Vasculogenic mimicry (VM) is the process where cancer cells adopt endothelial characteristics by forming tube-like structures and perfusing channels. This phenomenon has been demonstrated in several types of solid tumors and associated with the growth and survival of tumor cells. In this study, we investigated the presence of VM formation in human pancreatic ductal adenocarcinoma (PDAC) and elucidated the molecular mechanisms underlying the VM process. In human PDAC tissues, CD31-negative, periodic acid-Schiff (PAS)-positive channels were predominantly found in desmoplastic areas, which are generally also hypovascularized. We found a positive correlation of VM capacity to tumor size and NOTCH1 expression and nuclear localization with statistical significance, implicating that Notch activity is involved with VM formation. Additionally, our data showed that the presence of growth or angiogenic factors significantly increased Notch activity in PDAC cell lines and upregulated several mesenchymal marker genes, such as TWIST1 and SNAI1, which can be inhibited by a gamma-secretase inhibitor. Our data showed that Notch signaling plays an important role in inducing VM formation in PDAC by promoting the epithelial-to-mesenchymal transition process.

Prenatal diagnosis of abnormal brain lesions in the pump twin of a twin reversed arterial perfusion (TRAP) sequence is exceptionally rare, with only three cases documented in the literature. In this report, we present a case of prenatally diagnosed brain injury in the pump twin, correlating with defined cerebral territory, along with postnatal cranial ultrasound, developmental and clinical outcomes. A 22-year-old pregnant woman was initially misdiagnosed with a monochorionic diamniotic (MCDA) twin pregnancy complicated by single fetal demise. The viable twin corresponded to 17 weeks of gestation, while the demised twin measured 12 weeks with absent cardiac activity. Serial biweekly transabdominal neurosonography remained unremarkable until 25 weeks, when bilateral ventriculomegaly was detected in the surviving fetus. Maternal TORCH screen and fetal SNP array were unremarkable. The patient was referred to a specialized ultrasonography clinic, where re-evaluation confirmed a diagnosis of TRAP sequence. Transvaginal neurosonography and fetal MRI also revealed brain injury with raised suspicion of cortical malformation in the pump twin. Following multidisciplinary counseling, conservative management was selected. At 32 weeks, the patient delivered spontaneously preterm. The pump twin weighed 1,900 g with reassuring Apgar scores, while the acardiac acephalus twin weighed 20 g and exhibited severe malformations. Placental examination confirmed artery-to-artery and vein-to-vein anastomoses. At three weeks of age, cranial 2D and 3D ultrasounds revealed ongoing gyral development, restored cingulate sulcus, stable bilateral ventriculomegaly and partial regrowth of brain tissue in the affected areas. Now at 18 months, the child demonstrates normal growth and continues to achieve her age-appropriate gross motor and neurological milestones. This case underscores the value of comprehensive prenatal imaging in identifying brain injury in the pump twin of a TRAP sequence, raises awareness of its potential occurrence and highlights the possibility of postnatal neurological resilience, even after significant intrauterine challenges. It also emphasizes the importance of long-term postnatal follow-up, as brain development continues beyond infancy.

Objective: Gestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in the GDM population. This study used 2D and 3D ultrasound scanning to determine the correlation of fetal adrenal gland size and volume with fructosamine levels, HbA1c levels, estimated fetal weight (EFW), and neonatal birth weight in GDM patients. Methods: This study included eighty singleton pregnant women diagnosed with GDM between 24– 28 weeks of gestation. During weeks 32– 34 of gestation, the length, width, and depth of the fetal zone and total adrenal gland were measured using transabdominal 2D ultrasound. Virtual organ computer-aided analysis (VOCAL) software was used to evaluate fetal zone and total adrenal gland volume in 3D ultrasound. All the participants were followed until delivery. Pearson’s correlation analysis was conducted to examine the correlation between fetal adrenal gland ultrasound measurements and the factors of interest. Results: The study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and fourteen (17.5%) pregnant women with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the diet-controlled (GDMA1) and the insulin-managed (GDMA2) groups. All the participants had achieved optimal glucose levels at the time of ultrasound acquisition. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, only the fetal zone volume was significantly correlated with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9, p = 0.01) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3, p = 0.01). Conclusion: The fetal zone volume is correlated with EFW, fructosamine levels, and HbA1c levels. This non-invasive technique may be beneficial as an indirect marker for glycemic monitoring in GDM.

Background/Objectives: First-trimester anatomical screening (FTAS) enables early detection of fetal structural anomalies. However, data on transvaginal ultrasound performance across different operator experience levels remains limited. The primary objective was to compare the performance of transvaginal FTAS between inexperienced and experienced operators by comparing complete scan rates and anatomical visualization scores. The secondary objectives were to compare scan duration and learning curves between the two operators and to identify factors associated with successful examinations. Methods: In this randomized controlled trial, participants underwent transvaginal FTAS performed either by a first-year maternal–fetal medicine (MFM) fellow (inexperienced operator) or an MFM specialist (experienced operator) according to International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. Complete scan rates, anatomical visualization scores, scan duration, factors affecting visualization, and learning curves were compared between groups. Results: A total of 139 participants were included in the analysis, with 70 and 69 examinations performed by the inexperienced and experienced operators, respectively. Complete scan rates and visualization scores were not significantly different between groups (41.4% vs. 44.9% and 86.4% vs. 91.2%, respectively). On multivariate analysis, operator experience was independently associated with higher visualization scores (p = 0.010), but not complete scan rates. Scan duration was similar between groups (median (IQR): 20 (17) vs. 20 (15) min; p = 0.211). Fetal presentation and uterine position significantly influenced visualization outcomes. The inexperienced operator demonstrated a trend of gradual improvement over time, though not significantly, whereas the experienced operator maintained stable performance throughout the study period. Conclusions: After training, no statistically significant differences were observed between less experienced and experienced operators with respect to complete scan rate, scan duration, and learning curve, although visualization score was significantly higher in the experienced examiner on multivariate analysis. However, our findings should be interpreted with caution, as the conclusions were based on the performance of only one examiner in each group.