Objective:To construct a risk prediction model for Vaginal Intraepithelial Neoplasia Grade 2 or Worse(VaIN 2+)lesions,and to establish a nomogram for individual diagnosis of VaIN 2+and risk stratification,so as to provide guidance for the treatment of vaginal lesions.Methods:A total of 248 women diagnosed with VaIN through colposcopic biopsy at the Center for Gynecologic and Cervical Diseases,First Affiliated Hospital of Nanjing Medical University,from January 2021 to January 2024 were included in this study.Based on the gold standard established by histological and pathological findings,these patients were categorized into a lower VaIN 2 group and a VaIN 2+group.Univariate comparative analysis was performed on the two groups.Multivariate Logis-tic regression analysis was used to determine the risk factors of VaIN 2+and to construct a diagnostic model.The nomogram model was established by using R Studio software.The discrimination,calibration and clinical practical value of the model were evaluated by the area under the receiver operating characteristic(ROC)curve and cali-bration curve.Results:Univariate analysis identified that HPV type,cervical lesion grade,acetowhite change,vagi-nal lesion duration,vaginal lesion location,and cervical lesion duration as influencing factors for diagnosing VaIN 2+(P<0.1).Multivariate binary Logistic regression analysis indicated that HPV16/18 positivity,cervical lesion grade≥CIN 2,thick acetowhite change,vaginal lesion duration≥5 years,and vaginal lesion location at the upper 1/3 of the vagina were independent risk factors for diagnosing VaIN 2+(OR>1,P<0.05),while cervical lesion duration<3 years was a protective factor(OR<1,P<0.05),with acetowhite change having the greatest impact(OR4.54).A regression model was established based on the multivariate binary Logistic regression analysis,with an AUC of 0.813.A nomogram model was constructed and internally validated,yielding a consistency index(C-index)of 0.81.Patients were stratified into risk groups using the X-tile software,with higher total scores indi-cating a greater risk of developing VaIN 2+.Conclusions:The nomogram model constructed in this study can in-dividually predict the risk of VaIN 2+lesions in patients,with high accuracy and clinical practicability.

Objective:to investigate the expression of integrin αvβ3 and osteopontin(OPN)in decidual tissues in missed abortion women with polycystic ovarian syndrome(PCOS).Methods:PCOS women with missed abor-tion(PCOS missed abortion group),non-PCOS with missed abortion(non-PCOS missed abortion group)and women with normal early pregnancy induced abortion(normal control group)who were admitted to the First Affili-ated Hospital of Xi'an Jiaotong University from February 2018 to December 2022 were selected as participants,and 20 subjects in each group.The expressions of integrin αvβ3 and OPN in decidual tissues among the three groups were detected.Correlation analysis was conducted between the expression levels of integrin αvβ3 and OPN in PCOS patients with missed abortion.Results:Integrin αvβ3 and OPN were mainly expressed in the epi-thelial cells of the uterus,as well as in decidual cells.There were significant differences in the positive rates and IHC scores of integrin αvβ3 and OPN in decidual tissues among the three groups(P<0.05).The positive rates and IHC scores in PCOS missed abortion group were significantly lower compared with non-PCOS missed abor-tion group and normal control group,and the difference was statistically significant(P<0.05),but there was no significant difference between non-PCOS missed abortion group and normal control group(P>0.05).The integrin αvβ3 and OPN in decidual tissues were mainly co-located in uterine epithelial cells.There were significant differ-ences in immunofluorescence intensity of integrin αvβ3 and OPN among the three groups(P<0.05).The missed abortion group of PCOS was significantly lower than that of non-PCOS missed abortion group and normal control group,and the difference was statistically significant(P<0.01).No significant difference was found between non-PCOS missed abortion group and normal control group(P>0.05).There were significant differences in the protein expression levels and mRNA expression levels of integrin αvβ3 and OPN in decidual tissue among the three groups(P<0.05).PCOS missed abortion group was significantly lower than non-PCOS missed abortion group and normal control group,and the difference was statistically significant(P<0.01).There was no significant difference between non-PCOS missed abortion group and normal control group(P>0.05).The results of Pearson correlation analysis showed that the protein and mRNA expression levels of integrin αvβ3 and OPN in decidual tis-sue of PCOS patients with missed abortion were significantly positively correlated(r>0,P<0.01).Conclusions:The integrin αvβ3 and OPN were expressed in both epithelial cells of the uterus and decidual cells in early preg-nancy.The expressions of them were significantly decreased in decidual tissues of PCOS patients with missed a-bortion,which might be related to reduced endometrial receptivity.The role of integrin αvβ3 and OPN in the occur-rence of missed abortion needs further study.

Objective:Using oral iron preparations as the positive control,this study explores the efficacy and safety of intravenous iron isomaltoside in the treatment of moderate postpartum iron deficiency anemia(IDA),as well as the impact of anemia correction on fatigue levels and psychological status among postpartum patients.Methods:Eighty-four patients with moderate iron deficiency anemia during puerperium who were delivered at the Tianjin Medical University General Hospital from April 1,2022,to June 30,2023,were included and randomly as-signed1∶1 to the intravenous group(37cases)or the oraliron group(39cases).Theintravenous group received a one-time infusion of ferric derisomaltose(1000 mg)within 1-3 days after delivery.In the oral group,oral iron(150 mg/day for at least 4 weeks)was administered from postpartum day 1.The improvement effect of anemia and the occurrence of adverse reactions were compared between groups.At the same time,the quality of life assess-ment[Multidimensional Fatigue Inventory(MFI)]and postpartum depression assessment[Edinburgh Postnatal Depression Scale(EPDS)]were self-evaluated by electronic questionnaire,and the degree of fatigue and psy-chological condition were compared.Results:①After treatment,6-8 weeks postpartum follow-up showed that the Hb level(129.1±6.4 g/L vs.119.4±9.6 g/L),Hb growth value(49.8±9.4 g/L vs.39.8±11.8 g/L),and Hb growth percentage(62.7%vs.49.3%)Hb increase≥40 g/L(89.2%vs.53.8%),hematocrit level(34.8%vs.29.4%),mean corpuscular volume(97.6 fl vs.92.5 fl)in the intravenous group were significantly higher than those in the control group(P<0.05).②Comparison within groups:compared with the pre-treatment,the MFI scores of the intravenous group and the oral group were significantly lower after treatment(P<0.05),while the difference between the EPDS scores of the two groups before and after treatment was not statistically significant(P>0.05).Comparison between groups:there was no statistically significant difference in MFI scores and EPDS scores between the two groups before and after treatment(P>0.05).③There were no grade 3 or above adverse events occurred in either group.Conclusions:Intravenous ferric derisomaltose is effective and safe for the treat-ment of postpartum anemia,improving hemoglobin levels more rapidly than oral iron,with similar improvements in fatigue levels and no significant impact on postpartum depression as assessed by EPDS.

Objective:The rectus abdominis distance(IRD)was measured by ultrasonography at different sites in primiparous women at 6 weeks postpartum to explore the factors affecting IRD in primiparous women.Methods:A total of 881 primigravid women who underwent ultrasound examination of the rectus abdominis mus-cle at 6 weeks postpartum in The Second Affiliated Hospital of Air Force Medical University from January 1,2020 to December 31,2022 were selected as the study subjects.IRD was measured at 3 cm above the umbilicus,umbili-cus,and 3 cm below the umbilicus.Based on the site of diastasis recti abdominis(DRA)onset,IRD was catego-rized as single-site DRA,two-site DRA,and total abdominal DRA.The incidence of DRA at 6 weeks postpartum was counted and factors influencing IRD at the 3 sites were analyzed using multiple linear regression.Results:①At 6 weeks postpartum in primiparous women,the IRD at 3 cm above the umbilicus was 24.02±9.22 mm,at the umbilicus was 25.08±9.27 mm,and at the 3 cm below the umbilicus was 9.08±8.03 mm,with the largest IRD at the umbilicus and the smallest at the 3 cm below the umbilicus.②DRA occurred in 819 cases(92.96%)of which 473 cases(53.69%)were total abdominal DRA,119 cases(13.51%)were single-site DRA and 227 cases(25.77%)were two-sites DRA.③Multiple linear regression analysis showed that cesarean delivery,neonatal birth mass index(BMI),and maternal prenatal BMI were all significantly and positively associated with IRD at all 3 sites(β>0,P<0.05).Maternal age at delivery was significantly and positively associated with IRD at the umbilicus and 3 cm below the umbilicus(β>0,P<0.05),and gestational weight gain was significantly and positively associ-ated with IRD at 3 cm above the umbilicus and IRD at the umbilicus(β>0,P<0.05).Conclusions:There is high-er percentage of total abdominal DRA in primigravid women.IRD in primigravid women at 6 weeks postpartum is associated with a number of factors,among which cesarean delivery,neonatal birth BMI,maternal prenatal BMI,and age at delivery are high-risk factors for increased IRD.

Objective:To explore the differences in reproductive tract microbiota between patients with moder-ate and severe intrauterine adhesions(IUA)and infertile patients with normal uterine cavities and the clinical sig-nificance.Methods:Thirty patients were enrolled in the study from June 1,2022 to September 12,2022.Among them,15 cases were confirmed as moderate to severe IUA by hysteroscopy(group A),and 15 cases of primary infertility were excluded from intrauterine diseases through outpatient hysteroscopy(group B).Perform high-throughput sequencing of secretions from the vagina,cervix,and uterine cavity separately.Results:There is no difference in the α diversity of intrauterine microbiota between the two groups,but the α diversity of intrauterine mi-crobiota in group A is significantly higher than that of cervical microbiota(P=0.036).At the genus level,the top 10 relative abundances are the same for both groups.At the species level,the abundance of lactobacillus iners in group A is significantly lower than that in group B(P=0.001).There is no statistically significant difference in the abundance of microorganisms in the vagina,cervix and uterine cavity of group A.Conclusions:The types of en-dometrial microbiota in IUA patients and infertile women are roughly the same,but the composition is different.There are differences in the diversity of reproductive tract microbiota in patients with IUA,with a higher diversity of microbiota in the uterine cavity.Which suggests that the pathogenesis of IUA may be related to the changes of endometrial microbiota,increased microbial diversity,complex microbial species,especially the imbalance of the microecology of lactobacillus,which is not conducive to the repair of endometrial damage.

Objective:To explore the factors influencing the success of external cephalic version(ECV)and to construct a nomogram prediction model.Methods:The clinical and imaging data of 269 pregnant women who un-derwent ECV by two obstetricians in the Department of Obstetrics,Women and Children's Hospital,School of Medicine,Xiamen University,from 1 July 2018 to 31 July 2023 were collected,and 215 cases were selected as the training set and 54 cases as the validation set.According to the ECV outcome,the patients were divided into the success group(160 cases)and the failure group(55 cases)in the training set.A multifactorial Logistic regression analysis was performed to establish an ECV success rate prediction model and draw a nomogram.The perform-ance and accuracy of the model was evaluated and verified using the receiver operating characteristic(ROC)curve,calibration curve and the clinical decision curve(DCA).Results:ECV was performed in 269 pregnant women,with a total success rate of 75.46%,and the success rate of menstruating mothers(81.11%)was higher than that of primigravid women(64.04%),with a statistically significant difference(P<0.05).Multifactorial Logistic regression analysis showed that amniotic fluid index(AFI),placenta position,palpability of the fetal head,direction of the fetal back,and whether the fetal presentation engages the pelvis were independent factors affecting the success of ECV(P<0.05).The above five factors were used to construct a nomogram model with the area under the ROC curve(AUC)was 0.906,and the AUC for the validation set of this model was 0.831.Conclusions:The nomogram model for predicting the success rate of external cephalic version constructed has good accuracy and high clinical application value.

Objective:To investigate the clinicopathological features,treatment and prognosis of endometrial carcinoma arising in endometrial polyps(EPs).Methods:Thirty-eight cases of endometrial carcinoma arising in EPs were collected in the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2021.The clinical data,pathological characteristics,and follow-up information were retrospectively analyzed from three dimensions:tumor histological type,the menopausal status of the patients and the scope of malignant le-sions.Results:①In terms of tumor histological type,uterine endometrioid carcinoma 33 cases(86.8%)and uter-ine serous carcinoma 50 cases(13.2%),the mean age of patients with endometrioid carcinoma arising from EPs was significantly lower than that of patients with serous carcinoma arising from EPs(53.3±10.0 years vs.63.4±10.3 years,P=0.043).②In terms of menopausal status,endometrioid carcinoma progressed from atypical poly-poid adenomyoma(APA)accounted for 55.6%(10/18)and 5.0%(1/20)in the pre-and post-menopausal group,respectively(P=0.001).The rate of adjuvant therapy was significantly lower in premenopausal patients than in postmenopausal patients(16.7%vs.50.0%,P=0.043).③There were no significant differences in pa-tients age,menopausal status,BMI,comorbidities,abnormal uterine bleeding,maximum diameter of EP,tumor stage,grade,treatment or recurrence rate between cases with tumors confined and unconfined to EPs.Conclu-sions:Endometrioid and serous carcinomas progressed from EPs were more common in perimenopausal and postmenopausal patients,respectively.Malignancies derived from APA contributed to almost half of EP-arising carcinomas in premenopausal women,with a higher degree of differentiation and a low rate of postoperative adju-vant therapy.

Objective:To evaluate the clinical value of DH3 human papilloma virus(HPV)DNA and Aptima HPV E6/E7 mRNA testing in detecting cervical lesions.Methods:Retrospective analysis included 1254 cases test-ed with DH3-HPV DNA and 8263 cases tested with Aptima HPV E6/E7 mRNA from January 1,2022 to December 31,2023 at Women's Hospital,School of Medicine,Zhejiang University.All patients have follow-up re-sults of cervical biopsy pathology.Cervical biopsy histopathology served as the gold standard.The sensitivity and specificity for detecting low-grade squamous intraepithelial lesion and higher cervical lesions(LSIL+)or high-grade squamous intraepithelial lesion and higher cervical lesions(HSIL+)were compared between the two meth-ods.Results:The positive prevalence was 75.44%(946/1254)in DH3-HPV DNA testing,and 79.29%(6552/8263)in Aptima HPV E6/E7 mRNA testing.In women older than55 years,Aptima HPV E6/E7 mRNA showed a higher positive rate than that of DH3-HPV DNA[84.70%(1583/1869)vs.76.34%(200/262),P<0.05).The sensi-tivity of DH3-HPV DNA and Aptima HPV E6/E7 mRNA detection of LSIL+was 90.63%(493/544)and 91.79%(2953/3217),respectively,with no statistically significant difference(P>0.05).The specificity of DH3-HPV DNA and Aptima HPV E6/E7 mRNA 16/18 geneotyping detection using LSIL+was 83.94%(596/710)and 85.67%(4323/5046),respectively,with no statistically significant difference(P>0.05).The sensitivity of DH3-HPV DNA and Aptima HPV E6/E7 mRNA detection for HSIL+lesions was 93.94%(124/132)and 97.51%(782/802),respectively,with no statistically significant difference(P>0.05).The specificity of Aptima HPV E6/E7 mRNA 16/18/45 geneotyping detection using HSIL+was 83.50%(6230/7461),significantly higher than that of DH3-HPV DNA 16/18 geneotyping detection at 81.02%(909/1122),with statistically significant difference(P<0.05).Conclusions:The sensitivity of DH3-HPV DNA and Aptima HPV E6/E7 mRNA in the detection of cervical lesions is similar.Aptima HPV E6/E7 mRNA geneotyping has a high specificity in the detection of HSIL+than DH3-HPV DNA geneotyping.The higher positive prevalence of Aptima HPV E6/E7 mRNA in women older than 55 years may reflect increased HPV integration rates in this population.

Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

Objective:To explore the correlation between intrahepatic cholestasis of pregnancy(ICP)and ad-verse pregnancy outcomes.Methods:A total of 511 singleton pregnant women with ICP treated at The Third Affili-ated Hospital of Guangzhou Medical University from August 2017 to January 2024 were selected as the study sub-jects.Among them,patients were divided into the adverse pregnancy outcome group(n=49)and the control group without adverse pregnancy outcomes(n=462).The general and clinical data of the two groups were com-pared and analyzed.Results:①General situation:The number of pregnancies and deliveries,ICU transfer rate,total hospital stay,and total hospitalization costs were significantly higher in the adverse pregnancy outcome group compared to the control group(P<0.05).The number of prenatal check-ups,diagnostic gestational weeks,and gestational weeks at delivery were significantly lower compared to the control group(P<0.05).②Clinical symp-toms:The incidence of itching in the adverse pregnancy outcome group was lower compared to the control group(10.2%vs.26.6%,P<0.05),while other symptoms such as rash,fatigue,jaundice,and gastrointestinal symp-toms showed no significant difference between the two groups(P>0.05).③Laboratory examinations:Compared with the control group,patients in the adverse pregnancy outcome group had significantly the increased levels of alanine aminotransferase,aspartate aminotransferase,uric acid,urea nitrogen,and triglycerides,and significantly the decreased levels of alkaline phosphatase and fasting blood glucose,with statistical significance(P<0.05).Other biochemical indicators showed no significant difference between the two groups(P>0.05).④ICP grading and complications:The proportion of early-onset ICP,severe and very severe ICP in the adverse pregnancy out-come group was significantly higher compared to the control group(P<0.001);the proportion of adverse preg-nancy outcome group with pregnancy-induced hypertension was significantly higher compared to the control group;the incidence of preterm birth,fetal growth restriction,meconium-stained amniotic fluid,and fetal distress in the adverse pregnancy outcome group was significantly higher compared to the control group(P<0.001).⑤Neo-natal outcomes:The neonatal Apgar scores(1 min,5 min,10 min)and neonatal weight in the adverse pregnancy outcome group were lower compared to the control group(P<0.001),and the incidence of mild neonatal asphyx-ia was significantly higher,with a statistically significant difference(P<0.001).Conclusions:The severity of ICP is closely related to the occurrence of adverse pregnancy outcomes.Therefore,it is clinically necessary to pay at-tention to the grading of ICP,closely monitor the levels of total bile acids and liver enzymes,and try to avoid ad-verse pregnancy outcomes,especially intrauterine fetal death.