Background: Intrauterine adhesions (IUAs) or Asherman syndrome (AS) represent pathological conditions that affect the endometrium and significantly influence female fertility through a variety of mechanisms. This study aims to identify risk factors, explore pathophysiological mechanisms, diagnostic approaches, and assess how medical background influence the development of these conditions. It also seeks to associate the severity of conditions with clinical outcomes, such as fertility, miscarriages, and menstrual cycle disorders, using American Fertility Society (AFS) scoring system. Materials and methods: This retrospective cohort study included 134 patients aged 18 to 45, who followed hysteroscopy between 2016 and 2024 at two hospitals in Iasi, focusing on those diagnosed with IUAs (102 patients) and AS (32 patients), based on hysteroscopic approach. The exclusions were based of factors like acute uterine bleeding, intrauterine device, obesity and other severe conditions. Results and discussions: Women over 35 years are more likely to develop these conditions due to prior gynaecological procedures which are often associated with fertility issues. Hysteroscopy is established as the gold standard for both diagnosis and treatment, intraoperative diagnosis representing 45.6 % of cases. Amenorrhea is a primary indicator in AS patients (OR = 26.19) and dysmenorrhea as a potential marker for IUAs (OR = 2.67). Patients with IUAs and primary infertility (82.9%) typically have an AFS score 1, corresponding to improved conception rates. Those with AS and primary infertility often present an AFS score 2 (54.5%); patients with AS and secondary infertility were linked to AFS score 3 (58.8%; p = 0.137). Although the incidence of miscarriages is comparable between the two groups, the timing differs: IUAs are predominantly associated with first trimester losses (64.9%), whereas AS is more commonly linked to second trimester miscarriages (45.5%; p = 0.001). Conclusions: The study highlights the necessity of a personalized approach in diagnosing and treating IUAs and AS, considering factors such as age, fertility index, and disease severity. The integration of hysteroscopic techniques with individualized treatment plans based on the patient’s unique medical profile is crucial for adequate management of IUAs and AS.

Background: Ultrasonography is essential for diagnosing endometrial pathologies, such as hyperplasia, polyps, and endometrial cancer. The International Endometrial Tumor Analysis (IETA) group provides guidelines for using ultrasound to assess endometrial thickness, texture, and irregularities, aiding in the diagnosis of these conditions. The aim of this study was to evaluate the utility of various endometrial morphological features, as assessed by gray-scale ultrasound, and endometrial vascular features, as assessed by power Doppler ultrasound, in differentiating benign and malignant endometrial pathologies. A secondary objective was to compare the effectiveness of these ultrasound techniques in assessing myometrial invasion. Methods: A total of 162 women, both pre- and postmenopausal, with or without abnormal vaginal bleeding were enrolled in a prospective study. All participants underwent transvaginal gray-scale and color Doppler ultrasound examinations, conducted by examiners with over 15 years of experience in gynecological ultrasonography. Endometrial morphology and vascularity characteristics were evaluated based on the IETA group criteria, which include parameters such as endometrial uniformity, echogenicity, the three-layer pattern, regularity of the endometrial–myometrial border, Doppler color score, and vascular pattern (single dominant vessel with or without branching, multiple vessels with focal or multifocal origin, scattered vessels, color splashes, and circular flow). Sonographic findings were compared with histopathological results for comprehensive assessment. Results: The mean age of the study population was 56.46 ± 10.84 years, with a range from 36 to 88 years. Approximately 53.08% of the subjects were postmenopausal. The mean endometrial thickness, as measured by transvaginal ultrasonography, was 18.02 ± 10.94 mm with a range of 5 to 64 mm (p = 0.028), and it was found to be a significant predictor of endometrial malignancy. The AUC for the ROC analysis was 0.682 (95% CI: 0.452–0.912), with a cut-off threshold of 26 mm, yielding a sensitivity of 62.5% and a specificity of 89%. Vascularization was absent in 68.4% of patients with polyps. Among the cases with submucosal myomas, 80% exhibited a circular flow pattern. Malignant lesions were identified in 22.84% of the cases. Subjective ultrasound assessment of myometrial invasion, categorized as <50% or ≥50%, corresponded in all cases with the histopathological evaluation, demonstrating the effectiveness of ultrasound in evaluating myometrial invasion in endometrial cancer. Conclusions: In this study, cystic atrophic endometrium was identified as the most prevalent cause of postmenopausal bleeding. The most significant ultrasound parameters for predicting malignancy included heterogeneous endometrial echogenicity, increased endometrial thickness, and the presence of multiple vessels with multifocal origins or scattered vascular patterns. Additionally, color Doppler blood flow mapping was demonstrated to be an effective diagnostic tool for the differential diagnosis of benign intrauterine focal lesions.

Neurodevelopment is a dynamic and multifactorial process, critical in the early stages of life, involving the formation of neural networks, the establishment of synapses, and the maturation of cognitive, social and emotional circuits. In this context, the gut microbiome emerges as an essential regulator of neurodevelopment, exerting influences through multiple biochemical and immunological mechanisms that define the “gut-brain axis”. The microbiota modulates neurodevelopment by regulating neurotransmitters (serotonin, dopamine, GABA), the production of microbial metabolites, including short-chain fatty acids, the modulation of inflammatory cytokines, and vagal signaling to the central nervous system. Recent evidence highlights the role of microbiota in modulating microglia, synaptogenesis, dendritic maturation, and neuronal plasticity, emphasizing how these processes are influenced by microbial activity rather than providing a comprehensive treatise on plasticity itself. Gut microbiota disturbances, or dysbiosis, have been associated with various neuropsychiatric and neurodevelopmental disorders, contributing to cognitive, behavioral, and emotional dysfunctions. This article summarizes, in a narrative manner, the main dysbiosis patterns identified in these disorders and the biological mechanisms by which the microbiome influences neuronal development and function, including immune–neuronal interactions, metabolomic modulation, and neuroendocrine signaling. Finally, emerging directions of intervention aimed at adjusting the microbial profile, such as dietary adjustment, the use of probiotics, prebiotics, symbiotics, and fecal microbiota transplantation, are presented with the aim of positively influencing neurodevelopment and preventing or ameliorating associated dysfunctions. This review emphasizes the need for longitudinal, rigorous, and controlled clinical trials to validate the efficacy of microbiota modulation strategies and to substantiate their integration into individualized pediatric management protocols.

Background: Childhood obesity has become a major public health concern worldwide. Increasing evidence suggests that alterations in the gut microbiome may play a significant role in the development and progression of pediatric obesity. This narrative review synthesizes and analyzes recent studies investigating microbiome alterations in children with obesity, highlighting emerging insights and their potential implications for disease management. Understanding the relationship between gut microbial composition and obesity may provide new perspectives for prevention and therapeutic strategies in overweight pediatric populations. This narrative review was conducted through a search of major biomedical databases, including PubMed and Web of Science, complemented by manual screening of reference lists of relevant articles. Key findings: Children affected by obesity exhibit significant changes in gut microbiome composition, characterized by reduced microbial diversity and predominance of the Firmicutes and Bacteroidetes phyla. The balance between these two bacterial groups appears critical for maintaining gut homeostasis. Studies consistently report an increased Firmicutes-to-Bacteroidetes ratio in children with elevated body weight, suggesting that disruption of this balance may contribute to metabolic dysregulation and obesity-related pathologies. Given the essential role of the gut microbiota in nutrient metabolism and energy extraction, dysbiosis in obesity is associated with enhanced energy harvest and lipid absorption. Certain bacterial populations may promote increased caloric uptake, thereby contributing to weight gain and adiposity. Multidimensional interventions, including dietary modification and physical activity, have demonstrated the potential to reduce obesogenic microbiota patterns and restore microbial diversity. Additionally, probiotic supplementation is being investigated as a strategy to reestablish microbial homeostasis and potentially support body mass index reduction. Despite promising findings, further research is required to clarify mechanisms, establish causality, and determine the clinical effectiveness of microbiome-targeted therapies before they can be fully integrated into the management of pediatric obesity.

Accurate lymph node staging is crucial for both prognosis (in the event of early-stage disease) and treatment (for local control of disease) in patients with breast cancer. Sentinel lymph node biopsy (SLNB) has been studied in numerous international trials, showing that it allows about 70% of axillary lymph node dissection (ALND) to be avoided and thus significantly reduces the morbidity associated with ALND. SLNB represents a necessary step in the diagnostic algorithm for breast neoplasms because the surgical treatment for breast cancer has become progressively less invasive. We present a case of a 70-year-old woman with multicentric breast cancer (MBC) treated by surgery at “Cuza Vodă” Women’s University Hospital, Iassy, Romania. In this case, only the ultrasonography established the diagnosis of left MBC with certainty. Conclusion: The detection of sentinel lymph nodes (SLNs) for MBC must be indicated. In this type of cancer, SLNB is accurate and practical, with sufficient quality control and interdisciplinary collaboration between surgical, nuclear medicine, and pathology units. Lymphoscintigraphy allows the patient to avoid axillary clearance surgery if the sentinel node is negative for metastatic disease. The variability of Ki67, PR, HER2, and ER status supports the idea that all individual foci should be tested in MBC cases to provide the best management and prognosis.

Background: Sexual dysfunction (SD) is a common yet under-recognized consequence of traumatic brain injury (TBI), with significant implications for physical health, psychological well-being, interpersonal relationships and social reintegration. Although TBI research has largely focused on cognitive, motor and behavioral outcomes, the impact of SD remains insufficiently addressed in both clinical practice and rehabilitation programs. Objectives: This review aims to synthesize current evidence on the prevalence, mechanisms and management of SD following TBI, while emphasizing the importance of gender-sensitive and multidisciplinary approaches to care. Methods: A narrative review was conducted by searching PubMed, Scopus and Web of Science for English-language articles published between 2000 and 2025 using combinations of the following keywords: traumatic brain injury, sexual dysfunction, neuroendocrine dysfunction, psychological sequelae and rehabilitation. Priority was given to peer-reviewed clinical studies, systematic reviews and expert consensus guidelines that addressed neurological, endocrine, cognitive, psychological and social aspects of SD in TBI survivors. Exclusion criteria included case reports with insufficient clinical detail and non-peer-reviewed sources. Articles were screened for relevance to both pathophysiological mechanisms and therapeutic strategies. Results: The etiology of post-TBI SD is multifactorial, involving direct neurological injury, hypothalamic–pituitary dysfunction, emotional and cognitive impairments, as well as psychological challenges such as stigma and relationship strain. Men and women may present distinct symptom profiles; for instance, men more frequently report erectile dysfunction and hypogonadism, whereas women more commonly experience challenges with arousal, lubrication and psychological stress. Effective interventions include pharmacotherapy, hormone replacement therapy, psychotherapy and rehabilitative approaches designed to restore intimacy and quality of life. Optimal outcomes are achieved through multidisciplinary collaboration among neurology, endocrinology, psychiatry, psychology and rehabilitation medicine. Conclusions: Sexual dysfunction should be recognized as a critical component of TBI sequelae rather than a secondary concern. Routine screening, gender-sensitive assessment and the integration of individualized, multidisciplinary care pathways are essential to improving patient outcomes. Advancing clinical awareness and standardization in this area holds the potential to significantly enhance the holistic recovery and reintegration of TBI survivors.