Abstract:Oxidative stress is a key pathophysiological mechanism in preeclampsia.Therefore,antioxidant stress holds significant importance for the prevention and treatment of preeclampsia and its related complications.This paper systematically reviews the molecular mechanisms and pathophysiological significance of nuclear factor-erythroid 2-related factor 2(Nrf2)in regulating oxidative stress in preeclampsia.Recent studies have found that the signaling pathway constituted by Nrf2 and its negative regulatory protein,Kelch-like ECH-associated protein 1(KEAP1),is frequently dysregulated or functionally impaired in placental tissues of preeclampsia patients and in animal models.This impairment leads to the inhibited transcriptional activation of downstream antioxidant genes,such as heme oxygenase-1 and NAD(P)H:quinone oxidoreductase 1,thereby exacerbating placental oxidative damage.Further research indicates that Nrf2 not only regulates the gene expression profile driven by the antioxidant response element(ARE)but also participates in placental formation and remodeling by influencing vascular endothelial cell function and trophoblast apoptosis.Nrf2 is a key nodal molecule linking oxidative stress to the pathological progression of preeclampsia,and its activation status is closely associated with disease severity and progression.

Abstract:Objective:To evaluate the predictive utility of serum insulin-like growth factor 1(IGF1)and sex hormone-binding globulin(SHBG)for postpartum glucose metabolism outcomes in patients with gestational diabetes mellitus(GDM).Methods:120 women with GDM in the third trimester(GDM group)and 120 healthy pregnant controls(control group)were recruited between June 2022 and October 2024.According to postpartum glucose status,the GDM cohort was subdivided into an abnormal outcome group(n=48)and a normal outcome group(n=72).Serum IGF1 and SHBG levels were quantified by enzyme-linked immunosorbent assay(ELISA).Baseline characteristics and biochemical parameters were compared between the GDM and control groups,and between the abnormal and normal outcome subgroups.Multivariate logistic regression was used to identify determinants of impaired postpartum glucose metabolism.Receiver operating characteristic(ROC)curve analysis assessed the predictive performance of serum IGF1 and SHBG,individually and in combination.Results:Serum IGF1 was higher and SHBG was lower in the GDM group than in the control group(both P<0.05).Women in the abnormal outcome subgroup exhibited higher triglyceride(TG)and IGF1 levels and lower serum SHBG levels compared with the normal outcome subgroup(all P<0.05).Both IGF1 and SHBG were independent predictors of postpartum glucose metabolism impairment(both P<0.05).The combined model of serum IGF1 and SHBG had a higher value in predicting abnormal postpartum glucose metabolism glucose in GDM patients than single indicators alone(both P<0.05).Conclusions:Elevated serum IGF1 and reduced SHBG are associated with abnormal postpartum glucose metabolism in GDM.Their combined measurement offers superior predictive accuracy for identifying women with high risk of persistent glucose dysregulation after delivery.

Abstract:Low-grade appendiceal mucinous neoplasm(LAMN)is a rare and heterogeneous gastrointestinal tumor.When LAMN secretes mucin that spreads into the peritoneal cavity,forming pseudomyxoma peritonei(PMP)and involving the ovarian,its clinical manifestations and auxiliary examinations are highly similar to those of ovarian mucinous tumors with pelvic and abdominal metastasis,which can easily lead to preoperative misdiagnosis.LAMN complicated by PMP has a high risk of postoperative recurrence,and standardized treatment can improve the prognosis.Given that the treatment regimens for LAMN and ovarian mucinous tumors are different,early identification of the tumor origin is the key to treatment.We report a case of a patient with LAMN complicated by PMP initially presenting as an ovarian tumor.The patient presented with abdominal distension and abdominal pain.Preoperative imaging studies suggested an ovarian tumor.Intraoperative pathological diagnosis indicated a borderline mucinous ovarian tumor,while postoperative pathology confirmed LAMN involving the ovaries.The patient refused hyperthermic intraperitoneal chemotherapy.After one year postoperative surveillance,no recurrence or metastasis was observed.This case aims to provide a reference for the clinical management of cases with difficult differential diagnosis between ovarian tumors and LAMN,so as to avoid misdiagnosis and inappropriate treatment.

Abstract:Endometriosis(EMs)is a common disease of the female reproductive system,which can seriously affect the quality of life of patients,especially those with chronic pelvic pain(CPP).The pathological mechanism is complex.Traditional drug therapy and surgical interventions often fail to achieve sustained and complete pain relief,and the recurrence rate is high.Literature data show that physical therapy methods such as physical exercise,myofascial manual therapy,biofeedback,electro-neural modulation,magnetic stimulation therapy,radiofrequency therapy,and acupuncture act on the pain pathway to relieve patients'pain through mechanisms such as improving local blood circulation,regulating nerve conduction,reducing inflammatory responses,and promoting tissue repair.These approaches are expected to become potential complementary therapies for EMs-related CPP when drug and surgical treatments are ineffective.Currently,the number of high-quality,large-sample randomized controlled trials on physical therapy for EMs is still relatively limited.More studies are needed in the future to confirm its clinical efficacy.

Abstract:The microecological balance of the female reproductive tract is the core of maintaining reproductive health,and the genus Lactobacillus,as the dominant flora,plays a crucial role.In the vagina,the dominant species such as Lactobacillus crispatus and Lactobacillus jensenii can maintain environmental stability through acid production,secretion of antibacterial substances,and immune regulation,which is a sign of a healthy microecology.In contrast,the dominance of Lactobacillus iners or a state of high diversity increases the risks of bacterial vaginosis,persistent human papilloma virus(HPV)infection,and preterm birth.However,the function of Lactobacillus iners is affected by the strain source and host status.Multiple 16S rRNA sequencing studies have shown that a low-biomass microbiota community can be detected in the endometrium,and there is still controversy over whether Lactobacillus is the dominant genus in its community composition.Uterine cavity microecological dysbiosis(decrease in Lactobacillus,increase in pathogenic bacteria,or enrichment of specific bacteria)is closely related to chronic endometritis,intrauterine adhesions,and endometriosis.Currently,in terms of intervention strategies,the application of specific probiotic strains or targeted engineered bacteria has potential in the adjuvant treatment of bacterial vaginosis or HPV infection,prevention of recurrence after intrauterine adhesion surgery,and promotion of endometrial repair.However,there are still challenges in the level of existing evidence,the precision of strain selection,and the translational application of engineered bacteria.In the future,in-depth research at the strain and functional gene levels,combined with multi-omics and strict methodologies,is needed to promote the precise diagnosis and treatment of the female reproductive tract microecology.

Abstract:Unicornuate uterus is one of the important types of Müllerian duct developmental abnormalities,referring to a uterine malformation formed by the normal development of only one Müllerian duct.Epidemiological data indicate that the incidence of this malformation in the uterine malformation is 0.3％-4.0％,and about 35％of cases are complicated by a rudimentary uterine horn and ipsilateral renal agenesis.A case of a teenage patient with a non-communicating left rudimentary uterine horn with a cavity and ipsilateral renal agenesis is reported.The clinical manifestation was progressive exacerbation of dysmenorrhea.The diagnosis was confirmed by pelvic magnetic resonance imaging.After excluding surgical contraindications,single-port trans-umbilical laparoscopic resection of the rudimentary uterine horn,left salpingectomy,resection of pelvic endometriotic lesions,pelvic adhesion lysis,and umbilical plastic surgery were performed.Postoperative pathological examination confirmed that the endometrium of the rudimentary uterine horn was in the secretory phase,and the patient's dysmenorrhea symptoms were relieved.This indicates that early diagnosis and standardized surgical management are of great significance for improving patients' quality of life.

Abstract:Objective:To analyze the relationship between preeclampsia(PE)in pregnant women and the risk of congenital heart disease(CHD)in their offspring,based on the Chinese Birth Cohort from 2018 to 2022.Methods:This was a prospective cohort study.Pregnant women who participated in the"Chinese Birth Cohort"study from February 2018 to December 2022 were selected as the study subjects.An electronic data collection system was used to collect baseline and follow-up information.A multivariate logistic regression model was used to analyze the association between PE in pregnant women and the risk of CHD in their offspring.Results:A total of 152 151 singleton pregnant women were included in this study.The average age of all pregnant women was(30.66±4.11)years.The incidence of CHD in offspring was 0.88％(1 340 cases).There were 4 565 pregnant women with PE in this study,with an incidence of 3.00％.The incidence of CHD in the offspring of pregnant women with PE was significantly higher than that of pregnant women without PE(1.31％vs.0.87％,P=0.002).The results of the multivariate logistic regression model analysis showed that PE in pregnant women was significantly associated with the occurrence of CHD in offspring(OR=1.434,95％CI:1.101-1.868,P=0.008).PE was positively associated with the occurrence of ventricular septal defect(OR=1.513,95％CI:1.047-2.185,P=0.027),persistent left superior vena cava(OR=3.683,95％CI:1.647-8.232,P=0.002),and patent foramen ovale(OR=3.158,95％CI:1.642-6.075,P=0.001)in offspring.Conclusions:PE in pregnant women may increase the risk of CHD in their offspring.

Abstract:The incidence and mortality rates of gynecological malignancies are increasing year by year,posing a serious threat to women's health.Traditional Chinese medicine is widely used in the comprehensive treatment of gynecological malignancies.As the most common active components of traditional Chinese medicine,the mechanisms of Chinese herbal polysaccharides against gynecological malignancies include regulating tumor-related signaling pathways,arresting the tumor cell cycle,inhibiting tumor cell metastasis and invasion,promoting tumor cell apoptosis,autophagy and ferroptosis,suppressing tumor cell immune escape and epithelial-mesenchymal transition,regulating the expression of oncogenes and tumor suppressor genes,and serving as efficient drug earriers to reduce toxicity and enhance efficacy.However,the clinical application of traditional Chinese medicine polysaccharides still faces challenges such as low bioavailability and complex separation and extraction.In the future,it is necessary to conduct further basic research and clinical trials to provide references for the development of innovative traditional Chinese medicine and promote the wide clinical application of the combination of traditional Chinese and Western medicine in the treatment of gynecological malignancies.

Abstract:Insulin resistance(IR)is a key pathophysiological driving factor for polycystic ovary syndrome(PCOS).Approximately 56.3％of Chinese PCOS patients have IR.Although the hyperinsulinemic-euglycemic clamp test is the gold standard for diagnosing IR,alternative indicators such as the homeostasis model assessment of insulin resistance(HOMA-IR)are more commonly used based on clinical feasibility.Lifestyle intervention is the cornerstone of treatment.High-intensity interval training can significantly improve insulin sensitivity and reproductive outcomes by enhancing skeletal muscle glucose metabolism.Time-restricted eating and ketogenic diet can enhance insulin sensitivity and improve endocrine and metabolic indicators independently of weight loss effects.Psychophysical interventions targeting psychological comorbidities also contribute to improving metabolism and enhancing the quality of life.In terms of drug therapy,apart from the traditional insulin-sensitizing drug metformin,thiazolidinediones(such as pioglitazone)have also shown potential in improving the metabolic level of PCOS.The rational use of metabolic supplements can also help PCOS patients restore menstrual regularity and improve metabolic indicators.

Abstract:Protein lactylation modification mediated by lactate accumulation is a new type of epigenetic modification.It is a protein modification method in which lactyl groups are covalently coupled to lysine residues of proteins to regulate gene expression.Due to the physiological hypoxia in the placenta during early pregnancy,placental cells have developed a series of hypoxia-response mechanisms.Different degrees of protein lactylation modification have been found to be involved in these mechanisms.Protein lactylation modification mediates cellular energy flow,trophoblast cell function expression,immune function,and inflammatory responses.When pathological hypoxia occurs in the placenta,it can lead to placental dysfunction,abnormal trophoblast cell proliferation,and impaired invasion function.On this basis,pregnancy complications such as preeclampsia(PE),gestational diabetes mellitus(GDM),and recurrent spontaneous abortion(RSA)may occur.High levels of protein lactylation in patients with PE and GDM can cause placental dysfunction,reduce the migration and invasion ability of trophoblast cells,and participate in the occurrence and development of the diseases.Protein lactylation modification participates in the pathogenesis of RSA by regulating trophoblast cell apoptosis and the immune function at the maternal-fetal interface.This review summarizes the research progress of protein lactylation modification in placental hypoxia and pregnancy complications,aiming to provide new ideas for the prevention and treatment of placental-derived pregnancy complications related to fetal hypoxia.

Abstract:Uterine rupture is a rare and severe obstetric complication,mainly associated with a history of previous cesarean section or other uterine surgeries.This paper reports a case where a patient,who had underwent laparoscopic right salpingectomy and right cornual uterine wedge resection due to cornual pregnancy,became pregnant again only 4 months after surgery.At 32+1 weeks of gestation,she presented with acute abdomen.Due to non-specific symptoms of the patient,mainly manifested as persistent lower abdominal pain accompanied by nausea and vomiting,which overlapped with the symptoms of common acute abdomen conditions in the second and third trimesters of pregnancy such as threatened preterm labor,placental abruption,and acute appendicitis,it was difficult to directly distinguish the condition through clinical manifestations.Additionally,the patient initially only mentioned the history of right salpingectomy and did not clearly state the key surgical information of previous cornual pregnancy and cornual uterine wedge resection,resulting in the failure of early identification of the risk of uterine rupture related to the uterine scar in clinical practice.After bedside ultrasound examination revealed intra-abdominal effusion indicating internal hemorrhage,and after repeated inquiries and a detailed review of the surgical history,the diagnosis of uterine rupture was gradually focused on.Subsequently,an emergency laparotomy was performed,and a live infant was delivered by cesarean section,confirming the diagnosis of uterine rupture.The patient lost 1 200 mL of blood during the operation and recovered well after the surgery.For pregnant women with a history of cornual uterine surgery,the following key points should be emphasized in pregnancy management:strict contraception for 2 years(to allow uterine scar mature),and enhanced ultrasound monitoring in the second and third trimesters of pregnancy(to evaluate the thickness of the scar and the abdominal cavity situation).In clinical diagnosis and treatment,a detailed medical history,especially the history of non-cesarean uterine surgeries,should be obtained.In cases of acute abdomen,ultrasound should be used to check for intra-abdominal hemorrhage and uterine structural abnormalities as a priority.Once the diagnosis is confirmed,emergency surgery should be initiated immediately to reduce maternal and fetal risks.

Abstract:External cephalic version(ECV),as an important intervention for correcting breech presentation in the late stage of pregnancy,the prediction of its success rate is crucial for clinical decision-making.Currently,the model-building methods widely used in clinical practice mainly include traditional statistical models and machine-learning models.This paper systematically reviews the application progress of these two types of models in predicting the success rate of ECV.Traditional statistical models,such as the Logistic regression model,are easy to interpret and have strong clinical applicability,but their performance is limited when dealing with complex data.The emerging machine-learning models show better prediction potential,but they also face challenges such as poor interpretability and difficulty in clinical integration.Future research should focus on promoting multicenter,large-sample,and prospective data collection,strengthening the external validation and standardization of models.At the same time,it is necessary to improve the transparency and clinical applicability of machine-learning models,develop prediction tools that can be easily integrated into the clinical process,and ultimately construct a precise and individualized ECV decision-making system to effectively reduce the cesarean section rate without medical indications.

Abstract:Endometriosis(EMs)is a common chronic inflammatory gynecological disease.Existing surgical and drug treatments have limitations,and dietary intervention,as an auxiliary strategy,has attracted much attention.Among dietary components,polyphenolic compounds(such as quercetin,curcumin,resveratrol,etc.)can play a role in the prevention and treatment of EMs through their antioxidant and anti-inflammatory properties;vitamins C,E,D,and B complex can improve the condition by reducing oxidative stress and alleviating inflammation;minerals such as calcium and potassium are negatively correlated with the risk of EMs,and a low-nickel diet can relieve symptoms.In terms of dietary types,increased intake of dairy products,fruits and vegetables,ω-3 fatty acids may be associated with a reduced risk of EMs,while trans-unsaturated fatty acids and red meat may increase the risk of EMs.Among dietary patterns,the Mediterranean diet and anti-inflammatory diet can improve symptoms such as pain related to EMs.The low FODMAP diet helps relieve gastrointestinal symptoms in EMs patients with irritable bowel syndrome,while a gluten-free diet is not recommended for routine use due to insufficient evidence.Dietary intervention has good prospects in the management of EMs,but current studies have limitations such as small sample sizes and non-standardized interventions.More large-scale studies are needed for verification in the future.

Abstract:Myeloid-derived suppressor cells(MDSCs)are a type of myeloid progenitor cells with immune characteristics.These cells not only have immunosuppressive and inflammation-promoting effects,but also crucial for the establishment of normal pregnancy as well as the development of pathological pregnancy.Among them,the proliferation of MDSC promotes pathogen infection and accelerates tumor progression.Moreover,MDSC are indispensable for establishing maternal-fetal immune tolerance and ensuring the stability of the maternal-fetal interface.However,the imbalance of MDSC function or abnormal quantity can lead to pathological pregnancies that endanger the safety of the mother and the fetus,such as spontaneous abortion,preeclampsia,fetal growth restriction,recurrent miscarriage,and even preterm birth and stillbirth.Therefore,in-depth research on the basic characteristics of MDSC and their mechanism of action in pregnancy and pregnancy-related diseases is expected to provide important theoretical basis and diagnosis-treatment directions for the further exploration of maternal-fetal medicine and the early prevention and diagnosis of pathological pregnancy.

Abstract:Follicular lymphoma(FL)is an indolent non-Hodgkin lymphoma characterized by painless lymph node enlargement over several years.It is relatively rare for FL to present with ascites as the main symptom.Moreover,the laboratory test results of such patients are often atypical,making it difficult to distinguish from other peritoneal metastatic diseases.This paper reports a case of a patient with a history of endometrial tumor who did not complete the chemotherapy course as prescribed and was lost to follow-up 2 months after surgery.The patient presented with progressive abdominal distension.Ultrasound showed a large amount of ascites in the abdominal cavity.Enhanced CT of the whole abdomen reported multiple enlarged lymph nodes in the retroperitoneum and mesentery,and nodular thickening of the peritoneum and greater omentum.No tumor cells were found in the ascitic cytology examination.A laparoscopy exploration was performed,and the final postoperative pathology confirmed FL.The patient has completed chemotherapy of rituximab plus bendamustine for 6 cycles,and no recurrence has been observed so far.When patients with a history of abdominal malignancies present with peritoneal lesions,especially in the presence of lymph node enlargement,even if lymphoma cannot be clearly diagnosed by imaging,in addition to considering the metastasis of the primary tumor,hematological malignancies should be included in the differential diagnosis system.

Abstract:Cervical cancer,ovarian cancer and endometrial cancer are important causes of female mortality.Although standardized treatment can improve the condition of some patients,a considerable proportion of patients still have a poor prognosis and continuous disease progression.Early diagnosis and treatment are key strategies to improve the prognosis of patients with gynecological malignancies and reduce the disease burden.Therefore,exploring more effective therapeutic targets is of great significance.Delta-like ligand 4(DLL4),as a key ligand of the Notch signaling pathway,plays an important role in tumor angiogenesis,tumor stem cell maintenance,and immune environment regulation.In recent years,studies have found that DLL4 is significantly highly expressed in various gynecological malignancies such as ovarian cancer,cervical cancer and endometrial cancer,and its expression level is closely related to tumor stage,metastasis and poor prognosis,showing the potential as a novel targeted therapeutic target.This article systematically elaborates on the biological functions of DLL4 and reviews the research progress on the correlation between DLL4 and the three major gynecological malignancies,aiming to provide new ideas for the precise treatment of gynecological malignancies.

Abstract:Autophagy is a highly conserved intracellular degradation and recycling process.Its core mechanism is to degrade the damaged,senescent or redundant biomacromolecules and organelles within the cell through the lysosomal system and reuse the degradation products to maintain cellular homeostasis.Recent studies have shown that changes in autophagy levels affect the occurrence and development of various endometrial diseases,including endometriosis(EMs),endometrial cancer,and intrauterine adhesions(IUA).Autophagy shows bidirectional regulatory characteristics in the occurrence and development of EMs and endometrial cancer,which may either promote or inhibit the progression of the diseases.The level of autophagy is down regulated during the development of IUA.This review summarizes the roles and mechanisms of autophagy in these diseases and explores its potential clinical applications,aiming to provide new ideas for future research.

Abstract:Ovarian cancer(OC)is the gynecological malignant tumor with the highest mortality rate.Most patients are diagnosed at an advanced stage and have a poor prognosis.The cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)signaling pathway,as a core hub of innate immunity,triggers type Ⅰ interferon response by recognizing abnormal cytoplasmic DNA and plays a crucial role in regulating anti-tumor immunity and the tumor microenvironment.This pathway shows a"double-edged sword"characteristic in OC.Acute activation can enhance anti-tumor immunity through mechanisms such as enhancing antigen presentation by dendritic cells and promoting CD8+T cell infiltration.Chronic and persistent activation promotes tumor progression by driving the non-classical nuclear factor-κB pathway.Additionally,this pathway in OC is often inactivated due to factors such as epigenetic silencing or inhibition by metabolites,further weakening immune surveillance.Based on its bidirectional regulatory characteristics,STING agonists and their combined application with immune checkpoint inhibitors,poly(ADP-ribose)polymerase inhibitors,chemotherapy,or oncolytic viruses provide new directions for the treatment of OC.

Abstract:Pelvic splenosis is a rare clinical phenomenon,usually caused by ectopic implantation of splenic tissue due to splenic trauma or surgery.Most patients with this disease have no obvious clinical symptoms and it is often incidentally detected during imaging examinations.Due to its special anatomical location and imaging features,it is very easy to be confused with ovarian tumors,resulting in a relatively high misdiagnosis rate.This paper reports a case where the preoperative ultrasound examination showed a solid mass in the adnexal area.Without considering the patient's history of partial splenectomy,pelvic splenosis was misdiagnosed as an ovarian tumor.The aim is to improve the clinical physicians'awareness of this disease,provide references for clinical diagnosis and differential diagnosis,and thus reduce the occurrence of misdiagnosis and mistreatment.

Abstract:Objective:To analyze the guiding value of ultrasonic monitoring parameters in the first stage of labor for maternal delivery modes.Methods:A total of 218 hospitalized parturients admitted from January to December 2024 were selected.Ultrasonic parameters were dynamically monitored during the first stage of labor,including head-symphysis distance(HSD),head progression distance(HPD),angle of progression(AOP),midline angle(MLA),and pubic arch angle(PAA).The parturients were divided into a spontaneous delivery group(n=166)and a cesarean section group(n=52),according to their delivery modes.The general clinical data and the values of HSD,HPD,AOP,MLA and PAA were compared between the two groups.Binary logistic regression was used to analyze the factors influencing cesarean section in parturients.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of single ultrasonic parameters and their combination in predicting maternal delivery modes.Results:Increased HSD and HPD were risk factors for cesarean section,while increased AOP,MLA,and PAA were protective factors for cesarean section,with statistically significant differences(P＜0.05).The area under the curve(AUC)values of HSD,HPD,AOP,MLA,PAA,and the combination of the five indicators were 0.803,0.737,0.905,0.778,0.737,and 0.967 respectively;the sensitivities were 0.673,0.846.0.819,0.654,0.645,and 0.923 respectively;the specificities were 0.855,0.536,0.865,0.885,0.731,and 0.898 respectively.The AUC of the combination was higher than that of single indicators,with good specificity and sensitivity,and the difference was statistically significant(P＜0.05).Conclusions:HSD,HPD,AOP,MLA,and PAA monitored by ultrasound in the first stage of labor have important guiding significance for judging maternal delivery modes.The predictive efficacy of the combination of the five parameters is better than that of single parameters.