The maternal mortality ratio (MMR) is a core indicator of health-system performance and equity. In China, interpretation of recent maternal mortality trends is increasingly influenced by differences between modeled global estimates and national surveillance data. We aimed to characterize the maternal mortality transition and subnational inequities in China from 1990 to 2023 by comparing Global Burden of Disease (GBD) 2023 estimates with data from the National Maternal Mortality Surveillance System (NMMSS). We integrated model-based estimates from the GBD 2023 with real-world data from China’s NMMSS. Assessment focused on key burden metrics, including disability-adjusted life years, MMR, mortality and incidence. Joinpoint regression was used to identify temporal trend changes. Scenario-based projections and Bayesian age-period-cohort (BAPC) models were applied to forecast progress toward the “Healthy China 2030 target”. Subnational inequalities in maternal healthcare service coverage were also examined. GBD estimates showed China’s MMR declined from 121.9 (1990) to 10.7 (2023) per 100,000 live births, while NMMSS reported 15.1 per 100,000 live births in 2023. According to GBD, the leading cause shifted from maternal hemorrhage to indirect disorders, whereas NMMSS consistently identified obstetric hemorrhage as the primary cause. The urban–rural disparity narrowed substantially, but subnational inequities persisted, particularly in western provinces. The MMR rapid decline during 2004–2015 was followed by a plateau. Scenario-based projections indicate that sustaining recent progress would enable China to achieve the Healthy China 2030 target (MMR <12 per 100,000 live births). China has made remarkable progress in maternal health and significantly reduced urban–rural disparities. However, critical differences between GBD estimates and NMMSS data underscore the need for improved local data collection. Targeted strategies, such as integrating cardiovascular risk screening in eastern provinces and strengthening obstetric emergency capacity in western regions, are essential to further reduce maternal mortality and achieve the Healthy China 2030 goal.

Advanced ovarian cancer is the most lethal gynecologic malignancy, and the clinical value of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. This study aimed to define the efficacy of HIPEC by integrating the highest level of evidence and to delineate the research landscape of the field. We conducted a systematic search of multiple databases, including randomized controlled trials (RCTs) up to June 2025, for a meta-analysis and bibliometric review. Study selection was guided by the PICOS framework to define eligibility criteria. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Statistical pooling for the meta-analysis was executed with the Review Manager, and bibliometric analysis was performed and plotted by Bibliometrix and VOSviewer software. Nine RCTs (1621 patients) were included in the meta-analysis. HIPEC significantly improved OS in both primary (HR = 0.71[0.60 to 0.84], P < 0.001) and recurrent ovarian cancer (HR = 0.73[0.58 to 0.92], P = 0.008), and improved PFS in primary cancer (HR 0.74, 95 % CI 0.61-0.91). Subgroup analysis revealed that the greatest benefit was observed in patients who received HIPEC after neoadjuvant chemotherapy (NACT) and when the open technique was used. The bibliometric analysis revealed an annual rise in the number of studies in this field, with the United States and China making leading contributions. This meta-analysis indicated HIPEC had a positive prognosis for advanced ovarian cancer, especially for primary ovarian cancer and patients undergoing neoadjuvant chemotherapy. The bibliometric analysis highlighted the need for more large-sample and high-quality clinical trials to establish higher-level evidence in subsequent research.

Gastric-type endocervical adenocarcinoma (G-EAC), an uncommon HPV-negative mucinous adenocarcinoma of gastric pyloric-type epithelial differentiation, represents a significant diagnostic challenge due to its insidious etiology and vague clinical presentation. The anatomic depth of lesions within the endocervical canal frequently makes suboptimal biopsy samples both responsible for decreased diagnostic sensitivity and repeated false-negative biopsies delaying early detection. Most of the cases are diagnosed at late stages with frequent extrapelvic metastases, and these are linked with poor clinical outcomes. This case report retrospectively examines the clinicopathological characteristics, pitfalls in diagnosis, and treatment strategies for G-EAC to ensure better identification and management of this virulent neoplasm.

Background: Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract affecting women globally. The study aimed to assess the global prevalence and years lived with disability (YLDs) of PID from 1990 to 2021 and analyze influencing factors. Methods: The 2021 Global Burden of Disease (GBD) dataset provided data on the PID statistics of women of childbearing age (15– 49 years), including case counts and age-standardized rates (ASRs). Trends were assessed using estimated annual percentage changes (EAPCs), while the relation of regions, nations and Socio-demographic Index (SDI) was examined using local weighted regression (Lowess). To predict the burden, the Bayesian age-period-cohort (BAPC) model was devised. Results: The GBD data show PID burden negatively correlated with SDI: the age-standardized prevalence rate (ASPR) and the age-standardized years lived with disability rate (ASYR) were higher in low-SDI regions (eg, sub-Saharan Africa) and lower in high-SDI regions (eg, Western Europe). In 2021, rates were 27.02 and 3.68 per 100,000, respectively. Country disparities are marked (Guinea-Bissau highest). Burden peaks at ages 30– 39. Projections show persistent increases in both rates across childbearing ages through 2050. Conclusion: Through severity-stratified estimations, detailed cause-specific burden analysis, and BAPC projection modeling, this study provides a comprehensive and detailed description of the global burden and epidemiological trends of PID. Despite overall progress, persistent disparities remain notably the disproportionately high burden in low-SDI regions such as sub-Saharan Africa and Eastern Europe. These projections underscore an urgent need for context-specific prevention strategies, including strengthened STI screening and treatment, improved antibiotic access, and community-based sexual health education tailored to local health system capacity.

Background Ovarian Sertoli-Leydig cell tumors (SLCTs) are rare sex cord-stromal neoplasms. Poorly differentiated SLCTs can harbor heterologous elements, among which myogenic differentiation poses a significant diagnostic challenge [1–3]. Case presentation A 45-year-old female patient presented with abdominal pain and large pelvic masses. Initial core needle biopsy suggested leiomyosarcoma, showing a malignant spindle cell proliferation positive for smooth muscle actin (SMA), desmin, and mutant-type p53. However, upon examination of the fully resected specimen, a biphasic tumor comprising intermingled epithelioid and spindle cells was identified. An expanded immunohistochemical analysis subsequently revised the diagnosis to a poorly differentiated Sertoli-Leydig cell tumor (SLCT) with smooth muscle differentiation. The patient underwent five cycles of chemotherapy with paclitaxel and carboplatin and remained free of recurrence at the 6-month follow-up. Diagnostic highlight The tumor closely mimicked a primary leiomyosarcoma. Diagnostic precision was achieved through identification of biphasic architecture in the surgical specimen and demonstration of diffuse, robust nuclear positivity for the sex cord-stromal marker SF-1, which superseded the misleading focal expression of myogenic markers. Conclusion This case highlights the critical importance of including Sertoli-Leydig cell tumor (SLCT) in the differential diagnosis of pelvic spindle cell tumors. Utilizing a comprehensive immunohistochemical panel that incorporates sex cord-stromal markers is imperative to avoid diagnostic inaccuracies and to facilitate appropriate clinical management.