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15 August 2014, Volume 41 Issue 4
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Clinical Application of Minimally Invasive Techniques in Gynecological Malignant Tumor LIN Shao-dan;LIN Zhong-qiu 2014, 41 (4):  333-338.  Abstract ( 1204 )   PDF (990KB) ( 5131 )   Minimally invasive operation technologies, including laparoscopic surgery, robot assisted laparoscopic surgery, hysteroscopic surgery, vaginal surgery, and all kinds of operation with small incision, with the advantage of fewer traumas, smaller scar , rapid recuperation and better acceptance by patients, play more and more important roles in the diagnosis and treatment of gynecologic malignant tumor. Three incision technique and laparoscopic inguinal lymphadenectomy are effective for improving postoperative poor wound healing in patients with vulva cancer. Transvaginal or laparoscopic hysterectomy, laparoscopic appendectomy, laparoscopic radical hysterectomy and pelvic lymphadenectomy are allowed to be performed in the suitable patients with cervical or endometrial cancer. For some select patients with early ovarian cancer and some with isolated recurrent lesion, minimally invasive surgical approaches may be employed by experienced gynecologic oncologists to achieve the surgical staging procedure or cytoreduction. In most instances with ovarian cancer, comprehensive surgical staging and tumor reductive surgery should be completed by an abdominal approach. The indications of minimally invasive operation should be strictly controlled. Highly individualized approach should be chosen to make sure the least injury, minimal inflammation, best healing and therapeutic effect. Related Articles | Metrics

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Safety of Minimally Invasive Surgery in Gynecologic Oncology CHEN Ya-xia;XIE Xing 2014, 41 (4):  339-341.  Abstract ( 1171 )   PDF (600KB) ( 5169 )   Patients with gynecological malignant tumor are relatively older than patients with benign gynecological diseases. The operation process for gynecological cancers is more complicated and need longer operation time than for benign gynecological diseases. Malignant tumor has possibility of wound planting and recurrence. Many doctors worry about peri-operation complications and the prognosis of patients with gynecologic cancers received minimally invasive operation. At present, the minimally invasive operation in gynecological malignant tumor was far less than in the benign gynecological diseases. But a lot of literature shows that in cervical cancer, endometrial cancer, ovarian cancer and other gynecological malignant tumors, the prognosis and peri-operation complication rate in patients treated with laparoscopic radical operation are similar or even better than patients treated with traditional open operation. In conclusion, minimally invasive treatment of gynecologic malignant tumor by doctors with laparoscopic operation skills is feasible, reasonable and safe. Related Articles | Metrics

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Present Situation and Related Problems of Minimally Invasive Surgical Treatment of Cervical Cancer LIANG Zhi-qing 2014, 41 (4):  342-346.  Abstract ( 1093 )   PDF (739KB) ( 5167 )   With the advancement of science and technology, laparoscopic and robot-assisted laparoscopic and other minimally invasive surgery has become the preferred method of surgical treatment of cervical cancer. At present, surgical treatments of cervical cancer include radical hysterectomy, nerve-sparing radical hysterectomy, radical trachelectomy, and pelvic and para-aortic lymphadenectomy, even para-uterine tissue and pelvic organ excision performed with single port or multi port laparoscopic and robot-assisted laparoscopic surgery. Its advantages include the expansion of the surgical field and visualization, to reduce the amount of bleeding and operative complication, reduce the need for analgesics, shorter hospital stay, faster recovery and so on. Minimally invasive surgical treatment of cervical cancer represents the future direction of cancer treatment, randomized multi-center clinical studies through a large sample, obtained category one of evidence to provide the most effective and advanced surgical treatment for cervical cancer patients. Related Articles | Metrics

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Hot Topics of Cervical Cancer Screening QU Peng-peng 2014, 41 (4):  347-350.  Abstract ( 1139 )   PDF (575KB) ( 5194 )   Cervical cancer is preventable and curable in early stage. Different screening strategy should be chosen in different region and population. Cytology-based world-wide cervical cancer screening has led to a substantial reduction of the incidence of cervical cancer. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited. After human papillomavirus （HPV） was identified as a cause of invasive cervical cancer, HPV DNA testing was developed to screen for the disease, screening strategies has changed（primary screening：cytology-based→HPV-based or Co-testing→HPV16/18 genotyping）. Although HPV testing is sensitive, it has poor specificity and positive predictive value, not everyone who carries HPV 16 or 18 develops CIN or cancer. This weakness could be overcome by application of biomarkers. Related Articles | Metrics

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Progress of Cytoreductive Surgery in Recurrent Ovarian Cancer ZHAO Jian-guo;QU Peng-peng 2014, 41 (4):  351-354.  Abstract ( 1202 )   PDF (491KB) ( 5175 )   The treatment of recurrent ovarian cancer is the difficulty in gynecologic oncology. Its treatments include surgery，chemotherapy，targeted therapy，biological therapy，etc. The cytoreductive surgery is a treatment of recurrent ovarian cancer，including secondary cytoreductive surgery and multiple cytoreductive surgery. Principle treatment of recurrent ovarian cancer is ensuring patients′ quality of life and prolonging the survival time as long as possible. Strict surgical indications were involved in secondary cytoreductive surgery and multiple cytoreductive surgery. It is a key role that all visible leision must be removed during the cytoreductive surgery in recurrent ovarian cancer as much as possible，in order to minimize the tumor burden and reduce the clones of resistant-drug. Secondary or multiple cytoreductive surgery is more complex，multidisciplinary collaboration is required to complete the surgery and take good care after surgery. With premise of unchanging the quality of survival patients recovery should be promoted under multidisciplinary collaboration. Chemotherapy after optimal secondary or multiple cytoreductive surgery may improve the overall survival of patients.The rule of treatment must be complied. Related Articles | Metrics

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Research Progress of Factors Associated with Parametrial Involvement of Early Cervical Cancer LIN Shao-dan;LU Huai-wu;XIE Qing-sheng;ZHANG Yuan-yuan;GUAN Mei-mei;LIN Zhong-qiu 2014, 41 (4):  355-360.  Abstract ( 1204 )   PDF (814KB) ( 5148 )   Parametrial involvement is one of the most important prognostic factors of cervical cancer. Parametrial involvement is defined as either malignant cell in the parametrium or tumor emboli within lymphvascular channels or lymph nodes. The factors associated with parametrial involvement of early cervical cancer are age，stage，grade，tumor size，invasion depth，pelvic lymph node metastases，lymphvascular invasion（LVSI），uterine involvement，vaginal involvement，the preoperative serum of squamous cell carcinoma and ovarian metastasis. It is generally believed that the most important factors associated with parametrial involvement of early cervical cancer are tumor size，invasion depth，pelvic lymph node metastases，LVSI. The researchers have proposed the criteria of the low risk for parametrial involvement include tumor size≤2 cm，invasion＜5 mm or ＜10 mm，negative lymph nodes and negative lymphvascular invasion. Patients at low risk could be considered for less radical surgery such as modified radical hysterectomy or simple hysterectomy or trachelectomy with pelvic lymphadenectomy. Related Articles | Metrics

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Establishment of HPV16 Positive Cervical Cancer Cell Lines with Stable Silence of STAT3 SHEN Qing-li;HE Yao-juan;GUO Kai-min;YE Ming;LIN Zhong-qiu 2014, 41 (4):  366-369.  Abstract ( 1119 )   PDF (715KB) ( 5168 )   Objective：Constructing retroviral vector of small hairpin RNA （shRNA） targeting human transducer and activator of transcription 3（STAT3），establishing stable infected HPV16 positive cervical cancer cell lines，to further explore the role of STAT3 in the development of HPV16 positive cervical cancer. Methods：Design and synthetise three siRNA sequences targeting STAT3，then select one with best gene interference effect，and construct STAT3-shRNA vector，pSUPERretro-puro-STAT3. The recombinant plasmid was transfected into packaging cell line 293FT and then infected into HPV16 positive cervical cancer cell line SiHa and CaSki cells. Cells were selected with puromycin for 2 weeks，passaged around every 3 days，and named with SiHa/STAT3-sh and CaSki/STAT3-sh. Expression of STAT3 was analyzed by quantitative reverse transcription polymerase chain reaction （qRT-PCR） and western blotting. Results：The knockdown of the expression of STAT3 mRNA was over 99%（P＜0.01），that of the expression of STAT3 total protein was over 70% （P＜0.01） and that of the expression of STAT3 phosphorylated protein was over 78% （P＜0.01） in both SiHa/STAT3-sh and CaSki/STAT3-sh cells． Conclusions：HPV16 positive cervical cancer cell lines with stable silence of STAT3 were successfully established. Related Articles | Metrics

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Expression and Clinical Significance of BRMS1 and NF-κB in Cervical Carcinogenesis MAO Li;YANG Yong-xiu 2014, 41 (4):  370-373.  Abstract ( 1177 )   PDF (704KB) ( 5239 )   Objective：To study the protein expression and clinical significance of breast cancer metastasis suppressor l（BRMS1） and nuclear factor kappa B（NF-κB p50） in cervical carcinogenesis. Methods：The immunohistochemical method（Super Sensitive TM IHC）was used to determine expressions of BRMS1 and NF-κB p50 were in chronic cervicitis tissues，CINⅠ tissues，CINⅡ-Ⅲ tissues and cervical carcinoma tissues. The clinical significance was analyzed with histopalthological records. Results：① The positive rates of BRMS1 in cervical carcinoma ,CINⅠand CINⅡ-Ⅲ tissues were much lower than that in chronic cervicitis tissues, the differences were significant（all P<0.05），moreover the positive expressions were much lower or absent in cervical cancer tissues with ⅡB-Ⅳ stage，depth of invasion>1/2 and with lymph node metastasis, the differences were significant（all P＜0.05）. ②The positive rates of NF-κB p50 in cervical carcinoma，CINⅠand CIN Ⅱ-Ⅲ tissues were much higher than that in chronic cervicitis tissues（all P<0.05），moreover the positive expressions were much higher in cervical cancer tissues with tumor size≥4 cm，poor differentiation，depth of invasion>1/2 and with lymph node metastasis, the differences were significant（all P＜0.05）. ③The expression level of BRMS1 was negatively correlated with that of NF-κB p50 in cervical carcinoma（rs= 0.426，P＜0.001）. Conclusions：It is closely related to cancer cell invasion and metastasis that the expression of BRMS1 decreased significantly，while the expression of NF-κB conversely increased. In addition，BRMS1 may inhibit NF-κB expression in invasion and metastasis of cervical cancer. Related Articles | Metrics

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Clinical Outcomes of Neoadjuvant Chemotherapy on Patients with Stage ⅠB2-ⅡB Cervical Cancer YE Lei;ZHU Jian-long;FENG Ling-da;WENG Lei;WANG Xi-peng 2014, 41 (4):  374-378.  Abstract ( 1134 )   PDF (773KB) ( 5206 )   Objective： To discuss the impact of neoadjuvant chemotherapy（ＮＡＣＴ） on high-risk factors as frequently reported by post-surgical pathology and the overall survival rate in patients with stage ⅠB2-ⅡB cervical cancer. Methods：A retrospective analysis was performed on the clinical data from 196 patients of stages ⅠB2-ⅡB cervical cancer admitted to First Maternity and Infant Hospital Affiliated to Tongji University during January 2003 to June 2013. Patients were divided into two groups: 71 cases received pre-surgical NACT based on platinum and taxol (NACT group) and 125 cases received primary surgical treatment (PST group) without pre-surgical NACT. Both groups received radical hysterectomy, bilateral salpingo-oophorectomy(age ＞45 years old) plus pelvic lymph node dissection with or without para-aortic lymphadenectomy. In the NACT group, reduction in tumor size was observed after chemotherapy. Pelvic lymph node metastasis, depth of myometral invasion, lympho-vascular space invasion, bulky tumor, parametrial invasion, positive vaginal resection margin and survival rates were compared between the two groups. Results：In NACT group, data missing were 15 cases, 4 cases (7.1%) had complete remission (CR), 27 cases (48.2%) had partial remission (PR), 18 cases (32.1%) were stable disease (SD) and 7 cases (12.5%) were progression of disease (PD). Compared with the PST group, patients in NACT group had greater reduction in the size of uterus and width of cervical lesion, more lymph nodes dissected, and fewer bulky tumors with≥ 50% thickness myometrial invasion (all P＜0.05). There were no statistically significant differences in other 5 high-risk factors and blood loss, duration of operation, the overall survival rate between the two groups (all P＞0.05). Conclusions：Neoadjuvant chemotherapy has certain recent clinical curative effects, however, did not improve the overall survival rate, therefore, doctors should carefully consider the clinical application of NACT. Neoadjuvant chemotherapy has a certain effect on controling pathologic risk factors of the bulky cervical cancer after surgery. Accordingly, for massive type, surgery after neoadjuvant chemotherapy will be a safe treatment. Related Articles | Metrics

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A Systematic Review for the Preserve Fertility Surgery in Malignant Ovarian Germ Cell Tumor WEI Ren-ji;LI Li 2014, 41 (4):  379-383.  Abstract ( 1130 )   PDF (883KB) ( 5149 )   Objective：To evaluate the survival rate, recurrence rate and postoperative pregnancy after fertility preservation operation in patients with malignant ovarian germ cell tumor. Methods：We searched for studies in PubMed and VIP database et al，case control study which conformed to the standards was included and finished quality evaluation. The homogeneity study used RevMan 5.1 software for Meta analysis. Results：We identified 11 retrospective case control trial，which described fertility preservation operation and radical operation in malignant ovarian germ cell tumor and compared their survival. The Meta analysis results：patients with malignant ovarian germ cell tumors after fertility-sparing surgery had a better survival rate than the radical operation ones, the difference was statistically significant （OR=1.88，95%CI：1.32-2.69，P=0.000 5）. Malignant ovarian germ cell tumors with preservation of fertility with lower recurrence rate than patients not to preserve fertility operation， the difference was statistically significant（OR=0.11，95%CI:0.03-0.38，P=0.000 7）. Only 4 clinical case studies detailed record and analyzed the number of patients who trying to get pregnant and actual successful pregnancy，and calculate the total pregnancy rate was 86.7%. Conclusions：Preserve fertility operation had a better survival rate and recurrence rate than the radical operation patients with ovarian malignant germ cell tumor，could maintain the reproductive function and normal pregnancies，improved the quality of patients life. Related Articles | Metrics

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The Relationship between High-Mobility Group Box 1 Protein and Cervical Cancer PANG Xiao-ao;ZHANG Yao;ZHANG Shu-lan 2014, 41 (4):  386-389.  Abstract ( 1105 )   PDF (569KB) ( 5179 )   Cervical cancer is second only to breast cancer was the most common female malignant tumor, a serious threat to women′s lives. Reported at home and abroad in recent years, cervical cancer incidence and mortality were significantly decreased, but there was a tendency of younger under 35 cervical cancer incidence rate rose significantly. Cervical cancer, the fundamental cause of the disease is recognized as with human papilloma virus (human papillomavirus, HPV) infection related,after the HPV infection most of the host immune system can clear the virus, when the body′s immune system dysfunction, cervical epithelial cells due to HPV infections cannot be effectively remove viruses, eventually lead to cervical cancer. After virus infection through a variety of mechanisms to escape immune recognition. High mobility group protein 1 (high mobility group box 1 protein, HMGB1) play an important role in the process of induction of host immune suppression, the protein expression level of cervical squamous carcinoma related proteins. But chronic inflammation caused by HPV infection progression to cervical cancer whether HMGB1 play a role in this process, the specific mechanism remains unclear. Therefore, understand the change of the host immune system for cervical cancer diagnosis, treatment and prevention will be of great significance. This will be for HMGB1 and reviews the correlation between cervical cancer immune. Related Articles | Metrics

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Relationship between miRNA Regulating Epithelial-Mesenchymal Transition and Metastasis in Ovarian Cancer ZHANG Yue;ZHANG Shu 2014, 41 (4):  390-394.  Abstract ( 1189 )   PDF (832KB) ( 5205 )   Ovarian cancer is a common gynecological malignancy and one of leading causes of cancer-related morbidity and mortality in female patients around the globe. The metastasis of ovarian cancer is an important factor in causing deaths. EMT （epithelial-mesenchymal transition） refers to the transition process from the phenotype of epithelial cells to mesenchymal phenotype and is closely associated with the malignant progression of tumors in its invasion and metastasis. MicroRNA （miRNA） are a class of small molecule and noncoding RNAs which inhibit translation of the mRNA transcript of the genes expression，and become more and more concerned in regulating EMT progress. Many kinds of miRNA expressed abnormally and related to the occurrence and development of ovarian cancer，are expected to be used in early diagnosis，treatment and prognosis.In this review，we presented recent research regarding the role of EMT and related microRNAs in the malignant progression of ovarian cancer. Related Articles | Metrics

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Progress of Estrogen Trans-membrane Receptor GPR30 and Its Role in Endometrial and Ovarian Carcinomas ZHENG Li-hua;CHENG Zhong-ping 2014, 41 (4):  395-400.  Abstract ( 1126 )   PDF (842KB) ( 5192 )   Endometrial and ovarian carcinomas are malignant neoplasms in the female reproductive system. Estrogen has been proved as an epidemic factor throughout gynecological carcinoma. Recently, it has been found that G-protein-coupled receptor 30（ＧＰＲ３０） mediates cell proliferation and survival through nongenomic effects in hypo-exposure of estrogen. Moreover, the role of tumor associated fibroblasts in carcinoma has frequently been taken into account. We review and reveal the role of GPR30 in the regulation of endometrial and ovarian carcinomas in order to provide new molecular target therapy. Related Articles | Metrics

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Related Research of Endometrial Cancer and microRNA LIU Qi-wei;YANG Min;TONG Xiao-wen;WANG Jian-jun 2014, 41 (4):  401-404.  Abstract ( 1055 )   PDF (491KB) ( 5182 )   microRNAs（miRNAs） are non-coding RNAs that can regulate mRNA in the level of post-translational modification，transcription and post-transcription. And they are associated with growth，development and invading of tumors as oncogenic miRNAs and tumor suppressor miRNAs. Relationships of miRNAs with endometrial cancer（EC） have recently emerged. For instance，miRNA-200 family，miRNA-205，miR-129-2，miR-203，miR-302，miR-194，miR-30c，miR-204，miR-34，miR-125，miRNA-152，miRNA-503，etc. With the deeper research，miRNAs may be used in clinical applications as one of new targets. In this article，there is an overview about the recent research of miRNAs and EC. Related Articles | Metrics

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Phosphatidylinositol 3-hydroxy Kinase and Endometrial Cancer WANG Kai-yue;ZHOU Huai-jun 2014, 41 (4):  405-409.  Abstract ( 1017 )   PDF (785KB) ( 5180 )   Phosphatidylinositol 3-hydroxy kinase (PI3K) signalling pathway specially regulate a range of cellular essential physical processes, including proliferation, differentiation, cell cycle progression ,which is closely bound up to the formation, development and prognosis of various human cancers. Based on the difference of comprising subunits, phosphatidylinositol 3-hydroxy kinase (PI3K) can be divided into three classes, including PI3K classⅠ,Ⅱ and Ⅲ. The substrate specificity, as well as the corresponding catalytic product downstream, also differ among such three classes biological effects and lead to specific biological effects. Various subunits of PI3K classⅠalways undergo mutation or amplification, accompanied by predominant carcinogenic potential. PI3K class Ⅱ mainly controls cell proliferation and apoptosis, regulate cell cycle progression and the formation of newborn vessels, whereas PI3K class Ⅲ can induce the autophagy procedure of endometrial glandular epithelial cells and inhibit their excessive proliferation. This article mainly provides a review concerning the specific relationship between pathogenesis of Gynecological cancers, especially endometrial carcinoma and various PI3K regulatory subunits and catalytic subunits. Related Articles | Metrics

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Diagnosis of Endometrial Cancer MA Xin-xin;WANG Jian-liu 2014, 41 (4):  410-413.  Abstract ( 1220 )   PDF (810KB) ( 5210 )   Endometrial cancer is epithelial primary endometrial malignant tumors， is one of three malignant tumors in female genital tract. In recent years, its incidence is increasing，ｅspecially in perimenopausal and postmenopausal womeｎ，ｔｈe incidence of higher. The manifestations of abnormal vaginal bleeding or vaginal dischargｅ，ｅspecially for the high risk factoｒｓ， should be considered to have endometrial cancer may. Over the years, scholars are also constantly exploring the method of diagnosis in endometrial cancer at home and abroad. Auxiliary examination include ultrasound，computer tomography scanning (CT)， magnetic resonance imaging (MRI)， hysteroscopy (HS)， endometrial biopsy and endometrial cytology (ECT)， detection of tumor markers, it should be combined with a variety of examination to confirm the diagnosis. The latest research progress of the disease diagnosis was overviewed. Related Articles | Metrics

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Advances in the Chemotherapy of Endometrial Carcinoma HAO Man;JIN Ping 2014, 41 (4):  414-418.  Abstract ( 1645 )   PDF (575KB) ( 5092 )   Endometrial carcinoma is the most common malignancy of the female genital tract. The traditional treatment of endometrial cancer is surgical excision supplemented by radiotherapy，chemotherapy and hormone therapy. Chemotherapy were used for the treatment of advanced and recurrent cancer patients，the recent studies concluded that adjuvant chemotherapy or chemotherapy combined with radiotherapy can reduce the rate of local recurrence and distant metastasis disease for the early high-risk endometrial cancer. Indications of chemotherapy，drug selection and chemotherapy regimens could affected the efficacy of chemotherapy. The side-effects of molecular targeted therapeutic drugs are weaker than chemotherapy drugs，too expensive of the clinical application and efficacy are not plausible，is not recommended as routine treatment. Related Articles | Metrics

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Incidence of Gestational Diabetes Mellitus and Pregnancy Outcomes of Pregnant Women with Subclinical Hypothyroidism KANG Su-ya;WANG Yun;WU Li 2014, 41 (4):  419-422.  Abstract ( 1204 )   PDF (610KB) ( 5154 )   Objective： To explore differences in incidence of gestational diabetes mellitus （ＧＤＭ） and pregnancy outcomes for patients with subclinical hypothyroidism（ＳＣＨ） ｖｅrsus normal pregnant women. Methods: A retrospective chart review of 342 pregnant women with SCＨ（ＳＣＨ ｇｒｏｕｐ） ａnd 2 605 pregnant women with normal thyroid functiｏｎ（ｃｏｎｔｒｏｌ ｇｒｏｕｐ） diagnosed by serum thyroid function screening presented for prenatal care was performed. The incidences of GDM diagnosed by oral glucose tolerance tｅｓｔ （ＯＧＴＴ） ｏｆ ｔwo groups were compared. Each group was divided into GDM & normal OGTT subgroups by results of OGTT, the following parameters of every subgroup were abstracted and appropriate statistical tests were performed: serum levels of TSH/FT4/TPOAb, incidences of abortion and premature delivery, the average weeks of delivery, the weights/lengths/head circumferences of neonates. Results: SCH group developed higher incidence of GDM than control group. Frequencies of TPOAb positivity were higher in SCH group than control group, while no significant differences were indicated between SCH subgroups neither was between control subgroups（Ｐ＜０．０１）. Serum TSH level of SCH group was higher than control group while serum FT4 level was lower（Ｐ＜０．０１）， while no significant differences of TSH and T4 levels were indicated between ＳＣＨ ｓｕｂｇｒｏｕｐｓ ｎｅｉｔｈｅｒ ｗｅｒｅ ｂｅｔｗｅｅｎ ｃｏｎｔｒｏｌ ｓｕｂｇｒｏｕｐｓ（Ｐ＞０．０５）． Ｉｎｃｉｄｅｎｃｅ ｏｆ ａｂｏｒｔｉｏｎ ａｎｄ ｐｒｅｍａｔｕｒｅ ｄｅｌｉｖｅｒｙ ｉｎ ＳＣＨ－ＧＤＭ ｓｕｂｇｒｏｕｐ ｗａｓ ｓｉｇｎｉｆｉｃａｎｔ ｈｉｇｈｅｒ ｔｈａｎ ｒａｔｅｓ ｉｎ ＳＣＨ－ｎｏｒｍａｌ ＯＧＴＴ ｓｕｂｇｒｏｕｐｓ ａｎｄ ｂｏｔｈ ｃｏｎｔｒｏｌ ｓｕｂｇｒｏｕｐｓ（Ｐ＜０．０１）． Ｔｈｅ ｒａｔｅ ｗａｓ ｈｉｇｈｅｒ ｉｎ ＳＣＨ－ｎｏｒｍａｌ ＯＧＴＴ ｓｕｂｇｒｏｕｐ ｔｈａｎ ｉｎ ｃｏｎｔｒｏｌ－ｎｏｒｍａｌ ＯＧＴＴ ｓｕｂｇｒｏｕｐ （Ｐ＜０．０１） ａｓ ｗｅｌｌ ａｓ ｉｎ ｃｏｎｔｒｏｌ－ＧＤＭ ｓｕｂｇｒｏｕｐ ｔｈａｎ ｃｏｎｔｒｏｌ－ｎｏｒｍａｌ ＯＧＴＴ ｓｕｂｇｒｏｕｐ （Ｐ＜０．０５）， ｗｈｉｌｅ ｎｏ ｓｉｇｎｉｆｉｃａｎｃｅ ｄｉｆｆｅｒｅｎｃｅ ｗａｓ ｓｈｏｗｅｄ ｂｅｔｗｅｅｎ ｓｕｂｇｒｏｕｐｓ ＳＣＨ－ｎｏｒｍａｌ ＯＧＴＴ ａｎｄ ｃｏｎｔｒｏｌ－ＧＤＭ （Ｐ＞０．０５）． Ｎｏ ｓｔａｔｉｓｔｉｃａｌ ｄｉｆｆｅｒｅｎｃｅ ｏｆ ｔｈｅ ａｖｅｒａｇｅ ｗｅｅｋｓ ｏｆ ｄｅｌｉｖｅｒｙ ｗａｓ ｆｏｕｎｄ ｂｅｔｗｅｅｎ ＳＣＨ ｓｕｂｇｒｏｕｐｓ（Ｐ＞０．０５）， ｗｈｉｌｅ ｂｏｔｈ ｗｅｒｅ ｓｈｏｒｔｅｒ ｔｈａｎ ｗｅｅｋｓ ｏｆ ｃｏｎｔｒｏｌ ｓｕｂｇｒｏｕｐｓ（Ｐ＜０．０１）. No differences were indicated in the weights/lengths/ head circumferences of neonates. Conclusions: SCH increases incidence of GDM in gestation period, Risk of adverse pregnant outcomes is higher when SCH complicated with GDM because it′s more harmful than simple disease. SCH patients should be observed emphatically, specially in monitoring and controlling levels of blood sugar. Related Articles | Metrics

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Effect of Prophylactic Carbetocin in Prevention of Postpartum Hemorrhage Following Cesarean Delivery in Women with Hypertensive Disorder Complicating Pregnancy HAN Ling-xiao;YU Fang;HOU Hai-yan;SHI Hai-xia;WU Tao;YANG Wei-ping 2014, 41 (4):  423-425.  Abstract ( 1206 )   PDF (472KB) ( 5180 )   Objective： To explore carbetocin in the prevention of postpartum hemorrhage （PPH） following cesarean delivery in women with hypertensive disorder complicating pregnancy. Methods：Prospective randomized control study was carried out on single pregnancy with gestation more than 32 weeks following cesarean delivery. All the cases were randomized to receive either carbetocin （treatment group，n=90） or oxytocin （control group，n=90）. Following delivery of each baby，20 IU oxytocin was infusion and 100 microgram carbetocin（treatment group） and 100 microgram oxytocin（control group） were given as myometrium injection. 24 h blood volume of postpartum，blood pressure，birth weight，Apgar scores，maternal heart rate and drug adverse reaction were collected. Results：The estimated blood loss within 24 h in treatment group was significantly lower than control group（P＜0.05）. The incidence postpartum haemorrhage of treatment and control group had no difference（14.4% vs． 20.0%，P＞0.05）. There was no difference in birth weight，Apgar scores，neonatal asphyxia and amniotic fluid characteristics between the two groups（P＞0.05）. There was no significant syndrome of nausea and vomiting. Conclusions：Carbetocin makes better effect than common oxytocin on prevention of postpartum haemorrhage cesarean delivery in women with hypertensive disorder complicating pregnancy，and no adverse complication was found. Related Articles | Metrics

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The Clinical Effects of Bilateral Uterine Artery Embolization in the Pernicious Placenta Previa HUANG Yan;YANG Ying 2014, 41 (4):  426-428.  Abstract ( 1049 )   PDF (463KB) ( 5187 )   Objective： To observe the clinical effects of bilateral uterine artery embolization in the pernicious placenta previa after cesarean section. Methods：13 cases of pernicious placenta previa were terminating pregnancy by cesarean section. The perioperative period bleeding occurred in different degree，uterine artery embolization using immediately line after cesarean section for hemostasis. Results：After uterine artery embolization，12 cases of vaginal bleeding was significantly reduced，1 case as a result of the lower uterine segment blood sinus was extremely rich，maternal vaginal bleeding was still more，subtotal hysterectomy immediately. Before and after uterine artery embolization, hemoglobin showed no obvious reduced. Postoperative uterine had better recovery and no recurrence of uterine bleeding. Conclusions：Application of uterine artery embolization in pernicious placenta previa during cesarean section to hemostasis and preserve the uterus，is an effective treatment of uterine bleeding. Related Articles | Metrics

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Use of the Angle of Progression and the Midline Angle in Stage Labor ZHANG Zhi-kun;CHEN Xu;YU Yang;CUI Hong-yan 2014, 41 (4):  429-430.  Abstract ( 1217 )   PDF (1309KB) ( 5227 )   Objective：To observe the variation and clinical significance of the angle of progression（AOP） and the midline angle（MLA） in stage of labor. Methods：Transperineal ultrasound were performed in 97 single cephalic term pregnancies. AOP and MLA were performed when the cervix enlarged at 2-3 cm，4-5 cm，7-8 cm and 9-10 cm. We analyzed the relationship between AOP and MLA. Results：Along with the birth process, the AOP is gradually increasing while the MLA is reduced gradually. There was a negative correlation between AOP and MLA. Conclusions：The transperineal ultrasound can be used in monitoring of the stages of labor，and exploite the advantages of noninvasiveness，convenience，reduce infection and repeatability. Related Articles | Metrics

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Treatment of 7 Cases of Postpartum Hemorrhage Caused by Uterine Inertia with Massaging Uterus Continuously YAN Li 2014, 41 (4):  431-433.  Abstract ( 1246 )   PDF (442KB) ( 5153 )   Objective： To investigate the clinical value of continuous uterine massage treatment of uterine inertia postpartum hemorrhage. Methods：By retrospective study method，seven cases of intractable postpartum hemorrhage patients were received the treatment of continuous uterine massage for 1 to 2.5 hours in addition with the apply of uterotonic form August 2010 to May 2011，the one was received uterine artery embolization by digital subtraction angiography（DSA） before continuous uterine massage who is the pernicious placenta previa，the others were received continuous uterine massage in the condition of supplement the blood volume and the vital signs stable. Results：Seven patients were successfully saved，their uterine and fertility were also kept. Conclusions：The effect of continuous uterine massage treatment of uterine inertia postpartum hemorrhage is significance，and the operation is simple，convenient，economical，which was combined with drug treatment may be more effective to shorten the bleeding time. Related Articles | Metrics

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Clinical Analysis of 1 466 Cases of Preterm Birth from 2008 to 2012 ZHOU Xin;YIN Yin;ZHANG Guo-ying;SUN Li-zhou 2014, 41 (4):  434-437.  Abstract ( 1070 )   PDF (520KB) ( 5150 )   Objective： To explore the variation tendency of different gestational weeks and types of prematurity and the relationship of preterm-related factors，mode of delivery，premature child birth weight and neonatal asphyxia. Methods：Retrospective analysis of 1 466 hospital delivery cases of preterm labor in the first Affiliated Hospital of Nanjing Medical University from January 2008 to December 2012. Statistical analysis of the tendency，the preterm-related factors，mode of delivery and the neonatal asphyxia of different gestational weeks of prematurity （early preterm，interim preterm，late preterm） and different types （spontaneous preterm birth，treatment of preterm labor）. Results：①From 2008 to 2012，the rate of preterm birth increased year by year（χ2=65.69，P＜0.001），while varying periods preterm showed an increasing trend，different types of preterm birth tended to increase. ②Varying periods of spontaneous preterm relevant factors include premature rupture of membranes，multiple pregnancy，abnormal fetal position，gestational diabetes some other unexplained factors and so on；the varying periods of therapeutic premature factors include gestational hypertension，placental factors，pregnancy complications，multiple pregnancy，intrahepatic cholestasis of pregnancy，fetal distress and so on. ③The vaginal delivery and cesarean section rate of different gestational weeks of preterm delivery was no significant difference （P＞0.05），while was statistically significant difference （P＜0.05） in different types of preterm delivery. The treatment of preterm cesarean section is higher than spontaneous preterm labor （P＜0.05）. ④The Birth weight and neonatal asphyxia varying different periods of preterm birth have been statistically significant（P＜0.05）, early preterm children with neonatal asphyxia （53.01%） higher than interim （33.46%，P＜0.05） and late preterm infants（28.61%，P＜0.05），no significant difference in interim and late preterm children（P＞0.05）. Conclusions：We should discriminate the preterm potential risk factors earlier and strengthen the perinatal management to reduce the incidence of preterm birth and improve the perinatal outcomes. Related Articles | Metrics

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Study about Cases of Transvaginal Removal of Cesarean Scar Pregnancy FAN Xiao-dong;ZHU Ying-jun 2014, 41 (4):  438-440.  Abstract ( 1081 )   PDF (593KB) ( 5232 )   Objective：To evaluate the clinical value of transvaginal removal of caesarean scar pregnancy （CSP）. Methods：This was a retrospective study on 6 patients with CSP enrolled from September 2012 to September 2013, 6 patients treated by transvaginal removal of caesarean scar pregnancy. Intra-operative blood loss, time required for blood hCG droping to normal, hospital stay and menstruation recovery were observed. Results：The procedure was completed in all the patients without causing complications. Intra-operative blood loss was 20-50 mL，（28.33±11.25）mL; time of blood hCG droping to normal was 10-22 d, （16.83±4.21）d; time of hospital stay was 5-8 d,（6.50±1.05 d）; and time of menstruation recovery was 26-58 d,（35±11.73）d. Conclusions：Transvaginal removal of Caesarean scar pregnancy is a safe, economical, quickly and efficient procedure for patients with CSP. Related Articles | Metrics

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The Role of Trophoblastic Debris in the Pathogenesis of Preeclampsia SHEN Fang;CHEN Qi;XIAO Jian-ping 2014, 41 (4):  443-447.  Abstract ( 1122 )   PDF (742KB) ( 5216 )   Preeclampsia is a pregnancy specific complication which is characterized by systemic endothelial cell activation and exaggerated inflammatory response. Although the pathogenesis of preeclampsia is unclear，it is well recognized that placental factor(s) and maternal factor(s) contribute to the pathogenesis of preeclampsia. Trophoblastic debris shed from placenta is one of the possible placental factors. During the pregnancy, trophoblastic debris is shed into the maternal blood to become trapped against the maternal pulmonary endothelium as early as 6 weeks of gestation in an apoptosis form. Trophoblastic debris was reported to be involved in the pathogenesis of preeclampsia in 1893. The increased amount of trophoblastic debris is seen in preeclampsia. Recent study showed that phagocytosis of necrotic trophoblastic debris results in endothelial cell activation that seen in preeclampsia. There are many potential factors that could switch apoptotic trophoblastic debris into necrotic trophoblastic debris. Of them, antiphospholid antibodies, inflammatory cytokines like IL-6, TGF-β1 and failure of spiral artery transformation play an important role on it. To date even there is no effective treatment on preeclampsia, calcium and vitamin C supplementation may reduce the risk for developing preeclampsia through preventing endothelial cell activation induced by phagocytosis of necrotic trophoblastic debris. Related Articles | Metrics

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Advances in Gestational Age Estimating Based on Last Menstrual Period and Ultrasound LIANG Shuang;LI Xiao-tian 2014, 41 (4):  448-450.  Abstract ( 1125 )   PDF (348KB) ( 5127 )   Last menstrual period（LMP），which is a common means of estimation of gestational age，is simple，economical and low-cost. However，this method has many defects. Studies have demonstrated ultrasonography measurement to be superior to the LMP in estimation of gestational age and is receiving more and more attention. It is becoming the preferred choice for estimation of day of delivery in many countries. There is clinically significant difference among areas when determining gestational age on the basis of ultrasonography measurement. But there is no a sonographic dating formula based on ultrasonography measurement in Chinese population. This paper reviews the LMP and ultrasound characteristics and calculate gestational age ultrasound assessment of gestational age specific method for processing to provide a better basis for obstetrics. Related Articles | Metrics

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Effects of Associated Simple Acupuncture Therapy in the Treatment of Primary Dysmenorrhea：a Systematic Review QIN Ai-ling;MA Rui-ping;XIAO Wan;YI Li-juan;TIAN Xu 2014, 41 (4):  453-458.  Abstract ( 1103 )   PDF (1717KB) ( 5146 )   Objective： To systematically review the effectiveness of associated simple acupuncture therapy in the treatment of primary dysmenorrhea（PD）. Methods：Databases such as PubMed，Web of Science（SCI），CBM，CNKI，VIP and WANFANG DATA were electronically searched to collect the randomized controlled trials（RCTs）（up to December 2012），and the relevant references of the included articles were also manually searched. According to the inclusion and exclusion criteria，literature was screened，data were extracted and methodological quality of the included studies was assessed. Then Meta analyses were performed by using RevMan 5.2 software. Results：A total of 20 RCTs involving 2 134 participants were included. Results of Meta analyses showed that：①total efficiency of associated simple acupuncture therapy was better than that of control method，with statistically significant differences [RR=1.19，95%CI（1.14，1.24），P＜0.000] and [RR=1.15，95%CI（1.10，1.21），P=0.03]. ②Associated simple acupuncture therapy was better than control method in releasing degree of serious symptoms of PD，with statistically significant differences [MD=3.20，95%CI（2.36，3.04），P＜0.000] and [MD=2.09，95%CI（0.16，4.02），P=0.03]. ③ There was no statistical difference in reducing level of the peripheral blood prostaglandin F2α between the two groups [MD=0.13，95%CI（-0.13，0.39），P=0.32]. Conclusions：Associated simple acupuncture therapy can significantly relieve pain in patients with PD and overall efficiency. Due to limitations on the quantity and quality of included studies，this conclusion has yet to be carried out in large， multicenter study to verify. Related Articles | Metrics

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Management of Cervicovaginal Fistulas with Different Methods According to Individual Conditions ZHONG Sen;LANG Jing-he 2014, 41 (4):  459-461.  Abstract ( 1169 )   PDF (567KB) ( 5104 )   Objective：It focuses on how to improve the success rate of treatment of long -standing cervico-vaginal fistulas in different conditions and to relief the patients′ symptoms. Methods: We analysed 15 cases registered and treated in Peking Union Medical College Hospital from September 2000 to October 2013, on their clinic conditions, surgery methods, effectiveness and follow-up. Results: According to the patients′ individual conditions, 15 patients received different treatments respectively. Among 15 cases, 4 cases received directly-simple-repair, 5 cases received longitudinal-incision-repair, 4 cases received amputation and deformation of cervix , and 2 cases received hysterectomy. Only one case needed reoperation for relapse, the other 14 patients didn′t relapse or recomplain for those related symptoms as abnormal vaginal bleeding and vaginal secretions. Conclusions: According to individual conditions, it can improve the success rate of treatment and relief the patients′ symptoms greatly by adopting different treatment. Related Articles | Metrics

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Bone Morphogenetic Protein 4，Bone Morphogenetic Protein 7 and Polycystic Ovary Syndrome HUANG Xiao;JIN Jie-wen;WANG Yong 2014, 41 (4):  462-465.  Abstract ( 1133 )   PDF (620KB) ( 5171 )   Polycystic ovary syndrome（PCOS） is one of the common endocrine disorder affecting women of reproductive age，and is characterized by oligo- or anovulation，hyperandrogenism and polycystic ovaries. Some findings show that the cause of PCOS has something to do with the abnormal regulation of transcription factors，such as the Transforming Growth Factor-beta（TGF-β） superfamily. Bone Morphogenetic Protein 4（BMP4） and Bone Morphogenetic Protein 7（BMP7） are both important members in TGF-β superfamily， and play an significant role in the folliculogenesis、ovulation and the development and apotosis of granulosa cells in ovary. As a result，in order to know more about the pathogenesis and treatment of PCOS， it is necessary to make clear the regulation function of BMP4 and BMP7 in female reproductive system. Related Articles | Metrics

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Mechanism of Peripheral Vascular Motion and Central in Hot Flushes of Menopause SUN Yu;BAI Wen-pei 2014, 41 (4):  466-468.  Abstract ( 1136 )   PDF (426KB) ( 5200 )   Hot flash is the most common and special symptom of menopause and also is one of the most painful symptoms. However，the mechanisms responsible for the pathogenesis of the hot flash are not completely understood. Recently，some researchers found that hot flash could be associated with kinds of factors .Among all possible reasons, hypothalamic temperature set point becoming narrow are widely accepted by most scholars . In addition, the low level of estrogen leads high level noradrenalin and low level 5-hydroxytryptamine which will impact thermoregulation. And also hot flash could be bound with calcitonin gene-related peptide ,beta-endorphin and other social psychological factors. Now we will summarize the current studies in the mechanisms of the hot flash. Related Articles | Metrics

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Association of CAPN-10 SNPs with Polycystic Ovary Syndrome DENG Miao;LIU Yuan-wei;ZHANG Hong-yan;et al 2014, 41 (4):  469-472.  Abstract ( 1171 )   PDF (603KB) ( 5095 )   Polycystic ovary syndrome（PCOS） is a common endocrine disease in women. The phenomenon of familial aggregation suggests the role of genetic factors. Recent studies revealed that insulin resistanc（IR） played an important role in the pathophysiology of PCOS，most of the PCOS patients suffered from IR. Calpain-10 gene（CAPN-10） was the first positional cloned gene that was associated with type-2 diabetes mellitus（T2DM）. Its mutation was relevant to IR, which affected the genetic susceptibility of T2DM. Due to the common mechanism of IR, CAPN-10 became an important candidate gene for PCOS. And difference in the genome sequence and modification was the fundamental reason for the difference of genetic susceptibility,in which the variation of single nucleotide polymorphiｓｍｓ （ＳＮＰ） ｃaused by 90%. Currently, data base of SNＰ （ｄｂＳＮＰ） ｈａd listed 521 human CAPN-10 SNP locus. Now we will summarise the current status and progress in between CAPN-10 and PCOS. Related Articles | Metrics

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Association of Leptin and OB-R Research Progress in Endometriosis ZHANG Wei-yi;LI Ya-li 2014, 41 (4):  473-476.  Abstract ( 1105 )   PDF (559KB) ( 5116 )   Endometriosis is a gynecologic benign disease with biological behavior of malignant tumor， characterized by the feature of pain，infertility and pelvic mass. The incidence of the disease rises up recently which affected the life quality seriously，but the pathogenic mechanism is unclear. A number of basic and clinical research discovered that the expression and regulation of leptin and OB-R played an important role in the occurrence and progress of endometriosis including vascular neogenesis，cell proliferation and apoptosis，immunological regulation，inflammation reaction and metabolism. It can provide the new breakthrough point of endometriosis pathogenic study，clinical treatment and new drug exploitation by researching on the leptin，OB-R，regularity of the expression and change of its upstream and downstream gene. Related Articles | Metrics

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Relationship between VEGF and Related Factors and Abnormal Uterine Bleeding Induced by Intrauterine Device ZHAO Lu;YIN Zhen-hui;YANG Hua 2014, 41 (4):  477-480.  Abstract ( 1062 )   PDF (595KB) ( 5127 )   Intrauterine device（IUD） is one of the widely used long-acting contraceptive methods. At present，our country has the widespread use of copper containing IUD，but the placement of IUD women often have some adverse reactions，such as menorrhagia，irregular bleeding，abnormal vaginal discharge，pain，especially with the highest incidence of abnormal uterine bleeding. Patients with a serious impact on recognition of copper containing IUD and acceptance，which has been plagued by a problem that can not be ignored in clinic. At present it has been proved that human endometrium contains a variety of angiogenesis factor. Vascular endothelial growth factor（VEGF） is an important regulator of endometrial vessels formed，and affected by many factors. A number of research on the relationship between VEGF and related factors and the copper IUD induced abnormal uterine bleeding，the copper containing IUD side reactions of targeted therapy has opened up a new prospect. Related Articles | Metrics