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15 June 2014, Volume 41 Issue 3
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Ultrasound Surveillance in Twin Pregnancy JING Bai-hua;CHEN Qian 2014, 41 (3):  209-212.  Abstract ( 1583 )   PDF (596KB) ( 5131 )   As high risk pregnancy，twin pregnancy increases the morbidity and mortality of maternal-fetal complications. Recently，more and more obstetricians paid attention to the problems caused by the increased incidence of twin pregnancy. Therefore，antenatal surveillance can help to reduce the maternal-fetal complications and improve mother and child outcome through early diagnosis of abnormal fetals. Ultrasound contributes to determination of chorionicity，amnionicity and placentas，assessment of fetal growth and screening for anomalies in twin pregnancy. Rational prenatal ultrasonography is reliable method for the diagnosis and assessment of twins and provide evidence for clinical treatment. Related Articles | Metrics

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The Application of Metabolomics for Gestational Diabetes Mellitus ZHOU Ling;SHEN Gui-ping;XU Jing-jing;DENG Ling-li;DONG Ji-yang;HUANG Xiu-min 2014, 41 (3):  213-217.  Abstract ( 1186 )   PDF (697KB) ( 5107 )   Gestational diabetes mellitus （GDM） easily lead to some complications，such as preeclampsia，polyhydramnios，macrosomia，and so on. The traditional diagnostic protocols for GDM mainly rely on detecting elevated glucose levels in blood，often late in the second trimester. Therefore the treatment time for the patients is not enough and the serious risk to maternal and child health raise. Metabolomics is an approach that investigates the metabolic responses of living systems to internal or external stimuli or genetic modification. The application of metabolomics to GDM research will help to interpret the pathogenesis of GDM. In addition，it can also provide the theoretical and experimental support for prevention and treatment of GDM as well as the prognosis of mothers and their infants. The characteristics of the common detection methods and the metabolomics studies of GDM were analyzed and compared in detail in this paper，and the metabolomic studies in GDM was further reviewed. Related Articles | Metrics

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The Research Progress of Pregnancy Complicated with Myasthenia Gravis HUA Shao-fang;HAN Yu-huan 2014, 41 (3):  218-220.  Abstract ( 1014 )   PDF (421KB) ( 5157 )   Myasthenia gravis （MG） is an autoimmune disease of the neuromuscular junction characterized by skeletal muscle weakness. The course of MG during pregnancy is unpredictable. The stage and medication of MG will have effects on fetus，neonate and long-term outcome of the offspring. There will be an interaction between MG and pregnancy，partum，anaesthesia. The patients should be given individual regimen during pregnancy. If well-controlled，the patient will undergo caesarean section only with obstetric indication. The duration should be shortened by forceps when vaginal delivery. Strict surveillance and therapeutic regimen are crucial to the pregnant women with MG. This article reviews the advances on clinical research in pregnancy complicated with MG. Related Articles | Metrics

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Abdominal Compartment Syndrome during Perinatal Period LI Wei-jie;CHEN Juan-juan;HE Qing;XIE Yu-zhen;LI Ying-tao 2014, 41 (3):  221-224.  Abstract ( 1034 )   PDF (550KB) ( 5129 )   The increase in intra-abdominal pressure（IAP） will lead to multiple organ dysfunctions. There will be often complicated with abdominal compartment syndrome（ACS） or intra-abdominal high pressure（IAH），if pregnancy with serious internal medical or surgical diseases，or with serious complications. Furthermore，it will lead to an increased risk of maternal and perinatal mortality. Key measures for the diagnosis and prevention of ACS or IAH is monitoring IAP，the pregnancy maternal normal IAP standards and testing methods are not yet clear，that the bladder pressure method is still the gold standard of detection maternal IAP. For severe maternal IAP monitoring，we should do early detection and early treatment to avoid the occurrence of ACS. Once diagnosis of ACS，we should do early intervention，and the surgical decompression if it proves necessary. Related Articles | Metrics

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Exercise during Pregnancy SONG Meng-jiu;LI Ting 2014, 41 (3):  225-228.  Abstract ( 1473 )   PDF (538KB) ( 5128 )   Women are at low risk for adverse fetal or maternal events（preeclampsia，gestational diabetes mellitus，premature labor），if they participate in routine physical activity during pregnancy. Benefits from exercise during pregnancy include weight management，therapy for GDM，relief from low back pain，improved sense of well-being and enhanced sleep. Although there are still some arguments about the potential risk of exercise during pregnancy，many countries have published guidelines for exercise during pregnancy and the postpartum period，these guidelines are made for women who do not have any additional risk factors for adverse maternal or perinatal outcome. The benefits and potential risks of exercise during pregnancy and the suitable exercise during pregnancy are reviewed in this article，and also we think an investigation on the exercise during pregnancy of Chinese women should be carried out，and on the basis of that a guideline should be developed as soon as possible. Related Articles | Metrics

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Research Progress of MicroRNA-375 in Gynecological Malignant Tumors ZHANG Li-li;HAO Min;ZHAO Wei-hong 2014, 41 (3):  229-231.  Abstract ( 1029 )   PDF (712KB) ( 5110 )   MicroRNA-375 is a highly conservative miRNA，which play important roles in suppressing proliferation，promoting apoptosis，suppressing invasion and metastasis by means of regulating the expression of genes. The research has revealed that miR-375 is remarkably down-regulated in many tumor cells and ontic tissues，and is closely related in cancer development and progression. Recent years，the research on miR-375 in cervical cancer and endometrial cancer is increasing，but the mechanism should be studied future. This article elaborates biological function of miR-375 and improvements of some studies in gynecological malignant tumors. Related Articles | Metrics

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Research Progress of Albumin-bound Paclitaxel in Gynecologic Oncology ZENG Jing;ZHANG Rong 2014, 41 (3):  232-235.  Abstract ( 1262 )   PDF (605KB) ( 5159 )   Albumin-bound paclitaxel is a novel formulation of paclitaxel with albumin as its solvent. Compare to the conventional paclitaxel formulation （solvent is polyoxyethylene castor oil and ethanol），its anti-tumor capability is more effective and hematologic toxicity，severe allergic reaction and other side effects are less. In recent years，albumin-bound paclitaxel are widely used on clinical studies of gynecologic oncology. There are three Phase Ⅱ clinical studies currently reported on ovarian cancer，nanoparticle albumin-bound paclitaxel in platinum-sensitive patients and platinum-resistant patients with ovarian，peritoneal，or fallopian tube canceral and bevacizumab with albumin-bound paclitaxel in patients with recurrent，platinum-resistant primary epithelial ovarian or primary peritoneal carcinoma,which have shown the efficacy and tolerated adverse reactions. The study reported a phase Ⅱ trial of nab-paclitaxel in the treatment of recurrent or persistent advanced cervix cancer and point out that albumin-bound paclitaxel is a considering drug with little side effects. In short，there is only a few study on albumin-bound paclitaxel in gynecologic oncology until now and we need more further study. Related Articles | Metrics

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Progress of DNA Methylation Changes in Ovarian Cancer DING Yi;GONG Xiao-ming 2014, 41 (3):  236-239.  Abstract ( 1051 )   PDF (487KB) ( 5137 )   Ovarian cancers are the most common gynecological neoplasms，which has the highest mortality rate of cancers of the reproductive organs，because of lack of effective early diagnostic tool. DNA methylation is the first epigenetic changes discovered by human. Methlation of RASSF1A、BRCA1 and hMLH1 genes play an important role in the development of ovarian cancers. Detection of these genes could help early cancer diagnosis. However, some DNA methylation, like hMLH1, decline the sensitivity of chemotherapy drugs to tumor cells. Demethylation drugs which can reexpress those genes may improve the effect of chemotherapy and prognosis. In this review，we have summarized the newest researchs of DNA methylation changes in ovarian cancer. Related Articles | Metrics

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Progress of Treatment in Recurrent Ovarian Cancer with Trabectedin ZHAO Jian-guo;QU Peng-peng 2014, 41 (3):  240-243.  Abstract ( 1112 )   PDF (567KB) ( 5096 )   Trabectedin （Yondelis■） is a new non-platinum antineoplastic drug with a unique antitumor mechanism. It′s main side effect is the reversible liver injury, and it′s cardiac toxicity is low. Trabectedin can be applied with anthracycline-based drugs in the treatment of recurrent ovarian cancer. The optional treatment clinically include：single drug 3 weeks plan，single drug weekly therapy，combined anthracycline-based drugs，the best effect is the in combinational scheme. Trabectedin make satisfied curative effect in platinum sensitive recurrent ovarian cancer，especially treatment-free interval （TFI） 6-12 month. The platinum resistance and refractory ovarian cancer curative effect is not obvious. Application of Trabectedin can extend the TFI ,as to create conditions for using platinum drugs again. Related Articles | Metrics

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Quality of Life for Patients with Ovarian Cancer RAO Yang;QU Peng-peng 2014, 41 (3):  244-246.  Abstract ( 969 )   PDF (644KB) ( 5120 )   Despite advances in diagnostic techniques and therapy，ovarian cancer is the most malignant cancer in women， and the first leading cause of cancer related death of the gynecologic malignancy. In each phase of the illness （surgery and chemotherapy，follow-up，relapse and sequential therapy，bowel obstruction and end of life），quality of life （QOL） is one of the most important considerations. In the recent years，the assessments of the quality of life in patients with ovarian cancer have increased. Different agents for the chemotherapy，intraperitoneal therapy，the timing for the chemotherapy，different therapy，and the therapeutic effect are all the influencing factors for the quality of life in the patients with ovarian cancer. The other factors such as psychological and emotional problems，family and social assistance，sexual issues and menopausal syndrome will also affect quality of life. Related Articles | Metrics

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Treatment Progress of Cervical Adenocarcinoma WEN Qiang;FANG Su-hua 2014, 41 (3):  247-251.  Abstract ( 1101 )   PDF (603KB) ( 5132 )   The optimal treatment pattern for cervical adenocarcinoma is still undefined. Patients with ceruical adenocarcinoma in situ often need a simple hysterectomy. But to young patients，fertility-sparing surgeries such as cervical conization and LEEP are also options. To stageⅠA1 cervical adenocarcinoma，simple hysterectomy is much more used than radical hysterectomy now，but to young patients，cervical conization is also appropriate. The choice of treatment for most women with stage ⅠA2 to ⅡA disease is radical hysterectomy plus lymphedenectomy. Some patients require platinum based chemoradiation after surgery because of high-risk surgical-pathologic features. Primary radiation with weekly Cisplatin may be the best option for patients with stage ⅡB to ⅣA cervical adenocarcinoma. Furthermore，Paclitaxel with Cisplatin can be used as neo-adjuvant chemotherapy before radiation or as consolidation chemotherapy following radiation. To choose a treatment for ⅣB diseases is always difficult. Sometimes a palliative chemotherapy such as Paclitaxel plus Carboplatin or Gemcitabine plus Cisplatin is needed. Patients with local advanced or bulky diseases are difficult to deal with. Neo-adjuvant chemotherapy can be used to shrink the tumor. But whether it can prolong survival is still controversial. Management of relapsed or persistent diseases should be individualized，depending on the location of disease and the type of previous therapy. The treatment options including total pelvic exenteration，pelvic radiation and platinum based chemotherapy. Related Articles | Metrics

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MicroRNA in Cervical Cancer WANG Hong-hong;HAO Min;ZHAO Wei-hong 2014, 41 (3):  252-255.  Abstract ( 909 )   PDF (568KB) ( 5069 )   MicroRNA（miRNA） is a family of 18-25 nucleotide non-coding RNA. Accumulating evidence indicated that miRNA played an important role in regulating the cells，proliferation，apoptosis and tumorigenesis. miRNA may be closely associated with a variety of tumor occurrence，development，invasion and metastasis. Great concern has been raised regarding the correlation between cervical cancer and miRNA recently. The aberrant expressions of several miRNAs in cervical cancer were demonstrated to be involved in the occurrence and development of cervical cancer. However researches on the abnormal expression and regulation mechanism of the miRNA in cervical cancer were not much，still need further research. Here is to discuss the relationship between miRNA and cervical cancer and the possible regulation mechanism of the abnormal expression of miRNA. Related Articles | Metrics

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Application of Radiofrequency Ablation in the Treatment of Uterine Fibroids LU Jing;YUAN Yu-qia;JIANG Xiao-jing 2014, 41 (3):  256-259.  Abstract ( 1058 )   PDF (640KB) ( 5127 )   As the medical level is increasing and the popularity of gynecological routine examination for the women，the incidence of uterine fibroids becomes higher and higher. There are many ways to treat the uterine fibroids. The radiofrequency thermal ablation （RFA） is a minimally invasive procedure which provides significant clinical improvement in myoma volume reduction by destroying the myoma tissues without harming overlying organs or tissues. Now it is gradually recognized by clinicians as a simple，safe and effective treatment. This article shows a brief overview from the principle，indication and contraindication，method of intraoperative anesthesia and surgery，complications and treatment ways，the evaluation of the curative effect，the changes of the postoperative pathology and practicability of RFA of uterine fibroids. Related Articles | Metrics

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The Action of Immune Cells in the Pathogenesis of Endometriosis LI Zhuo-li;HAO Min;ZHAO Wei-hong 2014, 41 (3):  260-262.  Abstract ( 961 )   PDF (405KB) ( 5118 )   Endometriosis （EMs） is a common gynecologic disease，the prevalence is 10%-15%，and still rising. But the pathogenesis remain unclear. In the multitudinous hypothesis，the immune theory has drawn more and more attention，and become a hot research. Recently，many studies demonstrate that EMs is an immune inflammatory disease. In abdominal cavity，the change of immune cells （macrophages，NK cells，T cells，DC，mast cells） quantity and function can enhance the ability of endometrial cell invasion，adhesion，proliferation，angiogenesis，promote the ectopic lesions growth and maintenance，and made the endometrial cells that reverse into abdominal cavity to escape from immune surveillance. Related Articles | Metrics

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Current Situation and Progress of Progesterone in the Treatment of Endometriosis LI Xue-mei;HE Chun-ni 2014, 41 (3):  263-266.  Abstract ( 923 )   PDF (570KB) ( 5123 )   Endometriosis （EMs） is a common，benign and chronic disease of gynecology，it requires long-term or repeated courses of medication treatment to control its related symptoms. EMs is often treated surgically but with a higher rate of recurrence，patients of postoperation often need medical adjuvant therapy. EMs is a kind of estrogen dependent disease，the purpose of drug treatment is to creat an environment of low estrogen, inhibit the growth of ectopic endometrium or make it atrophy. Progestins have good tolerability，minor metabolic effects and low cost，there must therefore be considered drugs of choice and are currently the only safe and economic alternative to surgery, and levonorgestrel releasing intrauterine system is especially suitable for the patients who have EMs combined uterine muscle gland disease. According to the stage of individual，the choice of progestin program is different when select a therapeutic schedule drug adverse reaction and mechanism of accurate action should be considered. This article reviews the latest researches of progestins in treating EMs on molecular mechanism，commonly used types，commonly used formulations and dosage，application prospect. Related Articles | Metrics

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Study of Refractory Bacterial Vaginosis with the Gardnerella Vaginalis Biofilm YU Hong-min;SU Ting-ting;SUI Long 2014, 41 (3):  267-271.  Abstract ( 1004 )   PDF (821KB) ( 5119 )   Bacterial vaginosis（BV） can increase susceptibility of women to pelvic inflammatory disease，adverse pregnancy outcome and the risk of acquiring sexually transmitted diseases. Because of the factors causing BV and recurrent BV are complex，its etiology or pathogenesis still remains elusive. This review summarizes the microbiology and pathophysiology aspects of BV to enhance understanding of the vaginal microbiota，which is characterized by the depletion of hydrogen peroxide-producing lactobacilli species and aggregation of bacterial vaginosis-associated bacteria（BVAB）. Bacterial biofilm，formed by Gardnerella vaginalis in particular colonizes and adheres on the vaginal epithelium，can′t be completely eradicated by host immune system or antibiotics，contributing to the chronic and recalcitrant infection. Further outlines on the current clinical therapy and the need to cater to specific biofilm eradication treatment to minimize its recurrence. 【Keywords】 Vaginosis，bacterial；Drug resistance，microbial；Drug resistance，bacterial；Gardnerella vaginalis；Biofilms Related Articles | Metrics

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Retrospective Analysis of 14 Cases with Pregnancy Complicating Acute Pancreatitis GUO Yan-wei;ZHU Yan-ju 2014, 41 (3):  272-273.  Abstract ( 1035 )   PDF (336KB) ( 5093 )   Objective：To explore risk factors of acute pancreatitis during pregnancy, providing the basis for large sample research. Methods：A retrospective analysis of 14 cases of pregnancy with the clinical data of patients with acute pancreatitis, studying the risk factors. Results： 14 cases of patients with acute pancreatitis during pregnancy （12 patients for farmers, 2 cases as urban residents）, 1 case of mid-term pregnancy, the rest are in third trimester; 9 cases are of light pancreatitis, 5 cases are of heavy pancreatitis ; 2 cases for cholecystitis or with a history of cholelith disease, 10 cases were associated with hyperlipidemia; 3 cases were complicated with pregnancy hypertension disease;1 case for pregnancy with diabetes ketoacidosis. 13 cases recovered, 1 case death, including fetal death in 2 cases. Conclusions：The late pregnancy period is high incidence of acute pancreatitis and hyperlipidemia is one of the most important risk factor for pregnancy with acute pancreatitis. Normative antenatal examination to pregnant women and grass-roots system training to obstetricians are the keys to reduce adverse pregnancy . Related Articles | Metrics

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Pregnancy Outcome of Iron-deficiency Anemia in Third Trimester FAN Xiao-dong;WANG Ru;CHANG Wen-yan 2014, 41 (3):  274-276.  Abstract ( 984 )   PDF (434KB) ( 5087 )   Objective：To study the influence on pregnant women with iron deficiency anemia（IDA） and infants，and put forward the corresponding preventive measures. Methods：According to the diagnosis of anemia in the eighth edition of Obstetrics and Gynecology, retrospective analysis of 421 patients with iron deficiency anemia in late pregnancy [368 patients with moderate iron-deficiency anemia（IDA） and 53 patients with severe IDA] and 500 patients without IDA （control group）. Analysis of three groups of rate of postpartum hemorrhage and cesarean section and obstetrical forceps delivery，incidence of oligohydramnios and amniotic fluid pollution，rate of fetal distress and neonatal asphyxia , low neonatal birth weight. Results：The rates of postpartum hemorrhage，cesarean section，amniotic fluid pollution，fetal distress，neonatal asphyxia and low neonatal birth weight in severe IDA group are higher than the rates in moderate IDA group and control group（P＜0.05）. The rates of amniotic fluid pollution，fetal distress，neonatal asphyxia and low neonatal birth weight in moderate IDA group are higher than the rates in control group（P＜0.05）. There is no statistically difference in rate of obstetrical forceps delivery and oligohydramnios in three groups（P＞0.05）. Conclusions：Pregnancy with iron deficiency anemia have an adverse effect on maternity pregnancy outcome，we should strengthen the prevention of anemia during pregnancy. Related Articles | Metrics

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Analgesic Effect of Ambulatory Labor Analgesia and Its Influence on the Mother and Fetus LI Qiu-rong;LIANG Li-fen;CHEN Zhen-ming 2014, 41 (3):  277-279.  Abstract ( 1057 )   PDF (586KB) ( 5165 )   Objective：Effects of analgesia effect of ambulatory labor analgesia and its influence on the mother and fetus. Methods: A retrospective analysis of 177 cases of pregnant women in our hospital from September 2012 to September 2013. According to the mode of delivery, the cases were divided into painless delivery grouｐ （ｎ＝８３） ａｎd conventional delivery group （ｎ＝９４）, and compared the two groups in the labor pain score, birth process and newborn situation. Results: Cesarean section rate was significantly lower in painless childbirth group than that in conventional delivery group; the first stage in painless childbirth group is shorter than the conventional delivery group ,the second stage of labor was significantly prolonged compared with that inthe conventional delivery grｏｕｐ （Ｐ＜０．０５）, third stage has no significant statistical difference in two groｕｐｓ （Ｐ＞０．０５）; painless childbirth pregnant woman the production process of VAS scores were significantly lower than that of conventional delivery grouｐ （Ｐ＜０．０５）; and the incidence of neonatal Apgar score of two groups of fetal distress were no significant statistical difference （Ｐ＞０．０５）; the two group of postpartum hemorrhage and the incidence of bleeding volume were not significantly difference （Ｐ＞０．０５）; conventional delivery group no untoward reaction of postpartum, painless labor group 4 cases of orthostatic hypotension （５．６％）, 3 cases of lower extremity muscle weakness （４．２％）, were after symptomatic treatment in 3 h mitigation. Conclusions: Ambulatory labor analgesia can significantly reduce maternal pain of the production process, and will not lead to severe postpartum complications, fetal harm, is an effective, safe childbirth analgesia method, is worthy of clinical application. Related Articles | Metrics

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The Value of Color Doppler Ultrasound in Diagnosis of Placenta Accrete WANG Ling-hong;WU Chao 2014, 41 (3):  280-281.  Abstract ( 1001 )   PDF (1337KB) ( 5084 )   Objective： To evaluate the value of color Doppler ultrasound in the diagnosis of placenta accreta. Methods：Retrospective analysis of 93 cases diagnosed as placenta low state，low-lying placenta or placenta previa through ultrasound examination in our hospital between January 2012 to October 2013. 24 cases were diagnosed as placenta implantation among them. Abdominal and transvaginal ultrasonography focus in observing the thickness，position and internal echo of the placenta，the thickness of uterine muscle in placental site，the relationship between the placenta and uterine muscle，and the adjacent urinary bladder wall blood flow in placental site were also included. Results：24 patients were suspected of placenta implantation by color Doppler ultrasonography，20 cases were confirmed of placenta implantation by pathology after operation，including 4 cases of placenta adherence，14 cases of placenta accreta，2 cases of placenta penetration.，5 cases of misdiagnosis, missed diagnosis in 1 cases. Sensitivity and specificity of color Doppler ultrasonography was 95.00% and 93.15% respectively. The positive predictive value and the negative predictive value of color Doppler ultrasonography was 79.17% and 98.55% respectively. Conclusions：The color Doppler ultrasound is a preferred method for prenatal diagnosis of placenta accreta. Related Articles | Metrics

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Contrast Study between Two－Dimensional Ultrasound, Three－Dimensional Ultrasound in Diagnosing Ovarian Tumors GUO Lin-na;HUANG Fan 2014, 41 (3):  282-284.  Abstract ( 1022 )   PDF (612KB) ( 5092 )   Objective： To evaluate the clinical value of 3D-US in discriminate diagnosing ovarian tumor. Methods： Preoperative 2D-US and 3D-US was performed in 62 patients with suspected adnexal masses to observe the morphology of ovarian tumors and made the ultrasound diagnosis. Results：48 patients were diagnosed correctly by 2D-US, the accuracy of 2D-US diagnosing ovarian tumor is 77.4%. 14 patients were misdiagnosed, the misdiagnosis rate of 2D-US is 22.6%. 58 patients were diagnosed correctly by 3D-US, the accuracy of 3D-US is 93.5%. 4 patients were misdiagnosed, the misdiagnosis rate of 3D-US is 6.5%. Conclusions：3D-US can offer more morphology information than 2D-US, it can elevate the accuracy of discriminating ovarian tumor. Related Articles | Metrics

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Application of Tumor Markers for the Dualistic Model about Epithelial Ovarian Cancer ZHANG Shuang-ge 2014, 41 (3):  285-289.  Abstract ( 961 )   PDF (827KB) ( 5158 )   Objective： To explore serum human epididymis protein 4 （HE4），cancer antigen 125 （CA125） for the dualistic model about epithelial ovarian cancer （EOC） application value. Methods：The electrochemical luminescence method to detect serum HE4 and CA125 levels of patients in hospital to be intend to do surgery because of pelvic masses or ovarian cyst from February 2012 to April 2013，including gynecological inflammation（n=65），endometriosis （n=509），benign ovarian tumors（n=887），borderline ovarian tumors（n=73），epithelial ovarian cancer（n=132，78 cases of Ⅰtype，54 cases of Ⅱ type） and 71 cases of healthy women，to evaluate in application value of the model. Results：Epithelial ovarian cancer patients serum HE4 and CA125 expression level and FIGO stage were a significant positive correlation（rs=0.534，0.541，P=0.000）. The serum level of HE4 and CA125 expression in the epithelial ovarian cancer of Ⅱtype were higher than that of the Ⅰ type in all stage，the difference was statistically significant. The serum level of HE4 expression in the high-grade serous carcinoma were higher than the low-grade serous carcinoma，the difference was statistically significant. The serum level of HE4 expression in epithelial ovarian cancer were higher than that of the other groups，the difference was statistically significant（P＜0.05）. The serum level of CA125 expression in Ⅰstage EOC and gynecological inflammation，endometriosis were no significant difference（P＞0.05）. The serum level of CA125 expression in Ⅱ-Ⅲstage EOC of Ⅰ type and endometriosis were no significant difference （P＞0.05）. The area under the receiver operating curve （ＲＯＣ－ＡＵＣ） of HE4 and ROC were 0.877，0.786，accuracy（90.0%，70.5%），sensitivity（67.4%，69.7%），specificity（92.1%，72.6%），Youden index（0.595，0.403）. Conclusions：The specificity of HE4 assay is higher than CAl25 assay in the diagnosis of ovarian carcinoma. Single serum HE4 and CA125 detection has a certain significance to the early diagnosis staging，pathology typing and prognosis of epithelial ovarian cancer，which can be used as an important index for the diagnosis of epithelial ovarian cancer. Related Articles | Metrics

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The Effect of Chemotherapy for Recurrent Epithelial Ovarian Cancer：A Meta Analysis DANG Cai-ling;LI Li;YANG Zhi-jun 2014, 41 (3):  290-297.  Abstract ( 939 )   PDF (1702KB) ( 5172 )   Objective： To systematically assess the clinical efficacy and toxic reaction of different chemotherapy regimens for recurrent epithelial ovarian cancer. Methods：The literature spublished between January 1，1995 and December 31，2011 in PubMed，Embase，Medline，Cochrane Library，EBMR，CBM，CJFD，and CNKI were searched. The RCT were searched which about the effect of different chemotherapy regimens on the progress free survival（PFS），overall survival（OS），the number of responses，complete responses，grade 3-4 hematologic toxicity reaction，grade 3-4 nonhematologic toxicity reaction for recurrent epithelial ovarian cancer. The literatures were screened according to the inclusive and exclusive criteria by two reviewers independently，then the RevMan 5.1 software was used for meta-analyses. Results：14 RCT（including 7 for platinum-sensitive and 7 for platinum-resistance） were included. Meta analysis showed that carboplatin-based chemotherapy was a favorable factor for OS（OR=0.50，95%CI：0.32-0.78，P=0.002） and responses rate（OR=1.87，95%CI：1.38-2.55，P＜0.000 1） in platinum-sensitive patients，but it was not a favorable factor for PFS（OR=1.19，95%CI：0.60-2.33，P=0.62）and can increase the risk of leukocyte reduction. Two studies show that topotecan can improve OS in platinum-resistance patients. Gemcitabine was not a favorable factor for responses rate（OR=1.29，95%CI：0.67-2.46，P=0.45） and can increase the risk of neutropenia reduction （OR=2.97，95%CI：1.70-5.17，P=0.000 1） compared with PLD in platinum-resistance patients. Conclusions：Carboplatin-based chemotherapy can be improve OS and responses rate in platinum-sensitive patients，It should pay attention to monitor hematologic toxicity reaction during chemotherapies. Topotecan can improve OS but it was not a favorable factor for PFS in platinum-resistance patients. It can be used as research direction in the future for platinum-resistance patients. It is not a high methodological quality studies in this meta analysis and still need more rigorous quality RCT study to confirmed. Related Articles | Metrics

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HCRT for Advanced Cervical Carcinoma：A Meta-analysis MA Xiao-ping;YANG Yong-xiu;GE Yan 2014, 41 (3):  298-303.  Abstract ( 1060 )   PDF (909KB) ( 5129 )   Objective： To evaluate the clinical effect and safety of hyperthermia combined with radiotherapy and chemotherapy（HRCT） for advanced cervical cancer. Methods：The database such as， The Cochrane library， PubMed， EMBASE， CBM，CNKI，VIP and WANFANG Data were searched up to May of 2013， and other sources as supplied were also retrieved to collect all the relevant randomized controlled trials （RCTs） on comparing HCRT with non-HCRT .The quality of the included trials was assessed according to the Cochrane Hand book 5.1 for systematic review and the features of this study as well. Meta-analyses were conducted by using RevMan 5.2 software. Results：A total of sixteen RCTs involving 1 295 patients were included. The results of Meta-analysis showed that ①HCRT group′s short-term efficacy（complete remission rate，local control rate）were higher than HRT group，CRT group and RT group. HCRT group′s efficiency rate were higher than CRT group and RT group.HCRT group′s long-term efficacy：one year disease-free survival rate was higher than CRT group and HRT group. In terms of two-year and five-year survival rate, there were no significant differences compared with non-HCRT. In terms of three-year survival rate，there were no significant differences compared with CRT group and RT group，but was higher than HRT group.② Safety evaluation：the incidence rates of bladder reaction， rectum reaction and dry dermatitis were similar among the HCRT group and the non-HCRT group .There were no significant differences in HCRT compared with non-HCRT. Considering the incidence rates of gastrointestinal reaction，marrow suppression， HCRT group was higher than RT and HRT group. There were significant differences between HCRT group and RT and HRT group . Conclusions：Compared with other therapies，HCRT tends to improve the clinical efficacy，but this result needs to be proved by more clinical trails. HCRT is superior to the routine radio-chemotherapy in efficacy，but the relevant evidence for proving its long-term efficacy and safety is still required. Related Articles | Metrics

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Analysis of the Clinical Effects about Paclitaxel Plus Oxaliplatin in Treatment of Recurrent or Advanced Cervical Cancer TIAN Xiu-lan;ZHAI Jian-jun;FENG Bi-bo;WANG Hui-xiang 2014, 41 (3):  304-306.  Abstract ( 1157 )   PDF (481KB) ( 5081 )   Objective： To investigate the clinical efficacy and adverse reactions of paclitaxel plus oxaliplatin in the treatment of recurrent or advanced cervical cancer. Methods：32 patients of recurrent or advanced cervical cancer were given the chemotherapy of paclitaxel plus oxaliplatin ：the dose of paclitaxel was 150 mg/m2 intravenous infusion ≥3 h in the first day，and the dose of oxaliplatin was 130 mg/m2 intravenous infusion ≥ 2 h in the second day，the course was repeated every 3 weeks，the evaluations of the short term or long term and adverse reactions were evaluated after 2 cycles treatment. Results：All patients can participate in the evaluation of curative effect，and the total effective rate was 25%. The median progression free survival and median overall survival were 21.2 weeks and 52.1 weeks respectively. The main adverse reactions were toxicities and myelosuppression，non-hematologic adverse reaction was mild. Conclusions：Paclitaxel plus oxaliplatin has quite valid curative effect on the treatment of recurrent or advanced cervical cancer patients，the adverse reactions can be tolerated，which was worthy for the further clinical research. Related Articles | Metrics

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The Efficacy and Safety of Uterine Artery Embolization for Cesarean Scar Pregnancy and Cervical Ectopic Pregnancy LONG De-lai;WEI Zhen-he;YANG Hua 2014, 41 (3):  307-310.  Abstract ( 975 )   PDF (830KB) ( 5154 )   Objective： To assess the efficacy and safety of uterine arteries embolization （UAE） for the treatment of cesarean scar pregnancies （CSP） and cervical ectopic pregnancy （CEP）. Methods：A prospective study for case series of seventy-six women with CSP and fourteen women with CEP were accurately identified by Tianjin Central Hospital of Gynecology Obstetrics between April 1，2011 and April 1，2013. All of the patients underwent UAE combined with methotrexat （MTX）. Results：All of the patients were successfully treated without any severe adverse reactions or complications，and did not need a repetitive uterine artery embolism or uterus resection or partial resection of the local lesions. No significant differences of blood loss were seen between whether the embryo was alive before UEA（CSP：t=0.234；CEP：t=0.730，P＞0.05）. There is no correlation between beta-human chorionic gonadotropin level before UAE and blood loss. The difference was found to be statistically significant between whether the beta-human chorionic gonadotropin level dropped obviously（CSP：t=-6.683；CEP：t=-5.461，P=0.000），and the difference was also found significant between the different types of CSP（t=5.731，P=0.000）.The complications were mainly fever and abdominal pain； 70 patients were followed up，and all of them had recovered their normal menstruation . Conclusions：UAE with MTX appears to be a safe and effective treatment for CSP and CEP. Related Articles | Metrics

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The Influencing Factors and Treatment of Cesarean Scar Pregnancy ZHAI Jun-ying;GUAN Zheng;LIU Hui;LI Ya-li 2014, 41 (3):  311-313.  Abstract ( 974 )   PDF (577KB) ( 5100 )   Objective： To investigate the influencing factors of cesarean scar pregnancy （CSP） and the suitable measures of diagnosis and treatment. Methods：From January 2007 to August 2012，51 cases were diagnosed as CSP in our hospital. The patients′ information were analyzed such as the indications of cesarean, postoperative recovery and the CSP time. According to patients′ condition curettage, uterine artery embolism, laparoscopic and/or hysteroscopic treatment, exsecting the focus per vagina, hysterectomy were selected. Results：All the cases were diagnosed by transvaginal ultrasound. The time of occurrence CSP were 5-147 months（average 60.5±9.5）. Gravidity 2-6. Excepting 10（19.61%） cases performed cesarean after uterine contraction，41（80.39%）cases were selectively cesarean without any uterine contraction. 48（94.12%） cases were cured successfully by conservative treatment. Of those 8 cases with ultrasonic monitoring, 19 cases after uterine artery embolism, 8 cases monitored by laparoscope or/and hysteroscope, 11 intramuscular or cervical injection with methotrexate, 2 anterior uterine wall neoplasty per vagina. 3 cases were performed hysterectomy with heavy bleeding, one case died of hemorrhagic shock. Conclusions：CSP are high-risk pregnancy, it′s very important with early diagnose and suitable treatment. Transvaginal ultrasound is the preferred diagnostic method of CSP. Related Articles | Metrics

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Analysis on Anterior Pelvic Organ Prolapse Treated by Improved Anterior Pelvic Reconstruction Combined with Sacrospinous Ligament Suspension CHI Yu-gang;LIU Lu-bin;YANG Mei;WEN Ya-ling;ZHANG Hua 2014, 41 (3):  314-316.  Abstract ( 1020 )   PDF (564KB) ( 5103 )   Objective: To evaluate the clinical efficacy and safety of the improved anterior pelvic reconstruction combined with sacrospinous ligament suspension in treatment of anterior pelvic organ prolapse. Methods：55 cases with anterior pelvic organ prolapse （stage Ⅲ or stage Ⅳ according to POP-Q staging） from January 2010 to July 2012 were retrospectively analyzed. 17 cases received the improved anterior pelvic reconstruction and sacrospinous ligament suspension （the combination group），18 cases received only the improved anterior pelvic reconstruction （the reconstruction group），and 20 cases received the vaginal antetheca repair （the routine treatment group）. Results：There were significant differences in the average operation time，the amount of blood loss, and hospitalization day after operation in the three groups（P＜0.05）. There was no significant difference in the curative rate of one month after operation in the three groups，but the curative rate of 3 and 6 months after operation in the combination group was significantly higher than those in others groups （P＜0.05）. In the combination group and the reconstruction group, there were not adverse effects such as hematoma，urethra，bladder and rectum injury. However，there were 3 cases with the postoperative urinary retention in the routine treatment group. They recovered by heteropathy. Conclusions：The improved anterior pelvic reconstruction combined with sacrospinous ligament suspension can successfully repair defects of the anterior pelvic structure with better short-term efficacy, safe and feasible. However，its long-term efficacy needs further observation. Related Articles | Metrics

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Study of Lower Urinary Tract Morphological Changes after Hysterectomy by Ultrasound WANG Man-li;GUO Yu-ping;CONG Shu-zhen;ZHOU Rui-li;WU Li-sang 2014, 41 (3):  317-320.  Abstract ( 1042 )   PDF (669KB) ( 5129 )   Objective： To investigate the static and dynamic morphological changes of bladder and urethral after hysterectomy by ultrasound，and evaluate the anatomical changes. Methods：Grouping 136 cases of hysterectomy patients according to surgical mode and scope of removal，Group A：29 cases of laparoscopic-assisted vaginal hysterectomy; Group B：41 cases of abdominal hysterectomy; Group C：66 cases of abdominal radical hysterectomy. Control group：50 cases of no pelvic or abdomen surgical operation experience. Apply abdominal and perineal ultrasound inspection to the groups，measuring parameters include UVJ-M，PUVA and bladder post-void residual volume. Results：There were significant changes in the anatomical structure of urinary tract like bladder and urethra in group C cases after surgery, UVJ-M, PUVA-r and PUVA-s had significant differences between group C and control group （Ｐ＜０．０１）. There were changes in the anatomical structure of urinary tract like bladder and urethra in group B cases after surgery, but the degree of change is small compared with group C, UVJ-M had significant changes between group B and control group or group B and group Ｃ （Ｐ＜０．０１）, PUVA-r, PUVA-s had no significant changes between group B and control group （Ｐ＞０．０５）． There were no significant changes in the anatomical structure of urinary tract like bladder and urethra in group A cases after surgery, UVJ-M, PUVA-r and PUVA-s had no significant changes between group A and control group （Ｐ＞０．０５）． Conclusions：①Ultrasound can provide a real time observation for the morphological changes of bladder and urethral after hysterectomy and provide an objective evaluation for the anatomical changes. ②Abdominal radical hysterectomy brings the most significant morphological changes of bladder and urethral compared with the other 2 types of hysterectomy，and there are almost no changes by laparoscopic-assisted vaginal hysterectomy. Related Articles | Metrics

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TNF-α, E2, E6 and E7 in Different Cervical Lesion and Correlation Analysis between Them LI Shi-rong;LIU Dong-qing;HU Feng-ying 2014, 41 (3):  321-323.  Abstract ( 1018 )   PDF (492KB) ( 5159 )   Objective： To detect TNF-α，E2，E6 and E7 in different cervical lesion and analyse the relationship between them. Methods：According to different pathology result， specimens were divided into normal group of HPV negative，HPV16 positive normal group，HPV16 positive CINⅠ-Ⅱ，HPV16 positive CINⅢ，HPV16 positive SCC group. TNF-α，E2，E6 and E7 proteins of each group specimens were detected by using RT-PCR，and the result of the test were analyzed statistically. Results：HPV E6 and E7 gene expression is positively correlated with the malignant degree of cervical cells，and the E7 gradually rising trend is more significant. The E2 fall after rise to CINⅡ，and of TNF-α basic is the rising trend in different cervical lesions ，but the expression has no obvious difference between CINⅢ group and cervical invasive cancer. Conclusions：With the ratio of E2/E7 to predict or diagnose the degree of high cervical lesions might be more accurate. Elevated inflammatory cytokines of TNF-α may increase the destruction of E2, which lead to excessive expression of oncogene E6 and E7，thus promote the occurrence of cervical cancer. Related Articles | Metrics

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Expression of Cyclin E and Its Related Proteins in Gestational Trophoblastic Disease LI Na;QU Peng-peng 2014, 41 (3):  324-326.  Abstract ( 1048 )   PDF (392KB) ( 5118 )   Objective： To investigate the expression of Cyclin E，CDK-2 and their inhibitors P27KIP1 and P21WAF1/CIP1 in gestational trophoblastic disease（GTD）. Methods：Expression of the above indexes were determined immunohistochemically by specific antibodies for these proteins on formalin-fixed paraffin sections of 30 of normal placenta tissues，38 of hydatidiform moles and 9 of gestational trophoblastic neoplasms （GTN）， including 8 invasive moles and 1 choriocarcinoma. Results：①The expression of Cyclin E and CDK-2 in GTD was significantly higher than that in normal placentas（P＜0.01）. The expression of P27KIP1 and P21WAF1/CIP1 in GTN was significantly lower than that in hydatidiform moles and normal placenta tissues，respectively（P＜0.05）. Moreover，the expression of P27KIP1 and P21WAF1/CIP1 in hydatidiform moles which developed GTN was significantly lower than those spontaneously regressed.②Significant negative correlations between the Cyclin E and P27KIP1，P21WAF1/CIP1 staining indexes were observed（P＜0.05）. There was a positive correlation between the expression of CDK-2 and Cyclin E（P＜0.05）. Also，the expression of P27KIP1 and P21WAF1/CIP1 showed positive correlation （P＜0.05）. CDK-2 showed inverse expression pattern compared with P27KIP1 and P21WAF1/CIP1，but no statistical difference was observed（P＞0.05）. Conclusions：Disregulation of Cyclin E/CDK-2 complex and its inhibitors participated in the development of gestational trophoblastic tumor. P27KIP1 and P21WAF1/CIP1 may be used as effective indicators for the prognosis of hydatidiform moles. Related Articles | Metrics