Placenta accreta spectrum (PAS) presents a significant obstetric challenge, associated with considerable maternal and fetal-neonatal morbidity and mortality. Nevertheless, it is imperative to acknowledge that a noteworthy subset of PAS cases remains undetected until the time of delivery, thereby contributing to an augmented incidence of morbidity among the affected individuals. The delayed identification of PAS not only hinders timely intervention but also exacerbates the associated health risks for both the maternal and fetal outcomes. This underscores the urgency to innovate strategies for early PAS diagnosis. In this study, we aimed to explore plasma proteins as potential diagnostic biomarkers for PAS. Integrated transcriptome and proteomic analyses were conducted to establish a novel diagnostic approach. A cohort of 15 pregnant women diagnosed with PAS and delivering at Inonu University Faculty of Medicine between 01/04/2021 and 01/01/2023, along with a matched control group of 15 pregnant women without PAS complications, were enrolled. Plasma protein identification utilized enzymatic digestion and liquid chromatography-tandem mass spectrometry techniques. Proteomic analysis identified 228 plasma proteins, of which 85 showed significant differences (P < 0.001) between PAS and control cases. We refined this to a set of 20 proteins for model construction, resulting in a highly accurate classification model (96.9% accuracy). Notable associations were observed for proteins encoded by P01859 (Immunoglobulin heavy constant gamma 2), P02538 (Keratin type II cytoskeletal 6A), P29622 [Kallistatin (also known as Serpin A4)], P17900 (Ganglioside GM2 activator Calmodulin-like protein 5), and P01619 (Immunoglobulin kappa variable 3–20), with fold changes indicating their relevance in distinguishing PAS from control groups. In conclusion, our study has identified novel plasma proteins that could serve as potential biomarkers for early diagnosis of PAS in pregnant women. Further research and validation in larger PAS cohorts are necessary to determine the clinical utility and reliability of these proteomic biomarkers for diagnosing PAS.

The triglyceride–glucose (TyG) index has recently gained attention as a cost-effective and easily calculable surrogate marker reflecting insulin resistance–related metabolic risk. Given the close interplay between thyroid hormones, lipid metabolism, glucose regulation, and inflammation, evaluating the association between thyroid dysfunction and the TyG index remains clinically relevant. This study aimed to investigate variation in the TyG index across different thyroid function states—overt hypothyroidism (OH), subclinical hypothyroidism (SCH), euthyroidism (EH), and healthy controls—and to assess its associations with lipid parameters and inflammatory markers, including the CRP/albumin ratio. In this cross-sectional observational study, 222 adults were categorized according to thyroid status based on TSH and free T4 levels. The TyG index was calculated using fasting glucose and triglyceride values. Associations with lipid and inflammatory markers were evaluated, and receiver operating characteristic (ROC) analysis was performed to assess the ability of the TyG index to discriminate individuals with elevated TyG-defined metabolic risk. No statistically significant differences in TyG index levels were observed across thyroid function groups (p = 0.152). However, the TyG index showed significant positive correlations with triglyceride levels (r = 0.419, p < 0.001), CRP/albumin ratio (r = 0.342, p < 0.001), and LDL-C (r = 0.204, p = 0.009). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.731; 95% CI: 0.652–0.809), identifying individuals with higher TyG levels associated with increased metabolic risk. Although TyG index levels did not differ significantly across thyroid function states, their associations with lipid and inflammatory markers suggest that the TyG index reflects metabolic and inflammatory risk profiles independent of thyroid status, rather than serving as a direct diagnostic measure of insulin resistance.

Background: Dysfunctional uterine bleeding (DUB) affects up to 30% of women of reproductive age and may result in anemia, diminished quality of life, and increased healthcare utilization. While stress-axis dysregulation has been implicated in various menstrual disorders, the role of autonomic and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in DUB remains insufficiently understood. This study aims to investigate whether women with the International Federation of Gynecology and Obstetrics (FIGO)-classified DUB exhibit alterations in autonomic nervous system (ANS) function and endocrine profiles compared to healthy controls during the early follicular phase. By assessing heart rate variability (HRV) indices and circulating reproductive and metabolic hormones, the study seeks to clarify the potential role of autonomic imbalance and the HPA axis—related hormonal markers in the pathophysiology of DUB. Methods: In this prospective case–control study, 34 women with FIGO-classified DUB and 36 age- and body mass index–matched healthy controls underwent biochemical and hormonal assays and five-minute HRV recordings during the early follicular phase (days 3–7 of menses). Serum cortisol was not measured. Time-domain (standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), percentage of successive NN intervals differing by more than 50 ms (pNN50)) and frequency-domain (very-low-frequency power (VLF), low-frequency (LF), high-frequency (HF), LF/HF) HRV metrics were analyzed alongside follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, thyroid-stimulating hormone (TSH), dehydroepiandrosterone sulfate (DHEA-SO₄), glucose, and hemoglobin. Statistical comparisons employed Student's t-tests or Mann–Whitney U tests, with Pearson/Spearman correlations exploring interrelationships among variables. Results: Anthropometric, biochemical, hormonal, and HRV parameters did not differ significantly between DUB and control groups (all p > 0.05). Correlation analyses across the combined cohort revealed expected age-related declines in vagal indices (e.g., RMSSD) and hormone levels (testosterone, DHEA-SO₄), inverse associations between body mass index (BMI) and SDNN/total power, and robust intercorrelations among HRV measures. Notably, FSH positively correlated with VLF power (r = 0.243, p < 0.05), while heart rate inversely tracked RMSSD (r = –0.567, p < 0.01). Conclusions: In a rigorously controlled, follicular-phase cohort, women with DUB exhibit preserved cardiac autonomic regulation and comparable endocrine profiles to healthy peers. These negative findings suggest that, under resting conditions, ANS imbalance may not drive DUB pathophysiology. Future research should integrate direct HPA-axis biomarkers (e.g., cortisol), longitudinal HRV across the menstrual cycle, and stratification by DUB subtype to uncover subtler stress–reproductive interactions.

Background/Objectives: Round spermatid injection (ROSI) is considered an experimental “last resort” option for couples with severe male factor infertility when mature spermatozoa cannot be obtained. We aimed to identify which stage of the clinical chain most strongly constrains overall success in routine practice and to describe the observed safety signal. Methods: We conducted a retrospective single-center cohort study of 221 consecutive ROSI-evaluated cycles (2021–2024). Outcomes were analyzed using a chain-of-outcome framework with explicit denominators: cycle-level feasibility (≥1 injected oocyte), two pronuclei (2PN) formation per injected oocyte, blastocyst development per 2PN, transfer per blastocyst cycle, and clinical pregnancy per transfer and per initiated cycle. Exact (Clopper–Pearson) 95% confidence intervals (CIs) were reported. Results: ROSI feasibility was observed in 5 of 221 initiated cycles (2.3%; exact 95% CI 0.7–5.2). Among the five transfer procedures performed after successful progression through upstream stages, clinical pregnancy occurred in four (80.0%; exact 95% CI 28.4–99.5). At the initiated-cycle level, overall clinical pregnancy was 4 of 221 cycles (1.8%; exact 95% CI 0.5–4.6). Conclusions: The overall effectiveness of ROSI remained low at the initiated-cycle level because very few cycles reached procedural feasibility and early attrition remained substantial. Conditional downstream outcomes may appear favorable only among the rare cycles reaching fertilization and transfer, while safety inference remains highly imprecise due to small denominators. Because only five cycles reached feasibility, all downstream conditional estimates remained highly unstable and sensitive to single-case variation.