BackgroundThis study aims to evaluate the influence of the timing for bromocriptine withdrawal in pregnant women with pituitary prolactin-secreting microadenomas.MethodsIn this retrospective study,188 pregnant women diagnosed with pituitary prolactin-secreting microadenomas, who delivered between January 2005 and June 2023 were categorized into four groups based on their use and duration of bromocriptine therapy. Their pregnancy and neonatal outcomes were analyzed.ResultsAmong the 188 patients, the incidence of neurological symptoms during pre-pregnancy varied significantly across the groups (P = 0.000), with the highest prevalence in Group A (21.7%) and minimal to no symptoms in other Groups. The live birth rates and miscarriage rates did not show statistically significant differences across the groups (P = 0.508). Premature birth rates were 6.5%, 6.2%, 13.2%, and 0% for Groups A, B, C, and D, respectively. Notably, the incidence of small-for-gestational-age (SGA) infants increased with prolonged bromocriptine use, while large-for-gestational-age (LGA) rates decreased, though these trends were not statistically significant (P = 0.068). Median gestational age differed significantly across groups (P = 0.000), but neonatal weights remained comparable (P = 0.471).ConclusionDiscontinuation of bromocriptine after pregnancy confirmation is generally safe for patients with pituitary prolactin-secreting microadenomas. However, for patients with pre-existing neurological or ophthalmological symptoms, or those untreated prior to pregnancy, close monitoring and potential continuation of dopamine agonist therapy are waranted. Bromocriptine exposure throughout pregnancy does not increase the risk of miscarriage, congenital anomalies, or adverse neonatal outcomes. But further prospective studies are needed to elucidate the long-term effects of bromocriptine on fetal development.

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, yet its association with neuropsychiatric disorders (NPDs) in offspring remains inconsistent and requires updated synthesis. Methods We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to March 2025. A total of 21 observational studies involving 6.8 million mothers and 7.4 million offspring were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results Maternal PCOS was significantly associated with increased risks of autism spectrum disorder (OR = 1.44, 95% CI: 1.36–1.53), attention-deficit/hyperactivity disorder (OR = 1.42, 95% CI: 1.35–1.49), chronic tic disorders (OR = 1.45, 95% CI: 1.24–1.68), anxiety (OR = 1.34, 95% CI: 1.27–1.42), other behavioral/emotional disorders (OR = 1.35, 95% CI: 1.30–1.39), and neurological malformations (OR = 1.47, 95% CI: 1.12–1.94). Subgroup analyses by offspring sex and diagnostic criteria showed consistent effects, though sex differences were not significant. Sensitivity analyses confirmed result stability. Conclusion This study provides evidence of an association between maternal PCOS and elevated odds of NPDs in children, highlighting the potential importance of prenatal metabolic health and developmental surveillance in this population. Clinical trial number Not applicable.

Chronic stress disrupts female reproductive function, but the central mechanisms linking stress exposure to altered gonadotropin-releasing hormone (GnRH) pulsatility remain incompletely defined. The arcuate kisspeptin/neurokinin B/dynorphin (KNDy) network is a core component of the GnRH pulse generator, yet it functions within an expanded regulatory system involving fast amino-acid neurotransmission, steroid feedback, nitric oxide signaling, glial communication, metabolic cues, and stress-responsive neuropeptides. This review synthesizes evidence showing how hypothalamic-pituitary-adrenal (HPA)-axis activation may suppress KNDy-GnRH output. Corticotropin-releasing hormone, glucocorticoids, gonadotropin-inhibitory hormone/RFamide-related peptide-3, glial inflammatory mediators, serotonergic input, and energy-sensitive neuropeptides may converge to impair GnRH pulse-generator function. We further discuss the relevance of these mechanisms to functional hypothalamic amenorrhea, stress-sensitive polycystic ovary syndrome (PCOS) phenotypes, and developmental versus adult stress exposure. Overall, stress-induced reproductive dysfunction is best understood as disrupted network-level neuroendocrine rhythm regulation.

Purpose:This study aimed to develop international expert consensus statements on chronic endometritis (CE) through a comprehensive literature review of existing evidence and a modified Delphi approach. Methods:Ten panelists of the Japan Society of Reproductive Medicine Female Reproductive Tract Special Interest Group on CE performed a comprehensive review of the literature and derived statements with related comments on six specific domains of interest on CE. A two-round modified e-Delphi questionnaire was conducted among 31 international experts to evaluate the statements. Results:Twenty-three out of 24 statements, including 43 detailed items, on epidemiology (associated diseases and risk factors), symptomatology (asymptomatic or oligosymptomatic nature with subtle and nondescript gynecologic manifestations), etiology and pathogenesis (inflammation, infection, and clinical course), microbiology (associated pathogens), diagnosis (histopathology, immunohistochemistry, hysteroscopy, and microbiome analysis), and treatment (antibiotics, surgery, and multidrug resistance) finally reached a consensus. Notably, for the histopathologic diagnosis of CE, a threshold of ≥ 5 endometrial stromal plasma cells/10 high-power fields received an agreement rate of 81%. Conclusions:This comprehensive literature review and Delphi study provide a real-world clinical perspective on CE from diverse international experts. These consensus statements have the potential to lay a foundation for diagnostic criteria and/or clinical guidelines on CE.

BackgroundThe diagnosis of metabolic syndrome (MetS) in patients with polycystic ovary syndrome (PCOS) is complex. Various indicators are utilized to predict MetS in clinical practice. Nonetheless, there is ongoing debate regarding which indicator possesses a higher predictive value. This study examines the accuracy of the lipid accumulation product (LAP) in screening for MetS among patients with PCOS and compares it with other indicators.MethodsA systematic literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible studies. Outcomes were pooled using the mean difference, odds ratio, and diagnostic accuracy parameters, (including sensitivity, specificity, and the area under the summary receiver operating characteristic (AUROC) curve. Comparative analysis was performed using the Z-test.ResultsA meta-analysis of 11 studies comprising 3720 participants revealed that LAP was significantly elevated in PCOS patients with MetS, with a pooled MD of 2.52 units (P<0.001). LAP demonstrated a strong association with MetS, yielding a pooled OR of 34.31 (P<0.001). For the detection of MetS, LAP exhibited a pooled sensitivity of 87% (95% CI: 79%–92%), specificity of 84% (95% CI: 79%–89%), and an AUROC of 0.92 (95% CI: 0.89–0.94). The AUROC of LAP was significantly superior to that of body mass index, waist circumference, triglyceride levels, and abdominal volume index (P<0.001).ConclusionLAP represent as a cost-effective, simple, and a better proxy indicator for screening MetS in the PCOS population.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025638798.

OBJECTIVE:To test the hypothesis that women assigned to a natural ovulation regimen before frozen embryo transfer compared with a programmed regimen would have an increased chance of a healthy live birth and a reduced risk of pre-eclampsia or eclampsia. DESIGN:Multicentre, randomised, parallel group, assessor blinded clinical trial. SETTING:24 academic fertility centres in China. PARTICIPANTS:4376 ovulatory women (aged 20-40 years) planning to undergo a frozen single blastocyst transfer. INTERVENTIONS:Eligible participants were randomised (1:1) to receive a natural ovulation regimen or a programmed regimen of hormone replacement for endometrial preparation. Endometrial preparation and frozen embryo transfer timing were determined in the natural ovulation regimen group by monitoring natural follicle development and measuring serum levels of luteinising hormone, oestradiol, and progesterone. In the programmed regimen group, endometrial preparation was achieved by sequential administration of oestrogen and progesterone. MAIN OUTCOMES AND MEASURES:Primary outcomes were a healthy live birth and pre-eclampsia or eclampsia after a frozen embryo transfer. Secondary outcomes were cycle cancellation, biochemical pregnancy, clinical pregnancy, ongoing pregnancy, pregnancy loss, ectopic pregnancy, live birth, birth weight, and maternal, fetal, and neonatal complications. RESULTS:In the intention-to-treat analyses, 910 (41.6%) of 2185 patients in the natural ovulation regimen group and 890 (40.6%) of 2191 in the programmed regimen group achieved a healthy live birth (relative ratio 1.03 (95% confidence interval (CI) 0.96 to 1.10); P=0.49). The risk of pre-eclampsia was lower in the natural ovulation regimen group among patients who achieved clinical pregnancy than in the programmed regimen group (2.9% (38 of 1302) v 4.6% (61 of 1326); 0.63 (0.43 to 0.94); P=0.02). The incidences of early pregnancy loss (12.1% (158 of 1302) v 15.2% (201 of 1326); 0.80 (0.66 to 0.97)), placental accreta spectrum (1.8% (24 of 1302) v 3.6% (48 of 1326); 0.51 (0.31 to 0.83)), caesarean section (69.5% (776 of 1117) v 75.6% (831 of 1100); 0.92 (0.87 to 0.97)), and postpartum haemorrhage (2.0% (22 of 1117) v 6.1% (67 of 1100); 0.32 (0.20 to 0.52)) were lower in the natural ovulation regimen group. No differences between groups were observed for birth weight or neonatal complications. The rate of cycle cancellation was higher in the natural ovulation regimen (16.2% (354 of 2185) v 11.5% (251 of 2191), P<0.001). The prespecified per protocol and subgroup analyses yielded results consistent with the intention-to-treat analyses. CONCLUSIONS:In ovulatory women, a natural ovulation regimen for endometrial preparation was as effective as programmed regimen in terms of achieving a healthy live birth after frozen embryo transfer, but with a lower risk of maternal complications during pregnancy. TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR2200057990.

Patients with endometriosis have greater risk of infertility, which is associated with compromised ovarian function. Dysfunction in follicular granulosa cells and hyperactivation of oestrogen receptor beta (ERβ) are evident in endometriosis. It is also known that anti-Müllerian hormone (AMH)/Smad signalling pathway regulates ovarian activity. In this study, we aimed to explore effects of oestradiol (E2)/ERβ on follicular granulosa cells and on AMH/Smad signalling in endometriosis. The human ovarian granulosa cells were obtained from patients with tubal factor infertility and ovarian endometriosis, respectively, who underwent IVF/ICSI-ET using GnRH antagonist protocol in our hospital. A human ovarian granulosa tumour cell line (KGN) was cultured and subject to treatments with oestradiol and/or PHTPP (a selective ERβ antagonist). Cell viability, apoptosis, migration, and invasion were assessed. The mRNA and protein expressions were also investigated. It was found that AMH/Smad signalling pathway was suppressed in human ovarian granulosa cells in patients with ovarian endometriosis. Then, in KGN cells, E2 treatment (10-10  mol/L for 72 h) did not alter cell viability or apoptosis, but E2 decreased migration and invasion via ERβ. Further, E2 inhibited AMH/Smad signalling pathway via ERβ in KGN cells. Conversely, selective inhibition of ERβ could reverse these effects. In conclusion, activation of E2/ERβ compromised the function of follicular granulosa cells in endometriosis, which may be mediated by AMH/Smad signalling pathway.

[This corrects the article DOI: 10.3389/fendo.2025.1644373.].

Objective:To investigate the effects of combined oral contraceptives (COCs) and metformin treatment on the lactonase activity and status of paraoxonase 1 (PON1), and oxidative stress levels in patients with polycystic ovary syndrome (PCOS) and insulin resistance (IR). Design:A prospective, self-controlled study. Methods:Sixty patients diagnosed with PCOS and IR underwent three months of comprehensive therapy, including lifestyle modification, oral metformin (1000-1500 mg/day), and a COC (3 mg drospirenone and 20 µg ethinyl estradiol). Clinical data and blood samples were collected at baseline and after three months of treatment. PON1 levels, lactonase activity, and normalized lactonase activity (NLA), along with PON1 Q192R and C-108T genetic polymorphisms, oxidative stress markers, hormonal profiles, and metabolic parameters, were analyzed. Results:After treatment, significant decreases were observed in body mass index (BMI), Global Acne Grading System scores, androstenedione, fasting insulin, the homeostasis model assessment of insulin resistance index, and total antioxidant capacity (P < 0.05). In contrast, serum PON1 lactonase activity, apolipoprotein (apo)A1, triglycerides, and 2-h glucose levels were significantly increased (P < 0.05). Spearman's correlation analysis showed that lactonase activity and PON1 status were correlated with serum apoA1, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total oxidant status, and the oxidative stress index (P < 0.05). Moreover, the group with improved NLA showed higher PON1 lactonase activity and HDL-C levels, whereas the group without improved NLA showed higher PON1 levels after treatment. Conclusion:Treatment with COCs and metformin enhanced the antioxidant capacity of circulating HDL and improved BMI, glycolipid metabolism, IR, and hyperandrogenism in patients with PCOS and IR. Clinical Trial Registration:https://www.chictr.org.cn/showproj.html?proj=152682, identifier ChiCTR2200057114.

Ovarian tissue cryopreservation is an established fertility-preserving option, but oxidative stress and apoptosis during vitrification and warming markedly compromise follicular survival. Abscisic acid (ABA), a phytohormone also present in mammals, has been reported to exert antioxidant and anti-apoptotic effects in several cell types. This study investigated whether ABA supplementation could protect mouse ovarian tissue from cryo-induced injury and improve post-warming recovery. Ovaries from adult mice were assigned to four groups: fresh control, vitrification alone, vitrification plus 1 µM ABA, and vitrification plus 100 µM ABA. After vitrification and warming, tissues were either analyzed immediately or cultured in vitro for 10 days. Follicular morphology and ultrastructure were assessed by hematoxylin and eosin staining and transmission electron microscopy. Oxidative stress, mitochondrial function, DNA damage, apoptosis, granulosa cell proliferation, estradiol secretion, and gonadotropin receptor expression were evaluated. Vitrification alone increased reactive oxygen species and malondialdehyde levels, reduced antioxidant enzyme activities and ATP content, and induced follicular and mitochondrial damage. ABA supplementation, particularly at 100 µM, attenuated oxidative stress, preserved mitochondrial integrity, reduced DNA damage and apoptosis, and improved follicular morphology. During in vitro culture, ABA-treated tissues showed enhanced granulosa cell proliferation, increased estradiol secretion, and restored Fshr and Lhr expression compared with vitrification alone. These findings demonstrate that ABA mitigates vitrification-induced oxidative stress and mitochondria-dependent apoptosis, thereby supporting the structural and functional recovery of cryopreserved ovarian tissue.

OBJECTIVE:This study aimed to characterize maternal-fetal serum metabolomics profiles in polycystic ovary syndrome (PCOS) pregnancies and explore potential links between metabolomic alterations and neurodevelopmental outcomes in offspring. METHODS:A prospective birth cohort study enrolled 20 PCOS and 20 non-PCOS women (selected via propensity score matching from a larger cohort of 58 non-PCOS participants) from West China Second University Hospital, Sichuan University, between January 2019 and January 2020. Offspring development was assessed at 27 months using the Ages & Stages Questionnaires (ASQ). Non-targeted metabolomics analyses were performed on maternal serum (collected at 32-36 weeks of gestation) and fetal serum from the umbilical vein at delivery. Metabolite pattern recognition was performed using supervised OPLS-DA and genetic algorithms (GA) to identify significant metabolites, with pathway enrichment analysis conducted using the KEGG database. RESULTS:Women with PCOS exhibited significantly higher testosterone and free androgen index levels across pregnancy. Metabolomics analysis identified 32 differentially abundant metabolites in maternal serum, mainly related to unsaturated fatty acid and histidine metabolism, and 28 metabolites in fetal serum, including those involved in pyrimidine metabolism. Enrichment analyses revealed schizophrenia-related pathways in both PCOS maternal and fetal serum-a finding mechanistically relevant to neurodevelopmental risks in PCOS offspring. Notably, these metabolomic changes were enriched in placental pathways and involved the retinoic acid-related orphan receptor alpha (RORA), which may contribute to neurodevelopmental abnormalities observed in offspring of PCOS patients. CONCLUSION:This study identifies a potential link between maternal metabolic disturbances in PCOS and neurodevelopmental abnormalities in offspring through metabolomic analysis. Significant metabolites related to unsaturated fatty acids, pyrimidine, and histidine metabolism were found, with pathways enriched in neurodevelopmental disorders, particularly involving the RORA.

Background:Chronic endometritis (CE), a persistent inflammatory condition of the endometrial lining, is clinically linked with adverse reproductive outcomes. It is currently hypothesized to be associated with infection, and is often treated with broad-spectrum antibiotics. However, the specific microbial alterations remain poorly defined due to heterogeneous findings. Methods:PubMed, Web of Science, Medline, Embase, Cochrane Library, and Scopus were searched for studies published up to July 2025. Studies were included if they compared CE patients to non-CE controls and analyzed vaginal or endometrial microbiota. Standardized mean difference (SMD) for alpha-diversity, odds ratio (OR) for microbial detection rates, with 95% confidence intervals (CIs) were calculated. Qualitative syntheses of beta-diversity and microbial abundance profiles were also performed. Result:Twenty-two studies (n = 1274 CE patients, n = 1109 controls) were included. Alpha-diversity indices showed no significant differences for both vaginal and endometrial microbiota. However, a subgroup analysis revealed a significant upregulation in endometrial Chao1 indices in 16S V4 sequencing studies (SMD = 0.38, 95% CI: 0.06 to 0.70, I 2 = 0). Beta-diversity findings were inconsistent, though three endometrial studies reported significant intergroup differences. Qualitative synthesis revealed a decrease in Lactobacillus and an increase in opportunistic pathogens, including Gardnerella and Sphingomonas. Pooled analysis of microbial detection rates showed significantly higher prevalence for Enterococcus (OR = 4.93, 95% CI: 2.13 to 11.39, I 2 = 48%) and Ureaplasma (OR = 6.30, 95% CI: 2.53 to 15.68, I 2 = 0%) in CE patients. Conclusion:CE is associated with dysbiosis of the vaginal and endometrial microbiota, characterized by a shift from beneficial commensals to pathogenic microbes. This dysbiosis may contribute to an altered the intrauterine immune microenvironment. Systematic review registration:PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420251115587, identifier CRD420251115587.

Pregnant women with Polycystic ovary syndrome (PCOS) often experience exacerbated endocrine and metabolic dysfunction. While existing studies lack prospective data exist for Chinese populations. Our study aimed to characterize endocrine profiles in Chinese PCOS pregnancies using a prospective cohort. Ninety-one participants (33 PCOS, 58 non-PCOS) were enrolled. Endocrine and metabolic parameters were measured at three trimesters (12-16, 24-28, 32-36 weeks). Primary outcomes included total testosterone (T), sex hormone-binding globulin (SHBG), and free androgen index (FAI). Secondary outcomes covered fasting insulin (FINS), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), LDL, and HDL. Logistic regression models adjusted for confounders were used for group comparisons. Women with PCOS exhibited higher T and FAI levels compared to women without PCOS across all gestational windows, even after adjusting for factors including pre-pregnancy BMI. Women with PCOS exhibited elevated FINS levels and HOMA-IR at 12-16 weeks and 32-36 weeks of gestation. After adjustment for pre-pregnancy BMI, initial glucose metabolism differences were attenuated and no longer statistically significant. Women with PCOS displayed minor lipid metabolic differences in lipid metabolism. This study highlights complex metabolic changes in PCOS pregnancies, characterized by persistent hyperandrogenism and altered glucose metabolism. Pre-pregnancy BMI might emerge as the key driver of exacerbated glucose dysregulation.

BackgroundEndometriosis (EMS) and adenomyosis have adverse effects on women’s fertility. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are effective treatments for these diseases. Research has shown that different embryo transfer strategies in IVF/ICSI can influence gestational outcomes. This systematic review and meta-analysis aimed to evaluate the impact of freeze-all embryo transfer (FET) versus fresh embryo transfer (ET) strategies in IVF/ICSI cycles for infertile women with EMS and adenomyosis.MethodA comprehensive search was conducted across PubMed, EMBASE, MEDLINE, Web of Science, Google Scholar, and Chinese databases to identify studies examining different embryo transfer strategies in IVF/ICSI cycles among patients with EMS and adenomyosis. The outcomes analyzed included rates of implantation, clinical pregnancy, miscarriage, and live birth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models.ResultsIn patients with EMS, the results demonstrated that the FET strategy yielded higher clinical pregnancy (OR: 1.25; 95% CI: 1.11, 1.40), live birth rates (OR: 1.31; 95% CI: 1.15, 1.49), and implantation rates (OR: 1.27; 95% CI: 1.05, 1.54) compared to the fresh ET strategy. The miscarriage rate (OR: 0.89; 95% CI: 0.52, 1.52) and the ectopic pregnancy rate (OR: 0.51; 95% CI: 0.24, 1.07) were comparable between groups. For the group of women with adenomyosis, the IVF/ICSI outcomes were comparable between the FET and fresh ET strategies.ConclusionIn IVF/ICSI, the FET strategy has been associated with more favorable reproductive outcomes compared to the fresh ET strategy in women with EMS. Whereas in women with adenomyosis, pregnancy outcomes were comparable between the FET and fresh ET groups.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024563268, identifier CRD42024563268.

Advanced maternal age (AMA, ≥35 years) women undergoing assisted reproductive technology (ART) face reduced live birth rates (LBR) and remain a major clinical challenge. In a large randomized trial, Zishen Yutai Pill (ZYP) improved LBR in the general population, and a subsequent post hoc analysis suggested efficacy in AMA women, though it was underpowered to draw firm conclusions. To address the issue, we conducted a multicenter, prospective, double-blind, placebo-controlled, randomized trial (NCT03703700) to evaluate whether ZYP increases LBR in AMA women. Women aged 35-42 years with BMI < 28 kg/m2 at 12 tertiary-level hospitals in China were randomly assigned to receive ZYP or placebo orally (5 g once, three times daily) from day 19-23 of the preceding menstrual cycle until 2 weeks after embryo transfer, continuing to 5 weeks post transfer if biochemical pregnancy was confirmed. The primary outcome was fresh-cycle LBR. A total of 1467 participants (734 ZYP, 733 placebo) were enrolled. In the intention-to-treat analysis, live birth occurred in 23.3

Endometriosis is a chronic gynecological disorder characterized by progressive fibrosis, which is closely associated with clinical symptoms such as dysmenorrhea and infertility. While myofibroblast activation is central to fibrogenesis, the cellular origins and regulatory mechanisms remain incompletely understood. This study demonstrates that the macrophage-myofibroblast transition (MMT) is a novel source of myofibroblasts in endometriosis and is regulated by the TGFB1/SMAD3 signaling pathway. Using single-cell RNA sequencing, we identified a distinct subpopulation of CD68+ macrophages co-expressing ACTA2 and extracellular matrix (ECM)-related genes in the human endometrium, which exhibited a myofibroblast-like transcriptional profile and were predominantly located at a fibrotic terminal state along the pseudotime trajectory. Histological and ultrastructural analyses revealed varying degrees of fibrosis and elevated TGFB1 expression in eutopic and ectopic endometrium in endometriosis patients and mouse models. Immunofluorescence confirmed that MMT-positive cells, co-expressing CD68 and α-SMA, were enriched in endometriotic tissues and primarily derived from M2 macrophages. In mouse models of endometriosis, pharmacological inhibition of TGFB1/SMAD3 signaling significantly reduced the number of MMT-positive cells and attenuated collagen deposition, particularly in the eutopic endometrium. Furthermore, reduced ectopic lesion volume and epithelial ultrastructural damage following pathway inhibition suggested impaired ectopic lesion survival. These results demonstrate that the TGFB1/SMAD3 pathway-driven MMT might be a novel contributor to endometrial fibrosis in endometriosis. Targeting the TGFB1/SMAD3 signaling axis may provide a dual antifibrotic and anti-lesion strategy, offering therapeutic potential to intervene in the progression of endometriosis.

Using high-purity tungsten powder and amorphous boron powder as raw materials,high-purity W2B alloy powder was efficiently synthesized at low temperatures by mechanical activation combined with reactive synthesis.The effects of mechanical activation time on the morphology,particle size distribution,and specific surface area of the powders were investigated,and the relationship among phase composition,synthesis temperature,and reaction mechanism was elucidated.The results indicate that mechanical activation can effectively refine the particles,and the surface area and dislocation density of the powder increase with the prolongation of the mechanical activation time.The content of the W2B phase in the reaction-synthesized powder increases as the mechanical activation time increases.After 20 h of mechanical activation,the true density of the reaction-synthesized powder reaches 17.01 g/cm3,with the W2B phase content of 96wt％.This powder contains 23wt％more W2B phase compared to the powder without the mechanical activation reaction.During the reactive synthesis,the B atoms diffuse into the W matrix,resulting in the formation of the low-density WB phase.Mechanical activation introduces a significant number of dislocation defects,which creates a channel for atom diffusion and accelerates the transformation from the WB phase to the W2B phase.

Background: The incidence of endometriosis-associated malignancies (EAMs) is approximately 1%, with the majority occurring in the ovaries. This condition is often referred to as endometriosis-associated ovarian cancer (EAOC). However, the EAMs are rarer occurrences at other sites, such as the rectovaginal septum, abdominal wall, or perineal incision. Case: This case involves a 51-year-old female hospitalized at Zhuhai Integrated Traditional Chinese and Western Medicine Hospital with abdominal pain and constipation. Colonoscopy revealed a rectal mass, and histopathological analysis indicated adenocarcinoma, suggesting endometrial cancer metastasis. However, following total laparoscopic hysterectomy, rectal resection, and lymph node dissection, pathological examination confirmed a final diagnosis of rectal endometriosis-associated malignancy (EAM) combined with endometrial cancer. Following surgery, chemotherapy, and radiotherapy, the patient remained disease-free during a 2-year follow-up period. Conclusions: This case is rare and noteworthy, involving EAMs of the rectum combined with EC. Surgical intervention followed by adjuvant treatment could improve survival outcomes. Therefore, an accurate diagnosis is critical for effective management.

Background: Ectopic pregnancy is a major early-pregnancy cause of maternal mortality, and hysteroscopy is the gold standard for uterine cavity assessment, offering direct visualization, accurate pathology, easy biopsy, and immediate therapeutic intervention. However, no studies have evaluated whether hysteroscopy improves subsequent pregnancy outcomes in infertile women with a prior ectopic pregnancy. This study aimed to evaluate the necessity of routine office hysteroscopy prior to the first embryo transfer in infertile women with a history of ectopic pregnancy, based on the hypothesis that hysteroscopy may assist in identifying intrauterine pathologies that could impact pregnancy outcomes. Methods: We conducted a single-center retrospective cohort study including consecutive patients with a history of ectopic pregnancy at a university-affiliated hospital between January 2018 and December 2022. Patients were divided into two groups according to whether they underwent hysteroscopy prior to embryo transfer. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups. Results: A total of 714 patients were included in the analysis. Following PSM, no significant differences in baseline characteristics were observed between the two groups. The clinical pregnancy rate was 58.26% in the hysteroscopy group and 53.22% in the non-hysteroscopy group (p = 0.397). Subgroup analysis revealed that patients diagnosed with and treated for chronic endometritis (CE) exhibited a higher spontaneous miscarriage rate (46.90%) and a lower live birth rate (25.00%) compared to the disease-free group (miscarriage rate 18.00%, live birth rate 45.61%), the endometrial polyps (EP) group (miscarriage rate 10.00%, live birth rate 52.31%), and CE + EP group (miscarriage rate 25.00%, live birth rate 44.26%). Conclusions: Routine hysteroscopy prior to first embryo transfer in women with a history of ectopic pregnancy did not significantly improve clinical pregnancy rates. However, hysteroscopy proved valuable in identifying intrauterine abnormalities such as CE and EP, which were associated with adverse reproductive outcomes. Further prospective studies are warranted to determine whether targeted diagnosis and management of these conditions can improve live birth rates in this population.