OBJECTIVE:To analyze the factors related to pregnancy of endometriosis and whether Chinese herbal medicines (CHMs) can improve pregnancy outcomes in patients with endometriosis in long-term management. METHODS:This multicenter cohort study retrospectively analyzed the clinical data of endometriosis patients with fertility needs from January 2019 to November 2019. A total of 252 patients with endometriosis from 5 level-III Grade A hospitals in Beijing were included in this study. Univariate and multivariate logistic regression analysis were performed for the relevant factors. The propensity score matching (PSM) function of SPSS software was used to match the CHMs group with the non-CHMs group. The pregnancy rate and live birth rate were analyzed. RESULTS:The results of univariate analysis showed that age, disease course, presence of infertility, presence of adenomyosis, time after surgery or use of gonadotropin-releasing hormone agonist (GnRH-a), use of CHMs and follow-up time were influencing factors of pregnancy in endometriosis patients (P<0.05). The results of multivariate analysis showed that age, presence of adenomyosis, time after surgery or use of GnRH-a, use of CHMs and follow-up time were independent factors affecting pregnancy in endometriosis patients, among which, age ⩾35 years old, presence of adenomyosis and follow-up time >6 months were independent risk factors (OR=0.445, 0.348, 0.140, respectively, P<0.05), time after surgery or use of GnRH-a ⩽6 months and use of CHMs were independent protective factors (OR=3.839, 3.842, respectively, P<0.05). After PSM, 99 pairs of two groups were matched successfully. The pregnancy rate of the CHMs group was higher than that of the non-CHMs group [55.56% (55/99) vs. 36.36% (36/99), P<0.05]. The live birth rate of the CHMs group was higher than that of the non-CHMs group [49.49% (49/99) vs. 35.35% (35/99), P<0.05]. CONCLUSION:CHMs can effectively improve clinical pregnancy rate and live birth rate of patients with endometriosis in the chronic disease management.

Abstract Background: Human papillomavirus (HPV) is a double-stranded circular DNA virus that mainly infects the human epidermis and mucosal squamous epithelium. We aimed to explore the mechanism of the Rhizoma Smilacis Glabrae (RSG) and Phellodendron compound in the treatment of HPV by network pharmacology and molecular docking. Methods: Potential targets and active compounds of RSG and Phellodendron, as well as HPV-related targets, were retrieved from public databases. First, the key targets were obtained by intersection of the differentially expression genes (DEGs) between HPV (+)and HPV (-)tissue samples from GSE3292 dataset and top 10 proteins from protein-protein interaction (PPI) network according to Degree. Gene set enrichment analysis (GSEA) of key targets was analyzed. Subsequently, immune microenvironmentwas explored by CIBERSORT algorithm. The competing endogenouse RNA (ceRNA) network of key targets was created. Lastly, molecular docking was performed to predict the binding activityof active ingredients with key targets. Results: A total of 37 bioactive ingredients of RSG and Phellodendron, and 59 RSG and Phellodendron-HPV-related targets were screened. GSEA showed (ESR1, EGFR and PTEN) were associated with PI3K-AKT signaling pathway. Immune infiltration analysis showed that CD8 T cells were found more abundant in the HPV (+) groups. Moreover, lncRNA-miRNA-mRNA network containing 20 nodes (3 key targets, 13 miRNAs and 4 lncRNAs) and 29 edges was constructed. Finally, molecular docking suggested that quercetin combined well with EGFR and PTEN, and palmatine had the strong affinity with ESR1. Conclusion: 3 key targets (ESR1, EGFR and PTEN) and 2 bioactive ingredients (quercetin and palmatine) were successfully identified for RSG and Phellodendron against HPV, which provided theoretical basis for the clinical application of traditional Chinese medicine compound and the molecular mechanism of human papillomavirus infection.

Purpose Exploring the status and related factors of postoperative recurrence of ovarian endometriosis. Methods This study analyzed the results of questionnaires conducted in 27 hospitals across the country from January 2019 to November 2021. All women were divided into recurrence group and non-recurrence group to analyze the recurrence rate and related factors after ovarian endometriosis surgery. Results The recurrence rates of ovarian endometriosis within 1 year, 1–2 years, 2–3 years, 3–4 years, 4–5 years and more than 5 years were 6.27%, 35.85%, 55.38%, 65.00% and 56.82%, respectively. Significant differences were found between two groups in terms of age at surgery (OR: 0.342, 95%CI: 0.244–0.481, P < 0.001), presence of dysmenorrhea (OR: 1.758, 95%CI: 1.337–2.312, P < 0.001), presence of adenomyosis (OR: 1.948, 95%CI: 1.417–2.678, P < 0.001) and family history of endometriosis or adenomyosis (OR: 1.678, 95%CI: 1.035–2.721, P = 0.021). The age at surgery (OR: 0.358, 95%CI: 0.253–0.506, P < 0.001), presence of dysmenorrhea (OR: 1.379, 95%CI: 1.026–1.853, P = 0.033) and presence of adenomyosis (OR: 1.799, 95%CI: 1.275–2.537, P = 0.001) were significantly associated with endometrioma recurrence in multivariate analysis. No significant associations were found between the recurrence rate and body mass index (BMI), educational background, age of menarche, gravida, parity, uterine leiomyoma, endometrial polyps or postoperative use of gonadotropin-releasing hormone agonist (GnRH-a). Conclusions Dysmenorrhea and presence of adenomyosis are independent risk factors for postoperative recurrence of ovarian endometriosis, and older age is an independent protective factor for postoperative recurrence.

Background: Endometriosis(EM) is a common disease that occurs in reproductive age. 50% endometriosis patients is suffering from infertility. Follicular development is the main cause of endometriosis-associated infertility. Here the study based on apoptosis of granulosa cells during follicular development will explore the effect and the possible mechanism of Huoxue Xiaoyi Decoction (HXXYD) on apoptosis of ovarian granulosa cells in endometriosis model rats. Methods: Thirty 8-week-old female SD rats were divided into four groups: blank group, sham-operation group, model group and HXXYD group. Blank group, sham-operation group and model group were given double-distilled water, while HXXYD group were given HXXYD for 15 days. After intragastric administration, blood samples from abdominal aorta of rats were collected to detect oxidative and antioxidative indexes including ROS, T-SOD, CAT. The morphology of follicles were observed by H&E staining and every stage of follicles were calculated. The location of granulosa cells and apoptosis related factors including Bax, Bcl-2, caspase-3 were stained by immunohistochemistry staining. The apoptosis of granulosa cells were stained by TUNEL staining and the rate of apoptosis were calculated. Apoptosis related proteins including p-JNK, Bax, Bcl-2, caspase-3 were detected by Western blot. Results: The level of serum ROS decreased, and the levels of serum T-SOD and CAT increased in the HXXYD group. The number of secondary follicles increased in HXXYD group. The expression of Bax, caspase-3 in ovarian granulosa cells decreased and the expression of Bcl-2 increased in the HXXYD group with immunochemical staining. The apoptosis rate of ovarian granulosa cells in the HXXYD group decreased. The expression of p-JNK, Bax and caspase-3 protein decreased, the expression of Bcl-2 increased in the HXXYD group.Conclusions: These results indicate that HXXYD may improve the oxidative stress state, decrease the apoptosis of ovarian granulosa cells, and improve the development of follicles in endometriosis model rats through ROS-JNK signaling pathway.