Journal of International Reproductive Health/Family Planning

Experimental Study on the Involvement of Lipid Peroxidation and Ferroptosis in the Regulation of Senescent Ovarian Granulosa Cells

DONG Si-rui, MENG Yan

2026, 45 (3): 177-183. doi: 10.12280/gjszjk.20260180

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Objective: To compare the levels of lipid peroxidation, iron accumulation and ferroptosis sensitivity between normal and senescent ovarian granulosa cells by the in vivo and in vitro experiments. Methods: The mitochondrial status and iron accumulation in the ovarian tissues of female C57BL/6 mice aged 3 months (reproductive active period) and 12 months (reproductive senescence) were detected in the in vivo experiment. In the in vitro experiment, the SVOG cell, the human ovarian granulosa cell line, was used to develope the senescence model by thapsigargin (TG). The cellular senescence-related markers, lipid peroxidation and ferroptosis-related markers were detected. Senescence-associated proteins such as P16, P21 and TP53 were included. Pro-inflammatory cytokines of the senescence-associated secretory phenotype (SASP), including interleukin-1A (IL-1A), IL-1B, IL-6 and C-X-C chemokine ligand 8 (CXCL8) were analyzed. The ferroptosis and lipid peroxidation indicators were also tested, including the expression levels of ferroptosis-related proteins [glutathione peroxidase 4 (GPX4), transferrin receptor (TFRC), and nuclear receptor coactivator 4 (NCOA4)], and the levels of reactive oxygen species (ROS), malondialdehyde (MDA), and ferrous ion (Fe²⁺). Results: The in vivo experiment confirmed a significant increase in the iron accumulation in senescence ovaries (P<0.01). The in vitro experiment confirmed that TG successfully induced the senescence model of SVOG cells and reduced cell viability (P<0.05). In the senescent cells, the expression of the ferroptosis-related protein GPX4 was decreased (P<0.000 1), while the expressions of TFRC and NCOA4 were increased (P<0.01). Furthermore, the levels of ROS, MDA and Fe²⁺, were all increased (P<0.01). Conclusions: Senescent ovarian granulosa cells display the iron accumulation and the elevated lipid peroxidation, and the increased ferroptosis sensitivity, indicating that ferroptosis participates in the regulation of ovarian granulosa cell aging.

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Analysis of the Impact of Lymphadenectomy on Survival in FIGO Ⅱ-Ⅳ Ovarian Mucinous Carcinoma Based on the SEER Database

FANG Jin, YANG Hui, WANG Zhi

2026, 45 (3): 184-189. doi: 10.12280/gjszjk.20260042

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Objective: To evaluate the relationship between the application of lymphadenectomy and overall survival in patients with FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma, and to explore whether this relationship differs by lymph node metastasis status. Methods: Based on the Surveillance, Epidemiology, and End Results(SEER) database, we retrospectively identified the patients diagnosed with primary FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma from 2004 to 2021. Clinical characteristics were compared between the patients who underwent lymphadenectomy and those who did not. Cox proportional hazard models were used to assess the association of lymphadenectomy and other clinical factors with overall survival, with stratified analysis conducted according to lymph node metastasis status. Results: A total of 726 patients were included, of whom 340 (46.8%) underwent lymphadenectomy. Among the 336 patients with pathological records of lymph nodes, 95 (28.3%) had lymph node metastasis. Compared with patients of the non-lymphadenectomy group, patients of the lymphadenectomy group were younger, had earlier FIGO stages and higher proportion of unilateral tumors, and were more likely to receive chemotherapy (all P<0.05). Multivariable Cox proportional hazard models analysis showed that lymphadenectomy was independently associated with longer overall survival (aHR=0.58, 95%CI: 0.48-0.70, P<0.001). Stratified analysis by lymph node metastasis status revealed that, compared with the patients of the non-lymphadenectomy group, the patients without lymph node metastasis who underwent lymphadenectomy had significantly longer overall survival (HR=0.41, 95%CI: 0.33-0.50, P<0.001), while no significant association was observed between lymphadenectomy and overall survival in those patients with lymph node metastasis (HR=0.87, 95%CI: 0.67-1.12, P=0.281). Conclusions: The clinical value of lymphadenectomy in FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma may primarily lie in accurate staging and prognostic stratification. However, direct survival benefit remains to be further verified. Clinical decision-making should comprehensively balance the surgical tolerance and the risk of nodal metastasis.

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Research on Dyadic Coping and Anxiety/Depression in Separated Couples with Infertility Undergoing IVF-ET Based on Actor-Partner Interdependence Model

DU Chao, CHENG Xu, YU Xin-tong, SUN Kai-xuan, ZHANG Qian, ZHOU Jing

2026, 45 (3): 190-195. doi: 10.12280/gjszjk.20260039

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Objective: The psychological health status of infertile couples is affected by the dyadic coping. This study was designed to explore the impact patterns of dyadic coping on the anxiety and depression in non-cohabiting infertile couples undergoing in vitro fertilization-embryo transfer (IVF-ET), based on the actor-partner interdependence model (APIM). Methods: A total of 187 non-cohabiting infertile couples undergoing IVF-ET at the reproductive medicine department of our hospital from March to August 2024 were selected. Data on age, duration of infertility, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and dyadic coping inventory (DCI) were collected. Correlation analysis and APIM were used to investigate the effects of dyadic coping on their negative emotions. Results: The prevalences of anxiety and depression were 19.25% (36/187) and 26.74% (50/187) in female partners, while 1.07% (2/187) and 15.51% (29/187) in male partners, respectively. In both male and female partners, the statistically significant differences were observed in SAS and SDS standard scores across different long-distance relationship duration groups, with the group of >5 years showing the highest scores (P<0.05). Standard scores of SAS and SDS in both spouses were negatively correlated with their own and their partners' total DCI scores (P<0.05). The APIM indicated that the negative emotions of the male partners were significantly influenced by both actor and partner effects (P<0.05). The negative emotions of female partners were only significantly influenced by their own actor effects (P<0.05), and the partner effects were not significant (P=0.128). Conclusions: Dyadic coping in non-cohabiting infertile couples exerts distinct actor and partner effects on the negative emotions, highlighting the need for tailored and evidence-based nursing interventions.

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Study on the Relationship among Pregnancy Stress, Psychological Resilience and Coping Styles in Patients with Non-Criteria Obstetric Antiphospholipid Syndrome

LIN Yin-cui, TENG Wei, CHEN Yan, WANG Shan-lin

2026, 45 (3): 196-203. doi: 10.12280/gjszjk.20260008

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Objective: To explore the relationship among pregnancy stress, psychological resilience and coping styles in patients with non-criteria obstetric antiphospholipid syndrome (NCOAPS), and to analyze the mediating effect of coping styles between psychological resilience and pregnancy stress. Methods: From September 2022 to September 2025, the NCOAPS patients admitted to our hospital were selected for investigation by convenience sampling method. The general information questionnaire, pregnancy pressure scale (PPS), connor-davidson resilience scale (CD-RISC), and simplified coping style questionnaire (SCSQ) were used to investigate. The relationship among pregnancy stress, psychological resilience, and coping styles in NCOAPS patients was analyzed. Results: Pearson correlation analysis showed that pregnancy stress in NCOAPS patients was negatively correlated with psychological resilience (r=-0.624, P<0.001), positively correlated with negative coping (r=0.538, P<0.001), and negatively correlated with positive coping (r=-0.487, P<0.001); and that psychological resilience was negatively correlated with negative coping (r=-0.512, P<0.001) and positively correlated with positive coping (r=0.596, P<0.001). Mediation analysis showed that the direct effect of psychological resilience on pregnancy stress in NCOAPS patients was significant, with an effect value of -0.489 (95%CI: -0.628--0.350), accounting for 68.39% of the total effect. Negative coping and positive coping had partial mediating effects between psychological resilience and pregnancy stress, with mediating effect values of -0.130 (95%CI: -0.209--0.079) and -0.096 (95%CI: -0.163--0.042), accounting for 18.18% and 13.43% of the total effect, respectively. The total indirect effect was -0.226 (95%CI: -0.312--0.119), accounting for 31.61% of the total effect. Effect size evaluation showed that there were large effect correlations between psychological resilience and pregnancy stress, positive coping, and negative coping (r≥0.50). Mediation analysis indicated that the individual mediating effects of negative coping (standardized effect= -0.164) and positive coping (standardized effect=-0.123) both reached medium levels, and the total indirect effect (standardized effect=-0.287) reached a large effect level. Regression model effect size evaluation showed that the predictive effect of psychological resilience on pregnancy stress was large (f ²=0.637, explaining 38.90% of variance). After controlling the psychological resilience, the incremental contribution of negative coping was a medium effect (f ²=0.232, incremental variance explained=14.20%), and the incremental contribution of positive coping was a small effect (f ²=0.091, incremental variance explained=5.60%). Conclusions: Pregnancy stress, psychological resilience, and coping styles are closely related in NCOAPS patients. Psychological resilience can directly affect pregnancy stress, and can also indirectly affect pregnancy stress through the mediating effects of positive and negative coping. Clinically, pregnancy stress can be alleviated by enhancing patients' psychological resilience and positive coping abilities, and reducing negative coping.

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Recurrence and Lung Metastasis of Uterine Inflammatory Myofibroblastic Tumor: A Case Report

WU Bo-ming, CHEN Zi-jun, PAN Ru, LUO Yu, YANG Hai-kun

2026, 45 (3): 204-208. doi: 10.12280/gjszjk.20250654

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Uterine inflammatory myofibroblastic tumor (UIMT) is an extremely rare mesenchymal tumor with intermediate biological potential. It is easily misdiagnosed at the initial presentation, with the risks of recurrence and metastasis. We report a case of a 54-year-old woman who underwent laparoscopic total hysterectomy with bilateral salpingectomy at another hospital after a uterine mass was detected. Six months after surgery, she developed abdominal distension and discomfort. Examination at our hospital suggested the recurrence of the pelvic tumor with pulmonary metastasis. She underwent an open pelvic adhesiolysis and pelvic mass resection, and the pathological diagnosis was inflammatory myofibroblastic tumor. The patient refused further treatment, and the tumor progressed more than two months after surgery. The diagnosis of UIMT mainly relies on immunohistochemical analysis and supplementary molecular testing. Accurate preoperative diagnosis is helpful for formulating a treatment plan, with the aim of improving the survival rate.

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Complete Androgen Insensitivity Syndrome Complicated with Bilateral Ovarian Gynandroblastoma: A Case Report

XIE Xiao-bing, HOU Tao

2026, 45 (3): 209-213. doi: 10.12280/gjszjk.20250562

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Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive genetic disease, which is caused by the mutations of androgen receptor gene. CAIS is relatively rare, and the cases complicated with gynandroblastoma are more rarer. We report a case that the karyotype is 46, XY, female gender and bilateral ovarian gynandroblastoma. The patient was a female aged 53 years, with primary amenorrhea. She was hospitalized due to dull pain in the lower abdomen. The female's secondary sexual characteristics and vulva development were normal. The levels of estradiol and inhibin B were increased before surgery. Imaging examination revealed a huge pelvic mass (about 16 cm in diameter) and unclear uterus. During the operation, the left ovarian tumor was seen, the appearance of the right adnexa was normal. The right adnexa was connected to a muscular tissue, the size of about 4 cm×2 cm, considered primordial uterus. The left adnexectomy was performed. The intraoperative frozen pathology showed a borderline or low-grade malignant tumor, and further comprehensive staged surgery was performed. The final diagnosis of postoperative pathology was gynandroblastoma. The karyotype analysis of peripheral blood was 46,XY. Such patients need early diagnosis and intervention, to fundamentally prevent the occurrence of gonadal tumors.

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Ovarian Nongestational Choriocarcinoma Presenting as Acute Abdomen: A Case Report

DAI Qi-sha, ZHANG Tian-hui, ZENG Wei-hong, HUANG Li-shan, LIU Hao-chang, YANG Hai-kun

2026, 45 (3): 214-217. doi: 10.12280/gjszjk.20260054

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Ovarian nongestational choriocarcinoma (ONGC) is an extremely rare malignant ovarian tumor, characterized by high malignancy and poor prognosis. Early diagnosis and prompt chemotherapy are crucial for improving outcomes; however, due to the lack of specific clinical manifestations and imaging features, preoperative misdiagnosis or missed diagnosis is common, leading to delayed treatment. We report a case of a 14-year-old female patient who presented with progressively worsening lower abdominal pain as the initial symptom, with no history of menarche or sexual activity. Preoperative magnetic resonance imaging revealed a right adnexal mass, and emergency ovarian cystectomy was performed. The postoperative immunohistochemical examination, combined with clinical history, confirmed the final diagnosis of ONGC. The patient received postoperative chemotherapy, but the disease progressed rapidly with multiple metastases to the lungs and gastrointestinal tract developing shortly after surgery, resulting in her death after 38 days of operation. Based on this case, serum β-human chorionic gonadotropin should be routinely tested in pediatric and adolescent patients with ovarian tumors, regardless of menstrual or sexual history. ONGC should be highly suspected when MRI demonstrates unilateral ovarian hypervascular cystic-solid masses with hemorrhage and necrosis. Once highly suspected or confirmed, early surgical resection of all lesions should be performed with fertility preservation if possible, followed by timely standardized postoperative chemotherapy. Residual disease after surgery and delayed treatment are two critical factors for poor prognosis. Given the highly malignant nature and rapid progression of this disease, emphasis should be placed on early diagnosis and treatment.

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Transabdominal Ultrasound-Guided Oocyte Retrieval in Ovulation Induction Cycle: A Report of Two Cases

ZHU Yan-jun, WEN Yi, GONG Fei

2026, 45 (3): 218-223. doi: 10.12280/gjszjk.20250446

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In the process of assisted reproductive treatment, when ovarian visualization is not possible with transvaginal ultrasound and oocyte retrieval via transvaginal approach is difficult, the transabdominal ultrasound-guided oocyte retrieval is a safe and effective alternative option. We report two cases of transabdominal oocyte retrieval. One patient with congenital anal atresia had a vaginal stoma created due to prolonged fecal infiltration, with a high risk of infection during vaginal egg retrieval. The ovaries could not be palpated vaginally; therefore, oocyte retrieval was performed under transabdominal ultrasound guidance. Another patient with multiple uterine fibroids; with an enlarged uterus, who had the right ovary inaccessible via vaginal ultrasound; therefore, the combined transvaginal and transabdominal ultrasound-guided oocyte retrieval was performed. Both procedures resulted in the successful oocyte retrieval and the formation of transplantable embryos, suggesting that for those patients with ovaries inaccessible via vaginal examination and who experienced difficulties with vaginal oocyte retrieval, the transabdominal oocyte retrieval may significantly improve the chances of obtaining oocytes and embryos, thus improve the outcomes of assisted reproduction. This technique is safe and highly operable, but preoperative evaluation of oocyte retrieval should be emphasized in clinical practice to fully anticipate the difficulty of oocyte retrieval. Multidisciplinary discussions involving radiology and other relevant departments, along with thorough communication with the patient, as to minimize the possible medical disputes.

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Mechanisms and Application Status of Melatonin in Protecting Ovarian Reserve Function

CHEN Wen-jun, XU Xian-li, ZHANG Yi-chao

2026, 45 (3): 224-229. doi: 10.12280/gjszjk.20250620

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Melatonin is an indoleamine hormone primarily synthesized by the pineal gland, known for its roles in regulating sleep, exerting antioxidant effects, and scavenging free radicals. Recent studies have found that melatonin can improve ovarian reserve function and delay ovarian aging through multiple mechanisms. Oxidative stress promotes follicular atresia and serves as a key pathological mechanism leading to diminished ovarian reserve. Melatonin can effectively counteract oxidative stress by scavenging free radicals, with a particular mitochondrial targeting capacity, can inhibit granulosa cell apoptosis and ferroptosis, and regulate autophagy to promote follicular development. Melatonin can modulate multiple signaling pathways including nuclear factor-erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE), phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), and silent information regulator 1 (SIRT1) to exert the ovarian protection. For example, melatonin has shown the promising application in mitigating the ovarian toxicity caused by radiotherapy or chemotherapy, and in fertility preservation. Clinical studies have demonstrated the potential value of melatonin in assisted reproductive technology, especially in patients with diminished ovarian reserve. However, the efficacy shows heterogeneity and lacks high-quality evidence-based medical support. Further studies are needed to clarify its therapeutic effects and optimize treatment strategies, thereby providing a foundation for the application of melatonin in the field of ovarian protection.

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Research Progress on the Mechanism of KIF18B in Female Reproductive Function

WANG Wei, DAI Bai, SHA Ri-na, TUO Ya

2026, 45 (3): 230-235. doi: 10.12280/gjszjk.20260032

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The maintenance and decline of female fertility is a complex physiological process. Kinesin family member 18B (KIF18B) maintains the genome stability by regulating spindle microtubule dynamics to ensure the accurate alignment and segregation of chromosomes. Given the critical role of KIF18B in cell division, its potential functions in the female reproductive system have also attracted attention. KIF18B may participate in oocyte maturation by affecting meiotic spindle assembly, and its association with signaling pathways such as phosphoinositide 3-kinase/protein kinase B/mechanistic target of rapamycin complex 1 (PI3K/Akt/mTORC1) suggests a potential role in primordial follicle activation and ovarian aging. In addition, the regulation of KIF18B on microtubule dynamics implies the involvement in endometrial structural remodeling. As an upstream regulatory node of the Wnt/β-catenin pathway, KIF18B influences the establishment of endometrial receptivity. Dysfunction of KIF18B, including the increased rate of oocyte aneuploidy, the diminished ovarian reserve, and the reduced endometrial receptivity could further increase the risk of adverse pregnancy outcomes. This review summarizes the molecular mechanisms and functions of KIF18B, elucidates its regulatory roles in key reproductive processes and the potential links between its dysfunction and poor pregnancy outcomes, and discusses its prospective value as a biomarker for assessing fertility.

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Research Progress on Comorbidity Mechanisms of Mental Disorders and Reproductive System Diseases

WEI Qian, HE Yu-jie

2026, 45 (3): 236-241. doi: 10.12280/gjszjk.20260024

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Both mental disorders and reproductive system diseases represent major challenges of global public health. The two conditions frequently co-occur clinically, mutually influencing each other and forming a vicious cycle. Research confirms that mental disorders share common pathophysiological mechanisms with female infertility, polycystic ovary syndrome, endometriosis, diminished ovarian reserve, recurrent implantation failure, recurrent spontaneous abortion, and male infertility. The core mechanisms primarily involve hormonal imbalance caused by dysfunction of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, activation of immune inflammation and alterations in the cytokine profile, oxidative stress damage to gametes and embryos, abnormal epigenetic regulation, and potential effects of the microbiota-gut-brain axis. These mechanisms intertwine to form a complex network, revealing both the biological nature of mental disorders as independent risk factors for reproductive system diseases, and elucidating the pathophysiological processes through which reproductive system diseases conversely increase susceptibility to mental disorders. However, the specific mechanisms underlying the comorbidity of mental disorders and reproductive system diseases are not completely clear. We review the research progress in the aforementioned comorbidity mechanisms, providing a theoretical basis for deepening our understanding of their intrinsic biological connections and developing interdisciplinary precision diagnosis and treatment strategies.

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Mechanism and Application of Gratitude Intervention in Psychological Adjustment of Infertile Individuals

SUN Ning, YANG Jin-ji, HU Chun-xiu

2026, 45 (3): 242-246. doi: 10.12280/gjszjk.20260126

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Infertile individuals frequently suffer from multidimensional psychological distress, such as anxiety, depression, and stigma. These psychological disturbances not only markedly impair their quality of life and treatment compliance, but also may compromise reproductive function via neuroendocrine and inflammatory pathways, thereby adversely affecting the outcomes of assisted reproductive technology (ART). Most clinical psychological interventions rely primarily on passive support and lack the structured training to strengthen the capacity of active emotional regulation. Accordingly, the efficacy in relieving psychological distress and improving ART outcomes remains limited in infertile patients. Gratitude intervention, as a vital intervention in positive psychology, exerts unique advantages by enhancing positive affect, strengthening social support, and boosting self-efficacy, while its neurobiological underpinnings are progressively being elucidated. It has exhibited promising application prospects across diverse patient groups. Although preliminary studies have indicated that gratitude interventions hold potential value in promoting psychological adjustment among infertile patients, the current evidence base remains limited. Future research is warranted to further validate its clinical efficacy and elucidate the underlying mechanisms.

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Research Progress on the Effect and Mechanism of Acupuncture Intervention at Different Stages of IVF-ET

KUANG Qian-qian, ZHAO Xian, ZHANG Ning, XI Jin, YUAN Rong-li, LIU Qi, WANG Meng-jing

2026, 45 (3): 247-252. doi: 10.12280/gjszjk.20260065

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As a core modality of assisted reproductive technology, in vitro fertilization-embryo transfer (IVF-ET) is limited by low clinical pregnancy rate, high risk of complications, and substantial psychological burden on patients. As a non-invasive and safe adjuvant therapy, acupuncture can be applied throughout the entire IVF-ET cycle, including preoperative preparation, ovulation induction, pre- and post-transfer periods, post-operative miscarriage prevention, and complication intervention. Acupuncture can effectively improve ovarian reserve and poor ovarian response, enhance endometrial receptivity, reduce the risk of complications such as ovarian hyperstimulation syndrome, and alleviate anxiety, depression, and oocyte retrieval pain. The mechanism underlying these effects is closely related to the regulation of the neuro-endocrine-immune network. The multi-target and multi-phase advantages of acupuncture provide a strategy of adjuvant therapy for elevating the clinical pregnancy rate of IVF-ET and optimizing overall treatment outcomes.

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Research Progress on the Mechanisms of Flavonoids in the Treatment of Endometriosis

LIU Ya-li, GU Jia-qi

2026, 45 (3): 253-258. doi: 10.12280/gjszjk.20260043

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Endometriosis (EMs) is a gynecological disorder characterized by chronic inflammation and estrogen dependence. Flavonoids, owing to their diverse pharmacological activities including anti-inflammatory, antioxidant, and anti-angiogenic effects, are a group of promising candidates in EMs treatment research. Flavonoids can intervene in the initiation and progression of EMs by targeting key pathological processes, such as chronic inflammation and immune dysregulation, estrogen dependence, angiogenesis, pain sensitization, as well as lesion invasion, migration and fibrosis. Different subclasses of flavonoids (including flavones, flavonols, flavanones, isoflavones, and flavanols) modulate key signaling pathways such as nuclear factor-κB (NF-κB), phosphoinositide 3-kinase/protein kinase B (PI3K/Akt), mitogen-activated protein kinase (MAPK), hypoxia-inducible factor-1α/vascular endothelial growth factor (HIF-1α/VEGF), and nuclear factor-erythroid 2-related factor 2 (Nrf2). Through these pathways, flavonoids may exert specific effects in suppressing inflammation, regulating estrogen metabolism and signaling, inhibiting angiogenesis, alleviating pain sensitization, suppressing cell invasion and migration, and reducing fibrosis. This review summarizes the mechanisms of multi-target and multi-pathway synergistic actions of flavonoids, to provide a theoretical foundation for promoting the application of flavonoids in the treatment of EMs.

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Research Progress on Screening for Female Pelvic Floor Dysfunction

LIANG Li-chun, MO Zhi-yuan, ZHONG Qing-mei, HUANG Jing, TANG Gui-yan

2026, 45 (3): 259-264. doi: 10.12280/gjszjk.20250632

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The prevalence of female pelvic floor dysfunction (PFD) ranges from 17.8% to 74.07%, which severely compromises the life quality and mental health of women. The screening modalities commonly used for PFD, such as pelvic organ prolapse quantification (POP-Q) staging system, standardized questionnaires, two-dimensional ultrasound and static MRI, are only capable of evaluating the static anatomical structure, yet they are highly subjective and lack the dynamic and functional assessment. Although emerging screening techniques exhibit respective advantages, they also present inherent limitations. High-density electromyography features high spatial resolution and enables precise localization of muscle injury, but entails high equipment costs. Three-dimensional/four-dimensional ultrasound and dynamic MRI allow a dynamic and functional evaluation, yet they are constrained by high costs and limited accessibility in primary care settings. Biomarker detection (e.g., 8-hydroxy-2'-deoxyguanosine, etc.) can provide molecular-level diagnostic evidence, but it still requires further validation with large clinical samples. Artificial intelligence prediction models demonstrate promising predictive performance, but lack the standardized multicenter validation. PFD screening is undergoing a transition from single-technique evaluation to multimodal integration. The establishment of a multimodal integration strategy, implementation of a hierarchical screening pathway, and formulation of individualized screening protocols are expected to achieve early detection, precise diagnosis, early intervention of PFD, and ultimately improve the life quality and prognosis of PFD patients.

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