Abstract:A case of peritoneal malignant mesothelioma(PMM)is reported.The patient presented due to a palpable abdominal mass.Color Doppler ultrasound indicated a hypoechoic mass in the pelvic cavity.Before the operation,the patient was tentatively diagnosed with a pelvic malignant tumor.Subsequently,a laparoscopic exploration was performed,and the lesions on the surface of the bilateral fallopian tubes and ovaries were resected during the operation.The nature of the mass could not be determined by introperative pathological examination.After the operation,the routine pathological examination,following further consultation,confirmed it as a malignant tumor,suspected to be a malignant mesothelioma,possibly originating from the peritoneum.Then,a cytoreductive surgery was carried out.After the operation,the patient's symptoms were relieved,but the patient refused further treatment.PMM is a clinically rare,highly invasive malignant tumor originating from serosal mesothelial and sub-mesothelial cells.It commonly occurs in the pleura and peritoneum and is closely associated with asbestos exposure.The disease has an insidious onset,lacks typical symptoms,and has low imaging specificity,posing certain difficulties in clinical diagnosis and treatment.Most cases are diagnosed at an advanced stage,with a poor prognosis.The main treatment for PMM is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

Abstract:Cervical cancer is one of the most common gynecological malignancies.The phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway is one of the signal transduction pathways closely related to cervical cancer.Studies have found that quercetin,luteolin,triterpenoids from Inonotus obliquus,tubeimoside Ⅰ,and neferine can inhibit the activation of the PI3K/Akt pathway,reduce the phosphorylation levels of PI3K and Akt,and induce apoptosis in HeLa cells.Wogonin,rotenone,saikosaponin A,lycorine,camptothecin,shikonin,and artemisinin activate pro-apoptotic proteins and autophagic complexes through this pathway,promoting cell autophagy and apoptosis.Paeonol,oxymatrine,and protopanaxadiol inhibit cell migration and invasion by regulating the epithelial-mesenchymal transition mediated by the PI3K/Akt signaling pathway.Arsenic trioxide,paclitaxel,and gambogic acid can block this pathway,reduce the expression of angiogenesis-related proteins,and inhibit tumor angiogenesis.Pterostilbene down-regulates the expression of mammalian target of rapamycin through this pathway,affecting the tumor microenvironment.Traditional Chinese medicine monomers affect the proliferation,apoptosis,autophagy,migration,invasion of HeLa cells and the tumor microenvironment by regulating the PI3K/Akt signaling pathway,providing new therapeutic perspectives and theoretical basis for cervical cancer.

Abstract:A case of severe adverse reaction after a single-dose methotrexate combined with mifepristone for ectopic pregnancy is reported.After receiving drug treatment for ectopic pregnancy at an outside hospital,the patient developed high fever,oral ulcers,rashes,diarrhea,and bone marrow suppression.Due to the failure of timely recognition and treatment,the condition progressed to severe complications such as grade Ⅳ oral mucositis,grade Ⅳ bone marrow suppression,septic shock,and multiple organ dysfunction.After being transferred to our hospital,the patient finally improved after active treatments including calcium folinate rescue,anti-infection,granulocyte stimulating factor therapy,total parenteral nutrition,and blood product transfusions.Currently,all guidelines for the drug treatment of ectopic pregnancy recommend a single-dose of methotrexate,and multiple-doses if necessary.The combined use of methotrexate and mifepristone is not recommended.Medical staff should be aware of the adverse reactions of the drugs and strengthens monitoring.Once the aforementioned adverse reactions occur,early recognition and standardized treatment can prevent the occurrence of severe complications.

Abstract:Pelvic floor dysfunction(PFD)is a common health problem among women,severely affecting the quality of life of postpartum and elderly women.With the improvement of people's health awareness and the development of population aging,the early detection and intervention of PFD have become a global public-health priority.Pelvic floor electrophysiological examination,with its advantages of non-invasiveness and dynamic monitoring,has been widely used in the diagnosis and treatment of PFD.This technology can objectively quantify pelvic floor electromyographic signals and has high sensitivity for the screening of early asymptomatic PFD.In the evaluation of treatment efficacy,it can accurately reflect the rehabilitation effect.Additionally,it also provides support for the research on the mechanisms of PFD,such as distinguishing the differences in electromyographic characteristics among different patients.However,this technology still has some problems,including insufficient standardization,limited evaluation of deep muscle groups,and lack of multidisciplinary collaboration.In the future,it is necessary to promote technological innovation,strengthen multidisciplinary integration,and establish an interdisciplinary collaboration system to achieve precise prevention and control of PFD.

Abstract:Intrahepatic cholestasis of pregnancy(ICP)is a liver disease that commonly occurs in the second and third trimesters of pregnancy.Its main manifestations are skin pruritus and elevated serum total bile acid levels,which can lead to adverse pregnancy outcomes.The 2024 guideline of the Society of Obstetricians and Gynaecologists of Canada(SOGC)states that the diagnostic criterion for ICP is non-fasting serum bile acid＞19 μmol/L.Serum bile acid levels should be monitored every 2-4 weeks.The timing of delivery is determined individually based on the highest bile acid level during pregnancy and combined with high-risk factors.Ursodeoxycholic acid(UDCA)is the first-line treatment for ICP.The 2022 guideline of the Royal College of Obstetricians and Gynaecologists(RCOG)in the UK stipulates that the diagnostic criterion for ICP is random bile acid ≥19 μmol/L accompanied by pruritus without skin lesions,and it does not recommend the routine use of UDCA to reduce the risk of adverse perinatal outcomes in ICP.The 2024 Chinese guideline recommends using a fasting serum bile acid level≥ 10 μmol/L or a post-meal serum bile acid level≥ 19 μmol/L as the diagnostic criterion for ICP,and there are also slight differences in the auxiliary examinations,treatment regimens,frequency of prenatal monitoring,and timing of delivery for ICP.By interpreting the 2024 SOGC guideline and conducting a comparative analysis of the three guidelines,we hope to provide more evidence for clinicians in the diagnosis and treatment of ICP.

Abstract:Strontium is one of the essential trace elements in the human body.The strontium content in pregnancy women may have a certain impact on pregnancy outcomes,especially in terms of fetal growth and development and pregnancy-related complications.Research has shown that abnormal strontium content in pregnant women may participate in the pathological processes of pregnancy-related diseases by interfering with redox homeostasis.Oxidative stress is one of the pathogenic mechanisms of diseases such as pre-eclampsia,gestational diabetes mellitus,and fetal growth restriction.In recent years,studies have found that strontium can participate in the regulation of oxidative stress responses by regulating the activity of antioxidant enzymes and inhibiting lipid peroxidation,suggesting that it may play a certain role in maintaining oxidative balance during pregnancy.Therefore,maintaining an appropriate strontium level in pregnant women is potentially of great significance for reducing the risk of pregnancy complications such as pre-eclampsia and gestational diabetes mellitus,promoting normal fetal growth and development,and thus ensuring the health of both the mother and the infant.

Abstract:Polycystic ovary syndrome(PCOS),as a complex endocrine and metabolic disorder,has a relatively high incidence among women of reproductive age,significantly affecting the reproductive health and quality of life.Traditional treatment regimens are only limited to symptom improvement and cannot reverse the pathological process of PCOS.Therefore,it is difficult to completely cure the disease and effectively prevent long-term complications.Human umbilical cord mesenchymal stem cell(hUC-MSC)and its derived extracellular vesicles have unique immunomodulatory,anti-inflammatory,tissue repair capabilities,and are expected to become a new treatment method for PCOS.Studies have shown that hUC-MSC transplantation and its derived cell-free therapy have positive effects on regulating the immune microenvironment,improving oocyte quality,and alleviating PCOS-related pathological changes through multiple mechanisms,such as regulating the inflammatory response and inflammatory signal transduction,inhibiting programmed cell death of ovarian granulosa cells,and maintaining mitochondrial homeostasis.Furthermore,these also show potential clinical value in improving the reproductive outcomes of PCOS patients and preventing long-term complications,providing a theoretical basis for further in-depth research on the mechanism of action of hUC-MSC and its clinical translation.

Abstract:Choriocarcinoma is a highly malignant gestational trophoblastic tumor that is prone to early metastasis.Cesarean scar pregnancy complicated with choriocarcinoma lacks specific clinical symptoms,is extremely rare clinically,and is easily misdiagnosed in the early stage.Early diagnosis and treatment are crucial for the prognosis.A case of cesarean scar pregnancy complicated with choriocarcinoma is reported.The patient was admitted to the hospital due to amenorrhea for 59 days accompanied by vaginal bleeding for 2 days.After hysteroscopic removal of the scar pregnancy tissue,the pathological diagnosis was cesarean scar pregnancy.After the operation,the serum level of[3-human chorionic gonadotropin(β-hCG)decreased and then abnormally increased again.Ultrasound showed an abnormal echo mass at the scar site,and gestational trophoblastic disease was suspected.After laparoscopic resection of the cesarean scar pregnancy lesion,the pathological diagnosis was choriocarcinoma.After two courses of chemotherapy with the fluorouracil+actinomycin-D+vincristine(FAV)regimen,the patient's blood β-hCG turned negative.Transvaginal ultrasound showed no abnormal mass.The patient had no recurrence during the 11-month follow-up after the end of chemotherapy.

Abstract:Some patients with Mayer-Rokitansky-Kuster-Hauser(MRKH)syndrome have underdeveloped uterus.Among them,adenomyosis in a rudimentary uterus without functional endometrium rarely caused pelvic pain.We reported a case of MRKH syndrome complicated with adenomyosis.The 49-year-old patient presented with periodic abdominal pain and a pelvic solid mass.Laparoscopic exploration suggested bilateral rudimentary uterus with adenomyosis in the left uterus.Bilateral rudimentary hysterectomy was performed,and the diagnosis was confirmed by histopathological examination.The patient was discharged smoothly after the operation,and follow-up showed relief of abdominal pain without recurrence.Meanwhile,a literature review was conducted to discuss the diagnosis and treatment of MRKH syndrome complicated with adenomyosis.

Abstract:A case of a rare non-human papilloma virus(HPV)-related mesonephric adenocarcinoma(MNA)of the cervix is reported,and its clinical diagnosis and treatment characteristics,pathological features,and causes of misdiagnosis are analyzed in depth.The patient was a postmenopausal woman with no obvious clinical symptoms,and the previous cervical HPV and thin-prep cytology test results were both negative.She suddenly had vaginal bleeding 2 years after menopause.Clinical physical examination showed that the cervix looked normal,but the uterus was significantly enlarged.At the initial diagnosis,it was misdiagnosed as endometrial cancer.After the surgery,the diagnosis of cervical malignant tumor was confirmed by histopathological examination,and MNA was diagnosed by immunohistochemical analysis.This case emphasizes the crucial role of multi-disciplinary collaboration in the diagnosis and treatment of non-HPV-related cervical adenocarcinoma.It prompts clinicians to pay more attention to patients with atypical symptoms,comprehensively use means such as medical history collection,laboratory tests,imaging evaluation,and pathological analysis,broaden the diagnostic thinking,and strengthen the multidisciplinary collaboration mechanism,so as to reduce the misdiagnosis rate and promote the precise diagnosis and treatment of non-HPV-related cervical adenocarcinoma.

Abstract:With the rapid development of high-throughput sequencing technology,the role of long non-coding RNA(lncRNA)HOX transcript antisense RNA(HOTAIR)in gynecological malignant tumors has been gradually revealed.Studies have shown that HOTAIR is generally highly expressed in cervical cancer,ovarian cancer,and endometrial cancer,and is closely related to tumor progression,metastasis,and drug resistance.HOTAIR participates in the processes of tumor proliferation,invasion,metastasis,and drug resistance by regulating signaling pathways such as Wnt/β-catenin,transforming growth factor-β(TGF-β)/epithelial-mesenchymal transition(EMT),Notch,and phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt).In addition,its genetic polymorphisms(such as single nucleotide polymorphisms)are closely related to the susceptibility of gynecological malignant tumors.Its characteristic of regulating microRNA function as a competing endogenous RNA(ceRNA)further highlights its key role in tumor molecular regulation.HOTAIR can not only serve as a potential molecular marker for the diagnosis and prognostic evaluation of gynecological malignant tumors,but may also become an important target for future individualized treatment strategies.

Abstract:Uterine rupture is a critical obstetric emergency characterized by sudden onset,rapid progression,and high maternal-fetal mortality.While the most common predisposing factor is a scarred uterus,spontaneous uterine and ovarian rupture in late pregnancy without prior surgical history is exceedingly rare.This report describes the diagnosis and management of a non-scarred uterine pregnancy with concurrent uterine and ovarian rupture in an advanced-age patient.The case highlights unique mechanisms of rupture in non-scarred uteri,including advanced maternal age,history of ankylosing spondylitis,and long-term glucocorticoid use,all of which may compromise uterine myometrial integrity.Early diagnosis and immediate intervention were pivotal in improving outcomes,underscoring the importance of multidisciplinary collaboration in emergency obstetric care.This case provides clinical insights into early risk stratification and optimal management of non-scarred uterine rupture to prevent adverse pregnancy outcomes.

Abstract:Endometriosis(EMs)is a benign lesion,but its lesions have diverse morphologies and different depths,and can involve multiple organs.It has a long-term course and is difficult to cure completely.Failure to recognize or completely remove the lesions during surgery is considered the main cause of EMs recurrence.How to locate the lesions during surgery,determine their scope,perform precise resection,and avoid organ damage at the same time is a major challenge for surgeons.As an enhanced visualization technology,near-infrared fluorescence imaging technology can,on the one hand,provide additional real-time visual information during surgery to help surgeons locate the lesion and their scope;On the other hand,it is convenient to use and has high safety.Many scholars have begun to apply it in EMs surgery and have made progress in lesion detection,surgical visualization and navigation,blood supply assessment,and prognosis prediction.This article reviews the application progress of near-infrared fluorescence imaging technology in gynecological EMs surgery.

Abstract:Quercetin is a flavonoid compound extracted from Chinese herbal medicine.It is widely distributed and has good therapeutic effects on both benign and malignant tumors.The mechanisms of quercetin against cervical cancer include:inhibiting cell proliferation by suppressing transforming growth factor-β1(TGF-β1);inhibiting cell invasion and migration by down-regulating the expression of matrix metalloproteinase-9(MMP-9);promoting cell apoptosis by promoting oxidative stress,activating the p53 gene,activating endoplasmic reticulum stress,and activating AMP-activated protein kinase(AMPK);increasing radiosensitivity by arresting the cell cycle and down-regulating the ratio of B-cell lymphoma 2(Bcl-2)/Bcl-2 associated X protein(Bax);increasing chemosensitivity by regulating the expression of apoptotic factors;and exerting anti-cervical cancer effects by interfering with signaling pathways such as phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt),Wnt/β-catenin,and Janus kinase 2(JAK2)/signal transducer and activator of transcription 3(STAT3).Quercetin has broad application prospects in the field of cervical cancer treatment.However,the clinical application of quercetin is still limited by poor water solubility and low bioavailability.In the future,in-depth exploration is needed at multiple levels from basic research to clinical application to clarify the dose-response relationship and standardize the medication regimen,aiming to provide more effective strategies for the treatment of cervical cancer.

Abstract:Cervical adenoid basal cell carcinoma(ABC)is a rare malignancy that is frequently associated with high-risk human papillomavirus(HPV)infection and often coexists with high-grade squamous intraepithelial lesion(HSIL).Due to its nonspecific clinical manifestations,ABC is prone to misdiagnosis,and its pathogenesis remains unclear,posing diagnostic challenges.This report presents a postmenopausal patient with cervical ABC who was admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine with the chief complaint of cervical lesion 3 days prior.Given the patient's lack of fertility desire,a total hysterectomy with bilateral salpingo-oophorectomy was performed.No postoperative complications or recurrence has been observed during follow-up.By summarizing the etiology,clinical characteristics,and key diagnostic and therapeutic considerations of this disease,this case aims to enhance clinicians' understanding of cervical ABC and improve diagnostic accuracy and management strategies.

Abstract:Premature ovarian insufficiency(POI),characterized by the premature decline of ovarian function in women of reproductive age,significantly impairs quality of life and fertility.Its incidence has been rising globally.While conventional hormone replacement therapy(HRT)alleviated symptoms,its efficacy in restoring ovarian function or achieving pregnancy remains limited.With the emergence of regenerative medicine,platelet rich plasma(PRP)has garnered attention as a novel biologic therapeutic strategy.PRP,enriched with diverse growth factors,demonstrates potential to activate angiogenesis,cell proliferation,anti-apoptosis,and cell repair,thereby offering a promising avenue for ovarian regeneration.Preliminary clinical studies,though predominantly exploratory,suggest that PRP may improve the ovarian microenvironment,reactivate folliculogenesis,and enhance pregnancy rates.However,current evidence is constrained by small sample sizes and a lack of large-scale randomized controlled trials.The safety profile of PRP remains incompletely defined.While no serious adverse effects have been reported in POI applications,risks(e.g.infection,hypersensitivity)observed in other medical fields warrant caution.This review synthesizes the potential mechanisms of PRP in ovarian functional recovery,summarizes current clinical progress,and identifies key research gaps,aiming to provide a theoretical basis and research directions for clinical treatment.

Abstract:Fetal growth restriction(FGR)is a pregnancy complication closely associated with adverse pregnancy outcomes.Early diagnosis and monitoring of FGR are crucial for improving prognosis.In recent years,studies have found that the cerebral-placental-uterine ratio(CPUR),as a novel Doppler ultrasound parameter,shows significant advantages in predicting FGR by integrating the hemodynamic indicators of the fetal middle cerebral artery,umbilical artery,and uterine artery.CPUR has high predictive potential for both early-onset and late-onset FGR.Particularly in late-onset FGR,some studies have shown that the predictive efficacy of CPUR is superior to that of traditional blood flow indicators,and it is significantly associated with adverse pregnancy outcomes such as operative delivery and perinatal mortality.In addition,the predictive value of CPUR for adverse perinatal outcomes in patients with hypertensive disorders of pregnancy and pregestational diabetes has also been preliminarily validated.This review summarizes the application value and research progress of CPUR in FGR,aiming to achieve early diagnosis and rational monitoring of high-risk fetuses with FGR though CPUR,reduce the occurrence of adverse pregnancy outcomes of FGR,and provide a theoretical basis for the clinical promotion and individualized intervention of CPUR.

Abstract:Stillbirth is one of the severe complications of pregnancy.The occurrence of stillbirth not only brings huge psychological burdens and harm to pregnant women and their families but also imposes relatively large economic burden on society.Hypertensive disorders of pregnancy(HDP)are one of the common complications during pregnancy.Recent studies have shown that HDP is one of the important maternal factors leading to stillbirth.However,little is known about the influence of different hypertension classifications on HDP and stillbirth.The relationship between blood pressure control levels and stillbirth remains controversial,and there are also disputes about whether the use of drugs such as aspirin in the treatment of HDP in pregnant women is beneficial.This review summarizes the influence of HDP on stillbirth,the impact of drug treatment for HDP on stillbirth,the mechanism by which HDP leads to stillbirth,and the management of stillbirth caused by HDP,aiming to provide more scientific and accurate guidance for the prevention and management of stillbirth.

Abstract:Endometrial stromal sarcoma(ESS)is a rare pathological entity,and its primary occurrence in the ovary is exceptionally uncommon,with limited cases reported in the literature.This report presents a case of primary ovarian ESS in a patient admitted for a pelvic mass incidentally detected during routine examination.The patient was asymptomatic,and imaging revealed bilateral adnexal masses,initially suspected to be of sex cord-stromal origin.Surgical intervention included total hysterectomy with bilateral salpingo-oophorectomy(incorporating left ovarian mass excision),right pelvic mass excision,and rectal surface nodule resection.Histopathological examination confirmed the diagnosis of ovarian ESS with rectal metastasis.Postoperatively,the patient received one cycle of liposomal doxorubicin hydrochloride chemotherapy.

Abstract:Objective:To evaluate the clinical utility of an artificial intelligence(AI)model constructed from multiple laboratory indicators for diagnosing ovarian malignancies.Methods:A retrospective analysis was conducted on laboratory data from 3 465 patients with ovarian malignant tumors and 6 987 patients with benign ovarian tumors at the First Affiliated Hospital of Zhengzhou University.Patients were randomly divided into training(n=7 317)and testing(n=3 135)sets at a ratio of 7∶3.Feature selection was performed using the Boruta algorithm and Lasso regression.Four models(random forest,logistic regression,support vector machine,and gradient boosting decision tree)were constructed.Model performance was evaluated by area under the curve(AUC),accuracy,precision,recall,and F1-score.Results:The random forest model achieved optimal performance in the testing set(AUC=0.924,accuracy=0.872,recall=0.749),outperforming the other three models and conventional single biomarkers[human epididymis protein 4(HE4),carbohydrate antigen 125(CA125),CA15-3,and D-dimer].Feature importance analysis identified 15 clinical significant indicators:HE4,CA15-3,CA19-9,CA125,CA724,alpha-fetoprotein,D-dimer,fibrinogen,albumin,lactate dehydrogenase,neutrophil percentage,absolute neutrophil count,lymphocyte percentage,absolute lymphocyte count,and platelet count.Conclusions:The random forest model based on laboratory data demonstrated high diagnostic efficacy for ovarian malignancies with promising clinical applicability.Future studies should incorporate multicenter data and multimodal information to enhance model generalizability and interpretability,facilitating its integration into clinical practice.