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15 August 2012, Volume 39 Issue 4
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Advances in Screening， Diagnosis and Treatment for Cervical Cancer GAO Yong-liang;ZHU Jian-qing 2012, 39 (4):  319-321.  Abstract ( 1803 )   PDF (232KB) ( 5035 )   Cervical cancer screening is an important means to early diagnosis for cervical cancer. Because of progress in epidemiology and HPV research，ACOG made an important modification to screening start time and frequency etc. Squmous cell carcinoma antigen detection plays an important role in diagnosis and disease monitors for cervical cancer. The reform and innovation of treatment，such as redical trachelectomy，neoadjuvant chemotherapy，concurrent chemotherapy and radiotherapy， intensity-modulated radiation therapy etc，make the treatment effect continuously improved. Related Articles | Metrics

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The Progresses of Diagnosis and Treatment of Uterine Malignant Tumor——Cervical Cancer LIN Zhong-qiu;LU Huai-wu 2012, 39 (4):  322-326.  Abstract ( 1853 )   PDF (362KB) ( 5148 )   The uterus is an organ which nurtures the embryo，fetus and produces menstruation. At the same time，it is also an organ which is likely to suffer from malignant tumor. Each part of the uterus including cervix，corpus uteri， endometrium，myometrium is prone to malignant tumor. Cervical cancer is the most common gynecological malignancies. Persistent infection of high risk papillomavirus is the main reason of precancerous and cervical cancer. The main pathological type was squamous cell carcinoma and adenocarcinoma. Definite diagnosis can depend on cervix biopsy and histopathology. We can judge the severity from the FIGO clinical staging. The treatment of early stage cervical cancer is surgery，while in treatment of the middle and advanced stage cervical cancer，radiaotherapy is the core and chemotherapy is the complement. Nowadays targeted therapy provides a new approach to local advanced， recurrent and metastasis cervical cancer. HPV vaccine has been used to prevent the cervical cancer now. Related Articles | Metrics

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Metabolic Syndrome and Endometrial Carcinoma XUE Feng-xia;MOU Nan 2012, 39 (4):  327-329.  Abstract ( 1736 )   PDF (186KB) ( 5045 )   Metabolic syndrome contains several metabolic disorders with insulin resistance as its pathophysiological basis. Epidemiological studies show that not only metabolic syndrome， but also metabolic syndrome related obesity， diabetes and hypertension which characterized with insulin resistance are all risk factors of endometrial carcinoma. At the state of insulin resistance， circulating insulin levels will increase. As a result， insulin promotes the development of endometrial carcinoma directly through the activation of its signaling pathway and indirectly through the up-regulation of the blood estrogen levels. Moreover， in the development of insulin resistance， the development of endometrial carcinoma is probably promoted simultaneously by some adipocytokines. Taken together， insulin resistance is a bridge related endometrial carcinoma with metabolic syndrome. Treatment targeting insulin resistance may serve as therapeutical purpose for inhibiting the development of metabolic syndrome related endometrial carcinoma. Related Articles | Metrics

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Research Progress of Cervical Adenocarcinoma LI Qing;FENG Wei-wei 2012, 39 (4):  330-333.  Abstract ( 1783 )   PDF (229KB) ( 5200 )   Cervical adenocarcinoma（CA）， fewer than squamous cell carcinoma（SCC）， is a special pathological type of cervical cancer. Recently， there is a rising incidence and proportion of CA related to cervical cancer. CA is more often seen in younger population and has a poorer prognosis than SCC. In addition， compared with SCC， higher rate of ovarian metastasis and lower sensitivity to both radiotherapy and chemotherapy affect the diagnosis and treatment of CA. The research progress of cervical adenocarcinoma was reviewed in this article， focused on the pathogenic factors（estrogen，progesterone and human papillomaviidae）， risk factors for ovary metastasis， ovarian preservation and the clinical applications of radiotherapy and chemotherapy. Related Articles | Metrics

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Large Cell Neuroendocrine Carcinoma of the Cervix MAO Dong-rui;OUYANG Zhen-bo;LIU Ping;CHEN Chun-lin 2012, 39 (4):  334-336.  Abstract ( 3880 )   PDF (229KB) ( 5413 )   Large cell neuroendocrine carcinoma （LCNEC） of the cervix is a rare cervical malignancy. The prognosis of LCNEC of the cervix is very poor showing a high degree of malignity， a rapid progression， a high relapse rate and early blood spread. Its development is closely related to high-risk human papilloma virus infection. Although the cytologic abnormality can aid to the diagnosis of LCNEC of the cervix， the pathologic examination combined with immunohistochemical study is the main method for its diagnosis and differential diagnosis. There is no unified therapy at present， but a majority of scholars presume that operation combined with radiotherapy and chemotherapy can improve the survival rate. Related Articles | Metrics

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Study of Natural History of Cervical Intraepithelial Neoplasia Grade WULAN Na;RONG Xuan;LI Rui-zhen;LIU Zhi-hong;LI Juan;WANG Chun;LIU Miao;TANG Guo-liang 2012, 39 (4):  337-340.  Abstract ( 1736 )   PDF (401KB) ( 5214 )   Objective：To investigate the natural history of CINⅠ lesions. Methods：548 patients were enrolled into the cohort. They were followed up for 24-48 months without any treatment. Every 6 to 12 months， the patients were called back to have the Liquid-based Cytological Test and High-risk Human papillomavirus Test（HC-Ⅱ）. If the LCT was ASCUS and HR-HPV was positive or LCT was higher than ASCUS， then colposcopy was used to assess the disease situation and multi-point biopsies were made at the same time. The biopsy results were the gold standard to assess the outcome if it was progression， resistance or regression. Results： ①The 36 months dropout rate was 10.22%. ②At the end of the follow-up， 16 patients had progressed to higher grade lesions， including 11 CINⅡ and 5 CINⅢ. No one had progressed to invasive cervical cancer. 29 patients whose CINⅠ lesions had resistant and 477 patients had regressed. Within 6 months， the CINⅠ progression rate， resistance rate and regression rate was separately 0.57%， 67.05%， and 37.36%. Within 12 months， the CINⅠ progression rate， resistance rate and regression rate was separately 1.15%， 48.08%， and 55.56%. Within 24 months， the CINⅠ progression rate， resistance rate and regression rate was separately 2.30%， 20.88%， and 77.20%. Within 36 months， the CINⅠ progression rate， resistance rate and regression rate was separately 3.07%， 5.56%， and 85.63%. ③The 6， 12， 24， 36 months HR-HPV cultivate clearance rate of HR-HPV positive CINⅠ was separately 52.76%， 61.84%， 82.64%， and 94.52%. Conclusions： ① Most of the CINⅠ lesions （85.71%） can regress themselves during 36 months， only few part（3.07%） of them will progress to high grade lesions. The cultivate progression rate and regression rate became higher and higher along with the time during the 36 months follow-up. ②The cultivate rate of HR-HPV clearance became higher and higher with the time during the 36 months follow-up. ③CINⅠ were caused by transient HR-HPV infection，HR-HPV positive CINⅠ lesions had the same regression trend with HR-HPV clearance. Related Articles | Metrics

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The Importance of Basic Applied Research on Ovarian Cancer Kong Bei-hua 2012, 39 (4):  344-347.  Abstract ( 1675 )   PDF (270KB) ( 5141 )   The article evaluated the Dualistic theory and the extraovarian origin of ovarian cancer，and indicated their guiding role on the clinical diagnosis and treatment of ovarian cancer.We analysed the current status and developing direction of the related research on the diagnosis and treatment.The importance of translational studies on the ovarian cancer was emphasized. Related Articles | Metrics

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Advances on Tumor Markers for Diagnosis of Ovarian Cancer CHEN Li-lan;DI Wen 2012, 39 (4):  348-351.  Abstract ( 1349 )   PDF (246KB) ( 5036 )   Ovarian cancer is one of the most common and lethal gynecological malignancy，leading cause of cancer deaths among women. It has been the main tumor that threatens the life and the health of women. The early clinical symptoms of ovarian cancer conceal，70% of the patients attending is late，the 5-year survival rate was only 30%，and 5 year's survival rate of early ovarian cancer was 90%. Now it is urgent and necessary to search new tumor markers with high specificity and sensitivity that are useful for early diagnosis of ovarian cancer and for the improvement of survival rate. Carbohydrate antigen，human epididymis 4（HE4），NECTIN4，lysophosphatidic acid（LPA），trkA and microRNA play a role in ovarian cancer diagnosis，of which CA125 is most widely used in clinical diagnosis. Micro RNAs as new tumor markers can improve the diagnosis methods of ovarian cancer. Related Articles | Metrics

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Tumor Microenvironment Affecting Biological Behaviour of Malignant Ovarian Neoplasms: an Update JI Fang;DI Wen 2012, 39 (4):  352-355.  Abstract ( 1600 )   PDF (209KB) ( 5007 )   The tumor microenvironment is a tumor cell， stromal cells， cytokines， immune cells such as tumor constitute the environment of local pathology， which is tissue hypoxia， acidosis， interstitial high pressure and so on. In tumor microenvironment in a large number of growth factors， proteolytic enzymes and the immune inflammatory response which interact on the tumor cell surface， play an important impact on cell proliferation，metastasis，differentiation. Early symptoms of ovarian cancer because of its atypical metastatic quickly， so the prognosis is poor， has become one of the serious threat to women′s health tumor. In this paper the tumor microenvironment and the malignant behavior of ovarian cancer combined with each other， are reviewed. Related Articles | Metrics

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Advances on Ovarian Cancer Related Metabolomics ZHOU Ying-qun;DI Wen 2012, 39 (4):  356-359.  Abstract ( 1670 )   PDF (259KB) ( 5041 )   Metabolomics is a new “omics” techniques which uses analytical chemistry detection methods and bioinformatics strategy to study the global metabolites in biological systems （cells， tissues， living organisms）. Any physiological or pathological changes can be revealed by the metabolic phenotype， the metabolic changes demonstrated in the development of ovarian cancer must be measured by metabolomics. The systematic，holistic，dynamic information for ovarian cancer will be obtained， which can provide a theoretical basis for early diagnosis and proper treatment. There is a review for the concept of metabolomics， their research methods and applications on ovarian cancer. Related Articles | Metrics

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The Pathological Update Concept and Early Diagnosis on Epithelial Ovarian Carcinomas SHEN Yan;LIU Yi-xin 2012, 39 (4):  360-363.  Abstract ( 1473 )   PDF (257KB) ( 5172 )   Epithelial ovarian carcinoma is a heterogeneous group of tumors. Based on clinical、morphological and molecular genetic analysis， a dualistic model about epithelial ovarian carcinomas was proposed which divided surface epithelial ovarian tumors into two broad categories designated type I and type II tumors corresponding to two main pathways of tumorigenesis. Due to the different histological types of this group， tumor cells are different in origin and pathogenesis， new concept is that the personalized parameters should be used in histological grading in order to better reflect its prognosis and guidance in assessing the value of clinical treatment. Determination of CA125 and human epididymal protein（HE4）serum levels and mesothelin urinary level is expected to achieve early diagnosis of ovarian cancer and risk assessment. Related Articles | Metrics

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Progress in Diagnosis and Treatment on Ovarian Clear Cell Adenocarcinoma LIU Guo-yan;YUAN Bi-bo;MI Ruo-ran 2012, 39 (4):  364-367.  Abstract ( 1726 )   PDF (253KB) ( 5532 )   Ovarian clear cell adenocarcinoma（OCCA） is uncommon histotype in epithelial ovarian cancer， which is characterised by its association with endometriosis， and frequent mutations of ARID1A and PIK3CA. Patients in early stage amount for high proportion， and clinical manifestation of OCCA has no specifity. Morphology of cells in ascites， tumor marker and iconography are helpful to diagnosis before surgery. The treatment of OCCA mainly includes comprehensive staging surgery and combined chemotherapy such as paclitaxel， platinum， irinotecan，mitomycin and etoposide etc. Clinical stage， size of residual tumor， state of cytology of ascites could affect the prognosis of the patients. Related Articles | Metrics

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Clinical Progress of Treatment on Recurrent Epithelial Ovarian Cancer DANG Cai-ling;LI Li 2012, 39 (4):  368-372.  Abstract ( 1472 )   PDF (237KB) ( 5039 )   Most of patients with epithelial ovarian cancer was advanced as the initial treatment. Although cytoreductive surgery and adjuvant paclitaxel/platinum-based chemotherapy have made the most of patients in clinical remission， but there are still 80% of patients to relapse eventually. The principle of treatment for recurrent EOC is palliative rather than cure. The quality of life should be to consider once again on treatment. According to the situation in patients with initial surgery and postoperative chemotherapy and means， efficacy， toxicity， relapse types ，the treatment programs was to be developed individually in order to alleviate and control symptoms of the disease， and improve quality of life and prolong progression-free survival for patient. As only a single lesion or recurrence lesion reduction by surgery effectively，the cytoreductive surgery combined with chemotherapy would be to implement. While those with large and extensive metastasis even， the only chemotherapy would be to consider. In developing the program of chemotherapy， drug-resistant， refractory and refractory patients was often considered as a group， which would be to encourage to ongoing clinical trials or receiving non-platinum chemotherapy， the patients with sensitive ovarian cancer was recommended to receive platinum or platinum plus paclitaxel-based chemotherapy. Biological treatment as an alternative cancer therapy model was more and more attended as an importance strong complement to traditional surgery and chemotherapy. Related Articles | Metrics

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The Establishment of Animal Model of Orthotopically Transplanted Ovarian Carcinoma LIU Yi-jie;DUAN Gang;DUAN Ping;LU Xiao-sheng;MEI Jie;HUA Ying;LU Jie-qiang 2012, 39 (4):  373-375.  Abstract ( 1523 )   PDF (6251KB) ( 5236 )   Objective：To establish an animal model with ovarian carcinoma to simulate the clinical tumor development. Methods：Human ovarian carcinoma cell lines SKOV3 and multi-level A2780 in exponential phase of growth were inoculated subcutaneously in nude mice， A2780 cells were also inoculated intraperitoneally. The third generation of SKOV3 subcutaneous tumor was transplantated below the capsule of the right ovary. Results：Subcutaneous inoculations of human ovarian carcinoma SKOV3 cells and orthotopic transplantations of SKOV3 subcutaneous tumor both succeeded in all mice. Six to eight weeks after orthotopic transplantations， tumors invasion into surrounding tissues were observed， as well as dull red effusion with peritoneal metastasis and lymph node metastasis. The subcutaneous inoculation of multi-level cell lines A2780 all failed in tumor formation. Eight weeks after A2780 cells were injected in intraperitoneal cavity， 2-3 mL colorless ascites appeared， ovarian and spleen grew obviously， but tumor was not detected. Conclusions：The SKOV3 orthotopically transplantated animal model was successfully established. The inoculation of A2780 cell lines failed in tumor formation， possibly due to their sensitivities to non-specific immunity in the host. Related Articles | Metrics

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The Significance of Fasting Plasma Glucose Screening for Gestational Diabetes Mellitus and Effect on Pregnancy Outcome CHE Rong-hua;HUANG Ya-juan 2012, 39 (4):  376-379.  Abstract ( 1422 )   PDF (280KB) ( 5172 )   The incidence of gestational diabetes mellius（GDM） is increasing year by year， adverse pregnancy outcomes are strongly associated with fasting plasma glucose level. With increasing fasting glucose levels， considered a normoglycemia range， the risk of large-for-gestational-age（LGA） neonates and/or macrosomia， primary cesarean section， neonatal hypoglycemia， hyperinsulinemia and later diabetes is increasing. The diagnosis and treatment of GDM， in early pregnancy， may help to improve pregnancy outcomes. Using fasting plasma glucose as a screening test for GDM has been getting attention. It is easy to administer， inexpensive， reproducible and easily accepted by pregnant women. Currently， most results indicate a fair correlation between first-trimester fasting glucose level and glucose challenge test（GCT） and oral glucose tolerance test（OGTT）. Moreover， it can signifinantly decrease the number of OGTTs needed for the diagnosis of GDM. The FPG as a screening test for GDM have a higher value. Related Articles | Metrics

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Glyburide for the Treatment of Gestational Diabetes Mellitus LIU Shuang-ping;CHENG Hai-dong 2012, 39 (4):  380-383.  Abstract ( 1602 )   PDF (245KB) ( 4960 )   Gestational diabetes mellitus is one of the most common complications during pregnancy. The control of blood sugar impacts on maternal and fetal outcome of pregnancy. Currently， it usually gives the patients with diet and exercise to control the blood sugar in our clinical practice. If it can not work， insulin will be used. There is rarely oral hypoglycemic medication being used in clinical practice in gestational diabetes mellitus. Glibenclamide used as a commonly used oral hypoglycemic agents has not been found teratogenic effects in the present animal experiments and clinical trials. The clinical application is increasing in foreign countries. This article will discuss the applications of glibenclamide in gestational diabetes mellitus. Related Articles | Metrics

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Present Research of SHBG Gene Polymorphism XIA Yan-jie;WANG Yong 2012, 39 (4):  384-387.  Abstract ( 1458 )   PDF (252KB) ( 4951 )   Sex hormone-binding globulin is a kind of hormone carrier protein mainly synthesized in the liver， which functions by adjusting the concentration of sex hormones. Up to now， many diseases such as Type Ⅱ diabetes （T2DM）， cardiovascular disease， cancer and polycystic ovary syndrome （PCOS） have been found related with serum SHBG. There is considerable heterogeneity in the results of these studies indicating the multiplicity of the factors influencing SHBG variation. However， the most important of evidences suggest that some common genetic variants of SHBG may influence SHBG levels. Related Articles | Metrics

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Advances About the Relationship Between Polycystic Ovarian Syndrome and Hypothyroidism CHENG Hai-ying;GAO Tian-yang 2012, 39 (4):  388-390.  Abstract ( 2048 )   PDF (234KB) ( 5003 )   Polycystic ovarian syndrome（PCOS） is a heterogeneous and polymorphic endocrine disease. Studies have shown that patients with PCOS had a higher incidence of thyroid disease. Earlier studies mainly consider that women with PCOS can affect the pituitary-thyroid axis，and their immune system was over-stimulated . Recently，new research reveals that genetic variation in the 3′-untranslated region of gonadotropin-releasing hormone receptor is associated with thyroid function in PCOS patients. At the same time， changes in thyroid function can affect ovulation disorders and insulin resistance in women with PCOS. Related Articles | Metrics

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Effect of Combined Contraceptive Pills on Glucose Metabolism in PCOS Women WANG Qiu-yi;HUANG Wei 2012, 39 (4):  391-394.  Abstract ( 1477 )   PDF (212KB) ( 5022 )   Most of polycystic ovarian syndrome （PCOS） women had impedimental glucose metabolism，lipid metabolism， and metabolic syndrome， which result in increased risks of diabetes mellitus and cardiovascular diseases. Oral contraceptive pills（COC）， as the first line therapy for antiandrogen and menstrual regulation in PCOS women， obtained satisfactorily clinical outcome. However， it may aggravate metabolic problems when used in PCOS women with metabolic dysfunction. A new kind of COC—Yasmin consisted of drospirenone which acted as antiandrogen and anti-aldosterone has almost no negative effect on glucose metabolism， should be one of choices for PCOS women with metabolic dysfunction. Related Articles | Metrics

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The Advance of the Endometriosis in the Pathogenesis ZHOU Li-lan;LIN Wan-jun 2012, 39 (4):  395-398.  Abstract ( 1450 )   PDF (193KB) ( 5070 )   Endometriosis is the common and frequent disease in the women of child-bearing age. Currently，the generally received pathogenesis of endometriosis is the theory of retrograde menstruation or implantation. Reflux of endometrium spill into the abdominal cavity，which must by adhere，invade and angiogenesis， developing endometriosis. In addition， this progress must be completed under the factors as some protease，cytokines and so on. Several proteins and cytokines，such as matrix metalloproteinase（MMP），tissue inhibitor of metalloproteinase（TIMP），Survivin（a member of the inhibitors of apoptosis protein）andvascular endothelial growth factor（VEGF），play an important role in the pathogenesis of endometriosis. By inhibiting or increasing the synthesis of these proteins or cytokines， we may get a new breakthrough in the cure of endometriosis. Related Articles | Metrics

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Combined Oral Contraceptives in the Treatment of Primary Dysmenorrhea：a Systematic Review ZHANG Wen-tao;ZHAO Qin-li;YANG Yong-xiu 2012, 39 (4):  399-401.  Abstract ( 1430 )   PDF (1131KB) ( 4974 )   Objective：To evaluate the efficacy and safety of the combined oral contraceptive（COC） in the treatment of primary dysmenorrheal. Methods：Medline，Embase，The Chinese Biomedical Database（CJFD） and Chinese science and technology journal full-text database（CSJD）. All of the included studies were evaluated by Cochrane Handbook， homogenous studies were analyzed by Revman5.1.1 software. Results：Eight studies were included. Compared with placebo group，the COC group had a statistically significant in MDQ score（MD=2.7，95%CI：0.92-4.48，P=0.003） and VAS score（MD= 0.87，95%CI：0.54-1.21，P＜0.000 01）， The COC group has no statistically significant in adverse effect（OR=1.13，95%CI：0.76-1.68，P=0.54）. Conclusions： The COC can significantly reduce the pain score of the patients of primary dysmenorrheal，and it to be worthy of clinical application. But there is limited studies and the measure or index of these studies are different， so we look forward to more high quality studies to further prove the effectiveness of the COC. Related Articles | Metrics

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Clinical Analysis of 110 Cases of Pregnancy with Idiopathic Thrombocytopenic Purpura FENG Lan-lan;ZHANG Jian-ping 2012, 39 (4):  402-404.  Abstract ( 1347 )   PDF (228KB) ( 4976 )   Objective：To study the diagnosis and management of pregnant women with idiopathic thrombocytopenic purpura（ITP）. Methods：The clinical data of preganacies with ITP from January 1997 to April 2011 were analysed. Results：Among the 110 cases，vaginal delivery and cesarean section were performed in 68（61.8%） and 42（38.2%） cases respectively．The incidence of postpartum hemorhage was 2.7%（3／110 cases）. There was no maternal death.33，25 and 48 cases were treated by glucocorticoids，glucocorticoids plus gamma globulin，and transfusion of platelets，respectively. Except 1 case the platelet count of peripheral blood in newborns was less than 100×109/L .Others were high than 100×109/L. There were no intracranial hemorhage and other diseases related to platelet decrease Conclusions：ITP has very little direct effects on mother and fetus if receive timely treatment. Glucocorticoids，gamma globulin and transfusion of platelets are effective methods for the treatment of ITP in pregnancy. The mode of delivery is determined by obstetrical considerations. They should be delivered vaginally if there is no obstetrical complications. To severely thrombocytopenic cases，selected cesarean should be performed when there are sufficient fresh platelet. Related Articles | Metrics

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Clinical Analysis of 30 Pregnancy Cases Complicated with Acute Appendicitis DAI Ming;SUN Sheng;ZHOU Yan-fen 2012, 39 (4):  405-406.  Abstract ( 1551 )   PDF (167KB) ( 4989 )   Objective：To discuss the therapy of the pregnancy associated with acute appendicitis. Methods：Retrospectively reviewed the 30 cases admitted by our hospital from December 2005 to December 2010 of acute appendicitis in pregnant women. Results： 14 patients used expectant treatment，and they all were early pregnancy， and mid-term patients；16 patients adopted operation，1 patient was aborted ，1 patient was stillbirth and other surgical patients including mother and child are good. The symptom in late stage is not obvious ，but the frequency of gangrene and perforation is the highest. Conclusions：Operation in time is the best option in late stage ，lots of department cooperation is the most important condition to improve the prognosis of pregnant women and fetus. Related Articles | Metrics

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The Effects of Biofeedback Electrical Stimulation Treatment on Postpartum Female Pelvic Function Restore WEI Hong 2012, 39 (4):  407-408.  Abstract ( 1550 )   PDF (6141KB) ( 5139 )   Objective:To use biological feedback and electrical stimulation to treatment to promote the postpartum pelvic floor function recovery. Methods:300 women at the rehabilitation of 42 days post delivery,were randomly divided into two groups. The study and the control group was 150 women invidually. The pelvic floor muscles strength and muscle fiber damage type was tested and evaluated,with the biofeedback,electrical stimulation as the main treatment at the rehabilitation,observation and study the clinical effect. Results:Before treatment at the classification level than 4 muscle strength in 259 cases,accounting for 86.3%,after one cause of treatment,compared with the control group,the vaginal pressure,kind I and II muscle strength were significantly improve in the study group(p＜0.05). Conclusions:Biofeedback,electrical stimulation as the main treatment at the rehabilitation technology,combined with the family training,can effectively improve maternal vagina,strengthen the pelvic floor muscles pressure strength,improve the quality of life postpartum. Related Articles | Metrics