Effect of dienogest treatment on uterine fibroid volume in patients with endometriosis or adenomyosis complicated by uterine fibroids

BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.

Rapidly growing extensive polypoid endometriosis after gonadotropin-releasing hormone agonist discontinuation:A case report

BACKGROUND Polypoid endometriosis(PEM)is a rare and unique type of endometriosis.To date,no article has provided a systematic report of this disease.The current article provides a complete report on rare PEM based on ultrasound,magnetic resonance imaging,intraoperative findings and postoperative pathology data.CASE SUMMARY A 38-year-old female patient was admitted to our hospital after complaining of“vague pain in the right lower quadrant with an aggravated menstrual period for 8 mo”.The patient underwent laparoscopic exploratory surgery on January 7,2022.The postoperative pathology revealed extensive PEM.CONCLUSION PEM is a type of endometriosis that is a benign disease but has biological properties similar to malignant tumours.

Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery

Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.

Evidence-based assessment of acupuncture skills using a newly developed simulation-based test:A validation study

Objective:Acupuncture is an efficient treatment modality for many different training,but the technique can be challenging to master.Identification of the different acupuncture points can now be practiced in a standardized and patient-safe simulation-based environment.We aim to gather additional evidence regarding simulation-based training of acupuncture skills and hope that the simulation-based test developed and will be used for simulation-based mastery learning in future develop.Methods:The aim of this study was to develop a test of acupuncture skills using the TCM(Traditional Chinese Medicine) Meridians & Acupoints Anatomy Teaching Platform and gather validity evidence using Messick’s framework.Novice medical students without prior experience in acupuncture(n=43),intermediate medical students who had finished the mandatory acupuncture course(n=24),and skilled acupuncture doctors(n=17) were included in the study.One-hundred and seven acupuncture points were presented to the participants in identical randomized order and they were asked to identify each point by touching the correct anatomical location on the simulator.The simulator automatically registered the accuracy of participants’ answers.Results:The reliability of the final test(66 acupuncture points) was at a high level with a Cronbach’s alpha of 0.98 and only 16 acupuncture points were needed to ensure a reliability of 0.90.The test could discriminate significantly between all three groups and a credible pass/fail-score of 34 points was determined which resulted in eight out of 43(19%) novices passing the test and only two out of 17(12%)experienced failing the test.These consequences were statistically significant(P <0.001).Conclusion:Based on Messick’s framework we demonstrated strong validity evidence for a newly developed simulation-based test of acupuncture points localization skills.The test can be used as an aid to decide when trainees are ready to progress to more advanced training and clinical practice.Compared with the traditional point-point test,the point-point evaluation of the simulator can be more objective and reduce the effort of teachers.

Chinese Expert Consensus on Clinical Application of Female Contraceptive Methods

Unintended pregnancy is a global issue, with approximately 85,000,000 women around the world having unintended pregnancy annually. The contents of clinical application of women’s contraceptive methods are very wide, involving multiple areas. This consensus deeply discusses the specific contraceptive needs at different statuses, combined with gynecological diseases, postabortion contraception, and postpartum family planning, ensuring the correct use of contraceptive methods under the corresponding status. The top priority of the consensus is the specific contraception consensus section for women combined with gynecological diseases because medical treatment effect as well as side effects should be weighed carefully. The consensus is to make high-efficiency and individual contraceptive strategy for different groups based on multidisciplinary(gynecology, obstetrics, and family planning) and multidimensional aspects, which can provide uniform guidance for medical and health organizations under the condition as relevant global guidance or consensus is still lacking.