In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical societies to develop this guidelineⅡfor cervical cancer screening. This guide focuses on standardizing methods for triaging abnormal cervical cancer screening results, with the aim of reducing overdiagnosis and missed diagnosis through refined management. Cervical cytology is currently the main triage method for individuals with positive high-risk human papillomavirus (HR-HPV) detection. Primary screening with cytology is managed based on the different risks of their results. In addition, p16/Ki-67 dual stain (DS) is acceptable for triage HPV-positive test results without genotyping or those positive for other (non-16/18) HR-HPV types (12 HR-HPV). It can also be used for triage in co-testing with HPV-positive results (no genotyping or 12HR-HPV) when the cytology result shows NILM, ASC-US and LSIL. Methylation is acceptable for triage of individuals testing 12 HR-HPV-positive. HPV gene integration testing could be used for the triage of HR-HPV positive individuals based on current research results in China. All these new testing methods must utilize reagents that have been approved by authoritative institutions and clinically validated for relevant indications. Additional clinical evidence is required for other methods such as HPV extended genotyping or HPV viral load, etc.

Human papilloma virus (HPV) is a double-stranded DNA virus that causes almost all cervical cancers due to high-risk HPV infection. More than 400 different HPV subtypes have been identified in recent years, and most HPV infections are asymptomatic and resolve spontaneously. Women with a normal immune system, starting with high-risk HPV infection, usually take 15 to 20 years to develop cervical cancer, but for immunocompromised women, such as untreated women living with HIV (WLHIV), cervical cancer may progress more quickly (5 to 10 years). In 2006, prophylactic HPV vaccine was developed and marketed, but it has no therapeutic effect on patients who have been infected with HPV or precancerous lesions. The development of therapeutic HPV vaccine may provide an important complement to the current methods for the prevention and treatment of cervical cancer. Currently, the therapeutic HPV vaccine is in the early clinical trials, which is different from the existing HPV prophylactic vaccine to prevent new HPV infection, therapeutic HPV vaccine will be designed to clear or treat existing HPV infections, their associated precancerous lesions and invasive cervical cancer as well. Therefore, a reasonable therapeutic HPV vaccine development strategy will not only allow the therapeutic HPV vaccine product development enterprises to avoid detours and improve the transformation efficiency, but also benefit patients with HPV infection, related lesions and even cancer as soon as possible. With the goal of clearing infection and treating cervical precancerous lesions. The expert concensus focus on the clinical development direction, target population, characteristic and vaccination programme of therapeutic HPV vaccine, aiming to accelerate and promote the research and development of therapeutic HPV vaccine, and will provide reference for the development of therapeutic HPV vaccine products and the formulation of national policies related to therapeutic HPV vaccine.

Objective To investigate the clinical applicability of human papillomavirus (HPV) point-of-care testing (POCT) in screening cervical intraepithelial lesions in high-risk populations. Methods In 499 patients with colposcopic referral indication, HPV POCT method and Sanger sequencing were used for HPV detection, and the consistency of HPV POCT rapid detection method was compared to evaluate the accuracy of HPV detection. Combined with the pathological results of patients, the clinical prediction performance of cervical intraepithelial lesions in high-risk population was analyzed. Results Among 499 patients, the overall HPV infection rate was 82.57% (412/499). The overall coincidence rate between HPV POCT method and Sanger sequencing technology was 90.49% (1 094/1 209). Taking Sanger sequencing detection results as a reference, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HPV POCT method were higher than 90.00%, and the Kappa consistency coefficient was greater than 0.90 (P<0.001). The sensitivity and specificity of HPV POCT for screening of cervical intraepithelial neoplasia (CIN) 2+ and CIN 3 is comparable to that of Sanger sequencing. Conclusions HPV POCT method demonstrated high consistency with Sanger sequencing in terms of HPV detection and CIN 2+prediction.

目的 探究曼月乐联合小剂量地屈孕酮片治疗子宫腺肌症患者的效果。方法 选取2020年5月至2022年5月在安徽医科大学附属巢湖医院治疗的100例患子宫腺肌症患者作为研究对象。按随机数字表法患者分为对照组和实验组各50例。给予对照组患者曼月乐节育环治疗，在此基础上，给予实验组小剂量地屈孕酮片联合治疗，比较两组治疗的总有效率、治疗前后的月经失血图（pictorial blood loss assessment chart, PBAC）月经量评分以及视觉模拟评分法（visual analogue scales, VAS）、及不良反应情况。结果 实验组的临床疗效明显优于对照组，差异有统计学意义（P＜0.05）；治疗后，两组的PBAC月经量以及VAS评分均较治疗前降低，且实验组显著低于对照组（P＜0.05）；两组患者服药期间的不良反应发生率差异无统计学意义（P＞0.05）。结论 曼月乐联合小剂量地屈孕酮片治疗子宫腺肌症疗效显著，减轻痛经程度，减少经血量，定全性高，值得临床应用。

预防性人乳头瘤病毒（human papilloma virus， HPV）疫苗接种是预防HPV感染的有效方法，可降低HPV 感染相关疾病的发生。目前国内外临床试验及真实世界研究均表明，预防性HPV疫苗是安全的，具有很好的免疫原性、保护效力和保护效果。优先推荐9~26岁女性接种HPV疫苗，重点是9~14岁女孩；同时推荐27~45岁女性和9~26岁男性接种，倡导男女共防。对于HPV感染或细胞学异常人群、HPV相关病变治疗史人群、遗传易感人群、子宫颈癌发病高风险生活方式人群，以及免疫功能低下人群均推荐预防性HPV疫苗接种。接种HPV疫苗后仍应定期进行子宫颈癌筛查。

卵巢癌（ovarian cancer, OC）缺乏有效的早期检测手段，大多数的卵巢癌通常被诊断为转移性病变，其复发率很高，极易发生耐药，使得临床治疗卵巢癌的效果受到局限。目前手术加化疗联合靶向药物维持治疗是各大指南推荐晚期卵巢癌和复发性卵巢癌的标准治疗模式，但仍存在较大治疗争议。因此，寻找克服卵巢癌复发和耐药患者潜在治疗新策略仍是临床急需解决的问题。最近提出一种新的调节性细胞死亡方式——“铜死亡（cuprotosis）”，铜是一切生物体代谢必不可少的辅因子，它能通过多种机制诱发细胞死亡。“铜死亡”的提出为铜所诱发的细胞死亡又增添了新思路，在肿瘤的预防与治疗中也具有巨大的潜力。因此，本文概述铜死亡及铜代谢抗肿瘤的作用机理及其在卵巢癌变中的研究进展，为卵巢癌治疗提供新的基础。

Objective To investigate the efficacy and side effects of different combined strategies of programmed cell death protein 1 (PD-1)/programmed cell death protein 1 ligand (PD-L1) inhibitors in the treatment of advanced ovarian cancer. Methods By searching Pubmed, Embase and Cochrane library, literature on PD-1/PD-L1 immunosuppressants combined with different strategies for ovarian cancer up to November 2023 was collected for quality assessment and data extraction. The meta-analysis was performed using Revman 5.3 and Stata 15.0 software. Results Eleven single-arm studies were included. The results of meta-analysis showed that PD-1/PD-L1 inhibitors combined with different regimens [chemotherapy agents, polyadenosine diphosphoribose polymerase (PARP) inhibitors, and anti-vascular targeting agents] in the treatment of advanced ovarian cancer were clinically beneficial, with an objective response rate of 24%. The heterogeneity was 60%, and the causes were analyzed by subgroups. The results showed that the objective remission rate of PD-1/PD-L1 inhibitor combined with anti-vascular targeted drugs in the treatment of advanced ovarian cancer was 25%, and the disease control rate was 60%. The objective response rate of combined anti-vascular targeting drugs was 64%. Treatment with PD-1/PD-L1 inhibitors combined with different drugs had a progression-free survival rate of 43% at 6 months, 26% at 12 months, and 79% overall at 12 months. The incidence of grade 3~5 adverse reactions was 28%, with hypertension, nausea and anemia being the most common. Conclusions PD-1/PD-L1 inhibitors combined with different regiments in the treatment of advanced ovarian cancer significantly improved the survival and prognosis of patients. And the incidence of adverse reactions is considerable.

Objective To investigate the carcinogenic mechanisms of molecular abnormalities in high-grade endometrial stromal sarcoma (HG-ESS). Methods The clinicopathological data of 21 patients with HG-ESS were retrospectively analyzed. Fluorescence in situ hybridization (FISH) was performed on the tumor samples using YWHAE single fusion translocation probe. RNA sequencing was performed on 5 patients with accessible tumor tissues to verify the fusion status. Immunohistochemistry (IHC) and immunofluorescence (IF) were performed for patients with YWHAE-NUTM2B fusion to verify the fusion function. Based on Kaplan-Meier method and log-rank test, survival analysis was performed on patients with positive and negative YWHAE fusion. Results The average age at diagnosis of the 21 HG-ESS patients was (46.1±12.6) years old, and HG-ESS patients all had abnormal vaginal bleeding symptom. FISH results of 21 HG-ESS patients were negative in 11 cases, positive in 7 cases, and atypical in 3 cases. The RNA sequencing results of 5 accessible tissue samples showed that YWHAE-NUTM2B typical fusion was detected in 1 FISH-positive and 1 FISH-atypical patient, and no fusion was detected in 3 FISH-negative samples. The nuclear expression of the fusion gene product (14-3-3ε) was confirmed by IHC and IF in two cases with YWHAE-NUTM2B fusion detected using RNA sequencing. Kaplan-Meier survival curve suggested that the YWHAE fusion positive group survived slightly better than the YWHAE fusion negative group, but the difference between these two groups was not statistically significant (P>0.05). Conclusions FISH and RNA sequencing methods are effective techniques for differential diagnosis of HG-ESS. RNA sequencing should be performed in HG-ESS patients with negative and atypical YWHAE fusion FISH results to check the presence of YWHAE fusion or other specific structural variants.

女性外阴整形是人体整形的一部分，随着女性生殖健康和美学理念的变化，小阴唇整形被更多女性所接受，其手术量跃居首位，与此同时却忽略了阴蒂包皮冗余的处理。近年来，在对小阴唇整形的同时也关注阴蒂包皮整形，将其作为一个整体，而阴蒂肿大的分类、手术方式、并发症等尚无统一定论，本文通过文献回顾对上述问题进行介绍。

Objective To compare the efficacy of weight loss therapy and drug therapy (Yousiyue combined with metformin) on obese polycystic ovary syndrome (PCOS). Methods A total of 106 patients with overweight/obese PCOS admitted to Huainan Maternal and Child Health Hospital from January 2022 to October 2022 were included and randomly divided into weight loss group (n=53) and drug group (n=53). The weight loss group was treated with weight loss therapy, and the drug group was given Yousiyue combined with metformin. Both groups were treated for 3 months. BMI, PCOS sign score, insulin-related indicators, sex hormones indicators and glucolipid metabolism indicators before and after treatment and pregnancy rate and adverse reactions were compared. Results The baseline data revealed no statistically significant differences between both groups (P>0.05). After treatment, the BMI, waist circumference, PCOS sign score, and levels of TC and TG in both groups were significantly decreased (P<0.05), and the BMI, waist circumference, TC and TG in weight loss group were lower than those in drug group (P<0.05). After 3 cycles of treatment, the HOMA-IR, AMH and T in drug group were significantly lower compared with those in weight loss group (P<0.05), but there were no obvious differences in other indicators (FINS, HOMA-β, LH, E2, and FPG) between groups (P>0.05). During follow-up, there were no statistical differences in the biochemical pregnancy rate and clinical pregnancy rate between the two groups (P>0.05). Conclusions Weight loss therapy has the same efficacy as Yousiyue combined with metformin on patients with obese PCOS, and both therapies can effectively improve the insulin resistance, hormone disorder and glucolipid metabolism imbalance, and enhance the clinical pregnancy rate. However, weight loss therapy is healthier and safer.

细胞间信息交流是维持机体各种组织器官发育的基本作用机制。众所周知，良好的子宫内膜容受性能够提高胚胎种植，依赖于细胞间信息传递的主要调节因素-外泌体。在外泌体合成过程中，不同细胞的囊泡中含有不同的物质，因此，外泌体包含的遗传和蛋白质组信息有望成为子宫内膜疾病的生物标记物或治疗靶点。本文对外泌体在子宫内膜方面的应用进行了文献综述, 以便为临床研究提供理论依据。

胎儿生长受限（fetal growth restriction, FGR）是围产儿患病和死亡的重要原因，且可能对其远期生长发育带来不良影响，因此加强对FGR胎儿的监测，及时发现胎儿异常并采取处理措施十分重要。电子胎心监护是判断是否存在胎儿缺氧的有效手段。近年来人工智能在医学领域的广泛应用，为胎心监护的判读提供了更多可能性。本文从传统方法和人工智能两个方面综述电子胎心监护在FGR监测的应用，讨论其现状、问题和发展前景。

Objective To investigate the application of the thickness of lower uterine segment of the anterior wall in late pregnancy measured by transvaginal ultrasound in predicting uterine scar during cesarean section. Methods A total of 120 pregnant women with scarred uterus who received transvaginal ultrasonography for measuring the thickness of lower uterine segment of the anterior wall in late pregnancy and gave birth in the People’s Hospital of Leshan from June 2019 to February 2022 were selected as the research subjects. According to the thickness of lower uterine segment of the anterior wall measured in late pregnancy, the subjects were divided into<1.00 mm group, 1.0-2.0 mm group and>2.0 mm group, with 40 cases in each group. The three groups were compared on intraoperative scar condition and the thickness of lower uterine segment of the anterior wall in women with poor (gradeⅡ, gradeⅢand gradeⅣ) scar formation during operation. Results Of the 120 pregnant women, 27 had poor uterine scar formation during operation. The proportions of poor uterine scar formation in the 1.0-2.0 mm group and the>2.0 mm group were lower than that in the<1.00 mm group (P<0.05). The proportion of poor uterine scar formation in the>2.0 mm group was lower than that in the 1.0-2.0 mm group (P<0.05). The proportions of gradeⅢand gradeⅣuterine scar in the<1.00 mm group and the 1.0-2.0 mm group were higher than those in the>2.0 mm group. In the <1.0 mm group, the proportion of intraoperative gradeⅢuterine scar was the highest. Pregnant women with gradeⅣuterine scar during operation had the thickness of lower uterine segment of the anterior wall smaller than 1 mm. The average thickness of lower uterine segment of the anterior wall in pregnant women with gradeⅡ, gradeⅢ, and gradeⅣuterine scar decreased in order (P<0.05). Conclusion For pregnant women with thinner than 2 mm of lower uterine segment of the anterior wall measured by transvaginal ultrasound in late pregnancy, especially thinner than 1 mm, necessary measures should be taken in advance to prevent scar rupture.