During certain clinical situations, some parturients require instruments for operative vaginal delivery, and various designs of vacuum extractors may affect the fetal head. To investigate the biomechanical effects of divergent sizes of silicone rubber vacuum extractors, we employed finite element analysis in this study. First, we constructed computer models for different vacuum extractor sizes (diameters: 40 mm, 50 mm, 60 mm, and 70 mm), flat surface, hemispherical ball, and fetal head shape. A hemispherical ball was the main design for the vacuum extractor model, and the material used for the vacuum extractor was silicone rubber. Next, the settings of 1 mm vacuum extractor displacement and vacuum cap pressure of 60 cmHg were applied. The main observation markers of this study were the respective von Mises stresses on the vacuum extractor and skull by the reaction force on the fixed end. The concluded results revealed that vacuum extractors with larger diameters lead to greater reaction force, stress, and strain on fetal heads. Therefore, this study’s biomechanical analytic consequences suggest that clinicians avoid selecting larger vacuum extractors during operative instrumental delivery so that fetal heads will experience less external force, deformation, and resultant complications. It could also provide a practical reference for obstetricians for instrumental vaginal delivery with the vacuum extractor made of silicone rubber.

Background: Premature ovarian insufficiency (POI) is characterized by granulosa cell (GC) dysfunction, reduced steroidogenesis, and hypoestrogenism, often secondary to chemotherapy. Despite advancements in regenerative medicine, cell-free nanotherapies remain underexplored for POI treatment. Purpose: This study investigates the therapeutic efficacy of primed avian mesenchymal stem cell-derived small extracellular vesicles (primed AMSC-sEVs) in a cyclophosphamide (CTX)-induced GC injury model, mimicking POI-associated hormonal dysfunction. Methods: Primed AMSC-sEVs were characterized in terms of particle size, concentration, and zeta potential using the Exoid TRPS and electrophoretic mobility platforms. Functional comparisons between primed and naïve AMSC-sEVs were conducted in human granulosa cells (hGCs), evaluating cell viability, apoptosis, steroidogenesis, and ovarian function-associated gene expression. miRNA content was assessed by next-generation sequencing and qRT-PCR. Results: Primed AMSC-sEVs displayed a smaller, more uniform size distribution, significantly enhanced particle concentration, and greater negative zeta potential (mean − 24.4 mV vs − 13.3 mV), suggesting improved colloidal stability. In vitro, primed sEVs dose-dependently enhanced hGC proliferation, restored CTX-induced suppression of AMH, FSHR, and LHCGR, and elevated estradiol and progesterone levels. Apoptotic markers (cleaved Caspase-3, BAX, PARP) were reduced, while BCL-2 was upregulated. Key miRNAs involved in steroidogenic and apoptotic regulation (miR-21, miR-22, miR-23b, miR-145, miR-199a) were enriched in primed sEVs. Conclusion: Primed AMSC-sEVs offer a promising nanotherapeutic strategy to restore ovarian cell function in POI-like conditions via enhanced anti-apoptotic and steroidogenic effects. These findings support the translational potential of Primed sEVs for fertility preservation and the management of menopausal hormone deficiency, including early-stage ovarian insufficiency and genitourinary syndrome of menopause.

Background: Patients with recurrent ovarian cancer often face difficulty choosing treatment such as chemotherapy or targeted therapy. Aim: This study aimed to design this patient decision aid (PDA), which presents therapeutic efficacy and cost to help patients make appropriate and personalized treatment decisions. Methods: A PDA was developed according to the International PDA Standards (IPDAS), and α and β tests were conducted on 14 healthcare professionals and 10 public representatives as test participants. Results: Using a Likert scale, the public representatives gave positive comments about the advantages and disadvantages of the PDA’s fair presentation of treatment choices and promotion of doctor–patient shared decision-making (SDM) (average score, 3.7–4.5 points). Similarly, the healthcare professionals were optimistic that this PDA could help patients more easily understand their choices (average score, 4.3–4.4 points). The average anxiety level before and after PDA use decreased from 7.5–5 points (scale, 1–10). Conclusion: According to this newly developed PDA, doctors and the public play a pivotal role: the latest medical literature and treatment options are kept up with, and the most correct and updated information is provided for use by doctors and patients. Therefore, the PDA design’s original intention and purpose were fulfilled.

Background: Acute viral hepatitis is the most common cause of jaundice during pregnancy. Distinct immunological changes during pregnancy and the postpartum period are possible crucial factors associated with flares of chronic hepatitis B. Case: We present the case of a healthy pregnant hepatitis B virus (HBV) carrier at 38 weeks of gestation. She underwent an emergent cesarean section due to acute hepatitis B flare, and ultimately underwent liver transplantation due to a decompensating liver based on an estimated Model for End-Stage Liver Disease score. Conclusions: For pregnant HBsAg positive women, close monitoring with serum HBV-DNA and spartate transaminase (AST)/alanine transaminase (ALT) levels every 3 months is highly recommended. According to the latest guidelines, prenatal antiviral therapy, postpartum HBV vaccination, and hepatitis B immunoglobulin should be administered to prevent mother-to-child transmission.

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems worldwide. As a result, remote areas such as the Penghu Islands have encountered unique challenges related to pediatric care. This study examined the effects of the pandemic on the emergency air medical transport (EAMT) of pediatric patients from the Penghu Islands to Taiwan. Materials and Methods: This retrospective study analyzed 40 pediatric patients who received EAMT from the Penghu Islands to Taiwan between January 2017 and December 2022. This study compared patients before and during the COVID-19 pandemic and focused on patient demographics, reasons for EAMT, and clinical outcomes. Due to the small sample size, non-parametric statistical methods were applied, including the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Results: Among the 40 pediatric patients analyzed, the median age decreased from 3 years (IQR, 0–5 years) before the pandemic to 1 year (IQR, 0–5 years) during the pandemic. While the overall increase in hospital length of stay during the pandemic was not statistically significant, a significant prolongation was observed in preschool-aged children and neonates without trauma (20 days vs. 9 days; p < 0.05). The lack of specialist physicians became an increasingly prominent factor for EAMT during the pandemic (p = 0.056). The most common medical reasons for EAMT were critical illness (35%), neonatal diseases (30%), and neurological conditions (27.5%), with similar distributions across both time periods. Conclusions: The COVID-19 pandemic heightened existing healthcare disparities in the Penghu Islands, particularly by increasing reliance on EAMT due to a shortage of pediatric specialists. Hospital stays for preschool children and neonates significantly increased during the pandemic, suggesting delayed or prolonged care. These findings underscore the need to strengthen local pediatric infrastructure, decentralize specialist services, and improve emergency preparedness to better support vulnerable populations in remote areas during future public health emergencies.