Search Results (3,441)

Accurate assessment of hypoxia-related fetal risk during labour is essential for improving perinatal outcomes while avoiding unnecessary operative interventions. Although deep learning has shown promise for automated fetal risk assessment, most existing approaches rely on cardiotocography (CTG) alone; CTG interpretation is known to suffer from a high false-positive rate and may not fully reflect fetal status without complementary clinical context. To address this limitation, we propose MIRF-Net, a multimodal intrapartum fetal risk assessment framework that jointly models (i) CTG time-series signals, (ii) Gramian Angular Difference Field (GADF) images that encode global correlation structure of fetal heart rate, and (iii) structured maternal metadata. MIRF-Net combines a PatchTST encoder for CTG, a pretrained ResNet101 for GADF images, and an autoencoder for maternal metadata and then performs cross-modal interaction learning with a fusion Transformer for final risk prediction. Using 552 eligible CTG recordings from the public CTU-UHB intrapartum database, which were split into training, validation, and test sets at a ratio of 6:2:2, MIRF-Net outperforms representative baselines on the test set, achieving a quality index (QI) of 74.76%, AUC of 0.7413, and Brier score of 0.2537, indicating improved discrimination and better-calibrated risk probabilities. Ablation studies further confirm the complementary contributions of each modality and show that Transformer-based fusion yields the most consistent overall gains. These results suggest that MIRF-Net provides reliable decision support for intelligent intrapartum monitoring. Full article

Background/Objectives: Maternal diet during pregnancy may influence neonatal outcomes, but dietary behaviours are socially patterned and were measured differently across cohorts. We therefore evaluated whether cohort-specific, partially harmonized maternal dietary patterns were associated with adverse birth outcomes after accounting for maternal and socioeconomic characteristics in two Italian birth cohorts. Methods: We analyzed 3234 mother–infant dyads from Piccolipiù (2011–2015) and 1564 from MAMI-MED (2020–ongoing). Maternal diet was captured by cohort-specific food questionnaires and grouped into food categories. Principal component analysis identified dietary patterns; pattern scores were categorized into tertiles and combined into five joint-adherence profiles. Logistic regression estimated odds ratios (OR) for preterm birth (PTB, <37 weeks), low birth weight (LBW, ≤2500 g), macrosomia (≥4000 g), and small/large for gestational age (SGA/LGA), with progressive adjustment for maternal age, pre-pregnancy body mass index (BMI), education, employment, and (Piccolipiù) income. Results: Two comparable patterns emerged in both cohorts: Western (processed foods, fried items, snacks/sweets, sugar-sweetened beverages) and Prudent (fruit, vegetables, fish, whole grains/yogurt). Western adherence was more common among younger women and those with disadvantage, whereas Prudent adherence tracked higher education, employment and income. After full adjustment, dietary profiles were not consistently associated with PTB, SGA or LGA in either cohort. In Piccolipiù, preferential Prudent adherence was associated with lower odds of LBW (OR 0.49; 95% CI 0.24–0.92) and higher odds of macrosomia (OR 1.56; 95% CI 1.06–2.30). Across cohorts, higher pre-pregnancy BMI predicted macrosomia/LGA, while lower education increased the probability of PTB and LBW. Conclusions: Across two Italian birth cohorts, maternal dietary patterns were socially stratified, whereas pre-pregnancy BMI and maternal education were more consistently associated with birth outcomes than dietary-pattern adherence per se. Full article

Hyperekplexia is a neurologic disorder of marked perinatal significance. Affected neonates display generalized hypertonia and exaggerated startle reflex in response to innocuous stimuli, potentially leading to life-threatening apneic episodes. Although symptom severity typically diminishes during the first year of life, affected individuals often continue to exhibit disabling motor dysfunction and frequent unprotected falls throughout adulthood. Currently, no targeted therapeutic interventions are available. The pathophysiology involves partial or complete disruption of inhibitory glycinergic neurotransmission. Mutations in the gene encoding the neuronal glycine transporter GlyT2 (SLC6A5) represent the second-most frequent genetic etiology of human hyperekplexia. To investigate the mechanistic basis for the heightened severity of symptoms during the perinatal period, we examined the role of GlyT2 in neuronal differentiation using the PC12 cell model. Pharmacological induction of differentiation demonstrated that clones stably expressing GFP-GlyT2 exhibit increased expression of neuronal differentiation markers and enhanced neurite outgrowth—both in number and length—relative to parental PC12 cells. These clones also displayed elevated cytosolic calcium levels, which were attenuated by calmodulin overexpression, subsequently downregulating differentiation marker expression. We hereby proved that GlyT2 is clearly implicated in growth cone progression and differentiation of PC12 cells into neurons by increasing internal calcium and binding to growth cone proteins. Finally, our results were validated in primary neurons. Full article

Preeclampsia (PE) is a leading cause of maternal and perinatal complications and is classified by early or late onset according to the gestational age. The complex pathogenesis of PE involves placental ischemia, oxidative stress, angiogenic imbalance, and inflammation, all of which contribute to impaired placentation and widespread maternal endothelial dysfunction. These mechanisms drive hypertension, multi-organ involvement, and increased long-term cardiovascular risk. Parallel research highlighted the role of the NLRP3 inflammasome, a multiprotein complex that, upon activation, increases the gene expression, processing, and release of the pro-inflammatory cytokines IL-1β and IL-18. The NLRP3 pathway is markedly upregulated in placentas from pregnant women with PE, where endogenous danger signals stimulate inflammasome activation and amplify inflammation. Increasing evidence indicates that microRNAs (miRNAs) help regulate inflammatory processes, including the NLRP3 inflammasome, thereby affecting placental function and maternal adaptation. Although several immunoregulatory miRNAs may influence NLRP3 activity, their specific contribution to inflammasome regulation in PE remains insufficiently understood. Understanding these interactions could reveal new therapeutic targets for PE. In this narrative review, we explore the interconnected roles of endothelial dysfunction, inflammasome activation, and miRNA-mediated regulation in the pathogenesis of PE. Full article

Objectives: Gestational diabetes is linked to increased inflammatory and metabolic stress during the neonatal period. Among the biomarkers elucidating the relationship between diabetes and inflammation, the interleukin-33 (IL-33)/ST2 signaling pathway is of particular interest. Research on the IL-33/sST2 axis in pregnancies complicated by diabetes indicates that these biomarkers are associated with maternal metabolic disorders and inflammation. Therefore, evaluating sST2 levels in infants of diabetic mothers is essential for identifying a biological marker of systemic inflammation resulting from intrauterine hyperglycemia and for clarifying the specific risks associated with this condition. The objective of this study was to examine sST2 levels in infants born to diabetic mothers and to assess their association with perinatal inflammation, metabolic stress, and clinical outcomes. Methods: This prospective observational study included term infants born at Pamukkale University Medical Faculty Hospital. The study group comprised term infants whose mothers had gestational diabetes, while the control group consisted of term infants born to healthy mothers without diabetes. sST2 levels were measured from serum samples obtained from cord blood at birth using the ELISA method. Factors influencing sST2 levels were analyzed using regression analyses. Results: sST2 levels were significantly higher in the diabetic group than in the control group (p < 0.001). The incidences of large for gestational age (LGA), small for gestational age (SGA), hypoglycemia, postnatal respiratory distress, and both the frequency and duration of neonatal intensive care unit admissions were also significantly elevated in the diabetic group. Multivariate analysis identified gestational diabetes as independent predictor. Conclusions: This study is among the first to demonstrate increased sST2 levels at birth in infants of diabetic mothers. The results indicate that intrauterine exposure to hyperglycemia due to gestational diabetes may be associated with heightened inflammation and metabolic stress in the neonatal period, and that sST2 may serve as a potential biomarker reflecting fetal exposure. Full article

The continuous emergence of SARS-CoV-2 variants highlights the need for novel antiviral agents with favorable safety profiles. Marine microalgae constitute a valuable source of bioactive compounds, including antiviral peptides. Building on previous in silico identification of peptides derived from the marine microalga Phaeodactylum tricornutum with predicted activity against SARS-CoV-2, this study evaluated the antiviral capacity of peptide fractions generated by enzymatic hydrolysis and separated by molecular weight (10–30, 5–10, 3–5, and <3 kDa) in human alveolar epithelial A549 cells infected with the SARS-CoV-2. Cytotoxicity analyses, assessed using MTT and resazurin assays, revealed a moderate, concentration-dependent reduction in metabolic activity while maintaining overall cell viability within an acceptable range for antiviral evaluation, with higher-molecular-weight fractions (10–30 and 5–10 kDa) displaying the most stable profiles. Antiviral activity was assessed by flow cytometry following post-infection treatment. Lower-molecular-weight fractions (3–5 and <3 kDa) showed early reductions in infection at low concentrations but exhibited variable responses. In contrast, the 10–30 and 5–10 kDa fractions showed more robust, dose-dependent inhibition at medium and high concentrations, reducing infection levels to levels close to those observed in uninfected controls. Comparative analysis with the reference antiviral drug lopinavir demonstrated that peptide fractions exhibit lower cytotoxicity while retaining antiviral activity under equivalent experimental conditions. Overall, these results indicate that antiviral efficacy is strongly influenced by peptide molecular weight and consistency of response. This work provides experimental in vitro validation of P. tricornutum–derived peptide fractions as marine antiviral candidates and supports the integration of in silico and functional approaches for marine drug discovery. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Background: Hypothyroidism is one of the most common endocrine conditions during pregnancy and has been associated with poor obstetric and perinatal outcomes. There is still a lack of data from Middle Eastern populations, despite its clinical significance. This study aimed to evaluate thyroid management patterns during pregnancy and examine the association between thyroid function control and maternal and perinatal outcomes in women with hypothyroidism at a tertiary care center in Qatar. Methods: A retrospective cohort study including 379 pregnant women with hypothyroidism diagnosed between January 2019 and November 2022 was conducted at Sidra Medicine in Doha, Qatar. Based on trimester-specific Thyroid-stimulating hormone (TSH )reference values, participants were categorized as having adequately or inadequately controlled thyroid function. Data on obstetrics, biochemistry, and demographics were taken from electronic medical records (EMR). Statistical analyses were performed using chi-square tests for categorical variables and t-tests for continuous variables, with a significance threshold of p < 0.05. Results: Participants had a mean Body Mass Index (BMI) of 30.33 ± 6.14 kg/m² and an average age of 32.65 ± 4.99 years; 54% of them were Qataris. Of the patients, 58.5% had positive thyroid antibodies and 55.7% had pre-gestational hypothyroidism. Women with pre-gestational hypothyroidism required significantly higher levothyroxine doses compared with those with gestational hypothyroidism (93.2 ± 47.5 mcg/day vs. 67.6 ± 30.1 mcg/day; p < 0.001). Treatment adjustment was demonstrated by the improvement in TSH normalization from 51.3% in the first trimester to 64.2% in the third trimester (p = 0.041). No significant associations were observed with pre-eclampsia, preterm delivery, hypertension, or placental abruption. However, women with normal third-trimester TSH had a higher prevalence of gestational diabetes mellitus (GDM) compared with those with elevated TSH (51.6% vs. 36.8%; p = 0.013). Conclusions: Appropriate trimester-specific monitoring and timely levothyroxine titration was associated with improved biochemical control without adverse maternal outcomes. Greater levothyroxine requirements in women with pre-gestational hypothyroidism emphasize the importance of early intervention. These findings highlight the potential benefit of structured thyroid monitoring and multidisciplinary care approaches in pregnancy and may help inform future regional clinical practice guidelines. Full article

Background: Main risk factors associated with the development of sarcopenia (coexistence of muscle mass loss and dysfunction) are a sedentary lifestyle coupled with obesity. Associated mitochondrial dysfunction leads to energy deficits and perturbations in the balance between protein synthesis and degradation, thereby triggering muscle dysfunction or atrophy. Aside from exercise, which is challenging to implement and maintain, particularly in women, treatments for diminishing sarcopenia are scarce. The objective of the present study was to evaluate the effect of the flavanol (−)-epicatechin (EC) in a hypercaloric diet-induced obese female rat model. Muscle strength and endurance, as well as relative mitochondrial DNA content in skeletal muscle, were assessed. Methods: Female rats were fed a hypercaloric diet to induce obesity, as evidenced by increases in body weight, Lee index, and lipid profile alterations, and by abdominal fat accumulation, and to promote a sarcopenic phenotype. Functional tests of grip strength and mobility (treadmill) were performed. Mitochondrial relative content was evaluated by measuring the ratio of mtDNA/nuclear DNA, and the expression of genes related to mitochondrial biogenesis (Pgc1-α, Tfam), fusion (Mfn1 and Opa1), fission (Drp1 and Fis1), and mitophagy (Pink1 and Pkn), and function; citrate synthase and Ucp3 were also evaluated. Results: A significant decrease in mobility and strength was observed in obese female rats, accompanied by reduced mitochondrial numbers, activity, and dynamics, but not by changes in muscle size or weight. Treatment with EC induced mitochondrial biogenesis and positive changes in mitochondrial dynamics (fission and fusion) and activity, as measured indirectly by changes in citrate synthase and Ucp3 expression. Discussion: Results reinforce the potential of EC as a modulator of mitochondrial function in dysfunctional conditions associated with obesity, thereby attenuating the mechanisms underlying sarcopenia. Full article

Background: Hypoxic–ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and long-term neurodevelopmental impairment despite advances in perinatal care and the widespread use of therapeutic hypothermia. Reliable early prognostic markers are essential for risk stratification and long-term follow-up planning. This study aimed to evaluate long-term neurodevelopmental outcomes and associated prognostic factors in neonates with HIE treated in the era of therapeutic hypothermia. Methods: This retrospective cohort study was conducted in a tertiary neonatal intensive care unit between January 2020 and June 2024. Neonates with gestational age ≥ 35 weeks diagnosed with HIE were included. Clinical characteristics, laboratory parameters, neurophysiological findings, neuroimaging results, and indicators of multiorgan dysfunction were recorded. Long-term neurodevelopmental outcomes were assessed at 18 to 24 months of age. The primary outcome was death or severe neurodevelopmental impairment. Multivariable logistic regression analysis was performed to identify independent predictors of adverse outcomes. Results: A total of 99 neonates were included. Therapeutic hypothermia was administered to 86 (86.9%) infants. Severe neurodevelopmental impairment or death occurred in 18 (18.2%) patients. Cerebral palsy was diagnosed in 19 (20.9%) survivors, developmental delay in 12 (13.2%), epilepsy in 16 (17.6%), and feeding difficulties in 9 (9.9%). In multivariable analysis, higher lactate levels (adjusted OR = 1.239, 95% CI = 1.052–1.458), lower Apgar score at 5 min (adjusted OR = 0.570, 95% CI = 0.344–0.944), and renal dysfunction (adjusted OR = 7.947, 95% CI = 2.027–31.164) were independently associated with severe neurodevelopmental impairment or death. Multiorgan dysfunction and abnormal neurophysiological and neuroimaging findings were significantly associated with adverse outcomes. Conclusions: Early biochemical markers, neurological assessments, neurophysiological recordings, neuroimaging patterns, and systemic organ dysfunction are closely associated with long-term neurodevelopmental outcomes in neonates with HIE. A multidimensional approach to early prognostic evaluation may improve risk stratification and guide targeted follow-up and intervention strategies. Full article

Precision in radiotherapy requires the development of standardized, reproducible, and biologically relevant models to accurately assess the efficacy and safety of various radiobiological sources. This review presents a novel approach using precision-cut organotypic tissue slices (OTSs), or organotypic tissue cultures (OTCs), as a representative model with potential for unifying the assessment of radiobiological sources. Derived from specific organs, OTSs retain the complex architecture and multicellular environment of the tissue, providing a unique platform that bridges the gap between in vitro cell cultures and in vivo animal models. The typed OTSs can effectively mimic the in vivo physiological responses to ionizing radiation, providing insight into the mechanisms of radiation-induced damage and repair, and the potential for radiation-induced toxicity and side effects. The emerging practices for the use of OTSs in radiobiological studies include slice mechanical preparation, radiation exposure, and outcomes assessment. The prepared approach for OTS preparation promises to improve the reliability and comparability of radiobiological studies, facilitating the development of safer and more effective radiation therapies. OTSs have the potential to significantly advance our understanding and application of radiation medicine and research by providing a physiologically relevant assessment of radiobiological effects of novel ionizing radiation sources. Full article

This article addresses physical activity during pregnancy and the postpartum period, a crucial public health concern. We examine the latest insights into physical activity during the perinatal phase, highlighting key findings on the attitudes, perceived barriers, and factors that influence participation. Engaging in moderate physical activity during this period is deemed safe and offers numerous benefits, such as lowered risks of gestational diabetes, preeclampsia, and excessive weight gain, alongside enhanced mental health and sleep quality. After childbirth, continued physical activity provides advantages such as weight management, reduced postpartum depression risk, improved sleep patterns, and a better overall quality of life. However, activity during these stages is often hindered by various barriers stemming from personal issues, societal influences, knowledge gaps, and environmental obstacles. Notably, these challenges tend to shift between pregnancy and postpartum; safety concerns are more prevalent during pregnancy, while issues like fatigue, lack of time, and childcare responsibilities become more significant after delivery. This article uses a socio-ecological framework to analyze these obstacles in depth, categorizing them into intrapersonal, interpersonal, environmental, organizational, and policy-based levels. Full article

Background: Pediatric hepatitis C virus (HCV) infection is often asymptomatic but may lead to significant liver disease later in life. In Romania, data on pediatric HCV remains scarce. This study aimed to describe the clinical and epidemiological characteristics of children with chronic HCV infection in a Romanian cohort. Methods: We conducted a retrospective study that included 83 pediatric patients evaluated for chronic hepatitis C between 1995 and 2024 at a tertiary pediatric hospital from Bucharest, Romania. Demographic data, routes of transmission, biochemical parameters, viral load, and liver fibrosis assessed by FibroScan^® or liver biopsy were analyzed. Results: The median age at diagnosis was 73 months (IQR 36–156), with a slight female predominance (54.2%). Vertical transmission was the most common (48.2%). Most children had normal or mildly elevated transaminases at diagnosis. Although pediatric HCV hepatic involvement is generally considered mild, in our cohort only 40.6% of children had absent or mild fibrosis at diagnosis, while in 33.7% of cases moderate fibrosis was identified, and 8.4% had severe fibrosis or cirrhosis. No significant correlations were found between viral load, transaminase levels, and fibrosis severity. Conclusions: Pediatric HCV infection in Romania is frequently diagnosed late, mainly due to the lack of systematic perinatal screening. Although liver disease is generally mild, the cases of advanced fibrosis highlight the need for early diagnosis and improved screening strategies. Full article

Background: Depression in men often goes unrecognized, even though it leads to high rates of suicide. Men may show symptoms that are external, behavioral, or physical, which traditional assessment tools focused on internal symptoms do not adequately reflect. Methods: A narrative review was carried out to gather evidence on depression scales tailored for men. We searched PubMed up to November 2025 for studies discussing the development, validation, and clinical use of the Gotland Male Depression Scale (GMDS), the Male Depression Risk Scale (MDRS-22 and MDRS-7), and the Gender-Sensitive Depression Screening scale (GSDS-26). We organized the findings by instrument. Results: The studies indicate that male-sensitive scales capture symptom domains such as emotional suppression, anger, risk-taking behaviors, substance misuse, and somatic complaints. The GMDS has demonstrated applicability across psychiatric, somatic, and paternal perinatal populations. The MDRS-22 and MDRS-7 were particularly sensitive to externalizing symptom patterns associated with male presentations of depression and behavioral profiles linked to elevated suicide risk. The GSDS-26 integrates both prototypical and externalizing symptoms, enabling the identification of diverse depressive profiles. However, the current evidence base remains limited due to a reliance on non-clinical samples and the scarcity of long-term and cross-cultural validation studies. Conclusions: Male-sensitive depression scales may serve as useful complementary screening tools that improve recognition of male-typical depressive presentations and behavioral patterns associated with increased suicide risk. Further clinical and longitudinal research is needed to confirm their diagnostic accuracy and clinical utility. Full article

Background: Recent evidence suggests the potential role of fetal cardiac function parameters in the assessment of different obstetrical conditions. Despite this evidence, the application of cardiac function parameters to routine fetal cardiac evaluation is limited. Among other reasons, the lack of accessibility to a simple, practical instrument offering tips on how to carry out a fetal cardiac functional assessment could explain this restricted application. Methods: A narrative review of the available literature on how to practically carry out a fetal cardiac function assessment was reviewed and summarized to offer an instrument to assess fetal cardiac function alongside the classical morphological evaluation. Results: The contents of this guide are focused exclusively on the practical details to carry out a fetal cardiac function assessment and voluntarily exclude the definition of and indications for the parameters assessed. The guide includes the assessment of fetal cardiac morphometry, valvular evaluation and cardiac contractility. Conclusions: The aim of this guide is to make fetal cardiac functional parameters more accessible to maternal and fetal medicine health professionals with a good background knowledge of fetal cardiology. Full article