Abstract:Objective To investigate the risk factors for surgical site infection(SSI)during the perioperative period in patients with gynecological malignancies,providing evidence for preventing clinical infection and optimizing patient management.Methods Clinical data of 531 patients who underwent total hysterectomy with a confirmed diagnosis of gynecological malignancies at the First Affliated Hospital of Soochow University from June 1,2016 to May 31,2024 were retrospectively collected.Patients were divided into an SSI group and a non-SSI group based on infection occurrence.Variables were collected and analyzed using univariate and multivariate logistic regression analyses,including age,body mass index,ASA score,medical history,laboratory blood test results,primary diseases and surgical details.Results Among 531 patients,46 developed SSI,yielding an incidence rate of 8.66％.Univariate analysis revealed significant associations between SSI and age,history of diabetes mellitus,anemia,ASA score,surgical approach,intraoperative blood loss,and perioperative prophylactic antibiotic use(P＜0.05).Multivariate analysis further identified age≥60 years,diabetes,anemia,ASA score ≥3,open abdominal surgery,and intraoperative blood loss ≥500 mL as independent risk factors for SSI(P＜0.05).Conclusions Advanced age,diabetes,anemia,high ASA score,open abdominal surgery,and significant intraoperative bleeding are key risk factors for SSI in gynecological malignancy patients.Clinical strategies should focus on optimizing perioperative management,including glycemic control,anemia correction,optimization of the surgical approach,and hemorrhage reduction,to decrease infection risks and improve patient outcomes.

Abstract:Adenomyosis is a common gynecological disease,and the iron-deficiency anemia caused by it poses a serious threat to the health of patients.This disease mainly affects women of childbearing age between 30 and 50 years old,causing symptoms such as dysmenorrhea and menstrual disorders.Long-term abnormal uterine bleeding further triggers iron-deficiency anemia.Iron-deficiency anemia not only exacerbates the clinical symptoms of patients,but also significantly reduces patients' quality of life.In recent years,there's significant progress in the treatment of adenomyosis combined with iron-deficiency anemia.In terms of drug therapy,hemostatic drugs such as GnRH-a,LNG-IUS,and oral progesterone drugs are widely used to control symptoms,while iron supplements and the drugs that promote iron absorption have become key to correcting anemia.In terms of surgical treatment,the optimization of surgical methods such as uterine adenomyomectomy and hysterectomy provides patients with more effective treatment options.Patients with adenomyosis often require individualized comprehensive treatment,which,combined with drug therapy and surgical treatment,can control the symptoms of adenomyosis more effectively,reduce surgical complications,and improve the patient's hemoglobin level and quality of life.

Abstract:Objective Previous studies on the surgical treatment of cesarean scar pregnancy(CSP)have primarily focused on traditional dilation and curettage.In recent years,hysteroscopic resection of the scar site pregnancy lesion has gradually become an important method for CSP treatment,but it still faces the risk of retained products of conception(RPOC).This study aims to explore the risk factors associated with RPOC after hysteroscopic surgery for CSP by integrating multi-dimensional objective indicators.Methods A retrospective analysis was conducted in 1022 patients diagnosed with CSP and treated with hysteroscopic surgery at the Obstetrics and Gynecology Department of Peking University Third Hospital from January 2014 to October 2024.Patients with postoperative RPOC were included as the study group,and those without RPOC as the control group.Differences in medical history,clinical manifestations,laboratory and imaging examinations,and other aspects were compared between the two groups.Results The overall incidence of RPOC after hysteroscopic surgery for CSP was 4.0％(41/1022).Univariate analysis indicated that patient's age,uterine position,gravidity and parity,number of cesarean sections,history of CSP,history of intrauterine surgery,gestational age at this CSP diagnosis,presence of fetal heart activity,and preoperative clinical symptoms(abdominal pain/vaginal bleeding)were not directly related to postoperative RPOC(all P＞0.05).After incorporating interaction analysis,multivariate logistic regression analysis revealed that a mean gestational sac diameter≥ 15 mm and a residual myometrial thickness＜2.5 mm at the lower uterine segment scar site measured by magnetic resonance imaging(OR=4.262,95％CI 2.179-8.337,P＜0.001)were independent risk factors for RPOC.Conclusions RPOC after hysteroscopic surgery for CSP is closely related to the diameter of the gestational sac and the residual myometrial thickness at the lower uterine segment scar site.A comprehensive assessment and strict indication control should be conducted before CSP patients undergo hysteroscopic surgery.Early detection and early intervention are important ways to reduce the incidence of RPOC.

Abstract:Objective To identify the risk factors for postpartum outcomes of patients with pregnancy complicated by TOF after cesarean section.Methods A retrospective analysis was conducted on the postpartum outcomes of 42 patients with pregnancy complicated by TOF admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from May 2011 to May 2020.Logistic regression model was used to identify the risk factors for postpartum outcomes.Results No maternal death occurred;16 mothers had adverse postpartum outcomes,18(42.86％)had preoperative NYHA cardiac function classification of Ⅲ-Ⅳ,10(23.81％)had no preoperative TOF surgery,and 12(28.57％)had percutaneous SpO2＜90％upon admission.No neonatal death or neonatal asphyxia occurred.The study revealed that NYHA cardiac function classification of Ⅲ-Ⅳ(OR=9.43,95％CI 2.21-36.523,P=0.002),no TOF surgery(OR=32.14,95％CI 3.46-298.78,P=0.002),percutaneous SpO2＜90％(OR=9.10,95％CI 1.92-43.19,P=0.005),ventricular septal defect(OR=32.14,95％CI 3.46-298.74,P=0.002),cyanosis(OR=32.14,95％CI 3.46-298.78,P=0.002),and the absence of a multidisciplinary team(MDT)collaboration model(OR=7.00,95％CI 1.72-28.55,P=0.007)were risk factors for adverse postpartum outcomes of patients with pregnancy complicated by TOF.Conclusions No preoperative TOF surgery,complication with ventricular septal defect,preoperative percutaneous SpO2＜90％,and cyanosis seem to be associated with adverse postpartum outcomes.The application of the multidisciplinary diagnosis and treatment model may improve postpartum outcomes.

Abstract:Anemia frequently occurs in gynecologic malignancy patients undergoing adjuvant therapy,with iron-deficiency anemia(IDA)being the most prevalent.Anemia reduces patients' tolerance to treatment,leading to therapy delays,dose reductions,or even discontinuation.This may result in chemotherapy resistance and decreased radiotherapy sensitivity.Correcting anemia can improve prognosis,so standardized anemia management is essential.Common therapeutic approaches include iron supplementation,erythropoiesis-stimulating agents(ESAs),and blood transfusions.Among these,third-generation intravenous iron preparations have emerged as a new option in the anemia management in adjuvant therapy for patients with gynecological malignancies due to their rapid iron repletion,reduced transfusion risks,and the convenience of single-dose administration.

Abstract:Objective To establish a multimodal collaborative"one-stop"integrated healthcare and prevention system for cervical cancer in order to help accelerate the elimination of cervical cancer.Methods All clinical data from outpatients,inpatients and follow-up visits of patients,who were diagnosed with HPV infection,cervical intraepithelial neoplasia,or cervical cancer,totally 32 250 patients,were collected from the Department of Gynecology at the Second Hospital of Jilin University from June 2022 to March 2025.Utilizing Enterprise Master Patient Index(EMPI)technology,the relevant data were dynamically integrated.A structured electronic medical record system,restricted selection fields,mandatory validation,and a combined"manual+AI"follow-up mode were employed to establish an informatics-based management system for cervical cancer that covered the entire disease cycle.Results Implementation of the system significantly enhanced screening capacity for cervical cancer,with the detection rate of HSIL+increasing from 7.2％to 12.4％(P＜0.0001).Follow-up quality was improved,with 12 434 times of follow-up completed,an average return visit rate being 89.2％,and a telephone follow-up rate being 100％.The postoperative HPV positivity rate within two years of surgery increased from 27.4％to 47.1％(P＜0.0001).The preoperative staging rate was improved from 83.8％to 92.3％(P＜0.0001),reflecting better compliance with standardized clinical pathways.Furthermore,an AI-assisted colposcopic diagnosis model and a two-stage cervical disease risk prediction model were successfully developed(HPV infection prediction AUC=0.9266;HSIL risk prediction AUC=0.8429).Conclusion The establishment and application of the multimodal collaborative"one-stop"integrated healthcare and prevention system for cervical cancer have realized closed-loop management of the clinical pathway,facilitating clinical and scientific research innovation and promoting the provincial-level prevention and treatment collaboration,which provides a new replicable paradigm for regional prevention and treatment of cervical cancer.

Abstract:Objective To investigate the efficacy of intravascular smooth muscle stimulation combined with traditional electrical stimulation in the treatment of postpartum myofascial pelvic pain syndrome(MPPS).Methods A total of 120 postpartum MPPS patients admitted to the Pelvic Floor and Urological Rehabilitation Center of Dalian Women and Children's Medical Center(Group)from June 2023 to December 2024 were randomly divided into a lifestyle guidance group,a traditional electrical stimulation group,and a combined electrical stimulation group,with 40 patients in each group.The visual analog scale score for pelvic floor myofascial tenderness,pain-related clinical symptoms,pelvic floor muscle strength,pelvic floor electrophysiological parameters and overall effective rate were compared before and after treatment.Results There were no significant differences in the VAS scores for pelvic floor myofascial tenderness,pain-related clinical symptoms,pelvic floor muscle strength or pelvic floor electrophysiological parameters among the three groups before treatment(P＞0.05).After treatment,the aforementioned indicators improved in all groups,with more significant improvements in the combined group(P＜0.05).The overall effective rate in the combined electrical stimulation group was higher than that in the traditional electrical stimulation group and the lifestyle guidance group,with a statistically significant difference(P＜0.05).Only a few patients experienced adverse reactions such as mild soreness or dizziness,which were relieved after adjusting the current intensity,and no serious adverse events occurred.Conclusions The combination of intravascular smooth muscle stimulation(CMLV)with traditional electrical stimulation is effective,safe and reliable in the treatment of postpartum MPPS,which can significantly reduce pelvic floor muscle pain,improve pain-related clinical symptoms,decrease pelvic floor muscle fatigue,enhance pelvic floor muscle strength and voluntary contraction ability,and improve pelvic-abdominal coordination.It is worthy of clinical promotion and application.

Abstract:Objective To investigate the expression and significance of histone methyltransferase SMYD3 in endometrial carcinoma.Methods Totally 85 patients with endometrial cancer who underwent surgical treatment at The Tenth Affiliated Hospital,Southern Medical University from January 2014 to December 2020 were selected.The expression of SMYD3 in endometrial carcinoma tissue,atypical endometrial hyperplasia tissue,and normal endometrium tissue was assessed by immunohistochemical staining.The correlation between SMYD3 expression and clinicopathological characteristics and prognosis of patients was analyzed.Results The positive rate of SMYD3 expression in the endometrial carcinoma tissue was 83.53％,which was higher than that in atypical endometrial hyperplasia tissue(43.33％)and normal endometrium tissue(26.67％),and the difference was statistically significant(P＜0.05).The expression level of SMYD3 was associated with FIGO stage,lymphovascular space involvement,and lymph node metastasis in patients with endometrial carcinoma(P＜0.05).The patients with higher SMYD3 expression had shorter overall survival time than those with lower SMYD3 expression(P＜0.05).Conclusion The expression of SMYD3 is high in endometrial carcinoma,which is closely correlated with tumour progression and poor prognosis,suggesting that it can be used as a potential prognostic indicator and therapeutic target.

Abstract:The incidence of anemia during the perioperative period in gynecology is high,with iron-deficiency anemia being the most common type.Anemia is an important factor affecting postoperative recovery and prognosis of patients,especially in terms of surgical risks and postoperative complications.As one of the main methods in correcting anemia,the rational application and selection of iron agents are particularly important.This article reviews the epidemiological characteristics of anemia during the perioperative period in gynecology and the clinical application effects of different types of iron agents,providing a reference for clinical practice.

Abstract:Abnormal Uterine Bleeding(AUB)is the leading cause of anemia in women of reproductive age.Perioperative anemia associated with AUB significantly increases surgical risks and adversely affects patient outcomes.Therefore,a systematic perioperative blood management protocol is crucial.This includes:Preoperatively,make clear the etiology based on the FIGO PALM-COEIN classification system and assess the severity and type of anemia through laboratory investigations(routine blood test,iron metabolism,etc.);for acute AUB,rapid stabilization of vital signs,correction of coagulopathy,and iron replenishment(or transfusion if indicated)are priorities;for chronic AUB,scheduling elective surgery along with vigorous anemia correction is necessary(oral iron is suitable for 4-8 weeks before operation,while intravenous iron,particularly third-generation agents like ferric derisomaltose,offers faster efficacy and better tolerance.Intraoperatively,minimally invasive techniques should be prioritized along with meticulous haemostasis,continuous blood loss monitoring,and blood conservation strategies(e.g.cell salvage),and allogeneic transfusion should be reserved for cases meeting strict criteria.Postoperatively,close monitoring,preventing bleeding and continued anemia correction are essential.Long-term management aims to prevent recurrence,focusing on controlling bleeding through surgery or medical therapies[e.g.Levonorgestrel-Releasing Intrauterine System(LNG-IUS),hormonal treatments]tailored to the underlying causes.This is combined with a full course of iron therapy to replenish stores,nutritional intervention,lifestyle modifications,regular follow-up monitoring,and patient education.A multidisciplinary approach is employed when necessary to achieve effective menstrual control,prevent anemia recurrence,and ultimately improve patient prognosis and quality of life.

Abstract:Objective To investigate the distribution of human papilloma virus(HPV)genotypes and analyze the impact of HPV infection on vaginal vault epithelial cell lesions.Methods A total of 191 patients with positive HPV genotyping results from exfoliated vaginal stump cells after hysterectomy at Yancheng Maternal and Child Health Care Hospital Affiliated to Yangzhou University(January 2021-December 2024)were retrospectively analyzed.The HPV genotype distribution and its correlation with vaginal cell lesions were statistically analyzed.Results Twenty-three HPV subtypes were detected in the 191 patients.The top six high-risk HPV genotypes were 52,16,58,31,51,and 18 subtypes.Single-type,dual-type,and multiple-type infections accounted for 102(53.40％),54(28.27％),and 26(13.61％)cases,respectively,with one patient infected by six subtypes.Colposcopy results revealed that there was no intraepithelial lesion or malignancy(NILM)in 73 cases(38.22％),while there was vaginal intraepithelial neoplasia(VaIN)grade Ⅰ in 95 cases(49.74％),grade Ⅱ n 20(10.47％),and grade Ⅲ in 3(1.57％).The number of HPV subtypes showed no statistically significant correlation with hysterectomy indications or vaginal vault epithelial pathology degree.However,HPV 16 infection in vaginal stump was significantly associated with the degree of vaginal vault epithelial pathology.Conclusions The genotypes of HPV infection in vaginal stump are distributed differently in different regions.It is recommended that women in Yancheng area should give priority to HPV 9 vaccine,and HPV-infected patients should be properly treated,especially HPV 16-positive patients,who should receive timely TCT and colposcopy in a standardized manner for early diagnosis and treatment of VaIN.

Abstract:Anemia during pregnancy and the postpartum period is a global public health issue,significantly associated with adverse obstetric outcomes,and iron deficiency(ID)is its primary cause.Currently,novel high-dose intravenous iron formulations,which allow single-dose infusion of ≥1000 mg within 15-30 minutes,have been approved for clinical use in China.However,obstetricians and gynecologists lack sufficient understanding of their efficacy and safety in pregnant and postpartum women.This article discusses the application of high-dose intravenous iron in pregnant and postpartum women.

Abstract:The rapid and successive formation of arterial and venous thromboses across multiple organ systems with-in a short period is commonly referred to as a"thrombotic storm",and catastrophic antiphospholipid syndrome(CAPS)is a rare but highly lethal subtype of this throm-boinflammatory disease.Despite its low incidence,CAPS progresses rapidly,has a high mortality rate,and is often misdiagnosed or diagnosed too late.In pregnant patients,especially,it poses a severe threat to both maternal and fe-tal health.Timely identification and prompt and active treat-ment have become important clinical issues in improving outcomes.This article focuses on the early recognition and therapeutic strategies for CAPS.

Abstract:Evans Syndrome(ES)is a rare autoimmune dis-ease characterized by the presence of at least two types of autoimmune cytopenia(AIC).The etiology of ES is complex and diverse and secondary ES is relatively common.Its oc-currence and development are related to primary diseases such as lymphoproliferative disorders,infections,and auto-immune diseases,and the fatality rate is relatively high.When ES is combined with pregnancy,the incidence of perinatal complications is high,which may lead to serious maternal-fetal complications.This article elaborates and summarizes the relevant researches on Evans syndrome at home and abroad,aiming to explore the etiology of Evans syndrome and its impact on pregnancy,provide certain the-oretical support for the clinical diagnosis and treatment of ES combined with pregnancy,and improve the maternal and infant outcomes.

Abstract:Thrombotic microangiopathy(TMA)during preg-nancy comprises a group of life-threatening disorders af-fecting both mothers and infants,characterized by complex pathogenesis,diverse clinical manifestations,and signifi-cant therapeutic challenges.Plasma exchange and hemodi-alysis are two important blood purification techniques that play a vital role in the management of pregnancy-associat-ed TMA.This article,based on the latest domestic and in-ternational research advancements and clinical experi-ence,provides an in-depth exploration of the application of plasma exchange and hemodialysis in pregnancy-associ-ated TMA.It analyzes therapeutic mechanisms,operational key points,efficacy evaluation,and complication manage-ment for different TMA subtypes,aiming to provide clinical physicians with references,optimize treatment strategies and improve maternal and fetal outcomes.

Abstract:Postpartum hemolytic uremic syndrome refers to a serious life-threatening syndrome characterized by acute microvascular hemolytic anemia,thrombocytopenia,and acute renal failure that occurs after childbirth.If not treat-ed,it will lead to a mortalityrate of up to 90％.The etiology is still unknown.Current research suggests that endothelial dysfunction,coagulation fibrinolysis imbalance,and abnor-mal activation of the complement system are the main pathogenesis of this syndrome.Although the incidence is ex-tremely low,the mortality rate is high and the treatment op-tions are limited.In recent years,with the deepening of re-search on the complement system,new treatment methods such as complement inhibitors have brought new hope to PHUS patients.This article elaborates and discusses its pathogenesis,diagnosis and treatment.

Abstract:Pregnancy-associated thrombotic thrombocyto-penic purpura(TTP)is a rare obstetric complication charac-terized by thrombocytopenia,microangiopathic hemolytic anemia,and multi-organ dysfunction.The hypercoagulable state of pregnancy,combined with deficient or inhibited ADAMTS13 enzyme activity,significantly exacerbates dis-ease risk,resulting in high mortality if untreated.This arti-cle systematically reviews the pathological mechanisms,early diagnostic biomarkers,and intervention strategies for gestational TTP.A multidisciplinary clinical management pathway is proposed and the future research directions based on the latest scientific advances are discussed.

Abstract:Objective To explore the association between various meteorological factors and the risk of lactational mastitis in Nanjing.Methods The patients with lactational mastitis admitted to the First Affiliated Hospital of Nanjing Medical University between January 1,2023 and December 31,2023 were enrolled as study subjects.Epidemiological methods were used to describe the epidemic characteristics of lactational mastitis.The daily data of meteorological factors during the study period were obtained from Nanjing Meteorological Observation Center.Then a time series database was established,and Spearman rank correlation analysis was used to analyze the correlation between daily number of cases of lactational mastitis and meteorological factors.Distributed lag nonlinear model(DLNM)was built to quantitatively analyze and evaluate the exposure-lag effects of various meteorological factors on the incidence of lactational mastitis as well as the incidence risk of lactational mastitis under extreme meteorological conditions.Results(1)A total of 282 lactational mastitis patients were included in the study.The incidence of lactational mastitis showed an overall trend of first increasing and then decreasing in 2023,showing a periodical bimodal structure and a significant seasonal effect,with minor peaks in May and December.(2)The risk of lactational mastitis decreased as air pressure increased.When exposed to low pressure,the relative risk of lactational mastitis peaked on the 9th lag day(RR 1.14,95％CI 1.01-1.28).When exposed to high pressure,the relative risk of lactational mastitis continued to increase within the 14 lag days.(3)The risk of lactational mastitis increased as temperature rose.When exposed to low temperature,the relative risk of lactational mastitis gradually increased during the lag period of 0～14 days.However,when exposed to high temperature,the relative risk of lactational mastitis peaked on the 8th day(RR 1.07,95％CI 0.99-1.16).Conclusions Daily mean pressure and highest daily temperature have a non-linear relationship with the incidence of lactational mastitis in Nanjing,and there is a significant lag effect.Exposure to low pressure and high temperature significantly increases the incidence risk of lactational mastitis.

Abstract:The accurate diagnosis and prompt management of pregnancy-associated complications are crucial for safe-guarding the well-being of both mothers and infants.This is particularly true for diseases presenting with similar clini-cal manifestations yet having markedly distinct treatment strategies.The HELLP syndrome(characterized by hemoly-sis,elevated liver enzymes,and thrombocytopenia)and postpartum hemolytic uremic syndrome(PHUS),as typical examples of pregnancy-related thrombotic microangiopathy(TMA),share comparable clinical features but possess fun-damental pathological disparities.Both diseases have an in-sidious onset and progress rapidly,and misdiagnosis or de-layed diagnosis is not uncommon,which significantly com-promises patient prognosis.Thus,the accurate discrimina-tion between the HELLP syndrome and PHUS is pivotal for enhancing diagnostic and therapeutic efficacy and reducing maternal mortality.This article comprehensively analyzes the similarities and differences in the pathogenesis,clini-cal characteristics,and laboratory findings of the two con-ditions.It proposes a differential diagnosis approach based on multidisciplinary cooperation and underlines the signifi-cance of early recognition in improving prognosis.By re-viewing the latest domestic and international guidelines and clinical practices,key differential diagnostic points are summarized,aiming to offer a reference for clinical de-cision-making.

Abstract:Thrombocytopenia is a common hematologic complication during pregnancy,and immune thrombocyto-penia and thrombotic microangiopathy(TMA)are rare but important etiologies,requiring precise differentiation due to their distinct pathological mechanisms,treatment strate-gies,and maternal-fetal risks.Immune thrombocytopenia refers to thrombocytopenia mediated by abnormal immune activation.The diagnosis of primary immune thrombocyto-penia(ITP)should exclude secondary ITP due to other causes(such as autoimmune diseases,infections,drugs,tumors,etc.),and the treatment for ITP primarily involves glucocorticoids and intravenous immunoglobulin.TMA is a group of heterogeneous diseases with the core pathological features of microvascular thrombosis,presenting with mi-croangiopathic hemolysis,thrombocytopenia,and multi-or-gan dysfunction,which requires specific interventions based on different disease types,such as pregnancy termi-nation,plasma exchange,or complement inhibitors.This ar-ticle systematically outlines the key points for differential diagnosis of ITP and TMA based on clinical features,labo-ratory tests and molecular markers,emphasizing the criti-cal importance of initiating targeted therapy promptly in im-proving maternal-fetal prognosis.