. Exponentiated coefficients are reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). EMS time intervals were compared between periods. Results: The analytical cohort comprised 2,837,523 eligible activations. At the interruption on 1 March 2020, the model estimated an immediate 19.0% level increase in weekly call volume (level-change IRR = 1.19; 95% CI: 1.06–1.33), followed by a relative decline in the post-interruption weekly trend (slope-change IRR = 0.996; 95% CI: 0.994–0.997). The largest complaint-specific immediate level-change IRRs were observed for penetrating injuries (IRR = 7.60; 95% CI: 5.40–10.70), pregnancy or obstetric emergencies (IRR = 3.59; 95% CI: 2.66–4.84), and allergic reactions (IRR = 3.21; 95% CI: 2.32–4.44); traffic-accident activations had a lower level (IRR = 0.59; 95% CI: 0.53–0.66). Median response, scene, transport, and total EMS intervals were longer by 1, 2, 2, and 4 min, respectively. Conclusions: Among the included non-COVID-19 mid- and high-priority activations, pandemic onset was associated with a higher immediate call level followed by a declining relative weekly trend and modestly longer EMS intervals. Complaint-specific differences may inform surveillance and service-capacity planning, but the observational design and exclusions preclude causal interpretation or inference about total SRCA workload. Full article

Hepatitis E virus (HEV) is a major global public health concern, particularly in resource-limited regions. Approximately 12.5% of individuals worldwide have been exposed to HEV, and 15–110 million individuals have current or recent HEV infection. HEV poses an especially serious threat to pregnant women, in whom infection can progress to severe disease and is associated with a high case fatality rate, particularly during the third trimester. Moreover, maternal HEV infection can lead to various adverse outcomes in fetuses and/or neonates, as documented in both developing and developed countries. No HEV-specific antiviral therapy is approved for use during pregnancy, and pregnancy-specific evidence and recommendations for HEV vaccination remain limited. This narrative review summarizes the diagnosis, prevalence, clinical manifestations, mechanisms underlying severe disease, treatment, and prevention of HEV infection in this high-risk population. It aims to improve clinicians’ awareness of the potential impact of HEV infection on pregnant women and their fetuses/neonates, to promote public health literacy, and to accelerate future disease-control efforts. Full article

Background: Gender-affirming testosterone therapy is an essential component of medical transition for transgender men. Despite its widespread use, the histopathological effects of testosterone exposure on the uterus, ovaries, and fallopian tubes remain incompletely characterized. This study aimed to characterize histopathological findings in the gynecologic organs of transgender men receiving testosterone therapy before gender-affirming hysterectomy with bilateral salpingo-oophorectomy. Methods: This retrospective cohort study included transgender men who underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy at a tertiary referral center between 2015 and 2019. Demographic characteristics, duration of testosterone therapy, operative findings, and histopathological results were reviewed. Estrogen receptor (ER) and progesterone receptor (PR) expression in uterine tissues was assessed immunohistochemically. Results: Fifty-two transgender men were included. The median age was 25.5 years (range, 19–46 years), the median body mass index was 24.8 kg/m², and the mean duration of testosterone therapy was 16.1 ± 7.8 months. Proliferative endometrium was the predominant pattern (78.8%), followed by inactive (17.3%) and atrophic (3.8%) endometrium. Endometrial polyps were identified in 13.5% of patients. Multifollicular ovarian morphology was observed in 90.4%, and paratubal cysts in 63.5%. No premalignant or malignant lesions were detected. ER expression was positive in all endometrial samples and in 92% of myometrial specimens, while PR expression was preserved in all evaluated uterine tissues. Conclusions: In this cohort, proliferative endometrium and multifollicular ovarian morphology were common despite testosterone therapy, and uterine ER and PR expression remained detectable. The absence of premalignant or malignant lesions was reassuring within the observed exposure period; however, the retrospective design, modest sample size, absence of a control group, limited characterization of hormone exposure, and lack of longitudinal follow-up preclude conclusions regarding long-term oncologic safety or malignancy risk. Full article

Limited information is available regarding the role of melatonin in regulating seasonal reproductive activity and oxidative stress in sheep under subtropical climatic conditions. Therefore, the present study evaluated the effect of melatonin administration on reproductive performance, hormonal profile, and antioxidant status in ewes during breeding and non-breeding seasons. A total of 48 clinically healthy multiparous ewes (2–5 years old) were equally divided into breeding and non-breeding season groups (n = 24 each). During each season, animals were allocated into four treatment groups: Group I (control; corn oil @ 1 mL/animal, s/c, n = 6), Group II (melatonin @ 10 mg/animal, s/c, n = 6), Group III (melatonin @ 20 mg/animal, s/c, n = 6), and Group IV (melatonin @ 40 mg/animal, s/c, n = 6). Melatonin administration significantly improved estrus response and conception rate during both seasons. During the breeding season, estrus response was observed in 33.33%, 100%, 100%, and 66.67% of animals in Groups I, II, III, and IV, respectively, whereas during the non-breeding season, estrus response was 0%, 83.33%, 100%, and 33.33%, respectively. Similarly, conception rates during the breeding season were 50%, 100%, 100%, and 66.67%, respectively, while corresponding values during the non-breeding season were 0%, 80%, 100%, and 50%. Serum estrogen concentration increased significantly (p < 0.05) in Groups II and III, particularly on day 7 during the breeding season and on day 14 during the non-breeding season. Progesterone concentration increased significantly (p < 0.05) on day 30 following 10 and 20 mg melatonin treatment during both seasons. Antioxidant enzyme activities, including glutathione peroxidase, superoxide dismutase, and catalase, were significantly enhanced following melatonin treatment. In conclusion, subcutaneous administration of melatonin improved reproductive performance, hormonal profile, and antioxidant status in sheep under subtropical conditions, with 20 mg melatonin/animal producing the most favorable responses, particularly during the non-breeding season. Full article

The meiotic spindle is essential for accurate chromosome segregation during oocyte maturation and fertilization, and its alteration might be considered a major contributor to age-related aneuploidy and reproductive failure. Spindle formation is inherently vulnerable to errors and contributes to the unusually high frequency of chromosome segregation defects observed in human eggs. Human oocytes are particularly prone to aneuploidy; the presence of an abnormal chromosome number, which represents one of the leading causes of infertility, recurrent pregnancy loss, implantation failure, and congenital disorders in neonates. Previous studies have reported a U-shaped relationship between maternal age and aneuploidy rates, with relatively higher rates observed in both very young females and in women of advanced maternal age. Conversely, aneuploidy rates appear comparatively lower during the intervening reproductive-age period, particularly between approximately 25 and 35 years of age. Because most aneuploid embryos fail to develop successfully after fertilization, chromosome segregation errors in oocytes have profound consequences for female reproductive success. Aneuploidy primarily arises from defects during meiotic chromosome segregation. Faithful chromosome segregation depends on the accurate assembly and function of the meiotic spindle, a dynamic microtubule-based structure that aligns and separates homologous chromosomes during meiosis I and sister chromatids during meiosis II. Growing evidence indicates that chromosome mis-segregation results from the combined effects of impaired sister chromatid cohesion, altered kinetochore architecture, defective microtubule dynamics, weakened spindle assembly checkpoint activity, and age-related metabolic decline. Together, these defects compromise spindle integrity and reduce the fidelity of chromosome separation. Furthermore, the intrinsic instability of the acentrosomal spindle increases the likelihood of incorrect microtubule–kinetochore attachments, a defect that becomes more prevalent with maternal aging due to progressive deterioration of chromosome organization and kinetochore function. This review summarizes the current understanding of the molecular mechanisms regulating meiotic spindle assembly and function in human oocytes and examines how their disruption contributes to chromosome segregation errors and embryonic aneuploidy. We discuss the interplay between spindle abnormalities and upstream cellular defects, distinguish meiotic from post-zygotic origins of chromosomal abnormalities, and evaluate the clinical significance of spindle assessment in assisted reproductive technologies. Finally, we critically examine emerging strategies aimed at preserving chromosome segregation fidelity, including approaches targeting mitochondrial function and spindle regulation, while distinguishing interventions supported by mechanistic evidence from those that remain preclinical or speculative. Full article

Background: Deep-learning artificial intelligence (AI) for mammographic screening moved from proof of concept to randomised evaluation in a single decade. We reviewed and meta-analysed its diagnostic accuracy and its effect on screening programmes, covering the literature published between 2015 and 2025. Methods: PubMed and Europe PMC were searched from 1 January 2015 to 31 December 2025, supplemented by ClinicalTrials.gov and by forward and backward citation searching (PRISMA 2020, PRISMA-DTA, PRISMA-S). Eligible studies evaluated a deep-learning system for cancer detection or triage in a screening population against a histopathological reference standard. Four syntheses were performed: standalone accuracy pooled on the logit-AUC scale (A), a bivariate sensitivity–specificity model (A2), cancer detection rate ratio for AI-integrated versus standard reading (B), and recall rate ratio (C). Random-effects models used restricted maximum likelihood with Knapp–Hartung intervals. Risk of bias was assessed with QUADAS-2 and QUADAS-C, and certainty with GRADE. Results: Twenty-six studies (27 reports, 2019–2025) were included. Pooled standalone AUC across 14 studies and 1,214,885 examinations was 0.890 (95% CI 0.858–0.915), with I² = 97.4% and a 95% prediction interval of 0.731–0.960. Neither publication year (p = 0.79) nor enriched versus consecutive sampling (p = 0.94) explained this dispersion in meta-regression. The bivariate model (k = 9) gave a summary sensitivity of 73.3% (64.5–80.6) at a specificity of 92.4% (86.8–95.8). Across randomised and paired prospective trials (k = 3), the pooled detection rate ratio was 1.13 (0.83–1.55), with the MASAI randomised trial alone reporting 1.29 (1.09–1.51) and a 44% reduction in screen reading. Non-randomised implementation studies (k = 5), which include a 463,094-women German programme evaluation, pooled to 1.22 (1.08–1.37) with little dispersion (I² = 19.0%). Recall changed little overall (0.95, 0.81–1.12). Certainty was very low for accuracy outcomes and moderate for the single randomised trial. Conclusions: A decade of evidence supports AI as a second reader and triage tool in organised screening, not as an autonomous replacement for the radiologist. Pooled accuracy is high on average but so dispersed that it cannot be transferred to a new programme; local validation before deployment remains necessary. The larger and more precise detection gains come from non-randomised designs, which is the pattern confounding would produce, so the randomised evidence remains the anchor. Interval-cancer and mortality endpoints are still awaited. Full article

Background: Breast cancer survivors frequently experience persistent sensory, psychosocial, and functional sequelae that may not be captured by pain measures alone. Understanding recovery trajectories throughout treatment and survivorship may help identify women at risk of long-term recovery-related difficulties. Objective: To investigate sensory, psychosocial, functional, and quality-of-life trajectories throughout breast cancer treatment. Methods: This prospective longitudinal study included women undergoing unilateral breast cancer surgery assessed at six time points before and after surgery, including before and after adjuvant treatments when applicable. Outcomes included sensory function, pain, upper-limb function, psychosocial variables, and quality of life. Results: Seventy-two women (57 ± 11 years) were included. Despite stable pain intensity and self-reported sensitization symptoms, fear of movement increased (TSK-11: MD [95%CI] = +9[0;22]), quality of life deteriorated (FACT-B: 3–12 month MD [95%CI] = −10[−19;−1]), and upper-limb function initially worsened before partially recovering. Objective sensory alterations suggested dynamic changes in somatosensory processing but were not consistently accompanied by greater pain intensity or self-reported sensitization symptoms. Conclusions: Recovery after breast cancer treatment is multidimensional and cannot be adequately reflected by pain intensity alone. Multidimensional assessment may help identify women at risk of persistent recovery-related difficulties and support personalized survivorship care. Full article

Background/Objectives: To evaluate the association between the newly defined cerebroplacental–renal ratio (CPRR) and adverse perinatal outcome (APO) in pregnancy-induced hypertension (PIH), and to compare its discriminative performance with the cerebroplacental ratio (CPR) and cerebroplacental–uterine ratio (CPUR). Methods: This prospective, single-center cohort study included 105 women with PIH (preeclampsia, n = 63; gestational hypertension, n = 42). Doppler assessment was performed at ≥34 + 0 weeks and within 7 days before delivery. CPR was calculated as middle cerebral artery pulsatility index (PI)/umbilical artery PI, CPUR as CPR/mean uterine artery PI, and CPRR as CPR/right renal artery PI. APO was defined by the presence of any of the following: non-reassuring fetal status, a 5 min Apgar score <7, neonatal intensive care unit admission, or neonatal death. Receiver operating characteristic analysis and multivariable logistic regression adjusted for gestational age at ultrasound assessment and diagnosis group were performed. Results: APO occurred in 37 pregnancies (35.2%). CPUR and CPRR were significantly lower in the APO group, whereas CPR did not differ significantly. CPRR showed a higher apparent AUC for APO than CPR and CPUR (AUC 0.786, 95% CI 0.698–0.875), with significantly higher AUCs on pairwise DeLong comparisons. After adjustment, CPRR was the only Doppler index independently associated with APO (adjusted OR 1.423 per 0.1-unit decrease; 95% CI 1.162–1.743; p = 0.001). Conclusions: CPRR was independently associated with APO in PIH and showed higher discriminative performance than CPR and CPUR; however, these findings require validation in independent, multicenter studies before clinical application. Full article