Jiming Chen

Background: Sacrospinous ligament fixation has become one of the important surgical procedures for treating pelvic organ prolapse. The traditional vaginal sacrospinous ligament fixation determines the suspension site through digital rectal examination, which carries a higher risk of intraoperative nerve injury and hemorrhage. This article aims to introduce the transvaginal extraperitoneal space anatomical sacrospinous ligament fixation and compare it with the traditional vaginal sacrospinous ligament fixation. A total of 40 patients were included in this study, and all patients were divided into the TEASLF group ( n = 20) and the TSSLF group ( n = 20) according to the principle of voluntary choice. Materials and methods: This article proposes the transvaginal extraperitoneal space anatomical sacrospinous ligament fixation, combining the advantages of precise endoscopic treatment with sacrospinous ligament fixation, and retrospectively analyzes the clinical data of 40 patients to evaluate this procedure. Results: The treatment effects of the two groups were comparable. The intraoperative hemorrhage volume in this procedure was significantly reduced compared to the traditional group, but the operation time was slightly longer than that of the traditional group. There were no statistically significant differences between the two groups in postoperative hospital stay, postoperative ventilation time, catheter removal time, improvement in POPQ scores, and improvement in PFIQ-7 and PFDI-20 scores. Conclusion: Transvaginal extraperitoneal space anatomical sacrospinous ligament fixation is safe and effective for treating pelvic organ prolapse. This procedure provides better exposure of the surgical field, allows suturing under direct vision, helps avoid vascular and neuronal injury, and enables faster and more convenient hemostasis. This procedure also aids junior physicians in understanding the anatomy of the sacrospinous ligament, facilitating clinical teaching and technical promotion.

Background and objective: Diagnosis and treatment strategies for adenomyosis are influenced by multiple factors, including patient preferences, adenomyosis subtype, and disease progression, with no standardized protocol currently established. In 2012, Kishi proposed four subtypes of adenomyosis based on magnetic resonance imaging (MRI) to guide clinical treatment. This study focuses on patients with severe adenomyosis who do not desire future fertility but wish to preserve their uterus. It investigates the clinical efficacy of subtotal adenomyotic lesion resection based on the Kishi classification, combined with sequential levonorgestrel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone agonist (GnRH-a) therapy, in the management of severe adenomyosis, and evaluates the clinical outcomes and safety of this approach. Methods: We used a descriptive case series design. A retrospective analysis was performed on 34 patients with severe adenomyosis who underwent this treatment protocol at the Department of Gynecology, the Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from December 2017 to October 2022. Clinical parameters, including hemoglobin concentrations, dysmenorrhea severity scores, and menstrual blood loss scores, before and after treatment, were observed and recorded. Results: All 34 patients successfully underwent surgery. Comparisons of postoperative and preoperative values showed significant improvements in dysmenorrhea severity score, menstrual blood loss score, hemoglobin concentration, serum cancer antigen-125 (CA125) level, and uterine volume (all p < 0.001). Only one patient experienced downward displacement of the intrauterine device, and a transvaginal ultrasonography revealed that the upper end of the device was approximately 1.5 cm away from the uterine fundus. One patient exhibited a mild elevation in CA125, accompanied by an increase in dysmenorrhea severity score to 3 points, without a significant increase in menstrual blood loss being observed. No disease progression was noted in any patient. Conclusion: In patients with severe adenomyosis who do not desire future fertility, who have a strong preference for uterine preservation, and who have failed multiple conservative treatments, this combined regimen was associated with significant improvements in dysmenorrhea severity, menstrual blood loss, anemia, CA125 levels, and uterine volume over a 12-month observation period, without any serious adverse events. This finding suggests that the regimen may be a safe and effective treatment option. However, its exact efficacy still requires validation through prospective controlled studies.

Intravenous leiomyomatosis (IVL) is a rare and special type variant of leiomyoma characterized by intravascular proliferation of benign smooth muscle cells extending beyond the uterus into the heart and even to the pulmonary arteries through a variety of ways. Owing to its rare occurrence and lacking of obvious symptoms, early diagnosis is very difficult. Complete excision of tumors is vital for a favorable prognosis. There is no consensus about the operative drug-assisted treatment to reduce the risk of recurrence. Pathogenesis of IVL is not clear, and chromosomal and genetic changes may accelerated the development of IVL. Herein, we report 9 patients with early stage IVL. Nine patients were admitted to the hospital with different symptoms for surgical treatment, and postoperative pathology was suggestive of intravascular smooth muscle tumor. Close follow-up of the patient post-operatively revealed that hysterectomy and bilateral adnexectomy could be chosen when the mass was limited to the uterus or pelvic cavity, and for patients with fertility requirements, myomectomy might also be feasible. About hormonal or the other adjuvant therapies after operation, there are still controversies, and further studies are needed to verify these findings. We retrospectively analyzed the clinical data of the patients and explored their clinical features, treatment and prognosis, aiming to improve the understanding of this disease.

Background: High-intensity focused ultrasound (HIFU) ablation is widely regarded as a safe and minimally invasive technique for treating uterine fibroids. However, severe complications such as uterine rupture and septic shock remain exceedingly rare. Case presentation: We report a case of a 42-year-old woman who developed uterine rupture complicated by septic shock one month after undergoing HIFU ablation for uterine fibroids. Conclusions: Although HIFU ablation for uterine fibroids is widely considered a safe and minimally invasive procedure, clinicians should recognize the potential for severe complications, including uterine rupture and septic shock.

The prevalence of osteoporosis will continue to rise as the world’s population ages. Since women’s bones are smaller and thinner than men’s, bone loss accelerates as estrogen levels fall. Based on their primary effects, drugs used to treat osteoporosis can be categorized into three groups: 1. Anti-resorptive medications. These primarily prevent osteoclasts from resorbing bone, which has a secondary effect on bone growth. Commonly used anti-resorptive drugs include bisphosphonates, denosumab, hormone replacement therapy, and raloxifene. 2. Anabolic medicines. These mainly stimulate osteoblasts to produce new bone, although they may also affect bone resorption. Common examples include teriparatide, romosozumab, and parathyroid hormone. 3. Phytoestrogens. These are non-steroidal, naturally occurring plant compounds with estrogenic and/or anti-estrogenic properties that resemble estrogen.

Thoracic endometriosis syndrome is a rare form of endometriosis in which endometrial tissue is thought to migrate to the lungs and, with the onset of menstruation, the ectopic foci bleed, causing a range of pulmonary manifestations. In this paper we have collected the clinical data of two patients with thoracic endometriosis syndrome, both of whom presented with haemoptysis as the first symptom and had a history of endometriosis. After 6 courses of treatment with gonadotropin-releasing hormone analogues followed by maintenance treatment with dienogest, the patients’ haemoptysis symptoms were relieved, the CT lesions in the lungs were significantly resorbed compared with the previous ones, and no recurrence was observed at long-term follow-up.

Objective: To enhance postoperative recovery in gynecological malignancies by evaluating the clinical efficacy and safety of Enhanced Recovery After Surgery (ERAS) combined with enteral nutrition.Methods: This study included 127 patients with gynecological malignancies treated at Zigong Fourth People’s Hospital between January and December 2022. Based on patient preference, 60 were placed in the study group (ERAS + enteral nutrition) and 67 in the control group (traditional care). The two groups were compared on postoperative protein levels, electrolyte balance, and recovery indicators, including the time to first anal exhaust, defecation, and hospital stay duration. Additionally, preoperative thirst, hunger, anxiety scores, postoperative complications, and total hospitalization costs were evaluated.Results: The study group had higher postoperative total protein (66.59 ± 10.97 g/L) and albumin (43.47 ± 51.27 g/L) than the control group, with a significantly lower incidence of hypoproteinemia (18.33% vs. 50.75%, p < 0.05). There were no significant differences in hemoglobin, lymphocyte count, or electrolytes. The study group recovered bowel function earlier than the control group, with significant differences in defecation time (p < 0.05). No significant differences were observed in anal exhaust time, hospital stay, complications, or total costs. The study group had better anxiety, thirst, and hunger scores (p < 0.05).Conclusion: ERAS combined with enteral nutrition is safe and effective for gynecological cancer surgery, reducing hypoproteinemia, promoting gastrointestinal recovery, and improving patient experience and psychological well-being.

To investigate the protective effect of ammonium trichloride tellurate (AS101) on doxorubicin induced ovarian function damage in rats. Eighteen female SD rats were randomly divided into three groups with 6 rats in each group: group A blank control group (0.9% normal saline 0.1 ml intraperitoneally for 21 consecutive days), group B (0.9% normal saline 0.1 ml intraperitoneally for 5 days, doxorubicin 10 mg / kg intraperitoneally on day 6, and continued to be injected with normal saline for 15 days), group C (0.9% normal saline 0.1 ml intraperitoneally for 5 days, doxorubicin 10 mg / kg intraperitoneally on day 6, and continued to be injected with AS101 twice every other day). The contents to be recorded by the operator team include: (1) before operation: ① observe the general state of rats in each group and record the weight of rats. ② Vaginal smears of rats in each group were observed at the same time every day to observe the estrous cycle of rats. (2) After operation: ① observe the general state of rats in each group, read the weight of rats, and record the data Vaginal smears of rats in each group were observed at the same time every day after operation to observe the estrous cycle of rats. ③ At the end of the postoperative observation period, blood samples were taken from the tail of rats to measure the serum levels of estrogen 2 (E2), follicle stimulating hormone (FSH), and anti-M ü llerian hormone (AMH). ④ At the end of the observation period, the animals were sacrificed to observe the development of bilateral ovarian follicles. ⑤ At the end of the observation period, blood was taken from the abdominal aorta of rats after anesthesia, and the upper serum was separated after centrifugation at 3000 rpm. The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and reactive oxygen species (ROS) were measured according to the operation methods of the kit instructions. The body weight of rats in group B was significantly lower than that in group A, while that in group C was significantly higher than that in group B (P < 0.05). The estrous cycle of rats in group B was disordered, and the estrous cycle of rats in group C was restored regularly (P < 0.05). The serum estradiol(E2) and AMH levels in group C were significantly higher than those in group B, and the FSH level was significantly lower than that in group B. Compared with group B, the number of primary follicles increased and the number of atretic follicles decreased in group C (P < 0.05). The SOD level in group B was lower than that in group A, and that in group C was higher than that in group B (P < 0.05). The levels of MDA and ROS in group B were higher than those in group A (P < 0.05), while those in group C were lower than those in group B (P < 0.05). AS101 can protect the damage of doxorubicin on ovarian function in rats, and its mechanism is related to its antioxidant effect. Not applicable.

The abdominal wall is one of the rare sites of endometriosis, and its clinical incidence is increasing year by year with the increasing cesarean section rate nowadays. A retrospective analysis was made on patients with abdominal wall endometriosis who attended Changzhou Second Hospital of Nanjing Medical University from January 2013 to December 2022. They were grouped by depth of infiltration of lesion and direction of incision, and the differences between the groups were compared. A total of 228 patients aged 32.7 ± 4.2 with abdominal wall endometriosis were included in this study, including 210 cases with a history of abdominal transverse incision surgery, 16 cases with a history of vertical incision surgery, 1 case with a history of uterine fibroids surgery, and 1 case with primary abdominal endometriosis, and 178 cases with the primary symptom of cyclic pain. The patients were classified as solitary and complex ones according to the number of lesions. Both groups were statistically significant for BMI, number of caesarean sections, operation time, bleeding, and postoperative hospital stay (p < 0.05). According to the depth of infiltration, the patients were divided into fascial, rectus abdominis, and peritoneal types, with differences in latency time, CA125, maximum diameter of the lesion, operation time, bleeding, and postoperative hospital stay (p < 0.05). The direction of incision for caesarean section had no significant effect on the development of endometriosis in the abdominal wall or whether the lesions were multiple (p > 0.05). On imaging, magnetic resonance imaging was more accurate for lesion typing. AWE should be diagnosed early and treated surgically. The clinical manifestations of the same type are different, and CA125 testing and abdominal wall ultrasound can be used preoperatively for lesion typing. Nuclear magnetic resonance (NMR) may be used to improve preoperative preparations for difficult diagnosis or typing.

In this study, ovarian transplantation at different sites was performed on the rat model of premature ovarian failure, to explore the effect on the recovery of ovarian function, and to evaluate the application value in the treatment of ovarian function decline caused by the application of chemotherapy drugs. Thirty 2-month-old female SD rats of SPF grade were randomly divided into five groups, and both ovaries in the model group were treated with cisplatin (11 mg/kg) for modelling. After successful modelling, another 18 rats were taken as donor rats: group A was the control group, group B was the model group and group CDE was the experimental group. Ovary transplantation was performed using muscle, subcutaneous and renal peritoneum, respectively, and the rats were monitored for their general condition, estrous cycle and serum hormone levels after surgery. At the end of the observation period, the rats were executed and follicular development was observed.We confirm that all methods are carried out in accordance with the relevant guidelines and regulations.After 14 days of xenotransplantation, the general condition of the rats in the experimental group was better than that of the model group. Serum E2 and AMH levels were significantly higher than those in the model group (P = 0.000), and FSH levels were significantly lower than those in the control group (P = 0.000). Cisplatin can be used to successfully establish the rat POF model; the three transplantation sites (muscle, subcutaneous and renal peritoneum) selected in this experiment can make the transplanted ovarian tissue survive and successfully restore the endocrine function of the body, and the effect of which showed no significant difference.