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Abstract Endometrioid carcinoma with sex cord-like formations and hyalinization of the uterine corpus, or corded and hyalinized endometrioid adenocarcinoma (CHEC), is a rare morphological variant of endometrioid carcinoma, for which there is limited literature and few cases reports. Most researchers tend to consider CHEC as a low-grade cancer with a favorable prognosis. Full-staging surgery is the primary choice for this disease, and no case of CHEC has been previously reported to be treated conservatively. Here, we present the following case to explore the possibility of fertility-preserving treatment for young women with CHEC. A 23-year-old nulliparous patient diagnosed with presumed stage IA CHEC received fertility-sparing treatment at the Obstetrics and Gynecology Hospital of Fudan University and got a complete response (CR) after 10 months of conservative treatment. The patient subsequently became pregnant spontaneously, successfully conceived, and gave birth to a healthy male neonate without any sign of recurrence during 37 months follow-up after CR. The patient’s postpartum follow-up is continuing. Presently, CHEC is not included in the fertility-sparing field of any available guidelines. This case indicates that fertility-sparing treatment may be an option for highly selected patients with CHEC. Continuous follow-up remains mandatory to observe long-term outcomes.

Abstract Purpose To investigate the efficacy of fertility-preserving treatment for young women with synchronous primary neoplasm of endometrium and ovary. Methods We retrospectively reviewed eight patients with concurrent primary grade 1 presumed stage IA endometrioid endometrial adenocarcinoma (EEA) or endometrial atypical hyperplasia (EAH) and primary stage I ovarian tumors who underwent fertility-sparing treatment in the Obstetrics and Gynecology Hospital of Fudan University between April 2016 and December 2022. Results Synchronous endometrial and ovarian cancers (SEOC) accounted for 50% of these eight patients. The median age of patients was 30.5 years (range, 28–34 years). None of them received chemotherapy. The median treatment time was 4 months (range, 3–8 months). 87.5% (7/8) cases achieved complete response (CR), and the median time to CR was 3.8 months (range, 1.5–7.7 months). Among patients who got CR, none of them showed any signs of recurrence. Pregnancies and successful deliveries were achieved in 4 of 5 patients. Till September 2023, the median follow-up period was 50.5 months (range:15.2–85.2 months). Conclusion Fertility-sparing treatment is feasible for highly selected patients with synchronous neoplasm of the endometrium and ovary, but strict screening and monitoring are mandatory. Though the results of our limited cases are encouraging, long follow-up and more clinical data are required. Enrolled patients must be fully informed of the risks during conservative treatment.

Abstract Background Progestins are used as fertility‐sparing regimens for young patients with stage 1A endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH). CD163+ macrophages promote estrogen‐dependent EEC development, but whether they induce progestin insensitivity remains unclear. This study aimed to investigate the possible effects of CD163+ macrophages on progestin response in AEH/EEC patients. Methods The number of infiltrating CD163+ macrophages in progestin‐insensitive and ‐sensitive endometrial lesions was compared. The effects of CD163+ macrophages on progestin responses and progesterone receptor (PR) expression in EC cells were evaluated in vitro. ATAC‐seq and RNA‐seq were combined to identify molecular/biological changes induced by CD163+ macrophages in progestin‐insensitive EC cells. Results Increased CD163+ macrophage infiltration was significantly associated with progestin insensitivity and longer treatment durations in AEH/EEC patients. Additionally, the number of CD163+ macrophages was negatively correlated with PR expression in AEH/EEC tissues. Furthermore, the CD163+ macrophage‐mediated microenvironment and secreted cytokines downregulated PR expression and impaired the response of EC cells to medroxyprogesterone acetate (MPA). RNA‐seq analysis demonstrated that CD163+ macrophages antagonized PR signaling by blocking or even reversing MPA‐regulated differential gene expression. Based on RNA‐seq and ATAC‐seq analyses, extracellular matrix (ECM) signaling and ECM‐related transcription factors, FOXF2, POU1F1, and RUNX1were identified to potentially be involved in CD163+ macrophage‐induced progestin insensitivity in endometrial cancer patients. Conclusions We identified CD163+ macrophages as an important mediator of progestin desensitization and an unfavorable factor for the efficacy of fertility‐preserving treatment in AEH/EEC patients.

Objective: To study the changes of physicochemical properties in Shuidouchi before and after fermentation, and to preliminarily explore the inhibitory effect of its extracts on castration-resistant prostate cancer cells (CRPC). Methods: Shuidouchi was fermented using three high-yielding protease strains. With reference to the national standard methods, contents ofamino nitrogen, total acid, pH, reducing sugar and soybean isoflavones in Shuidouchi before and after fermentation were tested, and total phenol and flavonoids were examined by chemical method. And the antioxidant capacity of Shuidouchi extracts was also determined. Finally, the inhibitory effect of Shuidouchi extracts fermented with the optimal strain was observed. Results: Fermented by high-yielding protease strains，the contents of amino nitrogen, reducing sugar, isoflavone and antioxidant capacity of soybean were all improved compared with steamed soybean, among which B19 strain fermented Shuidouchi had the best effect. And the extract of Shuidouchi fermented by B19 strain could selectively kill CRPC cells and promote their apoptosis, and inhibit the secretion of prostate-specific antigen (PSA), androgen (T) and dihydrotestosterone (DHT). Conclusion: Fermentation by high-yielding protease strains of Shuidouchi can change the physicochemical properties, and enhance its nutritional activities. Moreover, the extract of Shuidouchi fermented with B19 strain has an inhibitory effect on CRPC cells. This study provides data references and theoretical support for the research and development of health functional foods related to Shuidouchi.

In response to increasing environmental deterioration, the vigorous development of the integrated energy system is an important measure to achieve the goal of carbon neutrality. In order to ensure that the system takes into account the economic operation under the premise of low carbon and environmental protection, this paper proposes a bi-level optimal low-carbon economic operation model for the regional integrated energy system (RIES). At the upper level, the objective of the RIES is economic optimization, which contains the carbon emission cost so that the system would change its preference for high-carbon energy to limit the carbon emission of the system. At the lower level, an electricity and natural gas pricing model is established, and a carbon emission flow (CEF) model is used to calculate the price of carbon emissions. This proposed bi-level optimization model is converted to a single-level mathematical problem with KKT (Karush–Kuhn–Tucker) conditions for efficient calculation. The proposed optimal model is tested on the five-bus power system and seven-node natural gas system, and numerical results indicate the optimal operating model with this proposed carbon pricing method can effectively reduce carbon emissions and minimize the total operating cost of RIES.