Huadi Yang

Vaginal stump rupture due to sexual activity leading to small intestine vaginal hernia and intestinal necrosis in a woman after cervical cancer surgery: A case report

Rationale: Radical hysterectomy is the standard surgical procedure for early-stage cervical cancer, and postoperative adjuvant chemoradiotherapy is administered based on pathological high-risk and intermediate-risk factors. After treatment of cervical cancer, all focus is placed on postoperative recurrence, metastasis and menopausal symptoms, and almost no one pays attention to the recovery of vaginal elasticity and sexual activity of reproductive-age women. Due to frequent surgery and radiation therapy for cervical cancer patients, the length and elasticity of the vagina are reduced. Cervical cancer patients need to be aware of issues related to sexual activity, such as vaginal shortening or shrinking, the impact of cancer on sexuality, and when to restore sexual activity after surgery. Patients who receive this information can better cope with these changes. We report a clinical case with the aim of sharing our experiences and calling for an emphasis on the recovery of vaginal stump and vaginal elasticity and sexual activity guidance after radical hysterectomy. Patient concerns: A 48-year-old woman with cervical cancer who underwent radical hysterectomy 6 years ago was admitted to the gastrointestinal surgery ward urgently, having shown severe upper abdominal pain accompanied 6 hours after sex activity. Diagnoses: Small bowel vaginal hernia with intestinal necrosis was diagnosed. Interventions: Urgent surgery was performed to resect the necrotic small intestine and repair the vaginal stump and pelvic floor. Outcomes: After surgery, she recovered well and is currently under regular follow-up for cervical cancer. Lessons: It is crucial to regularly guide and follow-up on patients’ sexual behavior during the follow-up period after cervical cancer surgery. Gynecologists should fully inform the time for restoring sexual relations after cervical cancer surgery. Nursing staff should be guided to avoid premature and excessive sexual activity to the vaginal cuff to prevent rupture and other potential complications. Effective medical intervention should be implemented as early as possible for patients with vaginal sac rupture after cervical cancer surgery. Current research on sexual activity after cervical cancer surgery has many limitations and more detailed studies are needed. A specific questionnaire to assess sexual activity and a clinical study to determine the appropriate medication to restore vaginal elasticity are expected.

Fuzheng Jiedu Decoction Induces Apoptosis and Enhances Cisplatin Efficacy in Ovarian Cancer Cells In Vitro and In Vivo through Inhibiting the PI3K/AKT/mTOR/NF‐κB Signaling Pathway

Objectives. This study is aimed at investigating the anticancer activity of Fuzheng Jiedu decoction (FJD) alone or in combination with cisplatin in ovarian cancer (OC) models, as well as its underlying mechanisms of action. Methods. The anticancer activities of FJD, cisplatin, and the combination of the PI3K inhibitor (LY294002, LY) or activator (IGF‐1) were evaluated in OC cell lines in vitro and in a SKOV3 xenograft mouse model in vivo. The cell proliferation and invasion ability were measured using MTT, EdU, and transwell assays, respectively. The cell apoptosis was examined by flow cytometry and JC‐1 assays. The expression levels of the Bcl‐2 family and the PI3K/AKT/mTOR/NF‐κB pathway‐related proteins were analyzed by Western blot. Results. The in vivo and in vitro studies showed that FJD administration could significantly inhibit cell proliferation and promote cell apoptosis in two OC cell lines SKOV3 and 3AO and partially decreased the tumor volumes and weights. In addition, FJD could significantly downregulate the protein levels of p‐PI3K/PI3K, p‐AKT/AKT, p‐mTOR/mTOR, NF‐κB, p38, and Bcl‐2 and upregulate the Bax, Cyt‐C, and cleaved caspase‐3 in OC tumor tissues and cells. FJD cotreatment increased the efficacy of cisplatin, including inhibiting OC cell proliferation and invasion, promoting cell apoptosis, and inhibiting the PI3K/AKT/mTOR signaling pathway, while this enhancement was suppressed by IGF‐1. Similarly, LY also enhanced the anticancer efficacy of cisplatin. Conclusions. This study indicated that FJD could improve the efficacy of cisplatin by inhibiting the PI3K/AKT/mTOR/NF‐κB signaling pathway. It is suggested that FJD may be a valuable adjuvant drug for the treatment of OC.