This prospective study investigated the association between elevated neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein (CRP), procalcitonin, and tumor necrosis factor-alpha (TNF-alpha) and the risk of developing neurological complications in mechanically ventilated neonates. The aim was to evaluate these biomarkers’ predictive value for neurological complications. Within a one-year period from January to December 2022, this research encompassed neonates born at ≥35 weeks of gestational age who required mechanical ventilation in the neonatal intensive care unit (NICU) from the first day of life. Biomarkers were measured within the first 24 h and at 72 h. Sensitivity, specificity, and area under the curve (AUC) values were calculated for each biomarker to establish the best cutoff values for predicting neurological complications. The final analysis included a total of 85 newborns, of which 26 developed neurological complications and 59 without such complications. Among the studied biomarkers, TNF-alpha at >12.8 pg/mL in the first 24 h demonstrated the highest predictive value for neurological complications, with a sensitivity of 82%, specificity of 69%, and the highest AUC (0.574, p = 0.005). At 72 h, TNF-alpha levels greater than 14.3 pg/mL showed further increased predictive accuracy (sensitivity of 87%, specificity of 72%, AUC of 0.593, p < 0.001). The NMR also emerged as a significant predictor, with a cutoff value of >5.3 yielding a sensitivity of 78% and specificity of 67% (AUC of 0.562, p = 0.029) at 24 h, and a cutoff of >6.1 showing a sensitivity of 76% and specificity of 68% (AUC of 0.567, p = 0.025) at 72 h. Conversely, CRP and procalcitonin showed limited predictive value at both time points. This study identifies TNF-alpha and NMR as robust early predictors of neurological complications in mechanically ventilated neonates, underscoring their potential utility in guiding early intervention strategies. These findings highlight the importance of incorporating specific biomarker monitoring in the clinical management of at-risk neonates to mitigate the incidence of neurological complications.

This study investigates the differential expression of miRNA gene subtypes in tumoral versus benign nevi in individuals with melanoma, aiming to identify clinically significant correlations that could serve as reliable markers for assessing tumor stage and progression. Conducted between 2019 and 2022, this descriptive, quantitative observational research analyzed 90 formalin-fixed paraffin-embedded (FFPE) samples from the Pius Brinzeu County Emergency Clinical Hospital, Timisoara, including 45 samples of advanced-stage melanoma and 45 samples of pigmented nevi. miRNA purification and analysis were performed using the miRNeasy Kit and the Human Cancer PathwayFinder miScript miRNA PCR Array, with statistical analysis (including logistic regression) to determine associations with cancer staging, such as high Breslow index risk, number of mitoses, and vascular invasion. After the analysis and comparison of 180 miRNA gene subtypes, we selected 10 of the most upregulated and 10 most downregulated genes. The results revealed that hsa-miR-133b, hsa-miR-335-5p, hsa-miR-200a-3p, and hsa-miR-885-5p were significantly upregulated in melanoma samples, with fold changes ranging from 1.09 to 1.12. Conversely, hsa-miR-451a and hsa-miR-29b-3p showed notable downregulation in melanoma, with fold changes of 0.90 and 0.92, respectively. Additionally, logistic regression analysis identified hsa-miR-29b-3p (OR = 2.51) and hsa-miR-200a-3p (OR = 2.10) as significantly associated with an increased risk of a high Breslow index, while hsa-miR-127-3p and hsa-miR-451a were associated with a reduced risk. Conclusively, this study underscores the significant alterations in miRNA expression in melanoma compared to benign nevi and highlights the potential of specific miRNAs as biomarkers for melanoma progression. The identification of miRNAs with significant associations to melanoma characteristics suggests their utility in developing non-invasive, cost-effective diagnostic tools and in guiding therapeutic decisions, potentially improving patient outcomes in melanoma management.

This study aimed to investigate the impact of early erythropoietin (EPO) administration on the neurodevelopment of newborns, specifically focusing on its effects on hypoxic-ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH). The primary objective was to determine whether early EPO administration could impact the short-term neurodevelopmental outcomes and provide safety in neonates at risk for neurodevelopmental disorders. Conducted at the “Louis Turcanu” Children’s Emergency Clinical Hospital in Timisoara, Romania, this observational study included 121 neonates receiving EPO and 130 No EPO controls. EPO was administered within the first 48 h of life, with doses of 1000 U/kg that escalated to 2000 U/kg if necessary. Besides observing the occurrence of IVH and HIE, this study measured clinical and biochemical markers, including LDH, blood glucose, urea, creatinine, CPK, CRP, PCT, and erythropoietin levels alongside hematology and coagulation profiles. There were no significant differences in baseline characteristics between the groups. The EPO group showed significant reductions in LDH levels from days 1–3 to 7–10 (695.0 U/L to 442.0 U/L) and the APTT value (54.0 s) compared with the No EPO group (38.0 s). Notably, early EPO administration was associated with a significant decrease in HIE severity (beta coefficient: −0.38, p = 0.001). Additionally, lower gestational ages and hemoglobin levels correlated with increased severity of HIE. By week four, there was a significant reduction in moderate and severe HIE cases in the EPO group compared with controls (p = 0.001). Early administration of EPO in neonates significantly reduced the severity of IVH and HIE, suggesting its potential as a neuroprotective agent in neonatal care.

Background and Objectives: Appendectomy is the most frequent non-obstetric emergency operation in pregnancy, yet its relationship with preterm birth (PTB) remains uncertain. We systematically reviewed studies assessing PTB after appendectomy during pregnancy, focusing on surgical approach and histopathology. Methods: Following a PRISMA-guided protocol, we searched PubMed, Scopus, and Web of Science to 1 October 2025 for studies reporting gestational-age outcomes after appendectomy in pregnancy. Eligible designs were cohort or case–control studies and case series ≥ 5 pregnancies. Data on technique, timing, pathology, and PTB were extracted and synthesized narratively; meta-analysis was not performed because of heterogeneity. Results: Six studies including over one thousand pregnancies with appendectomy and over one million comparators were identified. In the largest registry study, appendectomy was associated with increased PTB risk (adjusted hazard ratio [aHR] 1.73, 95% CI 1.42–2.09), with a stronger association for planned than spontaneous PTB. A matched cohort reported PTB in 11.9% of operated women versus 5.4% of controls and a higher PTB rate after negative appendectomy (20.5% vs. 9.2% with inflamed appendices). In a single-center series, PTB occurred in 24.4% after open but 0% after laparoscopic appendectomy. Across studies, crude PTB rates after appendectomy ranged from 4.5% to 24.4%. Three of five studies reporting effect estimates found significantly elevated PTB risk, whereas two smaller cohorts showed null or imprecise associations. Conclusions: Current evidence suggests that appendectomy in pregnancy is associated with increased PTB risk, particularly after negative or late-gestation open procedures, supporting careful diagnostic work-up, preference for laparoscopy when feasible, and close obstetric follow-up.

Background and Objectives: Ovarian cancer remains the most lethal gynecologic malignancy, largely due to late diagnosis and the limitations of currently available diagnostic tools. Systemic inflammatory markers derived from routine blood tests have emerged as potential low-cost biomarkers, reflecting the interaction between tumor biology and the host immune response. This study aimed to evaluate the association and diagnostic value of preoperative inflammatory markers in distinguishing malignant from non-malignant ovarian tumors. Materials and Methods: This retrospective, single-center observational study included 780 adult female patients diagnosed with ovarian tumors and treated surgically between January 2020 and December 2025. Preoperative hematological parameters were obtained from complete blood count analyses performed before any therapeutic intervention. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. Comparisons were performed among benign, borderline, and malignant tumors. To avoid collinearity between mathematically interrelated inflammatory indices, three separate multivariable logistic regression models were constructed, each including age, CA-125, and one inflammatory index. Diagnostic performance of the individual inflammatory indices was assessed using receiver operating characteristic (ROC) curve analysis. Results: Patients with malignant tumors were significantly older and exhibited higher NLR and PLR values and lower LMR values than patients with non-malignant tumors (all p < 0.001). In separate multivariable models adjusted for age and CA-125, higher NLR (OR = 1.79, 95% CI: 1.41–2.27, p < 0.001) and PLR (OR = 1.43, 95% CI: 1.17–1.75, p = 0.001) remained significantly associated with malignant ovarian tumors, whereas higher LMR was inversely associated with malignancy (OR = 0.66, 95% CI: 0.52–0.85, p = 0.001). ROC analysis demonstrated moderate discriminative ability for NLR and PLR (AUC = 0.72 for both), whereas LMR showed lower discriminative performance (AUC = 0.64). Conclusions: Preoperative systemic inflammatory indices are significantly associated with ovarian tumor malignancy. NLR and PLR were positively associated with malignant disease, whereas LMR showed an inverse association, and these relationships remained significant after adjustment for age and CA-125. However, their individual discriminative performance was modest, suggesting that these readily available inflammatory indices should be considered complementary rather than standalone biomarkers for preoperative risk assessment.

Background and Objectives: Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes. Methods: We investigated a single-center prospective cohort (March 2023–December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge. Results: Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001). Conclusions: Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge.