Objective: To analyze the clinical characteristics and prognosis of cervical mucinous adenocarcinoma. Methods: The data of the patients diagnosed with cervical mucinous adenocarcinoma and cervical usual-type adenocarcinoma from the Surveillance, Epidemiology, and End Results(SEER) database, from 2000 to 2021, was retrospectively collected. The clinical characteristics and prognosis were analyzed and compared. Kaplan-Meier method was used for survival analysis, and Cox proportional hazards regression was employed to analyze the prognostic factors. Results: A total of 9 404 patients with cervical adenocarcinoma were included, among which 917 had mucinous adenocarcinoma and 8 487 had usual-type adenocarcinoma. The comparison of age at diagnosis, race, International Federation of Gynecology and Obstetrics (FIGO) 2018 staging, National Comprehensive Cancer Network (NCCN) staging, tumor diameter, lymph node metastasis status, and treatment modalities (surgery, radiotherapy, and chemotherapy) between patients with cervical mucinous adenocarcinoma and those with usual-type adenocarcinoma showed statistically significant differences (all P<0.05). Compared to the patients with usual-type adenocarcinoma, the patients with cervical mucinous adenocarcinoma had a higher proportion of Asian or Pacific Islander patients (14.2% vs. 10.5%), a higher proportion of locally advanced (42.1% vs. 36.7%) and metastatic (17.2% vs. 9.8%) patients, and a higher rate of lymph node metastasis (22.4% vs. 14.8%). For early-stage patients, surgical intervention was the main treatment method for both histological types; for locally advanced and metastatic patients, non-surgical treatments (chemotherapy and radiotherapy) were predominant, with a higher treatment rate for mucinous adenocarcinoma patients. The overall survival (OS) of patients with cervical mucinous adenocarcinoma was significantly shorter, particularly in early and locally advanced patients (both P<0.01). Multivariate Cox regression analysis revealed that older age, higher FIGO stage, and larger tumor diameter were independent risk factors for OS in the patients with cervical mucinous adenocarcinoma, while surgery and chemotherapy were independent protective factors. Surgery improved OS in the patients with cervical mucinous adenocarcinoma across different stages (all P<0.05). Conclusions: Compared to usual-type adenocarcinoma, cervical mucinous adenocarcinoma has worse prognosis, higher tendency for lymph node and distant metastasis. Surgical intervention can improve the OS of patients with mucinous adenocarcinoma, and has a certain protective effect on the locally advanced patients.

Objective: Based on the latent profile analysis, to understand the categorical characteristics of stigma in infertile women and the influencing factors of stigma in those infertile women. Methods: A cross-sectional survey was conducted, using convenience sampling to select 345 infertile women who visited the Reproductive Medicine Center of The First Affiliated Hospital of Anhui Medical University from April 2020 to June 2020. The General Information Survey, Female Infertility Stigma Scale (ISS), and Herth Hope Index (HHI) were used for the evaluation of stigma. Results: Latent profile analysis showed that the characteristics of stigma in infertile women were divided into three potential categories: "low stigma and low family stigma group" 150 cases (43.48%), "middle stigma group" 140 cases (40.58%), and "high stigma and high social stigma group" 55 cases (15.94%). There were significant differences in the stigma among different categories of infertile women in terms of educational level, occupation, marital history, place of residence, and relationship with their husbands (all P<0.05). Using the "low stigma and low family stigma group" as a reference, high school/vocational education level (OR=2.484, P=0.048) is a risk factor for the "middle stigma group", while being in a first marriage (OR=0.268, P=0.006) is a protective factor for the "middle stigma group". Living in rural towns (OR=2.764, P=0.046) is a risk factor for the "high stigma and high social stigma group", whereas having a good relationship with the husband (OR=0.382, P=0.034) and having a high total HHI score (OR=0.582, P=0.010) are two protective factors for the "high stigma and high social stigma group". Using the "middle stigma group" as a reference, having a high total HHI score (OR=0.531, P=0.002) is a protective factor for the "high stigma and high social stigma group". Conclusions: Clarifying the potential categories of stigma among infertile women can help medical staff take intervention measures targeting the influencing factors to reduce their feeling of stigma, and improve their psychological health.

Objective: To analyze the indications for prenatal diagnosis and postnatal follow-up outcomes in 21 fetuses diagnosed with 2q13 microdeletion syndrome. Methods: A retrospective analysis was conducted on 4 832 pregnant women who underwent amniocentesis for karyotyping and single nucleotide polymorphism array (SNP-array) testing at Prenatal Diagnosis Center of Quanzhou Women's and Children's Hospital between April 2020 and February 2024 due to various high-risk factors. Descriptive statistical methods were employed to evaluate the karyotype results, indications for invasive prenatal diagnosis, ultrasound findings, and postnatal follow-up outcomes of the 21 fetuses with 2q13 microdeletion syndrome. Results: Among the 21 fetuses identified with 2q13 microdeletion, 14 exhibited abnormal ultrasound findings; one couple were carriers of β-thalassemia; one case was flagged by noninvasive prenatal testing for sex chromosome abnormalities; one case was identified through high-risk serum screening; three cases involved advanced maternal age; and one case involved chromosomal abnormalities in both the mother and her first child. Karyotype analysis revealed that one case showed an inversion of chromosome 16, and that no abnormalities were detected in the remaining 20 cases. SNP-array testing revealed 2q13 microdeletion fragments ranging in size from 103.5 to 1 771.0 kb. Genetic testing revealed that four cases were maternally inherited, three were paternally inherited, two were de novo mutations, and twelve couples declined further verification. Four pregnancies were electively terminated after the informed decision-making based on comprehensive assessments, with no apparent external abnormalities observed in the fetuses. One case was lost to follow-up, 11 newborns were healthy at birth, and five exhibited varying degrees of congenital anomalies. Conclusions: The phenotypic manifestations of 2q13 microdeletion syndrome are highly variable, with most cases inherited from phenotypically normal parents. Genetic verification and long-term postnatal follow-up are essential for accurate clinical genetic counseling.

Objective: To explore the clinical significance of detecting Xp22.31 microdeletion/microduplication in prenatal diagnosis. Methods: A retrospective analysis was conducted on the data of 6 015 pregnant women who underwent the chromosome karyotype analysis and single nucleotide polymorphism array (SNP-array) testing of amniotic fluid/umbilical cord blood at the Prenatal Diagnosis Center of Quanzhou Women's and Children's Hospital from January 2017 to October 2023. The cases were grouped based on the confirmed Xp22.31 microdeletion/microduplication fetuses. The prenatal manifestations, genetic testing results, and follow-up outcomes were analyzed and compared between the two groups. Results: Among the 6 015 pregnant women, 68 cases of Xp22.31 microdeletion/microduplication were found by SNP-array. There were 18 cases of Xp22.31 microdeletion (13 males and 5 females). Five cases were verified by parents, of which 4 cases were inherited from their mothers with normal phenotype and 1 case was de novo mutation. Among 14 cases of Xp22.31 microdeletion with high risk of prenatal Down's syndrome screening(DSS), 11 cases had unconjugated estriol multiple of the median (uE₃MOM) values <0.1, which was significantly lower than the normal range. Among the 13 male microdeletion carriers, 1 terminated pregnancy, 1 lost follow-up, 11 continued pregnancy, 9 cases were diagnosed with ichthyosis after birth, and 2 had no obvious abnormalities. Five female deletion carriers were all born without obvious abnormalities. There were 50 cases of Xp22.31 microduplication (19 males and 31 females), 27 cases were verified by parents, and all of them were inherited from their parents. Of the 50 fetuses, 5 fetuses terminated pregnancy, 2 fetuses were lost to follow-up, and 43 fetuses continued pregnancy. Two fetuses had abnormal symptoms after birth, and the remaining 41 fetuses had no abnormalities. There were no significant differences in maternal age, ultrasound abnormality rate, and parental verification results between the two groups (all P>0.05). The high-risk rate of DSS and the proportion of male fetuses in the microdeletion group were higher than those in the microduplication group, while the detection rate and the rate of benign pregnancy outcomes in the microdeletion group were lower than those in the microduplication group (both P<0.05). The uE₃MOM value of high-risk fetuses in the DSS of the microdeletion group was lower than that of the microduplication group (P<0.05). Conclusions: Fetuses with Xp22.31 microdeletion/microduplication lack typical prenatal clinical features. For pregnant women with high risk of prenatal serological screening, especially those whose uE₃MOM value is significantly lower than the normal range, chromosomal microchange detection should be recommended. Male fetuses with Xp22.31 microdeletion mainly present with ichthyosis phenotype after birth, while female Xp22.31 microdeletion carriers have good pregnancy outcomes. Most of the Xp22.31 microduplication is parental inheritance, and the pregnancy outcome of fetus is likely to be benign.

Objective: To compare the short-term outcomes of intrauterine cavity reconstruction and menstrual function recovery after hysteroscopic adhesiolysis between patients with intrauterine adhesions (IUAs) caused by endometrial tuberculosis (ETB) and those with trauma-induced IUAs. Methods: A retrospective matched cohort study was conducted on patients with IUAs who underwent hysteroscopic adhesiolysis at Fuxing Hospital Affiliated Capital Medical University between July 2012 and January 2023. The study group included 54 patients with pathologically confirmed ETB who had completed anti-tuberculosis treatment, while the control group consisted of 108 patients with non-infectious, trauma-induced IUAs. The 1 ∶ 2 matching was performed based on age and preoperative American Fertility Society (AFS) scores. Changes in AFS scores before and one month after surgery, as well as improvements in menstrual patterns, were compared between the two groups. Subgroup analysis was conducted based on the severity of adhesions (moderate and severe). Results: No significant differences were observed between the two groups in terms of age, preoperative AFS scores, postoperative AFS scores, or the magnitude of score reduction (all P>0.05). The overall menstrual improvement rates were 68.5% (37/54) in the study group and 76.8% (83/108) in the control group, with no significant difference (P>0.05). Among patients with preoperative moderate IUAs, no statistically significant difference was observed in postoperative AFS scores between the two groups (P>0.05). In contrast, among those with severe IUAs, the study group had significantly higher postoperative AFS scores (P=0.031). Nevertheless, postoperative menstrual improvement rates did not differ significantly between the two groups in either the moderate or severe IUA subgroups (both P>0.05). Conclusions: Patients with ETB-related IUAs can achieve comparable short-term recovery in menstrual function to those with trauma-induced IUAs after standardized anti-tuberculosis treatment and hysteroscopic adhesiolysis. Moderate adhesions demonstrate promising potential for anatomical restoration, while severe adhesions present more limited recovery. Early identification and timely intervention are essential, and future strategies may benefit from severity-based stratified management and the integration of regenerative treatment for severe cases.

Women of childbearing age are a group with the second highest incidence of essential thrombocythemia, and the reproductive challenges of this group have attracted clinical attention. We report a case of an infertile patient with essential thrombocythaemia who gave birth successfully through in vitro fertilization-embryo transfer (IVF-ET). The patient received IVF-ET due to primary infertility and ineffective ovulation induction. During the treatment, the medication regimen was adjusted multiple times due to abnormal platelet level. Aspirin alone before and after the first transplantation and aspirin combined with low molecular weight heparin calcium before and after the subsequent transplantation did not get successfully pregnancy. The treatment strategy was then adjusted to use firstly aspirin combined with interferon-α to reduce the platelet level. After platelet level was well controlled, aspirin combined with low molecular weight heparin calcium treatment was used before and after embryo transfer. After successful pregnancy, this regimen was continued until delivery. Ultimately, a successful live birth was achieved. By exploring the clinical characteristics, treatment methods and successful experience of this case, the key role of individualized treatment plan in improving the success rate of assisted pregnancy is emphasized.

Pelvic tuberculosis is difficult to be discovered in clinic, and easy to be misdiagnosed, because of its concealed condition, no obvious clinical features and signs. We report a case of 29-year-old female who underwent laparoscopic exploration for a mass in the left adnexal area with the elevated carbohydrate antigen 125 (CA125) during in vitro fertilization-embryo transfer (IVF-ET). A large number of miliary nodules were found on the serosa surface of the uterus and fallopian tube under the laparoscopy. Pathological examination of the biopsy tissue showed granulomatous inflammation, with negative acid fast staining indicating a high possibility of tuberculosis. After empirical anti-tuberculosis treatment and CA125 levels were reduced to normal, the frozen-thawed embryo transfer was performed. The patient achieved a successful pregnancy and a healthy live birth. This case report combined with the literature review provides us a reference for the early diagnosis and treatment of infertile patients with pelvic tuberculosis.

Ovarian vein thrombosis (OVT), a rare puerperal complication, is often caused by puerperal infective endometritis. If left untreated, OVT may lead to serious complications such as infection spread or pulmonary embolism. However, OVT is prone to misdiagnosis and missed diagnosis in clinical practice. By reviewing the data of two patients admitted postpartum with low back pain, with or without fever, who were eventually diagnosed with OVT, we found that both patients had hydronephrosis on imaging during the course of their visits. After treatment, the hydronephrosis and ovarian vein thrombosis disappeared. Many relevant literatures showed that there are certain limitations in the original triple syndrome of puerperal OVT (fever, abdominal pain and abdominal mass). Hydronephrosis could be companied with puerperal OVT, suggesting that the ultrasound examination of urinary system should be performed routinely. If hydronephrosis be found, also suggesting the possibility of OVT in puerperal patients, a clear diagnosis should be make as soon as possible.

Pregnancy luteoma (PL) is an ovarian tumor-like lesion with very low incidence, which mostly occurs in the second and the third trimester. The etiology and pathogenesis of PL are unclear, and clinical manifestations vary greatly. There are no specific imaging features and serological markers. The misdiagnosis and mistreatment are prone to occur due to insufficient understanding and treatment experience. We report a case of PL, in which the patient presented with hyperandrogenism, hydrothorax and ascites, and elevated serum alpha-fetoprotein (AFP) and carbohydrate antigen 125 (CA125). Imaging suggested bilateral large ovarian masses. The possibility of malignant ovarian tumor cannot be ruled out, and surgical treatment was recommended. The patient refused to undergo surgery. After reviewing relevant literatures, we realized the possibility of PL. Conservative treatment and clinical observation were adopted. After a one-month follow-up, the symptoms disappeared, liver function returned to normal, and serum AFP and CA125 normal. Gynecological color ultrasound showed no abnormalities in the uterus and bilateral adnexa, ruling out ovarian malignancy. The follow-up was continued for 22 months with no abnormal conditions, and clinical outcome was satisfactory. Eventually, the bilateral PL was diagnosed, and the surgery as for this case was successfully avoided.

With the increase of male life span, the level of androgen secreted by testicular Leydig cells reduce continuously, which leads to the late onset of hypogonadism (LOH). Concurrently, spermatogenesis in the seminiferous tubules is compromised, leading to the reduction in both the quantity and quality of sperm, thereby decreasing male fertility. Males who suffered from testicular natural aging, influence of external environmental factors, metabolic factors, microcirculatory disorders, or certain disease states, generated reactive oxygen species in testes. Meanwhile, the mechanisms of antioxidant stress, such as superoxide dismutase, the Keap1/Nrf2 antioxidant pathway, the ubiquitination pathway, USP15, and the seminal plasma antioxidant system, exhibit relative inadequacy. Consequently, the continuous accumulation of oxidative stress inflicts the direct or/and indirect damage on the functions of Leydig cells and seminiferous tubules, which represents one of the primary pathophysiological mechanisms underlying LOH. Accumulating evidences have indicated that antioxidant therapy holds promise in retarding the progression of LOH. In this review, we comprehensively examine the oxidative stress in the testes of aging men and the occurrence of LOH, and discusse the potential application prospects of novel antioxidants in middle-aged and elderly male populations.

In vitro culture and cryopreservation of oocytes are two critical steps of assisted reproductive technology, and oxidative stress is a major limiting factor affecting the developmental quality of oocytes during above steps. At present, the commonly used natural antioxidants in clinical practice (such as melatonin, resveratrol, etc.) can alleviate oxidative damage, but the application effect is limited by inherent defects such as poor water solubility, low bioavailability and short metabolic half-life. In recent years, the rapid development of nanomaterial technology has provided new solutions to this challenge. Notably, nanoparticle-based antioxidant systems, owing to their unique free radical scavenging capacity and excellent biocompatibility, have been demonstrated significant advantages in in vitro manipulation of gamete. This article reviews the application progress of nanoparticles in the field of assisted reproduction, including the biological effects, potential mechanisms of reproductive toxicity, clinical prospects and future directions.

Coenzyme Q10 (CoQ10) is an endogenous lipid antioxidant that protects cellular function by scavenging free radicals and inhibiting lipid peroxidation. The human body requires approximately 500 mg of CoQ10 per day, yet only about 5 mg from dietary sources. Therefore, the exogenous supplementation of CoQ10 is necessary to maintain the normal reproductive function. Male infertility is significantly associated with the decreased sperm quality, and its core pathological mechanism lies in oxidative stress. CoQ10 reduces reactive oxygen species (ROS)-induced damage to sperm by improving mitochondrial function. Female infertility is often related to reproductive aging, postovulatory aging and endometriosis. CoQ10 can restore oocyte energy metabolism, decrease ROS to reduce the risk of embryonic abnormalities, and facilitate endometrial receptivity for embryo implantation. This review summarizes the critical role of CoQ10 in improving the functions of both male and female reproductive systems, and the application in improving the outcomes of assisted reproduction, by targeting the oxidative stress pathway. Future research should further explore the optimization of CoQ10 dosages and synergistic strategies with other antioxidants to advance its application in reproductive medicine.

Endometriosis (EMs) is one of the major causes of infertility in women of reproductive age. Defective decidualization is a key factor contributing to EMs-related infertility. Aberrant epigenetic regulation, progesterone resistance and dysregulated endometrial immune-inflammatory microenvironment are important pathological mechanisms underlying the decidualization defects in EMs, yet the specific mechanisms remain unclear. By reviewing relevant literatures, it has been found that epigenetic abnormalities in EMs mainly affect the expressions of decidualization-related genes through DNA methylation, RNA methylation, and histone modifications. Progesterone resistance in the endometrium leads to abnormal regulation of downstream gene expression and signaling pathways of progesterone receptors, hindering the decidualization process. Moreover, abnormal changes in endometrial immune cells, cytokines, and inflammatory pathways lead to dysregulation of the endometrial immune-inflammatory microenvironment, which impair the processes of decidualization and embryo implantation, which ultimately result in EMs-related infertility.

Spacetime-Medicine theory, based on traditional Chinese medicine (TCM), can be traced back to Huang Di Nei Jing. This theory argues that the masses of factors such as geographic environment and living conditions affect the physiological functions of the human body and the transmission of diseases. As a academic thought of TCM, Spacetime-Medicine theory has been applied in the diagnosis, treatment, and prevention of diseases and health maintenance. However, the reports on the Spacetime-Medicine theory of PCOS are fragmented. In this paper, we reviewed the ancient literatures, traced the characteristics of similar PCOS-related diseases in ancient texts, summarized ancient and modern treatment methods, and explained how geographical differences influence the diagnosis and treatment of PCOS, so as to reveale the evolutionary pattern of PCOS-related diseases. We hereby explore the concept of Spacetime-Medicine theory in relation to PCOS. Additionally, we explore the development of the PCOS-related treatment by the connection of traditional and modern Chinese medicine with modern technological advances, such as genomics and metabolomics, to provide a reference for the innovations and breakthroughs in the diagnosis and treatment of PCOS in terms of the modernization of TCM theory in the reproductive medicine.

In recent years, the number of patients seeking medical treatment due to hyperemesis gravidarum has been increasing year by year, becoming the second leading indication of hospitalization for pregnant women in early pregnancy in China. It can also increase the risk of postpartum depression, anxiety, and post-traumatic stress disorder for pregnant women. It is an important therapeutic principle of traditional Chinese medicine to treat the pregnancy-related diseases by simultaneously treating the disease and pacifying the fetus. As an important part of the classic of traditional Chinese medicine, acupuncture and moxibustion therapy, based on the meridian pathogenesis of hyperemesis gravidarum, combined with the pathogenic factors of hyperemesis gravidarum, individual endowment and special physiological conditions during pregnancy, has therapeutic advantages such as good therapeutic effect, high safety, convenient and flexible operation, etc. The treatment methods mainly include filiform needle acupuncture, moxibustion, point injection, press needle acupuncture, traditional Chinese medicine point application and combined therapy, which can effectively relieve nausea, vomiting, fatigue and other symptoms of patients with hyperemesis gravidarum. Therefore, it provides an option for the treatment of hyperemesis gravidarum.

Postpartum uterine necrosis is a rare condition, with only a few cases reported in the literature. It is closely associated with uterine ischemia and bacterial infections, with a poor prognosis, often necessitating hysterectomy. Uterine artery embolization, uterine compression suturing, and pelvic vessel ligation are important methods for managing refractory postpartum hemorrhage, primarily by interrupting uterine blood flow to achieve hemostasis. However, the combined use of multiple hemostatic techniques can often lead to uterine ischemia. If the patient also has concurrent genital tract inflammation, the infection may be exacerbated, leading to uterine necrosis and posing a potential risk of mortality. Currently, there is no standardized treatment protocol for postpartum uterine necrosis. Multidisciplinary team management can facilitate early identification and timely control of the condition, thereby preventing severe complications. Improving uterine blood flow and actively controlling infections are critical for preventing uterine necrosis. This article discusses the risk factors, preventive strategies, and clinical management approaches for postpartum uterine necrosis. The aim is to enhance obstetricians ' abilitity of identifying

risks and manage complications, thereby protecting maternal reproductive function and ensuring life safety.

High intensity focused ultrasound (HIFU), as a kind of non-invasive treatment, can project the ultrasound wave to the target tissues of the body, causing coagulative necrosis of the target tissues. HIFU has good clinical efficacy for patients with uterine fibroids who have fertility requirements. HIFU can improve the physiological function, relieve pain, and shorten the hospitalisation time and reduce medical costs. It can also reduce the likelihood of bleeding and infection. HIFU treatment for fibroids has less impact on ovarian function, improves endometrial tolerance, and reduces the incidence of pelvic adhesions, suggesting therapeutic advantages for protecting women's fertility. HIFU treatment for fibroids can shorten the interval between pregnancies after the treatment. The quality and reliability of studies on the effect of HIFU on pregnancy need to be further improved. In this paper, we review the effects of HIFU treatment of fibroids on ovarian function, the female reproductive tract, pregnancy, and fertility reservation.