BACKGROUND:The onset of arrhythmia during pregnancy has been noted as a significant issue in clinical management of adult congenital heart disease. The authors sought to examine the actual incidence of arrhythmias in CHD patients during pregnancy, as well as to distinguish prognostic predictors of arrhythmia in CHD pregnant patients, specifically focusing on the predictive value of echocardiographic parameters. METHODS:This retrospective study involved 244 pregnant patients with CHD in a tertiary hospital. Baseline characteristics and clinical presentation were systemically compared between the arrhythmia group and no arrhythmia group. Univariate analyses were performed to identify baseline characteristics and hemodynamic parameters associated with outcomes. Subsequent multivariate logistic regression model identified the adjusted odds ratio (aOR) and 95% CI to pinpoint the independent risk factors of arrhythmia in CHD pregnancy. RESULTS:The prevalence of arrhythmia in CHD patients during pregnancy was 17.6% (43/244). The arrhythmia group had more parity than the no arrhythmia group (0.72 vs 0.43, p = 0.010). Compared with the no arrhythmia group, the arrhythmia group's QRS duration was longer (105.1 ± 24.7 vs 93.6 ± 18.1 ms, p = 0.001). Patients with arrhythmia had both larger atrium size than patients without arrhythmia (right atrium: 51.0 ± 9.1 vs 47.4 ± 7.0 mm, p = 0.005; left atrium: 38.8 ± 7.6 vs 34.4 ± 4.8 mm, p = 0.000) respectively. Left ventricle end systolic volume in CHD patients with arrhythmia were considered larger than those without arrhythmia (29.9 ± 6.7 vs 27.7 ± 4.0 mm, p = 0.007), while not in left ventricle end diastolic volume (46.6 ± 9.2 vs 44.7 ± 5.2 mm, p = 0.067). The arrhythmia group were more likely to be presented with atrioventricular valve regurgitation (53.5% vs 15.4%, p = 0.000) than the no arrhythmia group. Multivariate logistic regression identified parity (aOR:1.895[95%CI: 1.033-3.478]), left atrium size (aOR:1.089[95%CI: 1.008-1.175]), and moderate atrioventricular valve regurgitation (aOR:3.317[95%CI: 1.272-8.647]) as independent contributors for arrhythmia during CHD pregnancy. CONCLUSION:Early identification of risk factors that may predispose to arrhythmias favorably impacts long-term arrhythmia incidence and maternal neonatal outcome.

BackgroundEndometriosis, a prevalent chronic gynecological condition, is frequently associated with infertility and pelvic pain. Despite numerous studies indicating a correlation between epigenetic regulation and endometriosis, its precise genetic etiology remains elusive. Methyltransferase-like 14 (METTL14), a crucial component of the N6-methyladenosine (m6A) RNA methyltransferase complex and an RNA binding scaffold, is known to play a pivotal role in various human diseases. The possibility that single nucleotide polymorphisms (SNPs) in the METTL14 gene contribute to susceptibility of endometriosis has not been thoroughly investigated.MethodsWe assessed the genotype frequencies of five potential functional METTL14 SNPs (rs298982 G>A, rs62328061A>G, rs9884978G>A, rs4834698C>T, and rs1064034A>T) in a Chinese population consisting of 458 patients with ovarian endometriosis and 462 healthy controls. We employed unconditional logistic regression and stratified analyses to evaluate their genotypic associations with the risk of ovarian endometriosis.ResultsAmong the five SNPs examined, we found that the rs298982 A allele was significantly associated with increased risk, whereas the rs62328061 G allele was linked to a decreased risk of ovarian endometriosis. Individuals harboring two unfavorable genotypes demonstrated a significantly elevated risk of ovarian endometriosis (adjusted odds ratio (AOR) = 1.57, 95% confidence interval (CI) = 1.16–2.13, P = 0.004) compared with those with no risk genotypes. Stratified analysis revealed the risk effect of rs298982 GA/AA genotypes in the gravidity≤1, parity≤1, rASRM stage I, and rASRM stage II + III + IVsubgroups. Haplotype analysis showed that individuals with the GATAA haplotype were at higher risk of ovarian endometriosis (AOR = 5.54, 95% CI = 1.63–18.87, P = 0.006), whereas the AGTTG haplotype exhibited protective effects (AOR = 0.55, 95% CI = 0.31–0.97, P = 0.039) compared with wild-type GACAG haplotype carriers. Additionally, Bayesian false discovery probability and false positive report probability analysis confirmed the robustness of the significant findings. Expression quantitative trait loci analysis revealed a significant association between the rs9884978 GA/AA genotypes and elevated METTL14 mRNA levels in fibroblasts and adrenal gland. Conversely, the rs298982 GA/GG genotypes were significantly associated with reduced METTL14 mRNA levels in the nucleus accumbens and frontal cortex.ConclusionOur results demonstrate that METTL14 polymorphisms are associated with susceptibility to ovarian endometriosis among Chinese women.

目的 总结分析腹膜后妊娠的临床表现、诊断、治疗及预后等,从而为临床诊治提供参考.方法 利用PubMed数据库、万方数据库及中国期刊全文数据库检索关于腹膜后妊娠的所有文献报道.通过阅读全文,总结分析腹膜后妊娠的临床表现及诊断方法,并重点探讨其治疗与预后.结果 共收集到文献报道42篇,腹膜后妊娠43例,46.2％的患者有输卵管妊娠史,76.7％的患者为自然妊娠,就诊时的平均停经天数为53.6 d.阴道流血和腹痛是腹膜后妊娠的主要症状,其中以腹痛最常见(62.8％).超声是诊断腹膜后妊娠的主要方法,初诊时仅有30.2％的患者被诊断为腹膜后妊娠,有30.2％的患者被误诊并进行了不必要的有创性治疗.腹膜后妊娠的妊娠部位复杂多变,可简单将其分为盆腔段腹膜后妊娠型和腹腔段腹膜后妊娠型.由于术前误诊,有34.9％的腹膜后妊娠患者经历了两次手术.除2例患者采用了妊娠囊内局部甲氨蝶呤注射外,其余41例均进行了手术治疗,所有患者均预后良好.结论 腹膜后妊娠是一种罕见的异位妊娠,由于认识不足,临床误诊率、误治率高.诊断腹膜后妊娠的关键是考虑到腹膜后妊娠的可能以及检查时的扫描野能够涵盖到妊娠部位.妊娠囊内甲氨蝶呤注射及手术切除是治疗腹膜后妊娠的有效方法.

Background: Endometriosis is a common chronic gynecologic disorder with a significant negative impact on women’s health. Wilms tumor 1-associated protein (WTAP) is a vital component of the RNA methyltransferase complex for N6-methyladenosine modification and plays a critical role in various human diseases. However, whether single nucleotide polymorphisms (SNPs) of the WTAP gene predispose to endometriosis risk remains to be investigated.Methods: We genotyped three WTAP polymorphisms in 473 ovarian endometriosis patients and 459 control participants using the Agena Bioscience MassArray iPLEX platform. The logistic regression models were utilized to assess the associations between WTAP SNPs and the risk of ovarian endometriosis.Results: In the single-locus analyses, we found that the rs1853259 G variant genotypes significantly increased, while the rs7766006 T variant genotypes significantly decreased the association with ovarian endometriosis risk. Combined analysis indicated that individuals with two unfavorable genotypes showed significantly higher ovarian endometriosis risk (adjusted OR = 1.71 [1.23–2.37], p = 0.001) than those with zero risk genotypes. In the stratified analysis, the risk effect of the rs1853259 AG/GG and rs7766006 GG genotypes was evident in subgroups of age ≤30, gravidity≤1, parity≤1, rASRM stage I, and the rs7766006 GG genotype was associated with worse risk (adjusted OR = 1.64 [1.08–2.48], p = 0.021) in the patients with rASRM stage II + III + IV. The haplotype analysis indicated that individuals with GGG haplotypes had a higher risk of ovarian endometriosis than wild-type AGG haplotype carriers. Moreover, false positive report probability and Bayesian false discovery probability analysis validated the reliability of the significant results. The quantitative expression trait loci analysis revealed that rs1853259 and rs7766006 were correlated with the expression levels of WTAP.Conclusion: Our findings demonstrated that WTAP polymorphisms were associated with susceptibility to ovarian endometriosis among Chinese women.

尿失禁(urinary incontinence,UI),即不随意性漏尿,是全球女性面临的一个普遍且重要的问题[1].虽然目前有许多有效治疗女性UI的传统保守措施,但是没有条件的女性UI患者无法获得相关的治疗[2].

Abstract Background: Endometrial cancer (UCEC) is a prevalent malignancy in the field of gynecology worldwide. The development of UCEC involves various factors including tumor mutation burden (TMB) and the infiltration of immune cells. Nonetheless, our understanding of the precise impact of these immune cells on both anti-cancer immunity and the pathogenesis of endometrial cancer remains limited. Methods: In this study, we utilized a two-sample Mendelian randomization (MR) analysis to validate the causal relationship between immune cell markers and the risk of endometrial cancer. By employing publicly available genetic data, we thoroughly examined potential associations between 731 immune cell markers and the risk of endometrial cancer. Twenty-two million variants were identified from 731 immune cell signatures in 3,757 Sardinians, which were classified as median fluorescence intensity (MFI), relative cell count (RC), absolute cell count (AC), and morphological parameter (MP).In order to ensure the dependability and robustness of our findings, we performed a comprehensive sensitivity analysis to assess both heterogeneity and horizontal pleiotropy. Findings: In this investigation, the impact of endometrial cancer on immune phenotypes was explored using a two-sample casual analysis method, primarily employing the IVW technique. To ensure the reliability of the results, adjustments were made for multiple testing using the FDR approach. A total of 9 immunophenotypes were identified as being linked to the risk of endometrial cancer. Various validation methods, such as the MR-Egger method and the MR-ESTO method, were employed to verify these findings. Among the identified immune phenotypes, 4 were associated with an increased risk of endometrial cancer. These included SSC-A on HLA DR+ CD4+ T cell( β=1.054, 95% CI=1.004~1.107, P=0.034, PFDR = 0.050)、CD14- CD16- Absolute Count (β=1.006, 95% CI=1.000~1.012, P=0.036, PFDR = 0.049)、CD20 on IgD- CD24- B cell(β=1.042, 95% CI=1.008~1.076, P=0.014, PFDR = 0.047)、CD11c+ monocyte %monocyte(β=1.072, 95% CI=1.017~1.129, P=0.009, PFDR = 0.047). Notably, the association between CD11c+ monocyte %monocyte and the risk of endometrial cancer was particularly pronounced, with a 7.2% increase. On the other hand, 5 immune phenotypes showed a reduced risk of endometrial cancer, including CD25++ CD4+ T cell %T cell(β=0.095, 95% CI=0.913~0.999, P=0.047, PFDR = 0.049), CD27 on unswitched memory B cell(β=0.960, 95% CI=0.921~1.000, P=0.049, PFDR = 0.049), HLA DR on B cell(β=0.966, 95% CI=0.939~0.994, P=0.017, PFDR = 0.047), CD39+ CD4+ T cell %CD4+ T cell(β=0.956, 95% CI=0.917~0.997, P=0.035, PFDR = 0.049). While CD14- CD16- Absolute Count and CD25++ CD4+ T cell %T cell exhibited statistical significance, their effect sizes may not be substantial. Interestingly, CD27 on unswitched memory B cell displayed pleiotropic forms and biased estimates, ruling out the presence of horizontal pleiotropy and enhancing the credibility of the results. Conclusion: This research provides genetic evidence that supports the strong connection between immune cells and endometrial cancer, contributing to a deeper comprehension of the disease's pathogenesis.

Objective: To elucidate clinical characteristics and build a prognostic nomogram for patients with vulvar cancer. Methods: The study population was drawn from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly assigned to training and validation sets. Cox proportional hazards model and competing risk model were used to identify the prognostic parameters of overall survival (OS) and cancer-specific survival (CSS) to construct a nomogram. The nomogram was assessed by concordance index (C-index), area under the curve (AUC), calibration plot, and decision curve analysis (DCA). Results: A total of 20,716 patients were included in epidemiological analysis, of whom 7,025 patients were selected in survival analysis, including 4,215 and 2,810 in training and validation sets, respectively. The multivariate Cox model showed that the predictors for OS were age, marital status, histopathology, differentiation and tumor node metastasis (TNM) stages, whether to undergo surgery and chemotherapy. However, the predictors for CSS were age, race, differentiation and TNM stages, whether to undergo surgery and radiation. The C-index for OS and CSS in the training set were 0.76 and 0.80. The AUC in the training set for 1-, 3-and 5-year OS and CSS were 0.84, 0.81, 0.80 and 0.88, 0.85, 0.83, respectively, which was similar in the validation set. The calibration curves showed good agreement between prediction and actual observations. DCA revealed that the nomogram had a better discrimination than TNM stages. Conclusions: The nomogram showed accurate prognostic prediction in OS and CSS for vulvar cancer, which could provide guidance to clinical practice.

We appreciate the article by Tangren et al.1 and read it with great interest. The authors conducted a large, retrospective cohort study of 462,053 women with 565,907 pregnancies. The study found that low eGFR with concurrent proteinuria was associated with increased risk of adverse pregnancy outcomes. We congratulate the authors for the successful article and would like to make some comments. First, previous studies have shown that CKD was associated with a higher risk of adverse pregnancy outcomes,2 and this study yielded a similar conclusion with various categories of eGFR and proteinuria. Of note, in clinical practice, many women often consult about the effect of renal function on pregnancy outcomes, especially in women with abnormally elevated serum creatinine (SCr) or eGFR <60 ml/min per 1.73 m2. They are mainly concerned about two issues. First, what effect a low eGFR will have on pregnancy outcomes? Second, whether pregnancy will accelerate the progression of kidney disease? However, this article only focused on the first question. Much of the previous literature3 about the second issue indicated that women with preexisting kidney disease risked more rapid progression to kidney failure or eGFR decline if they became pregnant. However, these studies were single-center or case reports with less number of participants. Thus, it is still necessary to clarify the association of pregnancy with the progression of CKD using a large cohort. Second, although the outcome of AKI was rare in women with advanced CKD in this study, we still cannot ignore it. We should pay attention not only to preconception kidney function but also to changes in SCr levels during pregnancy. Glomerular hyperfiltration is a typical physiological adaptation to early pregnancy, and consequently, SCr concentrations decline in the first trimester, plateau in the second, and increase in the third trimester.4 Although creatinine-based equations used to estimate GFR accurately reflect the physiological changes in renal function during pregnancy, Kidney Disease Improving Global Outcomes criteria for AKI may miss some cases. Creatinine values in the third trimester that are modestly elevated from the baseline may reflect a substantial fall in GFR from the normal expected level of hyperfiltration. It is possible, but unknown, whether cystatin-C–based eGFR estimation will be useful in this setting. In addition, to date, it is still unknown whether AKI onset during pregnancy has a poor prognosis for the newborn. In summary, we constantly obtain new evidence regarding the relationship between renal function and maternal/fetal outcomes, but we still face challenges.

Abstract Background: Metabolic dysregulation is a hallmark of cancer. However, evidence of a causal relationship between circulating metabolites and the promotion or prevention of colorectal cancer (CRC) is still lacking. We conducted a two-sample Mendelian Randomization (MR) analysis to assess the causal relationship between 1,400 genetically proxied blood metabolites and endometrial cancer. Methods: We extracted metabolite level data from 8,299 participants in the Canadian Longitudinal Study on Aging (CLSA) and conducted a genome-wide association study (GWAS). This study involved 1,091 metabolites and 309 metabolite ratios. We utilized the ebi-a-GCST006464 dataset from the GWAS Catalog database for endometrial cancer. This dataset covered the European population, with 12,906 cases of endometrial cancer and 108,979 controls for preliminary analysis. The primary method for causal analysis was the Inverse Variance Weighted (IVW) method, supplemented by M-R-Egger and weighted median analysis. To validate the robustness, heterogeneity, and pleiotropy of the results, we conducted comprehensive sensitivity analyses, including the Cochran Q test, MR-Egger intercept test, radial MR, and leave-one-out analysis. For the final identification of metabolites, we also performed linkage disequilibrium score regression and colocalization analysis. Results: The results of this study indicated significant associations between nine metabolites and endometrial cancer. These include: 5alpha-androstan-3alpha,17beta-diol monosulfate (1) levels (Odds Ratio [OR] 1.15, 95% Confidence Interval [CI]: 1.09-1.20, p=1.34×10−8), 5alpha-androstan-3beta,17beta-diol monosulfate (2) levels (OR 1.18, 95% CI: 1.08-1.29, p=6.46×10−7), Androstenediol (3beta,17beta) disulfate (1) levels (OR 1.23, 95% CI: 1.12-1.36, p=3.01×10−5), Hexadecanedioate (C16-DC) levels (OR 1.12, 95% CI: 1.06-1.19, p=8.43×10−5), 1-linoleoyl-GPG (18:2) levels (OR 1.13, 95% CI: 1.06-1.21, p=0.0001), Adenosine 5'-diphosphate (ADP) to pantothenate ratio (OR 1.18, 95% CI: 1.08-1.29, p=0.0001), Octadecenedioylcarnitine (C18:1-DC) levels (OR 1.11, 95% CI: 1.05-1.17, p=0.0001), Glutarate (C5-DC) levels (OR 1.18, 95% CI: 1.08-1.28, p=0.0003), X-22509 levels (OR 1.15, 95% CI: 1.06-1.24, p=0.0003). Conclusion: The results of this study reveal potential causal relationships between nine circulating metabolites and endometrial cancer, offering new insights into the biological mechanisms of endometrial cancer. These findings, derived from integrating genomics and metabolomics approaches, not only enhance our understanding of the pathogenesis of endometrial cancer but also have significant implications for the screening, prevention, and treatment strategies of endometrial cancer.

病例资料 患者,女,31岁,2018年6月12日因左下腹痛1月余于入住广东省第二人民医院妇科治疗.患者月经初潮12岁,月经周期和经期正常,月经量中等,无血块,自初潮起就有痛经,程度中至重度,无明显进行性加重,需口服布洛芬止痛.孕4产2,足月顺产2胎,人工流产2次.1月前患者无明显诱因出现阵发性左下腹痛,程度轻至中度,呈刺痛或隐痛,与进食、时间及体位无明显关系.

The authors have no conflicts of interest.

排卵障碍是引起月经异常、闭经及不孕症的主要原因.目前全世界普遍使用的排卵障碍分类系统的基本框架主要是由世界卫生组织(WHO)根据50 年前的临床水平及检验技术所提出的.随着影像学技术、实验室水平及临床研究的不断发展,该分类系统已不再能满足当前研究及临床的需求.为此,国际妇产科联盟(FIGO)于2022 年10 月发布了新的排卵障碍分类系统.该分类系统由三级多层组成,初级分类根据解剖结构分为下丘脑、垂体和卵巢,并将多囊卵巢综合征(PCOS)单独进行分类,简称HyPO-P.第二级分类根据病因进一步分为遗传、自身免疫、医源性、肿瘤、功能性、感染性和炎症性、创伤和血管、生理性、特发性、内分泌,使用"GAIN-FIT-PIE"方便记忆.第三级是确定引起或促成排卵障碍的特定疾病.

近年来,许多报道提示孕妇在妊娠期间至少出现过 1 次母亲心率伪影(maternal heart rate arte-fact,MHRA),甚至因此导致不良妊娠结局以及相关并发症[1].在约2.7％的分娩过程中,MHRA要么在异常的胎心率追踪时提供了正确的诊断,要么在正常的胎心率时提供了错误的诊断,而这两种情况都可能导致不良妊娠结局[2].因此,及时发现产时MHRA尤为重要,是保证良好妊娠结局的关键组成部分.然而,MHRA并未引起足够的重视,至今也尚无专门的指南或共识.为了更好地指导医护人员科学合理地识别、监测以及处理MHRA,加拿大妇产科医师协会(Society of Obstetrician and Gynaecolo-gists of Canada,SOGC)于2022年9月首次发布了《产时母亲心率伪影临床实践指南》(以下简称"指南")[3].为帮助医护人员提高对检测产时MHRA策略的认识,并在怀疑此类伪影时及时做出反应,从而改善围产期结局,现对指南中MHRA的定义、临床征象、监测技术、可疑MHRA的处理以及建议等进行分类整理和解读.

This study aimed to assess the association between ABO blood type and incident of type I endometrial cancer (EC), as well as the stage and differentiation. 213 patients with type I EC and 300 healthy controls were included. As a result, the frequencies of A, B, O, and AB blood types among patients with type I EC were 51 (23.9%), 59 (27.7%), 93 (43.7%) and 10 (4.7%), respectively. There were no significant differences in age, body mass index, and other baseline covariates between groups of ABO blood types (p > .05). Logistic regression model showed that women with blood type O was more likely to develop type I EC than those with type A (odds ratio (OR): 1.66, 95% confidence interval (CI): 1.05-2.63). However, there was no significant association of ABO blood type with stage and differentiation of type I EC (p > .05). In conclusion, blood type O was the most prevalent ABO blood type among patients with type I EC and was associated with increased risk of type I EC, while ABO blood type was not significantly associated with stage or differentiation of type I EC.IMPACT STATEMENTWhat is already known on this subject? Previous studies have produced inconsistent findings on association of ABO blood type with EC. Those studies also did not explore the relationship between ABO blood type and stage or differentiation of type I EC.What the results of this study add? The present study showed that women with blood type O was more likely to develop type I EC than those with type A and there was no significant association of ABO blood type with stage or differentiation of type I EC.What the implications are of these findings for clinical practice and/or further research? Gynaecologists should pay more attention to women with blood type O, who should undergo more active EC screening.

A global expert consensus (the Delphi consensus) on follicular development, pituitary inhibition, triggering ovulation, and luteal phase support was organized and published in 2021 by Merck Darmstadt, Germany, to further complement the 2019 European Society of Human Reproduction and Embryology (ESHRE) Guidelines on Ovarian Stimulation by in vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection(ICSI). Compared with the ESHRE guidelines, the Delphi consensus incorporates more types of research evidence and expert experience, and finally the expert group has reached a good consensus on follicular development, pituitary suppression and triggering of ovulation, but luteal support is still controversial. This article intends to provide a reference for the optimization of assisted reproductive technology through the interpretation of this consensus.

阴道毛滴虫病既往又称为滴虫阴道炎,是由阴道毛滴虫所致的一种性传播感染,也是最常见的非病毒性性传播疾病.2021年7月美国疾病预防与控制中心(CDC)发布了最新版的《性传播感染治疗指南》,对阴道毛滴虫病的诊治建议进行了更新.2021年中华医学会妇产科学分会感染性疾病协作组也发布了新的《阴道毛滴虫病诊治指南(2021修订版)》.现就主要根据最新的2021年CDC指南与2021年中国指南对阴道毛滴虫病的诊治进行解读.