Women's Hospital

Background: Digital approaches to preconception care (PCC) may help increase reproductive health awareness among women of reproductive age. This pilot study evaluated the usability, acceptability, and perceived impact of a digital PCC tool delivered during workplace health checkups in Japan.Methods: A quick response (QR) code linking to a digital PCC tool was distributed during routine workplace health checkups for women aged 18-40 years. Participants completed a questionnaire assessing perceived usefulness, ease of understanding, relevance to personal health, intention to seek medical consultation, and understanding of PCC. Because not all participants answered every item, denominators varied across outcomes. Age-group differences were examined using chi-square tests.Results: A total of 277 participants completed at least one questionnaire item and were included in the analysis. Perceived usefulness was high overall (92.8%) with a significant age-group difference (p = 0.001). Ease of understanding also showed a significant difference, with lower ratings in the 35-40 years group (p < 0.001). No significant age-group differences were observed for relevance to personal health (p = 0.795), intention to seek consultation (p = 0.748), or understanding of PCC (p = 0.444). PCC understanding remained high across all age groups (93.8%).Conclusions: The digital PCC tool was well accepted by women of reproductive age in a workplace setting. Although usefulness and ease of understanding varied by age, other outcomes were consistent across age groups. Further research with larger samples and longitudinal designs is needed to determine whether digital PCC tools influence real-world healthcare engagement.

Abstract Study question Can the cyclophosphamide equivalent dose (CED) given to young boys be used to predict future infertility? Summary answer Our data suggests that CED alone is not a good predictor of subsequent infertility. What is known already Currently young males are referred for fertility preservation based on the estimation of risk of infertility after gonadotoxic treatment utilizing the calculation of the cyclophosphamide equivalent dosage (CED). It has been generally assumed that, in young males, a CED of 3-4 g/m2 results in a risk level of 50 to 80% for future infertility and that ≥ 6 g/m2 results in a higher risk of infertility. However, data regarding the relative CED and subsequent adult recovery of spermatogenesis for these males is sparse. Study design, size, duration Testicular Tissue Cryopreservation (TTC) is offered at our centre1 to families of young boys with childhood cancer or immunologic disorders who will receive gonadotoxic treatment with &amp;gt;3 g/ m2 CED. A number of these boys are now adults and our aim was to assess the impact of this chemotherapy on their subsequent fertility as assessed by the presence of sperm in ejaculates. Participants/materials, setting, methods TTC has been performed for prepubertal or peripubertal boys (total =255), of whom 67 are now aged ≥ 18 years. 23 adult males have returned to produce a semen sample. Semen was provided a minimum of 5 years after cessation of treatment in all cases. Data is available for 11 boys who had testicular tissue frozen at age ≤13 years and 12 who had sperm observed during dissection of tissue (age 13-18 years). Main results and the role of chance In those who were pre /peri pubertal at the time of TTC, 9/11 adult males had some viable sperm and 5/11 had a normal density (&amp;gt;20 million/ml). The lowest CED at which no sperm were detected was 6.5 g/m2. However, 2 adult males had recovery to normal density following high CED (14 and 16 g/m2). In adult males who had some sperm frozen during TTC as post pubertal males, 10/12 had some viable sperm and 4/12 had normal densities. The lowest CED at which there were no sperm detected was 12 g/m2 but recovery to normal range also took place following 12 g/m2 in 1 male. The results showed wide variability in sperm density with CED, with a trend to lower sperm density at higher CED, and a rapid decline in sperm density at around 4 g/m2 CED in both groups. Limitations, reasons for caution The number of males who have returned to produce a semen sample for evaluation is low and needs to be increased to draw more reliable conclusions. Wider implications of the findings Discussion regarding chemotherapy related future infertility should be had with all parents / boys having a CED &amp;gt; 4 g/m2 and options provided to preserve testicular tissue and /or sperm. Reference: 1. Ho et al., (2017) Clinical Endocrinology. 87(3): p. 279-285 Trial registration number No

INTRODUCTION: Uterine fibroids, associated with pelvic pain, abnormal bleeding, and infertility, occur in over 50% of women. Although both are minimally invasive procedures, robotic procedures have been emphasized over MINI in training programs. Prior studies favor ROBA from a safety aspect; however, few studies have compared this to same-day mini-laparotomy myomectomies. This study sought to determine the safety and costs of MINI versus ROBA. METHODS: Patients who underwent MINI (n=98) at an outpatient surgery center were compared to 89 patients who underwent ROBA myomectomies. All patients had a same-day discharge. We compared mean estimated blood loss, mean operative times, and rate of complications (transfusions, organ injury, readmission). We extrapolated costs using existing literature and local information. Cost estimates included preoperative care, operating room (OR), recovery room, physician, and supply costs. RESULTS: MINI was associated with decreased operative time (97.5 minutes versus 181 minutes with ROBA), decreased time to discharge (210 minutes versus 481 minutes), fewer complications (one transfusion required for MINI, two transfusions for ROBA), and lower associated costs ($4,937 for MINI versus $7,299 with ROBA). There was a nonsignificant increase in estimated blood loss with MINI compared to ROBA. CONCLUSIONS/IMPLICATIONS: MINI myomectomies are a cost-effective, safe alternative to ROBA myomectomies. Using standard OR equipment and traditional surgical skills, MINI had shorter OR times and times to discharge at significantly reduced costs. With the large shift toward ROBA surgeries in recent years, this study determined that MINI remains a safe, cost-effective option for our patients.

Advancements in early detection and multimodal treatment strategies have significantly improved survival rates for early-stage breast cancer, now exceeding 80% at 10 years. However, breast cancer survivors (BCS) often experience persistent physical, psychological, and social challenges as direct consequences of cancer and its treatment. Effective survivorship care requires a proactive, multidisciplinary, and team-based approach to address these burdens comprehensively. Despite growing recognition of the complex needs of BCS, a persistent gap remains between symptom burden, supportive care needs, and actual care delivery. This disparity underscores the urgent need to innovate and optimize survivorship care models. This article explores the most prevalent symptoms and concerns experienced by BCS, particularly those arising from systemic and local therapies during post-treatment follow-up phase, and outlines evidence-based strategies for their management. Additionally, it examines the role of technology as a promising enabler in enhancing the quality, efficiency, accessibility, and patient-centeredness of survivorship care. By integrating multidisciplinary, proactive symptom management with digital health tools and innovative care approaches, health care systems can be equipped to better support BCS, ultimately improving their long-term health outcomes and quality of life.

Abstract Introduction Chronotype refers to an individual’s typical or preferred timing of behaviors throughout the day. A later chronotype has been associated with emotional dysregulation, psychological disturbances, and unhealthy foods, although these findings are still controversial and inconclusive. Therefore, we conducted this systematic review and meta-analysis to investigate the association between chronotype and disordered eating behaviors among the general population. Methods Online databases, including PubMed, Scopus, and ISI Web of Science, were searched. We used the PECOS framework as follows: Population (general population), Exposure (individuals with later chronotype), Comparison (individuals with earlier chronotype), Outcome (disordered eating behaviors), and Study design (observational studies). We enrolled 36 studies comprising 28,352 participants with a mean age and BMI ranging from 14.1-52.6 years and 19.83-34.54 kg/m2, respectively. Results Later chronotype (i.e., a lower MEQ score) was associated with a higher binge-eating behavior score (Correlation coefficient [r]: -0.39; 95% CI, -0.43, -0.35; P &amp;lt; 0.001; I2 = 94.38 %), higher disordered eating attitude score (r: -0.17; 95% CI, -0.20, -0.13; P &amp;lt; 0.001; I2 = 95.45 %), higher emotional eating score (r: -0.06; 95% CI, -0.11, -0.02; P = 0.010; I2 = 56.97 %), higher uncontrolled eating score (r: -0.14; 95% CI, -0.22, -0.06; P &amp;lt; 0.001; I2 = 77.01 %), higher food addiction score (r: -0.17; 95% CI, -0.23, -0.11; P &amp;lt; 0.001; I2 = 80.19 %), higher food craving score (r: -0.09; 95% CI, -0.12, -0.06; P &amp;lt; 0.001; I2 = 69.97 %), higher food-related disinhibition score (r: -0.11; 95% CI, -0.14, -0.08; P &amp;lt; 0.001; I2 = 76.85 %), and higher night-eating syndrome score (r: -0.19; 95% CI, -0.28, -0.10; P &amp;lt; 0.001; I2 = 80.26 %); as well as a lower restrained eating score (r: 0.11; 95% CI, 0.06, 0.15; P &amp;lt; 0.001; I2 = 7.01 %). Conclusion Our findings highlight an association between late chronotype and increased disordered eating behaviors; however, we need more longitudinal and intervention studies to test causality and underlying mechanisms. Support (if any) A.A. was partially supported by NIH grant R01-HL167746; F.A.J.L.S. by NIH grants R01-HL140574, R01-HL153969, R01-HL164454, and R01-HL167746.

Breast cancer is a leading cause of cancer-related mortality worldwide, and neoadjuvant chemotherapy (NAC) plays a pivotal role in its management by reducing tumor size, enabling breast-conserving surgery, and improving survival outcomes. Achieving pathologic complete response (pCR) is strongly associated with better overall survival (OS) and disease-free survival (DFS), particularly in aggressive subtypes such as triple-negative (TNBC) and HER2-positive breast cancers. This systematic review and meta-analysis evaluated the correlation between pCR, OS, and DFS in breast cancer patients treated with NAC, focusing exclusively on real-world data (RWD). A comprehensive search with PRISMA guidelines of major databases from 1999 to 2024 identified 22 retrospective studies comprising 12,115 patients. Hazard ratios (HRs) and confidence intervals (CIs) were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic. pCR was achieved in 20.9 % of patients, with higher rates in HER2-positive (44.4 %) and TNBC (31.3 %) subtypes. Achieving pCR was associated with a 30 % improvement in OS (HR: 1.30; 95 % CI: 1.28–1.33) and a 29 % improvement in DFS (HR: 1.29; 95 % CI: 1.24–1.32). Among TNBC patients, pCR correlated with a 51 % increase in DFS (HR: 1.51; 95 % CI: 1.19–1.93). Significant heterogeneity (I2 = 96 %) was observed across studies. These findings highlight the importance of pCR as a robust predictor of improved survival outcomes in breast cancer, particularly in TNBC and HER2-positive subtypes, and underscore the need for strategies to increase pCR rates to enhance long-term survival and disease control.

Abstract Background 5′-Nucleotidase Domain Containing 2 (NT5DC2), a cNT5-II family member catalyzing nucleotide hydrolysis, plays a crucial role in tumor initiation and progression. This study aims to elucidate NT5DC2’s potential role in multiple cancers and confirm its oncogenic significance in triple-negative breast cancer (TNBC). Methods Multiple databases analyzed NT5DC2 expression patterns and assessed its diagnostic and prognostic value in cancers. Immune correlation analyses were conducted using ESTIMATE and CIBERSORT. KEGG pathway enrichment analysis explored NT5DC2-associated molecular pathways. To further investigate its role in TNBC, comprehensive bioinformatics analyses, including gene expression profiling, single-cell RNA sequencing analysis, immune infiltration assessment, and gene set enrichment analysis (GSEA). Finally, in vitro experiments were conducted to validate NT5DC2’s oncogenic role in TNBC. Results Our findings indicate that high NT5DC2 expression is associated with poor prognosis and holds significant clinical diagnostic value across multiple cancer types. NT5DC2 is highly expressed in TNBC and correlates with unfavorable outcomes. Single-cell RNA sequencing analysis reveals that NT5DC2 is predominantly expressed in epithelial cells, where it regulates immune cells through the MIF signaling pathway. Enrichment and immune infiltration analyses indicate that NT5DC2 is closely linked to an immunosuppressive tumor microenvironment. In vitro experiments demonstrate that NT5DC2 knockdown significantly inhibits TNBC cell growth, underscoring its potential as a therapeutic target. Conclusion Our study demonstrates that NT5DC2 functions as an oncogene in multiple cancer types. It holds considerable clinical diagnostic significance and is intricately linked to an immunosuppressive tumor microenvironment, particularly in TNBC.

In recent years, initiation techniques for neuraxial labor analgesia have focused on enhancing analgesic quality while minimizing complications. This review aims to summarize recent evidence on the standard epidural (EPL), combined spinal-epidural (CSE), and dural puncture epidural (DPE) techniques, emphasizing their benefits, risks, and relevance in contemporary obstetric anesthesia care. The DPE technique offers unique values, combining the advantages from CSE and EPL techniques. DPE and CSE, compared with EPL, techniques involve a dural puncture with a spinal needle, and the resulting epidural-intrathecal conduit enables translocation of analgesic agents, providing faster onset, earlier sacral coverage, better catheter function, and more rapid epidural extension to surgical anesthesia. Moreover, by limiting the intrathecal dose administered with the CSE technique, the DPE technique lowers the risks of fetal bradycardia and pruritus. EPL and CSE techniques are widely used for neuraxial labor analgesia. The DPE technique offers a novel alternative, delivering high-quality analgesia with minimal complications. While the benefits of the DPE technique are increasingly being recognized, additional comparative research will better support anesthesiologists in selecting the most appropriate technique across diverse clinical scenarios.