Objective This study aimed to retrospectively characterise the clinical features of unexpected malignant endometrial lesions identified incidentally in patients undergoing hysterectomy for pelvic organ prolapse (POP) repair, and to identify potential high-risk factors to guide preoperative screening decisions in this population. Methods This study retrospectively reviewed patients who underwent hysterectomy for POP repair at Peking University People’s Hospital, a tertiary medical centre, between January 2008 and February 2024. A consecutive case series of women with unexpected postoperative malignant endometrial pathology was recruited. Demographic characteristics and auxiliary examination results were analysed to summarise the clinical features of these cases. Results Among 3588 asymptomatic women with negative preoperative auxiliary examinations who underwent concurrent hysterectomy for POP repair, 11 cases (0.3%) of unexpected malignant postoperative endometrial pathology were identified. Of these, 10 were endometrioid carcinoma, and one was uterine serous carcinoma; secondary staging surgery was performed in seven patients. Key clinical features among these 11 cases included advanced age (72.7%), overweight or obesity (60%) and hypertension (63.6%). Other comorbidities included hyperlipidaemia (27.3%), cardiovascular disease (18.2%), cerebrovascular disease (18.2%), diabetes (18.2%) and fatty liver (18.2%). Late-onset menopause or abnormal menstrual cycle history were seen in 9.1%. Tumour markers (CA125, CEA), though not routinely tested, were elevated in some patients. Notably, among cases with only overweight or obesity, 60% of occult cancers were identified. This detection rate increased to 90.9% with the addition of one metabolic syndrome complication and reached 100% in those with overweight and two or more metabolic syndrome components. Conclusion Unexpected endometrial malignancy was identified in 0.31% of asymptomatic women undergoing hysterectomy for POP repair despite negative preoperative screening. Overweight or obesity combined with metabolic syndrome components may represent a clinically relevant high-risk profile warranting consideration of targeted preoperative endometrial evaluation in women planning uterine-preserving pelvic floor repair, though prospective validation is needed before formal recommendations can be established.

Osteoarthritis (OA) is a degenerative joint disease marked by cartilage breakdown, chondrocyte apoptosis, and extracellular matrix (ECM) degradation. Non-coding RNAs, particularly circular RNAs (circRNAs), are increasingly recognized as key regulators of OA pathogenesis. This study reveals that circFN1 (hsa_circ_0058152) may act as a competing endogenous RNA, sponging miR-19b-3p and suppressing PTEN expression. This mechanism promotes chondrocyte apoptosis, enhances inflammatory responses, and accelerates ECM degradation, driving OA progression. We investigated the circFN1/miR-19b-3p/PTEN axis using in vitro experiments, including CCK-8 assays, qRT-PCR, Western blotting, ELISA, immunofluorescence, dual-luciferase reporter assays, and bioinformatics analyses to validate regulatory relationships and functional effects. Our study demonstrated that circFN1 suppresses chondrocyte proliferation and exacerbates the inflammatory microenvironment. We further revealed that circFN1 aggravates inflammation-induced chondrocyte injury in OA by repressing the miR-19b-3p/PTEN signaling axis. Collectively, we identified a novel circFN1/miR-19b-3p/PTEN pathway that amplifies IL-1β–induced osteoarthritis progression, highlighting its potential as a therapeutic target for OA intervention. This study identifies the circFN1/miR-19b-3p/PTEN axis as a novel regulator of OA progression. circFN1 may serve as a potential biomarker, and targeting this pathway could provide a basis for future therapeutic strategies.

The aim of this study was to examine the discrepancy between patient- and clinician-assessed modified Ferriman–Gallwey (mFG) hirsutism scores across four PCOS phenotypes and nine body sites, and to evaluate whether patient self-assessment could serve as a reliable tool for preliminary hirsutism screening and outpatient triage. This prospective observational study included 157 Han Chinese female patients aged 18–36 years, who were diagnosed with PCOS according to the Rotterdam criteria at an outpatient gynecological endocrinology clinic. All participants completed a self-assessment questionnaire, scoring terminal hair growth across nine body areas using the mFG scale. These self-assessed scores were compared with clinician-assessed scores independently obtained by two trained physicians who were blinded to patient self-assessment results. Patient self-assessed mFG scores were significantly higher than clinician-assessed scores in the overall PCOS cohort and phenotypes A and B (all P < 0.05), while no significant score differences were detected in phenotypes C and D. Despite higher self-assessed scores, Cohen’s kappa coefficients ranged from 0.551 to 0.855 across phenotypes, indicating moderate to almost perfect diagnostic agreement. Analyses for phenotype D were purely descriptive due to inadequate statistical power. Bland–Altman analysis demonstrated minimal mean scoring bias across all groups, yet the wide 95

Background Heavy menstrual bleeding (HMB) is a common and debilitating condition in women with bleeding disorders (BD). The underlying hemostatic abnormalities in these patients often make standard treatments ineffective. Clinical management is complicated in women with moderate-to-severe thrombocytopenia or those receiving antithrombotic therapy. To date, research addressing these two patient groups remains limited, with few safe and effective treatment options available due to their heightened bleeding risk. Therefore, the study aimed to evaluate low-dose mifepristone as a bridge therapy for refractory HMB in women with BD. Methods A retrospective cohort study was conducted among women aged 10-55 years with BD and refractory HMB, treated with mifepristone at the Department of Gynecology, Peking University People's Hospital, from 2010 to 2024. For some patients with acute severe bleeding, intrauterine balloon tamponade were initially used, followed by mifepristone therapy maintained for at least two months. In patients with chronic bleeding, mifepristone was initiated at any point during the menstrual cycle. The primary endpoint was change in pictorial blood assessment chart (PBAC) score. Secondary endpoints included hemoglobin levels, amenorrhea rate, Menorrhagia Multi-Attribute Scale (MMAS) scores, and safety parameters. Continuous paired comparisons were analyzed using the Wilcoxon signed-rank test, and repeated measurements using the Friedman test with Bonferroni correction. Results A total of 63 patients met the inclusion criteria, with the study cohort primarily comprising 48 cases of thrombocytopenia of diverse etiologies and 13 patients receiving antithrombotic therapy. Following one month of treatment, the median PBAC score decreased from 385 to 0, while median hemoglobin levels increased from 51 g/L to 84 g/L (Bonferroni-adjusted p<0.01). Amenorrhea was achieved in 92.1% of patients by one month, and in all evaluable patients by three months. MMAS scores improved. No thromboembolic events or clinically relevant coagulation abnormalities were observed. Liver function remained stable, with only transient enzyme elevations, which were attributed to chemotherapy. Conclusions In this retrospective cohort, low-dose mifepristone was associated with improved bleeding control and acceptable tolerability. It may serve as a potential bridge therapy for women with BD and refractory HMB. Prospective controlled studies are warranted.

Ankylosing spondylitis can present with severe kyphosis, scoliosis, and bilateral hip ankylosis, posing significant therapeutic challenges. Conventional "hip-first" or "spine-first" strategies are often limited by interdependent biomechanical constraints. This case report describes a successful staged "sandwich" protocol in a 48-year-old male with ankylosing spondylitis, thoracolumbar kyphosis, scoliosis, and bilateral hip ankylosis. The treatment involved three sequential stages: first, right total hip arthroplasty; second, pedicle subtraction osteotomy from T10 to L4; and third, contralateral total hip arthroplasty. This approach addressed critical issues including intraoperative positioning, global spinopelvic realignment, and individualized acetabular component orientation. Postoperative radiographs demonstrated marked improvement in spinal sagittal and coronal alignment, with well-positioned hip prostheses. The "sandwich" strategy adheres to a coherent biomechanical principle of "unlock-rebalance-match," systematically restoring mobility, correcting alignment, and ensuring long-term prosthetic stability. This approach offers a promising alternative for managing complex hip-spine syndrome in advanced ankylosing spondylitis.

Cyclophosphamide (CTX) is a first-line chemotherapeutic agent for various cancers but is associated with a significant risk of ovarian dysfunction, which may even progress to premature ovarian failure (POF). Granulosa cell senescence is a key phenotypic manifestation of this process. Hydroxychloroquine (HCQ) exerts anti-senescence effects in age-related diseases; however, its efficacy in preventing CTX-induced ovarian damage remains elusive. We aimed to verify the protective effect of HCQ using a CTX-induced POF mouse model. In vitro validation was performed using the human ovarian granulosa cell line (KGN), which was treated with phosphoramide mustard (PM, the active metabolite of CTX) and HCQ. HCQ partially reversed CTX-induced impairment of ovarian function, reduced follicular depletion, and improved serum hormone levels as well as reproductive outcomes. HCQ attenuated CTX-induced cellular senescence, stabilized mitochondrial membranes, decreased reactive oxygen species (ROS) production and mitochondrial DNA (mtDNA) leakage, inhibited the cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) signaling pathway, and suppressed the expression of senescence-associated secretory phenotype (SASP) factors. Collectively, our preclinical findings demonstrate that HCQ alleviates CTX-induced POF, which is associated with the mitigation of granulosa cell senescence and modulation of the mtDNA-cGAS signaling pathway.

Heterogeneity in the pathological response to neoadjuvant chemoimmunotherapy underscores the need for predictive biomarkers in resectable non-small cell lung cancer (NSCLC). This study identified baseline molecular features-particularly tumor proliferation signatures-associated with pathological response. Two retrospective cohorts (test, n = 81; validation, n = 107) of patients with NSCLC who received neoadjuvant chemoimmunotherapy were analyzed. Bulk RNA sequencing was performed on baseline biopsies from the test cohort, with immunohistochemistry (IHC) for PD-L1 and Ki-67 in both cohorts. Outcomes included major pathological response (MPR), pathological complete response (pCR), and event-free survival. In the test cohort, transcriptomic analysis showed that responders had significant upregulation of proliferation-related genes (eg, TP63, SOX2, NTRK2, and HMGA2) and activation of proliferation signatures (eg, chromosomal instability signature and core embryonic stem cell-like module), without activation of canonical immune-inflamed pathways. PD-L1 expression had limited predictive value (area under the curves [AUCs], 0.56-0.59 for MPR and 0.52-0.54 for pCR). In contrast, proliferation markers demonstrated higher performance: MKI67 messenger RNA predicted both MPR and pCR with an AUC of 0.71, and the Ki-67 IHC index yielded AUCs of 0.71 for MPR and 0.64 for pCR. The predictive value of the Ki-67 IHC index was validated in the independent cohort, with AUCs of 0.74 for MPR and 0.70 for pCR, and this association was generally consistent across squamous cell carcinoma and adenocarcinoma. A Ki-67 index ≥50% was significantly correlated with improved event-free survival in both cohorts (both Ps < .05). These findings indicate baseline tumor proliferation, particularly MKI67/Ki-67, as predictors of pathological response in NSCLC patients receiving neoadjuvant chemoimmunotherapy, supporting its potential clinical utility for patient selection.

Objective To compare the efficacy of oral and transdermal estrogens in improving the quality of life in perimenopausal and recently postmenopausal women.Methods 257 women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral estradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month). Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire.Results Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral estrogen group after 24 weeks.Conclusions This study showed that both transdermal and oral estrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.

This study aimed to assess the predictive and evaluative value of PD-L1 targeted 68Ga-THP-APN09 PET/CT in the neoadjuvant immunotherapy combined with chemotherapy for resectable non-small cell lung cancer (NSCLC), and to explore its potential in indicating immunotherapy-related adverse effects (irAEs). Fifty patients with resectable NSCLC enrolled in this prospective study underwent baseline 68Ga-THP-APN09 PET/CT and 18F-FDG PET/CT, with follow-up 18F-FDG PET/CT conducted, additionally, 36 patients received follow-up 68Ga-THP-APN09 PET/CT. Surgery was performed following 2–4 cycles of toripalimab combined with chemotherapy if R0 resection was feasible. The major pathologic response (MPR) state of the post-operative specimen and the adverse effects following combined therapy were documented. The correlation between PD-L1 expression and baseline 68Ga-THP-APN09 PET/CT uptake was determined. The predictive and evaluative efficacies of baseline and follow-up 68Ga-THP-APN09 PET/CT, along with 18F-FDG PET/CT, in determining MPR, were compared. The SUVmax values of baseline 68Ga-THP-APN09 PET/CT were significantly higher in patients exhibiting high-positive PD-L1 expression compared to those with low-positive and negative expression (P = 0.001). And the SUVmax values of baseline 68Ga-THP-APN09 PET/CT in the response group, as determined by 18F-FDG PET/CT evaluation, were significantly higher than those in the non-response group (3.4 vs. 2.4, P < 0.001). Totally, 41 patients underwent surgery, of which 27 achieved MPR, while 14 did not. The SUVmax in baseline 68Ga-THP-APN09 PET/CT demonstrated statistical significance between the MPR and non-MPR groups, with area under the ROC curve (AUC) of 0.88 (95 https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BMSI .

Cyclophosphamide (CTX) is widely used as a first-line chemotherapeutic agent for various cancers, but it is associated with significant risks of ovarian dysfunction, even progressing to premature ovarian failure (POF), with granulosa cell senescence being a key phenotypic manifestation. hydroxychloroquine (HCQ) has demonstrated anti-senescence properties in the context of age-related diseases, but its efficacy in preventing CTX-induced ovarian damage has not been fully elucidated. We conducted a controlled animal study using a CTX-induced POF model in female C57BL/6 mice, comprising three groups: vehicle control, CTX-only, and CTX + HCQ. Complementary in vitro studies were conducted using the human ovarian granulosa cell line KGN, treated with phosphoramide mustard (PM, the active metabolite of CTX) and HCQ. HCQ partially reversed the CTX-induced decrease in ovarian index, normalized the estrous cycle, reduced follicle depletion, and improved serum hormone levels as well as reproductive outcomes. HCQ reduced the expression of granulosa cell senescence markers and the area of senescence-associated β-galactosidase(SA-β-gal)-positive cells, stabilized mitochondrial membrane potential, decreased reactive oxygen species(ROS) production and mitochondrial DNA(mtDNA) leakage, inhibited cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling and suppressed senescence-associated secretory phenotype(SASP) factors. Collectively, HCQ protects CTX-induced POF by inhibiting activation of the mtDNA-cGAS signaling pathway, thereby alleviating granulosa cell senescence and preserving ovarian function.

IntroductionThis study aimed to investigate the underlying mechanisms involved in the cardioprotective effects of dehydroepiandrosterone (DHEA) on endoplasmic reticulum stress (ERS) -mediated apoptosis in human vascular smooth muscle cells (HVSMCs) and human umbilical vein endothelial cells (HUVECs).Material and methodsVarious concentrations of Dithiothreitol (DTT) were used to induce ERS-mediated apoptosis. DHEA was utilized to inhibit the apoptotic effects of DTT, while estrogen receptor (ER) antagonists ICI 182,780 and G15, the androgen receptor (AR) antagonist flutamide and the aromatase inhibitor letrozole were used to identify the receptors activated during DHEA treatment in HVSMCs and HUVECs. Flow cytometry assessed the apoptotic rate, and Western blotting analysis evaluated the expression levels of ERS-related proteins GRP78 and PERK, and the apoptotic protein marker CHOP. Furthermore, the primary receptor signaling pathways were identified using signaling pathway blockers: LY294002 (PI3K blocker), SP600125 (JNK blocker), and U0126 (ERK1/2 blocker).ResultsIn the DTT pretreatment group (0.8 mmol/L, for 8 h), the expressions of GRP78 and CHOP were significantly up regulated, indicating that an optimal ERS model was successfully established. Additionally, 10-4 mmol/L DHEA significantly inhibited the DTT-induced upregulation of GRP78 and CHOP. The results also demonstrated that the apoptotic rate in the DTT group was increased, while DHEA significantly reduced this rate. The addition of ER antagonists ICI 182,780 and G15 to HVSMCs reversed the effects of DHEA; however, the aromatase inhibitor letrozole and the AR antagonist flutamide did not reverse this effect. Notably, the use of the JNK inhibitor SP600125, the PI3K inhibitor LY294002, and the ERK1/2 inhibitor U0126 antagonized the protective effects of DHEA, with SP600125 showing the most significant impact on both HVSMCs and HUVECs.ConclusionOur study has identified a novel mechanism underlying the cardioprotective effects of DHEA. Specifically, DHEA may mitigate ERS-induced cell apoptosis by activating estrogen receptors ERα, ERβ, and GPER via the activated JNK pathway.

INTRODUCTION Abnormal uterine bleeding(AUB)is the most common reason adolescent females visit gynaecologists.From the onset of menarche,symptoms such as heavy menstrual bleeding(HMB)and/or prolonged menstruation can affect both physical and mental health,with potential lifelong impacts.Despite its preva-lence,there are relatively few studies on AUB in adolescence,and China lacks relevant guidelines and consensus on the issue.

Osteoporosis is a prevalent condition among the elderly, and current treatments are limited by their side effects. This study aimed to develop a safe nanocarbon material with anti-osteoporotic properties. A promising candidate, carbon quantum dots (CQDs), was synthesized using a single-step liquid-phase pulse method and characterized by transmission electron microscopy (TEM). To evaluate the biocompatibility and anti-osteoporotic effects of CQDs, they were administered at a dose of 276 μg/mL or a placebo to an osteoporotic mouse model (n = 16) for 3 months. Biocompatibility was assessed through monitoring weight changes, general health, blood tests, and H&E staining of visceral organs. To assess bone quality, imaging, histological analysis, and biomechanical tests were performed. The results showed that CQDs significantly inhibited osteoclastic activity, leading to improved bone mass and mechanical strength without obvious toxicity. These findings suggest CQDs as a promising candidate for safer osteoporosis therapies.

It is well known that premature ovarian insufficiency (POI) seriously affects the fertility, quality of life, and health of young women. A meta-analysis of global data indicated that the current population prevalence of POI is as high as 3.7 %, but exceeds 10 % in some countries and regions. When POI is caused by disease treatment, it is termed iatrogenic POI. Iatrogenic factors are the most common identifiable cause of POI, and iatrogenic POI has a high prevalence in young cancer survivors. Overall, iatrogenic POI accounts for approximately half of all cases, but data show that its prevalence in female cancer survivors under the age of 24 can reach up to 82.2 %. With the improvement of cancer treatment, this incidence is still rising. It arises in the context of a variety of diseases and has a complex etiology. Patients with iatrogenic POI tend to be younger than those with other types of POI, which means they can experience more harm from the condition, and there is an urgent need to diagnose, treat, and manage them as early as possible. However, there is currently no relevant consensus or guideline either within China or indeed internationally. This guideline expert group gathered data from doctors and patients in 34 provinces, municipalities, and autonomous regions across China through questionnaires to determine guideline-related issues and searched the literature in English-language databases such as Cochrane and PubMed since their establishment. After merging and deduplicating, literature evaluation and evidence grading were carried out. After discussion and induction, the clinical treatment and management guidelines for iatrogenic POI were formulated and combined with China's national conditions. The expert group ultimately addressed 19 clinical questions, as determined through a questionnaire survey and field investigation, and produced 26 recommendations based on international and domestic evidence from evidence-based medicine and clinical practice experience, to provide a reference for colleagues in clinical practice. The recommendations primarily reflect the context and needs within China and are intended for broad nationwide applicability, though regional adaptations based on local resources and practices may be necessary.

OBJECTIVE:While advances in allogeneic hematopoietic stem cell transplantation (allo-HSCT) have improved survival rates, the impact on reproductive function in Chinese female pediatric survivors remains underexplored. This study evaluated the incidence and factors influencing ovarian function impairment in these survivors. METHODS:A prospective study was conducted on 104 children who survived allo-HSCT between 2018 and 2021 at Beijing Children's Hospital. Data on hematologic disease, age, and ovarian function were collected. Statistical analyses assessed changes in sex hormone levels and identified factors linked to gonadal damage. RESULTS:Post-transplant, follicle-stimulating hormone levels rose significantly (p = 0.013 for girls ≥10 years old), while anti-Müllerian hormone levels decreased (p < 0.001). The incidence of premature ovarian insufficiency (POI) was 26.92% at 1 year, 47.44% at 2 years, and 70.18% at 3 years post-transplant. Risk factors for POI included transplantation age ≥10 years, weight >20 kg at transplantation, myeloablative conditioning, and total body irradiation (OR = 6.76, p = 0.005; OR = 6.63, p = 0.003; OR = 17, p = 0.017; OR = 15.03, p = 0.026). Only 3.85% of patients received ovarian function protection before transplantation. Among patients aged ≥12 years at follow-up, 86.36% developed POI, with 26.32% receiving oral estrogen replacement therapy. CONCLUSIONS:Hypogonadal function significantly declines in pediatric patients after allo-HSCT. Fertility protection and hormone replacement therapy were rarely used.

Although some evidence suggests that Chinese and white women might have different pelvic floor anatomy such as levator complex and connective tissue support for pelvic organs, it is unknown if these differences affect the mechanisms of pelvic organ prolapse. We sought to determine whether differences exist in MRI-based structural failure patterns between Chinese and American white women with prolapse. This is a case–control study in different racial cohorts recruited in China and the USA. The Chinese cohort included 19 women with anterior-predominant prolapse and 24 controls with normal pelvic support. The American white cohort included 30 women with anterior-predominant prolapse and 30 controls. Both cohorts underwent the same clinical evaluation and MRI protocol. Three structural support systems were quantified on stress 3D MRI at maximal Valsalva: vaginal factors (length, width); connective tissue attachment (cervix, lateral paravaginal height); and hiatus factors (urogenital hiatus size, major levator ani injury). Abnormal structural support was defined as any measurement outside the normal range defined as the 5th to 95th percentile in controls from the respective cohort. The percentages of the women with abnormal support in the two cohorts were compared. Among those with prolapse, Chinese women were more likely than white women to have abnormally long vaginal length and width (90

BACKGROUND:The association between preoperative wearable device step counts and surgical outcomes has not been examined using commercial devices linked to electronic health records (EHRs). This study measured the association between daily preoperative step counts and postoperative complications. STUDY DESIGN:Data were obtained using the All of Us (AOU) Research program, a nationwide initiative to collect EHR and health-related data from the population. Patients who underwent a surgical procedure included in the NSQIP-targeted procedures dataset were included. Patients who did not have available physical activity FitBit data were excluded. Primary outcome was the development of a postoperative complication. All analyses were performed in the AOU researcher workbench. RESULTS:Of 27,150 patients who underwent a surgical procedure, 475 participants with preoperative wearable data were included: 74.7% were female and 85.2% were White. The average age was 57.2 years. The overall rate of postoperative complications was 12.6%. Patients averaging less than 7,500 daily steps were at increased odds for developing a postoperative complication (odds ratio 1.83, 95% CI 1.01 to 3.31). After adjustment for age, sex, race, comorbid disease, BMI, and relative procedure risk, patients with a baseline average steps per day less than 7,500 were at increased odds for postoperative complication (adjusted odds ratio 2.06, 95% CI 1.05 to 4.06). CONCLUSIONS:This study found an increase in overall postoperative complication rate in patients recording lower average preoperative step counts. Patients with a baseline of less than 7,500 steps per day had increased odds of postoperative complications in this cohort. These data support the use of wearable devices for surgical risk stratification and suggest step count may measure preoperative fitness.

To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People’s Hospital from April 2017 to January 2023 were analyzed and summarized. A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81 years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12 ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24 IU/L in examination before OTC. FSH was greater than 10.0 IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84 g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43 g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58 min, and the average blood loss was 32.1 ± 41.6 mL. The maximum blood loss was 200 mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20 days and began HSCT within 30 days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3 years after HSCT and resumed regular menstruation 6 months after OTT. Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.

OBJECTIVE:To investigate the benefits of menstrual management in women undergoing hematopoietic stem cell transplantation (HSCT), in whom heavy menstrual bleeding (HMB) can be an underestimated bleeding complication. METHODS:This was a retrospective cohort study. Patients who had undergone HSCT in the Gynecological Endocrinology Clinic of Peking University People's Hospital were included over 10 years. The data of hematology and menstruation for all participants were collected. The management methods of the intervention group include gonadotropin-releasing hormone agonists (GnRHa), combined oral contraceptives (COC), or low-dose mifepristone. Patients who did not receive management were included in the control group. RESULTS:There were 112 patients included in the intervention group and 218 patients included in the control group. In all, 90.0%(297/330) of patients presented with HMB before HSCT. In the control group, 83.5%(182/218) of patients experienced menstruation in the laminar air-flow room (LAFR), whereas only 22.3%(25/112) did in the intervention group. After leaving the LAFR, the incidence of recurrent uterine bleeding was significantly reduced in the intervention group (17.9%(20/112/) versus 50.9%(111/218), p < 0.001). Patients who did not undergo menstrual management had a higher risk of bleeding than those who did (odds ratio 18.12, p < 0.001). CONCLUSION:Menstrual management significantly reduces the incidence of HMB in HSCT patients and acts as a protective factor to prevent menstrual bleeding in the LAFR.