Keloids are abnormal fibroproliferative responses in the skin that often occur without an apparent injury. Their pathogenesis remains incompletely understood, though genetic, environmental, and biochemical factors are believed to contribute. Topical medications (mostly TCA injection) are the most used treatments followed by surgery, alone or in association with other therapeutic options. In most cases, improvement has been described. A combination of altered collagen synthesis, overactive fibroblasts, and immune response contributes to keloid formation. Genomic studies have identified specific mutations, and the role of growth factors such as TGF-β has been confirmed as a key player in keloid pathogenesis. Although great improvements have been made from the molecular point of view and keloids are more easily diagnosed and treatable nowadays, they remain very challenging, having a great impact on quality of life. Their recurrence is still very high. Understanding genetic predisposition and microenvironmental influences is critical for developing more effective therapies. Advances in molecular research and clinical strategies are improving our understanding of keloids, but further studies are needed to establish precise diagnostic markers and more effective long-term treatments.

Objective: This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery. Data sources: MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024. Study eligibility criteria: We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery. Study appraisal and synthesis methods: Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months. Results: A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = − 0.02 (− 0.06, 0.02); I ² = 81%, p < 0.01), and six months (RD = − 0.11, CI − 0.15, − 0.07, I² = 91%, p < 0.01). Conclusions: Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure. Systematic review registration: PROSPERO, Unique identifier: CRD42024552495.

Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for “gender assignment”, such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.

Objective: Preventive strategies for bacterial vaginosis (BV) include sexual partner treatment, short-term consolidation therapy, and long-term maintenance interventions. This systematic review and network meta-analysis (NMA) compares the efficacy of these approaches and evaluates effect modification by baseline recurrence risk. Patients and Methods: Randomized-controlled trials (from inception to January 31, 2026) evaluating interventions to prevent BV recurrence in nonpregnant women were categorized into 3 analyses: partner treatment (pairwise meta-analysis), consolidation therapy, and long-term prevention (random-effects NMA). Certainty of evidence was evaluated using GRADE and CINeMA. Results: Partner treatment significantly reduced BV recurrence rates [incident rate ratio (IRR) =0.76, 95% CI=0.60–0.98; moderate-certainty evidence] compared with placebo/no treatment. In consolidation therapy, acidifying agents [risk ratio (RR)=0.22, 95% CI=0.08–0.62; moderate-certainty evidence], vaginal probiotics (RR=0.37, 95% CI=0.15–0.93; moderate-certainty evidence), and oral probiotics (RR=0.45, 95% CI=0.21–0.96; low-certainty evidence) reduced early recurrence or persistence compared with placebo. In long-term prevention, vaginal probiotics were the only intervention achieving statistical significance overall (IRR=0.74, 95% CI=0.58–0.96; moderate-certainty evidence). Among women at low baseline risk, oral probiotics (IRR = 0.49, 95% CI=0.28–0.85) and acidifying agents (IRR=0.48, 95% CI=0.24–0.96) were most effective. Among women at high baseline risk, vaginal probiotics (IRR=0.70, 95% CI=0.52–0.93) and intermittent antibiotic suppression (IRR=0.39, 95% CI=0.21–0.73) showed the greatest reduction in recurrence. Conclusions: Partner treatment, consolidation with probiotics or acidifying agents, and long-term vaginal probiotic maintenance reduce BV recurrence. Vaginal Lactobacillus preparations and acidifying agents represent the most evidence-supported nonantibiotic approaches for recurrence prevention.