IntroductionAdenomyosis is an enigmatic disease with estrogen dependence, and the exact pathogenic mechanisms remain confusing. Limited evidence points out the presence of gut flora changes in adenomyosis. However, evidence on how adenomyosis and gut microbiota crosstalk remains insufficient.MethodsThis study included 30 female diagnosed with adenomyosis and 28 healthy control participants. Fecal samples were collected from all subjects prior to the initiation of pharmacological treatment. The 16S rRNA gene sequencing technique was utilized to analyze the fecal samples, with the objective of characterizing the composition and potential functional profile of the gut microbiota, as well as examining the correlations between the gut microbiota and disease-related clinical variables.ResultsCompared with healthy controls, patients with adenomyosis showed a distinct gut microbial community composition. The adenomyosis group was significantly enriched in Prevotella_9 and Ligilactobacillus, whereas the control group had an enrichment in Anaerofustis, Akkermansia, and Anaerostipes. PICRUSt2 results showed significant down-regulation of PWY0-1061 (superpathway of L-alanine biosynthesis), P184-PWY (protocatechuate degradation I (meta-cleavage pathway)), and DHGLUCONATE-PYR-CAT-PWY (glucose degradation (oxidative)) pathways in the ADS group. Correlation analysis further revealed that the relative abundances of Akkermansia, Roseburia, Dialister, and Lachnoclostridium were significantly associated with clinical features of the disease.ConclusionA potential association exists between adenomyosis and the intestinal microbiome. Clinical characteristics of adenomyosis are related to the intestinal microbiota. These findings offer microbiota-derived evidence and new perspectives on the pathophysiology of adenomyosis.

Background: Endometriosis is a common gynecological disorder, with rising incidence rates and a decreasing age of onset, significantly affecting patients' quality of life and overall health. Urinary tract endometriosis (UTE) is a rare and invasive form of endometriosis that often leads to urinary obstruction and can even result in renal failure. The clinical significance of diagnosing and treating UTE is increasingly recognized. However, there is currently a lack of systematic bibliometric analysis to provide an overview of this field. The purpose of this study is to comprehensively summarize the research status in this field over the past 30 years and predict future development trends to address diagnostic and therapeutic challenges. Methods: A comprehensive analysis was conducted on literature related to UTE published in the Web of Science Core Collection from 1995 to 2024. Research trends in this field were thoroughly analyzed and visualized using VOSviewer, CiteSpace, and the Bibliometrix R package. Results: A total of 361 publications were analyzed, sourced from 122 journals, authored by 1,699 scholars affiliated with 610 institutions across 48 countries. Notably, Charles Chapron, Pietro Santulli, and Bruno Borghese from France led in publication volume. The University of Paris emerged as a prominent institution in this research area. Co-occurrence and co-citation analyses indicated that Charles Chapron holds the top position among global authors, demonstrating significant influence in the field. Future key research directions include studying the pathogenesis of the disease, conducting epidemiological studies, and developing comprehensive management strategies, with particular emphasis on renal and urethral endometriosis. Conclusions: This study represents the first bibliometric analysis of UTE, summarizing its key values and emerging trends. The treatment approach for UTE has undergone significant changes due to ongoing research, shifting from surgical interventions to integrated management strategies. This evolution encompasses early diagnosis, treatment options, preoperative assessment and preparation, and longterm postoperative follow-up. The importance of enhanced collaboration among specialists in urology, gynecology, and other multidisciplinary areas is emphasized to promote effective diagnosis and treatment of UTE.

OBJECTIVE:Asherman's syndrome (AS) is a significant cause of subfertility in women from developing countries. Over 80% of AS cases in these regions are linked to dilation and curettage (D&C) procedures following pregnancy. The incidence of AS in patients with infertility and recurrent miscarriage can be as high as 10%, while the pregnancy rate in cases of moderate to severe adhesions can be as low as 34%. We aimed to establish a hysteroscopic artificial intelligence system using image-deep-learning algorithms for fertility assessment. METHODS:This diagnostic study included 555 cases with 4922 hysteroscopic images from a Chinese intrauterine adhesions cohort clinical database (NCT05381376). The study evaluated two image-deep-learning algorithms' effectiveness in predicting pregnancy within one year, using AUCs and decision curve analysis. The models' performance was evaluated for two-year prediction via concordance index and cumulative time-dependent ROC. A quantifiable visualization panel of the system was established. RESULTS:The proportional hazard CNN system accurately predicted conception, with AUCs of 0.982, 0.992, and 0.990 in three randomly assigned datasets, superior to the InceptionV3 framework, and achieved a net benefit of 69.4% for subfertility assessment. The system fitted well with c-indexes of 0.920-0.940 and was time-stable. The quantifiable visualization panel displayed four intrauterine pathologies intuitively. The performance was comparable to senior hysteroscopists, with a kappa value of 0.84-0.89. CONCLUSIONS:The CNN based on the proportional hazard approach accurately assesses fertility postoperatively. The quantifiable visualization panel could assist in intrauterine pathologies assessment, optimize treatment strategies, and achieve individualized and cost-efficient practices.

Endometrial cancer (EC) is one of the most common gynecologic malignancies, with rising incidence in younger women. Given the favorable prognosis of early-stage disease, accurate diagnosis and effective fertility-preserving strategies are increasingly important. Hysteroscopy, enabling direct visualization of intrauterine lesions, plays a key role in both diagnosis and conservative management. This review summarizes current evidence on hysteroscopic morphological features of EC and their clinical significance. Classification based on surface architecture and atypical vascular patterns - such as glomerular and cerebroid types - provides early clues to tumor grade and prognosis. Tumor spread patterns (focal vs. diffuse) correlate with staging and survival outcomes, while hysteroscopic scoring systems enhance diagnostic precision. In fertility-preserving treatment, combining hysteroscopic resection with progestin therapy significantly improves complete remission rates and shortens treatment duration. Assisted reproductive technology further increases pregnancy and live birth outcomes post-remission. Molecular classification enables more tailored fertility-sparing strategies. Advances in imaging - such as narrow-band imaging and 5-aminolevulinic acid photodynamic diagnosis - enhance lesion detection by improving vascular visualization. Artificial intelligence-based hysteroscopic image analysis supports consistent lesion classification and fertility outcome prediction. Although concerns remain regarding retrograde dissemination, evidence affirms the safety and efficacy of hysteroscopy when properly performed. Hysteroscopic morphology, integrated with molecular profiling and advanced imaging technologies, represents a valuable and minimally invasive approach to personalized diagnosis and fertility preservation in EC.

Adenomyosis, an estrogen-dependent disorder, requires long-term therapy as current treatments (GnRH agonists, danazol, etc.) show symptom recurrence post-discontinuation. Dienogest (DNG), a selective progesterone receptor agonist, effectively reduces adenomyosis-related pain but causes abnormal uterine bleeding (AUB) in some patients, likely due to pseudodecidual breakthrough bleeding, significantly impacting treatment compliance. This review examines risk factors for DNG-associated AUB and advances in management strategies to improve patient adherence during prolonged therapy.

Adenomyosis (ADS) is a common gynecological disorder, and its pathogenesis remains unclear. This study explores the functions of circRNAs in the eutopic endometrium of ADS and their diagnostic efficacy for ADS. High-throughput RNA sequencing was performed on 12 eutopic endometrial samples from ADS patients and 3 control endometrial samples. Additionally, circRNAs were analyzed in conjunction with clinical features. A competitive endogenous RNA network was established based on bioinformatics analysis, comprising 3 circRNAs, 1 miRNA, and 13 mRNAs. In the ADS group, the expression levels of hsa_circ_0008959 and SLC15A4 were significantly reduced, while hsa-miR-124-3p expression was increased. SLC15A4 was associated with cell proliferation and invasion. Decreased expression of hsa_circ_0008959 and SLC15A4, along with high VAS scores and elevated hsa-miR-124-3p levels, were identified as risk factors for ADS development. The combination of hsa_circ_0008959 and VAS scores demonstrated the highest diagnostic value for ADS.

Background Macrophages play an essential role in regulating ovarian cancer immune microenvironment. Studies have shown that m6A methylation could influence immune microenvironment in cancer. In this study, we investigated the roles of m6A demethylase ALKBH5 and m6A recognition protein IGF2BP2 played in regulating macrophages polarization in ovarian cancer. Methods In this study, we first explored the differentially expressed m6A methylation enzymes in M0 and M2 macrophages according to two independent GEO datasets. TIMER2.0 and GSCA database were used to explore the immune analysis of ALKBH5 and IGF2BP2 in ovarian cancer. K-M plotter and TIMER2.0 databases were used to evaluate the prognostic role of ALKBH5 and IGF2BP2 in ovarian cancer. For CNV mutation analysis of ALKBH5 and IGF2BP2, cBioPortal and GSCA databases were used. For single-cell analysis, sc-TIME and HPA softwares were used to analyze the roles of ALKBH5 and IGF2BP2 played in immune cells in ovarian cancer. To identify the role of ALKBH5 played in macrophage polarization, RT-PCR was used to verify the macrophage polarization related markers in vitro study. The function of ALKBH5 played in ovarian cancer was further analyzed through GO and KEGG analysis. Findings In this study, we found that ALKBH5 and IGF2BP2 were up-regulated in M2 macrophages, which showed closely correlation with immune cells expressions in ovarian cancer, especially with macrophages. Ovarian cancer patients with higher expression of ALKBH5 and IGF2BP2 showed worse prognosis, possibly because of their close correlation with immune response. ALKBH5 also correlated with macrophage phenotypes in single-cell levels analysis. However, the expression level of IGF2BP2 in ovarian cancer immune microenvironment was very low. The results of RT-PCR indicated the potential role of ALKBH5 in M2 polarization of macrophages. Interpretation ALKBH5 participated in regulating macrophage M2 polarization in ovarian cancer immune microenvironment.

Objective: To develop a multimodal learning application system that integrates electronic medical records (EMR) and hysteroscopic images for reproductive outcome prediction and risk stratification of patients with intrauterine adhesions (IUAs) resulting from endometrial injuries. Materials and methods: EMR and 5014 revisited hysteroscopic images of 753 post hysteroscopic adhesiolysis patients from the multicenter IUA database we established were randomly allocated to training, validation, and test datasets. The respective datasets were used for model development, tuning, and testing of the multimodal learning application. MobilenetV3 was employed for image feature extraction, and XGBoost for EMR and image feature ensemble learning. The performance of the application was compared against the single-modal approaches (EMR or hysteroscopic images), DeepSurv and ElasticNet models, along with the clinical scoring systems. The primary outcome was the 1-year conception prediction accuracy, and the secondary outcome was the assisted reproductive technology (ART) benefit ratio after risk stratification. Results: The multimodal learning system exhibited superior performance in predicting conception within 1-year, achieving areas under the curves of 0.967 (95% CI: 0.950-0.985), 0.936 (95% CI: 0.883-0.989), and 0.965 (95% CI: 0.935-0.994) in the training, validation, and test datasets, respectively, surpassing single-modal approaches, other models and clinical scoring systems (all P<0.05). The application of the model operated seamlessly on the hysteroscopic platform, with an average analysis time of 3.7 +/- 0.8 s per patient. By employing the application's conception probability-based risk stratification, mid-high-risk patients demonstrated a significant ART benefit (odds ratio=6, 95% CI: 1.27-27.8, P=0.02), while low-risk patients exhibited good natural conception potential, with no significant increase in conception rates from ART treatment (P=1). Conclusions: The multimodal learning system using hysteroscopic images and EMR demonstrates promise in accurately predicting the natural conception of patients with IUAs and providing effective postoperative stratification, potentially contributing to ART triage after IUA procedures.

Intrauterine adhesions (IUAs) pose challenges to natural fertility and impede timely conception. Assisted reproductive technologies (ART) offer effective solutions but are often expensive in developing nations. This study introduces an artificial intelligence (AI) application, MobilenetV3PH, featuring a proportional hazard (PH) neural network architecture to predict reproductive outcomes following hysteroscopic adhesiolysis in IUAs and to categorize subfertility risks. The present study leveraged 4922 second-look hysteroscopic images obtained from 555 patients post-hysteroscopic adhesiolysis, sourced from a prospective IUA clinical database (NCT05381376). The prospective cohort was randomly partitioned into training, validation, and test sets for model development, hyperparameter validation, and external validation. MobilenetV3PH achieved a noteworthy Area Under the Curve (AUC) of 0.920, outperforming alternative models significantly. The AI application seamlessly integrated into the hysteroscopic platform, demonstrating an average analysis time of 35.7 ± 5.6 s per patient. Notably, it excelled in predicting natural conception compared to conventional clinical scoring methods. The identification of high-risk IUAs patients who encounter difficulties in natural conception through AI-predicted subfertility risks revealed that these individuals might derive greater benefits from ART (HR = 4.616, P = 0.007) compared to their low-risk counterparts (HR = 0.628, P = 0.534). Overall, this AI tool exhibits promise for practical clinical applications, assisting in the prediction of postoperative difficulties in natural conception, patient risk stratification, and management strategies making, ultimately enhancing cost-effective interventions.

Introduction:Intrauterine adhesions (IUAs) caused by endometrial injury, commonly occurring in developing countries, can lead to subfertility. This study aimed to develop and evaluate a DeepSurv architecture-based artificial intelligence (AI) system for predicting fertility outcomes after hysteroscopic adhesiolysis.Methods:This diagnostic study included 555 intrauterine adhesions (IUAs) treated with hysteroscopic adhesiolysis with 4,922 second-look hysteroscopic images from a prospective clinical database (IUADB, NCT05381376) with a minimum of 2 years of follow-up. These patients were randomly divided into training, validation, and test groups for model development, tuning, and external validation. Four transfer learning models were built using the DeepSurv architecture and a code-free AI application for pregnancy prediction was also developed. The primary outcome was the model’s ability to predict pregnancy within a year after adhesiolysis. Secondary outcomes were model performance which evaluated using time-dependent area under the curves (AUCs) and C-index, and ART benefits evaluated by hazard ratio (HR) among different risk groups.Results:External validation revealed that using the DeepSurv architecture, InceptionV3+ DeepSurv, InceptionResNetV2+ DeepSurv, and ResNet50+ DeepSurv achieved AUCs of 0.94, 0.95, and 0.93, respectively, for one-year pregnancy prediction, outperforming other models and clinical score systems. A code-free AI application was developed to identify candidates for ART. Patients with lower natural conception probability indicated by the application had a higher ART benefit hazard ratio (HR) of 3.13 (95% CI: 1.22–8.02, p = 0.017).Conclusion:InceptionV3+ DeepSurv, InceptionResNetV2+ DeepSurv, and ResNet50+ DeepSurv show potential in predicting the fertility outcomes of IUAs after hysteroscopic adhesiolysis. The code-free AI application based on the DeepSurv architecture facilitates personalized therapy following hysteroscopic adhesiolysis.

Objective: To investigate the effect of autologous platelet-rich plasma (PRP) perfusion on the levels of cytokines in uterine drainage fluid in patients with moderate to severe intrauterine adhesions (IUA) following hysteroscopic adhesiolysis. Methods: Thirty patients with moderate to severe IUA who underwent hysteroscopic adhesiolysis at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from November 2020 to March 2021 were randomly divided into two groups: the PRP group (15 patients with placement of intrauterine-suitable balloons and PRP infusion) and the control group (15 patients with placement of intrauterine-suitable balloons only). For all patients, the channel switch was opened 48 hours after the surgery. The drainage fluid of the uterine cavity was collected using syringes through the proximal end of the drainage channel switch at 24 hours after the surgery and through the drainage channel directly at 48, 72, 96, and 120 hours after the surgery, and the levels of related cytokines including platelet-derived growth factor BB (PDGF-BB), vascular endothelial growth factor A (VEGF-A), insulin-like growth factor 1 (IGF-1) and transforming growth factor-β1 (TGF-β1) in the drainage fluid of the uterine cavity were evaluated, respectively. Results: (1) The changes in volumes of uterine cavity drainage fluid: the total drainage fluid volumes of the PRP group and the control group in 120 hours after the surgery were (21.8±2.9) and (22.7±2.7) ml, respectively, and there was no statistically significant difference between the two groups (t=-0.847, P>0.05). No significant differences were found in the volumes of drainage fluid between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). (2) Variation in cytokine levels in the uterine cavity drainage fluid: ① PDGF-BB: median PDGF-BB levels at 24 and 48 hours after the surgery in the PRP group (6.6 and 9.6 μg/L, respectively) were significantly higher than those in the control group (4.7 and 2.7 μg/L, respectively; all P<0.05). There were no significant differences in PDGF-BB levels between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). ② VEGF-A: median VEGF-A levels at 24 and 48 hours after the surgery in the PRP group (3.5 and 2.8 μg/L, respectively) were significantly higher than those in the control group (1.6 and 1.2 μg/L, respectively; all P<0.05). There were no significant differences in VEGF-A levels between the two groups at 72, 96, and 120 hours after the surgery (all P>0.05). ③ IGF-1: median IGF-1 level at 48 hours after the surgery in the PRP group was significantly higher than that in the control group (39.5 vs 8.6 μg/L, P<0.05). No significant differences were found in IGF-1 levels at 24, 72, 96, and 120 hours after the surgery between the two groups (all P>0.05). ④ TGF-β1: There were no significant differences in TGF-β1 levles between the two groups at 24, 48, 72, 96, and 120 hours after the surgery (all P>0.05). Conclusions: PRP perfusion following hysteroscopic adhesiolysis may increase the levels of PDGF-BB, VEGF-A, and IGF-1 in the uterine cavity drainage fluid, which plays a beneficial role in improving wound microvascular formation, reducing adhesion reformation, and promoting endometrial regeneration and repair.

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ2=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ2=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

In the past decade, research on ultrasound therapy in obstetrics and gynecology has rapidly developed. Currently, high-intensity ultrasound has been widely used in clinical practice, while low-intensity ultrasound has gradually emerged as a new trend of transitioning from pre-clinical research to clinical applications. Low-intensity pulsed ultrasound (LIPUS), characterized by a non-invasive low-intensity pulse wave stimulation method, employs its non-thermal effects to achieve safe, economical, and convenient therapeutic outcomes. LIPUS converts into biochemical signals within cells through pathways such as cavitation, acoustic flow, and mechanical stimulation, regulating molecular biological mechanisms and exerting various biological effects. The molecular biology mechanisms underlying the application of LIPUS in obstetrics and gynecology mainly include signaling pathways, key gene expression, angiogenesis, inflammation inhibition, and stem cell differentiation. LIPUS plays a positive role in promoting soft tissue regeneration, bone regeneration, nerve regulation, and changes in cell membrane permeability. LIPUS can improve the treatment benefit of premature ovarian failure, pelvic floor dysfunction, nerve damage caused by intrauterine growth restriction, ovariectomized osteoporosis, and incomplete uterine involution through the above biological effects, and it also has application value in the adjuvant treatment of malignant tumors such as ovarian cancer and cervical cancer. This study outlines the biological mechanisms and applications of LIPUS in treating various obstetric and gynecologic diseases, aiming to promote its precise application and provide a theoretical basis for its use in the field.

Objective To investigate the clinical effect of laser wedge resection for labia minora hypertrophy.Methods A total of 13 cases of labia minora hypertrophy were treated between October 2019 and January 2022. The CO 2 laser wedge resection was used for labia minora reduction. The incision was designed according to the principle of bilateral symmetry for bilateral hypertrophy and the reference to the healthy side for unilateral hypertrophy. Results The operation time was 38-96 min（mean, 55.4±16.1 min）. All the 13 cases had one-stage of incision healing without surgical complications. After the operation, the symptoms such as friction pain disappeared, abnormal urine flow direction in 4 cases returned to normal, and 6 patients with sexual life had no sexual discomfort. All the 13 patients were postoperatively followed up for 1-6 months, with an average of 3.5 months. The appearance of the affected labia minora was normal, the color change was natural. The appearance of unilateral hypertrophy was basically the same as that of the healthy side, while bilateral hypertrophy was basically the same on both sides. The width of the labia minora on the affected side was normal（14.13±1.18 mm）. Conclusion The CO 2 wedge resection is a safe, effective and ideal method for labia minora hypertrophy, which has less wound damage, good hemostatic effect, and normal and natural shape of the labia minora after surgery.

Abstract Background Infertility is the primary clinical symptom and reason for visiting patients with intrauterine adhesions (IUAs). Exploring the factors influencing the prognosis of IUAs and establishing a predictive model for reproductive outcomes after hysteroscopic adhesiolysis (HA) are extremely important for the selection of clinical treatment and prognostic assessment. Methods The clinical informations of 369 individuals diagnosed with and treated for IUAs were obtained from the Intrauterine Adhesion Multicenter Prospective Clinical Database (IUADB, NCT05381376) and randomly divided into the training and validation cohorts. A univariate analysis was performed to identify relevant clinical indicators, followed by a least absolute shrinkage and selection operator (LASSO) regression for regularization and SHapley Additive exPlanation (SHAP) for extreme gradient boosting (XGBoost) predictive model visualization. Finally, receiver operating characteristic (ROC) curves were constructed to assess the model’s efficiency. Results Univariate analysis and LASSO regression demonstrated that 12 clinical indicators were significantly associated with postoperative reproductive outcomes in IUAs patients. SHAP visualization indicated that postoperative fallopian tube ostia, blood supply, uterine cavity shape and age had the highest significance. The area under the ROC curve (AUC) of the XGBoost model in the training and validation cohorts was 0.987 (95% CI 0.9787–0.996) and 0.9851 (95% CI 0.9668-1), respectively. These values were significantly higher than those of the American Fertility Society (AFS) classification, the Chinese Society for Gynaecological Endoscopy (CSGE) classification and endometrial thickness (all P < 0.01). Conclusions The XGBoost model had higher accuracy in predicting postoperative reproductive outcomes in IUAs patients. Clinically, our model may be useful for managing and categorizing IUAs and determining optimal action to aid in pregnancy. Trial registration: The study was an observational cohort study, and the data were obtained from the Chinese Uterine Adhesion Database (ClinicalTrials.gov; NCT05381376; 19/05/2022).

目的:探讨高强度聚焦超声(high-intensity focused ultrasound,HIFU)消融和手术切除治疗腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)的效果.方法:回顾性分析 2015 年 1 月—2019 年 11 月我院住院治疗的262 例AWE的临床资料,按照治疗方式分为HIFU组(n=64)和手术组(n=198),比较 2 组手术时间、术中出血量、住院时间、术后病灶大小、疼痛程度、临床疗效和并发症发生情况等.结果:HIFU组中位手术时间[34.5(22.3,47.3)min]明显短于手术组[40.0(30.0,60.0)min],差异有统计学意义(Z=-3.112,P=0.002);HIFU组中位住院时间[2.0(2.0,3.0)d]明显短于手术组[7.0(6.0,8.3)d],差异有统计学意义(Z=-11.982,P=0.000).HIFU组与手术组临床疗效比较差异无统计学意义(χ2=-1.207,P=0.227).HIFU组治疗后 1、3、6 个月行超声随访,病灶消融率分别为(88.25±13.09)％、(92.33±9.18)％和(98.67±4.09)％,至术后第 12 个月,病灶消融率均为 100.00％.治疗后1、3、6、12 个月病灶体积与治疗前比较差异均有统计学意义(均P＜0.05).HIFU组患者术后 3、6、12 个月疼痛评分均低于手术组(均P＜0.05).2 组患者术后不良反应发生率分别为 6.25％(4/64)和 3.54％(7/198),差异无统计学意义(χ2=0.340,P=0.560).结论:HIFU消融治疗AWE效果与手术切除相当,但在缩短手术时间、减少住院时间以及减轻术后疼痛等方面优于手术切除,因此HIFU消融可成为供AWE患者选择的安全、有效的治疗方式之一.

Solitary fibrous tumor(SFT)is a rare mesenchymal tumor,and vulvar SFT is particularly rare.Patients with vulvar SFT usually present with a painless mass in the vulva,the pathogenesis and etiology of which are unknown.Due to the extremely low incidence,gynecologists generally have insufficient understanding of it,which is easy to cause missed diagnoses and misdiagnoses.The data of a 33-year-old case of primary vulvar SFT were reported.The patient was admitted to the hospital due to self-conscious vulvar discomfort for 1 year,and color Doppler ultrasound showed a solid subcutaneous mass in the right labia majora.High-energy ultra pulse carbon dioxide laser vulvar mass resection was performed,and the mass appeared oval during the operation,with a size of about 3.0 cm×2.5 cm,with clear boundaries to surrounding tissues,and did not involve the muscular layer.It was diagnosed as vulvar SFT(low malignant potential)by pathology,immunohistochemistry and Demicco model risk stratification,and close follow-up was recommended.After 6 months of postoperative follow-up,no tumor recurrence or metastasis was seen.

BackgroundHysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive.MethodsThis study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients’ age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment.ResultsIn total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063–7.851, p= 0.000; and OR 3.603, 95% CI 1.903–6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812–6.455, p= 0.000; and OR 2.586, 95% CI 1.419–4.712, p= 0.002; respectively).ConclusionsHysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes.Trial registrationChi ECRCT20210343

Non-atypical endometrial hyperplasia is a benign disease without significant somatic genetic changes. Postmenopausal women with non-atypical endometrial hyperplasia have a significant risk of progression to endometrial cancer and persistent endometrial hyperplasia. Most cases of atypical endometrial hyperplasia in postmenopausal women are treated surgically, including hysterectomy. At present, the treatment of postmenopausal women with non-atypical endometrial hyperplasia is still controversial. Correct and timely diagnosis and treatment are of great significance to prevent progression of the lesion. This study mainly provides an updated synthesis of the literature that investigates the etiology, diagnosis and treatment of postmenopausal women with non-atypical endometrial hyperplasia. As of December 2022, a literature search related to postmenopausal non-atypical endometrial hyperplasia was conducted on the PubMed database. For most postmenopausal patients with non-atypical endometrial hyperplasia, regular re-examination should be performed during conservative treatment. For postmenopausal patients with endometrial cancer risk factors, persistent non-atypical endometrial hyperplasia or progesterone contraindications, hysterectomy and bilateral salpingo-oophorectomy should be the first choice.

The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as "adenomyosis", "junctional zone", and "infertility" to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.