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15 December 2015, Volume 42 Issue 6
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Advances in Ovarian Cancer Stem Cells WU Quan-feng;WANG Xi-peng 2015, 42 (6):  605-607.  Abstract ( 1116 )   PDF (338KB) ( 5108 )   Cancer stem cells(CSC) are a small group of cells with stem cell properties that are located in the tumor tissue. Ovarian cancer stem cells have four main features include self-renewing，multi-differentiating potential, strong proliferative ability and chemoresistance. Ovarian cancer has the highest mortality rate and poorest prognosis in gynecological malignant tumors. It has been considered, subset of cancer cells has acquired stem cell properties which causes the development of resistance to chemotherapeutic. Many studies show that there are subsets of cancer stem cells in fast-growing tumor cells in mice and these cells have various abilities of differentiation and resistance to chemotherapeutic. Thus, it plays an important role for therapy that gaining insight into the biological characteristics, surface markers of cancer stem cells and how to target in the treat of cancer stem cells. This review will highlight the research and clinical application of the ovarian cancer stem cells. Related Articles | Metrics

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Progress on Pathogenesis and Treatment of Malignant Struma Ovarii BAI Yang;ZHOU Xian-rong;LU Xin 2015, 42 (6):  608-611.  Abstract ( 1062 )   PDF (425KB) ( 5086 )   Struma ovarii is a highly specific and single endoderm differentiated mature teratoma and is composed predominantly of thyroid tissue. Malignant transformation of benign monodermal teratoma is a rare presentation of struma ovarii, reported that the rate is about 0.5%-5%. It is believed that malignant struma ovarii（MSO） has similar molecular mechanism such as BRAF, RAS mutation and RET/PCT rearrangements with the malignant tumors originating in the thyroid. Because of its clinical rare，currently there is still a lack of clear diagnostic criteria and principles of management. Some cancer experts advocated the use of primary thyroid carcinoma pathological criteria as the diagnostic basis of MSO. Complete surgical staging and adjuvant therapy such as total thyroidectomy, or thyroxine suppression, radioactive iodine ablation and external radiotherapy should be considered when the MSO has been diagnosed. It is observed that patients with MSO have an excellent disease-specific survival rate，postoperative adjuvant therapy can significantly improve the efficacy. Long-term follow-up after surgery were needed, thyroglobulin and total body 131I scan are useful as tumor marker for detection of metastases or tumor recurrence. Related Articles | Metrics

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Surgical Treatment for Early Stage Endometrial Cancer LU Xin-yi;NI Guan-tai 2015, 42 (6):  612-615.  Abstract ( 1092 )   PDF (504KB) ( 5031 )   Endometrial carcinoma is one of the most common gynecologic malignant tumor. Recent prospective data showed that, with the progress of laparoscopic operation techniques, minimally invasive surgery in patients with endometrial cancer treatment have been implemented. It is widely agreed that for early endometrial cancer standard operation treatment including operation excise uterus and bilateral tubal ovarian． Latest development of robotic surgical platform can offer optional advanced technologies for traditional laparoscopic surgery which demanding more, and can increase the number of patients with endometrial cancer treatment using minimally invasive surgery. The surgical treatment of early endometrial carcinoma combined abdominal and pelvic lymph node cleaning staging surgery as well as keep the reproductive function of patients with clinical effect has been a hot topic. The benefits of comprehensive staging operation, including lymph node cleaning in patients with early endometrial cancer is still controversial. This paper will review the current progress in the definition of early endometrial cancer, prognostic factors and new operation treatment and some are being incorporated into the new technology. Related Articles | Metrics

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The Origin of Non-uterine Pelvic Serous Carcinomas ZHAO Ting;LIU Xi-shi 2015, 42 (6):  616-620.  Abstract ( 1222 )   PDF (542KB) ( 4998 )   Serous ovarian carcinoma, serous tubal carcinoma and serous peritoneal carcinoma comprise non-uterine pelvic serous carcinoma. Serous ovarian carcinoma can be divided into low-grade and high-grade subtypes according to cell differentiation. These two subtypes are distinct disease for the extreme variation in clinical manifestation, prognosis and endometrial cysts molecular feature. It was considered that low-grade subtype arises from benign cysts of ovarian like the serous cystadenomas and endometrial cysts by borderline tumors. The origin of high-grade subtype is unclear and believed to arise from ovarian surface epithelium traditionally. Pathological examination of the fallopian tube after risk-reducing salpingo-oophorectomy of BRCA mutation carriers found that serous tubal intraepithelial carcinoma （STIC） was usually present，which may be the precursor lesion for high-grade serous ovarian carcinoma. The same lesion was found at the fimbriae of patients diagnosed of serous tubal or peritoneal carcinoma which sharing the similar clinical and molecular characters to high-grade serous ovarian carcinoma. It was suggested that the above three types of non-uterine serous carcinoma may all arise from the STIC lesion located in fimbriae of uterine tube. Related Articles | Metrics

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Progress of Hysteroscopy in Diagnosing Intrauterine Benign and Malignant Lesions TIAN Han-fei;TONG Xiu-qin 2015, 42 (6):  621-625.  Abstract ( 1070 )   PDF (670KB) ( 5049 )   Intrauterine lesions is a common gynecological and frequently-occurring disease which always with the complication of abnormal uterine bleeding clinically，and its cause complexly and pathology difficultly to decide. The early identification of benign and malignant lesions of the uterine cavity is essential to improve patients′ survival and prognosis. In recent years，with the rapid development of hysteroscopy technology，it not only can bring more intuitive and accurate diagnostic methods for the detection of benign and malignant lesions，but plays an important role in the cure for intra-cavitary uterine diseases. Especially for women who wish to preserve fertility, the hysteroscopic resection can avoid unnecessary hysterectomy and preserve reproductive function of patients，which important significance for clinical and social. Related Articles | Metrics

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The Correlative Study between Blood Flow Measurements and Microvessel Density Assessments in Ovarian Epithelial Serous Tumors PANG Yu-lan;XUE Hong-xia;JIAO Tong;LI Hui-dong 2015, 42 (6):  626-629.  Abstract ( 1218 )   PDF (574KB) ( 5015 )   Objective：To explore the resistance index（RI） and vessel class characteristics of different pathological nature of ovarian epithelial serous tumors with similar morphological characteristics, and the correlation between the two and microvessel density（MVD） and clinical reference value. Methods：To retrospectively analyse 76 cases of ovarian serous tumor patients treated in October 2012—July 2014 from Tianjin Renmin Hospital and Tianjin Central Hospital of Gynecology and Obstetrics , divided into 3 groups according to the postoperative pathologic results: benign group（30 cases）, the pathological results for benign serous cystadenoma with solid organization or nipple samples, excluding simple ovarian serous cystadenoma; border group（24 cases）, pathological results as borderline serous cystadenoma; stageⅠcarcinoma group（２２ ｃａｓｅｓ）, pathological results for serous cystadenocarcinoma, the International Federation of Gynecology and Obstetrics（FIGO） ovarian carcinoma stage for stage Ⅰ. Observed by Transvaginal Color Doppler Ultrasound（TVCDU）, vascular ＲＩ and Three-dimensional Color Power Doppler Angiography（3D-CPA） vessel class, evaluated the blood flow characteristics of ovarian serous tumors, and the correlation between MVD and the two parameters were researched. Results：There was statistically significant difference of MVD in different pathological nature of ovarian serous tumor（F=69.08, P＜0.001）, and stageⅠcarcinoma group was the highest among 3 groups（P＜0.001）; Compared RI of 3 groups, difference was statistically significant（F=17.36, P＜0.001）, the benign tumor group was higher than the border group and stageⅠcarcinoma group（P＜0.001）, the border and stageⅠcancer group without statistical difference（P＞0.05）; 3D-CPA vessels class of 3 groups was different from each other, statistically significantly（χ2= 27.263，P＜0.001）, of which the benign group is priority toⅠvessel class(63.3%), border and stageⅠcarcinoma group is priority toⅡ、Ⅲvessel class（70.8%, 100%, respectively）, benign group compared with border group and stageⅠcarcinoma group respectively, statistically significantly（P＜0.017）, the border groups and stageⅠcancer group without statistical difference（P=0.034＞0.017）. 3D-CPA vessel class was positively correlated with MVD （rs=0.794, P＞0.01）, while RI was negatively correlated with MVD （r=－0.786, P＜0.01）. Conclusions：RI and 3D-CPA vessel class can be used to evaluate tumor vascular blood flow characteristics before operation, which provides important clinical reference value to identify the pathological nature of ovarian serous tumor for those have similar morphological characteristics． Related Articles | Metrics

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Expression of maspin and p53 in Gestational Trophoblastic Disease and Its Clinical Significance WU Qi-bin;ZHENG Xiu;WU Li-xiang;SONG Yi-yi;SUN Peng-ming 2015, 42 (6):  630-633.  Abstract ( 1043 )   PDF (581KB) ( 5029 )   Objective：To explore the expressions of maspin and p53 in gestational trophoblastic disease, and their roles in the development of hydatidiform mole. Methods：The expressions of maspin and p53 were detected by immunohistochemistry （PV9000） in 22 cases of normal early pregnancies, 82 cases of hydatidiform moles （35 cases were followed up to occur malignant transformation） and 11 cases of gestational trophoblastic tumors. Results：Hydatidiform mole without malignant transformation group and normal early pregnancy group, hydatidiform mole with malignant group and hydatidiform mole without malignant transformation group, the positive expression rate of maspin was significantly lower, but the positive expression rate of p53 was significantly higher, the difference was statistically significant （P＜0.05）. In moles with malignant high risk factors such as β-hCG＞105 U/L, uterus volume ＞ gestation weeks, ovary lutein cyst ＞6 cm, the expression of maspin was lower than those groups such as β-hCG≤105 U/L，uterus volume ≤ gestation weeks, ovary lutein cyst ≤6 cm （P＜0.05）, while the expression of p53 was higher in moles with malignant high risk factors such as β-hCG＞105 U/L，ovary lutein cyst ＞6 cm compared with those without risk factors groups （P＜0.05）. Maspin expression was correlated with p53 （P＜0.05）. In 35 cases of malignant moles the expression of maspin in FIGO prognostic score ≥7 was lower than that in FIGO prognostic score ＜7（P＜0.05）. The expression of p53 in anatomy staging Ⅲ group was higher than that in anatomy staging Ⅰ-Ⅱ group （P＜0.05）. Conclusions：Decreased expression of maspin and high expression of p53 may be early events in the malignant transformation of hydatidiform mole. It is suggested that the joint detection of both proteins provide certain reference value in predicting hydatidiform mole malignant transformation and prognostic evaluation of gestational trophoblastic disease. Related Articles | Metrics

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Primary Ovarian Carcinoid Goiter: A Case Report and Review of the Literature WANG Yu;BAI Jing;LI Ai-jun 2015, 42 (6):  634-636.  Abstract ( 1030 )   PDF (556KB) ( 5101 )   Objective：To explore the clinical performance, pathological character, treatment and prognosis of primary ovarian carcinoid goiter. Methods：Retrospective analysis of clinical data of a case of primary ovarian carcinoid goiter in the First Affiliated Hospital of Zhengzhou University, including clinical manifestations, preoperative diagnosis, surgical procedures, pathologic findings, prognosis and postoperative follow-up tumor marker. Results： The patient had been carried out hysterectomy+bilateral salping-oophenrectomy+pelvic lymphadenectomy+omentum appendectomy surgery in our hospital. Routine pathological findings were demonstrated goiter primary ovarian carcinoidⅠA period, and constipation was improved after the surgery, tumor markers were not reduced to normal follow-up to now was two years and three months , but there was no signs of tumor recurrence and metastasis in all imaging findings. Conclusions：Goiter carcinoid is a very rare malignant ovarian tumors, lack of typical clinical symptoms and signs, for patients with severe constipation should eliminate this kind of tumor, and must be carried out a comprehensive immunohistochemical examination after the surgery. Related Articles | Metrics

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Retrospective Analysis of 72 Cases of Borderline Ovarian Tumors ZHANG Li;QIU Li-hua 2015, 42 (6):  637-641.  Abstract ( 993 )   PDF (701KB) ( 4952 )   Objective：To analyze retrospectively those cases of borderline ovarian tumors（BOTs） from Renji Hospital, School of Medicine, Shanghai Jiao Tong University in recent 10 years, including the prognosis of BOTs and factors affecting the prognosis. Methods： A total of 72 patients with BOTs were retrospectively analyzed, from March 2004 to October 2014, including clinical features, diagnosis, treatment and follow-up visit. Results：The mean age at diagnosis was （46.4±17.3） years, including 30（41.7%） patients aged ≤40 years, 22（30.6%） postmenopausal patients, and 47（65.3%） asymptomatic patients. The serum level of CA125 was increased in 29（50.9%） patients, and the level of CA199 in 18（31.6%） patients. The median sonographic dimension of serous BOTs mass （80 mm） was significantly larger than that of mucinous mass (185 mm) （P＜0.001）. 52（72.2%） patients were at stage Ⅰa, while 12（16.7%） at stage Ⅱ-Ⅳ. The recurrence was seen in 6 patients （6/72）, and the recurrence rate was only related to the surgical procedure by the COX regression analysis （P=0.045）. Conclusions：Patient with BOTs are younger, while the preoperative diagnosis rate is not high. The prognosis of BOTs treatment is relatively satisfying if the early diagnosis was achieved. The long-term follow-up visit is essential since BOTs have two reasonably high rates, recurence rate and canceration rate. Surgical procedure is the main factor related to recurrence. It is necessary to keep the long-term follow-up visit, including the survival period and affecting factors, in those BOTs patients after operation. Related Articles | Metrics

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Progress in Treatment of Cesarean Scar Pregnancy Asiyan Nusilati;LIN Kai-qing;XU Kai-hong;LIN Jun 2015, 42 (6):  644-647.  Abstract ( 1006 )   PDF (607KB) ( 4941 )   Cesarean scar pregnancy （CSP） is a very rare form of ectopic pregnancy and one of the long-term complications of cesarean section. A delay in diagnose or misdiagnose can lead to excessive hemorrhage, hemorrhagic shock , uterine rupture and may endanger the patient′s life. The pathogenesis of CSP is unknown and there is currently no consensus on the treatment. Simple methotrexate treatment has a high risk of hemorrhage, but it can be an adjuvant therapy for surgical treatment. Uterine curettage is a less invasive treatment, but it can also lead to a massive bleeding if you don′t know the indications well. Preoperative uterine artery embolization can reduce the bleeding, but it has many adverse reactions and it′s high priced. Given the lack of the sufficient evidence on the outcome of hysteroscopic, laparoscopic, these interventions should be applied in a research setting with long-term follow-up. Although transabdominal or tansvaginal local lesion resection with repair can treat the disease and remove the old scar, it is more invasive and should be the supplementary treatment of the precious treatments only. The first line treatment still needs a large number of study and research, therefore, the management plan should be individually tailored. Related Articles | Metrics

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Clinical Analysis of Acellular Dermal Matrix Vaginoplasty ZHAO Yan-hong;LI Liu-xia;ZHANG Ying;ZHAO Yan-ping;LI Jiao-jiao;LI Ling-yan;LIU Yan-xia;GUO Rui-xia;BIAN Ai-ping;ZHAO Qian 2015, 42 (6):  648-650.  Abstract ( 1142 )   PDF (699KB) ( 5032 )   Objective：To investigate the feasibility of vaginoplasty with an acellular dermal matrix（ADM） patch in the treatment of Mayer-Rokitansky-Kuster-Hauser（MRKH） syndrome. Methods：The clinical data of 42 cases of congenital absence of vagina (MRKH syndrome) from January 2012 to April 2015 in our hospital were analyzed retrospectively，including 12 cases underwent ADM vaginoplasty（observer group） and 30 cases underwent laparoscopic peritoneal vaginoplasty（control group）. The perioperative, postoperative complications and postoperative follow-up data were compared between the two groups. Results：All cases were successful. No injury occurred arround the adjacent organs. The mean operation time，intraoperation blood loss，postoperative anal exhaust time and complications in observer group were less than that of control group（P＜0.05），while the hospitalization expenses in observer group was higher than that of control group（P＜0.05）. The follow-up showed that the width of artificial vagina of the two groups were 2 fingers in average and the length ＞8 cm with smooth and elastic mucosa. The vagina mucosa was formed 3 months in the observer group after vaginoplasty to start sexual life，while 6 months in the control group. The female sexual function index（FSFI） of the 8 cases in the observer group had no statistical difference with that of 16 cases in the control group（P＞0.05）. Conclusions：Both the ADM vaginoplasty and the laparoscopic peritoneal vaginoplasty are optimal procedures for vaginal reconstruction. However，the ADM vaginoplasty is simpler，less injury，fewer complications and earlier start sexual life. Related Articles | Metrics

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Correlation between Vaspin Gene Polymorphism and Polycystic Ovary Syndrome CHAI Yi-qing;LIU Jie 2015, 42 (6):  651-653.  Abstract ( 929 )   PDF (665KB) ( 5019 )   Objective：To investigate the association between polycysitic ovary syndrome（PCOS） and gene polymorphism of Vaspin. Methods：This case-control study was performed on 200 patients with PCOS（PCOS group） and 200 healthy women（control group） from July 2011 to Augest 2014 diagnosed at Tianjin Central Hospital of Gynecology Obstetrics. The polymorphism of Vaspin rs2236242 were compared between two groups. Results：A significant difference against PCOS was found for Vaspin rs2236242 frequency in A vs. T allele（OR=0.68，95%CI：0.51-0.91，P=0.009）. The incidence of PCOS was lower in TA（OR=0.51，95%CI：0.33-0.79，P=0.002） or AA genotype （OR=0.47，95%CI：0.23-0.95，P=0.035）than in TT genotype in our Codominant and Dominant models. Dominant genetic model analysis showed that the incidence of PCOS was lower in TA+AA genotype than in TT genotype（OR=0.50，95%CI：0.33-0.77，P=0.001）. There were no significant differences in genotype frequencies between case and control group in recessive models（OR=0.71，95%CI：0.37-1.38，P=0.317）. Conclusions：The results showed that the polymorphism of Vaspin gene are associated with risk for PCOS. A allele and AA, TA genotype may play a role in the inhibition of PCOS disease. Related Articles | Metrics

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Meta Analysis of the Effectiveness of Bipolar and Monopolar Hysteroscopic Operations in the Treatment of Uterine Disease FAN Shu-dong;YANG Wen-xian;E Qi-min;XIAO Chao 2015, 42 (6):  654-660.  Abstract ( 1416 )   PDF (991KB) ( 4960 )   Objective：To compare the effectiveness of bipolar electrosurgical excision procedure and monopolar hysteroscopic operations in the treatment of uterine disease. Methods：Such databases as Medline，Embase，The Cochrane Library，CNKI，CBM，Wanfang Data were electronically searched. According to the inclusion and exclusion criteria，literature was screened，data were extracted，and the methodological quality of included studies were also assessed by two researchers. Then，meta-analysis was performed using RevMan 5.2 and stata12.0 software. Results：20 studies with 4 418 participants were included. Evidence was found that there were statistical differences in operation time，amount of blood loss，hospitalization time，blood electrolyte and blood glucose（P＜0.05）. Conclusions：The common clinical uterine cavity operation can be finished by bipolar electrosurgical excision procedure and monopolar hysteroscopic operations，but bipolar electrosurgical excision procedure has the priority in operation time，amount of blood loss，hospitalization time and blood electrolyte，and it′s worthy to be recommended in clinic. Related Articles | Metrics

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Effectiveness of Different Routes of Misoprostol Administration for Cervical Ripening before Uterine Cavity Operation：A Meta-analysis WANG Jun;E Qi-min;XIAO Chao 2015, 42 (6):  661-668.  Abstract ( 854 )   PDF (1010KB) ( 4960 )   Objective：To assess the efficacy and side effects of different routes of misoprostol administration for cervical ripening before uterine cavity operation. Methods：The databases of Medline，Embase，the Cochrane Library，CNKI，CBM，Wanfang Data were retrieved to October 2014. According to the inclusion and exclusion criteria，literature was screened and extracted by two researchers independently，and then the quality was reviewed by and treated by using Rev Man 5.2 software. Results：12 studies with 2 529 participants were included. Evidence was found that there were no statistical differences in cervical diameter，when misoprostol administered orally or sublingually or vaginally were compared in pairs（P＞0.05）. Uterine cavity operation time in vaginally administered was less than in the orally （P＜0.05）， but there was no significant difference in cervical dilatation time （P＞0.05）. Ａnd the above two index in sublingually administerd were less than in vaginally（Ｐ＜０．０５）. The incidence of nausea and diarrhea were found to be more common in the orally and sublingually administered misoprostol group compared with vaginally administered，and emesis was found to be more common in sublingually administered misoprostol group when comparing with vaginally administered misoprostol group（P＜0.05）. In addition，different routes of misoprostol administration were no statistical differences in incidence of side effects including cramping，vaginal bleeding，fever and shivering （P＞0.05）. Conclusions：Misoprostol administered orally or sublingually had similar efficacy in cervical ripening of vaginal misoprostol. In view of avoiding drug related side effects，vaginally route of misoprostol could be considered as an effective medication. Related Articles | Metrics

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Application of Metabonomics Technologies in the Perinatal Medicine LUO Lin-li;LUO Dong;ZHOU Rong 2015, 42 (6):  680-684.  Abstract ( 1037 )   PDF (759KB) ( 4924 )   Metabonomics analyzes the small molecule metabolites from samples using nuclear magnetic resonance and mass spectrum analysis technology and data analysis method. It can obtain the characteristic spectrum of metabolites which is closely related to the occurrence and development of the disease. It plays an important role in disease prevention, diagnosis, treatment and prognosis. The study found that the characteristic metabolites spectrum in the maternal plasma, urine, and amniotic fluid can predict fetal abnormalities, and maternal plasma metabonomics can predict the occurrence and type of preeclampsia, and placental and umbilical cord blood metabonomics can predict intrauterine hypoxia and the growth of fetal, and vaginal metabolomics can predict the occurrence of premature. Metabonomics technology has important guiding significance for studying the diseases occurrence, development and prognosis in pregnant women and neonatte. Related Articles | Metrics

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Progress on the Pathogenesis of Pre-eclampsia GAO Hong-juan;WANG Yong-hong 2015, 42 (6):  685-688.  Abstract ( 1001 )   PDF (796KB) ( 4966 )   Pre-eclampsia（PE） is a disease with 5%-8% incidence and is traditionally diagnosed by the characteristic of high blood pressure, proteinuria and edema after 20 weeks of pregnancy combined with multiple organ failure. It may lead to placental abruption, DIC, eclampsia, HELLP syndrome （thrombocytopenia, elevated liver enzymes and hemolysis）, renal failure, cerebral vascular accident and other serious complications, serious illness may develop eclampsia and multiple organ failure. PE is one of the main causes of maternal and perinatal child mortality. The main pathological basis is the various etiologies leading to endothelial cell damage, followed by a variety of vasoactive factors, inflammatory factors and clotting factor dysregulation, which appeared multiple organ dysfunction. There are placental trophoblast cell ischemia and hypoxia or doctrine, the doctrine of oxidative stress, immune dysregulation theory, genetics, and vascular endothelial damage theory and so on accounting for its mechanism. With further research on PE, is also has a new understanding to its pathogenesis. Related Articles | Metrics

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The Application of Aspirin in Pregnant Women with Systemic Lupus Erythematosus WU Jia-yue;DI Wen 2015, 42 (6):  689-692.  Abstract ( 1379 )   PDF (770KB) ( 4964 )   Pregnancy is a huge challenge for systemic lupus erythematosus（SLE） patients. Because hypercoagulable state can lead to various obstetric complications and adverse pregnancy outcomes. Therefore anticoagulant therapy is critical. The immune complex deposition and systemic inflammation cause placental structure injury, resulting in poor uteroplacental perfusion, and lead to imbalance of thromboxane A2（TXA2） and prostacycl, which is closely related to placental vascular thrombotic lesions. Aspirin by adjusting the balance of thromboxane and prostacyclin, inhibit platelet activity, and dilate blood vessels, which reducing the occurrence of adverse pregnancy outcomes and preventing obstetric complications. SLE and antiphospholipid syndrome（APS） pregnant women are recommended taking low-dose aspirin（40-160 mg/d） throughout pregnancy. Platelet aggregation test is an important indicator to monitor anti-platelet aggregation effect of the medicine. The safety of other anti-platelet aggregation medicine is still unknown. Heparin/low molecular weight heparin may be combined used according to the presence of the thrombosis and maternal miscarriage history. Related Articles | Metrics

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Research Progress of Pessary Use for Preventing Preterm Birth HAN Huan;BAO Yi-rong;QU Xiao-xian;YING Hao 2015, 42 (6):  693-697.  Abstract ( 1042 )   PDF (1013KB) ( 4932 )   The pessary has emerged as a possible treatment for the prevention of preterm birth，the exact mechanism in reducing the likelihood of preterm birth is unknown，one hypothese suggested that the pessary encompasses the cervix and changes the uterocervical angle. Different models of pessaries are used to prevent preterm birth and among them the most widely used is Arabin pessary. Its dome-like design resembled the vaginal fornix，surrounded the cervix as close as possible to internal. The pessary size should be choiced according to the clinical situation and cervical morphology. In recent years，many studies have shown that the use of pessary can significantly prolong the delivery gestational age, reduce the rate of preterm birth and poor perinatal outcome，especially in high risk population of women such as cervical incompetence and twins pregnancy. Compared with the other methods，like the use of progesterone in vagina and cervical cerclage, there′s no significant side effects have been reported，the most common complaint is an increase in vaginal discharge, besides，cervical pessary can be inserted and removed easily without the need for anesthesia and is noninvasive and inexpensive. However，due to the lack of available high quality randomized controlled trials，the benefit of the cervical pessary could not be confirmed and further research is urgently needed. Related Articles | Metrics

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The Role of Exercise Therapy in Treating the Gestational Diabetes Mellitus GUO Xiu-rong;WANG Xie-tong 2015, 42 (6):  698-701.  Abstract ( 955 )   PDF (805KB) ( 5004 )   Gestational diabetes mellitus（GDM） is the most prevalent metabolic disorder disease during the gestation period. Exercise therapy has become one of the basic methods to control the development of GDM for its efficiency in controlling the maternal body mass, reducing the burden of the cardiovascular system, reducing the level of blood pressure and improving the oxygen reserve. At present about the form of exercise，intensity，duration and monitoring of the fetal during pregnancy is still controversial. The safety and comfortable excise is suitable for the pregnant women and load movement should be avoided in the late pregnancy. Normal women keep on moderate aerobic exercise 30 minutes per day during their pregnancy, pay attention to their fetal movement and uterine contraction during the exercise in order to determine whether exercise too much. Exercise therapy can reduce the incidence of GDM and control the progress of GDM. Related Articles | Metrics

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The Relationship between Insulin-like Growth Factors and Fetal Birth Weight LI Jing;LU Wei-wei;SHENG Zhu-mei;ZHANG Zhi-fen 2015, 42 (6):  702-704.  Abstract ( 995 )   PDF (914KB) ( 4910 )   Objective：To discuss the relationship between insulin, insulin-like growth factor Ⅰ（IGF-Ⅰ）, IGF-Ⅱ, Insulin-like growth factor binding protein 1 （IGFBP-1）, IGFBP-3 in maternal blood and newborn blood and fetal birth weight. To search their influence on fetal growth and development. Methods：230 cases who gave birth in Hangzhou First People′s Hospital were selected from January 2012 to February 2013, according to the relationship between birth weight and gestational age, they were divided into 3 groups, SGA group: 15 cases who were small for gestational age infants, AGA group: 162 cases who were appropriate for gestational age infants, the LGA groups: 53 cases who were large for gestational age infants. Maternal blood and cord blood insulin, IGF-Ⅰ, IGF-Ⅱ, IGFBP-1 and IGFBP-3 levels were detected by enzyme-linked immunosorbent assay. Results：The insulin, IGF-Ⅰ, IGF- Ⅱand IGFBP-3 level in the three groups of maternal and cord blood were different（all P＜0.001）. The LGA group was higher than the AGA group, and the AGA group was also higher than the SGA group （all P＜0.01）. Maternal blood IGF-Ⅱand cord blood insulin, IGF-Ⅰ, IGF-Ⅱ can influence fetal birth weight. Conclusions：Maternal blood IGF-Ⅱand cord blood insulin, IGF-Ⅰ, IGF-Ⅱ could be the key factors which can affect fetal growth and development. Related Articles | Metrics

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The Value of Endometriosis Fertility Index in Predicting the None-ART Pregnancy Outcome after Laparoscopic for Stage Ⅲ or Stage Ⅳ Endometriosis-associated Infertility LI Xiao-hong;ZENG Li-ping;HE Fang;SHEN Xue-ge;TANG Hui-ru;WU Rui-fang 2015, 42 (6):  705-707.  Abstract ( 1014 )   PDF (971KB) ( 4943 )   Objective：To assess the value of endometriosis fertility index（EFI） in predicting the none-ART pregnancy outcome after conservative surgery for stage Ⅲ-Ⅳ endometriosis（EMs）-associated infertility. Methods：Medical documents of 48 infertile patients who were confirmed of stage Ⅲ-Ⅳ EMs by laparoscopy were retrospectively studied from January 2011 to December 2012 in Peking University of Shenzhen Hospital, The EFI score was calculated on history and detailed surgical findings. All patients were followed up to assess fertility outcome. Results：The overall postoperative none-ART pregnancy rate within 24 months was 52.1%. The postoperative none-ART pregnancy rate was 41.7%，8.3% and 2.1% in the first six month, the 7 to 12 months and the 13 to 24 months, there were statistically difference at the diffierent periods of follow-up （χ2=30.301，P=0.000）. The postoperative none-ART pregnancy rate was correlated with EFI scoring and ovarian simulation （P＜0.05）. However, the postoperative pregnancy rate had no correlation with r-AFS staging（P＞0.05）. ROC curve analysis of EFI showed that the area under curve was 0.681（95% CI：0. 527-0. 834，P=0.033）. The critical value of pregnancy predicted by EFI within two years after the operation was 5.5, with sensitivity of 85.2% and specificity of 42.9%. Conclusions：EFI scores could well predict none-ART pregnancy rate in patients with stage Ⅲ- Ⅳ EMs -associated infertility. EFI scores may be used to guide postoperative treatment. Related Articles | Metrics

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Efficacy of Conservative Surgeries on Controlling Severe Postpartum Hemorrhage Following Cesarean Section FENG Bi-bo;ZHAI Jian-jun;CAI Yu 2015, 42 (6):  708-711.  Abstract ( 959 )   PDF (1088KB) ( 5060 )   Objective：To investigate the efficacy of different hemostatic surgeries to control severe postpartum hemorrhage following cesarean section and analyze the reason for homeostasis failure. Methods：135 cases with severe postpartum hemorrhage following cesarean section were randomly divided into improved uterine compression sutures group（65 cases） and uterine gauze packing group（70 cases）. The operating time，intraoperative and postoperative bleeding，hemostatic success rate，hysterectomy rate and complication rate were compared between two groups. Results：The operating time and intraoperative bleeding of improved uterine compression sutures group were significantly lower than those of uterine gauze packing group（P＜0.05）. There were not significant differences in hemostatic success rate，postoperative bleeding and hysterectomy rate between the two groups（all P＞0.05）. The hemostatic success rate of patients with placental disorders including placenta previa, placenta accrete in improved uterine compression sutures group was significantly lower than that in uterine gauze packing group （P＜0.05），while the hemostatic success rate of patients with excessive uterine stretch factor was significantly higher than that in uterine gauze packing group（P＜0.05）. There were no significant difference in the incidence of lochia time after surgery, time of menstruation turn over and menstruation reduction, dysmenorrheal, intrauterine adhesion and obstetric infection between the two groups（all P＞0.05）. Conclusions：Improved uterine compression sutures had such advantages as less bleeding，shorter operating time and higher success rate in excessive uterine stretch factor inducing bleeding. The uterine gauze packing has better hemostatic effect for placental factors inducing hemorrhage. Clinical treatment should be individualized. Related Articles | Metrics