Abstract:Ovarian cancer(OC)is one of the common malignant tumors in the female reproductive system.Its early stage symptoms are insidious,and most patients are diagnosed at an advanced stage,which seriously threatens the lives and health of patients.Currently,the treatment of OC mainly includes surgery and chemotherapy,but problems such as drug resistance,recurrence and adverse reactions are prone to occur.Therefore,it is urgent to seek safer and more effective treatment strategies.In recent years,Chinese herbal medicine has attracted wide attention due to its high efficiency and no obvious toxic side effects,and has become a research hotspot in the field of oncology.The nuclear factor-κB(NF-κB)signaling pathway plays a crucial role in the processes of OC cell proliferation,apoptosis,metastasis and invasion.Its continuous abnormal activation is closely related to the occurrence and development of OC.Studies have shown that Chinese medicine can inhibit the progression of OC by regulating the NF-κB signaling pathway,providing new ideas for the prevention and treatment of OC.This article summarizes the current research status of Chinese medicine monomers and compounds in the treatment of OC by regulating the NF-κB signaling pathway through reviewing relevant domestic and foreign literature in recent years,aiming to provide a scientific theoretical basis for the clinical research and drug development of OC.

Abstract:Cervical cancer ranks second in the incidence of female malignant tumors in China and is one of the main causes of female cancer-related deaths.Moreover,the overall incidence showed an upward trend.Currently,the thin-prep cytology test(TCT)and high-risk human papilloma virus(HR-HPV)DNA testing are the main screening methods for cervical cancer.However,both have limitations.The TCT results have poor reproducibility and low sensitivity,while the HR-HPV DNA test has low specificity,which may lead to over-diagnosis and over-treatment.Therefore,a more accurate screening program is urgently needed.With the rapid development of DNA methylation detection technology,multiple gene methylations have been used in cervical cancer screening.Among them,the methylation of paired box gene 1(PAX1)/junctional adhesion molecule 3(JAM3)dual-gene has attracted much attention.Some studies have reported that it is related to the migration and invasion of cervical cancer cells.Although the current related research is not yet perfect,the PA X1/JAM3 dual-gene methylation has great potential in the field of cervical cancer screening and treatment.The combined application of PAX1/JAM3 dual-gene methylation can help optimize the cervical cancer screening strategy and improve the accuracy of clinical triage.This review summarizes the application of PAXl/JAM3 dual-gene methylation in cervical cancer screening and treatment,aiming to provide a theoretical basis for the precise implementation and hierarchical management of cervical cancer screening.

Abstract:Preeclampsia(PE)is a pregnancy-specific multisystem disease,mainly characterized by newly-onset hypertension accompanied by proteinuria or end-organ dysfunction after 20 weeks of gestation.The pathogenesis of PE is complex,involving multiple factors such as vascular endothelial dysfunction and oxidative stress imbalance.In recent years,the elevation of serum uric acid level,as a biomarker of oxidative stress,has gradually attracted attention for its correlation with the severity of PE and adverse pregnancy outcomes.Studies have shown that serum uric acid level in patients with PE is significantly increased.The mechanism may be related to placental ischemia-hypoxia,changes in renal hemodynamics,and upregulation of the expression of uric acid transporters in renal tubules.Uric acid participates in the pathological progression of PE through pathways such as triggering oxidative stress,inhibiting the function of vascular endothelial cells,and activating the inflammatory response,and has a synergistic effect with other PE biomarkers.Although the serum uric acid level is closely related to the severity of PE and adverse pregnancy outcomes,and an elevated serum uric acid level in the early stage of pregnancy can predict the risk of PE,the specificity of uric acid as an independent diagnostic marker is limited,and its elevation may also have a synergistic effect with other inflammatory markers.Future research should focus on further optimizing the detection method of uric acid as a biomarker,reaching a consensus on the critical value,and developing a combined prediction model,clarifying the specific role of uric acid in the pathological mechanism of PE,so as to provide a more powerful theoretical basis for early intervention.

Abstract:A case of primary undifferentiated uterine sarcoma of the cervix is reported.The patient presented for medical consultation due to vaginal bleeding for 1 week after 7 years of menopause.A 9 cm mass in the cervix was detected during a gynecological examination.Imaging studies indicated a huge cervical mass and pelvic effusion,with no obvious enlarged lymph nodes.Subsequently,an abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed.Postoperative pathological biopsy and immunohistochemistry suggested low-grade undifferentiated uterine sarcoma.After the operation,the patient refused radiotherapy and chemotherapy and did not undergo regular follow-up.Six months later,the patient presented again with vaginal bleeding and lower abdominal distension and pain.Imaging showed a space-occupying lesion at the vaginal stump,and tumor recurrence was considered possible.Therefore,transcatheter internal iliac artery embolization,iliac artery angiography and intra-arterial injection of chemotherapy drugs(cisplatin 60 mg+epirubicin 30 mg)were carried out.Two months later,the patient received chemotherapy once at another hospital due to intermittent vaginal bleeding.The patient was followed up regularly for 9 months,during which no treatment was administered,and intermittent vaginal bleeding occurred.The patient was then lost to follow-up.

Abstract:Pelvic venous plexus thrombosis complicating pregnancy is a relatively severe pregnancy-related complication.This disease has a low incidence rate and atypical clinical manifestations,so it is generally difficult to detect.We report a case where,after pregnancy achieved through assisted reproductive technology,a mass in the pelvic venous plexus was detected by routine color Doppler ultrasound examination at more than 40 days of gestation.The ultrasound indicated early pregnancy complicated with pelvic venous plexus thrombosis.After anticoagulant treatment with low-molecular-weight heparin and tocolysis treatment with dydrogesterone,the thrombus disappeared,and the prognosis of the mother and the infant was good.The purpose of reporting this case is to improve the awareness of this disease among ultrasound physicians and clinical physicians.For pregnant women with suspected"thrombophilia"based on clinical laboratory tests and family history,the ultrasound examination should include the intrauterine embryonic development,the condition of the adnexa,and also pay attention to the examination of the pelvic venous plexus,so as to achieve early diagnosis and early treatment of pelvic venous plexus thrombosis and improve the maternal-fetal outcomes.

Abstract:Dysbiosis of the reproductive tract microbiota can lead to reproductive tract infections,including lower genital tract infections(such as vaginitis and cervicitis)and upper genital tract infections(such as endometritis and pelvic inflammatory disease),among various conditions.These infections not only cause infertility,chronic pelvic pain,and seriously affect women's health,but during pregnancy,they can also result in adverse pregnancy outcomes such as preterm birth,miscarriage,premature rupture of membranes,chorioamnionitis and stillbirth.This review focuses on the colonization of microbiota in different regions of the reproductive tract in healthy pregnant women,the changes in microbiota composition that cause disorders,and the impact of these changes on pregnancy outcomes.The aim is to provide a theoretical basis for better screening,prevention,and treatment of common adverse pregnancy outcomes,as well as to offer novel insights on maternal and infant health protection.

Abstract:Endometrial polyps(EP)are benign lesions formed by the excessive proliferation of local glands and stroma in the endometrium.They often present as abnormal uterine bleeding and infertility,and the pathogenesis has not been fully elucidated.Current research shows that the pathogenesis of EP is relatively complex,and the relevant mechanisms mainly involve:hormonal and metabolic imbalances,manifested as local estrogen dominance and insulin resistance synergistically promoting endometrial proliferation and inhibiting apoptosis;abnormal cell proliferation and apoptosis,leading to cells escaping programmed death;changes in the inflammatory microenvironment,with abnormal activation of the nuclear factor-κB(NF-κB)pathway and dysfunction of its downstream effector molecules,and co-existence with chronic endometritis;genetic abnormalities,where RAS gene mutations drive polyp growth,and activation of the Wnt signaling pathway further drives polyp clonal proliferation and vascular abnormalities;dysregulation of the genital tract microbiota,where ascending infection by pathogens leads to abnormal repair and hyperplasia of the endometrium and participates in the pathogenesis of EP.This indicates that EP is the result of multifactor and multi-signaling pathway regulation.

Abstract:The influence of gestational nutrition on the maternal gut microbiota and fetal development is a hot-topic in clinical research.Increasing attention has been paid to the impact of the maternal internal environment on fetal development and the long-term health of offspring.Traditionally,it was believed that fetal development was mainly dominated by genetic programs.However,studies have shown that the fetus has complex perception and learning abilities,and the maternal nutritional and metabolic status is a key factor determining the health of offspring.Based on the"thrifty phenotype hypothesis",intrauterine malnutrition in the fetus can increase the risk of metabolic diseases in adulthood through metabolic reprogramming.Gestational nutrition has a profound impact on fetal developmental programming and the long-term health of offspring by reshaping the gut microbiota and its metabolite profile.This review summarizes the dynamic changes in gut microbiota during pregnancy,the hormonal and immune regulatory mechanisms,and the effects of different dietary patterns on the gut microbiota and the health of mothers and infants.

Abstract:Objective:To explore the risk factors for pre-eclampsia(PE)complicating elderly pregnant women,and construct and validate a nomogram risk prediction model.Methods:The clinical data of 1 287 elderly pregnant women admitted to the Suqian First Hospital,Jiangsu Province from January 2017 to August 2024 were retrospectively analyzed.The pregnant women were randomly divided into a training set(n=858)and a validation set(n=429)at a ratio of 2∶1.According to the pregnant women in the training set were further divided into a complication group(n=94)and a non-complication group(n=764).The clinical data of the two groups were compared.Binary logistic regression analysis was used to screen the influence factors for PE complicating elderly pregnant women,and a nomogram model was constructed based on the results.The Bootstrap method was used for internal validation of the model.The concordance index(C-index)was calculated,and calibration curve,receiver operating characteristic(ROC)curve,and decision curve were drawn to evaluate the predictive performance of the model.The validation set data were used for further internal validation of the model.Results:Binary logistic regression analysis showed that a high pre-pregnancy body mass index(BMI),a family history of hypertension,a previous history of PE,a history of spontaneous abortion,gestational diabetes mellitus,high serum uric acid,and malnutrition were all risk factors for PE complicating elderly pregnant women(all P＜0.05),while a high platelet count and regular prenatal check-ups were protective factors(both P＜0.05).A nomogram risk prediction model for PE complicating elderly pregnant women was constructed based on the results of the multivariate analysis.After internal validation,the C-indices of the training set and the validation set were 0.841 and 0.823 respectively,and the calibration curves were closed to the ideal curves.The ROC curves showed that in the training set,the sensitivity,specificity,area under the curve(AUC),and optimal cut-off value were 87.10％,81.88％,0.859 and 316 points respectively;in the validation set,they were 83.87％,82.61％,0.842 and 310 points respectively.Decision curve analysis showed that when the threshold probability of the training set were between 0.03-0.74 and 0.77-0.82,and that of the validation set were between 0.02-0.70,0.73-0.76 and 0.83-1.00,a higher net benefit could be obtained.Conclusions:Pre-pregnancy BMI,family history of hypertension,previous history of PE,history of spontaneous abortion,gestational diabetes mellitus,platelet count,serum uric acid,malnutrition,and regular prenatal check-ups are all influencing factors for PE complicating elderly pregnant women.The nomogram risk prediction model for PE complicating elderly pregnant women constructed based on these factors has high predictive performance and can guide the early clinical screening of high-risk pregnant women for timely intervention.

Abstract:The etiology of refractory postpartum hemorrhage vary greatly.A small number of cases are actually diagnosed as atypical amniotic fluid embolism.Since it is difficult to identify clinically and the condition is critical,the routine treatment for postpartum hemorrhage is often ineffective,seriously threatening the lives of the mother and the fetus.A case is reported in which a patient underwent sequential induction of labor with oxytocin and dinoprostone suppositories due to premature rupture of membranes at term.After the onset of labor,the labor progressed rapidly,fetal distress occurred,and severe postpartum hemorrhage occurred after vaginal assisted delivery.Multidisciplinary emergency treatment was promptly carried out,and the outcomes of the mother and the fetus were good.After the onset of labor,the patient's platelet count decreased,and unexplained severe coagulation dysfunction occurred shortly after delivery.It was considered to be disseminated intravascular coagulation(DIC)-type amniotic fluid embolism.A retrospective analysis of the diagnosis and treatment process of this patient reveals that it is very necessary to standardize the induction of labor measures for pregnant women with high-risk factors for amniotic fluid embolism.Abnormal signs after the onset of labor should be closely observed,amniotic fluid embolism should be identified in a timely manner,and emergency treatment measures should be taken promptly to ensure the safety of the mother and the infant.

Abstract:Cushing syndrome(CS)is a rare endocrine disorder characterized by hypercortisolism.CS complicating pregnancy is even rarer.Affected by the physiological increase of cortisol levels during pregnancy,the diagnosis and management of this disease are particularly complex.A case of a pregnant patient with adrenocorticotropic hormone(ACTH)-independent CS presenting with hip pain as the first symptom is reported.The patient had obvious metabolic disorders and typical signs of CS.Laboratory tests indicated hypercortisolism,and an adrenal ultrasound revealed an adenoma in the right adrenal gland.A multidisciplinary team collaborated to develop an individualized plan.The patient underwent a cesarean section at 30+3 weeks of gestation,and a right adrenalectomy was performed 6 weeks after delivery.The symptoms improved significantly after the operation,and the follow-up indicated favorable outcomes for both the mother and the infant.This case suggests that if there are abnormal weight gain,metabolic disorders,or skin changes during pregnancy,the possibility of potential endocrine diseases should be alerted and evaluated as early as possible.Multidisciplinary collaboration and psychological intervention are the keys to optimizing the pregnancy outcomes of CS patients.

Abstract:Objective:To analyze the changing trends of the disease burden of ectopic pregnancy in China from 1990 to 2021,predict its future epidemic trends,and provide a basis for optimizing prevention and control strategies.Methods:Based on the data from Global Burden of Disease(GBD)2021,data such as the incidence rate,prevalence rate,and disability-adjusted life year(DALY)rate of ectopic pregnancy were extracted.Joinpoint regression analysis was used to analyze the time trends,The age-period-cohort model was used to analyze the age,period,and cohort effects,and the autoregressive integrated moving average(ARIMA)model was used to predict the disease burden from 2022 to 2036.Results:In 2021,the number of new cases of ectopic pregnancy in China was 1.525 9 million,a decrease of 32.03％compared with 1990;the number of prevalent cases was 12 600,a decrease of 31.89％compared with 1990;and DALY caused by ectopic pregnancy was 5 900 person-years,a decrease of 63.58％compared with 1990.The average annual percentage changes(AAPC)of the age-standardized incidence rate(ASIR),age-standardized prevalence rate(ASPR),and age-standardized DALY rate(ASDR)were-2.82％,-1.07％,and-1.07％,respectively,with statistically significant differences(all P＜0.001),showing an overall downward trend.However,the ASIR and ASPR showed a phased rebound from 2010 to 2014(annual percentage changes were 6.45％and 6.43％).The age effect showed that from 1990 to 2021,the DALY rate of ectopic pregnancy in China first increased and then decreased with age.The period effects showed a downward trend from 1992 to 2022,with the relative risk(RR)value decreasing by 0.83.The cohort effect showed that the RR value was relatively high from 1935 to 1950,and there was no significant change from 1955 to 2005.The prediction results of the ARIMA model showed that from 2022 to 2036,the AS1R and ASPR of ectopic pregnancy would show an upward trend,while the ASDR would show a downward trend.The ASDR would decrease from 0.46 per 100 000 in 2021 to 0.12 per 100 000 in 2036,the ASPR would increase from 0.91 per 100 000 to 1.08 per 100 000,an increase of about 18.68％,and the ASIR would increase from 110.95 per 100 000 to 130.62 per 100 000,an increase of 17.73％.Conclusions:From 1990 to 2021,the disease burden of ectopic pregnancy in China showed an overall downward trend,with a phased rebound from 2010 to 2014.It is predicted that the ASIR and ASPR may increase in the future.Currently,the disease burden is mainly concentrated among women of child-bearing age aged 30-34,suggesting that contraceptive guidance(such as long-acting reversible contraceptive measures)and reproductive health management for high-risk age group(30-34 years old)should be emphasized and screening.Primary-level diagnosis and treatment capabilities for high-risk birth cohorts should be strengthened to cope with the possible rebound of the disease burden in the future.

Abstract:Polycystic ovary syndrome(PCOS)is a common endocrine and metabolic disease among women of reproductive age.The imbalance of glucose and lipid metabolic homeostasis in PCOS can interfere with decidualization process of endometrial stromal cell(ESC)and significantly increase the risk of adverse pregnancy outcomes.Studies have found that in terms of glucose metabolism,there are abnormal mechanisms in patients with PCOS,such as abnormal epigenetic regulation,insulin signaling pathway transduction disorders,and the influence of hyperandrogenism on endoplasmic reticulum stress.In terms of lipid metabolism,hyperandrogenism acts on the Wilms tumor 1-very low density lipoprotein receptor(WT1-VLDLR)pathway,leading to abnormal lipid storage,and the disorder of PCOS-related adipokines inhibits ESC decidualization.This review summarizes the mechanisms of abnormal glucose and lipid metabolism during the decidualization of ESC in patients with PCOS,providing a theoretical basis for in-depth research on the metabolic factors of reproductive disorders in PCOS and the further development of treatment strategies targeting metabolic remodeling.

Abstract:In clinical practice,the treatment success rate of preterm premature rupture of membrane(PPROM)in twin pregnancy is very low.Once it is complicated with cervical insufficiency,the treatment becomes even more difficult.A case of a pregnant woman with dichorionic diamniotic twins who experienced PPROM in one fetus at 16+6 weeks of gestation is reported.After anti-infection and uterine contraction inhibition treatment,selective fetal reduction was performed when the condition was stable,enabling the fetus with intact membranes to continue to survive.Nine days after the operation(at 19+1 weeks of gestation),cervical insufficiency occurred,and an emergency cervical cerclage was carried out,successfully prolonging the pregnancy.At term,the pregnant woman planned a vaginal delivery,but fetal heart rate deceleration occurred during the process,and a cesarean section was then performed,resulting in the smooth delivery of a healthy newborn.This case suggests that for twin pregnancies complicated with PPROM and cervical insufficiency,selective fetal reduction combined with emergency cervical cerclage may be an effective treatment method under specific circumstances,providing a reference for the clinical diagnosis and treatment of related diseases.

Abstract:Postmenopausal women face a significant increase in health risks such as cardiovascular diseases,osteoporotic fractures,and obesity due to decline in estrogen level.As a healthy dietary pattern,the Mediterranean diet can improve these adverse outcomes through multiple mechanisms.The polyphenols and monounsaturated fatty acids rich in it can improve lipid metabolism,reduce oxidative stress and chronic inflammation to protect the cardiovascular system.The high dietary fiber and specific bioactive components help enhance satiety,promote fat metabolism,and improve insulin sensitivity for weight management.It can also protect bone health by regulating the"gut-bone axis",providing sufficient calcium,vitamin D,vitamin K,and through the anti-inflammatory and antioxidant effects of polyphenols.However,the promotion of this dietary pattern in non-Mediterranean regions faces challenges in cultural adaptation,mainly due to the differences in the usage habits of extra virgin olive oil.It is necessary to explore local alternative solutions based on local oils with similar nutritional characteristics and develop individualized strategies combined with behavioral interventions to provide effective and feasible nutritional intervention approaches for the health management of postmenopausal women in China.

Abstract:Teratoma is a congenital embryogenic tumor,and its occurrence in the placenta is rare.A case of mature teratoma of the placenta is reported here.The patient was a 23-year-old woman.Prenatal ultrasound examination revealed a well-defined,encapsulated mixed-echo mass connected to the fetal surface of the placenta through a band-like structure.Multiple strong-echo spots with posterior acoustic shadows were detected inside,and placental teratoma was considered.Subsequently,regular ultrasound re-examinations were conducted,and no obvious changes were found in the size and echo of the mixed-echo mass.At 40+5 weeks of gestation,a live female infant was delivered vaginally.The placenta was delivered smoothly.A yellow tissue was observed at the edge of the placenta with the naked eye,and it was confirmed as a mature teratoma of the placenta by postpartum pathology.Through this case report,the characteristics of placental teratoma are summarized to improve the understanding of this disease,with the hope of providing a reference for clinical diagnosis and treatment.

Abstract:Endometriosis(EMs)is a common chronic gynecological disease.Its core pathology is the ectopic growth of endometrial tissue,but traditional theories struggle to comprehensively explain its complex mechanisms,resulting in challenges of delayed diagnosis and poor treatment outcomes in clinical practice.The application of single-cell sequencing technology provides a new perspective for revealing the cellular and molecular mechanisms of EMs.By analyzing multi-omics information such as the genome and transcriptome of individual cells,this technology overcomes the problem of homogenization of single-cell heterogeneity in traditional sequencing technologies.Studies have found that in the immune microenvironment,the dynamic changes of immune cell subsets in the abdominal cavity and lesions reveal the synergistic effects of immune escape and the inflammatory microenvironment.The fibrosis process involves the deposition of extracellular matrix dominated by myofibroblasts,and the M2 polarization of macrophages exacerbates fibrosis through microenvironmental remodeling or inhibition of epithelial apoptosis.Abnormal angiogenesis is associated with the expansion of tumor-derived endothelial cell and dysregulation of pro-angiogenic factors.Additionally,there is a molecular association between EMs and ovarian cancer,which reveals the mechanisms of infertility caused by impaired oocyte maturation and decreased endometrial receptivity.The emerging spatial transcriptomics technology,which integrates single-cell resolution with spatial location information,further promotes the study of microenvironmental heterogeneity.Despite facing challenges in data complexity and technical processing,single-cell sequencing still has significant potential in high-throughput optimization and multi-omic integration.With technological advancements,this field is expected to break through the bottlenecks in the diagnosis and treatment of EMs and accelerate the transformation from basic research to precise clinical treatment.

Abstract:Ovarian cancer is a gynecological malignant tumor with the highest mortality rate,and its recurrence and drug resistance are closely related to lipid metabolism reprogramming.Studies have shown that abnormal lipid metabolism promotes the synthesis of fatty acid and cholesterol through the abnormal activation of core metabolic enzymes,alters the fluidity of the cell membrane,and drives oncogenic signal transduction.Meanwhile,ascites,exosomes,and immune cells in the tumor microenvironment further enhance tumor metastasis and platinum resistance through lipid transport and metabolic remodeling.Moreover,lipid metabolism interacts with epigenetic modifications and immune checkpoint regulation to reshape the immune response and induce immune escape.These mechanisms work together to maintain the survival,invasion,and drug-resistant phenotypes of cancer cells.Therefore,targeting the key nodes or related pathways of lipid metabolism is not only expected to become molecular markers for the diagnosis and prognosis of ovarian cancer,but also provides a theoretical basis for the combined treatment strategy of metabolic intervention and immune regulation,showing important clinical translational value.

Abstract:Endometrial cancer(EC)is one of the most common malignant tumors in the female reproductive system,and its incidence is on the rise globally.Glucagon-like peptide-1 receptor agonist(GLP-1RA)as hypoglycemic drug,has gradually attracted attention for their potential role in the treatment of EC.Existing studies have preliminarily demonstrated that GLP-1RA can regulate the physiological activities of EC by activating multiple signaling pathways such as AMP-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR)and cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA).This further affects apoptosis,autophagy,ferroptosis,and cell cycle arrest of EC cells,and shows the potential to overcome cisplatin chemotherapy resistance in a hyperglycemic environment,thereby inhibiting the survival,migration,and invasion abilities of EC cells.In addition,GLP-1RA can upregulate the expression of glucagon-like peptide-1 receptor(GLP-1R),and changes in the expression level of GLP-1R can be detected in both normal tissues and EC tissues.Therefore,GLP-1RA has potential application value in the treatment of EC.This review summarizes the latest research progress of GLP-1RA in the occurrence and development of EC from the perspectives of key targets,physiological mechanisms,and effects,aiming to provide reference for future research.