Laparoscopic management of perivascular a retroperitoneal perivascular ectopic pregnancy

Retroperitoneal ectopic_pregnancy(REP)is one of the most special species of abdominal pregnancy.Due to possible invasion of retroperitoneal macrovascular,inconspicuous clinical manifestation and difficulty of diagnosis from imaging,the diagnosis and treatment of REP are easy to be delayed.REP represents a great challenge to surgeons due to the rarity and varying clinical presentations,from asymptomatic patients to patients with unstable haemodynamics,in cases of advanced ruptured ectopic gestation presenting with life-threatening retroperitoneal haemorrhage.Therefore,although REP accounts for only 1%of ectopic pregnancy.

Comprehensive overview of genotype distribution and prevalence of human papillomavirus in cervical lesions

Acrosscervical squamousandgl and ular lesions,a spectrum of human papillomavirus(HPV)genotypes has been identified.This review aims to provide a comprehensive summary detailing the distribution and profile of HPV genotypes detected in cervical lesions,leveraging insights from histological and cytological findings.High-risk HPV(HR-HPV)genotypes exhibit varying degrees of oncogenic potential,with HPV16 and HPV18 identified as the most prevalent and oncogenic types.Thedistribution of HR-HPVgenotypes varies among different degrees of the cervical lesions and varies between squamous andglandular neoplasia.HPV16 is predominantly associated with severe lesions(precancers and carcinomas),while HPV18 demonstrates a significantly higher prevalence in endocervical as compared with squamous neoplasia.The distribution of HR-HPV in severe squamous lesions is complex,involving many HR-HPV genotypes in addition to HPV16,while the distribution of HR-HPV genotypes in endocervical glandular lesions is mainly limited in HPV18 and HPV16.Large datasets from China have identified the three mostcommon HR-HPVgenotypes in this population as stratified by diagnostic category:HPV52,HPV16,HPV58 in histologically negative cases and cervical intraepithelial neoplasia 1(CIN1);HPV16,HPV52,HPV58 in CIN2/3;HPV16,HPV58,HPV52 or HPV18 in squamous cell carcinoma(SCC);HPV16,HPV18 and HPV52 in endocervical adenocarcinoma in situ(AIS),invasiveadenocarcinoma,as well asmixedsquamous and glandular lesions.HPV33 is the fourth most common HPVtype in CIN2/3and SCC,whileHPV45occursmore commonly in AIS and adenocarcinoma,compared with squamous lesions.The prevalence and distribution of multiple HR-HPV coinfections vary across different cervical diseases.The clinical significance and pathogenesis of these multiple HR-HPV infections remain uncertain,although recent two large studies demonstrate that multiple HR-HPV infections are not associated with cumulatively higher risk of high-grade cervical squamous lesiondevelopment,suggestingcompetitiveand/or cooperative interactions among HPVgenotypes.Extensive HPV genotyping aids in risk assessment and optimising clinical approaches for women with mild abnormalities in Pap cytology.Women with atypical squamous cells of undetermined significance(ASC-US)and low-grade squamous intraepithelial lesion(LSIL)Pap test results and with the infection of some HR-HPV genotypes carry a very low risk of high-grade cervical lesions.HPV genotyping can allow for risk stratification and triage optimisation for these HR-HPV-positive women.Women with atypical glandular cell(AGC)Pap test results showed a specific HPV genotyping pattern and extended HPV genotyping may be helpful for the clinical management of AGCs.Continual advancements in clinical guidelines integrating extended genotyping would increase diagnostic accuracy and refine strategies in clinical management.

Chinese expert consensus on diagnosis and treatment of anal intraepithelial neoplasia

Anal high-grade squamous intraepithelial lesion(HSIL)refers to the precancerous lesions of anal squamous cell carcinoma(ASCC).Anal cancer is often asymptomatic in its early stage.

Advancements in research on transcutaneous electrical acupoint stimulation for alleviating pelvic pain in women

Background Pelvicpain isacommon complaint of discomfort in women,with an increasing incidence and seriously affecting patients'quality of life.Its etiology involves multiple systems and disciplines,and therefore treatment modalities are diverse.Transcutaneous electrical acupoint stimulation(TEAS)therapy is a classic analgesic means,and electrical stimulation of local acupoints can achieveobviousanalgesiceffects.Thisreviewaims to discuss the application of TEAS for the treatment of various types of pelvic pain,the selection of optimal parameters and the renewal of equipment.Method Result TEAS fortreatmentof pelvic pain in women has been reported mainly for endometriosis,pelvic inflammatory disease(PID),intrauterine adhesion(IUA),pelvic stasis syndrome,interstitial cystitis,primary dysmenorrhoea and other diseases.And for parameter selection,the most used of frequency is dilatational wave,the most used stimulation intensity is 10-20 mA,and the acupoint selection should be based on the specific conditions of thepatient.Conclusions The analgesic mechanism of TEAS has not been fully elucidated,but the efficacy of the treatment is remarkable and thereare no significant adverse effects.The selection of the parameters for TEAS and the combinationof acupoints fordifferent pains are stillthe maindirections offutureresearch.

Cytokine landscapes of pregnancy:mapping gestational immune phases

Background Synchronised physiological adaptations occur during pregnancy to achieve systemic,immune and neuroendocrine equilibrium in the mother's body,allowing semiallogenic fetal growth.Main text Depending on the cytokine profile alterations occurring through pregnancy,the latter can be divided into three distinct phases.In the first immunological phase of pregnancy,proinflammatory cytokines promote inflammatory reactions needed for implantation.In the second phase,a possible change from proinflammatory to anti-inflammatory cytokines creates a symbiosis between maternal and fetal components,ensuring fetal development.In the third phase,inflammatory and cytolytic cytokines operate again to reinforce an inflammatory environment for parturition.The article offers a detailed account of immune adaptations during pregnancy and highlights the distinctive cytokine profiles that mark each phase.Conclusion By providing a simplified depiction of pregnancy phases based on cytokine profiles,the article aims to inspire more research in reproductive immunology and improve the management of pregnancy-related inflammation and infection.

Rationality of the FIGO2023 staging for early-stage endometrial cancer,compared with the FIGO2009 staging

Objective The International Federation of Gynecology and Obstetrics(FIGO)released a new stagingfor endometrial cancer(EC),which revised the FIG02009 staging to include histopathological andmolecular features.The purpose of this study was to validate the prognostic accuracy of the new staging and discuss its clinical applicability.Methods In this single-centre retrospective study,540 patients with primary surgically treated early-stage EC were enrolled and staged according to FIG02009/2023.Kaplan-Meier survival analysis was used to compare for prognostic differentiation.Cox regression was used to identify potential prognostic indicators.Results A total of 81 patients underwent staging shifts,allstage elevation.The prognosis difference between new stages I and Il was more significant.The new staging was more predictive of death postoperatively.Lesion maximum diameter(LMD)was one of the independent risk factors associated with prognosis.Taking LMD=5.70 cm as the cut-off value could further differentiate patients with divergent prognoseswithin FIG02023stage IIC.Conclusion FIG02023 stagingdemonstrated greater prognostic accuracy.In addition,LMD may be another critical factor affecting prognosis.

The role of oestrogen and oestrogencalcium axis in endometrial carcinoma

Unopposed oestrogen is recognised as an inducer of endometrial cancer.Over the past 50 years,the effects of oestrogen on the endometrium and endometrial cancer have been a hot topic in the field of gynaecological oncology.In recent years,a series of studies by our team revealed that the non-genomic transcriptional effects of oestrogen can influence the progression of endometrial carcinoma by regulating calcium ions,suggesting that inhibiting calcium ion channelproteins could serve as an adjuvant therapy for endometrial cancer.In this review,we retrospectively summarise the sources of oestrogen in vivo,the effects of oestrogens on the uterus and endometrium,oestrogen signalling and the clinical application of oestrogen-related compounds,emphasising the significant role of oestrogen-calcium axis inhibition in adjuvant therapy for endometrial cancer.

Embarking on a brand new journey with Gynecology and Obstetrics Clinical Medicine

The year 2024 is a milestone for Gynecology and Obstetrics Clinical Medicine(GOCM)as the journal has decided to transition and collaborate with BMJ Publishing Group.For GOCM,this signifies a newjourney,while we continue to be driven by the commitment to deliver evidence-based,reliable and robust research findings to readers.

Current state and influencing factors of social alienation in patients with stress urinary incontinence

Objective To understand the current level of social alienation among patients with stress urinary incontinence(Sul)andanalyse the influencing factors to provide a foundation for better clinical support for patients'reintegration into society.Methods We conductedacomprehensive surveyand analysis involving 230 patients with SUl using a general information questionnaire,a general sense of alienation scaleandasocial impactscale.Results The general sense of alienation scale score of patientswith SUlwas25.43±13.994,whilethe social impact score was 39.25±12.167.Multiple linear regression analysis revealed that marital status,primary caregiver,presence of concurrent illnesses and severity of urinary incontinence were the key influencing factors contributing to SUl-related social alienation(p<0.05).Conclusion Patients who suffered from SUl experienced a moderate level of social alienation.Tailored interventions are recommended,especiallyfor individuals who are divorced,rely on friends or relatives as primary caregivers,have concurrentillnesses or experience severe Sul,to enhance their social integration.

Externallyvalidated nomogramfor predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction(FGR)

Objective This studyaimed at developing an available predictive model of singleton pregnancies with fetal growth restriction(FGR)for accurate and individualised prognosis assessment.Methods The prediction nomogram was developed by using multivariable Cox regression with data for 301 singleton FGR pregnancies at Peking University People's Hospital.External validation was performed in 321eligible singleton FGR pregnancies at the Affiliated Hospital of Qingdao University.Results Absent umbilical arterial flow,fetal anomaly,history of abnormal pregnancy,non-cephalic presentation and historyof caesarean sectionwere independent prognostic factors foradverse perinatal outcomes in singleton FGR pregnancies in the training set.In the training cohort of the internal validation set,the nomogram estimated pregnancy prognosis of FGR singleton pregnancies based on these five variables,with a concordance index(C-index)of 0.859(95%Cl:0.81 to 0.90)for predicting termination of pregnancy(TOP),which included intrauterine fetal death and therapeutic lethal induction,with a C-index of 0.92(95%Cl:0.86 to 0.98)for predicting stillbirth,and a C-index of 0.87(95%Cl:0.83 to 0.92)for predicting therapeutic lethal induction with indications.Encouragingly,consistent results wereobserved in the external validation set,witha C-index of 0.776(95%Cl:0.71 to 0.84)for predicting TOP,which included intrauterine fetal death and therapeutic lethal induction,with a C-index of 0.773(95%Cl:0.70 to 0.84)for predicting stillbirth,and a C-index of 0.776(95%Cl:0.70 to 0.85)for predicting therapeutic lethal induction with indications.Furthermore,the calibrations of the nomograms predicting the 28th and 34th TOPfreegestation week strongly corresponded to theactual survivaloutcome.Conclusion This prediction model may help clinicians indecision-making for singleton pregnancies with FGR,especially for patients with a single abnormal umbilical arterial flow orfetal anomaly,without induced labour indications for these abnormalities.

Clinical significance of extended high-risk human papillomavirus genotyping and viral load in cervical cancer and precancerous lesions

Persistent infections with specific high-risk human papillomavirus(HR-HPV)strains are the leading cause of cervical cancer and precancerous lesions.HPV-16 and HPV-18 are associated with more than 70%of cervical cancer.However,with recent widespread vaccination efforts against cervical cancer,the infection rates of HPV-16 and HPV-18 have decreased across all age groups,while the infection rates of other HR-HPV strains have increased.The non-16/18 HR-HPV strains play an important role in cervical lesions.These strains can be identified with extended genotyping,and the 2019 American Society for Colposcopy and Cervical Pathology(ASCCP)guidelines recommended an HPV-based testing to assess the risk of cervical disease in patients.We reviewed and analyzed the clinical benefits of applying extended HR-HPV genotyping,which was published by the International Agency for Research on Cancer(HPV-16,18,31,33,35,39,45,51,52,56,58,59,66,and 68),to cervical cancer screening.This review concluded that cervical cancer screening needs to include extended HR-HPV genotyping.The examination of extended HR-HPV genotyping in cervical intraepithelial lesions and cervical cancers can help guide clinical practices.

Deep vein thrombosis in early pregnancy:A retrospective study

Objective:To investigate the clinical characteristics,management,and prognosis of deep vein thrombosis(DVT)during early pregnancy.Methods:We conducted a retrospective study among women with DVT during their first trimester of pregnancy who were admitted to the obstetrics department of Peking University People's Hospital between March 2008 and May 2021.We analyzed clinical data of eight patients,including their general condition,obstetric characteristics,diagnosis,treatment,and gestational outcomes.Results:Risk factors for DVT in the first trimester included personal history of DVT,thrombophilia and immune diseases,and DVT was more likely to affect the left leg.The main manifestation of DVT was pain or swelling of the affected limbs.D-dimer levels after anticoagulant treatment showed a downward trend compared with those before treatment(P=0.09),while D-dimer levels increased significantly after delivery compared with those before delivery(P=0.03).All the patients started on low-molecular-weight heparin(LMWH)therapy after a diagnosis of DVT.Temporary inferior vena cava(IVC)filters were implanted in 3 patients with mixed thrombosis before delivery,but were removed after the operation.Except for 1 case with thrombophilia who refused treatment,others underwent anticoagulation therapy from 6 weeks to 1 year postpartum.Seven patients achieved a successful delivery with live births.Conclusion:During early pregnancy,DVT was more common in women with maternal risk factors.More cases of venous thromboembolism(VTE)were observed in the left leg.For women with a high risk of DVT,medical intervention,early identification,accurate diagnosis and precise treatment during early pregnancy should be promoted.

Characteristics of molecular classification in 52 endometrial cancer and atypical hyperplasia patients receiving fertility-sparing treatment

Objective To investigate the molecular classification of endometrial cancer(EC)and atypical endometrial hyperplasia(AEH)patients treated with fertility-sparing treatment(FST),and its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 52​EC and AEH patients who received FST and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2022,were retrospectively collected.We analyzed the relationship between molecular classification and clinicopathological factors and treatment outcomes.Results(1)Of the 52 patients,including 46​EC and 6 AEH patients,42(80.8%)achieved complete remission(CR)after FST,with a median time to achieve CR of 9 months.Ten cases(23.8%)had recurrence.(2)Patients were distributed into 4 molecular subgroups as 39 cases(75%)of copy number low(CNL),7 cases(13.5%)of microsatellite instability-high(MSI-H),4 cases(7.7%)of POLE mutations(POLEmut),and 2 cases(3.8%)of copy number high(CNH).Patients with MSI-H subgroup had more family history of tumor(6/7),more with loss of expression of mismatch repair(MMR)protein(7/7),and higher expression level of Ki-67(3/3).(3)Patients with MSI-H subgroup had the lowest CR rate at 6 months(0/7,P​=​0.014),and survival analysis showed that such patients were less likely to achieve CR than those with CNL(P​=​0.022).For CNL patients,median 6-month CR rate was 40.6%.In addition,CR was obtained in 3(3/4)POLEmut patients and 2(2/2)CNH patients,respectively.Conclusions Molecular classification relates with the treatment response in patients with EC and AEH receiving FST.Patients with MSI-H subgroup have poor treatment efficacy,and patients with CNL need to be further divided to predict treatment benefit.There are also a few successful cases in POLEmut and CNH subtgroups,which needs further research.

Integrative medicine for pelvic floor disorders:A conceptual framework

1.Introduction Pelvic floor disorders encompass a wide range of dysfunctions,including issues of urination,defecation,pelvic organ prolapse,pain,and sexual health.These disorders are highly prevalent,with approximately one-quarter of adult women in the United States reporting the experience of at least one of these conditions.1 The co-occurring symptoms,arising from shared pathogenesis,have a significant impact on the patient's physical and emotional well-being,as well as impose economic burdens on both the individual and the healthcare system.Traditional single-specialty practices have proven insufficient to meet the diverse needs of patients.

The clinical significance of human papillomavirus and p16^(INK4a)in vulvar tumors

Vulvar cancer is the fourth most common gynecological malignancy,with a global incidence of an estimated 45,240 new cases and 17,427 deaths in 2022.1 The 5-year survival rate for vulvar cancer is about 70%based on data from the SEER database.2 More than 90%of vulvar cancer was vulvar squamous cell carcinoma(SCC),which included keratinizing,non-keratinizing,basaloid,warty,and verrucous carcinoma.

Advances in ablative treatment for human papillomavirus related cervical pre-cancer lesions

HPV infection is the primary cause of cervical intraepithelial neoplasia(CIN),with persistent high-risk HPV infection being the leading factor in the development of cervical cancer.In addition to the application of large loop excision of the transformation zone(LLETZ)for the treatment of cervical pre-cancerous lesions,various ablative techniques,including thermal ablation,cryotherapy,carbon dioxide(CO_(2))laser therapy,and focused ultrasound therapy also play significant roles in the management of cervical intraepithelial neoplasia.This review presents a comprehensive overview of the pathophysiology of cervical HPV infection and discusses the ablative methods commonly used in clinical practice,along with their indication and contradiction,especially in women with high-grade squamous intraepithelial lesions.The aim is to identify safe and effective treatment strategies for treating cervical intraepithelial neoplasia,thereby avoiding under-or over-treatment,which may reduce the incidenceandprogr ssion of cervical cancer through timely diagnosis and treatment.

Guidelines for cervical cancer screening in China

In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies,a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening.The guideline recommends high-risk human papillomavirus(hr-HPV)testing as the preferred method for primary screening,which should have been approved by authoritative institutions and clinically validated for primary screening.In areas without access to HPV testing,cytology can be used as an alternative.However,it is recommended to replace cytology with HPV-based screening as conditions permit.Cotesting(HPV testing in combination with cytology)is recommended for areas with sufficient medical resources,opportunistic screening populations,and partial special populations.The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years,or cytology alone every three years.Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening.Corresponding screening programs are proposed for different special populations.The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.

Molecular typing guiding treatment and prognosis of endometrial cancer

Genetic abnormalities,such as PTEN,PIK3CA,CTNNB1,ARID1A,and ERBB2,which frequently occur in endometrial cancer(EC),are potential therapeutic targets.In 2013,integrated genomic analysis conducted by The Cancer Genome Atlas identified four molecular subtypes,including POLE ultra-mutated,microsatellite instability hypermutated,copy-number low,and copy-number high,which strongly correlate with prognosis.Surrogate markers-based molecular classification methods have been developed to make these molecular classifications accessible and affordable,achieving classification into POLEmut,mismatch repair deficient(MMRd),p53abn,and no specific molecular profile(NSMP)with normal p53 expression.Although POLEmut EC has aggressive pathologic features,there are few cases of advanced and/or recurrence.Therefore,the possibility of de-escalating adjuvant therapy can be considered.Additionally,immune checkpoint inhibitors(ICI)may be a candidate for treating advanced and recurrent POLEmut EC because of their high immunogenicity.MMRd EC shows an intermediate prognosis between those of POLEmut and p53abn EC.MMRd EC is generally characterized by high immunogenicity similar to POLEmut EC,suggesting that ICI can also be a potential therapeutic agent.Among the four molecular subtypes,p53abn EC has the worst prognosis.However,some p53abn tumors have the molecular hallmark of homologous recombination deficiency and could be treated with poly(ADP-ribose)polymerase inhibitors.In addition,some p53abn tumors overexpress the human epidermal growth factor receptor 2,which can also be a potential therapeutic target.NSMP EC are a heterogeneous population because they lack characteristic molecular biological features.Approximately half of the NSMP EC show high expression of estrogen receptor/progesterone receptor,suggesting the possibility of hormonal therapy.In addition,the PI3K/AKT/mTOR pathway frequently altered in EC may be a therapeutic target.This review summarizes the molecular biological characteristics and potential therapeutic agents in molecularly featured EC.Several clinical trials are in progress to stratify EC into molecular classifications and demonstrate the efficacy and safety of molecularly matched treatment and management strategies.

A simplified method for evaluating the anatomical axis of the upper two-thirds of the vagina on MRI:A hospital-based cross-sectional study

Backgrounds:Pelvic organ prolapse commonly affects the upper two-thirds of the vagina.However,evaluating this region in its normal position presents challenges.This study aimed to assess the anatomical axis of this vaginal segment using pelvic magnetic resonance imaging measurements.Methods:A retrospective study of 614 hospitalized women from two hospitals,who were rigorously screened to exclude those with Pelvic Organ Prolapse or known anatomical variations(median age:43 years,range:17-76 years).Two reference lines were used:the pubococcygeal line(PCL)and a line from the inferior pubic symphysis to the third sacral vertebra(PS3L).Distances between the distal,middle,and apical points of the upper vagina and the reference lines,as well as the angles between the upper vagina and the reference lines,were measured.Comparisons were made among different age groups.Results:The median distances from the distal,middle,and apical vaginal points to the PCL were 0.4 cm(interquartile range[IQR]:0.0-0.7 cm),2.1 cm(IQR:1.7-2.5 cm)and 3.1 cm(IQR:2.5-3.7 cm),respectively.The median PCL-vaginal angle was 29.0°(IQR:23.0-34.0°).The median distances from the distal,middle,and apical vaginal points to the PS3L were-0.5 cm(IQR:-0.9-0.0 cm),0.0 cm(IQR:-0.4-0.6 cm),and-0.2 cm(IQR:-0.9-0.0 cm),respectively.The median PS3L-vaginal angle was 0.0°(IQR:-4.0-7.0°).Women aged 50 years or older had slightly lower vaginal points and slightly larger angles than younger groups in relation to both reference lines(p<.001).The vaginal axis in younger groups appeared parallel to the PS3L.Conclusions:The axis of the upper two-thirds vagina was proximate to a line from the inferior pubic symphysis to the third sacral vertebra,particularly in younger women.It will likely become a simplified method for roughly assessing the vaginal axis in its situ at first glance.

Selective applications of excisional surgical treatments of cervical precancers

Cervical precancers encompass high-grade squamous intraepithelial lesion and adenocarcinoma in situ.Treatment of precancerous lesions can reduce cervical cancer mortality and prevent the development of invasive cervical cancer.The choice of treatment regimen needs to follow the principle of individualization and should be based on a combination of factors,including the patient's age,fertility requirements,pregnancy status,pathological type,type of colposcopic transformation zone,patient's follow-up conditions,and the experience of the treating provider.This article presents an opinion regarding the appropriate indications for excisional surgery and total hysterectomy in the management of precancerous lesions of the cervix,with the aim of establishing standardized therapeutic approaches for the treatment of precancerous lesions of the cervix.