ObjectiveVarious guidelines recommend offering germline genetic testing to all patients diagnosed with epithelial ovarian cancer, as it helps guide treatment decisions, identify cancer risks in other organs, and empowers patients to notify families for timely screening and risk-reducing surgery. Our study aimed to explore the awareness and uptake rate of germline genetic testing among Chinese women with epithelial ovarian cancer, and to analyze the determinants influencing their decision.MethodsA cross sectional study was conducted at Obstetrics and Gynecology Hospital of Fudan University between November 2023 to September 2024. A questionnaire was used to assess patients’ awareness of germline genetic testing. Disease-related data were extracted from electronic medical records. Binary logistic regression analysis was performed to identify factors associated with uptake of germline genetic testing.ResultsOf the total 154 patients included, 100 underwent germline genetic testing, with an uptake rate of 64.94%. Among included patients, 62.99% demonstrated low awareness of germline genetic testing and 37.01% exhibited a high level of awareness. Logistic regression analysis showed that higher monthly per-capita household income (OR = 3.30, 95 % CI 1.24-8.75, P = 0.017), a family history of BRCA-related cancers (OR = 6.30, 95% CI 1.16-34.12, P = 0.033), and high awareness of germline genetic testing (OR = 8.81, 95 % CI 2.58-30.12, P = 0.001) were associated with a significantly increased likelihood of undergoing testing. Additionally, 19.6% of the tested patients carried a pathogenic variant.ConclusionAmong Chinese patients with epithelial ovarian cancer, awareness of germline genetic testing is generally low, with critical deficiencies in knowledge that directly inform clinical decision-making and familial risk management. Nearly two-thirds of patients diagnosed with epithelial ovarian cancer had undergone germline genetic testing. Socioeconomic status, family history of associated cancer, and patients’ awareness of genetic testing are the principal determinants of germline genetic testing utilization in this population.

Background:Uterine contraction is a meaningful indicator for labor onset and appropriate hospital admission. Inaccurate self-assessment may lead to premature admission, unnecessary interventions, and higher healthcare resource use. Traditional monitoring devices have limited portability and comfort, restricting home-based use. Objective:This study developed and validated a wearable system integrating flexible sensors, a data acquisition platform, and machine learning models to monitor uterine contractions and identify labor onset, focusing on late pregnancy and the pre-labor period. Methods:A flexible sensor-based device was developed and validated against hospital toco. Contraction data from 82 participants (104 recordings) were preprocessed and segmented, and features were extracted for model training. Hospital admission was classified into recommended admission (RA), deferred admission (DA), and selective admission (SA). Several ML models were trained and evaluated via 10-fold stratified cross-validation using accuracy, precision, recall, F 1-score, and area under the curve. Shapley Additive Explanations (SHAP) analysis interpreted feature contributions. Results:A total of 82 participants were enrolled, and 104 uterine contraction recordings were collected, ranging from 10 to 70 min (mean 20.3). Two hundred and seventy-seven processed segments were obtained for analysis. Contraction signals were generally consistent with toco measurements (r = 0.85-0.95). XGBoost achieved accuracy of 0.87 for RA classification, and SHAP identified kurtosis, signal energy area, and standard deviation as key features. Conclusion:The system enabled accurate monitoring of uterine contractions, improved estimation of hospital admission timing, reduced premature admission risk, and demonstrated high wearability, offering a feasible solution for home obstetric monitoring.

OBJECTIVE:To synthesize randomized controlled trials (RCTs) regarding the effectiveness of pre-pregnancy weight loss interventions on the risk of gestational diabetes mellitus (GDM) in women with overweight or obesity. METHODS:Comprehensive literature searches were conducted across nine databases from inception to May 2024. RCTs comparing pre-pregnancy weight loss interventions with blank control or active control among adult women with overweight or obesity were included. Meta-analyses, using a random-effects model, were performed to pool results of RCTs. RESULTS:Six studies, including 1632 participants, were included. The effectiveness of pre-pregnancy weight loss interventions on changes in weight and body mass index (BMI) was statistically significant (mean difference [MD] = -6.02, 95% confidence interval [CI] [-8.94, -3.10], I2 = 98%; MD = -2.22, 95% CI [-3.44, -1.00], I2 = 98%). However, there was no statistically significant difference in the risk of GDM in women receiving pre-pregnancy weight loss interventions compared with controls (Odd Ratio [OR] = 0.70, 95% CI [0.48, 1.03], I2 = 2%). LINKING EVIDENCE TO ACTION:Pre-pregnancy weight loss interventions do not significantly impact the risk of GDM in women with overweight or obesity. Due to the small number of studies, small sample size, and large heterogeneity of pre-pregnancy weight loss interventions, further research is required. TRIAL REGISTRATION:ClinicalTrials.gov identifier: CRD42023482808.

Family-specific variant genetic testing is crucial for cancer risk management among at-risk relatives of individuals with hereditary gynecological cancer. However, the uptake of such testing remains suboptimal, and the factors influencing uptake have not been fully elucidated. This study aimed to investigate the uptake of family-specific variant genetic testing among at-risk relatives of probands with hereditary gynecological cancers and to identify factors associated with testing uptake. A cross-sectional study was conducted between August 2023 and September 2024 at the Obstetrics and Gynecology Hospital of Fudan University. Seventy probands with confirmed pathogenic or likely pathogenic (P/LP) germline variants in hereditary gynecological cancer susceptibility genes, along with their 307 at-risk relatives, were enrolled. Self-designed questionnaires were used to collect characteristics of probands and their at-risk relatives, as well as the features of their relationships. Multivariate binary logistic regression analysis was performed to identify factors associated with testing uptake. Among the 70 probands, isolated ovarian cancer accounted for the highest proportion of personal malignancies (60.00

BackgroundCancer-related cognitive impairment (CRCI) is one of the most prevalent and persistent symptoms reported by women with ovarian cancer. This study aims to comprehensively explore the symptom experience of CRCI in people/women with ovarian cancer.MethodsSemi-structured interviews were conducted with eligible people/women with ovarian cancer in Cancer Center of Fudan University, Shanghai, China. The interview guide and data coding were developed based on the symptom management theory. Qualitative content analysis was utilized to identify and refine key themes and sub-themes.ResultsThe study included 31 participants with a mean age of 51.38 years (range: 25-65 years) and a median time since diagnosis of one year (range: 0.35-14.2 years). Four themes and ten sub-themes were identified: Theme 1 CRCI Perception, including two subthemes: 'Experiencing subtle cognitive decline' and 'No feeling or no opportunity to feel the changes in cognitive function'. Theme 2 CRCI Attribution, including three subthemes: 'social disengagement and values reconstruction' 'symptom entanglement' and 'surgical anesthesia and chemotherapy'. Theme 3 CRCI Impacts: 'contained life disruption' and 'eroded self-efficacy'. Theme 4 Adaptive responses: 'cognitive load reduction' 'Compensatory strategies' and 'Passive acceptance'.ConclusionsThe majority of women with ovarian cancer in this study reported experiencing CRCI, primarily characterized by memory and attention deficits. Sociocultural context and individual cancer copying style played an important role on the CRCI symptom experience, underscoring the need for culturally sensitive, patient-centered interventions to address CRCI in ovarian cancer care.

Cryopreservation and transplantation of intact ovaries offer a promising approach to fertility restoration in cancer patients. However, ischemia–reperfusion injury following transplantation significantly impairs graft function. This study aimed to evaluate the protective effects of melatonin and elucidate its underlying mechanisms of action, including antioxidant and anti-inflammatory properties. Intact ovaries from 8 to 12-week-old LEWIS rats were cryopreserved and subsequently transplanted. Melatonin (25 mg/kg and 50 mg/kg) was administered daily from day 1 to day 4 postoperatively. Estrous cycle recovery and ovarian histology were examined, along with measurements of hormone concentrations, antioxidant activity, and inflammatory mediators. The oxidative stress response, particularly the nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response elements (ARE) signaling pathway—including Nrf2, Kelch-like ECH-associated protein 1 (Keap1), and sMafg—was investigated to elucidate melatonin’s protective mechanisms. The roles of melatonin receptors and Nrf2 were investigated using specific receptor antagonists (Luzindole, 4P-PDOT) and an inhibitor (ML385) to confirm the involvement of the MT1/Nrf2/ARE pathway. As a result, rats treated with high-dose melatonin (50 mg/kg) exhibited accelerated estrous cycle recovery, reduced follicular loss, improved serum hormone levels, enhanced antioxidant capacity in serum and ovarian tissue, and decreased levels of inflammatory cytokines. Furthermore, melatonin exerted its antioxidant and anti-inflammatory effects through activation of the Nrf2/ARE signaling pathway via the MT1 receptor. These protective effects were abolished by the inhibition of either Nrf2 or MT1 receptor. In conclusion, these findings demonstrate that melatonin mitigates oxidative stress and inflammatory damage in intact transplanted ovaries through the MT1/Nrf2/ARE signaling axis, thereby preserving ovarian function post-transplantation.

AIM:This study aims to investigate physical inactivity levels in early pregnancy and explore the associated factors among Chinese pregnant women. DESIGN:A convergent mixed-methods study was employed, comprising a cross-sectional survey (n = 802) and in-depth semi-structured interviews (n = 18). METHODS:First trimester pregnant women were recruited through convenience sampling method between August 2022 and March 2023. Sociodemographic, obstetric, social support, and lifestyle characteristics were obtained using a structured questionnaire. Physical inactivity levels were assessed using the International Physical Activity Questionnaire. Quantitative data were analysed using logistic regression, while qualitative data underwent thematic analysis. The results were integrated through a side-by-side comparison approach. RESULTS:The prevalence of physical inactivity in early pregnancy was 51.2%, with walking being the predominant activity. Logistic regression analysis indicated that women under the age of 25 were more likely to engage in physical activity during early pregnancy than those aged 25-29 (adjusted odds ratio [aOR] = 2.213, 95% confidence interval [CI]: 1.063-4.605) and 30-34 years (aOR = 2.320, 95% CI: 1.107-4.866). Compared to women with a high school education or lower, those with a college degree (aOR = 2.158, 95% CI: 1.153-4.039) or a postgraduate education or higher (aOR = 2.116, 95% CI: 1.058-4.231) were more likely to be physically inactive during early pregnancy. Factors associated with higher inactivity included not engaging in regular exercise before pregnancy (aOR = 0.671, 95% CI: 0.500-0.900), experiencing vaginal bleeding in early pregnancy (aOR = 1.504, 95% CI: 1.097-2.063), and reporting poor sleep quality in early pregnancy (aOR = 1.529, 95% CI: 1.133-2.063). Thematic analysis identified four key themes: individual, interpersonal, social, and environmental factors. The main barriers included time constraints, pregnancy-related discomfort, fears and anxieties, lack of confidence, limited resources and conflicting advice. Key facilitators were spousal support and policies that encouraged or enabled exercise during pregnancy. PATIENT OR PUBLIC CONTRIBUTION:Pregnant women participated in surveys and interviews, while Dr. Hu, Nurse Director Zhu, and Shen were involved in participant recruitment.

Objective: To assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. Methods: From May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. Results: This study included 105 newly diagnosed OC patients, with an average age of 49.73 (+8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. Conclusion: The incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.

Background: Recently, the utilization of sugar as a cryoprotectant has garnered significant attention. Sucrose and trehalose, as non-permeable cryoprotectants, can effectively regulate the osmotic pressure inside and outside cells while maintaining cell membrane stability during cryopreservation. Furthermore, it has been observed that monosaccharides sugars, particularly fructose, exhibit superior efficacy in preserving the quality of frozen substances as compared to disaccharides and trisaccharides sugars. Nevertheless, there is currently limited research assessing the cryopreservation effects of sucrose, trehalose, and fructose. The objective of this experiment is to identify the best cryoprotectant between sucrose, trehalose, and fructose for intact rat ovaries. Methods: Intact ovaries with blood vessels were obtained from 20 adult Lewis female rats and divided accordingly into four groups: control (non-vitrified), sucrose, fructose, and trehalose. The ovarian samples were subjected to a stepped cryoprotectant exposure and subsequently follicular histological analysis using light and electron microscopy. Ovarian cell apoptosis was evaluated by BCL2-Associated X (BAX) immunohistochemistry and Terminal Deoxynucleotidyl Transferase-Mediated Deoxyuridine Triphosphate nick End-Labeling (TUNEL) analyses. Results: The sucrose and the trehalose groups preserved the ovarian histological structure better than the fructose group. Additionally, there was no statistical difference in the total follicle number between the sucrose and trehalose groups, but the percentage of apoptotic cells in the trehalose group was significantly lower than that of the sucrose group (p < 0.01). Conclusions: Sucrose and trehalose perfusion protocols preserved the ovarian histology. However, the least apoptotic changes were observed in the trehalose group. The study suggested that trehalose would be a well-applied cryoprotectant in the cryopreservation of intact rat ovaries.

BACKGROUND:Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy and is associated with adverse outcomes in both mothers and their children. After delivery, women who experience GDM are also at higher risk of both subsequent GDM and type 2 diabetes mellitus (T2DM) than those who do not. Therefore, healthcare providers and public health practitioners need to develop targeted and effective interventions for GDM. In this study, we aimed to explore the perceptions regarding health behaviors and related factors during the inter-pregnancy period among Chinese women with a history of GDM through the lens of the theory of planned behavior (TPB).METHODS:Between December 2021 and September 2022, 16 pregnant Chinese women with a history of GDM were purposively recruited from a tertiary maternity hospital in Shanghai for face-to-face semi-structured interviews. They were asked questions regarding their health behaviors and related factors. The transcribed data were analyzed using a directed qualitative content analysis method based on the theory of TPB.RESULTS:The health-related behaviors of the women varied substantially. We identified five domains that influenced women's behaviors according to TPB constructs and based on the data collected: behavioral attitude (perceived benefits of healthy behaviors and the relationship between experience and attitude towards the oral glucose tolerance testing); subjective norms (influences of significant others and traditional cultural beliefs); perceived behavior control (knowledge of the disease, multiple-role conflict, the impact of COVID-19, an unfriendly external environment and difficulty adhering to healthy diets), incentive mechanisms (self-reward and external incentives); preferences of professional and institutional support (making full use of social media platform and providing continuous health management).CONCLUSIONS:The health-related behaviors of women with a history of GDM were found to be affected by multiple factors. Healthcare professionals are recommended to provide women with sufficient information regarding the disease and to take advantage of the power of the family and other social support networks to improve women's subjective norms and to promote the adoption of a healthy lifestyle.

Background An increasing number of research have applied neuroimaging techniques to explore the potential neurobiological mechanism of Cancer-related cognitive impairment (CRCI). Purpose To explore the correlation between resting brain glucose metabolism and CRCI using 18F-FDG PET/CT in ovarian cancer (OC) patients. Methods From December 2021 to March 2022, 38 patients with OC were selected as the study group, and 38 healthy women of the same age (±1 year) who underwent routine physical examination using PET/CT were selected as the control group. Patients received further assessment with the Montreal Cognitive Assessment Scale (MoCA) and Perceived Deficit Questionnaire (PDQ). Independent sample t-test and Spearman correlation were conducted for data analysis. Results The resting brain glucose metabolism in the OC group was significantly lower than in the healthy controls. 60.52 % patients had neuropsychological impairment and retrospective memory were the most serious perceived cognitive impairments. The resting brain glucose metabolism in OC patients did not significantly correlate with neuropsychological performance but had significant positive correlation with subjective cognitive evaluation. Discussion Resting glucose metabolism was low in OC patients and associated with subjective cognitive impairment but not objective neuropsychological test results. 18F-FDG PET/CT can be used to evaluate brain function in OC patients and provide reliable imaging indicators for early recognition of and intervention for changes in cognitive function.

The progress achieved in anticancer therapy in recent years has been paralleled by an increase in the survival of women with cancer globally. Nonetheless, the gonadotoxic impact of anticancer drugs has led to ovarian failure in treated women. While there are documented cases of successful ovarian tissue transplants resulting in restored fertility and childbirth, challenges persist, including suboptimal functional recovery and limited graft lifespan. Melatonin, an inert hormone primarily secreted by the mammalian pineal gland, exhibits diverse physiological functions, including antioxidative, anti-inflammatory, anti-apoptotic, and angiogenesis-regulating properties. Consequently, researchers have explored melatonin as a modulator to enhance graft function recovery in ovarian transplantation experiments, yielding promising outcomes. This review examines the relevant literature, consolidating findings that underscore the positive effects of melatonin in safeguarding the morphology and structure of transplanted ovarian tissues, facilitating graft function recovery, and extending lifespan. The amassed evidence supports the consideration of melatonin as a prospective protective agent for human ovarian tissue transplantation in the future.

AIM:Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic. METHODS:Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements. RESULTS:Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1. CONCLUSION:The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.

Because contractions signal the approach of labor, pregnant women-especially primigravidas (i.e., women pregnant for the first time)-usually go to the hospital to seek medical intervention when they begin experiencing contractions, which is not conductive to good perinatal outcomes. Conventionally, uterine contraction monitoring requires specialized medical devices and relies on the doctor's clinical experience. Therefore, exploring an objective method to detect labor onset at home and avoid early hospital admission has essential importance. In this article, a labor progress monitoring system based on a sensing device, edge service, and Internet of things (IoT) platform is proposed, aiming to suggest suitable hospital admission times for low-risk primigravidas. The pregnant woman places the sensing device on her abdomen with the help of a belt to detect contraction activities. An intelligent edge service for contraction classification is deployed on a mobile phone. The system's artificial intelligence (AI)-assisted algorithm is lightweight, with 670 kB and 194 kB of memory dedicated to a convolutional neural network and long short-term memory, respectively. It classifies the pregnant woman as deferred admission, optional admission, or recommended admission according to different contraction states. An IoT platform connected to the hospital is implemented, providing professional suggestions from doctors. The test set collected in an emergency clinic shows that the proposed system can reach a classification accuracy of more than 96%. In conclusion, the proposed system enables remote labor progress monitoring at home and avoids early hospital admission.

Background and purpose: Carriers of BRCA1/2 gene germline mutations have an increased lifetime risk of ovarian, breast and other cancers. Early identification of these high-risk groups and targeted risk management programs are important for reducing cancer morbidity and mortality. The aim of this study was to analyze the genetic screening status and influencing factors of first-degree relatives of patients with hereditary breast-ovarian cancer syndrome (HBOC) with BRCA1 and BRCA2 gene germline mutations. Methods: A convenient sampling method was used to select 72 HBOC female patients with BRCA1/2 gene germline mutations and 316 first-degree relatives who had been diagnosed in the Obstetrics and Gynecology Hospital affiliated to Fudan University from February 2021 to April 2022, and a questionnaire survey was used to find out whether the first-degree relatives of HBOC patients accepted gene screening. Logistic regression was used to analyze the relevant influencing factors. Results: Among 72 female patients with HBOC, 93.1% (n=67) conveyed the results of gene screening to their first-degree relatives. Among first-degree relatives over age of 18, 32.3% (n=102) decided to carry out gene screening and genetic risk management. Logistic regression analysis showed that the disease type of patients, International Federation of Gynecology and Obstetrics (FIGO) stage of ovarian cancer, education level, first-degree relatives gender, education level and emotional intimacy between patients and relatives were significant factors affecting whether first-degree relatives were willing to accept genetic screening and genetic risk management (P<0.05). Conclusion: The current situation of gene screening for first-degree relatives of HBOC patients is not optimistic. For breast cancer patients, patients with lower education, male relatives, relatives with lower education and relatives with lower emotional closeness to patients, the probability of receiving gene screening is lower. We should apply targeted interventions to improve the self-gene screening behavior of these relatives.

AbstractBackground: Whole ovarian transplantation has the potential to restore fertility in cancer patients, but ovarian ischemia-reperfusion injury following transplantation causes decreased graft function. Melatonin protects against antioxidant damage and has anti-inflammatory effects, but its effects in whole ovarian transplantation have not been investigated.Objective:This study was aimed to verify the beneficial antioxidant and anti-inflammatory effects of melatonin in whole ovarian transplantation.Methods: The cryopreserved whole ovaries were allotransplanted in LEWIS rats. Forty rats were randomly divided into 8 groups: control group, sham surgery group, saline group; low-dose (25 mg/kg) melatonin group; high-dose (50 mg/kg) melatonin group; melatonin (50 mg/kg) + ML385 group; melatonin (50 mg/kg) + luzindole group, and melatonin+ 4P-PDOT group. The estrous cycle recovery was evaluated by vaginal exfoliative cell monitoring and serum hormone. Follicle morphology was observed by HE. The levels of eoxidative stress factors, antioxidant factors, and inflammatory factors in both serum and ovarian tissues were measured by ELISA, RT-qPCR, western blot and fenton detection. RT-qPCR, western blot and immunofluorescence assays were used to measure the levels of MT1 and Nrf2.Results: The rats in high-dose and low-dose melatonin groups recovered estrous cycle faster and lost fewer follicles, and the serum endocrine hormone levels were close to normal. The serum and ovarian tissue antioxidant capacity were significant higher, while the levels of inflammatory factors were significant lower in the high-dose and low-dose melatonin groups. In addition, the melatonin receptor MT1 was found to be involved in antioxidant and anti-inflammatory processes. Melatonin also triggered the Nrf2/ARE pathway activity via receptor MT1. Blocking Nrf2 or MT1 receptors could eliminate the beneficial effects of melatonin on whole transplanted ovaries. These findings suggest that melatonin can attenuate oxidative stress injury and inflammatory responses in whole transplanted ovaries via the MT1/Nrf2/ARE signaling pathway, thereby effectively protecting whole transplanted ovarian function.

目的:针对研究团队前期构建的助产质量评价指标体系进行试点应用和数据收集,并基于指标数据的可获得性进行优化.方法:对"某妇产科专科医院及妇幼保健院技术协作网"中的医疗机构进行问卷调查,了解助产质量评价指标体系数据的可获得性.基于调查结果,目的性选取5家机构收集助产质量评价指标体系数据;对5位数据收集负责人进行深度访谈,挖掘部分指标数据获得性低的深层原因;对相关指标的优化辅以专家咨询.结果:35家医疗机构的调查结果显示,部分指标数据的可获得性较低,主要原因为定义不明确、人工统计耗时长、无法通过人工获取.根据访谈和专家咨询结果,研究小组对8项指标中的9个内容进行优化.结论:优化后的助产质量评价指标体系在保持了指标合理性的同时提高了指标数据的可获得性,临床实用性得到了加强,为进一步的推广应用以及助产质量评价、比较打下基础.

Objective To evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer. Methods This is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed. Results A total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence ( P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence ( P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20–351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10–0.63, P = 0.003). The Kaplan–Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006). Conclusion Preoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.

Abstract Background Regular prenatal physical activity provides numerous health benefits to both mother and fetus. However, little is known about the physical activity status of pregnant women in China and whether they meet the current guidelines for prenatal physical activity. The aims of the study were to assess physical inactivity status and associated factors among pregnant women in Shanghai, China. Methods A cross-sectional study of 1636 pregnant women were recruited at a tertiary obstetrics and gynecology hospital in Shanghai. Maternal sociodemographic characteristics and health information were obtained using structured questionnaires or from the electronic medical records. Physical inactivity status was assessed using the International Physical Activity Questionnaire-Short Form. Factors pertinent to physical inactivity were identified by binary logistic regression and were reported with adjusted odds ratios (ORs) and 95% confidence intervals (CIs). All statistical analyses were performed using the SPSS software package. Results In total, the prevalence of physical inactivity was 47.5%. Walking was the main form of physical activity and only 2.8% of the pregnant women achieved the goal of at least 150 min of moderate-intensity physical activity weekly. Multivariate logistic regression identified a significant negative association of physical inactivity with personal monthly income (adjusted OR 0.648, 95% CI 0.505–0.831), engagement in regular exercise before pregnancy (adjusted OR 0.575, 95% CI 0.464–0.711) and in the second (adjusted OR 0.534, 95% CI 0.411–0.693) or third (adjusted OR 0.615, 95% CI 0.470–0.806) trimester of pregnancy. Women with nausea or vomiting during pregnancy were more likely to be physically inactive during pregnancy (adjusted OR 1.307, 95% CI 1.002–1.705). Conclusion Physical inactivity is highly prevalent among pregnant women in China. Further efforts should be taken to overcome the barriers to prenatal physical activity and to promote moderate- to vigorous-intensity activities among Chinese pregnant women.