Objective: To evaluate estrogen and progesterone levels' impact and combined effects on clinical pregnancy rate and live birth rate in gonadotropin-releasing hormone antagonist regimen with fresh embryo transfer on human chorionic gonadotropin (hCG) trigger day. Methods: The data of patients who underwent in vitro fertilization or intracytoplasmic sperm injection at The First Affiliated Hospital of Nanjing Medical University from January 2011 to January 2021 were collected. According to the number of retrieved oocytes, they were divided into the normal response group (5-15 oocytes) and the low response group (<5 oocytes). The ovulation induction outcomes and pregnancy outcomes of the two groups were compared. Statistical analysis was conducted using t test or chi-square test, and confounding factors were adjusted through multivariate regression models, and the hormone cut-off values were determined. Results: Among 3 595 patients, compared with the normal response group (n=2 614), the age of women in the low response group (n=981) had a negative impact on pregnancy outcomes (P<0.001), while the number of antral follicles, anti-Müllerian hormone, endometrial thickness and embryo quality were positively correlated with pregnancy outcomes (all P<0.05). Multivariate regression analysis indicated that in the normal response group, a higher level of estradiol on hCG trigger day were significantly associated with decreases in clinical pregnancy rate (OR=0.965, 95%CI: 0.946-0.984; P<0.001) and live birth rate (OR=0.973, 95%CI: 0.954-0.993; P=0.008). In the low response group, higher progesterone level was associated with poorer pregnancy outcomes (clinical pregnancy rate: OR=0.875, 95%CI: 0.794-0.961, P=0.006; live birth rate: OR=0.876, 95%CI: 0.793-0.966, P=0.009). The hormone cut-off values: the estradiol cut-off values for the normal and low response groups were 14 000 pmol/L and 6 000 pmol/L respectively, and the progesterone cut-off values for the normal and low response groups were 5.8 nmol/L and 4.0 nmol/L. When hormone levels exceed the cut-off values, pregnancy outcomes significantly decline, and the negative impact on pregnancy outcomes was most significant when both hormones increase (clinical pregnancy rate: normal response group P=0.010，low response group P=0.020; live birth rate: normal response group P=0.028，low response group P=0.014). Conclusions: In patients with normal response, compared with progesterone on hCG trigger day, the increase in estradiol significantly reduces the clinical pregnancy rate and live birth rate of fresh embryo transfer, which should be paid attention to. In patients with poor response, both higher progesterone and estradiol levels on hCG trigger day could significantly reduce the clinical pregnancy rate and live birth rate of fresh embryo transfer, and the combined effect is more obvious. It is recommended that for patients whose progesterone and estradiol on the hCG day exceed the corresponding cut-off values, all embryos should be frozen and embryo transfer should be postponed.
Objective: To evaluate the clinical application value of practical clinical classification system for cesarean scar pregnancy (CSP). Methods: A total of 1 076 patients with CSP admitted to Peking University Third Hospital from January 2014 to December 2023 were retrospectively included in the study. According to the practical clinical classification system for CSP, the patients were divided into 5 groups (type Ⅰ, Ⅱa, Ⅱb, Ⅲa and Ⅲb). The clinical characteristics, diagnosis and treatment variance of different types of CSP patients were analyzed, and the treatment strategy recommended by this study was compared with that recommended by the practical clinical classification system. Results: The prevalence of type Ⅰ, Ⅱa, Ⅱb, Ⅲa and Ⅲb were 37.1% (399/1 076), 42.0% (452/1 076), 8.5% (91/1 076), 10.5% (113/1 076) and 2.0% (21/1 076), respectively. The median gestational age at diagnosis was 47 days, the median length of hospital stay was 2 days, the median hospitalization cost was 5 816 yuan, the median operation time was 36 minutes, the median intraoperative blood loss was 23 ml, and 5.6% (60/1 076) patients had intraoperative blood loss≥300 ml; 2.6% (28/1 076) patients received blood transfusion, 94.9% (1 021/1 076) patients underwent minimally invasive surgery. There were significant differences in the above indicators between the 5 groups (all P<0.05). The treatments of 86.0% (925/1 076) patients were consistent with the recommendations of the practical clinical classification system. There were 7.7% (83/1 076) patients had more minimally invasive treatment compared with the recommendations, all of which were type Ⅲ patients. There were 6.3% (68/1 076) patients had more invasive treatment compared with the recommendations, mainly were type Ⅱa, Ⅱb and Ⅲa patients. The first-line treatment was successful in 96.4% (1 037/1 076) patients. Conclusions: Practical clinical classification system for CSP has good discrimination and clinical applicability, and provides the principle of minimally invasive surgery. For the management of type Ⅲ patients, individualized evaluation should be carried out on the basis of flexible application of the practical clinical classification system, combined with the diagnosis and treatment conditions of medical institutions and the patient's condition.
Objective:To investigate the inhibitory effects of phloroglucinol on eutopic stromal cells and ectopic stromal cells from endometriosis and its molecular mechanism.Methods:The effect of phloroglucinol on the survival rate of endometriosis-derived eutopic stromal cells hEM15A and ectopic stromal cells ihESCs was detected by cell counting kit 8 method. The effect of phloroglucinol on cell migration were evaluated by scratch test and Transwell migration test. The level of reactive oxygen species (ROS) in cells was detected by the fluorescence probe method. The expression of nuclear factor erythroid 2-related factor 2 (NRF2), kelch like ECH associated protein 1 (KEAP1), glutathione peroxidase 4 (GPX4) proteins in KEAP1/NRF2/GPX4 pathway was detected by western blot.Results:(1) The results of cell counting kit 8 method showed that phloroglucinol significantly reduced the cell viability of hEM15A and ihESCs [(47.89±1.93)% and (81.55±6.16)% after treatment with 5.550 mmol/L for 48 hours, (18.44±6.64)% and (66.09±1.63)% after treatment with 5.550 mmol/L for 72 hours, (23.20±4.95)% and (51.05±7.16)% after treatment with 11.100 mmol/L for 48 hours, (3.62±0.23)% and (40.14±2.63)% after treatment with 11.100 mmol/L for 72 hours; all P<0.05]. (2) Scratch test results showed that the cell migration rates of hEM15A cells and ihESCs cells at 24 hours time points without phloroglucinol (0 mmol/L) were (41.02±2.85)% and (41.60±1.77)%, respectively. Compared with the 0 mmol/L group of the respective cells, the migration rates of hEM15A and ihESCs cells treated with different concentrations (2.775, 5.550, 8.325, 11.100, 13.875 mmol/L) of phloroglucinol at 24 hours were significantly decreased [hEM15A cells were (21.28±2.96)%, (9.97±3.42)%, (3.39±0.79)%, (3.26±0.47)% and (2.38±0.11)%, ihESCs cells were (20.31±2.17)%, (17.17±1.44)%, (3.68±0.94)%, (2.96±1.19)% and (2.57±0.43)%; all P<0.05]. (3) The results of Transwell migration test showed that the numbers of migrated hEM15A and ihESCs cells were 196.00±14.00 and 73.67±5.51, respectively, at 24 hours without phloroglucinol (0 mmol/L) treatment. Compared with the respective 0 mmol/L group of the respective cells, there were no significant changes in the numbers of migration of the two cells in the 2.775 mmol/L group at 24 hours (190.30±42.59 and 68.33±16.56, respectively; all P>0.05). After treatment with the remaining higher concentration of phloroglucinol, the migration ability of hEM15A and ihESCs cells were significantly reduced (hEM15A cells were 131.70±29.96, 117.70±4.51, 83.33±12.42 and 42.33±13.87, ihESCs cells were 42.33±8.51, 41.00±9.54, 18.33±7.37 and 15.67±2.52; all P<0.05). (4) The results of ROS level detected by the fluorescence probe method showed that there were no significant changes in ROS levels in hEM15A cells and ihESCs cells after treatment with 2.775 mmol/L phloroglucinol for 24 hours (1.21±0.12 and 1.16±0.11, respectively; all P>0.05). After treatment for 48 and 72 hours, the levels of ROS in the two kinds of cells were significantly increased (2.75±1.15 and 2.76±0.74 in hEM15A cells, 2.82±0.72 and 2.90±0.82 in ihESCs cells; all P<0.05). (5) Western blot results showed that the expressions of KEAP1 in hEM15A cells and ihESCs cells were significantly decreased after phloroglucinol treatment (0.34±0.16 and 0.33±0.08; all P<0.05), and the expressions of NRF2 and GPX4 were significantly up-regulated (hEM15A cells were 2.88±0.44 and 2.09±0.06, ihESCs cells were 3.43±0.49 and 1.73±0.14; all P<0.05). Conclusion:Phloroglucinol could affect the survival of eutopic stromal cells and ectopic stromal cells from endometriosis by inducing oxidative stress, and its mechanism may be related to the activation of KEAP1/NRF2/GPX4 pathway and the imbalance of redox homeostasis.
Objective:To evaluate the efficacy and safety of hexaminolevulinate photodynamic therapy (HAL-PDT) for the treatment of cervical intraepithelial neoplasia 2 (CIN2).Methods:Data of this study were derived from an international multicenter, randomized, double-blind, placebo-controlled phase Ⅲ clinical trial (the APRICITY study) conducted between October 2020 and July 2023, with medical records obtained from 61 medical centers across 7 countries. A subgroup analysis was performed in patients with histologically confirmed CIN2 from this trial. Participants were randomly assigned in a 2∶1 ratio to the HAL-PDT group [5% hexaminolevulinate ointment and a light-emitting diode (LED) light source device] or the placebo group (placebo ointment with a non-illuminating device). The primary endpoint was the response rate at 6 months after the initial treatment. Secondary endpoints included histological regression rate, high-risk human papillomavirus (HR-HPV) clearance rate. Safety endpoints included treatment-related adverse events (TRAEs).Results:A total of 182 patients with CIN2 were included (120 in the HAL-PDT group, 62 in the placebo group). Baseline characteristics were balanced between the two groups (all P>0.05). At 6 months, the response rate [49.2% (59/120) vs 22.6% (14/62), P=0.001] and histological regression rates [57.5% (69/120) vs 30.6% (19/62), P=0.001] in the HAL-PDT group were significantly higher than those in the placebo group. The colposcopic lesion clearance rate at 6 months was also higher in the HAL-PDT group than in the placebo group [60.6% (60/99) vs 32.7% (17/52), P=0.001]. The risk of disease progression was lower in the HAL-PDT group ( RR=0.55, 95% CI:0.29-1.06; P=0.068). Analyses stratified by age, HR-HPV infection status, region, and lesion size consistently demonstrated benefit in the HAL-PDT group regarding response and histological regression rates. At the 12-month follow-up, HR-HPV clearance rates in the HAL-PDT group were significantly improved, reaching 45.9% for any HR-HPV subtype, 58.8% for HPV 16, and 55.4% for HPV 16/18. There was no statistically significant difference in the incidence of TRAEs between the two groups [31.1% (37/119) vs 25.8% (16/62), P=0.496]. The most commonly reported adverse events in the HAL-PDT group were increased vaginal discharge, abdominal pain, and vulvovaginal pain, all of which were mild and self-limiting. Conclusion:HAL-PDT demonstrated favorable efficacy and safety in patients with CIN2, providing a non-surgical treatment alternative for patients seeking fertility preservation and the maintenance of cervical integrity.
Objective:To investigate the clinicopathological features, treatment strategies and long-term follow-up of ovarian juvenile granulosa cell tumor (JGCT), and to provide evidence for clinical accurate diagnosis and individualized treatment.Methods:The clinicopathological data of 18 patients with JGCT diagnosed by surgery in Obstetrics and Gynecology Hospital, Fudan University from February 2009 to July 2025 were collected, and their clinical features, pathological molecular characteristics and prognosis were descriptively analyzed.Results:The median age at diagnosis was 14 years (range: 5-30 years). Two patients (2/18) were prepubertal (<10 years), twelve (12/18) were pubertal (10-19 years), and four (4/18) were post-pubertal (≥20 years). The main clinical manifestations of 17 patients who were first diagnosed in our hospital were abnormal vaginal bleeding (8 cases, 8/17), abdominal pain and distension (6 cases, 6/17) and pelvic mass (3 cases, 3/17). Imaging examination showed that the median maximum diameter of the tumor was 10 cm (range: 5-37 cm), and ascites or pelvic effusion was present in 5 cases. Carbohydrate antigen 125 (CA 125) level was >35.0 kU/L in 7 cases. All patients underwent fertility-preserving surgery and were classified as International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ [stage Ⅰa in 10 cases (10/18); stage Ⅰc in 8 cases (8/18)]. Six patients received platinum-based adjuvant chemotherapy after surgery, including 5 cases of BEP regimen (bleomycin+etoposide+cisplatin) and 1 case of PVB regimen (cisplatin+vincristine+bleomycin). Pathological examination showed that the tumors were unilateral in all cases, 8 cases (8/18) on the left side and 10 cases (10/18) on the right side. Macroscopically, the tumors were predominantly solid or cystic-solid. Microscopically, the tumors were mainly manifested as diffuse lamellar or multinodular solid tumors with variable number and size of follicular structures, and the follicular cavity was filled with basophilic or eosinophilic secretion. The cytoplasm was abundant with variable mitotic figures. Immunohistochemical staining showed that more than one sex cord mesenchymal marker was positive in all cases, epithelial membrane antigen (EMA) was negative, and cell proliferation-associated nuclear antigen (Ki-67) index was 5%-60%. Molecular analysis identified wild-type FOXL2 and DICER1 hotspot mutations in seven cases. One patient with recurrence harbored a TP53 nonsense mutation and a CDKN2A missense mutation, confirming anaplastic JGCT. The median follow-up time was 75.6 months (range: 4.1-201.4 months). One patient (1/18) developed pelvic and abdominal metastasis 23 months after the initial surgery. Among the 6 patients with premenarche, 4 patients had regular menstruation after surgery, and the other 2 patients were still young. The menstruation of patients with irregular menstruation before operation returned to normal after surgery. Two cases gave birth successfully after surgery. One patient who developed the disease during pregnancy experienced menopause 12 years after surgery. Conclusions:JGCT primarily affects females under 30 years old, and most of them are FIGO stage Ⅰ low-grade malignant tumors. Fertility-sparing surgery is associated with favorable outcomes. Some tumors appear purely cystic, which can lead to misdiagnosis. Anaplastic JGCT, harboring TP53 mutations, demonstrates aggressive clinical behavior. A comprehensive diagnostic approach integrating pathology, immunophenotype, and molecular features is therefore essential to guide personalized treatment and follow-up.
Objective: To investigate the embryonic chromosomal status and pregnancy outcomes of carriers of chromosomal structural rearrangements undergoing preimplantation genetic testing for structural rearrangement (PGT-SR), and to analyze the influence of factors on PGT-SR results. Methods: A retrospective analysis was conducted on clinical data from 700 couples with chromosomal structural rearrangements [including reciprocal translocation (RecT), Robertsonian translocation (RobT), and inversion] who underwent PGT-SR at Northwest Women's and Children's Hospital between 2019 and 2024. A total of 3 471 blastocysts were biopsied. A control group of 261 couples (1 282 biopsied blastocysts) with normal karyotypes undergoing preimplantation genetic testing for monogenic disease (PGT-M) due to monogenic disorders, matched for female age during the same period, were selected. Differences in euploidy rates and pregnancy outcomes after PGT-SR were compared among different types of structural rearrangement carriers. Furthermore, factors such as carrier sex, female age, and chromosomal breakpoint location were analyzed on the influence of embryonic euploidy. Results: (1) No statistically significant differences were observed among the RecT, RobT, and inversion groups in terms of male age, female body mass index, smoking history of both partners, basal follicle stimulating hormone, antral follicle count, number of oocytes retrieved, mature oocytes, 2 pronucleus zygotes, blastocyst formation, or biopsiable blastocysts (all P>0.05). (2) Significant differences were found among the RecT, RobT, and inversion groups in euploidy rate, mosaic embryo rate, aneuploidy rate, and the rates of derivative, de novo, and mixed aneuploidies (all P<0.05). The RecT group had the lowest euploidy rate, while the inversion group had the highest. The mosaic embryo rate was relatively higher in the inversion group. No significant difference was observed in the rate of aneuploidies unrelated to parental structural rearrangements among the RecT, RobT, and inversion groups (P>0.05). (3) Subgroup analysis within the RobT group showed that when the male had normal chromosomes and the female was the carrier, the embryonic aneuploidy rate was significantly higher than when the female was normal and the male was the carrier (52.34% vs 39.66%; P<0.01). In the RecT and inversion groups, breakpoint location was not an independent risk factor for embryonic aneuploidy (P>0.05). (4) Multivariate analysis using generalized estimating equation logistic regression showed that the likelihood of obtaining a euploid blastocyst were significantly lower in the RecT and RobT groups compared to the PGT-M control group (aOR=0.278, 95%CI: 0.237-0.327, P<0.01; aOR=0.569, 95%CI: 0.467-0.693, P<0.01, respectively), whereas the inversion group was similar to the control group (aOR=1.080, 95%CI: 0.802-1.455; P=0.613). Compared with the RecT group, the likelihood of aneuploidies unrelated to parental structural rearrangements was similar in the RobT and inversion groups (aOR=0.914, 95%CI: 0.739-1.131, P=0.408; aOR=0.792, 95%CI: 0.578-1.085, P=0.146, respectively). (5) In euploid single blastocyst frozen embryo transfer cycles, no statistically significant differences were found among the RecT, RobT, and inversion groups in endometrial preparation protocol, endometrial thickness on transfer day, human chorionic gonadotropin positivity rate, clinical pregnancy rate, spontaneous miscarriage rate, ongoing pregnancy rate, or ectopic pregnancy rate (all P>0.05). Conclusions: The type of chromosomal structural rearrangement significantly affects the embryonic euploidy rate. Chromosomal structural rearrangements primarily affect the segregation of rearrangement-related chromosomes, with no significant impact on the ploidy status of unrelated chromosomes. Factors such as the sex of the rearrangement carrier and female age influence embryonic euploidy, with heterogeneity observed among different rearrangement types. No significant statistical differences in pregnancy outcomes are found after transplantation of euploid embryos selected by PGT-SR.
Objective: To investigate the clinicopathological features of fumarate hydratase (FH)-deficient uterine leiomyomas associated with germline mutations of FH gene, and to provide a basis for efficient screening of high-risk individuals with FH gene germline mutations. Methods: The clinical data of 126 patients with FH-deficient uterine leiomyoma diagnosed in Women's Hospital, Zhejiang University School of Medicine from January 2023 to November 2025 were collected and retrospectively analyzed. The diagnosis of FH-deficient uterine leiomyoma in all patients was confirmed by FH or 2-succinate-cysteine (2SC) immunohistochemistry. Peripheral blood or normal tissue samples of all patients were collected for FH gene germline mutation detection by high-throughput next-generation sequencing technology. Results: A total of 15.9% (20/126) of the patients with FH-deficient uterine leiomyoma carried pathogenic or likely pathogenic germline mutations of FH gene. Univariate analysis showed that younger age, previous myomectomy history, no history of childbearing, presence of multiple leiomyomas, especially, patients with multiple FH-deficient leiomyomas (≥2 FH-deficient leiomyomas) and multifocal FH-deficient leiomyomas (FH-deficient leiomyomas distributed in different parts of the uterus, cervix, broad ligament, etc.) were more likely to carry FH gene germline mutations (all P<0.001). The prediction model based on "age≤45 years" and "multiple FH-deficient leiomyomas" had good predictive efficacy (area under the curve was 0.869, sensitivity was 90.0%, and specificity was 86.8%). Conclusion: Integration of clinicopathological features including patient age, multiple and multifocal distribution of FH-deficient leiomyomas could effectively improve the identification of high-risk individuals for FH gene germline mutation, so as to provide a basis for the development of accurate genetic screening.
Objective: To analyze the clinical characteristics of pregnant women with different risk factors of Stanford type A aortic dissection (TAAD), so as to provide evidence for early warning and stratified management. Methods: A total of 42 pregnant or puerperal women with pregnancy-associated TAAD admitted to Beijing Anzhen Hospital, Capital Medical University from January 2010 to May 2026 were retrospectively enrolled. They were divided into three groups according to risk factors: Marfan syndrome (MF) group, hypertension (HBP) group, and non-identified high-risk factor (N) group before TAAD onset. The onset characteristics, aortic diameter and maternal-fetal outcomes were compared among the three groups. Results: All 42 patients with TAAD underwent aortic surgery, and 4 cases (10%, 4/42) died. The neonatal survival rate was 100% (26/26) in pregnant women with onset in the third trimester of pregnancy, while the fetal loss rate reached 6/9 in those with onset in the second trimester. Typical clinical symptoms, such as sudden severe tearing or knife-like chest and back pain, with or without radiating pain were observed in 74% (31/42) of patients. There were 10 cases (24%) in the MF group, 12 cases (28%) in the HBP group, and 20 cases (48%) in the N group. The median aortic root diameter was 38.5 mm (31.0, 48.3 mm) in the HBP group, which was significantly smaller than 51.5 mm (43.5, 63.5 mm) in the MF group and 50.5 mm (44.5, 67.0 mm) in the N group (all P<0.05). No statistically significant difference was detected between the MF group and the N group (P>0.05). In the HBP group, 6/12 of pregnant women had an aortic root diameter less than 40 mm, whereas all patients in the MF group and N group had an aortic root diameter of 40 mm or above. The mortality rates of TAAD in MF group, HBP group and N group were 1/12, 0/10 and 15% (3/20), respectively, and the live birth rates were 10/12, 10/11 and 71% (15/21), respectively, without statistically significant differences among groups (all P>0.05). Conclusions: Pregnancy-related TAAD is fundamentally based on underlying aortic structural abnormalities. Hypertension could lower the critical aortic diameter for dissection. Occult aortic lesions are common in TAAD patients without risk factors. It is suggested that aortic ultrasound screening should be advanced to pre-pregnancy or early pregnancy, and more active monitoring and intervention strategies should be taken for hypertensive patients with aortic lesions.
Objective: To investigate the molecular mechanism of long intergenic non-protein coding RNA, regulator of reprogramming (Linc-ROR) in regulating the stemness of cancer stem cells in hypoxic microenvironment. Methods: A2780 cells were induced into ovarian cancer stem-like cells (OCS-LC) by sphere formation assay and identified by differentiation assay and flow cytometry analysis. Knockdown or overexpression of Linc-ROR, microRNA (miR)-181c-5p, and simultaneous knockdown or simultaneous overexpression of Linc-ROR and miR-181c-5p were constructed in OCS-LC cell lines. The mRNA levels were detected by quantitative reverse transcription PCR (RT-qPCR). Western blot was used to detect the stemness related octamer-binding transcription factor 4 (Oct-4) and Nanog homeobox transcription factor (Nanog). The protein expression levels of E-cadherin, Vimentin related to epithelial-mesenchymal transition (EMT) and hypoxia inducible factor-1α (HIF-1α) were also detected. Cell counting kit-8 (CCK-8), colony formation assay and transwell chamber assay were used to detect the effects of different factors on cell proliferation, invasion and other malignant biological behaviors. A subcutaneous xenograft model was constructed to explore the effect of Linc-ROR on the tumorigenicity of OCS-LC in vivo. Results: A2780 cells were successfully induced into OCS-LC. Flow cytometry analysis showed that the positive expression rate of CD133 on the surface of OCS-LC was significantly higher than that of A2780 cells (P<0.05). The results of dual luciferase reporter assay showed that there was a targeted binding site between Linc-ROR and miR-181c-5p. Under hypoxic condition, overexpression of Linc-ROR or knockdown of miR-181c-5p increased OCS-LC spheroid formation rate, shortened spheroid formation cycle, longer maximum spheroid diameter, and increased relative expression of Oct-4, Nanog, HIF-1α and Vimentin proteins compared with control group; the relative expression of E-cadherin protein was decreased, and the proliferation, invasion and metastasis ability of OCS-LC were enhanced (all P<0.05). However, knockdown of Linc-ROR or overexpression of miR-181c-5p showed opposite experimental results (all P<0.05). Simultaneous knocking down of Linc-ROR and miR-181c-5p or simultaneous overexpressing of Linc-ROR and miR-181c-5p could reverse the above biological effects of knocking down or overexpressing Linc-ROR. The results of animal experiments showed that overexpression of Linc-ROR enhanced the tumorigenic ability of OCS-LC in vivo. At the same time, the expression levels of Nanog, Oct-4, HIF-1α and Vimentin were increased, and the expression level of E-cadherin was decreased in transplanted tumor tissues (all P<0.05). Knockdown of Linc-ROR showed the opposite results (all P<0.05). Conclusion: Under hypoxia, Linc-ROR negatively regulates the expression of miR-181c-5p and upregulates the expression of HIF-1α to promote the stemness of OCS-LC and activate EMT, which may be one of the important mechanisms of Linc-ROR promoting the proliferation, invasion and metastasis of tumor cells.
自发性早产指在无医疗干预情况下自然发生的早产，是新生儿死亡及长期健康问题的主要诱因之一。准确预测自发性早产对临床干预和改善母儿预后具有重要意义。目前，妊娠中期超声测量子宫颈长度是预测自发性早产的主要手段，但其敏感度较低。近年来，医学影像与人工智能的深度融合为自发性早产预测开辟了新路径，尤其是基于子宫颈超声图像的影像组学分析。本文系统综述影像组学概念及其在子宫颈纹理分析中的应用基础，总结传统机器学习及深度学习模型在自发性早产预测中的研究现状及局限，归纳模型关注的解剖学新征象，并从研究设计、临床应用和技术转化三个层面提出展望，旨在为构建更高效的自发性早产预测模型提供支撑。
Objective: To analyze the epidemiological characteristics and long-term trends of women's genital prolapse in China. Methods: The data of the incidence and prevelence of genital prolapse in China in Global Burden of Disease 2023 were collected. The time trend analysis was performed using Joinpoint regression model to calculate annual percent change and average annual percent change (AAPC) of standardized incidence and prevalence. The age-period-cohort model was used to investigate the effects of age, period and birth cohort on the disease burden. Results: From 1990 to 2023, the absolute number of incident and prevalent cases of genital prolapse among Chinese women increased significantly (by 111.07% and 126.06%, respectively). However, the age-standardized incidence rates and age-standardized prevalence rates decreased respectively (AAPC=-0.47% and -0.52%, respectively). The age-period-cohort model analysis showed that: (1) the age-effect showed an increasing trend in the risk of genital prolapse incidence and prevalence (all P<0.05), expecially growing rapidly after 40 years old and 80 years old; (2) the period-effect indicated an increasing trend in the risk of genital prolapse incidence and prevalence over time (all P<0.05); (3) the cohort-effect demonstrated that compared to those born in earlier cohorts, women born in more recent cohorts had a significantly lower risk of genital prolapse (all P<0.05). Conclusions: Although the age-standardized incidence rates and age-standardized prevalence rates of genital prolapse among Chinese women have declined, the absolute number of cases and the disease burden continue are increasing. In response to the public health challenges presented by genital prolapse, the women aged 45 and above should be the focus of future genital prolapse prevention and control efforts, strengthened early screening and health management.
葡萄胎是一种良性妊娠滋养细胞疾病，主要表现为胎盘滋养细胞异常增殖和绒毛水肿变性，有进展为恶性妊娠滋养细胞肿瘤的潜能，并存在一定的复发概率，严重威胁患者的生殖健康。辅助生殖技术（ART）治疗妊娠后葡萄胎的发病率较自然妊娠显著降低，但目前关于ART预防葡萄胎发生的作用机制及核心调控环节尚未明确，很大程度限制了ART在葡萄胎预防上的推广应用。对于有生育需求的葡萄胎患者，尤其是复发性葡萄胎（RHM）患者，如何应用ART避免葡萄胎的再次发生，成为生殖医学领域亟待解决的问题之一。本综述立足于葡萄胎的发病机制及遗传学特点，系统阐述显微镜下胚胎观察、卵母细胞胞质内单精子注射法和胚胎植入前遗传学检测在葡萄胎的预防中的应用价值及局限性，并深入探讨ART在RHM患者临床管理中的应用策略。
Objective: To investigate the clinical efficacy and safety of hysteroscopy combined with ultrasound or laparoscopy in the treatment of angular pregnancy. Methods: The clinical and pathological data of 22 patients with angular pregnancy who were treated at Fu Xing Hospital, Capital Medical University from January 2008 to June 2025 were retrospectively analyzed. According to the type of angular pregnancy, minimally invasive surgery was performed using hysteroscopy combined with ultrasound or laparoscopy. Operative time, intraoperative blood loss and therapeutic outcomes were assessed. Results: A total of 12 patients with type Ⅰ angular pregnancy underwent hysteroscopic surgery under ultrasound monitoring. The median operative time was 26.5 minutes, and the median intraoperative blood loss was 5.0 ml, and no residual tissue. Ten patients with type Ⅱ angular pregnancy underwent hysteroscopic surgery combined with laparoscopy, including 8 cases of hysteroscopic surgery under laparoscopic monitoring, one case of hysteroscopy combined laparoscopic cornuostomy, and one case of hysteroscopy combined laparoscopic wedge resection of the uterine horn. The median operative time was 64.5 minutes, and the median intraoperative blood loss was 15.0 ml; complete removal of gestational tissue was achieved in 10 cases. All surgeries were completed successfully without perioperative complications. Follow-up at 4 and 8 weeks postoperatively revealed no residual gestational tissue or other complications in any patient. Conclusions: Hysteroscopy combined with ultrasound or laparoscopy for angular pregnancy demonstrates favorable clinical efficacy and safety. However, strict case selection is essential, and surgical strategies should be flexibly tailored based on imaging characteristics and intraoperative assessment.
卵巢恶性生殖细胞肿瘤（MOGCT）是一种罕见的卵巢恶性肿瘤，好发于青少年及年轻女性。多数患者诊断时为早期，治疗依靠手术和辅助化疗。MOGCT患者对以顺铂为基础的化疗高度敏感，预后相对良好，由于患者年龄段特殊，保留患者的生育力和器官功能已成为当代MOGCT治疗的核心目标之一。本文综述了MOGCT诊治的最新进展，重点探讨了基于改良的国际生殖细胞癌协作组（mIGCCCG）风险分层模型的治疗策略优化，旨在对低危患者减少辅助治疗以降低长期毒性，对高危患者确保充分治疗。文章还分析了儿童与成人患者治疗理念的差异，强调了手术范围（如淋巴结清扫的必要性）的争议以及新辅助化疗在特定晚期患者中的应用。随着治愈率的提高，长期幸存者的远期并发症管理日益重要。未来，通过多学科团队协作和个体化风险分层，在保持高治愈率的同时改善患者长期生命质量是MOGCT管理的核心方向。
Objective: To determine whether intravenous drip of water-soluble vitamin for injection can serve as an effective, reliable, economical, convenient and rapid biomarker for assessing ureteral patency during cystoscopy in patients undergoing transvaginal high uterosacral ligament suspension (TVHUS). Methods: During transvaginal reconstructive pelvic surgery, 20 ml of water-soluble vitamin for injection was administered intravenously 10-15 minutes prior to cystoscopy following completion of high uterosacral ligament suspension, accompanied by intravenous infusion of 20 mg furosemide. The administration time, as well as the start and end times of cystoscopy, were recorded, along with the duration required for ureteral urine staining. Results: From March 2005 to March 2025, over the past 20 years, the Fourth Medical Center, Chinese PLA General Hospital has performed a total of 1 825 TVHUS. 10 to 15 minutes before the scheduled cystoscopy during the operation, water-soluble vitamin for injection was intravenously dripped. Under the condition of ensuring the fluid balance throughout the patient's body, yellowing of urine was observed under cystoscopy in all cases, confirming the patency of ureter during the operation. In 1 808 cases (99.07%, 1 808/1 825), bilateral ureters were observed to spray urine during intraoperative cystoscopy. In 17 cases, only one ureter was observed to spray urine during intraoperative cystoscopy. Among them, 3 cases were caused by atrophy of one kidney, and the affected ureter had no spray urine. The remaining 14 cases (0.77%, 14/1 825) were considered to be caused by ureteral obstruction or distortion during the suture of the uterosacral ligament during the operation; after the uterosacral ligament suture was immediately removed and re-sutured, cystoscopy was performed again and it was found that the bilateral ureters sprayed urine smoothly. Conclusions: Water-soluble vitamin for injection represents a safe, effective, and cost-efficient approach that enhances cystoscopic visualization of ureteral patency during TVHUS, thereby reducing the incidence of intraoperative ureteral obstruction. This method is worthy of widespread adoption.
Objective: To explore the clinical features and diagnostic key points of gynecological malignancies complicated with paraneoplastic syndrome (PS). Methods: A retrospective analysis was conducted on the clinical data of 10 patients with gynecological malignancies complicated with PS admitted at Peking University People, Hospital from January 2016 to June 2025. The pathological types, stages of tumors, manifestations of PS, treatment and prognosis of primary tumors and PS were analyzed. The outcomes were evaluated through telephone follow-up. Results: (1) Tumor pathological types: ovarian malignant tumors were the most common (7 cases). Among them, 2 out of 3 patients with high-grade serous carcinoma presented with neurological PS, 2 out of 3 patients with clear cell carcinoma had hypercalcemia-type PS. In addition, 3 cases were other types of gynecological malignant tumors, including 1 case each of pelvic malignant tumor (not surgically treated, likely originating from the uterus), vulvar malignant tumor, and endometrial stromal sarcoma. (2) Types of PS: involving the nervous system (3 cases), metabolic disorders (3 cases, all with hypercalcemia), immune system (3 cases), and respiratory system (1 case). (3) Temporal relationship: PS was discovered simultaneously with the tumor in 4 cases, PS preceded the tumor in 3 cases, and PS occurred within 5 years after surgery in 3 cases. (4) Prognosis: 3 cases survived with the disease, 4 cases died, and 3 cases were lost to follow-up. Conclusions: Patients with advanced ovarian malignant tumors are a high-risk group for PS. High-grade serous carcinoma is prone to be complicated by neurological damage of PS; clear cell carcinoma is prone to be complicated by hypercalcemia of PS, which is often a manifestation in the terminal stage of the tumor; for immune system damage of PS, it is associated with a wide spectrum of gynecological malignancies and is more common in patients with recurrence and metastasis.
Objective: To evaluate the efficacy and safety of laser therapy in human immunodeficiency virus (HIV)-negative women with high-grade anal intraepithelial neoplasia (HGAIN). Methods: This study was a retrospective clinical study. HIV-negative patients who were first diagnosed with HGAIN in Obstetrics and Gynecology Hospital of Fudan University from January 2021 to June 2025 were included. All patients received CO₂ laser therapy at intervals of 4-6 weeks, for a maximum of four sessions. Treatment response was assessed 4-6 weeks after the final session via high-resolution anoscopy (HRA). Patients who achieved complete remission (CR) began follow-up at 6 months post-treatment, with subsequent surveillance including cytology, human papillomavirus (HPV) testing, HRA, and biopsy (if indicated) every 6-12 months to monitor recurrence. Results: A total of 64 patients were included, with a median age of 47.5 years (range: 25.0-68.0 years). Comorbid immune system diseases were found in 38% (24/64) of patients, HPV 16/18 infection rate was 70% (45/64), and 70% (45/64) had a lesion area≤50%. Eleven patients were lost to follow-up, and 53 patients were finally included in the efficacy analysis. The CR rate of laser therapy was 85% (45/53). Compared with the CR group, patients with persistent lesions were older (median age: 37.0 vs 52.5 years, P=0.028) and had a higher proportion of lesions>50% [22% (10/45) vs 5/8, P=0.033]. Among 45 patients with CR, the median follow-up was 11 months (range: 6-46 months), the recurrence rate was 40% (18/45), and the 1-year recurrence-free survival rate was 67.7%. Comorbid immune system disease was an independent risk factor for recurrence (HR=6.513, 95%CI: 1.866-22.735, P=0.003). The incidence of treatment-related adverse events was 64% (34/53), all of which were mild, mainly anal pain or discomfort (40%, 21/53) and mild bleeding (32%, 17/53), with no severe complications. Conclusions: CO₂ laser therapy is an effective and well-tolerated treatment for HGAIN in HIV-negative women, yielding a high CR rate and a favorable safety profile. Comorbid immune system disease is an independent risk factor for post-treatment recurrence, highlighting the need for enhanced follow-up and individualized management in these patients.
Objective: To investigate the effect of gestational weight gain (GWG) on the incidence of pre-eclampsia (PE) and to establish an ideal GWG range for preventing PE based on pre-pregnancy body mass index (BMI) stratification. Methods: The clinical data of 87 109 singleton pregnant women who delivered in Women's Hospital, Zhejiang University School of Medicine from January 2017 to December 2022 were retrospectively analyzed. Pregnant women were divided into PE group (n=2 900) and non-PE group (n=84 209) according to the presence or absence of PE. Pregnant women with severe PE (sPE) in the PE group were divided into sPE subgroup (n=1 376). Pregnant women were stratified into three groups according to their pre-pregnancy BMI: non-overweight/obesity, overweight and obesity. Multivariate logistic regression was used to analyze the effect of pre-pregnancy BMI on PE. Restricted cubic spline (RCS) model was used to fit the dose-response curve, and the relationship between the deviation of GWG from the recommended midpoint of the "Recommendations for Gestational Weight Gain in Pregnant Women (WS/T 801-2022)" and the incidence of PE was analyzed. The ideal GWG range for preventing PE in each pre-pregnancy BMI stratification was also inferred. Results: (1) In the non-PE group, the proportions of non-overweight/obesity, overweight and obesity were 87.07% (73 322/84 209), 11.18% (9 412/84 209) and 1.75% (1 475/84 209), respectively. In the PE group, the non-overweight/obesity, overweight and obesity accounted for 63.14% (1 831/2 900), 26.10% (757/2 900) and 10.76% (312/2 900), respectively. In the sPE subgroup, non-overweight/obesity, overweight and obesity accounted for 65.77% (905/1 376), 24.13% (332/1 376) and 10.10% (139/1 376), respectively. Compared with the non-PE group, the PE group and the sPE subgroup had a significantly higher proportion of pre-pregnancy overweight and obesity (all P<0.001). (2) After adjusting for covariates, the risk of PE in both overweight (aOR=2.49, 95%CI: 2.25-2.76) and obesity (aOR=5.57, 95%CI: 4.80-6.47) group was significantly higher than that in non-overweight/obesity group (all P<0.001). (3) RCS curve analysis showed that the risk of PE in pregnant women with different pre-pregnancy BMI levels increased in a dose-dependent manner with the deviation value of GWG. (4) The optimal GWG for PE prevention was generally located in the lower part of the recommended range of WS/T 801-2022 standard. The suggested GWG for non-overweight and obese pregnant women, overweight and obese pregnant women were 8.6-12.5 kg, 4.0-7.5 kg and 3.0-4.3 kg, respectively. Conclusion: Pre-pregnancy overweight or obesity significantly increased the risk of PE. It is suggested that the ideal GWG range for PE prevention should be controlled at the lower end of the recommended range of WS/T 801-2022 standard. Women who are overweight or obese before pregnancy should adopt more conservative weight management strategies to reduce the risk of PE.
