This study was a multicenter retrospective cohort study of term nulliparous women who underwent labor, and was conducted to develop an automated machine learning model for prediction of emergent cesarean section (CS) before onset of labor. Nine machine learning methods of logistic regression, random forest, Support Vector Machine (SVM), gradient boosting, extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), k-nearest neighbors (KNN), Voting, and Stacking were applied and compared for prediction of emergent CS during active labor. External validation was performed using a nationwide multicenter dataset for Korean fetal growth. A total of 6549 term nulliparous women was included in the analysis, and the emergent CS rate was 16.1%. The C-statistics values for KNN, Voting, XGBoost, Stacking, gradient boosting, random forest, LGBM, logistic regression, and SVM were 0.6, 0.69, 0.64, 0.59, 0.66, 0.68, 0.68, 0.7, and 0.69, respectively. The logistic regression model showed the best predictive performance with an accuracy of 0.78. The machine learning model identified nine significant variables of maternal age, height, weight at pre-pregnancy, pregnancy-associated hypertension, gestational age, and fetal sonographic findings. The C-statistic value for the logistic regression machine learning model in the external validation set (1391 term nulliparous women) was 0.69, with an overall accuracy of 0.68, a specificity of 0.83, and a sensitivity of 0.41. Machine learning algorithms with clinical and sonographic parameters at near term could be useful tools to predict individual risk of emergent CS during active labor in nulliparous women.

Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1–1.16 and aOR 7.46, 95% CI 6.97–7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29–1.54 and aOR 1.58, 95% CI 1.35–1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5–25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18–105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

Park H, et al. J Korean Med Sci. 2019 Dec;35(7):e26. https://doi.org/10.3346/jkms.2020.35.e26

Lee SJ, et al. J Korean Med Sci. 2023 Dec;39(1):e25. https://doi.org/10.3346/jkms.2024.39.e25

This study investigates the antimalarial potential of extracts and compounds from various plants used in traditional Korean medicine, in response to the increasing resistance of Plasmodium falciparum to standard treatments such as chloroquine and artemisinin. The antimalarial activity screening was conducted on 151 extracts, identifying the top seven candidates, including Geranium thunbergii (50% ethanol and 100% methanol extract), Reynoutria japonica, Amomum villosum (hot water and 50% ethanol extract), Cinnamomum zeylanicum, and Platycodon grandiflorum. Among these, G. thunbergii was identified as the top priority for further analysis due to its high antimalarial activity and high yield of bioactive compounds. The plant extracts were fractionated using ethyl acetate, chloroform, and hot water, and their efficacy against P. falciparum was evaluated through IC₅₀ determination and microscopic analysis. The compounds evaluated included ellagic acid, gallic acid, afzelin, quercetin, and protocatechuic acid. Among the tested compounds, ellagic acid showed the most potent antimalarial activity with an IC₅₀ of 1.60 ± 0.09 µM, followed by gallic acid (39.43 ± 1.48 µM) and afzelin (52.77 ± 1.84 µM). In contrast, quercetin (116.8 ± 3.78 µM) and protocatechuic acid (1.23 ± 0.02 mM) exhibited minimal antimalarial effects. Giemsa staining was employed to visualize parasite morphology and confirmed that ellagic acid is effective in inhibiting growth at the late trophozoite stage. These findings suggest that ellagic acid could serve as a promising lead compound for developing a novel antimalarial agent. This study highlights the importance of exploring plant-based compounds as alternative strategies against drug-resistant malaria. Further investigation into the mechanisms underlying the antimalarial activity of these compounds is necessary to fully validate their therapeutic potential.

Background: Babesia is an intraerythrocytic parasite often misdiagnosed as a malaria parasite, leading to inappropriate treatment of the disease especially in co-endemic areas. In recent years, optical diffraction tomography (ODT) has shown great potential in the field of pathogen detection by quantification of three-dimensional (3D) imaging tomograms. The 3D imaging of biological cells is crucial to investigate and provide valuable information about the mechanisms behind the pathophysiology of cells and tissues. Methods: The early ring stage of P. falciparum were obtained from stored stock of infected RBCs and of B. microti were obtained from infected patients during diagnosis. The ODT technique was applied to analyze and characterize detailed differences between P. falciparum and B. microti ring stage at the single cell level. Based on 3D quantitative information, accurate measurement was performed of morphological, biochemical, and biophysical parameters. Results: Accurate measurements of morphological parameters indicated that the host cell surface area at the ring stage in B. microti was significantly smaller (140.2 ± 17.1 µm²) than that in P. falciparum (159.0 ± 15.2 µm²), and sphericities showed higher levels in B. microti-parasitized cells (0.66 ± 0.05) than in P. falciparum (0.60 ± 0.04). Based on biochemical parameters, host cell hemoglobin level was significantly higher and membrane fluctuations were respectively more active in P. falciparum-infected cells (30.25 ± 2.96 pg; 141.3 ± 24.68 nm) than in B. microti (27.28 ± 3.52 pg; 110.1 ± 38.83 nm). The result indicates that P. falciparum more actively altered host RBCs than B. microti. Conclusion: Although P. falciparum and B. microti often show confusable characteristics under the microscope, and the actual three-dimensional properties are different. These differences could be used in differential clinical diagnosis of erythrocytes infected with B. microti and P. falciparum. Graphical