Hongwei Zhang

This study aims to explore the clinical efficacy and safety of hysteroscopic decidua polypectomy during pregnancy. This retrospective study analyzed 38 pat

Background/Objectives : Currently, no non-invasive detection method for endometrial cancer (EC) is recommended in clinical practice worldwide. This study aimed to evaluate the clinical value of detecting DNA methylation of CDO1 and CELF4 (CDO1m/CELF4m) in exfoliated cervical cells for the detection of EC in women with suspected endometrial lesions. Methods: A total of 2164 patients scheduled for hysteroscopic surgery due to suspected endometrial lesions at the Obstetrics and Gynecology Hospital of Fudan University between July 2023 and May 2024 were prospectively enrolled. Preoperative exfoliated cervical cells were collected for dual-gene methylation testing. Clinical data and endometrial thickness measured by transvaginal sonography (TVS) were recorded. Hysteroscopic histopathological diagnosis served as the gold standard to evaluate the performance of methylation testing alone and in combination with TVS. Results: This study included 2164 patients, comprising 33 EC cases, 31 cases of endometrial intraepithelial neoplasia (EIN), and 2100 cases of non-endometrial lesions, with mean ages of 51.7 ± 6.4, 49.5 ± 8.9, and 44.7 ± 9.8 years, respectively (p < 0.001). For EC detection, CDO1m/CELF4m positivity showed a sensitivity of 93.94% (95% CI: 79.77–99.26%), specificity of 96.7% (95% CI: 95.92–97.47%), positive predictive value (PPV) of 31.0% (95% CI: 25.96–36.53%), and negative predictive value (NPV) of 99.90% (95% CI: 99.63–99.98%). For EIN detection, the sensitivity was 83.87%, specificity 97.95%, PPV 37.68%, and NPV 99.76%. Combining TVS with DNA methylation detection further improved the sensitivity and NPV for both EC and EIN detection. Conclusions: DNA methylation detection in exfoliated cervical cells demonstrates high sensitivity and specificity for EC detection. The combination with TVS further enhances sensitivity and NPV, offering a simple and non-invasive triage strategy for patients with suspected endometrial lesions. This study was registered in China Clinical Trial Registry (ChiCTR2200055991) on 30 January 2023.

Background: Hysteroscopic myomectomy is a common procedure for treating submucosal leiomyomas, but fluid overload and subsequent pulmonary edema are significant complications. This study investigates whether phenylephrine-induced increases in mean arterial pressure (MAP) can reduce pulmonary edema and distention fluid absorption in patients undergoing hysteroscopic myomectomy. Material and Methods: This randomized controlled trial enrolled 44 patients scheduled for hysteroscopic myomectomy. Patients were randomly assigned to receive either phenylephrine infusion to maintain MAP at 100–120% of the baseline value or normal saline infusion during surgery. The primary outcome was the incidence of pulmonary edema assessed by lung ultrasound (LUS). Secondary outcomes included B-line scores, thoracic fluid content (TFC), distention fluid deficit, use of furosemide, and so on. Receiver operating characteristic (ROC) curve analysis was performed in distention fluid deficit and ΔTFC to predict pulmonary edema. Results: The phenylephrine group showed a significantly lower incidence of pulmonary edema [18.2 vs. 54.6%, RR = 0.33, 95% CI (0.13–0.81), P = 0.027] and lower LUS B-line scores [MD = −4.5, 95% CI (0–9), P = 0.016] compared to the control group. Additionally, the phenylephrine group had significantly reduced distention fluid deficit ( P = 0.018), lower TFC at the end of operation ( P = 0.008), and decreased use of furosemide ( P = 0.022). The best cutoff value in the diagnosis of pulmonary edema was 1900 ml for distention fluid deficit and 7.1/kΩ for ΔTFC, and areas under the ROC curves were 0.85, and 0.83, respectively. Conclusion: Phenylephrine administration during hysteroscopic myomectomy effectively reduces pulmonary edema and distention fluid absorption by increasing MAP. This study provides evidence for a new strategy in intraoperative fluid management for hysteroscopic surgeries.