Menstrual Volume Research Articles

Comparation of abdominal aortic balloon occlusion versus uterine artery embolization in the treatment of cesarean scar pregnancy.

This study is to uncover the advantages of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). To retrospectively analyze the clinical data of eighty patients with CSP after treatment in our hospital from 01/10/2019 to 01/05/2021. The 80 patients were divided into 2 groups: 41 patients were treated with abdominal aortic balloon occlusion and the control group (n = 39) underwent Uterine artery embolization (UAE). The amount of bleeding during the operation, the operation time of the uterine curettage, the X-ray fluoroscopy time under DSA, the surface dose in radiation, the length of hospital stay (LOS), and the postoperative complications were compared between these 2 groups (type II and type III). All the operations successfully retained the uterus. No balloon-related complications occurred in the experimental group. And in the control group, there were 14 cases of fever and 19 cases of pain after UAE. The fluoroscopy time of experimental group and control group were: (type II: (20.3 ± 7.1)s vs. (593.7 ± 284.5)s, p < 0.01), (type III: (21.2 ± 7.2)s vs. (509.8 ± 164.2)s, p < 0.01), the surface dose in radiation: (type II: (1.9 ± 0.7)mGy vs. (248.3 ± 85.9)mGy, p < 0.01), (type III: (2.1 ± 0.8)mGy vs.(252.0 ± 74.9)mGy, p < 0.01), the amount of bleeding during the operation: (type II:30.0(20.0, 50.0)ml vs. 20.0(10.0, 50.0)ml, p = 0.113), (type III:50.0 (17.5,162.5)ml vs. 50.0 (22.5, 72.5)ml, p = 0.623), the operation time of the uterine curettage:(type II: (54.8 ± 19.4)min vs.(43.9 ± 21.9)min, p = 0.071), (type III: (65.2 ± 50.4)min vs.(52.8 ± 20.1)min, p = 0.426), LOS: (type II:(5.4 ± 1.7)d vs.(5.4 ± 1.2)d, p = 0.816), (type III:(5.8 ± 2.4)d vs. (7.0 ± 1.7)d, p = 0.161). The follow-up was more than 3 months. No adverse reaction in the experimental group and 6 patients in the control group presented menstrual volume decrease. No balloon-related complications occurred in the abdominal aortic balloon occlusion and lower radiation exposure for both the operator and patient. And both abdominal aortic balloon occlusion and UAE can effectively reduce the bleeding during uterine curettage in patients with type II and III CSP.

The efficacy of levonorgestrelintrauterine system, drospirenone & ethinylestradiol tablets (II) and dydrogesterone in preventing the recurrence of endometrial polyps.

To analyze the efficacy of levonorgestrelintrauterine system, Drospirenone & ethinylestradiol tablets (II), and dydrogesterone in preventing the recurrence of endometrial polyps after hysteroscopic endometrial polypectomy. One hundred seventy patients who underwent hysteroscopic endometrial polypectomy in the Gynecology Department of Tianmen First People's Hospital in Hubei Province from January 2022 to June 2023 were randomly divided into the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, dydrogesterone group, and a control group. The recurrence rates, endometrial thickness, and menstrual volume changes at 6 and 12months post-operation were compared among these four groups. The recurrence rates in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group were lower than the control group, with statistical significance (P < 0.01), with the levonorgestrelintrauterine system group having the lowest recurrence rate. The endometrial thickness at 6 and 12months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was thinner than that of the control group and thinner than pre-operation, with statistical significance (P < 0.01). The menstrual volume at 3months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was significantly less than the control group, and less than the pre-operation volume. Dydrogesterone, drospirenone & ethinylestradiol tablets (II), and levonorgestrelintrauterine system all play a role in preventing the recurrence of endometrial polyps, but levonorgestrelintrauterine system is significantly better than dydrogesterone and Drospirenone & ethinylestradiol tablets (II) in terms of postoperative recurrence rate, endometrial thickness, menstrual changes, and compliance, and is worth promoting in clinical application.

The Sweet Relationship between the Endometrium and Protein Glycosylation.

The endometrium is an important part of women's bodies for menstruation and pregnancy. Various proteins are widely expressed on the surface of endometrial cells, and glycosylation is an important post-translational modification of proteins. Glycosylation modification is closely related not only to endometrial receptivity but also to common diseases related to endometrial receptivity. Glycosylation can improve endometrial receptivity, promote embryo localization and trophoblast cell adhesion and invasion, and contribute to successful implantation. Two diseases related to endometrial receptivity include endometriosis and endometrial cancer. As a common benign disease in women, endometriosis is often accompanied by an increased menstrual volume, prolonged menstrual periods, progressive and aggravated dysmenorrhea, and may be accompanied by infertility. Protein glycosylation modification of the endometrial surface indicates the severity of the disease and may be an important pathogenesis of endometriosis. In cancer, glycosylation modifications on the surface of tumor cells can be a marker to distinguish the type and severity of endometrial cancer. This review highlights the role of protein glycosylation in embryo-maternal endometrial dialogue and explores its potential mechanisms in diseases related to endometrial receptivity, which could provide a new clinical approach for their diagnosis and treatment.

Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy

Purpose To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. Materials and methods A total of 75 patients diagnosed with types 0–III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group). Results The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score. Conclusion HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.

Efficacy of hysteroscopic levonorgestrel‑releasing intrauterine device fixation in the treatment of adenomyosis: A cohort study.

The present study aimed to investigate the efficacy of hysteroscopic levonorgestrel-releasing intrauterine device (LNG-IUD) fixation surgery in the treatment of adenomyosis through a cohort study. The cohort study was performed at the Affiliated Jinhua Hospital of Wenzhou Medical University (Jinhua, China). A total of 31 women with adenomyosis were initially recruited from June 2020 to June 2022 and divided into an experimental group and a control group. The experimental group underwent hysteroscopic LNG-IUD fixation surgery and the control group underwent conventional implantation of the levonorgestrel-releasing intrauterine system. The assessed efficacy outcomes included the time of LNG-IUD expulsion, postoperative vaginal bleeding time, dysmenorrhea, and the menstrual blood loss score (MBLS). A total of 31 participants completed the research. The LNG-IUD expulsion rate was 6.25 and 60% (P<0.05) in the experimental and control group, respectively. The LNG-IUD in place time was 20.50 months (Q1, 15.75; Q3, 24.00) in the experimental group and 10.00 months (Q1, 6.50; Q3, 15.00) in the control group (P<0.05); the time of vaginal bleeding after surgery in the experimental and control groups were 12.50 days (9.25, 16.25) and 120.00 days (75.00, 120.00), respectively (P<0.05). Multiple-factor Cox regression analysis revealed that the LNG-IUD expulsion in patients with adenomyosis is associated with the hysteroscopic LNG-IUD fixation surgery [hazard ratio (HR), 1954.09], uterine cavity depth (HR, 16.63), MBLS (HR, 1.14), history of gonadotropin-releasing hormone agonist treatment in the previous 6 months (HR, 2.10), history of vaginal delivery (HR, 1.79) and history of cervical laceration (HR, 3.69). In conclusion, hysteroscopic LNG-IUD fixation reduces the rate of LNG-IUD expulsion, prolongs the time of LNG-IUD in the uterine cavity, reduces the time of postoperative vaginal bleeding, relieves the symptoms of dysmenorrhea and reduces the menstrual volume in the patients with adenomyosis. The present trial was retrospectively registered in the Chinese Clinical Trial Registry on 28th December 2023 (registration no. ChiCTR2300079233).

Association between dietary fat intake and risk of polycystic ovary syndrome

To analyze the association between dietary fat intake and the risk of polycystic ovarian syndrome(PCOS). PCOS patients treated in a tertiary hospital in Anhui Province from October 2021 to October 2022 were selected as the case group, and non-PCOS patients treated in the hospital during the same period were selected as the control group. A total of 262 subjects were included in the study, 131 were included in the case group and 131 in the control group. A semi-quantitative dietary frequency questionnaire was used to investigate the dietary intake in the past year, and the daily intake of various fatty acids and the ratio of fatty acid energy supply were calculated according to the food intake. Logistic regression analysis was used to investigate the association between dietary fat intake and the risk of PCOS. The dietary intakes of total fat, fatty acid, saturated fatty acid and monounsaturated fatty acid in PCOS patients were higher than those in control group(P&gt;0.05), and there was statistical significance in daily intakes of eicosapentaenoic acid between two groups(P&lt;0.05). After adjusting for confounding factors such as long-term residence, occupation, family per capita monthly income, menstrual cycle regularity, menstrual volume, and weight loss experience, Logistic regression analysis showed that the ratio of fat supply to energy was positively correlated with the risk of PCOS(OR=1.622, 95%CI 1.237-2.127). The energy supply ratio of monosaturated fatty acids(OR=0.597, 95%CI 0.373-0.955) and polyunsaturated fatty acids(OR=0.585, 95%CI 0.372-0.921) were negatively correlated with the risk of PCOS(P&lt;0.05). The energy supply ratio of fat was positively correlated with the risk of PCOS, while the energy supply ratio of monosaturated fatty acids and the energy supply ratio of polyunsaturated fatty acids were negatively correlated with the risk of PCOS.

High-intensity focused ultrasound for endometrial ablation in adenomyosis: a clinical study.

The present study aimed to investigate the clinical efficacy of endometrial ablation with high-intensity focused ultrasound (HIFU) for symptom relief in women with adenomyosis. Between July 2014 and July 2020, 167 patients with adenomyosis treated at the Zhongshan City People's Hospital were enrolled in this study. Patients were divided into two groups according to patient aspirations: the control group, including patients who only underwent ablation of adenomyosis lesions (group A) and the treatment group, including patients who underwent removal of adenomyosis lesions and endometrial ablation (group B). The reduced dysmenorrhea scores (visual analog scale) and menstrual volume scores (pictorial blood assessment chart) were measured before and after treatment. The scores were obtained by subtracting the postoperative scores from the preoperative scores and were compared to determine whether the symptoms had alleviated. Compared with the menstrual volume of group A, that in group B showed significant improvements. The average relief rates of dysmenorrhea in the two groups also showed significant improvement. However, the scores in group B showed a more significant improvement than those in group A. Therefore, our findings suggest that endometrial ablation using HIFU may be superior to conventional therapy with regard to alleviating the symptoms of increased menstruation in women with adenomyosis.

Efficacy of Kirin pill plus vitamin CE and coenzyme Q10 in the treatment of ovarian reserve hypofunction

Purpose: To investigate the efficacy of Kirin pill plus vitamin CE and coenzyme Q10 in the treatment of diminished ovarian reserve (DOR). &#x0D; Methods: 145 patients with ovarian reserve hypofunction hospitalized in Xiangyang Central Hospital, Xiangyang City, China from March 2019 to March 2022 were recruited and assigned randomly to receive either vitamin CE and coenzyme Q10 (control group), or vitamin CE and coenzyme Q10 plus Kirin pills (study group). The parameters/indices determined include menstrual recovery, clinical efficacy, sex hormone and serum anti-mullerian hormone (AMH) levels, changes in the number of ovarian sinus follicles, and levels of CD3+, CD4+ and CD8+ T cell. &#x0D; Results: There were no significant differences (p &gt; 0.05) observed among baseline data, pre-treatment sex hormones, serum AMH, ovarian antral follicle count, CD3+, CD4+, and CD8+ T cell levels. After the intervention, administration of the Kirin pill resulted in significantly lower serum follicle stimulating hormone (FSH) and FSH/luteinizing hormone (LH), elevated AMH levels, and better LH and estradiol (E2) levels in patients compared to the administration of vitamin CE and coenzyme Q10 (control group). The study group also showed superior ovarian reserve function and more ovarian basal sinus follicles than the control group (p &lt; 0.05). &#x0D; Conclusion: Kirin pill plus vitamin CE and coenzyme Q10 treatment regimen optimizes the ovarian reserve function of patients with DOR infertility by improving basal sex hormones, menstrual cycle and menstrual volume, AMH and ovarian basal sinus follicle count. Further clinical trials are required prior to application in clinical practice.

Analysis of related factors influencing postoperative recurrence of adenomyosis treated with HIFU.

To analyze the efficacy of high-intensity focused ultrasound (HIFU) for adenomyosis and postoperative recurrence and its influencing factors. Clinical and follow-up data of 308 patients with adenomyosis who were treated with HIFU in Haifu Center, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from September 2017 to January 2022 were retrospectively analyzed. The recurrence of adenomyosis and the efficacy of HIFU at 6months after surgery were followed up. To explore factors influencing postoperative prognosis and recurrence, the following variables were analyzed: patients' age, course of disease, gravidity and parity, size of the uterus, duration of HIFU, duration of irradiation, treatment intensity, dysmenorrhea score, time of follow-up, combined treatment of traditional Chinese medicine (TCM), western medicine adjuvant treatment, lesion location and type, and menorrhagia. Among the 308 patients, 238 (77%) were followed up from 6 to 36months, with an average follow-up time of 15.24 ± 9.97months. The other 70 (23%) were lost to follow-up. At 6-month after surgery, efficacy rates of dysmenorrhea and menorrhagia management were 86.7% and 89.3%, respectively. Postoperative recurrence rates were 4.8% (1-12months), 9.0% (12-24months), and 17.0% (24-36months) for dysmenorrhea; and 6.3% (1-12months), 2.4% (12-24months), and 12.2% (24-36months) for menorrhagia. Multivariate logistic regression analyses showed that parity (P = 0.043, OR = 1.773, 95% CI 1.018-3.087), uterine size (P = 0.019, OR = 1.004, 95% CI 1.001-1.007), combined treatment of TCM (P = 0.047, OR = 1.846, 95% CI 1.008-3.381), diffuse lesion type (P = 0.013, OR = 0.464, 95% CI 0.254-0.848) and ablation rate (P = 0.015, OR = 0.481, 95%CI 0.267-0.868) were prognostic factors (P < 0.05). Age, course of disease, gravidity, duration of HIFU, duration of irradiation, treatment intensity, preoperative dysmenorrhea score, time of follow-up, western medicine adjuvant therapy, lesion location, and preoperative menstrual volume had no effect on prognosis (P > 0.05). HIFU can effectively relieve dysmenorrhea and reduce menstrual volume in patients with adenomyosis. Parity, uterine size, lesion type (diffuse), and ablation rate are risk factors for symptom recurrence after HIFU, while the combination of TCM therapy is a protective factor for relapse. We, therefore, recommend TCM in the adjuvant setting after HIFU according to patient condition.

Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial

ObjectiveTo evaluate menstrual cup use and intrauterine device (IUD) expulsion. Study designWe performed a secondary analysis of a 3-year contraceptive efficacy trial comparing two copper 380 mm2 IUDs. Investigators randomized participants approximately 1:4 to the TCu380A or NTCu380-Mini IUD. Approximately 12 months after enrollment began, we advised participants against menstrual cup use due to observed IUD expulsions in cup users. We evaluated IUD expulsion (including spontaneous partial and complete expulsion and accidental self-removal) at 12 and 36 months. We used multivariable logistic regression to evaluate IUD expulsion by age, baseline menstrual volume, body mass index, IUD type, menstrual cup use, parity, and uterine length. ResultsThis analysis included 1046 participants (203 TCu380A and 843 NTCu380-Mini), with 879 (84.0%) nulliparas. Through 12 and 36 months, expulsion occurred in 74 (7.1%, 95% CI 5.5–8.6%) and 133 (12.7%, 95% CI 10.7–14.7%) participants, respectively. Overall, 250 (23.9%) reported menstrual cup use. More menstrual cup users than non-users experienced expulsion through 12 months (32/203 [15.8%] vs. 42/843 [5.0%]) and 36 months (58/250 [23.2%] vs. 75/796 [9.4%]). Through 36 months, NTCu380-Mini menstrual cup users had higher expulsion odds, while TCu380A cup users did not. Menstrual cup users more frequently experienced accidental self-removal than non-users in participants using the TCu380A (3/53 [5.7%] vs. 0/150 [0.0%]) and the NTCu380-Mini (20/197 [10.2%] vs. 7/646 [1.1%]). In multivariable regression, we found increased odds of expulsion through 36 months in participants using menstrual cups with the NTCu380-Mini (aOR 3.13, 95% CI 1.16–8.46) and <25 years (aOR 1.59, 95% CI 1.07–2.34). ConclusionsWe found higher odds of IUD expulsion with menstrual cup and concurrent NTCu380-Mini IUD use over 36 months of use, but not with concurrent TCu380A IUD use. Menstrual cup users experienced higher likelihood of accidental self-removal regardless of IUD type. ImplicationsMenstrual cup and NTCu380-Mini use may increase IUD expulsion risk and may increase accidental self-removal risk with TCu380A and NTCu380-Mini use. Clinicians should advise patients of these risks and consider warning patients using an IUD shaped like the NTCu380-Mini (Nova-T frames) of expulsion risk with menstrual cup use.

Proteomic detection of COX-2 pathway-related factors in patients with adenomyosis.

Investigating the relationship between cyclooxygenase-2 (COX-2) pathway-related factors and clinical features in patients with adenomyosis by proteomics could provide potential therapeutic targets. This study recruited 40 patients undergoing surgical hysterectomy and pathological diagnosis of adenomyosis, collected ectopic endometrial specimens, and recorded clinical data. The expression levels of COX-2 in ectopic uterus lesions were detected using the immunohistochemical (IHC) SP method. The 40 samples were then divided into a COX-2 low or high expression group. Five samples with the most typical expression levels were selected from each of the two groups and the differential proteins between the two groups were identified using label-free quantitative proteomics. WW domain-binding protein 2 (WBP2), interferon induced transmembrane protein 3 (IFITM3), and secreted frizzled-related protein 4 (SFRP4) were selected for further verification, and their relationships with COX-2 and clinical characteristics were analyzed. There were statistically significant differences in the expression of WBP2, IFITM3, and SFRP4 between the COX-2 low and high expression groups (P < 0.01). The expressions of COX-2, IFITM3, and SFRP4 were significantly correlated with dysmenorrhea between the two groups (P < 0.05), but not with uterine size or menstrual volume (P > 0.05). However, there was no significant correlation between the expression of WBP2 and dysmenorrhea, uterine size, and menstruation volume in both the high expression and low expression groups (P > 0.05). COX-2, IFITM3, SFRP4, and WBP2 may be involved in the pathogenesis of adenomyosis. COX-2, IFITM3, and SFRP4 may serve as potential molecular biomarkers or therapeutic targets in dysmenorrhea in patients with early adenomyosis.

Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis

ObjectiveThis trial was to investigate the effect of different treatment methods on the clinical efficacy and fertility outcome of patients with adenomyosis.MethodsIn total, 140 patients with adenomyosis were evenly and randomly allocated into group A (laparoscopic surgery), group B (laparoscopic surgery combined with gonadotropin-releasing hormone analogs [GnRH-a]), group C (ultrasound-guided percutaneous radiofrequency ablation), and group D (ultrasound-guided percutaneous radiofrequency ablation combined with GnRH-a). On the 3rd day after surgery, patients in group B and group D were subcutaneously injected with GnRH-a (Leuprorelin Acetate SR for Injection) at 3.75 mg/time, once every 4 weeks, for a total of 3 months. The therapeutic effects of the 4 groups were compared, including menstrual volume, dysmenorrhea score, uterine volume, clinical efficacy, luteinizing hormone (LH), estradiol (E2), and follicle-stimulating hormone (FSH) levels, CA125 levels, recurrence, pregnancy status, and pregnancy outcomes.ResultsAfter treatment, the menstrual volume of 4 groups was lowered, dysmenorrhea, Visual Analog Scale (VAS) score, LH, FSH, E2, and CA125 levels were reduced, and uterine volume was decreased. The menstrual volume, VAS score, levels of LH, FSH, E2, and CA125, and uterine volume were reduced in groups B, C, and D compared with group A, and the decrease was more significant in group D. The total effective rate of group D was 100.00%, which was higher than that of group A (71.43%), group B (80.00%), and group C (82.86%). After one year of drug withdrawal, the recurrence of hypermenorrhea, dysmenorrhea, uterine enlargement, and excessive CA125 in group D was significantly lower than that in groups A, B and C, and the recurrence in groups B and C was significantly lower than that in group A (P < 0.05). Compared with groups A, B, and C, group D had a higher pregnancy rate, natural pregnancy rate, and lower in vitro fertilization-embryo transfer rate (P < 0.05), but showed no significant difference in pregnancy outcomes.ConclusionUltrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate is effective in the treatment of adenomyosis, which can effectively relieve clinical symptoms, protect postoperative ovarian function, reduce recurrence rate, alleviate pain, and improve quality of life.

Long-term effects of hysteroscopic adhesiolysis on postoperative pregnancy rates and fertility outcomes in patients with intrauterine adhesions.

To investigate the long-term effects of hysteroscopic adhesiolysis on postoperative pregnancy rates and fertility outcomes in patients with intrauterine adhesions (IUA). A retrospective analysis was conducted on 105 patients with IUA treated at Baoji Maternal and Child Health Hospital from June 2022 to December 2023. All patients underwent hysteroscopic adhesiolysis. Based on the adjunctive treatment, patients were divided into two groups: the observation group (n=55), which received adhesiolysis plus balloon uterine stent placement, and the control group (n=50), which received adhesiolysis alone. We compared clinical efficacy, changes in endometrial thickness, menstrual volume, and serum estrogen levels, including estrogen receptor (ER) and progesterone receptor (PR) levels, between the two groups. Additionally, we recorded and compared the 3-month postoperative recurrence rate of IUA, pregnancy rates and outcomes, and complications. The predictive value of ER and PR levels for postoperative pregnancy was also analyzed. We then compared the general data of patients who became pregnant after surgery with those who did not, and used multivariate logistic regression to analyze the factors influencing postoperative non-pregnancy. The overall treatment efficacy was significantly higher in the observation group than in the control group (P<0.05). The observation group showed significantly greater improvements in endometrial thickness, menstrual volume, and serum estrogen levels compared to the control group (all P<0.05). The recurrence rate of adhesions during follow-up was significantly lower in the observation group than in the control group (P<0.05). The postoperative pregnancy rates and fertility outcomes were also significantly better in the observation group (both P<0.05). The sensitivity and specificity of ER levels in predicting postoperative pregnancy were 78.05% and 70.31%, respectively, with an AUC of 0.788. For PR levels, the sensitivity was 75.61%, specificity was 71.88%, and AUC was 0.834. Multivariate regression analysis indicated that age, adhesion severity, adhesion recurrence, and the use of a balloon uterine stent were independent risk factors affecting postoperative pregnancy in patients with IUA (P<0.05). The combination of adhesiolysis and intrauterine balloon stent placement in patients with moderate to severe intrauterine adhesions significantly IUA increases endometrial thickness and volume, promotes menstrual recovery, prevents re-adhesion, and improves pregnancy outcomes. This approach is recommended for clinical application.

Clinical and Genetic Characteristics of 30 Patients Misdiagnosed As Having ITP with Non-Muscle Myosin Heavy Chain 9-Related Disease (MYH9-RD): A Retrospective Analysis in China

Introduction : Non-muscle myosin heavy chain 9-related diseases (MYH9-RD) are rare autosomal dominant platelet (PLT) disorders presenting as nonsyndromic forms characterized by macrothrombocytopenia with giant PLTs and leukocyte inclusion bodies or as syndromic forms combining these hematological features with deafness, nephropathy, or cataracts. Owing to its low incidence and similar clinical manifestations, it is easily misdiagnosed as immune thrombocytopenia (ITP), leading to inappropriate treatment. To improve the diagnosis of this rare thrombocytopenic disease and minimize the misdiagnosis rate, we retrospectively analyzed the clinical, treatment, and genetic characteristics of patients with MYH9-RD who were initially misdiagnosed with ITP and compared the differences between pediatric and adult patients. Methods: Patients from various sites in China were enrolled. The inclusion criteria were macrothrombocytopenia on peripheral blood smear, MYH9 gene mutation detected by next-generation sequencing or whole exon sequencing and verified by Sanger sequencing, and absence of other acquired thrombocytopenia diseases. We collected basic information, clinical manifestations, and laboratory test results via medical records and telephone interviews. Results: Of the 30 patients, 17 were male, 13 were female, 14 were children, and 16 were adults. There was no significant difference in the mean PLT count (×10 9/L) at the time of diagnosis between children and adults (50.5 vs. 33.4, P=0.188). However, the median duration of misdiagnosis was significantly shorter in children (0.1 y vs. 9 y, P=0.000) (Table 1). Overall, 5 patients showed no signs of bleeding, while 25 presented with bleeding manifestations: 11 with skin bleeding spots and ecchymosis, 15 with epistaxis, 6 with gingival bleeding, and 3 with increased menstrual volume. Moreover, 21 patients showed no non-hematological manifestations, while 9 presented with non-hematological manifestations, which occurred exclusively in adult patients. Among the latter, 6 patients had nephropathy (2 underwent renal transplantation, and 2 underwent regular dialysis), 5 had hearing impairment (4 underwent high-frequency hearing impairment, and 1 received a cochlear implant due to deafness), and 1 had a congenital cataract. All patients received first- or second-line treatment for ITP. The most common treatment in children was immunoglobulins (12/14), followed by steroids (5/14) and traditional Chinese medicine (2/14). No children received &amp;gt;3 types of treatment, 4 children received &amp;gt;1, and 6 adult patients received &amp;gt;3. The highest number of treatment type for a single patient was up to 7. The median duration of ITP treatment was 1.5 y for adults and 0.1 y for children ( P=0.002). All patients presented heterozygous missense mutations in MYH9; 17/30 were spontaneous mutations, 7/30 were familial mutations (involving 6 paternal and 1 maternal origin), and 6/30 cases had an unknown inherited type. Fourteen cases were located in the N-terminal globular head region, and 16 cases were located in the C-terminal tail domain (Figure 1). Two novel mutations (not recorded in the Global Variome database), p. G1517V and p. K1674Q, were identified. In 2 adult patients with p.R702C mutations, proteinuria occurred in adolescence, followed by chronic renal failure (CRF), end-stage renal failure, and hearing loss. The 3 children with p.R702C mutation were aged &amp;lt;4 years and exhibited no non-hematological symptoms. Three of the 5 adults with p.E1841K mutations had CRF and underwent kidney transplantation. Conclusion s : Compared with pediatric patients, adult patients are more likely to be misdiagnosed with ITP, receive more types of inappropriate treatment for a longer period of time, and have more common non-hematological manifestations. To improve diagnostic accuracy and reduce the misdiagnosis rate for patients with thrombocytopenia, especially those with a poor response to ITP treatments, attention should be paid to mean PLT volume, family history, and genetic screening. Consistent with previous reports, patients with the p.R702C mutation showed early-stage kidney injury and hearing loss. The incidence of spontaneous mutations (56.7%) was significantly higher than previously reported (25-35%). The genetic characteristics of MYH9-RD and genotype-phenotype relationships in China require further clarification.

Changes in Women’s Menstruation Cycle After COVID-19 Vaccination and Infection

Since the COVID-19 case was discovered, Indonesia has been one of the affected nations and found various COVID-19 infection and immunization risks. Most females are in the menstrual cycle following COVID-19 infection, regardless of the number of days between cycles, blood quantity, or menses duration. This study examines the changes in menstruation post-COVID-19 infection and vaccination. This study used a cross-sectional observational study with an online questionnaire. The 758 female respondents in Yogyakarta were divided into two groups: 532 females who received vaccination and never have been infected with COVID-19 (Group A) and 226 females with a history of being infected with COVID-19 and vaccination (Group B). The data was analyzed using SPSS 26. The results found that most respondents aged 17-25 (90.24%) were students (80.87%). Both two groups had acne on Pre-menstrual syndrome (28.16%), 5-8 days of menstrual duration (73.75%), 30 days of menstruation duration length (57%), and the regular menstruation volume (63.19%) after COVID-19 vaccination. The comparative analysis of menstruation changes in two groups (p0.05), including menstrual duration (0.771), menstrual duration length (0.609), and menstrual volume (0.476) after COVID-19 vaccination. In conclusion, there was no significant difference in menstrual change between Group A and Group B. After vaccination, healthcare professionals can promote post-COVID-19 immunization counseling and services to women who experience an abnormal menstrual cycle.

Investigation of familial tendency of endometriosis

Objective: To investigate the familial heritability of endometriosis and to compare the clinical characteristics of patients with or without a family history of endometriosis. Methods: From January 2020 to June 2022, 850 patients with endometriosis confirmed by laparotomy or laparoscopy in Peking University Third Hospital were included in this study. Clinical data were collected, family history was followed up, and the differences of clinical indicators between patients with and without family history of endometriosis were compared. Results: A total of 850 patients were enrolled, with an average age of (33.8±7.0) years old, 315 (37.1%, 315/850) patients in stage Ⅲ and 496 (58.4%, 496/850) patients in stage Ⅳ. There were 100 patients with family history of endometriosis, accounting for 11.8% (100/850). Most of the 113 relatives involved were mothers, daughters and sisters (76.1%, 86/113), 81.5% (22/27) of the second and third degree relatives were maternal relatives. The median ages of patients with and without family history of endometriosis were 30 and 33 years old respectively at the time of diagnosis. The unmarried rate of patients with family history was higher [42.0% (42/100) vs 26.3% (197/750)]. The percentage of dysmenorrhea patients with family history was higher [89.0% (89/100) vs 55.5% (416/750)]. The medians of dysmenorrhea score in patients with and without family history were 6 and 2, and the median durations of dysmenorrhea were 10 and 1 years. There were significant differences in age, marital status, percentage of dysmenorrhea, dysmenorrhea score and duration (all P<0.001). The median levels of serum cancer antigen (CA) 125 in patients with family history and patients without family history at the time of diagnosis were 57.5 and 46.9 kU/L respectively, with a statistically significant difference (P<0.05). However, there were no significant differences between the two groups in nationality, bady mass index, menarche age, menstrual cycle, menstrual period, menstrual volume, serum CA19-9 level, cyst location and size, stage, history of adverse pregnancy and childbirth, infertility, adenomyosis and deep infiltrating endometriosis (all P>0.05). By comparing the specific conditions of dysmenorrhea patients with and without family history of endometriosis, there were no significant differences between the two groups in terms of the age of onset of dysmenorrhea, duration of dysmenorrhea, primary and secondary dysmenorrhea, and progressive aggravation of dysmenorrhea (all P>0.05). The difference in the degree of dysmenorrhea in dysmenorrhea patients with family history of endometriosis was significant (P<0.001). Conclusions: The incidence of endometriosis has a familial tendency, and most of the involved relatives are the first degree relatives. Compared with patients without family history of endometriosis, endometriosis patients with family history are diagnosed at an earlier age, with higher percentage of dysmenorrhea, had more severe dysmenorrhea and higher serum CA125 level.

Efficacy of recombinant bovine basic fibroblast growth factor to reduce hemorrhage after cervical loop electrosurgical excision procedure

ObjectiveIt has been reported that recombinant bovine basic fibroblast growth factor (rbFGF) may possess possible biological functions in promoting the process of wound healing. Consequently, our study aimed to investigate the hemostatic effect of topically applied rbFGF in patients who underwent a loop electrosurgical excision procedure (LEEP).MethodsIn this retrospective analysis, we meticulously examined clinicopathologic data from a cohort of 90 patients who underwent LEEP at our institution between 2020 and 2021. Subsequently, we conducted inquiries with the patients to ascertain the degree of vaginal bleeding experienced during the postoperative periods of 3 and 6 weeks, comparing it to their preoperative menstrual flow. The magnitude of the menstrual volume alteration was then quantified using a menstrual volume multiplier(MVM). The primary endpoints of our investigation were to assess the hemostatic effect of rbFGF by means of evaluating the MVM. Additionally, the secondary endpoints encompassed the assessment of treatment-related side effects of such as infection and dysmenorrhea.ResultsOur findings demonstrated a significant reduction in hemorrhage following cervical LEEP. Specifically, in the per-protocol analysis, the study group exhibited a statistically significantly decrease in MVM after 3 weeks (0 [0–0] vs. 1 [0–1], respectively; p < 0.001) and after 6 weeks (1 [1] vs. 2 [1–3], respectively; p < 0.001) of the procedure. No notable disparities were observed in the remaining outcomes between the two groups. Moreover, a logistic regression analysis was employed to explore the relationship between significant bleeding and rbFGF treatment (p < 0.001, OR = -2.47, 95% CI -4.07 ~-1.21), while controlling for confounding factors such as age, BMI, and surgical specimen.ConclusionsIn conclusion, our study findings highlight that the application of recombinant bovine basic fibroblast growth factorcan effectively mitigate hemorrhage subsequent to cervical loop electrosurgical excision procedure.

Clinical evaluation of autologous platelet-rich plasma therapy for intrauterine adhesions: a systematic review and meta-analysis.

This meta-analysis aims to evaluate the efficacy and safety of autologous platelet-rich plasma (PRP) administration in reducing adhesion recurrence and improving pregnancy outcomes in patients with intrauterine adhesion (IUA). We conducted a comprehensive search of Pubmed, Embase, the Cochrane Library, Web of Science, Scopus, and China National Knowledge Internet (CNKI) from inception to February 10, 2023, without any language or regional restrictions. We used random-effects models to assess odds ratios (OR) and weight mean differences (WMD) with 95% confidence intervals (CI). Our meta-analysis included a total of 730 patients from 10 clinical studies (6 RCTs and 4 non-RCTs). The results showed that PRP administration significantly increased endometrial thickness (WMD = 0.79, 95% CI: 0.40-1.19; P < 0.001; I2 = 0.0%), menstrual volume (WMD = 2.96, 95% CI = 2.30-3.61; P < 0.001; I2 = 0.0%), and days of menstruation (WMD = 1.13, 95% CI = 0.86-1.41; P < 0.001; I2 = 0.0%). Additionally, the clinical pregnancy rate was also improved (OR = 1.82, 95% CI: 1.19-2.78; P = 0.006; I2 = 0.0%). However, there was insufficient evidence to reach a conclusion regarding the effects of PRP on the recurrence rate of moderate to severe IUA, changes in AFS scores, miscarriage rate, and live birth rate. Our analysis confirms that autologous PRP is an effective treatment for IUA. However, the limited sample size suggests that the results should be interpreted with caution. Therefore, larger and well-designed studies are necessary in the future to confirm these findings and explore the optimal PRP dosing regimens further. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023391115.

Effect of COVID-19 on Menstruation: An Observational Study

Introduction: COVID-19 patients have been reported to have systemic complications. Analyzing its effect on the endocrine system is essential to ensure women’s reproductive health. Aim: This study aimed to determine the effect of COVID-19 disease on menstruation. Methods: It was a hospital-based cross-sectional study conducted from October 2021 to April 2022, using a validated questionnaire to collect the data. The study included females (15 to 49 years) who had confirmed COVID infection. Results: A total of 132 females participated in the study. For 29 (22%) patients presenting with menstrual cycle changes, most common change was prolonged cycle (14%). An increase in menstrual volume was reported by 12%, where as 35% of patients experienced more pain during menstruation. Menstrual irregularities were significantly higher in severe infection (p-value 0.04). Conclusion: There were transient changes in menstruation in COVID-19-infected patients, with a higher probability of menstruation abnormalities among severely infected patients.

Effects of high-intensity focused ultrasound combined with levonorgestrel-releasing intrauterine system on patients with adenomyosis

It is very important to treat adenomyosis which may cause infertility, menorrhagia, and dysmenorrhea for women at the reproductive age. High-intensity focused ultrasound (HIFU) is effective in destroying target tumor tissues without damaging the path of the ultrasound beam and surrounding normal tissues. The levonorgestrel-releasing intrauterine system (LN-IUS) is a medical system which is inserted into the uterine to provide medicinal treatment for temporary control of the symptoms caused by adenomyosis. This study was to investigate the effect of HIFU combined with the LN-IUS on adenomyosis. In the HIFU treatment, the parameters of the ultrasound were transmission frequency 0.8 MHz and input power 50–400 W (350 ± 30), and the temperature in the target tissue under these conditions would reach 60–100 °C (85 °C ± 6.3 °C). Size reduction and blood flow signal decrease were used to assess the effect of combined treatment. In this study, 131 patients with adenomyosis treated with HIFU combined with LN-IUS were retrospectively enrolled. The clinical and follow-up data were analyzed. After treatment, the volume of the uterine lesion was significantly decreased with an effective rate of 72.1%, and the adenomyosis blood flow signals were significantly reduced, with an effective rate of 71.3%. At six months, the menstrual cycle was significantly (P < 0.05) decreased from 31.4 ± 3.5 days before treatment to 28.6 ± 1.9 days, the menstrual period was significantly shortened from 7.9 ± 1.2 days before HIFU to 6.5 ± 1.3 days, and the menstrual volume was significantly (P < 0.05) decreased from 100 to 49% ± 13%. The serum hemoglobin significantly (P < 0.05) increased from 90.8 ± 6.2 g/L before treatment to 121.6 ± 10.8 g/L at six months for patients with anemia. Among seventy-two (92.3%) patients who finished the six-month follow-up, sixty-five (90.3%) patients had the dysmenorrhea completely relieved, and the other seven (9.7%) patients had only slight dysmenorrhea which did not affect their daily life. Adverse events occurred in 24 (18.3%) patients without causing severe consequences, including skin burns in two (1.5%) patients, skin swelling in four (3.1%), mild lower abdominal pain and low fever in 15 (11.5%), and subcutaneous induration in three (2.3%). Six months after treatment, no other serious side effects occurred in any patients with follow-up. In conclusions, the use of high-intensity focused ultrasound combined with the levonorgestrel-releasing intrauterine system for the treatment of adenomyosis is safe and effective even though the long-term effect remains to be confirmed.