International Journal of Women's Health最新文献

{"title":"A Cross-Sectional Study on the Association Between Abortion and Bipolar Disorder, Major Depression: Evidence from the UK Biobank.","authors":"Fengmei Tian, Yiqing Gu, Rongwei Gong, Jingfang Liu, Ibrar Hussain, Hongpeng Sun, Hao Sun, Zaixiang Tang","doi":"10.2147/IJWH.S627477","DOIUrl":"10.2147/IJWH.S627477","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous and induced abortion are common reproductive events. Limited research has investigated the association between abortion and women's mental health, particularly bipolar disorder and major depression (BDMD). This study aims to explore this association to offer theoretical insights into women's health.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from 21,196 female participants in the UK Biobank. Participants were divided into four groups: no abortion history, spontaneous abortion only, induced abortion only, and both spontaneous and induced abortions. Inverse probability of treatment weighting (IPTW) was applied to reduce biases in treatment assignment. Logistic regression was used to examine the relationship between abortion and BDMD, while restricted cubic spline regression was employed to explore the nonlinear association between the number of abortions and BDMD.</p><p><strong>Results: </strong>Among the 21,196 ever-gravid women, 10,583 (49.93%) experienced spontaneous abortion only, 7106 (33.53%) experienced induced abortion only, and 2804 (13.23%) experienced both spontaneous and induced abortions. The IPTW-multivariate logistic regression analysis showed that induced abortion only and both spontaneous and induced abortions were associated with BDMD, with adjusted odds ratios (ORs) of 1.18 (95% CI: 1.11-1.23) and 1.33 (95% CI: 1.27-1.39), respectively. Spontaneous abortion alone was not associated with BDMD, with an OR of 1.03 (95% CI: 0.98-1.08). A nonlinear association was identified between the number of abortions and BDMD.</p><p><strong>Conclusion: </strong>This study found that a history of abortion is linked to a higher risk of BDMD. Additional research is required to better understand this relationship and to offer theoretical insights for women's reproductive health.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"627477"},"PeriodicalIF":2.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study of Kocher Forceps-Guided Laparoscopic Transvaginal Sacrospinous Ligament Fixation: Technique and Initial Clinical Experience.","authors":"Bai Xue, Xiaoyan Huang, Ying Zhou, Qian Zhu","doi":"10.2147/IJWH.S623390","DOIUrl":"10.2147/IJWH.S623390","url":null,"abstract":"<p><strong>Background: </strong>Traditional transvaginal sacrospinous ligament fixation (SSLF) relies on palpation for suture placement under limited visualization. We developed a Kocher forceps-guided laparoscopic transvaginal SSLF technique that enables real-time laparoscopic visualization during suturing and eliminates the need for specialized transvaginal natural orifice transluminal endoscopic surgery (vNOTES) access platforms and insufflation. This study presents this novel technique and reports our initial clinical experience.</p><p><strong>Methods: </strong>Ten consecutive patients with pelvic organ prolapse (POP) who underwent this procedure at the Affiliated Jiangning Hospital of Nanjing Medical University between November 2024 and July 2025 were included. After opening the rectovaginal and right pararectal spaces, the sacrospinous ligament was identified by palpating the ischial spine. The surgeon then grasped the target site with a Kocher forceps and placed the suture under direct laparoscopic visualization. Demographic, preoperative, intraoperative, postoperative, and follow-up data were evaluated.</p><p><strong>Results: </strong>Ten postmenopausal women with stage III-IV POP successfully underwent the procedure. Median age was 64 years (range, 54-71), and median body mass index (BMI) was 24.30 kg/m² (range, 19.53-27.56). Concomitant procedures included hysterectomy with anterior and posterior colporrhaphy (n=5), partial cervicectomy with anterior colporrhaphy (n=1), partial cervicectomy with posterior colporrhaphy (n=1), and anterior and posterior colporrhaphy alone (n=3). Median operative time was 140 minutes (range, 82-230), and median estimated blood loss was 50 mL (range, 10-100). No perioperative complications occurred. At a median follow-up of 15.62 months (range, 2.27-17.03), no POP recurrence or surgical complications were observed.</p><p><strong>Conclusion: </strong>The Kocher forceps-guided laparoscopic transvaginal SSLF appears to be a feasible and safe surgical approach for POP in this small case series.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"623390"},"PeriodicalIF":2.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-Processed Food Intake, Circulating NMR Metabolomic Signatures and Risk of Osteoarthritis in Women.","authors":"Yi Li, Xiaoling Zhou","doi":"10.2147/IJWH.S625773","DOIUrl":"10.2147/IJWH.S625773","url":null,"abstract":"<p><strong>Purpose: </strong>Prospective evidence reporting statistical associations between ultra-processed food (UPF) intake and osteoarthritis (OA) risk in women is sparse, women suffer a disproportionately heavy OA burden with distinct metabolic and inflammatory characteristics, and the circulating biological correlates of UPF intake have not been integrated with OA risk in a unified analytical framework.</p><p><strong>Patients and methods: </strong>In a prospective multi-omics analysis, we studied women without baseline OA, with NOVA-based UPF intake reconstructed from repeated Oxford WebQ 24-hour dietary records. Cox proportional hazards models (age as time scale) estimated hazard ratios (HRs) per 1-SD UPF increase and across quartiles, adjusting for ethnicity, education, income, smoking, alcohol, physical activity and total energy intake (Model 2); stabilised inverse probability weighting (IPW) addressed UPF availability. Nightingale NMR metabolomic and Olink proteomic features were screened sequentially (UPF-to-omics, omics-to-OA; FDR<0.05); candidate correlates were summarised by principal component analysis into a UPF-related omics signature. We performed two-stage correlational screening for omics markers rather than formal causal mediation analysis. Notably, 61.8% of the female cohort lacked valid UPF dietary records; stabilised inverse probability weighting (IPW) with dual trimming thresholds was applied to mitigate potential selection bias from missing dietary data.</p><p><strong>Results: </strong>Among 13,122 women with UPF data (base female OA cohort 34,322), 528 knee OA, 473 hip OA, 1,908 any OA, 963 knee/hip OA and 57 hand OA events accrued. Model 2 demonstrated per-1-SD UPF increments were associated with higher any OA (HR 1.070, 95% CI 1.023-1.120, P=0.003) and knee/hip OA risk (HR 1.072, 95% CI 1.005-1.143, P=0.035), with the top UPF quartile linked to 28.8% higher knee OA risk; energy-adjusted and IPW-weighted analyses produced consistent estimates, while associations fully attenuated after adiposity adjustment in Model 3. UPF intake was related to 178 NMR features (FDR<0.05), including GlycA, omega-6/linoleic acid percentages and HDL-related lipoprotein indices. The combined PCA NMR signature independently predicted increased knee OA (HR 1.187, 95% CI 1.124-1.253, P<0.001) and any OA risk (HR 1.104, 95% CI 1.070-1.139, P<0.001). In exploratory Olink proteomic analyses, five proteins were associated with UPF intake at FDR<0.05, but no protein passed the pre-specified two-stage FDR screening for both UPF association and OA risk; nominal Olink signals are reported in the Supplementary Materials and interpreted as hypothesis-generating only.</p><p><strong>Conclusion: </strong>Higher UPF intake was associated with modestly increased OA risk in women; NMR signatures of inflammation and lipid metabolism provided exploratory biological context overlapping adiposity pathways.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"625773"},"PeriodicalIF":2.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, Regional, and National Burden of Acute Abdominal Conditions in Females-Appendicitis, Ectopic Pregnancy, Paralytic Ileus and Intestinal Obstruction, and Urolithiasis, 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021 with ARIMA Projections to 2030.","authors":"Xiaohui Dong, Zhijun Huang, Hui Li, Xiaojie Fu, Xiaoling Liang, Bin Xu","doi":"10.2147/IJWH.S620169","DOIUrl":"10.2147/IJWH.S620169","url":null,"abstract":"<p><strong>Background: </strong>Acute abdominal conditions--appendicitis, ectopic pregnancy, paralytic ileus and intestinal obstruction, and urolithiasis--are surgical emergencies carrying substantial risks of morbidity, mortality, and long-term disability. An integrated quantification of their collective burden may help identify shared vulnerabilities in global emergency surgical systems.</p><p><strong>Methods: </strong>Data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 were used to estimate incidence, prevalence, mortality, years lived with disability, and disability-adjusted life-years (DALYs) for the four conditions from 1990 to 2021 across 204 countries, 21 regions, and five Socio-demographic Index (SDI) quintiles. Temporal trends were quantified using the estimated annual percentage change, and Autoregressive Integrated Moving Average models projected key indicators to 2030. All analyses complied with GATHER guidelines.</p><p><strong>Results: </strong>In 2021, the combined age-standardised incidence rate was stable at 1,200 (95% UI 1,150-1,250) per 100,000 (EAPC -0.05%, 95% CI -0.10 to 0.00), while absolute cases rose by 85%, from 50 million in 1990 to 92 million in 2021. Age-standardised DALY rate declined (EAPC -1.2%, 95% CI -1.4 to -1.0) and global deaths fell by 20% (18-22%). Highest incidence rates occurred in Eastern Europe and Central Asia; the heaviest DALY burdens were in sub-Saharan Africa and South Asia. A bimodal age pattern was observed, peaking at 15-49 years (ectopic pregnancy, appendicitis) and ≥70 years (paralytic ileus and intestinal obstruction). Projections to 2030 indicate continued DALY declines for appendicitis, ectopic pregnancy, and paralytic ileus, whereas urolithiasis DALYs may oscillate or rise, particularly in middle- and high-SDI settings.</p><p><strong>Conclusion: </strong>The association between population growth and ageing and rising absolute case volumes suggests demographic shifts as a major driver of the escalating burden of acute abdominal conditions. Pronounced geographic and SDI-related disparities were observed alongside distinct age profiles across the four aetiologies, underscoring the need for context-specific planning of future emergency surgical and preventive care.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"620169"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Burden of Secondhand Smoke-Attributable ER-Negative Breast Cancer and Exploratory Immune-Metabolic Mediation Using Mendelian Randomization.","authors":"Defu Yang, Feng Shang, Xinying Ma, Haibo Zhang, Xue Ren, Xianqing Luan, Jianjing Wang, Ying Li, Tong Wu, Dongyang Lv, Ying Yan, Jing Liu, Ying Xu","doi":"10.2147/IJWH.S612541","DOIUrl":"10.2147/IJWH.S612541","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global burden of breast cancer attributable to secondhand smoke (SHS) and its potential biological pathways, particularly for estrogen receptor (ER)-negative disease, remain incompletely characterized. This study aimed to evaluate temporal trends in SHS-attributable breast cancer burden and to explore whether immune and metabolic traits may represent candidate pathways linking SHS exposure with ER-negative breast cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed the Global Burden of Disease 1990-2021 data to estimate temporal trends in SHS-attributable breast cancer burden using Joinpoint regression, Bayesian age-period-cohort modeling, decomposition analysis, and autoregressive integrated moving average forecasting to 2050. Two-sample Mendelian randomization (MR) was performed using 36-38 single-nucleotide polymorphism instruments for exposure to tobacco smoke outside the home. Exploratory two-step MR mediation analyses screened 637 serum metabolites and 731 immune phenotypes using the product-of-coefficients approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Globally, absolute SHS-attributable breast cancer deaths increased from 4,949 in 1990 to 7,518 in 2021, and disability-adjusted life years (DALYs) increased from 1.74×10&lt;sup&gt;5&lt;/sup&gt; to 2.57×10&lt;sup&gt;5&lt;/sup&gt;. In contrast, age-standardized death and DALY rates declined, with estimated annual percentage changes of -1.31% and -1.22% per year, respectively. Marked disparities were observed across Socio-Demographic Index regions. Projection analyses suggested a plateau around 2030, followed by widening uncertainty. Decomposition analysis indicated that population growth and population aging were major contributors to the increasing absolute burden. In MR analysis, genetically proxied SHS exposure outside the home showed a nominal positive association with ER-negative breast cancer in the inverse variance-weighted model (β = 0.9976; odds ratio = 2.71; 95% confidence interval = 1.08-6.82), although alternative MR estimators showed wider and less consistent estimates. Exploratory two-step MR identified lipid- and energy-related metabolites, including 10-nonadecenoate, eicosenoate, 3-hydroxybutyrate, and dihomo-linoleate 20:2n6, as candidate metabolic signals. A myeloid antigen-presentation phenotype, HLA-DR on CD33dim HLA-DR+ CD11b- cells, was also prioritized as a potential immune-related signal. However, the indirect-effect estimates were imprecise and should be interpreted as exploratory rather than confirmatory evidence of mediation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The age-standardized burden of SHS-attributable breast cancer has declined globally, whereas absolute deaths and DALYs have increased due to demographic growth and aging, with persistent SDI-linked disparities. MR analyses provided suggestive genetic-instrument evidence linking SHS exposure outside the home with ER-negative breast cancer, and exploratory mediation analyses prioritized lipid metabolism, ke","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"612541"},"PeriodicalIF":2.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Burden of Tuberculosis and Drug-Resistant Subtypes Among Women of Childbearing Age from 1990 to 2021, with Projections to 2030.","authors":"Jiawang Chen, Xiaozhen Peng, Yixiang Zheng, Ruochan Chen","doi":"10.2147/IJWH.S624782","DOIUrl":"10.2147/IJWH.S624782","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) poses a major threat to women of childbearing age (WCBA, 15-49 years), yet comprehensive global burden analyses remain limited. This study provides a comprehensive global spatiotemporal analysis of TB and drug-resistant subtypes among WCBA.</p><p><strong>Methods: </strong>Using Global Burden of Disease Study 2021 data, we assessed the global incidence and disability-adjusted life years (DALYs) of TB and drug-resistant subtypes among WCBA from 1990 to 2021, and projected trends to 2030 using Bayesian age-period-cohort models.</p><p><strong>Results: </strong>In 2021, an estimated 1.99 million WCBA developed TB globally. The age-standardized incidence rate (ASIR) and age-standardized DALY rate (ASDR) declined for overall TB and drug-susceptible TB (DS-TB), but increased for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). The large relative increases in XDR-TB should be interpreted cautiously because baseline estimates were very small and case definitions, testing capacity, and surveillance changed over time. The TB burden showed substantial geographic heterogeneity, with the highest age-standardized rates concentrated in Sub-Saharan Africa. Age-specific patterns showed higher ASIRs in younger populations, whereas ASDRs increased with age. Among the four GBD-attributable exposures included in the comparative analysis, high body-mass index had the largest modeled TB-related DALY rate in 2021. This restricted comparison should not be interpreted as ranking all established TB determinants. Projections suggest that overall TB incidence will decline, whereas the modeled XDR-TB ASIR may continue to rise through 2030 globally.</p><p><strong>Conclusion: </strong>Reducing TB among WCBA requires improved access to rapid diagnosis, drug susceptibility testing, effective DR-TB treatment, and risk-based TB screening within reproductive and antenatal care, particularly in low-SDI and high-burden settings. Pregnancy- and postpartum-specific surveillance should also be strengthened, as these populations are not separately identifiable in GBD 2021.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"624782"},"PeriodicalIF":2.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Disodium Etidronate on Bone Mineral Density in Postmenopausal Women: A Six-Month Prospective Study.","authors":"Weihan Kong, Li Wang, Huiyu Xue, Xin Feng","doi":"10.2147/IJWH.S586114","DOIUrl":"10.2147/IJWH.S586114","url":null,"abstract":"<p><strong>Background: </strong>Postmenopausal osteoporosis, characterized by rapid bone loss, raises fracture risk. Bisphosphonates are standard treatments. This study evaluates the 6-month efficacy of Disodium Etidronate, a first-generation bisphosphonate with a distinct mechanism, on bone mineral density (BMD) at the hip and lumbar spine in postmenopausal women, an area with limited data.</p><p><strong>Objective: </strong>This study aimed to assess the effect of a 6-month Disodium Etidronate course on BMD in postmenopausal women.</p><p><strong>Methods: </strong>A prospective cohort study enrolled 70 postmenopausal women. Participants received 60 mg of Disodium Etidronate orally once daily for six months. BMD at the femoral neck, trochanter, total hip, and lumbar spine (L1-L4) was measured via dual-energy X-ray absorptiometry (DXA) at baseline and post-treatment. Changes in BMD, site-specific differences, and influencing factors (age, BMI, calcium intake, exercise) were analyzed.</p><p><strong>Results: </strong>After treatment, BMD increased significantly at all sites (all P<0.001): femoral neck (0.70±0.15 to 0.75±0.13 g/cm²), trochanter (0.65±0.10 to 0.70±0.15 g/cm²), total hip (0.72±0.14 to 0.77±0.13 g/cm²), and lumbar spine L1-L4 (0.80±0.13 to 0.86±0.14 g/cm²). The lumbar spine increase exceeded the trochanter's (P=0.023). Age negatively correlated with BMD improvement (β=-0.25, P=0.001), while BMI (β=0.18, P=0.012), calcium intake (β=0.12, P=0.035), and exercise (β=0.15, P=0.021) showed positive correlations. Adverse reactions were mild (10% incidence).</p><p><strong>Conclusion: </strong>A six-month Disodium Etidronate regimen effectively increases BMD in postmenopausal women, with greater efficacy in the lumbar spine. Efficacy is influenced by age, BMI, calcium intake, and exercise. The treatment demonstrates good safety and tolerability.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"586114"},"PeriodicalIF":2.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Cervical Cerclage Band Erosion into the Rectal Lumen Complicated by Recto-Uterine Fistula: A Case Report.","authors":"Ziqian Tang, Qunzhi Zhang, Qi Li, Desheng Qi, Huan Chen","doi":"10.2147/IJWH.S629738","DOIUrl":"10.2147/IJWH.S629738","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic abdominal cervical cerclage (LACC) is a well-established intervention for cervical insufficiency. Long-term complications involving delayed band migration and erosion into adjacent viscera are exceptionally rare; the most frequently reported site is the urinary bladder. To the best of our knowledge, complete erosion into the intestinal lumen has not been previously reported. This report describes a case of complete cerclage band erosion into the rectal lumen, later complicated by recto-uterine fistula formation, and highlights the associated diagnostic and management challenges.</p><p><strong>Case: </strong>A 44-year-old asymptomatic woman with prior LACC presented for elective band removal. Preoperative evaluation, including pelvic ultrasound, was unrevealing. During laparoscopy, two cerclage bands were found entirely within the rectal lumen, necessitating unplanned rectal repair and diverting transverse colostomy. Three months later, pre-colostomy reversal imaging revealed a recto-uterine fistula. A multidisciplinary team recommended delayed surgical repair; the patient opted for conservative management.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this case represents the first report of complete transmural erosion of an LACC band into the rectum with subsequent recto-uterine fistula formation. This case demonstrates that cerclage removal in patients with complex surgical histories warrants careful preoperative planning and multidisciplinary preparedness. Given the extreme rarity of this complication, the decision regarding elective cerclage removal should be individualized.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"629738"},"PeriodicalIF":2.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance of the Ki-67 Index with an Optimal Cut-off Value of 32.5% in Uterine Sarcoma and Uterine Carcinosarcoma: A Retrospective Cohort Study.","authors":"Piaopiao Ye, Fang Wang, Xinyue Dai, Xiaoli Hu, Yuanqiu Wang","doi":"10.2147/IJWH.S595101","DOIUrl":"10.2147/IJWH.S595101","url":null,"abstract":"<p><strong>Objective: </strong>Uterine sarcomas and uterine carcinosarcomas are rare heterogeneous malignancies with poor prognosis. Though carcinosarcomas have been pathologically reclassified as dedifferentiated endometrial carcinomas, their highly aggressive clinical behavior merits combined analysis with uterine sarcomas. This study aimed to investigate the prognostic value of Ki-67 proliferation index in major histologic subtypes and identify an optimal cut-off value for risk stratification.</p><p><strong>Materials and methods: </strong>We retrospectively enrolled 86 surgically treated primary uterine sarcoma and carcinosarcoma patients (2006-2019). Ki-67 labeling index was detected via immunohistochemistry. The optimal cut-off value for Ki-67 was determined using receiver operating characteristic (ROC) curve analysis. Overall survival (OS) and progression-free survival (PFS) were evaluated via Kaplan-Meier curves and Cox regression.</p><p><strong>Results: </strong>The optimal Ki-67 cut-off value was 32.5%. High Ki-67 expression (≥32.5%) was significantly associated with older age (P=0.001), postmenopausal status (P=0.002), and aggressive histological subtypes 0.760 (P<0.001). High Ki-67 group had worse 3-year PFS (18.5% vs 76.4%) (range, 22-73) and 3-year OS (25.5% vs 85.4%). Multivariate analysis confirmed high Ki-67 as an independent prognostic factor for poorer PFS and OS (P < 0.001). Larger tumor size (P < 0.001), postmenopausal status (PFS: P = 0.001; OS: P = 0.002), and high-risk histological type (P < 0.001) also remained significant. Notably, the 32.5% cut-off applies across major histological subtypes.</p><p><strong>Conclusion: </strong>Ki-67 index serves as an independent biomarker for uterine sarcoma and carcinosarcoma. The 32.5% cut-off effectively divide patients into low- and high-risk groups, with the latter demonstrating significantly inferior survival outcomes.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"595101"},"PeriodicalIF":2.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Prediction of Antepartum Depression Symptoms: A Prospective Cohort Study.","authors":"Hongyan Xie, Shengnan Cong, Shiqian Ni, Jingjing Han, Xiaoqing Sun, Rong Zhu, Tingting Zhang, Meng Yao Wang, Yaxuan Wu, Aixia Zhang","doi":"10.2147/IJWH.S599295","DOIUrl":"10.2147/IJWH.S599295","url":null,"abstract":"<p><strong>Background: </strong>Antepartum depression is a common mental health issue. This study aimed to develop a tool to predict antepartum depression risk and contribute to improving the screening rate of antepartum depression.</p><p><strong>Methods: </strong>This study used a prospective design, including a total of 1,701 mid-pregnancy women, who were followed up until late pregnancy. We comprehensively incorporate predictors from biological, psychological, demography, and obstetrics. Several machine learning algorithms (logistic regression, random forest, support vector machine and extreme gradient boosting) were used to predict antepartum depression. Predictive variables were screened using the least absolute shrinkage and selection operator (LASSO). The models were built based on 70% of the training set and evaluated on the remaining 30% test set using metrics such as accuracy, precision, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). We also ranked the importance of the variables.</p><p><strong>Results: </strong>LASSO was used to select the nine variables (out of a total of 42). The importance ranking of the nine variables is as follows: psychological resilience, rumination, stress, social support, body image satisfaction during pregnancy, preparation for neonatal parenting, low-density lipoprotein cholesterol, work status and relationship with parents. The logistic regression achieved 68% accuracy, 25.6% precision, 68.7% sensitivity, 68.4% specificity, 37.3% F1-score, and 76% AUC in the test set. The random forest achieved 66.1% accuracy, 24.1% precision, 68.5% sensitivity, 65.7% specificity, 35.6% F1-score, and 75.4% AUC in the test set. The support vector machine achieved 65.1% accuracy, 23% precision, 65.7% sensitivity, 65.1% specificity, 34.1% F1-score, and 70.1% AUC in the test set. The extreme gradient boosting achieved 86.8% accuracy, 57.8% precision, 15.7% sensitivity, 98.1% specificity, 24.7% F1-score, and 71.8% AUC in the test set.</p><p><strong>Conclusion: </strong>The antepartum depression risk prediction model developed in this study has moderate discriminative ability, which helps achieve early identification and classification management of risk, and provides a basis for targeted interventions.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"18 ","pages":"599295"},"PeriodicalIF":2.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}