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Objective:As the cesarean section rate increases year by year,the treatment of previous cesarean scar defects(PCSD)poses a significant challenge.This study aims to evaluate the clinical value of preoperative magnetic resonance imaging(MRI)technology and analyze relevant influencing factors for patients with abnormal uterine bleeding(AUB)associated with cesarean scar defects who underwent laparoscopic surgery.Methods:A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology,the Third Xiangya Hospital of Central South University from 2018 to 2022.A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status:The clinically-cured group(n=28,49.1%)and the non-clinically-cured group(n=29,50.9%).After a postoperative follow-up period of 3 months for all participants,logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors.These factors included patient age,clinical symptoms,obstetric history,history of cesarean section,basic clinical information,preoperative MRI parameters,and postoperative menstrual conditions.Results:There were no significant differences in many aspects,including the patient's age at the time of previous cesarean section,number of pregnancy,time since the previous cesarean section,the uterus position assessed by preoperative T2 signal MRI,defect length,defect width,residual muscle layer thickness,adjacent uterine muscle layer thickness,and distance from the defect to the external cervical os between the 2 groups(all P>0.05).However,the time of onset of AUB symptoms(P=0.036,OR=1.019,95%CI 1.002 to 1.038)and the depth of the defect on the preoperative MRI(P=0.010,OR=5.793,95%CI 1.635 to 25.210)were identified as risk factors affecting the clinical cure rate.Conclusion:The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD,which could be helpful for evaluating the prognosis of disease.
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Objective:Currently,traditional cervical cancer screening methods,such as high-risk human papillomavirus testing and liquid based cytology(LBC),still possess limitations.This study aims to identify new diagnostic biomarkers to achieve the goal of"precision screening"via exploring the clinical value of DNA methylation[ΔCtP:paired box gene 1(PAX1)and ΔCtJ:junctional adhesion molecule 3(JAM3)]detection in cervical exfoliated cells for the diagnosis of high-grade cervical lesions. Methods:A total of 136 patients who underwent gynecological examinations in the vaginal room of the Department of Gynecology at the Third Xiangya Hospital of Central South University from June 2021 to June 2022 were retrospectively studied.Among them,122 patients had non-high-grade cervical lesions,and 14 patients had high-grade cervical lesions.The variables included general information(age,body mass index,and menopause status),LBC,high-risk human papillomavirus,cervical tissue pathology,vaginal examination results,and the ΔCt values of JAM3 and PAX1 gene methylation.Logistic regression analysis was used to identify the factors affecting the diagnosis of high-grade cervical lesions,followed by correlation analysis and construction of a conditional inference tree model. Results:Logistic regression analysis showed that the methylation ΔCt values of PAX1 and JAM3 genes and LBC detection results were statistically significant between the high-grade cervical lesions group and the non-high-grade cervical lesions group(all P<0.05).Correlation analysis revealed a negative correlation between cervical pathological changes and ΔCtP(r=-0.36,P<0.001),ΔCtJ(r=-0.448,P<0.001),LBC(r=-0.305,P<0.001),or bacterial diversity(r=-0.183,P=0.037).The conditional inference tree showed that when ΔCtJ>10.13,all of patients had non-high-grade cervical lesions,while ΔCtP>6.22,the number of non-high-grade lesions accounted for 97.5%(117/120),and high-grade lesions accounted for only 2.5%(3/120).When ΔCtJ>8.61 and LBC were atypical squamous cell of undetermined significance or negative for intraepithelial lesions or malignancy(NILM),105(99.1%)patients were non-high-grade cervical lesions,only 1(0.9%)patient was high-grade lesion.When the results of LBC were high-grade lesions,only 9 patients'histopathological examination was the high-grade lesions and 3 non-high-grade lesions.When LBC indicated low-grade lesions,atypical squamous cell of undetermined significance,no intraepithelial lesions,and ΔCtP>6.22,117(97.5%)of patients'histopathological examination was the non-high-grade lesions. Conclusion:The JAM3/PAX1 gene methylation test can be used independently for the stratified diagnosis of high-grade/non-high-grade cervical lesions in women with high-risk human papillomavirus infection,independent of the cytological results of cervical excision.The JAM3/PAX1 gene methylation test can also be used in combination with LBC to make up for the shortcomings of low sensitivity of LBC.In addition,the application of methylation kit in large-scale cervical cancer screening in the future will be good to the detection of more patients with high-grade cervical lesions,and achieve early screening and early treatment for cervical lesions/cancer.
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Objective:Uterine adhesion is mainly caused by endometrial injury,leading to poor postoperative pregnancy outcome.Therefore,preoperative evaluation on uterine cavity,especially endometrial condition,is very necessary.This study aims to explore the correlation between preoperative three-dimensional transvaginal ultrasound(3D-TVS)imaging characteristics and postoperative pregnancy outcomes after hysteroscopic adhesiolysis(HA). Methods:A total of 401 patients,who underwent HA surgery from February 22,2018 to October 31,2018 at the Third Xiangya Hospital of Central South University or Changsha Jiangwan Hospital,were enrolled,and we collected data regarding the preoperative 3D-TVS imaging characteristics and followed up their postoperative pregnancy outcomes.Correlation analysis and univariate and multivariate logistic regression analysis were performed between imaging features and pregnancy outcomes(live and non-live birth outcomes)in patients with intrauterine adhesion. Results:The results of correlation analysis showed that endometrial thickness,endometrial echo,visible tubal openings,endometrial blood flow,intercornual distance,and endometrial peristalsis were correlated with the live birth rate(all P<0.05).Logistic regression analysis revealed that in the HA patients with the live birth,the endometrial thickness was thicker(P<0.001),endometrial echo was more homogeneous(P<0.001),the number of tubal openings was more(P<0.001),the intercornual distance was wider(P<0.05),the endometrial blood flow,and irregular cases of endometrial peristaltic waves were more and cases of deficiency were fewer(both P<0.01)than those in the non-live birth group. Conclusion:Preoperative 3D-TVS imaging performance is closely related to pregnancy outcomes of HA patients,and preoperative 3D-TVS can be used to predict pregnancy outcomes after HA.
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Objective:This work aims to explore the application value of cervical exfoliated cell DNA (Cysteine dioxygenase type 1, CDO1 and CUGBP Elav-like family member 4, CELF4) methylation in the detection of endometrial cancer in women of childbearing age. Methods:From November 2021 to October 2022, a prospective study was conducted on a total number of 517 reproductive-age women with abnormal uterine bleeding who had surgical indications for hysteroscopy at the Xiangya Third Hospital of Central South University. The cervical exfoliated cells were collected for cytology, HPV (human papillomavirus) and gene methylation detection before operation. Clinical information of patients, level of tumor-related biomarkers, and endometrial thickness of transvaginal ultrasound (TVS) were also collected. Single factor regression method was used to analyze the high-risk factors of endometrial cancer. Receiver operating characteristic curve analysis was used to obtain the area under the curve(AUC), focusing on the screening efficacy of gene methylation test for endometrial cancer in women of childbearing age.Results:The age, body mass index (BMI)≥25 kg/m 2, endometrial thickness≥11 mm, CDO1 m ΔCt≤8.4, CELF4 m ΔCt≤8.8, and double gene methylation were associated with endometrial cancer in women of childbearing age, 1.16(1.08-1.25), 4.33(1.89-10.31), 9.49(3.88-26.69), 69.62(25.70-224.36), 23.64(9.66-63.99), 87.39(24.83-555.05), all P<0.05. The AUC was 0.90 (95% CI 0.83-0.97) of CDO1 m/ CELF4 m in diagnosing endometrial carcinoma was higher than others factors, with sensitivity and specificity of 91.7% (95% CI 80.6%-100%) and 88.8% (95% CI 86.0%-91.6%). TVS combined with DNA methylation detection further improved the sensitivity to 95.8% (95% CI 87.8%-100%), but could not improve the specificity 68.0% (95% CI 63.8%-72.1%). Conclusions:For women of childbearing age with abnormal uterine bleeding or abnormal vaginal discharge, the accuracy of cervical cytology DNA methyl detection of endometrial cancer is better than other non-invasive clinical programs. DNA methylation combined with TVS can improve the sensitivity of detection.
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OBJECTIVE@#To investigate the health safety of the offspring delivered following natural pregnancy after orthotopic fetal ovarian allotransplantation in rats.@*METHODS@#Any symptoms of spontaneous abortion during pregnancy and of any possible still birth and death of infant rats within 3 days after the delivery were observed and compared in 19 pregnant rats (the study group) after the orthotopic fetal ovarian allotransplantation and in another 10 pregnant rats (the control group). Forty offspring rats from each group were selected randomly. The mean weight at day 35 after the birth of offsprings was measured and compared. By routine G-banding technique, the karyotype was analyzed and the chromosomal number and structure were observed.@*RESULTS@#There was no spontaneous abortion, still birth, or death in the infants within 3 days after the birth in both groups. The body weight of offsprings at 35 days in both groups was (93.80 ± 4.93) g and (94.13 ± 4.53) g, respectively. There was no significant difference between the 2 groups (P> 0.05). The karyotype analysis indicated that the karyotype from both offspring groups was 42, XX or 42, XY. No chromosome abnormality (abnormal chromosomal number or abnormal chromosomal structure) was observed in both groups.@*CONCLUSION@#The health status of the offsprings of rats after orthotopic fetal ovarian allotransplantation is safe.
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Animais , Feminino , Masculino , Gravidez , Ratos , Animais Recém-Nascidos , Feto , Cariótipo , Ovário , Transplante , Ovulação , Fisiologia , Resultado da Gravidez , Ratos Sprague-Dawley , Transplante HomólogoRESUMO
Objective To assess the value of laparoscopy combined with hysteroscopy in the diagnosis and treatment of the ovulatory infertile female.Methods From Jan 2000 to May 2001, 140 ovulatory infertile patients were investigated and treated by laparoscopy combined with hysteroscopy. Findings of both the laparoscopy and hysteroscopy were compared with those of hysteroscopy alone and laparoscopy alone. Operative time, postoperative complications and days of hospitalization were recorded. Postoperative pregnancy outcomes were followed-up.Results This study demonstrates that combination of laparoscopy and hysteroscopy was superior to hysteroscopy alone and laparoscopy alone in the diagnosis of the ovulatory infertile female. It is short-time consumed, less traumatic, rapidly recovered. The postoperative pregnancy outcomes were satisfactory.Conclusions Laparoscopy combined with hysteroscopy is recommended as the primary precedure to the diagnosis and treatment of the ovulatory infertile female currently. It can cure some patients and provide reliable answer to whether assisted reproductive technique is needed as well.