Objective: To explore the clinical features and diagnostic key points of gynecological malignancies complicated with paraneoplastic syndrome (PS). Methods: A retrospective analysis was conducted on the clinical data of 10 patients with gynecological malignancies complicated with PS admitted at Peking University People, Hospital from January 2016 to June 2025. The pathological types, stages of tumors, manifestations of PS, treatment and prognosis of primary tumors and PS were analyzed. The outcomes were evaluated through telephone follow-up. Results: (1) Tumor pathological types: ovarian malignant tumors were the most common (7 cases). Among them, 2 out of 3 patients with high-grade serous carcinoma presented with neurological PS, 2 out of 3 patients with clear cell carcinoma had hypercalcemia-type PS. In addition, 3 cases were other types of gynecological malignant tumors, including 1 case each of pelvic malignant tumor (not surgically treated, likely originating from the uterus), vulvar malignant tumor, and endometrial stromal sarcoma. (2) Types of PS: involving the nervous system (3 cases), metabolic disorders (3 cases, all with hypercalcemia), immune system (3 cases), and respiratory system (1 case). (3) Temporal relationship: PS was discovered simultaneously with the tumor in 4 cases, PS preceded the tumor in 3 cases, and PS occurred within 5 years after surgery in 3 cases. (4) Prognosis: 3 cases survived with the disease, 4 cases died, and 3 cases were lost to follow-up. Conclusions: Patients with advanced ovarian malignant tumors are a high-risk group for PS. High-grade serous carcinoma is prone to be complicated by neurological damage of PS; clear cell carcinoma is prone to be complicated by hypercalcemia of PS, which is often a manifestation in the terminal stage of the tumor; for immune system damage of PS, it is associated with a wide spectrum of gynecological malignancies and is more common in patients with recurrence and metastasis.

Objective: To explore the perinatal outcomes and cost-effectiveness of posterior uterus approach combined with vascular occlusion in placenta percreta (PP). Methods: This study was a retrospective cohort study. Clinical data of 475 pregnant women with PP from six tertiary medical centers in China from January 2018 to April 2023 were collected. After propensity score matching, 324 pregnant women were included and divided into study group (posterior uterus approach combined with vascular occlusion, 162 cases) and control group (abdominal aortic balloon occlusion, 162 cases). The baseline characteristics, maternal and neonatal outcomes [including hysterectomy rate, intraoperative blood loss, blood transfusion rate, length of hospital stay, intensive care unit (ICU) transfer rate] and hospitalization costs were compared between the two groups. Incremental cost-effectiveness ratio (ICER) was used for cost-benefit analysis, and the willingness-to-pay threshold was set at 1 times of gross domestic product per capita in 2023 (CNY 91 700.0). Results: There were no significant differences in baseline characteristics of PP pregnant women between the two groups after matching. The hysterectomy rate (46.9% vs 16.1%), intraoperative blood loss (median: 1 450 vs 800 ml) and blood transfusion rate (77.8% vs 47.5%) in the study group were significantly higher than those in the control group, and the hospital stay was longer (median: 10 vs 7 days). However, the rate of postoperative ICU transfer (3.7% vs 13.6%) and secondary operation (0.0% vs 7.4%) in the study group were significantly lower than those in the control group (all P<0.05). There was no maternal death in the two groups, and there were no statistically significant differences in the incidence of urinary system injury, thrombosis and infection between the two groups (all P>0.05). The rate of neonatal intensive care unit (NICU) admission in the study group was significantly higher than that in the control group (50.6% vs 28.4%, P<0.001). In terms of hospitalization costs, the total hospitalization costs of the study group were significantly lower than those of the control group (median: CNY 29 361.8 vs 35 704.3, P<0.001). Cost-benefit analysis showed that taking non-ICU hospitalization as the effectiveness index, the cost of avoiding one case to be transferred to ICU in the study group was lower than that in the control group (CNY 29 996.5 vs 38 372.8), and the ICER was CNY 84 780.5, which was lower than the willingness-to-pay threshold, and the study group had economic advantages. Conclusions: It is effective for treating PP in posterior uterus approach combined with vascular occlusion. Although it is associated with higher hysterectomy rates and greater blood loss, it is relatively simpler to perform, and results in lower total hospitalization costs. It is suitable for areas with limited medical resources.

Objective: To determine whether intravenous drip of water-soluble vitamin for injection can serve as an effective, reliable, economical, convenient and rapid biomarker for assessing ureteral patency during cystoscopy in patients undergoing transvaginal high uterosacral ligament suspension (TVHUS). Methods: During transvaginal reconstructive pelvic surgery, 20 ml of water-soluble vitamin for injection was administered intravenously 10-15 minutes prior to cystoscopy following completion of high uterosacral ligament suspension, accompanied by intravenous infusion of 20 mg furosemide. The administration time, as well as the start and end times of cystoscopy, were recorded, along with the duration required for ureteral urine staining. Results: From March 2005 to March 2025, over the past 20 years, the Fourth Medical Center, Chinese PLA General Hospital has performed a total of 1 825 TVHUS. 10 to 15 minutes before the scheduled cystoscopy during the operation, water-soluble vitamin for injection was intravenously dripped. Under the condition of ensuring the fluid balance throughout the patient's body, yellowing of urine was observed under cystoscopy in all cases, confirming the patency of ureter during the operation. In 1 808 cases (99.07%, 1 808/1 825), bilateral ureters were observed to spray urine during intraoperative cystoscopy. In 17 cases, only one ureter was observed to spray urine during intraoperative cystoscopy. Among them, 3 cases were caused by atrophy of one kidney, and the affected ureter had no spray urine. The remaining 14 cases (0.77%, 14/1 825) were considered to be caused by ureteral obstruction or distortion during the suture of the uterosacral ligament during the operation; after the uterosacral ligament suture was immediately removed and re-sutured, cystoscopy was performed again and it was found that the bilateral ureters sprayed urine smoothly. Conclusions: Water-soluble vitamin for injection represents a safe, effective, and cost-efficient approach that enhances cystoscopic visualization of ureteral patency during TVHUS, thereby reducing the incidence of intraoperative ureteral obstruction. This method is worthy of widespread adoption.

Objective: To evaluate the prevalence of endometrial stromal plasma cell infiltration in infertile women undergoing frozen-thawed embryo transfer (FET), assess the ability of routine non-invasive clinical indicators to identify plasma cell infiltration, explore plasma cell thresholds using minimal endometrial sampling combined with cluster of differentiation 138 (CD138)+multiple myeloma antigen 1 (MUM-1) double immunohistochemical staining for chronic endometritis (CE), and analyze pregnancy outcomes after standardized treatment. Methods: Infertile women scheduled for FET between March 2023 and March 2025 at Guangdong Provincial Hospital of Chinese Medicine were enrolled. Patients were divided into biopsy (n=117) and non-biopsy groups (n=919). Endometrial samples in the biopsy group were examined using CD138+MUM-1 double immunohistochemical staining, and patients with at least one dual-positive plasma cell received standardized antimicrobial treatment. Logistic regression was used to analyze factors associated with plasma cell infiltration. Propensity score matching (PSM) was applied to balance baseline characteristics between the two groups, and pregnancy outcomes were compared. Results: A total of 1 096 patients with 1 483 embryo transfer cycles were included, including 177 patients in the biopsy group, 113 cases were dual-positive plasma cell, the plasma cell infiltration positivity rate was 63.8% (113/177); and the post-treatment conversion-to-negative rate was 86.2% (81/94). No significant associations were found between plasma cell infiltration and age, body mass index, anti-Müllerian hormone level, duration of infertility, or reproductive history (all P>0.05). After PSM, the pregnancy rate was significantly higher in the biopsy group (180 cycles) than that in the non-biopsy group (463 cycles), the pregnancy rates were 56.7% (102/180) vs 45.1% (209/463; P=0.009); subgroup analyses showed significantly improved pregnancy rates in patients with 1-4 or 5-10 plasma cells (all P<0.05). Miscarriage rates did not differ significantly between the two groups (P>0.05). Conclusions: Routine non-invasive clinical indicators are insufficient for identifying CE. Minimal endometrial sampling combined with CD138+MUM-1 double immunohistochemical staining has substantial diagnostic value, and even low-level plasma cell infiltration (1-4 cells) may be clinically meaningful. Targeted endometrial histological assessment and standardized treatment in patients likely to benefit may improve pregnancy outcomes.

Objective: To investigate the effect of gestational weight gain (GWG) on the incidence of pre-eclampsia (PE) and to establish an ideal GWG range for preventing PE based on pre-pregnancy body mass index (BMI) stratification. Methods: The clinical data of 87 109 singleton pregnant women who delivered in Women's Hospital, Zhejiang University School of Medicine from January 2017 to December 2022 were retrospectively analyzed. Pregnant women were divided into PE group (n=2 900) and non-PE group (n=84 209) according to the presence or absence of PE. Pregnant women with severe PE (sPE) in the PE group were divided into sPE subgroup (n=1 376). Pregnant women were stratified into three groups according to their pre-pregnancy BMI: non-overweight/obesity, overweight and obesity. Multivariate logistic regression was used to analyze the effect of pre-pregnancy BMI on PE. Restricted cubic spline (RCS) model was used to fit the dose-response curve, and the relationship between the deviation of GWG from the recommended midpoint of the "Recommendations for Gestational Weight Gain in Pregnant Women (WS/T 801-2022)" and the incidence of PE was analyzed. The ideal GWG range for preventing PE in each pre-pregnancy BMI stratification was also inferred. Results: (1) In the non-PE group, the proportions of non-overweight/obesity, overweight and obesity were 87.07% (73 322/84 209), 11.18% (9 412/84 209) and 1.75% (1 475/84 209), respectively. In the PE group, the non-overweight/obesity, overweight and obesity accounted for 63.14% (1 831/2 900), 26.10% (757/2 900) and 10.76% (312/2 900), respectively. In the sPE subgroup, non-overweight/obesity, overweight and obesity accounted for 65.77% (905/1 376), 24.13% (332/1 376) and 10.10% (139/1 376), respectively. Compared with the non-PE group, the PE group and the sPE subgroup had a significantly higher proportion of pre-pregnancy overweight and obesity (all P<0.001). (2) After adjusting for covariates, the risk of PE in both overweight (aOR=2.49, 95%CI: 2.25-2.76) and obesity (aOR=5.57, 95%CI: 4.80-6.47) group was significantly higher than that in non-overweight/obesity group (all P<0.001). (3) RCS curve analysis showed that the risk of PE in pregnant women with different pre-pregnancy BMI levels increased in a dose-dependent manner with the deviation value of GWG. (4) The optimal GWG for PE prevention was generally located in the lower part of the recommended range of WS/T 801-2022 standard. The suggested GWG for non-overweight and obese pregnant women, overweight and obese pregnant women were 8.6-12.5 kg, 4.0-7.5 kg and 3.0-4.3 kg, respectively. Conclusion: Pre-pregnancy overweight or obesity significantly increased the risk of PE. It is suggested that the ideal GWG range for PE prevention should be controlled at the lower end of the recommended range of WS/T 801-2022 standard. Women who are overweight or obese before pregnancy should adopt more conservative weight management strategies to reduce the risk of PE.

Objective: To evaluate the efficacy and safety of laser therapy in human immunodeficiency virus (HIV)-negative women with high-grade anal intraepithelial neoplasia (HGAIN). Methods: This study was a retrospective clinical study. HIV-negative patients who were first diagnosed with HGAIN in Obstetrics and Gynecology Hospital of Fudan University from January 2021 to June 2025 were included. All patients received CO₂ laser therapy at intervals of 4-6 weeks, for a maximum of four sessions. Treatment response was assessed 4-6 weeks after the final session via high-resolution anoscopy (HRA). Patients who achieved complete remission (CR) began follow-up at 6 months post-treatment, with subsequent surveillance including cytology, human papillomavirus (HPV) testing, HRA, and biopsy (if indicated) every 6-12 months to monitor recurrence. Results: A total of 64 patients were included, with a median age of 47.5 years (range: 25.0-68.0 years). Comorbid immune system diseases were found in 38% (24/64) of patients, HPV 16/18 infection rate was 70% (45/64), and 70% (45/64) had a lesion area≤50%. Eleven patients were lost to follow-up, and 53 patients were finally included in the efficacy analysis. The CR rate of laser therapy was 85% (45/53). Compared with the CR group, patients with persistent lesions were older (median age: 37.0 vs 52.5 years, P=0.028) and had a higher proportion of lesions>50% [22% (10/45) vs 5/8, P=0.033]. Among 45 patients with CR, the median follow-up was 11 months (range: 6-46 months), the recurrence rate was 40% (18/45), and the 1-year recurrence-free survival rate was 67.7%. Comorbid immune system disease was an independent risk factor for recurrence (HR=6.513, 95%CI: 1.866-22.735, P=0.003). The incidence of treatment-related adverse events was 64% (34/53), all of which were mild, mainly anal pain or discomfort (40%, 21/53) and mild bleeding (32%, 17/53), with no severe complications. Conclusions: CO₂ laser therapy is an effective and well-tolerated treatment for HGAIN in HIV-negative women, yielding a high CR rate and a favorable safety profile. Comorbid immune system disease is an independent risk factor for post-treatment recurrence, highlighting the need for enhanced follow-up and individualized management in these patients.

Objective: To explore the baseline demographic characteristics of women seeking induced abortion, the proportion of repeat induced abortion, the trend from 2019 through 2021 and risk factors of repeat induced abortions within the framework of the Prospective Cohort of Induced Abortion and Future Pregnancy Outcomes. Methods: Based on the Prospective Cohort of Induced Abortion and Future Pregnancy Outcomes, women seeking abortion due to unwanted pregnancy were recruited from 10 clinical research centers across the country, and a structured questionnaire was used to collect information on age, marital status, pregnancy and childbirth status, and induced abortion and so on. Baseline data of subjects recruited from the beginning of the cohort in 2019 to the end of 2021 were extracted for this study, and were statistically analyzed using the SPSS 22.0 software. χ2 test was used to compare the differences between years and characteristics associated with repeat induced abortion, linear by linear association test was used for the trend test, and logistic regression analysis was performed to identify risk factors of repeat induced abortion. Results: A total of 8 990 women with complete key baseline information from the beginning of the cohort in 2019 to the end of 2021 were included in this study. (1) The average age at the time of induced abortion was (28.9±5.1) years (range: 16-49 years); among all these women, 64.2% (5 776/8 990) were aged 25-34 years, 27.8% (2 496/8 990) were unmarried, 70.9% (6 378/8 990) had junior college or above educational background, and 48.8% (4 391/8 990) were clerks (including teachers, doctors, civil servants, etc.). (2) The proportion of repeat induced abortion was 43.3% (3 897/8 990), with no statistical significance between different years (P>0.05). (3) Age, marital status, education, occupation, smoking, alcohol consumption, number of children and reason for current unintended pregnancy were independent risk factors for repeat induced abortion (all P<0.05). The strongest factors associated significantly with repeat induced abortion were: age≥40 years (OR=17.249, 95%CI: 9.535-31.203), remarried, divorced or widowed (OR=2.209, 95%CI: 1.595-3.059), frequency of alcohol consumption>1 drink/week (OR=2.098, 95%CI: 1.239-3.550), frequency of smoking≥5 cigarettes/day (OR=1.938, 95%CI: 1.267-2.966), number of children≥2 (OR=1.643, 95%CI: 1.356-1.992), master's degree or higher education level (OR=0.351, 95%CI: 0.267-0.460). Conclusions: The 2019 to 2021 baseline information of the cohort reveals the characteristics of women seeking abortions, with the situation of repeated induced abortion still serious. Women who are with advanced maternal age, low educational level, unstable marital status, unemployed, smoking, drinking, with high frequency of sexual exposure, having more children, and using contraception but contraceptive failure in current unintended pregnancy carry an increased risk of repeat induced abortions. There is an urgent need for effective tertiary prevention interventions for unintended pregnancy and subsequent induced abortion, including early and universal access to sexual and reproductive health education, contraceptive delivery services, postpartum contraceptive services and emergency contraceptive services, and sustaining and strengthening post abortion care services. Promoting consistent and correct use of highly effective contraception is critical.

Objective: To investigate optimal long-term medication regimens combined with focused ultrasound ablation surgery (FUAS) for alleviating dysmenorrhea in patients with extrinsic adenomyosis. Methods: A retrospective research enrolled patients with extrinsic adenomyosis diagnosed by pelvic magnetic resonance imaging and presenting with significant dysmenorrhea symptoms, who underwent FUAS treatment at Qingdao Women and Children's Hospital from December 2019 to December 2023. Patients were divided into two groups based on postoperative treatment regimens: FUAS+gonadotrophin-releasing hormone agonist (GnRH-a)+levonorgestrel-releasing intrauterine system (LNG-IUS) group (Group LNG-IUS) and FUAS+GnRH-a+dienogest group (Group DNG). Clinical characteristics, imaging data, and treatment outcomes of the patients were retrospectively analyzed. Patients were followed up for 12 to 60 months to compare symptom improvement, recurrence rates, and adverse events among different treatment modalities. Results: (1) Clinical data: a total of 87 patients were included, with a mean age of (39.0±5.2) years, a median dysmenorrhea score of 8 and a median course of disease of 5 years. Group LNG-IUS comprised 53 patients with an average age of (40.2±5.2) years and a median dysmenorrhea score of 7 (including 34 cases of severe pain and 17 cases of moderate pain), among whom 24 patients (45.3%, 24/53) had deep infiltrating endometriosis (DIE). Group DNG had 34 patients with an average age of (37.1±4.5) years and a median dysmenorrhea score of 8 (including 21 cases of severe pain and 11 cases of moderate pain), among whom 25 patients (73.5%, 25/34) had DIE. (2) FUAS treatment information: in Group LNG-IUS, the average operation time was (82±29) minutes, with a median irradiation time of 570 s and an average ablation rate of (60.4±22.6)%. In Group DNG, the average operation time was (80±35) minutes, with a median irradiation time of 518 s and an average ablation rate of (58.7±17.8)%. No significant differences were observed in FUAS treatment parameters between the two groups (all P>0.05). (3) Follow-up: dysmenorrhea scores of both groups were significantly lower post treatment (all P<0.001). Different postoperative treatment regimens affected treatment outcomes (P=0.018). Long-term follow-up showed a significant difference in treatment effectiveness between the two groups (P<0.05). Uterine volume had significantly decreased in both groups compared to before treatment (all P<0.001). (4) Adverse events: adverse events during FUAS procedure were all classified as Society of Interventional Radiology (SIR) A-B, and drug-related adverse events were all grade 1-2, with no serious adverse events occurring in either group. Conclusions: Adjuvant therapy with GnRH-a and LNG-IUS or sequential dienogest after FUAS could effectively relieve dysmenorrhea in extrinsic adenomyosis patients, achieving favorable medium- and long-term therapeutic effects. The choice of medication regimen could be based on the patients' condition and personal preference. For patients with coexisting DIE, after contraindications are ruled out, sequential dienogest after FUAS combined with GnRH-a is a viable option.

Objective: To investigate the effects and underlying mechanisms of the recombinant bee venom peptide LSSDR412 on the malignant biological behavior of cervical cancer in vitro and in vivo, and to provide a theoretical basis for its potential clinical translation. Methods: Peptide LSSDR412 was obtained by chemical synthesis. Different concentrations of LSSDR412 were used as treatment groups. The effects of peptide LSSDR412 on the survival and proliferation of cervical cancer cell lines (Hela cells and Caski cells) were detected by cell counting kit-8 (CCK-8) and clone formation assay. Transwell chamber assay was used to detect the effect on cell migration and invasion. Western blot and co-immunoprecipitation assay were used to detect the expression and interaction of epithelial-mesenchymal transition (EMT) and Wnt/β-catenin signaling pathway related proteins. The cervical cancer xenograft model was established in nude mice, and the volume of subcutaneous xenograft tumor was detected after intraperitoneal injection of LSSDR412. The expression of the proliferation associated nuclear antigen (Ki-67) was detected by immunofluorescence. The lung metastasis model of cervical cancer bearing nude mice was established, and HE staining was used to detect the effect of intraperitoneal injection of LSSDR412 on lung metastasis. Results: Compared with the cells without LSSDR412 treatment, the survival rate, clone number, invasive and migratory cell number of Hela and Caski cells were significantly decreased after LSSDR412 treatment (all P<0.05), and showed a concentration-dependent trend. LSSDR412 could inhibit the EMT process of cervical cancer and inhibit the Wnt/β-catenin signaling pathway through Claudin-4 (CLDN4) to play an anti-cervical cancer effect. The results of in vivo experiments showed that the tumor weight of the LSSDR412 group was significantly lower than that of the control group [(0.292±0.073) vs (0.480±0.117) g; t=3.341, P=0.008]. The positive rate of Ki-67 in tumor tissue was significantly lower than that in the control group (21.95%±5.60% vs 87.27%±6.35%; t=26.72, P<0.001), and the proportion of intrapulmonary metastases was significantly lower than that of the control group [25.0% (16.3%, 45.0%) vs 39.1% (31.3%, 48.3%); U=31.00, P=0.044]. There was no significant pathological change in liver and kidney tissue structure in the LSSDR412 group. Conclusions: Peptide LSSDR412 shows significant inhibitory effects on the proliferation, migration and invasion of cervical cancer cells both in vitro and in vivo with no apparent toxic side effects. Its antitumor activity is primarily mediated through the suppression of the CLDN4-mediated Wnt/β-catenin signaling pathway.