This issue focuses on developing a unified, interdisciplinary approach to obstetrics, gynaecology, andrology and reproductive medicine based on objective data. The aim is to move from making decisions based on experience to using targeted, guided strategies based on early biomarkers and standardized algorithms. The review highlights studies demonstrating a pragmatic approach to life-threatening obstetric conditions, such as the management of coagulopathy in postpartum haemorrhage with a focus on the timely administration of tranexamic acid and the appropriate replacement of fibrinogen. It also covers new methods for combating postpartum infection and the early sepsis prediction. In gynaecological practice, the importance of minimal technological improvements (e.g. local antibiotic therapy during laparoscopy) in improving reproductive outcomes is emphasized, as is the relevance of organ-preserving surgery. There is a particular focus on structuring diagnostic pathways in andrology for azoospermia and oligozoospermia, where integrating spermiological, hormonal, ultrasound and genetic data enables differentiation of pathogenesis and development of personalized treatment strategies ranging from drug therapy to assisted reproductive technologies. The article also discusses the progressive integration of molecular markers (e.g. nectin-4 and components of extracellular vesicles) into clinical practice for diagnosing and prognosing reproductive system cancers, emphasizing the need for standardized analysis methods. The discussion of patient management strategies for menopausal women takes an interdisciplinary approach, requiring collaboration between gynaecologists, endocrinologists and dentists, and emphasizing the importance of preliminary hormonal correction prior to dental implantation. Taken together, the materials provide a comprehensive picture of the contemporary transformation of clinical practice, based on evidence-driven interdisciplinary dialogue.

Aim: to conduct a comprehensive analysis of clinical, anamnestic and immunological characteristics of women with infertility and/or a history of recurrent pregnancy loss.

Materials and Methods. A cross-sectional study included 302 women of reproductive age with a history of infertility and/or recurrent pregnancy loss by enrolling those who was planning pregnancy and directed for preconceptional councelling in 2023–2024. Patients were divided into 3 groups depending on whether they had experienced infertility (n = 108), recurrent pregnancy loss (n = 141), infertility and recurrent pregnancy loss (n = 53). The study flowchart included the collection of gynecological and obstetric histories, as well as ultrasound examination of the pelvic organs in follicular phase. Expression of innate immunity gene mRNAs was carried out: interleukins (IL) IL-1β, IL-10, IL-18, tumor necrosis factor-alpha (TNF-α), Toll-like receptor 4 (TLR4), GATA-binding protein 3 (GATA3), cluster of differentiation 68 (CD68), β₂-microglobulin. Based on the mRNA expression profiles of the studied genes, the integral inflammation index (II) was calculated automatically using binary logistic regression software. A local inflammatory reaction in the cervical mucosal scraping was recorded when the II value exceeded 60 %. Statistical analysis was performed using R v 4.4.3. In hypothesis testing, differences were considered statistically significant at p < 0.05.

Results. The prevalence of inflammatory endometrial pathology (chronic endometritis diagnosed by ultrasound) was comparable among groups 1, 2, 3 (16.7; 19.9; 18.9 %; p > 0,05). A greater incidence of ultrasound detected intrauterine adhesions was found in group 2 with combined infertility and recurrent pregnancy loss (17,0 %) compared to infertility group 1 (4.6 %; p = 0,022) and comparable to recurrent pregnancy loss group 3 (14.9 %; p > 0,05). Uterine septal removal was performed more often in group 2 (17.0 %) than in group 1 (1.9 %; p = 0,003). Endometriosis was diagnosed more often in group 2 (24,5 %) than in group 3 (7.8 %; p = 0,009). Reproductive history in combined pathology group 2 compared to infertility group 1 showed higher number of pregnancies (4.0 [3.0; 4.0] vs. 1.0 [0.0; 1.0]; p < 0.001), proportion of spontaneous miscarriages (50.9 % vs. 5.6 %; p < 0.001), prevalence of secondary infertility (24.5 % vs. 11.1 %; p < 0,001) and in vitro fertilization attempts (1.0 [0.0; 3.0] vs. 0.0 [0.0; 2.0]; p = 0.002). We found the difference in IL-1β gene expression in group 1 and group 3 (4.6 [3.5; 5.3]) vs. 4.9 [4.1; 5.8]; p = 0,044). This may suggest different mechanisms underlying endometrial-embryonic dialogue disorders with common inflammatory background: the general index of local inflammation was high in all groups (more than 60 %).

Conclusion. Prevalence of ultrasound chronic endometritis signs in groups 1, 2, 3 was up to 20 %. Patients with infertility and/or recurrent pregnancy loss, with chronic endometritis, concomitant dysbiotic disorders and activated local immunity need to correct vaginal microbiocenosis before pregnancy in order to prevent infectious and inflammatory complications. It is necessary to develop a screening program based on the characteristics of gynecological, obstetric, reproductive history, morbidity and local inflammatory gene expression levels. Our data confirm the importance of an integrated approach in assessing a role of infectious factor in origin of reproductive disorders.

Introduction. Vulvovaginal atrophy (VVA) is characterized by severe hypoestrogenism, impaired microcirculation, chronic inflammation, and decreased mucosal regeneration. In women with a varying clinical history, including applied antitumor treatment, such changes may differ in severity level. Despite that the role for pro-inflammatory cytokines in VVA has been extensively investigated, systemic immuno-inflammatory changes, primarily resulting in complement activation remained understudied.

Aim: to assess blood serum levels of C3 and C4 complement component levels in postmenopausal women with VVA coupled to clinical history, including various types of antitumor therapy, as well as in women without oncology history and in control group of healthy women.

Materials and Methods. A cross-sectional comparative study included five groups of postmenopausal women (n = 215): VVA after radical surgery (n = 52); VVA after chemoradiotherapy (CRT) (n = 27); VVA during antiestrogen therapy (n = 48); VVA without oncology history (n = 53); control group – healthy postmenopausal women (n = 35). The blood serum C3 and C4 levels were quantitated by immunoturbidimetry. The statistical analysis included the Kruskal–Wallis criterion and pairwise intergroup comparisons using the Mann–Whitney criterion with the Bonferroni correction.

Results. In all studied groups C3 and C4 levels were within the reference range, however, they differed significantly between the groups depending on the clinical history. The most prominent intergroup differences were observed in patients after CRT, who had higher C3 (1.62 g/L) and C4 (0.32 g/L) levels compared with control group (1.12 g/L for C3; 0.19 g/L for C4). In antiestrogenic therapy group (group 3) and surgical treatment group (group 1), C3 (1.48 g/L and 1.35 g/L, respectively) and C4 (0.28 g/L and 0.25 g/L, respectively) levels held an intermediate place between CRT group and control group. In women with VVA without oncology history, C3 (1.28 g/L) and C4 (0.23 g/L) levels were comparable to those in control group.

Conclusion. The data obtained evidence about variability of the systemic immuno-inflammatory profile in VVA driven by patient clinical history. Within the framework of the study, changes in C3 and C4 levels reflected general intergroup differences, which, however, remained within the reference range. The results emphasize a need for further research aimed at studying activated complement system components and their clinical significance in VVA.

Introduction. Azoospermia, defined as the absence of spermatozoa in the ejaculate after centrifugation, is one of the leading causes of male infertility, affecting approximately 1,0 % of men in the general population and up to 15,0 % of infertile patients. Timely differentiation between obstructive (ОА) and non-obstructive (NOA) azoospermia is critical for selecting appropriate treatment strategies, determining prognosis, and applying assisted reproductive technologies (ART).

Aim: to investigate the prevalence of different azoospermia forms of azoospermia in infertile men, within the context of real-world clinical practice at a non-specialized endocrine outpatient department, including personal observations, with consideration of/in comparison with the results of international and Russian epidemiological studies.

Materials and Methods. A comprehensive analysis of literature, clinical guidelines, and original data was performed. The study included 450 men aged 25–45 years with confirmed azoospermia. All patients underwent a comprehensive examination, including collection of anamnesis (reproductive, somatic, surgical); physical examination with assessment of secondary sexual characteristics, size and consistency of the testicles; double examination of ejaculate (centrifugation, microscopy); examination of blood hormone levels (follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, anti-Müllerian hormone, sex hormone-binding globulin, inhibin B; if indicated – estradiol, thyroid-stimulating hormone, thyroxine); scrotum ultrasound examination with Doppler ultrasonography; genetic testing – karyotyping, testing for microdeletions of Y chromosome azoospermia factor (AZF) of the Y chromosome, CFTR (cystic fibrosis transmembrane conductance regulator) gene testing; when indicated, testicular sperm extraction (TESE) biopsy was performed.

Results. NOA and OA were identified in 63.3 % and 30 % of patients, respectively. Among NOA cases, the leading causes were idiopathic forms (19.6 %), Klinefelter syndrome (8.4 %), Y-chromosome microdeletions (5.8 %), and hypogonadotropic hypogonadism (6.7 %). Varicocele was associated with NOA in 12 % of cases. These findings are consistent with global data, although minor ethnic and methodological differences were observed.

Conclusion. Azoospermia is a clinically and etiologically heterogeneous condition. Timely differentiation between its forms and the inclusion of genetic testing improve diagnostic accuracy and help optimizing management strategies. Standardization of diagnostic algorithms and a personalized approach increase ART effectiveness and the likelihood of fertility restoration.

Introduction. Infectious and inflammatory diseases (IIDs) represent a serious problem in modern obstetrics.

Aim: to improve methods for postpartum IIDs diagnosis, prognosis and treatment.

Materials and Methods. The study was conducted with 362 puerperants. At stage 1, there were retrospectively examined 199 patients with postpartum endometritis stratified as follows: IA (n = 113) – delivered by caesarean section (CS), IB (n = 86) – delivered by natural childbirth. At stage 2, a prospective, controlled study was conducted enrolling 163 puerperants. Group IIA (n = 124) consisted of patients with endometritis after CS, divided into 2 subgroups: subgroup IIA1 (n = 63) received antibacterial therapy and intrauterine sorbent VNIITU-1PVP, subgroup IIA2 (n = 61) – antibacterial treatment alone. Group IIB consisted of 39 puerperants who had a critical obstetric condition (COC), divided into 2 subgroups: IIB1 (n = 18) – patients with obstetric sepsis, IIB2 (n = 21) – without septic complications. Anamnestic data (complaints, disease history, characteristics of delivery, course of the postpartum period, timing of endometritis diagnosis), laboratory assay data (complete blood count, biochemical blood test, microbiological examination of uterine cultures, immunological study of IL-1β, IL-10, TNF-α cytokines in endometrial aspirate), and instrumental methods (ultrasound examination of pelvic organs, hysteroscopy, measurement of central venous pressure, infrared spectrometry of crushed carbon sorbent VNIITU-1PVP) were assessed. The APACHE, SOFA, NEWS2, AVPU scales were used to assess condition of post-COC puerperant women; χ²-test and Mann–Whitney test were applied to qualitative and quantitative variables to determine p-value. To develop a prognostic model for assessing obstetric sepsis in post-COC patients, the method of multiple logistic regression was used with step-by-step exclusion of variables until the minimum value of the Akaike criterion was reached. The obtained predictive formula was subjected to ROC analysis. Data calculations and graphical visualization were carried out using special libraries of the R language.

Results. In group IA vs. group IB patients, anemia (p = 0.004), leukocytosis (p < 0.001), a left shift in the leukocyte formula via leukocytosis (p < 0.001), hypoproteinemia (p< 0.001) were significantly more common, with Enterococcus faecalis (p = 0.02) and Enterococcus faecium (p = 0.02) more often cultured from the uterine cavity. The risk ratio of performing endometritis-related uterine extirpation in group IA was 5.33 (95 % CI = 1.43–19.78) compared with group IB. The use of the molded sorbent VNIITU-1PVP in subgroup IIA1 allowed 87.3 % to avoid microbial growth in the uterine cavity. The concentration of pro-inflammatory cytokines such as interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α) in the uterine cavity in subgroup IIA1 was also significantly lower than that of in subgroup IIA2 – by 4.0 and 3.2 times, respectively (p < 0.05). In subgroup IIA1, organ-preserving surgery was performed in 23 cases related to failure of uterine sutures. While analyzing the data of group IIB patients, the following cut-off points were found: international normalized ratio – 1.13, central venous pressure – 6 mm Hg, aspartate aminotransferase level – 45 IU/L, and a mathematical model for post-COC sepsis development was constructed. The effectiveness of the developed prognostic model for obstetric sepsis in post-COC puerperant patients had 94.5 % sensitivity and 90.5 % specificity.

Conclusion. The use of the molded sorbent VNIITU-1PVP reduces a progression risk for uterine inflammatory process. Using a prognostic risk model for obstetric sepsis allows to timely identify this complication.

Aim: to compare international and Russian epidemiological data on the causes of oligozoospermia and to develop differential diagnostics and patient management algorithm by taking into account endocrine, genetic and immunological factors.

Materials and Methods. A retrospective observational study included 210 men aged 25-45 years with confirmed oligozoospermia and infertility complaints. All patients underwent semen analysis according to the World Health Organization standards (2021), blood hormone testing (follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, thyroid-stimulating hormone, estradiol, inhibin B, anti-Müllerian hormone, 17-hydroxyprogesterone), scrotal ultrasound, as well as genetic testing (karyotyping and Y-chromosome microdeletions). The data provided by international clinical guidelines, European Association of Urology (EAU, 2024), American Urological Association/American Society for Reproductive Medicine (AUA/ASRM, 2024), publications in Russian and English retrieved from PubMed/MEDLINE, Scopus and eLibrary databases were analyzed.

Results. A wide spectrum of oligozoospermia causes was identified: endocrine disorders (hypo- and hypergonadotropic hypogonadism), Klinefelter syndrome, Y-chromosome microdeletions, varicocele, and obstructive forms. The pathophysiological mechanisms of hypogonadism, the clinical significance of Klinefelter syndrome, features of Y-chromosome azoospermia factor deletions, and the role of varicocele as a potentially reversible cause of male infertility are discussed in detail.

Conclusion. Differential diagnosis of oligozoospermia requires a comprehensive, stepwise approach. Incorporating repeated semen analysis, hormonal profiling, ultrasound, and genetic testing into the diagnostic algorithm enables identification of reversible causes (varicocele, hypogonadotropic hypogonadism) as well as timely diagnostics of genetic forms (Klinefelter syndrome, Y-chromosome microdeletions). This ensures a personalized therapeutic strategy and improves the effectiveness of assisted reproductive technologies.

Aim: to access the efficacy and safety of antibacterial irrigation in the treatment of pelvic inflammatory disease (PID) using video endoscopic techniques.

Materials and Methods. A prospective comparative study was conducted. At the first stage, in the period from 2021 to 2023, 80 PID patients were treated, who underwent diagnostic laparoscopy to clarify the diagnosis. The patients were randomized into 2 groups: main group received parenteral antibacterial therapy in combination with local antibacterial therapy by delivering an antibiotic solution to the surgical site via microirrigator; comparison group received standard parenteral antibacterial therapy. During treatment, all patients were assessed for clinical and laboratory parameters of the inflammatory process: febrile period length and tachycardia recorded; severity of pain syndrome assessed using a visual analogue scale (VAS); level of C-reactive protein (CRP) measured; performed a clinical blood test with analyzing leukocyte formula; performed pelvic organs ultrasound examination. The second study stage was carried out in 2024–2025 by further outpatient monitoring of patients to assess long-term sequelae, as well as repeated exacerbations and pregnancy onset term consequences, as well as the presence of repeated exacerbations and the onset of pregnancy.

Results. On day 5 after diagnostic laparoscopy in main group, the CRP level and leukocytosis indicators normalized in 50,0 and 55,0 % patients, respectively; in comparison group, normalization of such indicators was observed in 27.5 % (p = 0.039) and 32.5 % (p = 0.043) cases, respectively. At discharge, white blood cell count and WBC differential were normal in 92.5 % and 75.0 % (p = 0.034) patients in main and comparison group, respectively. Febrile period length in main group was 2-fold shorter than in comparison group; duration of tachycardia remained unaffected. On day 5 after diagnostic laparoscopy, the level of pain syndrome in main group was smaller by 2-fold than in comparison group. At discharge, the patients from main group had a more favorable pelvic organs ultrasound picture showing a decreased number of patients in the former having increased ovarian volume to 12 ml, with hyperechoic areas, tubal thickening (p = 0.034), detected varying amounts of fluid in the pelvic area (p = 0.027), higher number of patients without pathology of the pelvic organs based on ultrasound data (p = 0.041). In patients who received combination treatment (main group), pregnancy occurred 2 times more often than in those treated solely with standard drug therapy (comparison group). In addition, normalized menstrual cycle was noted significantly more often (p = 0.007) in main group – 17 (42.5 %) vs. 6 (15.0 %) cases in comparison group. While assessing the development of complications and repeated exacerbations, no statistically significant inter-group differences were found.

Conclusion. The method we propose can be considered as an alternative treatment option for PID patients, who were referred to undergo diagnostic laparoscopy during differential diagnostics. Taking into consideration the lack of highquality randomized studies that would definitively confirm our results, it seems relevant to continue further investigation on this issue.

Obstetric bleeding represents one of the main causes of maternal mortality worldwide. Along with hypertensive disorders it accounts for over half of maternal mortality cases. The implementation of strategies such as the "code red", increased institutionalized deliveries, early transfusions, and early obstetric alert system has reduced mortality. Cases of massive bleeding require admission to the Intensive Care Unit as they can progress to coagulopathy. This narrative review focuses on medications intended for the advanced management of coagulopathy in this population.

Introduction. Nectin-4, a cell adhesion molecule of the immunoglobulin superfamily (IgSF), has been extensively studied in oncological diseases. Nectin-4 is involved in the formation of intercellular connections and promotes tumor cell proliferation, migration and chemoresistance. Upregulated nectin-4 expression has been detected in various malignant neoplasms, including tumors of the female reproductive system – ovarian, endometrial, cervical cancer, as well as rare tumors of the vulva, vagina and fallopian tubes.

Aim: to summarize current data on nectin-4 role in the pathogenesis, diagnostics, prognosis and therapy of malignant tumors of the female reproductive system, and to assess the prospects for its clinical use in personalized medicine.

Materials and Methods. A search for relevant publications was conducted in the PubMed/MEDLINE, Scopus, Web of Science, Embase and eLibrary.ru databases beginning from January 2000 to December 2024. The inclusion criteria covered original and review articles devoted to nectin-4 in gynecological oncology. Key words in Russian and English, Boolean operators, and filtering by full-text, subject matter, and quality of research were used. From the 3955 identified publications, 65 were included in the review.

Results. Nectin-4 expression is associated with enhanced tumor cell proliferation, migration, and chemoresistance, whereas its involvement in generating tight intercellular junctions promotes the development of chemoresistant spheroids. In ovarian cancer, upregulated levels of nectin-4 messenger RNA (mRNA) and serum protein demonstrated high diagnostic and prognostic significance, especially in combination with traditional markers such as cancer antigen 125 (CA-125). In endometrial cancer, nectin-4 expression correlates with a deficiency of the mismatch repair system (MMR genes) MSH2/MSH6 genes and lowered progression-free survival. In cervical carcinoma, nectin-4 is related to drug resistance, thereby positioning it as a promising target for novel treatment strategies. The latter using nanoquinacrine and antibody-drug conjugates (ADCs) such as 9MW2821 and ADRX-0706, are currently undergoing clinical trials. Additionally, nectin-4 has shown relevance in non-malignant reproductive disorders such as endometriosis and preeclampsia.

Conclusion. Nectin-4 demonstrates high clinical significance as a diagnostic and prognostic marker in gynecological malignancies. Its expression is associated with aggressive disease progression and drug resistance, especially in ovarian, endometrial and cervical cancers. Clinical trials with nectin-4-targeted drugs, including ADCs, are underway. Thus, nectin-4 represents a promising target for the development of personalized diagnostic and therapeutic strategies in gynecological oncology.

Malignant neoplasms of the female reproductive system remain a significant global health concern, ranking among the leading causes of cancer incidence and mortality in women. Despite advances in the field of gynecologic oncology, early diagnosis and prognosis of such diseases continue to pose substantial challenges. In recent years, extracellular vesicles (EVs), including exosomes, microvesicles, and apoptotic bodies, have been increasingly attracted attention as key mediators of intercellular communication and carriers of biologically active molecules. EVs transport microRNAs, long non-coding RNAs, proteins, and other molecules that influence critical carcinogenic processes such as proliferation, angiogenesis, metastasis, and the development of chemoresistance. This review summarizes current data on the EVs role in the pathogenesis and progression of cervical, endometrial, and ovarian cancers. The diagnostic and prognostic potential of EV-associated biomolecular components is examined, with evidence from preclinical and clinical studies highlighting their promise as biomarkers. The review also discusses the prospects for clinical application of EVs, emphasizing the challenges of methodological standardization and the need for multicenter studies to validate their clinical utility. Additionally, the importance of integrating omics technologies and bioinformatics approaches is underscored as essential for improving patient stratification and advancing personalized therapy.

Here, we summarize current evidence on the impact of postmenopausal osteoporosis, menopause-related hormonal changes, and hormone therapy on dental implant outcomes. Epidemiology and pathogenesis of bone alterations are reviewed, with particular emphasis on the role of estrogen, progesterone, calcitonin, growth hormone, and insulin-like growth factor-1 (IGF-1) deficiency. Special attention is paid to the effects of menopausal hormone therapy and bioidentical forms of estradiol and progesterone on osteoporosis course and the effectiveness of dental implantation. The analysis highlights the risks of implant loss and the opportunities of interdisciplinary approach in dentistry and endocrinology to optimize implant osseointegration in postmenopausal women.

Introduction. According to the average statistical data, the incidence of ovarian tumors in children comprises about 4.6 %. In the adolescent population, ovarian epithelial tumors confidently hold a leading place. One of their histological subtypes is presented by mucinous cystadenoma. Due to the frequent asymptomatic course or the absence of specific clinical features, such cysts can long persist in the abdominal cavity and reach significant sizes. In the latter case they can manifest with the symptoms of serious complications such as obstruction of the urinary tract and the intestines, pedunculated masses torsion, ovarian torsion, rupture of cysts, etc. Thus, the main insidiousness of ovarian tumors lies in the delayed diagnostics and omitted surgical opportunities for ovary preservation.

Aim: to present a clinical case of a teenage girl with giant ovarian cystadenoma complicated by hydronephrosis due to ureteral compression.

Case presentation. A female patient R., 17 years old, was admitted to the surgical department on 12.02.2025, with complaints of abdominal enlargement, abdominal pain lasting over 4 months, frequent urinal miction and algodismenorrhea. Medical history dated of January 2025 showed that imaging research methods performed in different organizations revealed a multilocular cyst of the abdominal cavity – a mucinous cystadenoma of the left ovary, sized 193×195×271 mm, complicated by hydronephrosis of the right kidney. Physical examination revealed a local abdominal pain in the umbilical region as well as increased abdominal volume. General blood test found signs of mild iron deficiency. Blood screening tests for serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and cancer antigen-125 (CA-125) levels allowed to exclude oncological pathology.

Results. Further surgical treatment was performed. On 17.02.2025, patient R. underwent laparoscopic cystectomy. The passage of urine quickly returned to normal after removal of obstruction cause. A follow-up ultrasound examination on the day 7 post-surgery showed that the pelvis of the right kidney was markedly decreased. The postoperative period was unremarkable. Patient R. was discharged on day 8 with improvement. Recommendations were provided.

Conclusion. A clinical case presented here demonstrates an opportunity for developing complication such as hydronephrosis related to bulky ovarian cyst in adolescents. The surgical treatment confirms that even in case of giant cysts, cystectomy along with preserving maximum volume of the ovarian tissue may be performed thereby allowing to exert reproductive function in the future. However, such surgical treatment option should be performed only with confidence in benign tumor origin and presence of viable ovarian tissue.

The article explores the image of the Virgin and Child as a central theme in Byzantine and Russian iconography. Timeless and universal significance of this theme in art is emphasized primarily focusing on a detailed analysis of four key miraculous icons of the Mother of God: the Vladimir, Iveron, Donskoy, and Kazan icons. Historical origins, iconographic features, and role in the fate of Russia are examined for each icon. The article traces the profound spiritual connection between such images and national history, highlighting the moments when their intercession, according to believers, saved the country from enemy invasions and internal crises – from Tamerlane's invasion and liberation from the Mongol-Tatar yoke to the Time of Troubles, the Patriotic War of 1812, and the Great Patriotic War. The interaction between state and church is illustrated by examples of the icons transfer for public prayer and symbolic gestures of the Soviet government during the Great Patriotic War. The image of the Mother of God is an enduring symbol of maternal love, hope, and spiritual unity.