Ovarian cancer remains one of the most lethal gynecological malignancies worldwide. Sonodynamic therapy (SDT) offers a non-invasive treatment modality. However, the clinical efficacy of SDT is hampered by the insufficient tumor accumulation of sonosensitizers. Escherichia coli Nissle 1917 (EcN) stands out as a clinically approved strain with an excellent safety profile and tumor targeting ability. In this study, we developed a bioengineered probiotic platform utilizing EcN, surface-functionalized with hematoporphyrin monomethyl ether (HMME) and water-soluble chitosan, to enhance SDT and facilitate immune activation in ovarian cancer. The engineered probiotic HW@EcN, exhibited significant tumor-targeting ability, selectively accumulating in acidic tumor microenvironment (TME) and releasing HMME in a pH-responsive manner. Upon ultrasound (US) activation, HW@EcN generated reactive oxygen species (ROS), leading to tumor cell death and enhanced immune responses. In vivo studies using a C57BL/6 murine model demonstrated selective targeting of HW@EcN by tumor, and effective tumor growth inhibition, with significant immune activation indicated by increased CD4+ and CD8+ T cell and elevated IFN-γ levels. Histopathological analysis confirmed the biocompatibility of HW@EcN with minimal off-target toxicity. This bioengineered probiotic platform HW@EcN presents a clinically translatable approach for improving SDT efficacy and immune activation, paving the way for innovative cancer therapies.

RATIONALE:Ureteral injury from sutures during total hysterectomy is a relatively uncommon but potentially severe complication that can lead to serious sequelae such as ureterovaginal fistula or renal insufficiency. The management of such injuries remains challenging, and there is a need for effective and minimally invasive approaches to mitigate complications and enhance patient recovery. This study aims to introduce a novel minimally invasive alternative - transvaginal suture removal and ureteral stenting under local anesthesia - and to evaluate its efficacy in reducing complications and improving patient outcomes. PATIENT CONCERNS:A 49-year-old female experienced mild lumbar pain on the fourth day after total laparoscopic hysterectomy for uterine fibroids and adenomyosis. She had no prior kidney issues but developed postoperative right low back pain, microscopic hematuria, and ultrasound evidence of right hydronephrosis and ureteral dilation. DIAGNOSES:The patient was diagnosed with iatrogenic ureteral injury due to sutures, confirmed by ultrasound and surgical video review showing the right ureter partially sutured to the vaginal stump. INTERVENTIONS:We performed transvaginal suture removal and ureteral stenting under local anesthesia. This minimally invasive approach avoided general anesthesia and secondary laparoscopic surgery. OUTCOMES:The procedure was successful, with smooth suture removal and stent implantation. The patient's symptoms significantly improved on the second postoperative day. Follow-up at 1 month revealed no discomfort, and the ureteral stent was removed 3 months later. LESSONS:This case highlights transvaginal suture removal as a novel, minimally invasive treatment for iatrogenic lower ureteral injuries. This approach may be performed by gynecologists under local anesthesia, potentially preventing severe complications and reducing patient discomfort and costs.

BackgroundLymph-vascular space invasion (LVSI) is a crucial prognostic factor in cervical cancer (CC), and its assessment is essential for developing personalized treatment strategies.ObjectiveThe primary objective of this study was to focused on constructing LVSI predictive model based on clinical indicators and evaluating its predictive performance across different FIGO staging cohorts.Study designWe included 691 patients, with 348 patients having 2009 FIGO stage IB1-IIA2 CC assigned to Cohort 1, and 343 patients with 2018 FIGO stage IB1-IIIC1r CC assigned to Cohort 2. In Cohort 1, univariable and multivariable regression analyses, along with Mallows’ Cp, R squared-R, and LASSO, were used to select variables forming Model 1. Model 2 included the FIGO stage. We compared the contribution of different FIGO stages to the LVSI prediction model in both cohorts. The final LVSI prediction model for the entire cohort was constructed using selected variables and risk stratification was established. The models were evaluated through internal validations using ROC curves, C-index, Clinical Impact Curve (CIC), and Decision Curve.ResultsFive variables were incorporated into Model 1: age, Pathology, Depth of Stromal Invasion (DSI), SCC-Ag, and Lactate Dehydrogenase (LDH). Model 2 was established by incorporating the FIGO staging system. Compared with the two models, there was no significant difference in ROC, ΔC-index and ΔNRI. Adding FIGO clinical staging did not significantly improve predictive value. Model 1’s variable were included in the nomogram for the combined cohort. The AUC for the model-development cohort and validation cohort was 0.754 (95% CI: 0.711, 0.798) and 0.789 (95% CI: 0.727, 0.852), respectively. In both cohorts, risk stratification effectively distinguished the high-risk group, which had a significantly higher proportion of positive cases compared to the low and middle-risk groups (p < 0.01).ConclusionOur nomogram predictive model demonstrates robust LVSI prediction performance across different staging systems.

BackgroundAdenocarcinoma is a common histological subtype of cervical cancer, accounting for 10–15% of all cases. The prognosis of cervical adenocarcinoma with distant organ metastases remains unclear. Therefore, our study aimed to investigate the patterns and prognosis of distant organ metastasis in cervical adenocarcinoma.MethodsWe obtained data from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2010 to 2019. Cox regression, Kaplan–Meier, and log-rank analyses were conducted.ResultsWe observed that adenocarcinoma (AC) of the cervix primarily metastasizes to single organs, with a rate of 73.3%. The lungs are the most common organs of metastasis, followed by the liver and bones. Patients with bone metastases have a median survival period of 12 months, which is slightly longer compared to metastasis in other organs. Distant organ metastasis, age, positive lymph nodes, higher AJCC stages, larger tumor diameter, and higher cell grades are related to poor prognosis (p < 0.001). Furthermore, we have observed that surgical intervention, radiotherapy, and chemotherapy can potentially provide benefits for patients with distant organ metastases.ConclusionMetastasis is an independent prognostic factor for cervical adenocarcinoma patients. Surgery, radiotherapy, and chemotherapy can provide an overall survival advantage for patients with distant organ metastases.

BackgroundCervical cancer, primarily driven by high-risk human papillomavirus (HR-HPV) infection, ranks as the second most common cancer globally. Understanding combined infections’ role, including Cervical fungi, is crucial in cervical carcinogenesis. This study aims to explore the potential correlation between HR-HPV, cervical fungi, and cervical cancer, while adjusting for various factors.MethodsThe study population comprised patients undergoing colposcopy and conization due to abnormal cervical screening results. Clinical data including age, gravidity, HPV (human papillomavirus) genotypes, cervical pathology, and p16/Ki67 expression were extracted. Cervical TCT (ThinPrep Pap Test) and HPV testing are utilized for screening cervical lesions, with fungal presence suggested by TCT results. 5,528 participants were included in this study. Statistical analyses investigated associations between HPV/fungi co-infection and cervical lesions, employing multinomial logistic regression and interaction analysis.ResultsCo-infection with fungi and HPV may decrease the risk of cervical lesions compared to HPV infection alone. In the co-infection group, compared with HPV infection alone, the risk of low-grade squamous intraepithelial lesions (LSIL) was reduced by 27% (OR = 0.73, 95% CI: 0.59–0.90), the risk of high-grade squamous intraepithelial lesions (HSIL) was reduced by 35% (OR = 0.65, 95% CI: 0.51–0.82), and the risk of cervical cancer was reduced by 43% (OR = 0.57, 95% CI: 0.35–0.92). The interaction analysis revealed a negative interaction between fungal and HPV infections in the development of cervical cancer (RERI = −6.25, AP = −0.79, SI = 0.52), HSIL (RERI = −19.15, AP = −0.37, SI = 0.72) and LSIL (RERI = −1.87, AP = −0.33, SI = 0.71), suggesting a sub-additive effect, where the combined effect of the two infections was less than the sum of their individual effects. This indicates that fungal infection may attenuate the promoting effect of HPV on cervical lesions. In exploring the potential mechanism, we found that the co-infection group had significantly lower p16 positivity (54.6%) compared to the HPV-only group (60.2%) (p = 0.004), while there was no statistically significant difference in Ki67 positivity.ConclusionThis study unveils the intricate relationship between cervical fungi and HPV in cervical lesions. Co-infection with fungi and HPV against cervical lesions compared to HPV infection alone, indicating a novel clinical interaction. Lower p16 positivity in co-infection hints at a protective mechanism, urging further exploration.

目的 分析宫颈病变组织中磷脂酰肌醇3激酶(PI3K)-蛋白激酶B(Akt)信号通路相关蛋白的表达及与人乳头瘤病毒(HPV)感染的关系.方法 选择2019年2月-2021年12月福建省妇幼保健院收治的子宫颈鳞状细胞癌患者87例纳入子宫颈鳞状细胞癌组,另选择同期慢性子宫颈炎患者96例纳入慢性子宫颈炎组、子宫颈上皮内瘤变患者92例纳入子宫颈上皮内瘤变组;比较三组患者PI3K、Akt、核因子κB(NF-κB)阳性表达情况,检测不同病理情况子宫颈鳞状细胞癌患者PI3K、Akt、NF-KB阳性表达及HPV感染情况.通过Spearman相关性分析法分析PI3K-Akt信号通路相关蛋白的表达(PI3K、Akt、NF-κB)与HPV感染的相关性.结果 慢性子宫颈炎组、子宫颈上皮内瘤变组、子宫颈鳞状细胞癌组宫颈组织PI3K、Akt、NF-κB阳性表达情况呈升高趋势(P＜0.05);国际妇产科联盟(FIGO)分期Ⅲ～Ⅳ级、组织学分级低分化的宫颈癌患者宫颈组织中PI3K、Akt、NF-κB阳性表达率更高,淋巴结转移NF-κB阳性表达率更高(P＜0.05);子宫颈鳞状细胞癌患者87例,其中HPV阳性74例,阳性率85.06％;FIGO分期Ⅲ～Ⅳ级、组织学分级低分化患者HPV感染率更高(P＜0.05);Spearman相关性分析法结果显示,HPV 与 PI3K、Akt、NF-κB 表达呈正相关(r=0.681、0.639、0.877,P 均＜0.05),PI3K 与 Akt、NF-κB表达呈正相关(r=0.708、0.742,P 均＜0.05);Akt 与 NF-κB 表达呈正相关(r=0.637,P=0.009).结论 PI3K-Akt信号通路可参与慢性子宫颈炎-子宫颈上皮内瘤变-子宫颈鳞状细胞癌的病情发展,宫颈组织PI3K-Akt信号通路相关蛋白表达及与HPV感染密切相关,可能作为临床诊治的新靶点.

To explore the accuracy related to type and subtype between frozen section (FS) results and final pathology results in patients with endometrial cancer and to suggest whether it should be routinely performed.

妊娠滋养细胞肿瘤(GTN)是一种特殊类型的妇科恶性肿瘤,其组织学来源为胎盘的滋养细胞,与妊娠相关,好发于育龄妇女中,尤其在葡萄胎清宫、流产、异位妊娠中发生率较高.根据GTN的转移情况分为转移性与无转移性两种.化疗是GTN最主要的治疗方法,且该疾病对化疗极其敏感,是一种可通过化疗而治愈的疾病.但对于部分耐药患者,高危甚至极高危患者的治疗仍然是难点,这类患者往往容易反复发作,病情进展快,预后差.随着免疫治疗在子宫内膜癌、宫颈癌等疾病治疗上取得的显著疗效,其在GTN方面的研究也不断深入.因此,本综述分析GTN的诊断和分期,探讨GTN免疫治疗及分子靶向治疗的机制、方法及疗效,并针对免疫诊疗中存在的不良反应及采取的相应干预措施进行总结,以期为GTN诊疗提供新思路.

目的 研究影响宫颈癌患者术后下肢深静脉形成的相关因素,以此因素建立风险概率预测模型,以协助判断宫颈癌患者术后发生下肢深静脉血栓形成的风险,为临床实践提供参考.方法 回顾性分析2012年5月—2020年12月收治于福建省妇幼保健院的203例宫颈癌病例的临床病理资料,用Logistic回归法筛选出影响下肢深静脉血栓形成相关因素,建立Logistic风险概率预测模型,并算出该模型ROC曲线下面积.结果 经过单因素分析显示,年龄、总胆固醇、血浆D-二聚体、血浆纤维蛋白原、病理类型、抗凝为影响宫颈癌患者术后下肢深静脉血栓形成的因素,差异有统计学意义(t=-4.420、-2.020;Z=3.405、2.621;χ2=28.769、7.836,P<0.05);经过Logistic回归分析,结果显示,>55岁,D-二聚体>2 mg/L促进宫颈癌患者术后下肢深静脉血栓形成(OR=4.746、4.407,P<0.01),而使用抗凝剂则抑制宫颈癌患者术后下肢深静脉血栓形成(OR=0.274,P<0.01),由前述3个因素构建的风险预测模型的ROC曲线下面积为0.772(P<0.01),表明该模型预测能力良.结论 对于宫颈癌患者术后,年龄、血浆D-二聚体水平、抗凝是用于构建预测下肢深静脉血栓形成风险概率预测模型的相对最优因素,由此构建的风险概率预测模型具有良好的拟合优度和实用性,可为临床实践提供参考.

目的 研究影响ⅠA1～ⅡB期年轻﹙≤40岁)宫颈癌患者盆腔淋巴结转移相关因素,建立风险预测模型,为临床实践提供参考.方法 回顾性分析2012年1月—2019年10月收治于福建省妇幼保健院的169例ⅠA1～ⅡB期年轻宫颈癌病例的临床病理资料,用Logistic回归法筛选影响盆腔淋巴结转移相关因素,并建立风险预测模型和算出ROC曲线下面积.结果 经过计数资料的单因素分析,结果显示,Ⅱ期﹑肿瘤长径>4 cm﹑脉管癌栓﹑肌层浸润﹑宫旁浸润组盆腔淋巴结转移率更高,而血红蛋白浓度>100 g/L组盆腔淋巴结转移率更低,差异有统计学意义﹙P<0.05);经过Logistic回归分析,纳入预报模型的因素为肿瘤长径﹑脉管癌栓﹑肌层浸润﹑宫旁浸润﹑血红蛋白浓度,该模型对训练样本预测的一致百分率为81.1％,该模型ROC曲线下面积为0.825,表明该预报模型预报能力良好.结论 对于ⅠA1～ⅡB期年轻宫颈癌患者,肿瘤长径﹑脉管癌栓﹑肌层浸润﹑宫旁浸润﹑血红蛋白浓度是用于构建预测其盆腔淋巴结转移风险模型的相对最优因素,由此构建的模型具有良好的拟合优度和实用性.

目的 研究低危妊滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)单药化疗耐药的相关因素,建立风险预测模型,为临床实践提供参考.方法 回顾分析2010年1月—2019年11月收治于福建省妇幼保健院妇科的98例初治低危GTN患者的临床资料.结果 经过计数资料的单因素分析,结果显示,化疗前血β-HCG值>5000 U/L组、肺部转移病灶数目≥5个组、FIGO/WHO评分为5～6分组、发病距前次妊娠时间≥7个月组耐药率高,更生霉素组耐药率低,均差异有统计学意义(P<0.05);经过Logistic回归分析,纳入预报模型的因素为化疗前血β-HCG值、化疗药物、年龄、发病距前次妊娠时间,该模型对训练样本的一致正确率为84.7％,该模型ROC曲线下面积为0.876,表明该预报模型预报能力良.结论 对于低危GTN单药化疗患者,化疗前血β-HCG值、化疗药物、年龄、发病距前次妊娠时间情况是用于构建预测其耐药风险模型的相对最优因素,由此构建的模型具有良好的拟合优度和实用性,可为临床实践提供参考.

目的 分析剖宫术后在次妊娠阴道试产(VBAC)的妊娠结局.方法 分析随机在该院2016年7月-2017年6月收治的200例剖宫产再次妊娠阴道试产产妇,根据不同的生产方式进行分组,其中100例是剖宫组选择剖宫产术,另100例阴式组选择的阴道分娩的方式,之后对两组产妇的分娩结局进行对比.结果 阴式组产妇分娩结局情况:阴式组的产后出血量(168.41±11.3)mL、住院时间(3.5±1.6)d和总产程(10.4±1.9)h,剖宫组分别是(265.7±10.8)mL、(4.5±1.5)d、(11.6±2.1)h,差异有统计学意义(t=5.007、10.073、5.631;P＜0.05).阴式组产后并发症发生率是7.0％,显著低于剖宫产组的28.0％,两组数据差异有统计学意义(x2=15.684 3;P＜0.05).结论 对剖宫产术后再次妊娠产妇给予阴道试产妊娠结局显著优于剖宫产,而且产妇分娩出血量较少,产后出现并发症的情况比较少,产妇住院时间比较短,临床安全性很高,值得推广.

目的 研究妊娠糖尿病患者采用胰岛素泵的治疗效果,并分析对孕妇和胎儿的影响.方法 收集2016年1月—12月期间诊治的68例妊娠糖尿病患者临床资料,按随机数字表法分组.对照组34例患者采用传统方法注射胰岛素,试验组34例患者采用胰岛素泵强化治疗.观察2组患者的血糖控制情况,比较2组母婴并发症.结果 试验组血糖控制情况优于对照组(P<0.05);试验组母婴并发症发生率明显低于对照组(P<0.05).结论 胰岛素泵治疗妊娠糖尿病能更好地控制血糖,减少母婴并发症的发生.

目的 探讨妇科内分泌失调患者的临床治疗效果.方法 随机从我院2015年7月～2016年7月期间门诊妇科内分泌失调患者中,抽取80例纳入本研究,80例患者按入院单双顺序号分对照组(西医治疗)40例与研究组(中西医治疗)40例,将两组患者治疗状况纳入到讨论中,确保所得结论的可靠性.结果 研究组总治疗疗效92.50％高于对照组80.00％(P＜0.05).对比两组患者性激素指数(FSH、E2),治疗前差异无统计学意义(P＞0.05);治疗后,研究组高于对照组(P＜0.05).结论 临床治疗妇科内分泌失调疾病可建议将中西医结合,其疗效突出,和单一性西医进行对比,疗效更为明显,可进一步推广和普及.

目的 分析妊娠合并肝功能损害对妊娠结局的影响.方法 选取我院2013年1月~2015年10月收治的妊娠合并肝功能损害患者83例作为研究对象,采集患者临床资料回顾分析,探究妊娠合并肝功能损害临床表现、并发症以及对母体和胎儿的影响.结果 妊娠高血压综合征在中、晚期妊娠易发,晚期妊娠比中期妊娠发病率高;病毒性肝炎早、中、晚期妊娠都有机率发病,但是晚期妊娠发病机率更高;妊娠期肝内胆汁淤积症在中、晚期妊娠均会发病,晚期妊娠发病占比大;妊娠剧吐早期妊娠发病多于中期妊娠;妊娠合并肝功能损害容易引发胎膜早破、胎儿窘迫、早产,导致剖宫产机率高,产后出血机率大;新生儿Apgar评分低于正常妊娠分娩新生儿.结论 妊娠合并肝功能损害会增加胎膜早破、胎儿窘迫、高血压病、早产、剖宫产、产后出血的机率,会影响新生儿Apgar评分,引发妊娠不良结局,临床治疗时,尽早明确诊断,根据病因对症处理,最大限度保障母体及胎儿健康.

Objective To analyze the clinical characteristics and perinatal outcomes of early and late onset zevere preeclampsia.Methods Retrospectively analyzed on the clinic data of 515 cases of severe preeclampsia patients.Studyed on the clinic characteristics and organ damage of early and late onset patients,analyzed the feasibility of expectant management and the choosing of terminating pregnancy time and delivery mode for severe preeclampsia patients and explored the perinatal outcomes of fetuses and newboms.Results①The blood pressure,onset gestation,terminating gestation,management time,prenatal examination of early onset group and late onset group were different statistically.②The level of uric acid,uric protein in 24 h and HCT of early onset patients were higher than late onset patients,and there was a staffstical difference The weight of newborns in early onset group was lower than that in late onset group,there was a statistical difference.③135 times of complications occurred in early onset group,while 237 times in late onset group,91 patients of early onset severe preeclampsia developed organ damage,while 150 patients of late onset severe preeclampsia developed organ damage.Most were single organ damage in both of the two type of severe preeclampsia.④Patients with fewer gestation weeks had higher rate of SGA and higher perinatal mortality rate,and more newborns were sent to NICU.⑤Both group of caesarean birth operation and group of vaginal delivery were no statistical differences in the rates of severe asphyxia,SGA and perinatal mortality between the two delivery mode,excepting the NICU cases.Conclusion Early onset severe eclampsia occurs early and does heavy harm to the maternity and child.We can improve the perinatal outcomes evidenfly by the way of choosing cases strictly,monitoring carefully,implementing expectant management and terminating pregnancy properly.