To evaluate the effects of pelvic floor muscle training (PFMT) and perineal massage during late pregnancy on postpartum pelvic floor function in nulliparas. Randomised controlled trial. The Peking University First Hospital, a teaching hospital in China. Two-hundred nulliparas were included. Nulliparas were randomised into four groups in a 1:1:1:1 ratio. Group A, control; group B, perineal massage; group C, pelvic floor muscle training (PFMT); group D, perineal massage and PFMT. The intervention group received the corresponding intervention from 34 weeks of gestation until delivery. Changes in pelvic floor function from 34 weeks of gestation to 6 weeks postpartum were assessed using pelvic floor electromyography (EMG), pelvic organ prolapse quantitation (POP-Q), and pelvic floor distress inventory-20 (PFDI-20). Those with PFMT (groups C and D) had a smaller decline in pelvic floor EMG of fibre II than those without PFMT (groups A and B) [- 0.2 (- 7.1, 11.3) µV vs 6.1 (- 0.2, 15.2) µV, P = 0.040]. The same scenario was observed in the pelvic floor EMG of fibre I. The Aa point measurement differences of those with PFMT (groups C and D) were smaller than those without PFMT (groups A and B) [0.0 (0.0, 2.0) cm vs 1.0 (0.0, 3.0) cm, P = 0.006]. The same result was observed for point Ba. No difference was observed in EMG and POP-Q in nulliparas with (groups B and D) or without perineal massage (groups A and C). No differences were observed in PFDI-20 scores. PFMT during late pregnancy enhanced pelvic floor EMG, while perineal massage alone or PFMT combined with perineal massage did not. PFMT in late pregnancy enhances pelvic floor function.

Background: The relationship between pelvic organ prolapse (POP), an aging-related disease, and the senescence-related protein mitofusin 2 (Mfn2) has rarely been studied. The aim of the present study was to explore the therapeutic effects of the downregulation of Mfn2 expression by stem cells on POP through animal experiments. Methods: First, a rat POP model was constructed by ovariectomy and traction. The rats in the non-pelvic organ prolapse (NPOP) and POP groups were divided into four groups for negative controls (N1–N4, N1: NPOP-normal saline; N2: NPOP-untransfected stem cells; N3: NPOP-short hairpin negative control (NPOP-sh-NC); N4: NPOP-short hairpin-Mfn2 (NPOP-sh-Mfn2)), and four groups for prolapse (P1–P4, P1: POP-normal saline; P2: POP-untransfected stem cells; P3: POP-sh-NC; P4: POP-sh-Mfn2), respectively. Stem cells were then cultured and isolated. The expression of Mfn2 was inhibited by lentivirus transfection, and the stem cells were injected into the uterosacral ligament of the rats in each group. The expression levels of Mfn2 and procollagen 1A1/1A2/3A1 in the uterosacral ligaments of the rats were observed at 0, 7, 14, and 21 days after injection. Results: Compared to the rats in the NPOP group, the POP rats had significant prolapse. The Mfn2 expression in the uterosacral ligaments of the POP rats was significantly increased (p < 0.05, all), and the expression of procollagen 1A1/1A2/3A1 was significantly decreased (p < 0.001, all). The POP rat model maintained the same trend after 21 days (without stem cell injection). At day 14, compared to the rats in the N1 group, the Mfn2 expression in the uterosacral ligament of the rats in the N4 group was significantly decreased (p < 0.05, all), and the expression of procollagens was significantly increased (p < 0.05, all). Similarly, compared to the rats in the P1 group, the Mfn2 expression in the uterosacral ligament of the rats in the P4 group was significantly decreased (p < 0.05, all), and the expression of procollagens was significantly increased (p < 0.05, all). Similarly, on day 21, the Mfn2 mRNA and protein expression in the uterosacral ligament of the POP and NPOP rats was significantly decreased (p < 0.05, all), and the expression of procollagens was significantly increased (p < 0.05, all) in the rats in the sh-Mfn2 group (N4, P4) compared to the rats in the saline group (N1, P1). Conclusions: The downregulation of Mfn2 expression by stem cells decreased the expression of Mfn2 and increased the expression of procollagen1A1/1A2/3A1 in the uterosacral ligament of the POP rats; this effect was significant 14–21 days after the injection. Thus, Mfn2 may be a new target for POP control.

To evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) for cervical squamous intraepithelial lesion (SIL). We systematically searched PubMed and other databases to compare the effectiveness of 5-ALA PDT with observation, ablation, and conization. Outcomes included overall response rate (ORR), complete remission (CR) rate, HPV clearance rate, and other relevant endpoints. Single-arm analyses were additionally performed by lesion grade. A total of 3,354 patients were included across 19 studies. The ORR with PDT was significantly higher than with observation (OR = 10.27, 95% CI: 3.87–27.27) and ablation (OR = 2.57, 95% CI: 2.00-3.30), with no significant difference compared with conization. At 6 months, HPV clearance rate was significantly higher with PDT than with observation (OR = 11.47, 95% CI: 3.16–41.68) and ablation (OR = 1.46, 95% CI: 1.01–2.13), but was comparable to conization. PDT also associated with a lower risk of progression than observation (OR = 0.19, 95% CI: 0.11–0.34) and a lower recurrence rate than ablation (OR = 0.30, 95%CI 0.14–0.63). ORR was 0.86 (95% CI: 0.83–0.89) in LSIL and 0.91 (95% CI: 0.87–0.94) in HSIL, with a significant difference between groups ( P = 0.0289). 5-ALA PDT for cervical SIL improves ORR and HPV clearance compared with observation and ablation, with efficacy comparable to conization and only mild adverse events. It is effective across lesion grades, with slightly better responses in HSIL.