Objective: To investigate anxious and depressive emotions in patients underwent cervical cancer surgery and to analyze its influencing factors. Methods: A total of 304 patients who underwent primary cervical cancer surgery in Obstetrics and Gynecology Hospital, Fudan University from Oct 2018 to Jun 2021, were recruited to evaluate the clinical effect based on cervical cancer-patient reported outcome 137 scale (CC-PRO137 scale). This study focused on dimensions of depressive and anxious emotions within this scale and explored their influencing factors. Results: The average scores of their depressive and anxious emotions within half a year after surgery were 4.141±0.798 and 4.020±0.616, respectively; and the average scores of depressive and anxious emotions more than one year after surgery were 4.250±0.802 and 4.097±0.613, respectively. By using statistical methods including analysis of variance and t test, it was found that there were statistically significant differences in the scores of depression and anxiety among cervical cancer patients under different postoperative adjuvant treatments and at different postoperative time points (P < 0.05). However, there were no statistically significant differences in the scores of depression and anxiety among patients with different ages, surgical methods, and clinical stages of cervical cancer (P > 0.05). Conclusion: Patients underwent cervical cancer surgery may suffer varying degree of depressive and anxious emotions, and the main influencing factors are different adjuvant treatments and the length of time for postsurgical recovery. Medical practitioners should strengthen comfort and care for patients with cervical cancer, especially those who receive chemotherapy and radiotherapy treatments and are in the primary stage after the surgery. Formulating positive intervention measures can effectively reduce the psychological pain of patients and safeguard their physical and mental health.
Objective: To explore the clinical value of anti-Müllerian hormone (AMH) to optimize endocrine therapy for peri-menopausal early breast cancer. Methods: Two hundred and four patients of pre-menopausal breast cancer aged 45-55 years old between 2020 and 2023 were enrolled, and AMH≤0.1 ng/mL was considered as cut-off value for menopause. Switching from selective estrogen receptor modulator (SERM) to aromatase inhibitor aromatase inhibitor (AI) and initial endocrine therapy regimens were based on AMH, follicle-stimulating hormone (FSH) and estradiol (E2). Results: Pre-chemotherapy AMH level was significantly negatively correlated with FSH level (P < 0.001). Among 100 cases who were amenorrhea for one year during SERM treatment, 42 cases did not have AMH testing. Fourteen out of the 42 cases switched to AI within one year, and ovarian function recovery (OFR) occurred in 2 cases after AI switching. Fifteen cases with AMH > 0.1 ng/mL did not switch to AI within one year. Forty among 43 cases with AMH≤0.1 ng/mL switched to AI, after a significantly shorter median SERM treatment duration (3.15 months vs. 8.14 months, P < 0.001) and a significantly lower OFR rate (0 vs. 12.5%, P=0.023) compared with those who did not test AMH but switched to AI. AMH≤0.1 ng/mL was an independent risk factor of transition to menopause shortly in peri-menopausal patients (OR=35.857, P < 0.001). Among 104 cases with AMH tested before adjuvant chemotherapy, 69 cases had AMH > 0.1 ng/mL. Thirty-one out of the 69 cases were treated with ovarian function suppression (OFS) initially and 38 with SERM initially. Thirty-five cases with AMH≤0.1 ng/mL were all treated with SERM initially, with a higher rate of switching to AI (71.4% vs. 23.7%, P < 0.001) and a shorter SERM treatment duration (6.52 months vs. 13.56 months, P=0.016) compared with the 38 cases (AMH > 0.1 ng/mL) treated initially with SERM. After a median 30-month follow-up, no recurrence was observed in these thirty-five cases treated with SERM initially and AMH≤0.1 ng/mL, just like in OFS group. And they had a tendency of improved survival outcome compared with those treated with SERM initially and AMH > 0.1 ng/mL (Log Rank P=0.076). Conclusion: AMH could evaluate and predict menopause accurately, resulting in optimizing endocrine therapy for peri-menopausal patients effectively and safely.
Objective: To investigate and analyze the distribution of serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and squamous cell carcinoma-associated antigen (SCCA) levels in healthy pregnant women during pregnancy and to assess their diagnostic value for cervical cancer in pregnancy. Methods: A total of 441 healthy pregnant women and 69 patients with cervical cancer in pregnancy who attended the Obstetrics and Gynecology Hospital of Fudan University from Jan 2021 to May 2024 were selected, and 165 healthy women in the Physical Examination Center of the Obstetrics and Gynecology Hospital of Fudan University were included in the same period as the control group. The healthy pregnant women were divided into 143 in early pregnancy (T1 group), 147 in middle pregnancy (T2) and 151 in late pregnancy (T3). Serum CYFRA21-1 and SCCA values were detected and analyzed in all groups. One-way ANOVA, independent samples t-test, Mann-Whitney U-test, Kruskal-Wallis H-test, logistic analysis, and ROC curves were used for comparative analysis. Results: The CYFRA21-1 and SCCA values were 1.66 (1.19-2.17) ng/mL and 0.8 (0.6-1.0) ng/mL in the control group, 3.07 (2.11-4.14) ng/mL and 0.9 (0.7-1.3) ng/mL in the healthy pregnant women group, and were 4.33 (2.99-7.60) ng/mL and 1.8 (0.9-8.5) ng/mL in the patients with cervical cancer in pregnancy group, respectively. There was a statistically significant difference in the two serum values between every two groups (P < 0.05). CYFRA21-1 levels were 3.13 (2.46-4.05) ng/mL, 1.89 (1.50-2.53) ng/mL and 4.19 (3.48-5.43) ng/mL in the T1, T2, and T3 groups, respectively; and SCCA levels were 0.9 (0.7-1.1) ng/mL, 0.7 (0.6-1.0) ng/mL and 1.2 (0.8-1.7) ng/mL, respectively. The results of T1 and T3 groups were higher than those of the control group (P < 0.05); however, there was no statistically significant difference between the results of the T2 group and those of the control group (P > 0.05). The areas under the ROC curves for the diagnosis of cervical cancer in pregnancy for CYFRA21-1, SCCA, human epididymis protein 4 (HE4), anti-carcinoembryonic antigen (CEA) and joint indicators were 0.684, 0.724, 0.612, 0.791 and 0.913, with sensitivities of 36%, 48%, 38%, 57% and 73%, specificities of 96%, 97%, 89%, 86% and 99%, respectively. The cut-off values of each indicator were 6.05 ng/mL, 2.60 ng/mL, 51.45 pg/mL and 1.75 ng/mL, respectively. Conclusion: Serum CYFRA21-1 and SCCA levels were higher in pregnant women during early and late pregnancy compared with non-pregnant individuals, while they were not statistically different from non-pregnant women during mid-trimester. CYFRA21-1 and SCCA have diagnostic value for patients with cervical cancer during pregnancy.
Objective: To develop a nurse-led case management practice program for ovarian cancer patients, and to investigate its application effect initially. Methods: The case management practice model of ovarian cancer was formed through literature analysis, qualitative research and expert meeting method. Ovarian cancer patients who were given conventional nursing interventions from Aug 2022 to Jun 2023 and from Jul 2023 to Mar 2024 in Obstetrics and Gynecology Hospital, Fudan University were selected as the control group (n=16) and the intervention group (n=16). The patients'supportive care needs, disease symptoms and unplanned readmission rates were compared before and after intervention between two groups. Supportive Care Needs Survey Shortform 34 (SCNS-SF34) was used to collect patients' supportive care needs, and M.D. Anderson Symptom Inventory (MDASI) was used to assess disease symptoms. Results: The ovarian cancer case management practice program was constructed and revised to determine the qualification and professional competence of the ovarian cancer case manager, the core of practice, and the specific implementation pathway. After intervention, the total score and scores of all dimensions of SCNS-SF34 in the intervention group were lower than those of the control group (P < 0.001), the total score and scores of all dimensions of MDASI in the intervention group were lower than those of the control group (P < 0.05). There was no statistically significant difference in unplanned readmission rates between the two groups. Conclusion: The case management practice program for ovarian cancer patients was constructed with scientific validity, which can effectively meet the care needs of patients and alleviate their disease symptoms.
Objective: To compare the clinical efficacy and pregnancy outcomes of CO2 laser and loop electrosurgical excision procedure (LEEP) surgery in the treatment of cervical high-grade squamous intraepithelial lesion (HSIL)in women of childbearing age. Methods: Patients with cervical HSIL of appropriate reproductive age (20-34 years old) who underwent satisfied colposcope, subsequently treated with laser or LEEP between Jan 2019 and Dec 2021 in Obstetrics and Gynecology Hospital, Fudan University were collected. All the patients were interpreted as transformation zone (TZ) type 1/2, and colposcopy biopsy diagnosed as cervical high-grade squamous intraepithelial lesion (HSIL) and received laser or LEEP according to the physician's advice and the patient's wishes.The effectiveness of the two surgeries was evaluated, and postoperative cytology, HPV result, and colposcopic pathology were compared. We monitored the surgical pregnancy rate, pregnancy complications, and pregnancy results after the surgery. Results: A total of 566 cases, including 233 laser cases and 333 LEEP cases, were enrolled. There was no significant difference between the two groups in terms of preoperative cytology, HPV distribution, or the length of cervical canal. After 6 months of surgery, 91.5% of patients who underwent laser therapy and 86.9% of those who underwent LEEP had normal cytology. The histology cure rate was 91.5% and the HPV conversion rate was 74.6% in both groups. The results of cytology, HPV, and colposcopic pathology had no significant difference between the two groups. The length of postoperative cervical canal was significantly longer in laser group than that in LEEP group [(29.09±3.15) mm vs. (27.05±3.84) mm, P < 0.001]. There was no statistically significant difference in postoperative pregnancy rate and pregnancy outcome between the two groups. Conclusion: Laser ablation and LEEP produce comparable effects pregnancy outcomes in cervical HSIL patients with TZ types 1 and 2, while LEEP has pathologic feedback, so its misdiagnosis of invasive cancer reduce.
Objective: To evaluate the effect of gestational weight gain (GWG) on the labour process and delivery mode in primiparas undergoing epidural analgesia (EA). Methods: The medical records of all primiparas with singleton term deliveries who received EA at Obstetrics and Gynecology Hospital, Fudan University from Aug 2020 to Jan 2021 were retrospectively collected. The effects of excessive GWG on labor process and mode of delivery were evaluated using t tests and χ2 tests. Multivariate regression and multinomial logistic regression analyses were employed to examine the impact of various factors on labor process and mode of delivery. Results: A total of 1 283 primiparas were included in the study, with 646 cases in the excessive GWG group (study group) and 637 cases in the inadequate/adequate GWG group (control group). Before propensity score matching (PSM), the study group exhibited higher pre-pregnancy BMI values, longer gestational age, and more comorbidities compared to the control group (P < 0.001). After PSM, GWG had no statistically significant impact on the labor process or mode of delivery. Multivariate regression analysis showed that oxytocin had significant effects on the first stage of labor (P=0.001), the second stage of labor (P < 0.001), and mode of delivery (P=0.002). Gestational age (P=0.003) had a significant impact on the first stage of labor, while the mode of membrane rupture (P=0.003) and coexisting diabetes (P=0.015) had significant effects on the second stage of labor. Age (P < 0.001) and gestational age (P=0.019) had significant effects on the mode of delivery. Conclusion: Among nulliparous women receiving EA, there were no statistically significant differences in the labor process and mode of delivery between those with excessive GWG and those with inadequate/adequate GWG.
Objective: To explore the effects of early water intake after elective cesarean delivery on maternal satisfaction and gastric emptying. Methods: A total of 90 parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia between Jan 2024 and Mar 2024, were randomly divided into 2 groups: the W group, who received 100 mL of oral water intake, and the C group, who received 10 mL of water, approximately 10 min after surgery. The primary outcome was maternal satisfaction with early oral intake after cesarean delivery; the secondary outcomes included maternal degree of thirst and hunger, gastric emptying assessed by ultrasonography, body temperature, degree of shivering, thermal comfort score, time to postoperative first flatus, and time to initiation of lactation, and gastric emptying assessed by ultrasonography. Results: The VAS scores of maternal satisfaction 120 min after water intake in group C and group W were (46.7±19.8) mm and (76.8±16.9) mm, respectively (P < 0.001). At 30, 60, 90, and 120 min after water intake, the numerical rating scale (NRS) score of maternal thirst in group W was lower than that in group C (P < 0.01). At 90 min post-intake, the cross-sectional area (CSA) of gastric antrum in group W had returned to the baseline level. At 120 min after oral intake, there was no significant difference in gastric antrum CSA between the two groups. At 90 min and 120 min after oral intake, the cases of gastric antrum CSA > 10.3 cm2 in group W were 3 (6.7%) and 2 (4.4%), respectively, and there were no significant differences between the two groups. Changes in maternal residual gastric volume were consistent with CSA. There were no significant differences in postoperative blood pressure, heart rate, body temperature, the degree of shivering, thermal comfort score, time to flatus, or time to lactation between the two groups. Conclusion: Fully conscious parturients who drank 100 mL of water early after cesarean delivery reported greater satisfaction and experienced reduced thirst. Furthermore, there was no delay in maternal gastric emptying as a result of early oral water intake post-cesarean.
Objective: To investigate the satisfaction of clinical trial service quality of hospitals in Shanghai for clinical research associate (CRA), so as to provide reference for improving the quality of clinical trial service. Methods: From Oct to Nov 2023, CRAs were surveyed using the revised SERVQUAL (service quality) scale. The questionnaire included 29 items in 5 dimensions of assurance, reliability, tangibility, responsiveness and empathy. Based on the modified importance-performance analysis (IPA) analysis, it was figured out which item was in the improvement area. Results: A total of 163 CRAs from 10 companies were surveyed, and 160 valid questionnaires were collected. According to the revised IPA, 6, 2, 1, 2 and 2 items of the dimensions of assurance, reliability, tangibility, responsiveness and empathy fell into the improvement area, respectively. Conclusion: CRAs surveyed may not be satisfied with the clinical trial service of Shanghai hospitals. We need to propose optimization strategies to improve the quality of clinical trial service from the aspects of standardization awareness, review mode, process acquisition, response and management system flexibility.
Objective: To investigate the relevancy between diet and colostrum nutrition in pregnant women in the second and third trimesters. Methods: A total of 378 pregnant women who met the inclusion and exclusion criteria and were registered in the Obstetrics and Gynecology Hospital, Fudan University from Jun 2022 to Apr 2023 were included in the study by continuous sampling method. General information, diet in the second trimester, diet in the third trimester and colostrum data 48-72 h after delivery were collected. The relevancy between daily dietary nutrient intake and colostrum quality in pregnant women during the second and third trimesters was analyzed. Results: All of the 378 subjects met the colostrum collecting criteria. We found that dietary fat intake during the second trimester was positively correlated with colostrum quality (OR=2.408, 95%CI: 1.086-5.338), and energy was negatively correlated with colostrum quality (OR=0.319, 95%CI: 0.157-0.651). Dietary protein intake in the third trimester was positively correlated with colostrum quality (OR=5.905, 95%CI: 1.757-19.842). Conclusion: There is a certain relevancy between diet and colostrum nutrition. A reasonable diet during pregnancy is recommended to promote the quality of colostrum.
Objective: To investigate the depression level of postpartum women at the 12th month and its correlation with infant health status. Methods: Selecting mothers and infants who underwent prenatal examinations and successfully gave birth at Obstetrics and Gynecology Hospital, Fudan University from Dec 1, 2020 to Feb 28, 2021 as the research subjects. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate the depression level of postpartum women at the 12th month. A general information questionnaire was conducted to investigate the length, weight, feeding method, medical treatment for any reason, and sleep duration of infants at the age of 12 months. The neurodevelopmental assessment form for infants aged 11-15 months was used to assess their neurodevelopmental status at the age of 12 months. Results: Among the 538 postpartum women, 55 cases had an EPDS score≥9, and the rate of postpartum depression (PPD) was 10.223%. The depression level of postpartum women at the 12th month was negatively correlated with the duration of infant night sleep (P=0.019) and the total duration of sleep (P=0.017). It is negatively correlated with the fine motor development (P=0.036), social development (P=0.017) and total neurological development score of infants (P=0.047). There is no correlation with infant physical growth (length and weight), feeding methods, or medical treatment for various reasons. Conclusion: PPD has a negative impact on the sleep duration, fine motor development, and social development of infant, affecting the baby's neurological development. It is necessary to pay long-term attention to the mental health of the postpartum women in order to promote the healthy growth of the baby.
Objective: To explore the changes of hemodynamics in pregnant women with uncomplicated dichorionic (DC) twin pregnancy and monochorionic (MC) twin pregnancy, so as to better perform prenatal monitoring. Methods: A study was conducted to collect 64 pregnant women with uncomplicated twin pregnancy (41 cases of DC and 23 cases of MC) in the Obstetrics and Gynecology Hospital, Fudan University from May 2020 to Sept 2021, and 144 pregnant women with uncomplicated singleton pregnancies in the same period were selected as the control group. During the second trimester (20-28 weeks), conventional echocardiography was performed in pregnant women, and singleton pregnancy was used as the control. The left ventricular systolic, left ventricular diastolic, hemodynamic and cardiac structural parameters of DC and MC twin pregnancy were studied. Results: At 20-28 weeks of gestation, compared with singleton pregnancies, the heart rate, mean arterial pressure, cardiac output, cardiac index, stroke volume, left ventricular mass, stroke work index parameters of twin pregnancy were significantly increased, and the total vascular resistance was significantly decreased, and the differences were statistically significant (P < 0.05). The distribution of maternal hemodynamic parameters was similar in pregnant women with DC twin and MC twin pregnancy. Compared with DC twin pregnancy, MC twin pregnancy showed a significant increase in cardiac output (5.76 L/min vs. 5.36 L/min, P=0.031). Total vascular resistance significantly decreased (1 270 vs.1 407, P=0.037). Conclusion: Compared with singleton pregnancy, the hemodynamics of twin pregnancy significantly changed, which ensured the growth and development of the fetus by providing sufficient uteroplacental circulation. The cardiovascular adaptation patterns of DC and MC twin pregnancy were similar, but MC twin pregnancy had higher cardiac output and lower total vascular resistance.Monitoring the cardiac function of twin pregnancy, especially MC twin pregnancy, is very important for the safety of pregnant women.
Objective: To understand the disease experiences of women with endometriosis (EMs), so as to provide a basis for improving the diagnosis, treatment, nursing and support of this population. Methods: The databases of PubMed, Web of Science, Scopus, Embase, Cochrane Library, VIP, Wanfang Data, CNKI, CBM were retrieved on qualitative research about the disease experiences of endometriosis patients from inception to Jun 2023. The quality of the literature was evaluated by Joanna Briggs Institute (JBI) Critical Appraisal Tool for qualitative studies. Results: A total of 17 studies were included, 51 clear research findings were extracted, which were summarized into 10 new categories and 3 integrated results: (1) Cyclical episodes of the disease not only bring physical and psychological distress, but also lead to decreasing the patient's sense of female identity, destroying social and intimating relationships; (2) The doctor and patient interaction is influenced by imbalance of cognitive, the process of diagnosis and treatment is full of challenges, and patients have a demand for professional information and social support; (3) Growing up in pain, patients actively self-adjust and positively cope with the disease. Conclusion: EMs affects patients' quality of life physiologically and psychologically, with prevalent issues of delayed diagnosis and repeated treatments. The professional information supported by health professionals needs to be improved. Healthcare providers should pay more attention to patients' physical and emotional experiences in their clinical work, improve their informal support, participate in long-term management, and improve patients' ability to manage their diseases.
Objective: To reveal the clinical characteristics of heterotopic pregnancy (HP) and enhance the understanding of its complexity. Methods: A retrospective study was conducted among all 390 852 pregnant women who were treated in two tertiary hospitals of obstetrics and gynecology in Shanghai from Jan 2011 to May 2021. We screened and collected patients who were diagnosed as HP, and analyzed their clinical characteristics including menopause time, conception method, location of ectopic pregnancy (EP) and clinical manifestations. Results: A total of 185 HP cases enrolled and 14 EP site rupture cases were recognized. Among the 185 cases, 84.9% had their EP site in fallopian tube, 12.4% were cornual HP. In vitro fertilization-embryo transfer (IVF-ET) ranked first in conception method with rate of 83.8%, followed by ovulation induction with rate of 10.3% and spontaneous conception ranked last with rate of 5.4%. Vaginal bleeding was appeared in 38.4% HP patients, 21.1% patients experienced abdominal pain and 12.4% patients had vaginal bleeding complicated by abdominal pain. It is worth mentioning that, 25.4% patients had no clinical manifestation. The incidence of EP site rupture was 7.6%. In 14 EP rupture cases, 71.4% had abdominal pain as their first clinical manifestation. The post-operation live birth rate of EP site rupture patients was 78.6%, and abortion rate was 14.3%. Conclusion: The clinical manifestations of HP are diverse. For patients with vaginal bleeding and abdominal pain, conception method is IVF-ET or ovulation induction, detailed and dynamic transvaginal ultrasound examination should be careful carried out in the uterus and adnexal areas. Patients with abdominal pain should be alert to EP site rupture and early intervention was needed.
Objective: To explore the safety and management mode of hysteroscopy in three different modes: outpatient, daily and inpatient. Methods: The quality control data of patients who underwent hysteroscopic surgery in Hysterscopy Centre, Obstetrics and Gynecology Hospital, Fudan University from Jan 2019 to Dec 2021 were collected through the electronic information system of the hospital and the monthly quality control report of hysteroscopy center. The amount of surgery, the proportion of grade Ⅳ surgery, the analysis of operation types, the indicator including complications, and unanticipated secondary surgery were retrospectively analyzed. Results: From 2019 to 2021, 5 162 outpatient hysteroscopic patients, 15 331 daily hysteroscopic patients and 5 942 inpatient hysteroscopic patients were admitted in our hospital. The age of inpatient hysteroscopic patients was significantly older than those of outpatient and daily patients (P < 0.001). In the past three years, the proportion of daily hysteroscopy gradually increased, and the proportion of inpatient hysteroscopy gradually decreased (P < 0.001). The total percentage of grade Ⅳ hysteroscopic surgery was 12.9%, in which inpatient was higher than daily, and daily was higher than outpatient (P < 0.001). The incidence of complications and accidents during hysteroscopy was 0.117% (31/26 435), including 17 cases of uterine perforation, 7 cases of hysteroscopy failure, 3 cases of excessive intraoperative bleeding, 2 cases of fluid overload, 1 case of intestinal injury, and 1 case of anesthesia accident. The incidence of hysteroscopy in outpatient, daily and inpatient were 0.020% (1/5 162), 0.137% (21/15 331) and 0.151% (9/5 942) respectively. Conclusion: Hysteroscopy in outpatient, daily and inpatient are all safe and reliable. Outpatient and daily hysteroscopy can improve the efficiency of medical services, which has gradually become a trend.
Objective: To summarize the treatment of cervical cancer patients diagnosed before 34 weeks of gestation who chose to continue pregnancy, and to provide clinical experience for improving maternal and fetal outcomes. Methods: Clinical data of pregnant women with cervical cancer admitted to the Obstetrics and Gynecology Hospital, Fudan University from Jan 2013 to Feb 2024 were collected and analyzed. Treatment of patients diagnosed before 34 weeks of gestation and chose to continue pregnancy was summarized. Outcomes of patients and newborn were followed up. Results: A total of 15 patients were enrolled with a median age of 34 years old. Nine cases (9/15) represented clinical symptom of abnormal vaginal bleeding, 14 cases (14/15) of patients were diagnosed in the middle or late stages of pregnancy, 12 cases (12/15) diagnosed with tumor size of more than 2 cm, 13 patients (13/15) infected HPV type 16 or 18. The main pathological type was squamous cell carcinoma (9/15). Regarding therapy, one patient with stage Ⅰa1 was under observation and underwent a caesarean section and total hysterectomy at 35 weeks of gestation due to premature rupture of membrane and a scarred uterus. For the other patients with 14 stage Ⅰb, lymph node metastasis was excluded by pelvic lymphadenectomy or MRI, and then neoadjuvant chemotherapy was administered. Termination of pregnancy and standardized treatment for cervical cancer were provided after 34 weeks of gestation. One patient's pathology was upgraded to stage Ⅱa1 after surgery. Up to follow-up, 13 out of 15 patients had survived without tumors. The average gestational age of newborns was (35.0±1.5)weeks, and the average birth weight was (2 345.33±431.44)g. Blood tests conducted one day after delivery of the newborns revealed that: 8 newborns (8/15) had hypoleukocyte and one newborn (1/15) had anemia. After short-term hospitalization and supportive treatment, all newborns' progress was favorable. Conclusion: For pregnant patients with stage Ⅰb cervical cancer diagnosed before 34 weeks of gestation, postponing termination to after 34 weeks of gestation through neoadjuvant chemotherapy and then giving standardized treatment for cervical cancer was safe with favorable maternal and fetal prognosis.
Objective: To investigate the degree of fibrosis, the expression of estrogen and progesterone receptors, and the expression of angiogenesis-related molecules in polypoid endometriosis, with the aim of further elucidating its histopathological characteristics. Methods: The study retrospectively analyzed the clinicopathological data of 42 patients diagnosed with polypoid endometriosis through surgical treatment at Obstetrics and Gynecology Hospital, Fudan University from Apr 2014 to Aug 2020. Additionally, tissue samples from 19 cases of ovarian endometriotic cysts, 20 cases of adenomyosis, 20 cases of deep infiltrating endometriosis, and 20 cases of endometrial polyps, all pathologically confirmed, were collected as a control group. The degree of fibrosis, the expression of estrogen and progesterone receptors, and the expression of angiogenesis-related molecules in the lesions of each group were determined using Masson staining and immunohistochemistry. Results: The mean age of onset of the 42 patients with polypoid endometriosis was 41.24 years. And the most usual clinical manifestation is pelvic mass (24/42 patients). Immunohistochemical experiments showed that polypoid endometriosis was less fibrotic than ovarian endometriotic cysts, adenomyosis and deep infiltrating endometriosis but more fibrotic than endometrial polyps. Polypoid endometriosis also has a higher vascular density, increased expression of estrogen receptor-β (ER-β), and down-regulated expression of progesterone receptor B (PR-B). Conclusion: Polypoid endometriosis is a distinct subtype of endometriosis characterized by a lower degree of fibrosis, higher levels of estrogen receptor expression, and relatively rich vascularization, generally associated with a favorable prognosis.
Objective: To explore the mediating effect of maternal childbirth self-efficacy between reproductive health literacy during pregnancy and expected mode of delivery, in order to provide a reference for obstetric care providers to carry out scientific and reasonable childbirth decision support interventions. Methods: A questionnaire survey was conducted among pregnant women in late pregnancy seeing doctors in Obstetric Clinic of Obstetrics and Gynecology Hospital, Fudan University from Oct 2020 to Feb 2021 using convenience sampling. A general information questionnaire, the Reproductive Health Literacy Scale, and Childbirth Self-efficacy Scale were used in the survey. Linear regression and Logistic regression analyses were used to assess the associations between reproductive health literacy during pregnancy and childbirth self-efficacy and expected mode of delivery, respectively, and to assess the significance of the mediating effect of childbirth self-efficacy between productive health literacy during pregnancy and expected mode of delivery. The MacKinnon's product-of-coefficients method was used to assess the mediating effect of maternal childbirth self-efficacy. Results: A total of 343 participants were included in the study. Regression analysis results of factors influencing expected mode of delivery showed that reproductive health literacy during pregnancy (c'=1.644, 95%CI: 2.223-12.059) and childbirth self-efficacy (β=2.211, 95%CI: 6.300-13.215) were associated with expected mode of delivery (P < 0.001); childbirth self-efficacy was significantly and positively associated with reproductive health literacy during pregnancy (β=1.280, 95%CI: 0.102-0.165, P < 0.01). Childbirth self-efficacy was a mediating variable for health literacy during pregnancy and expected mode of delivery with an effect size of 24.8%. Conclusion: Childbirth self-efficacy mediated the association between reproductive health literacy during pregnancy and expected mode of delivery. Obstetric care providers should focus on strengthening maternal care and childbirth education, improving pregnant women's childbirth self-efficacy and reproductive health literacy during pregnancy, thereby enabling women to make scientific decisions on expected mode of delivery in order to promote normal childbirth.
Objective: To explore the clinical value of vaginoscopy in the diagnosis and treatment of uterine cavity diseases in virgins. Methods: We retrospectively reviewed the data of 450 patients who underwent vaginoscopy and traditional hysteroscopy in Obstetrics and Gynecology Hospital, Fudan University from Jan 2020 to Dec 2023, including vaginoscopy group (n=232) and traditional hysteroscopy group (n=218). The average ages of the two groups were 24.9±4.7 years and 25.5±5.4 years, and there was no significant difference between the two groups (P > 0.05). The operation time, estimated blood loss, fluid deficit, false passage, surgical failure, incidence of complications and postoperative pain score were compared between vaginoscopy group and traditional hysteroscopy group. Results: Compared with the traditional hysteroscopy group, the average operation time in the vaginoscopy group was shorter, the fluid deficit was less, and the VAS pain score was lower, but the rate of surgical failure was higher (7.8% vs. 0), all the differences were statistically significant (P < 0.05). In terms of complications, the incidence of false passage in the vaginoscopy group was less (0 vs. 3.2%) and the rate of hymen injury was lower (0 vs. 85.3%), the differences were statistically significant (P < 0.05). There was no significant difference in the estimated blood loss between the two groups, and the incidence of postoperative infection was similar in both groups. There were no complications such as uterine perforation and air embolism in both groups. Conclusion: Vaginoscopy is safe and effective, more minimally invasive than traditional hysteroscopy, does not damage the hymen, and is suitable for virgins. This technology is worthy of clinical application.
Objective: To determine the median effective dose (ED50) of ropivacaine for spinal anesthesia in sub-high altitude cesarean sections. Methods: A total of 30 parturients from sub-high altitudes received initial 14 mg (1.4 mL) of 1% ropivacaine intrathecally. Effectiveness was defined by sensory block to T6 within 15 minutes without additional epidural anesthesia. Doses were adjusted by ±1 mg based on response. ED50 and 95% CI were estimated using Dixon's method and isotonic regression. Adverse reactions were noted. Results: Thirty parturients with an average age of (30.88±5.56)years, gestational weeks of (40±1.41)weeks, height of (156.69±5.80) cm, and weight of (67.44±10.48) kg were studied. The ED50 was 10.68 mg (95%CI: 9.65-12.58 mg) by Dixon's method and 10.33 mg (95%CI: 9.41-12.07 mg) by isotonic regression. Intraoperatively, 8 cases of hypotension, 1 case of bradycardia, and 7 cases of nausea and vomiting were observed, no hypertension or shivering occurred among the parturients. Conclusion: The ED50 for ropivacaine in sub-high altitude cesarean sections is 10.68 mg, which is higher than the currently known ED50 required for patients in plain areas.
Patients with premature ovarian insufficiency (POI) suffer from a significant decline in ovarian function, which severely affects their fertility. To date, there is no definitive and effective treatment for patients with POI accompanied by infertility. Professor Wang Wen-jun proposed the principles of "integrating Chinese and western medicine, precise medication" "treating the root cause, adhering to the treatment rules and adjusting the prescription" and "being cautious of the subtle, preventing the gradual, and treating before changes occur" which have been effective when Chinese and western medicines are used in combination. This article also introduces three cases of patients with POI accompanied by infertility who successfully became pregnant after being treated with Professor Wang Wen-jun's integrated Chinese and western medicine treatment plan, aiming to provide ideas for the integrated treatment of POI accompanied by infertility.
Recurrent spontaneous abortion (RSA) is a complex clinical issue affecting the fertility health of many women. The treatment of RSA through the integration of traditional Chinese medicine (TCM) and western medicine had attracted attention due to the complementary advantages of both approaches. This article aimed to introduce professor Wang Wen-jun's unique diagnostic and therapeutic philosophy and methods in the prevention and treatment of RSA using an integrated approach of TCM and western medicine. Professor Wang Wen-jun excelled at combining disease identification with syndrome differentiation and treatment, and the precise application of both Chinese and western pharmaceuticals, and she emphasized pre-pregnancy conditioning and post-pregnancy fetal security, providing an efficient and safe therapeutic approach for the prevention and treatment of RSA, which had significantly improved the pregnancy outcomes for RSA patients.
Objective: To explore the construction and verification of the classification model for the five properties of traditional Chinese medicine: warm, cool, cold, hot, and neutral. Methods: Urine samples of mice after taking Chinese medicine of different properties were selected as research objects, and Raman spectroscopy-related technology was used for detection. The obtained data set was classified into training set and test set, and the classification model was constructed using four machine learning methods: random forest, extreme gradient boosting, support vector machine, and logistic regression. The model performance was evaluated using precision, recall, F1 score, and accuracy. Results: A total of 4 888 sets of spectra were collected in this study, of which 80%, totaling 3 910 sets of spectral data, were used to build the model, and the remaining 20%, totaling 978 sets of spectral data, were used to test model performance. The accuracy of the random forest model was 92%, the extreme gradient boosting model was 87%, the support vector machine model was 83%, and the logistic regression model was 75%. The Raman shifts with the highest classification weights were 872, 1 012, 1 108, 1 190 and 1 668 cm-1. Conclusion: Raman spectroscopy combined with machine learning algorithms can be used to classify the five medicinal properties of traditional Chinese medicine, among which the random forest model has the best effect.
Objective: To construct and identify an organoid model of human placental site trophoblastic tumor (PSTT). Methods: The tumor cells were obtained by digesting and separating the PSTT tissues and then embedded in Matrigel. The organoids were cultured in the specific organoid medium. The histological morphology of the organoid model was observed by HE staining and the expression levels of the PSTT specific markers [human placental prolactin (HPL), human leukocyte antigen-G (HLA-G) and placental alkaline phosphatase (PLAP)] were detected by immunohistochemistry and immunofluorescence, so as to evaluate the consistency between the organoid model and the PSTT tissue. Meanwhile, the morphology and forming efficiency of the constructed model were observed under a microscope after primary culture, passage generation and cryopreservation to evaluate its potential application as an organoid model in basic and clinical translational research of PSTT. Results: The constructed organoid model could proliferate stably, growing from small microspheres into compact solid spheres or spheres with follicle-like structures, and could passage after fully grown in 7-10 days. The cell state remained stable after passage, frozen storage and recovery. HE staining showed that the morphology of the cells in the organoids was similar to that of the primary PSTT tumor cells, and immunofluorescence staining showed that the organoids highly expressed HLA-G and lowly expressed β-HCG, indicating that the constructed organoid model mainly contained intermediate trophoblast. Conclusion: The adult-derived PSTT organoid (ADPO) models were successfully established.
A bicornuate uterus is a rare congenital uterine anomaly and structural abnormality that significantly impacts fertility and pregnancy outcomes. It is intimately linked with complications including infertility, miscarriage, preterm birth, fetal malformations, and placental abnormalities. This review delves into the effects of a bicornuate uterus on fertility, discusses prevalent obstetric complications, and highlights the adverse pregnancy outcomes for fetuses and newborns. Although reconstructive surgery can improve reproductive outcomes, spontaneous miscarriages and severe pregnancy complications may still occur. This article reviews the relevant literature, and explores the implications of a bicornuate uterus on pregnancy outcomes and its management strategies.
Acute intermittent porphyria (AIP) is a rare metabolic disorder primarily caused by a deficiency in hydroxymethylbilane synthase (HMBS), which severely impairs heme biosynthesis. AIP is characterized by severe abdominal pain and neurological symptoms, with acute attacks potentially leading to serious complications and life-threatening conditions. Although the prevalence of AIP is low, patients experience a significant decline in quality of life and bear considerable psychological burden, warranting close clinical attention. Diagnosis of AIP primarily relies on laboratory testing. Preventive and therapeutic strategies include avoidance of triggering factors, heme replacement therapy, and hormonal regulation. gonadotropin-releasing hormone agonists (GnRH-a) and hormone replacement therapy have shown efficacy in managing AIP attacks associated with the menstrual cycle, but close monitoring is necessary to mitigate adverse effects. This article reviews the pathophysiology, clinical features, and diagnostic approach of AIP, and explores its prevention and treatment strategies.
The incidence of premature ovarian insufficiency (POI) is increasing and showing a trend of affecting younger women, which not only affects women's fertility, but also has the risk of low estrogen in the short and long term. The etiology of POI is complex and highly heterogeneous, including genetic factors, iatrogenic factors, autoimmune dysfunction, infection and environmental factors, but idiopathic POI still accounts for the majority. A lot of researches have focused on the correlation between autoimmune diseases and POI, among which autoimmune thyroid disease (AITD) plays an important role. Therefore, this article will review the current status of POI, the possible pathogenesis of AITD and related treatment progress.
Congenital heart disease (CHD) is a prevalent birth defect in clinical practice, constituting one of the primary causes of infant death. As research on the placenta deepens and the imaging technology continually advances, researchers have found that there may be associations between CHD and placenta dysfunction. Investigating the correlation between placenta dysfunction and CHD has gradually become a research focus. The placenta and the fetal heart develop concurrently and share common signaling pathways, influenced by both genetic and environmental factors, known as the placenta-heart axis. This paper reviewed the current research landscape of the placenta-heart axis and the utilization of advanced ultrasound imaging technology to assess placental structure and function, in order to provide help for management and treatment of CHD.
The incidence of decreased ovarian reserve (DOR) is gradually increasing, with fluctuations in hormone levels causing a series of clinical syndromes.Among these, sleep disorders stand out as prominent symptoms, clinically manifested by difficulties in falling asleep, shortened sleep duration, and poor sleep quality, severely impacting the physical and mental health as well as the quality of life of women. Clinical observations have found a close relationship between decreased ovarian reserve and sleep disorders, where the two interact causally and reciprocally. Western medicine primarily focuses on improving behavioral cognition, administering sedatives and hypnotics, and hormone replacement therapy, albeit with certain limitations in efficacy. Traditional Chinese medicine emphasizes holistic views and syndrome differentiation in treatment, offering low side effects and unique advantages. This review summarizes recent literature on the research progress of sleep disorders and DOR from both Western and traditional Chinese medicine perspectives, providing reference for clinical treatment.
With the development of genetics and advances in genetic testing technology, the demand for cancer genetic counseling has increased dramatically. Advanced practice nurses play a key role in personalized health care delivery. The oncology genetic nurse-led genetic counseling services in foreign countries are becoming more and more mature, but in China, the work of oncology genetic counseling started late, and the combination of genetics/genomics with nursing is still in its infancy. There is still a lack of relevant research on oncology genetic nurses. This article introduced the qualification certification, core competence and clinical practice content of foreign oncology genetic nurses, and summarized the clinical practice effect of oncology genetic nurses and the enlightenment to China's advanced nursing practice, which provided references for the construction of oncology genetic nurses training programs and clinical service models suitable for China's national conditions, so as to meet the needs of the development of advanced nursing practice and the growing demand for precision oncology and high-quality genetic medical care.
Stat3 is a critical transcription factor involved in regulating embryonic development, cell proliferation, apoptosis, inflammation and angiogenesis. The Stat3 protein exists in two isoforms: the full-length Stat3α and the truncated Stat3β, which lacks the C-terminal transcriptional activation domain. Homozygous mutations in Stat3 in mice lead to early embryonic lethality, which can be rescued by the expression of Stat3β. To further understand the structure and function of the Stat3 protein, we expressed various truncated versions of Stat3 in yeast and demonstrated that Stat3 (aa2-11) could activate transcription in yeast and also function effectively in mammalian cells by performing yeast two-hybrid experiments and dual luciferase assay. Our study offers a potential explanation for how Stat3β expression can reverse the embryonic lethality observed in Stat3 gene mutant mice and enhances our understanding of the structure and function of the Stat3 protein.
This article reports a case of primary Müllerian adenosarcoma (MA) of the ovary admitted to the Obstetrics and Gynecology Hospital, Fudan University in 2022, reviews the literature on this rare disease, and shares the experience of its diagnosis and treatment. The patient was a 29-year-old unmarried woman who underwent laparoscopic resection of an ovarian lesion in another hospital. Intraoperatively, it was observed that "the right ovary was enlarged with a cauliflower-shaped mass at the lower pole, measuring about 11 cm×8 cm, unencapsulated, with a fish-like texture, which was completely excised and sent for examination." Postoperative consultation with a (tertiary) hospital in Beijing and our pathology department suggested the diagnosis of ovarian adenosarcoma. Therefore, we performed a comprehensive staged surgery for the patient, i.e., laparoscopic right salpingo-oophorectomy, cystectomy of the left ovary, omentectomy, multiple peritoneal biopsies, and hysteroscopic resection of cervical canal lesions. The patient received four cycles of postoperative chemotherapy with paclitaxel and ifosfamide. After chemotherapy, the patient has been regular followed up and showed no signs of recurrence during the almost 2-year postoperative follow-up period.
Hereditary breast cancer refers to breast cancer with a genetic susceptibility gene. PTEN germline mutations are rare in breast cancer, but patients with PTEN mutations have a high risk of breast cancer. In 2021, A young patient with bilateral breast cancer was admitted to the Obstetrics and Gynecology Hospital, Fudan University. Due to bilateral multiple breast lumps, she underwent Vacuum-Assisted Breast Biopsy, which was pathologically confirmed as right ductal carcinoma in situ, left breast invasive carcinoma. The patient had multiple neoplasms in bilateral axillary region skin, neck skin and bilateral inguinal regiona skin, and the second-generation sequencing results of peripheral blood genes showed PTEN gene mutation. Combined with family history, the patient was diagnosed with Cowden syndrome (CS). Such patients should be paid attention to cancer risk management and family management, so as to attain early diagnosis and treatment.
Congenital disorder of glycosylation type Id (CDG-Id) is due to a variation in the ALG3 gene that results in a defect in the encoded alpha-1, 3-mannosyltransferase. The pregnant woman in this case was 32 years old, G7P1, whose fifth singleton pregnancy had fetal malformations suggested by ultrasound at another hospital. After termination of pregnancy, she came to Obstetrics and Gynecology Hospital, Fudan University for genetic testing, with the result of ALG3 gene variants [NM_005787:c.67C > T(p.Gln23*), Heterozygote, Paternal; NM_005787:c.1188G > A(p.Trp396*), Heterozygote, Maternal]. In this singleton pregnancy at 21 weeks of gestation, prenatal ultrasound at our hospital demonstrated multiple fetal malformations, including micrognathia, cerebellar vermis absence, cystic occupancy of the posterior cranial fossa, all long bones of the limbs being short, scoliosis and stiffness of the finger joints as the main manifestations. The pregnancy was then terminated at another hospital, and subsequent genetic testing results confirmed that it was also due to ALG3 gene variants. This article focuses on the prenatal ultrasound manifestations and genetic features of CDG-Id, in order to improve the understanding of this disorder.
To investigate the perinatal features of fetal Kaposiform hemangioendothelioma (KHE) complicated with Kasabach-Merritt syndrome (KMS), we reported an incidental ultrasound finding of a subcutaneous mass on the back of the foetus in a 36-year-old woman at 38 weeks of pregnancy, with no other abnormal prenatal findings. The dorsal mass was hypoechoic, approximately 6-7 cm in diameter, and Doppler showed a striated blood flow signal. Fetal growth measurements were consistent with gestational age, and the amniotic fluid volume was normal. A live-born boy was delivered by caesarean section. The neonate had a large subcutaneous haemangioma on the left dorsum with thrombocytopenia and coagulopathy. He was diagnosed with KMS and was treated with intravenous high dose pulse methylprednisolone, sirolimus, surgical resection and blood transfusion. Histopathological and immunohistochemical findings confirmed tufted hemangioma and KHE. There was no residual recurrence on postoperative follow-up of 6 months.
