Abstract:Endometrial cancer(EC),as one of the three major malignant tumors in the female reproductive system,shows an increasing trend in incidence and mortality globally.Patients with early-stage EC have a favorable prognosis,but the survival time of those with advanced-stage and recurrent EC is significantly shortened.N6-methyladenosine(m6A)methylation is the most abundant epitranscriptomic modification in eukaryotic RNA,and the metabolism of RNA is dynamically regulated by three types of regulatory factors:methyltransferases,demethylases,and m6A-binding proteins.Studies have shown that abnormal expression of these regulatory factors plays a critical role in the pathogenesis and progression of EC.For instance,methyltransferase like 3(METTL3)activates the protein kinase B(Akt)signaling pathway,and Wilms' tumor 1-associating protein(WTAP)enhances the characteristics of EC stem cells by affecting the early growth response gene 1(EGR1)/PTEN pathway.Fat mass and obesity-associated protein(FTO)and AlkB homolog 5(ALKBH5)promote the proliferation and invasion of EC cells through signaling pathways such as phosphoinositide 3-kinase(PI3K)/Akt and by regulating the expression of insulin-like growth factor 1 receptor(IGF1R),respectively.In addition,YTH m6A RNA-binding protein 2(YTHDF2)and IGF2 mRNA binding protein(IGF2BP)also participate in the regulation of the malignant phenotypes of EC cells.These findings provide novel perspectives for the early diagnosis and precise therapy of EC.In terms of diagnosis and treatment,high expression of proteins such as METTL3,METTL14,and FTO indicates a poor prognosis,while YTHDF2 is a potential biomarker for identifying precancerous lesions.Furthermore,overexpression of METTL3 can activate CD8+T cells to inhibit the proliferation of EC,and the METTL3/FGD5-AS 1 axis mediates paclitaxel resistance,which lays a theoretical foundation for the immunotherapy of EC and the improvement of chemotherapy resistance.

Abstract:Exaggerated placental site(EPS)is a rare benign,non-neoplastic condition characterized by excessive proliferation of implantation site intermediate trophoblasts(ISITs)at the placental implantation site,typically occurring after delivery or abortion.The primary clinical manifestation of patients is persistent unexplained vaginal bleeding.Diagnosis is primarily pathological,with key features showing extensive infiltration of intermediate trophoblast cells into the uterine decidua and smooth muscle tissue.A case of patient with medication abortion and syphilis infection who presented with irregular vaginal bleeding and intermittent lower abdominal pain for 50 days post-abortion was reported.Ultrasound revealed retained products of conception involving the myometrium with rich blood flow signals,along with elevated serum β-human chorionic gonadotropin(β-hCG)levels.The patient underwent hysteroscopic resection of residual conception products under ultrasound guidance.Postoperative pathology confirmed EPS.Follow-up showed normalization of β-hCG levels,resumption of menstruation,and favorable prognosis.

Abstract:Objective:To evaluate the safety and efficacy of different induction methods in pregnant women in the second trimester with chronic kidney disease(CKD)Stages 3-5.Methods:A retrospective study was conducted on 17 pregnant women with CKD Stages 3-5 who underwent midtrimester induction of labor at the First Affiliated Hospital of Zhengzhou University between October 1,2019 and September 30,2023.Patients were divided into two groups based on induction method:the ethacridine group(intra-amniotic injection of ethacridine lactate,n=9)and the balloon catheter group(mechanical dilation with a Foley catheter,n=8).General characteristics,induction outcomes(success rate,induction-to-delivery interval,total labor duration),complications,and renal function before and after induction were compared.Results:No significant differences were observed in induction success rate(88.9％vs.100.0％,P=1.000),induction-to-delivery time,total labor duration,intra-partum blood loss,fetal weight,or incidence of retained products of conception(all P＞0.05).Neither group experienced complications such as postpartum hemorrhage,perineal laceration,placental abruption,disseminated intravascular coagulation,intrauterine infection,uterine rupture,conversion to cesarean section,or puerperal infection.Renal function markers(serum creatinine,blood urea nitrogen,uric acid and estimated glomerular filtration rate)remained stable before and after induction in both groups(all P＞0.05).For patients with a scarred uterus,success rate did not differ significantly(P=1.000).Conclusions:Both ethacridine lactate and balloon catheter methods are safe and effective for induction of labor in the second trimester in CKD Stages 3-5 patients,without increasing complication risks.However,each method has specific advantages and limitations.Multidisciplinary collaboration is recommended to select individualized induction strategies.

Abstract:Complex cervical adhesions following cold knife conization in postmenopausal women present a significant clinical challenge for gynecological procedures.The clinical data of two such cases were analyzed.In Case 1,the patient presented with endometrial thickening and abdominal distension,while Case 2 involved a uterine cavity mass with fluid accumulation.Cervical adhesiolysis was performed using ultrasound-guided direct puncture combined with methylene blue staining(Case 1),and blunt dissection with mosquito curved forceps(Case 2),followed by gradual cervical dilation using Hegar dilators and a combined cold knife-electrosurgery technique.Successful adhesiolysis and resection of endometrial lesion were achieved in both cases.The mean operative duration was 40 minutes,with an estimated blood loss of 5 mL.No complications(e.g.,uterine perforation or adjacent organ injury)occurred.Ultrasound-guided direct puncture with methylene blue staining or blunt dissection with mosquito curved forceps may overcome surgical limitations in postmenopausal women with post-conization cervical adhesions,offering a safe,minimally invasive,and effective approach for complex cases.

Abstract:Chronic endometritis(CE)is an inflammatory disease characterized by endometrial stromal edema,hyperemia,irregular thickening,and the presence of plasma cell infiltration.Recent studies have demonstrated that CE can reduce endometrial receptivity through multiple mechanisms,leading to adverse pregnancy outcomes such as infertility,recurrent implantation failure,and recurrent miscarriage.The specific mechanisms include:the disorder of the intrauterine immune microenvironment caused by the imbalance of the proportions of endometrial immune cells;the disruption of the intrauterine microbial homeostasis due to the decrease in the abundance of Lactobacillus and the increase of conditional pathogens;the dysregulation of the hormonal regulatory network resulting from the increased expression of estrogen receptors and the decreased responsiveness to progesterone;and the abnormal angiogenesis of the endometrium triggered by the overexpression of pro-angiogenic factors such as hypoxia-inducible factor and vascular endothelial growth factor.Elucidating the relationships between the above mentioned mechanisms and endometrial receptivity could provide a theoretical basis for the accurate clinical diagnosis,targeted therapies of CE,and the improvement of reproductive outcomes,and is of great significance for safeguarding female reproductive health.

Abstract:Primary carcinosarcoma of the fallopian tube is a rare malignant tumor originating from mesodermal tissues.Its etiology and pathogenesis remains unclear,and surgical treatment is the main clinical approach.We report a case of primary carcinosarcoma of the fallopian tube with extensive omental metastasis.The patient underwent pelvic magnetic resonance imaging because of abdominal pain,which revealed a large solid pelvic mass accompanied by enlarged bilateral iliac vessels and para-aortic lymph nodes.After multi-disciplinary discussion,the patient underwent transabdominal pelvic mass resection,total hysterectomy,omentectomy and appendectomy,pelvic lymph node dissection,and tumour cytoreduction surgery.After the operation,the patient received one cycle of intravenous chemotherapy with paclitaxel combined with carboplatin.Due to intolerable myelosuppression after chemotherapy,the patient signed out of the hospital and passed away according to telephone follow-up.By summarizing the onset characteristics,histopathological manifestations,diagnosis,treatment and prognosis of tubal carcinosarcoma in this case,we aim to improve clinicians' understanding of this disease and provide references for its clinical diagnosis and treatment.

Abstract:Obstetric sepsis remains a major cause of maternal mortality.Early recognition and interventions are of great significance in reducing maternal mortality.We report a case of pregnant woman with inevitable abortion who developed septic shock and was successfully treated through multidisciplinary collaboration.The patient was a 27-year-old primipara.After in vitro fertilization-embryo transfer(IVF-ET),at the mid trimester of pregnancy,amniocentesis was performed to rule out possible fetal chromosomal abnormalities due to the fetus having a right-side aortic arch.Premature rupture of membranes occurred 16 days after the amniocentesis.During the induction of labor,the patient presented with high fever,persistent hypotension,elevated white blood cells and procalcitonin,along with elevated blood lactic acid and creatinine and thrombocytopenia.After multidisciplinary collaborative treatment including fluid resuscitation,upgraded antibiotic therapy,vasopressors,and bedside continuous renal replacement therapy,the patient improved and was discharged from the hospital.This case suggests that obstetric sepsis and septic shock should be vigilant after amniocentesis.It also emphasizes the importance of early recognition,timely intervention and multidisciplinary collaboration in the successful management of obstetric sepsis and septic shock.

Abstract:Preeclampsia(PE)is a pregnancy-specific multisystem dysfunction disorder characterized by newly developed hypertension and proteinuria after 20 weeks of gestation.In severe cases,it can progress to eclampsia,which remains one of the important causes of poor prognosis and mortality for pregnant women and newborns globally.The pathogenesis of PE is complex,involving multiple pathophysiological processes such as abnormal placental development,vascular endothelial dysfunction,and oxidative stress imbalance.In recent years,studies have found that autophagy,an essential cellular homeostasis regulatory mechanism,degrades organelles and misfolded proteins through the lysosomal pathway and plays a key role in the occurrence and development of PE.Specifically,autophagy participates in the pathological process of PE by regulating multiple aspects,including the invasive ability of trophoblasts,the remodeling process of uterine spiral arteries,and the level of oxidative stress,the intensity of inflammatory response,and the state of endoplasmic reticulum stress.Notably,various signaling molecules and drugs can affect the progression of PE by regulating autophagy activity,providing a theoretical basis for the development of novel targeted therapeutic strategies.This review summarizes the molecular role of autophagy in the pathogenesis of PE and its therapeutic potential,aiming to provide new perspectives for a deeper understanding of the pathological mechanisms and its clinical prevention and treatment.

Abstract:Immune evasion is one of the core pathogenic mechanisms for the persistent infection of human papilloma virus(HPV)and the progression of related malignancies such as cervical cancer.At the molecular biological level,the genomic regions of HPV play a crucial role in invading and infecting host cells.At the level of the host immune response,HPV inhibits the functions of innate immune core effector cells such as natural killer cells,macrophages,and dendritic cells,and at the same time interferes with the T-lymphocyte-mediated adaptive immune response,ultimately leading to the functional exhaustion of immune effector cells and inducing an immune tolerance state.Notably,HPV can also disrupt the local vaginal microecological balance,causing an interactive imbalance between immune regulation and microbial homeostasis,and creating an immunosuppressive microenvironment conducive to the persistence presence of the virus.In-depth anaysis of these mechanisms is of great significance for the development of effective prevention and treatment strategies for HPV,and is expected to provide new ideas and targets for the prevention,diagnosis,and treatment of HPV-related diseases.

Abstract:Objective:To analyze 7 cases of Y chromosome abnormalities detected in amniotic fluid cells through prenatal testing,evaluate the correlations between different testing methodologies,and provide guidance for accurate interpretation of results in prenatal genetic counseling.Methods:We retrospectively reviewed 7 cases with prenatal testing diagnosis of Y chromosome abnormalities.Testing modalities included karyotype analysis,chromosomal microarray analysis(CMA),multiplex ligation-dependent probe amplification(MLPA),fluorescence in situ hybridization(FISH),and optical genome mapping(OGM).Comprehensive results were derived by integrating findings from these complementary techniques.Results:Among the 7 cases,6 exhibited mosaics(excluding Case 2).Case 1,2,6,and 7 showed consistent Y chromosome abnormalities across all testing methods.In contrast,Case 3,4,and 5 demonstrated discordant results between techniques.Conclusions:For accurate assessment of fetal Y chromosome status,we recommended a combined approach utilizing conventional karyotyping supplemented by molecular and cytogenetic methods(CMA/MLPA/FISH/OGM)to obtain comprehensive genomic information.Clinicians should correlate the specific type of Y chromosome abnormality with test results to predict potential postnatal phenotypes and provide appropriate genetic counseling.

Abstract:Vaginal atresia is a relatively rare congenital malformation of the reproductive tract,which is caused by the failure of the urogenital sinus to participate in the formation of the lower segment of the vagina.Different surgical methods may lead to different complications,and there is limited long-term data on postoperative complications and management at home and abroad.A patient with type Ⅱ vaginal atresia who has undergone sigmoid colon vaginoplasty with uterine preservation was treated at the People's Hospital of Xinjiang Uygur Autonomous Region.Thirty years after the surgery,the patients presented with paravaginal prolapse.After discussion by a multi-disciplinary team,the patient underwent vaginal reconstruction surgery and laparoscopic left ovarian cystectomy.The surgery was successful,and the patient had a good follow-up result 8 months after the surgery.This case aims to explore the long-term complications of sigmoid colon vaginoplasty for genital tract malformations and improve the understanding,diagnosis and treatment of such patients.

Abstract:Recurrent spontaneous abortion(RSA)is a complication of pregnancy,and its occurrence is related to many factors,such as abnormalities immune function,anatomical structure,chromosomal abnormalities,and endocrine abnormalities.Some targeted drugs have achieved certain curative effects in the treatment of RSA.Studies have shown that ATP citrate lyase(ACLY)can affect cell proliferation and function through intracellular metabolic pathways such as glucose metabolism and lipid metabolism.It can also mediate the expression of relevant cytokines through histone acetylation,thereby influencing the proliferation of immune cells and immune regulation,and participating in epigenetic regulation.This review summarizes the potential mechanism of action of ACLY in RSA,aiming to provide new theoretical basis for the targeted therapy of RSA.

Abstract:Preeclampsia is a pregnancy-specific disorder that severely threatens the maternal and fetal health,with a complex pathogenesis.Iron is indispensable for maintaining normal physiological functions,participating in oxygen transport,energy metabolism,and the synthesis of various enzymes.Abnormal serum iron levels can trigger a series of physiological disorders.Ferroptosis is a novel type of iron-dependent programmed cell death and characterized by lipid peroxidation.Studies have found that in patients with preeclampsia,exhibiting dysregulated serum iron metabolism and an increase in serum iron levels.This process may lead to damage to placental trophoblasts cells and vascular endothelial cells by inducing ferroptosis,resulting in insufficient trophoblast cell invasion and impaired remodeling of uterine spiral arteries,which ultimately impairs placental function and leads to adverse pregnancy outcomes.Abnormal serum iron metabolism and ferroptosis may represent key mechanisms in preeclampsia pathogenesis.Further investigation of the specific mechanisms is expected to provide novel insights and therapeutic targets for the early diagnosis,condition monitoring,and treatment of preeclampsia.

Abstract:Objective:To summarize the hysteroscopic imaging characteristics of endometrial tuberculosis(ETB)patients with successful pregnancy,and provide references for clinical diagnosis and treatment.Methods:A retrospective analysis was conducted on 111 ETB patients who visited the Hysteroscopy Center of Fuxing Hospital Affiliated to Capital Medical University from May 2012 to January 2020.Follow-up was carried out until March 2025.Among them,36 patients(32.4％,36/111)who finally achieved successful pregnancy were selected.Their medical records,hysteroscopic images and pregnancy outcome data were collected,and the characteristics of hysteroscopic manifestations were summarized.Results:Among the 36 patients with successful pregnancy,83.3％(30/36)were primary infertile.The conception methods included 29 cases of in vitro fertilization-embryo transfer(IVF-ET)and 7 cases of natural conception.Hysteroscopic manifestations included normal uterine cavity morphology in 8 cases(3 of them had endometrial hyperemia),tuberculous nodules in 2 cases,and tuberculous polyps in 8 cases.In addition,18 cases had different degrees of intrauterine adhesions(IUA),including 1 case of mild IUA,11 cases of moderate IUA and 6 cases of severe IUA,among which 3 cases were complicated with caseous necrosis.All patients received standardized anti-tuberculosis therapy.Among the 18 patients with IUA,all achieved successful pregnancy after hysteroscopic adhesiolysis.Conclusions:The hysteroscopic findings in ETB patients with successful pregnancy are diverse,including endometrial hyperemia,tuberculous nodules,tuberculous polyps,caseous necrosis and different degrees of IUA,and multiple lesions coexist in some cases.These manifestations constitute the hysteroscopic imaging of ETB in the context of pregnancy,which can provided references for preoperative assessment of fertility and individualized management.

Abstract:Cell apoptosis exists in the whole life of multicellular organisms ,which is capable to maintain homeostasis of tissues and organs through removing unwanted or damaged cells. Eukaryotic cells mediate apoptosis through four main pathways:the death receptor-mediated extrinsic pathway,the intrinsic mitochondrial pathway,granzyme B-mediated pathway and endoplasmic reticulum stress-mediated pathway. There are four important protein molecules involved in apoptotic pathways:caspases (the proteases which execute cell death),adapter proteins (caspase activators),Bcl-2 family proteins and Inhibitor of apoptosis proteins (IAPs). Cell apoptosis plays an important role in establishment of ovarian reserve and abnormal apoptosis inducing some diseases,such as endometriosis,ovarian cancer,et al. In this review we will discuss the apoptotic pathways and their mechanisms mentioned above.

Abstract:Cervical incompetence (cervical insufficiency, incompetent cervix) is a clinical diagnosis disease. However, the diagnosis is very fuzzy, lack of objective gold standard. In the medical literature on cervical incompetence its pathological physiology, screening method, diagnosis and treatment is controversial. The United States in February 2014, The American College of Obstetricians and Gynecologists (ACOG) has issued guidelines of the cervical cerclage treatment for cervical incompetence, which is much strong clinical practicability. In this paper, the literature basis and the level of evidence was shown by systematic review and summary about the definition of the cervical incompetence, etiology, diagnosis, treatment options among nonsurgical and surgical modalities, the candidates should not be considered for cervical cerclage morbidity of cervical cerclage, the role of postoperative ultrasonographic assessment for additional perioperative interventions, time of remove sewing material for transvaginal McDonald cerclage indicated in patients with no complications, the time of remove out sewing silk of women with cerclage and preterm premature rupture of membranes should be managed. Should cerclage be removed in women with preterm labor etc. Points out that at present there is no guideline for the treatment of cervical incompetence in China, in general more emphasis on bed rest and cervical cerclage operation. Compared with obstetrician and gynecologist in China , European and American doctors is more careful for cervical cerclage surgery.

Abstract:Objective:To investigate the efficacy of Bakri balloon tamponade and uterine compression suture (UCS) in treating postpartum hemorrhage for complete placenta previa during cesarean section. Methods:A retrospective study of 93 patients divided into two groups based on different hemostasis: the Bakri balloon tamponade group (n=32) and the uterine compression suture group (n=61). Treatment effects were observed. Results:The operation time for intrauterine Bakri balloon tamponade was significant shorter than the UCS group (P<0.05). Blood loss in the Bakri group was significant lower than the UCS group during the cesarean delivery (P<0.05). 2 cases in the UCS group were failed and required hysterectomy, and 1 case in the Bakri group with uterine compression suture avoided a subsequent hysterectomy. Conclusions:Bakri balloon tamponade is an effective way to control postpartum hemorrhage due to complete placenta previa during cesarean section.

Abstract:Labor pain,a complicated physiological and psychological activity during childbirth,contributes negative impact to labor,as its severe pain and long duration.This problem can be solved by several methods of labor analgesia,including pharmacological analgesia and non-pharmacological analgesia,which is going to reduce the pain during childbirth or even make it disappeared.Mostly,pharmacological analgesia is depended on using anaesthetic,analgesic and sedative,while non-pharmacological analgesia,the research hotspots of labor analgesia,relieves pains by psychological support,physical therapy and so forth.The ideal labor analgesia should effectively relieve the pains of the maternal and ensure the safety of maternal and infant.This paper summarizes the mechanism of labor pain and its impact on labor,the usual methods of labor analgesia and their features,so that we can grasp the characteristics of labor analgesia and then explore the method that not only effective but also easily accepted.