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15 October 2017, Volume 44 Issue 5
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Clinical Progress of Combined Chemoradiotherapy for Advanced Cervical Squamous Cell Carcinoma Zulpiyahan·Kurax，DING Yan，CHEN Zhi-fang 2017, 44 (5):  485-489.  Abstract ( 1422 )   PDF (824KB) ( 6485 )   Cervical cancer is one of the most common malignancies in women, ranking the second in the incidence of malignancy in Asia, second only to breast cancer, and the mortality rate is at 4th place. At present, concurrent radiotherapy and chemotherapy is a standard treatment program for advanced cervical cancer, which can provide the effective rate of treatment and the survival rate of patients, adverse reactions can be tolerated, but the combined use of concurrent chemotherapy regimens, benefit groups and targeted drugs remains to be further studied. Radiotherapy can be combined at different times with different types of chemotherapeutic agents, to improve the therapeutic effect. Related studies have shown that cisplatin and nedaplatin monotherapy treatment has the quite effect compared with platinum combined with fluorouracil, tegafur and other drugs 21 days of the program, but the monotherapy treatment has the smaller toxic side effects. Paclitaxel and nedaplatin are effective in consolidating chemotherapy regimens. Cisplatin-containing concurrent radiochemotherapy is recommended as the preferred treatment of locally advanced cervical cancer. Related Articles | Metrics

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Latest Progress of Diagnosis and Treatment of Young Women with Invasive Cervical Cancer LI Jun-li，DAI Xin-yue，WANG Yu-li，WU Yan-cheng，CHEN Lu-lu，HU Yan 2017, 44 (5):  490-493.  Abstract ( 1313 )   PDF (702KB) ( 6783 )   Invasive cervical cancer in women younger than 35-year-old is generally called young cervical cancer, and its incidence has been increasing in recent years. Cervical cancer in young women progresses more rapidly than in older patients, which might be related with young women′s high level of estrogen and their susceptibility to disordered vaginal microenvironment. The proportion of non-squamous cell carcinoma in young patients is higher than in older ones, leading to difficulty in diagnosis. However, taking imaging diagnosis and new molecular markers as novel auxiliary diagnosing methods have improved the efficiency of diagnosis. Young patients require fertility and better life quality, therefore, on the basis of traditional surgery, some new therapies, like minimally invasive surgery and uterine transplantation and so on, have been born. Advanced cervical cancer patients mainly conduct radiation/chemical therapy, some new types of radiation therapies (such as three-dimensional conformal radiation therapy and intensity modulated radiation therapy) can significantly improve young patients′ prognosis by killing more cancer cells and less normal tissue. Related Articles | Metrics

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Progress of Relationship between p38MAPK Pathway and Ovarian Carcinoma LONG Ling，ZHOU Qi，ZHANG Li 2017, 44 (5):  494-498.  Abstract ( 1486 )   PDF (892KB) ( 6672 )   Mitogen-activated protein kinases (MAPK) is a class of serine/threonine protein kinase. This cascade existed broadly in mammalian cells. The subfamily includes extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) and p38MAPK. It is a significant signaling pathway to deliver extracellular signals into nucleus, involved in the important mechanisms of cell growth and proliferation. Recently studies found that function of p38MAPK, mediating many cell reactions induced by stress, inflammatory cytokines or bacterial products and changing the level of gene expression through phosphorylation of transcription factor and play an important role in cell functions, involved in the process of oophoroma cells apoptosis, invasion, metastasis and drug resistance. Therefore, the clarification of mechanism of p38MAPK pathway will provide new thoughts and methods for diagnosis and treatment of ovarian cancer. This review summarizes the function of p38MAPK signal transduction pathway in ovarian cancer, and the p38MAPK related research progress of new drugs and drug resistance. Related Articles | Metrics

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Research Progress of Uterine Adenosarcoma XING Juan，SHEN Zhen，ZHOU Ying，YU Ting，WU Da-bao 2017, 44 (5):  499-502.  Abstract ( 2114 )   PDF (729KB) ( 9229 )   Adenosarcoma is constituted by benign glandular epithelium and malignant stroma as a low degree of malignant potential of mixed tumor, mostly derived from the endometrium, occasionally can occur in the ovary or extrauterine tissue. Uterine adenosarcoma is a rare female genital tract malignant tumor, more common in postmenopausal women, lack of specific clinical symptoms. The most common clinical manifestations are vaginal bleeding, cervical prolapse and uterine enlargement. Early diagnosis of the disease is difficult. Ultrasound and MRI have a certain diagnostic value, and "cuff" -like structure is the postoperative pathological characteristics of the performance. The occurrence of uterine adenosarcoma may be associated with endometriosis, long-term estrogen exposure and other factors, but the specific pathogenesis is not yet clear. The main treatment of the disease for the unilateral uterine adnexectomy (lymph node metastasis is rare, so lymph node dissection is not routine), radiotherapy and chemotherapy and hormone therapy is not yet accurate. But the survival and recurrence are closely affected by sarcoma overgrowth, disease staging, uterine muscle invasion depth, lymphatic metastasis, vascular invasion and so on. Related Articles | Metrics

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Advances in Diagnosis and Treatment of Vaginal Intraepithelial Neoplasia NIU Ya-meng，LI Ai-jun，BAI Jing 2017, 44 (5):  503-507.  Abstract ( 1797 )   PDF (727KB) ( 6943 )   Vaginal intraepithelial neopalsia (VAIN) is included vaginal squamous dysplasia and carcinoma in situ of a group of disease, is a rare precancerous lesions, the main risk factor is the persistent high-risk HPV virus infections, cervical intraepithelial neoplasia (CIN) and cervical cancer, the incidence of it is low. There is no obvious clinical symptom of vaginal intraepithelial neoplasia. The vaginal mucosa is basically normal and the diagnosis is mainly based on the accessory examination. Consistent with the three step diagnostic procedure for cervical intraepithelial neoplasia, it is usually found incidentally in colposcopy at the second stage of cervical cancer screening, often associated with cervical intraepithelial neoplasia. In recent years, with the popularization and improvement of colposcopy, the detection rate of vaginal intraepithelial neoplasia has increased significantly. The treatment of vaginal intraepithelial neoplasia mainly depends on the grade of the lesion. The VAINⅠ grade can be reduced by itself, without treatment and followed up closely. But the patients with high-risk HPV infection should pay attention to follow-up. VAINⅡ-Ⅲ grade is recognized as precancerous lesions, once diagnosed, the need for active treatment. The clinical treatment methods include surgical treatment, drug therapy, physical therapy and radiotherapy. But so far, there is no unified standard of clinical diagnosis and treatment. Each method has its advantages and disadvantages. It is very important to choose a treatment plan according to the patient′s own condition. Related Articles | Metrics

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Analysis of Factors Influencing Ovarian Function in Young Patients with Cervical Carcinoma after Radiotherapy HUANG Yu-lu，GUO Zi-yun，MA Yu-yi，LEI Jia，FAN Yu-juan，HUANG Zhuo-hua 2017, 44 (5):  508-511.  Abstract ( 1322 )   PDF (1003KB) ( 6727 )   Objective：To evaluate the association of ovarian transposition procedures in preserving ovarian function in relation to the location of the transposed ovaries in young cercical carcinoma patients who underwent the radiotherapy. Methods：The clinical data of 72 young patients with cervical cancer who underwent ovarian transposition between June 2012 and June 2016 in Wuzhou Red Cross Hospital were analyzed retrospectively. Ovarian endocrine function was assessed by observing the symptoms of perimenopausal period and serum FSH, LH, E2 level. Results：Based on receiver operator characteristic curve analysis, optimum cutoff value of location more than 1.5 cm above the iliac crest was significantly associated with preservation of ovarian function after treatment (area under receiver operator characteristic curve: 0.747, 95%CI: 0.593-0.902). Optimum cutoff value of age was 32.5 (area under receiver operator characteristic curve: 0.692, 95%CI: 0.522-0.860). Multivariate analysis confirmed that the location of transposed ovary higher than or equal to 1.5 cm above the iliac crest (OR=0.09, 95%CI：0.014-0.571) and less than or equal to 32.5 years old (OR=0.062, 95%CI: 0.006~0.655) were the most important factor for preserve ovarian function. Conclusions：The position of transposed ovary higher than 1.5 cm above the iliac crest is recommended to avoid ovarian damage after ovarian transposition after radiotherapy in young cervical carcinoma women. Related Articles | Metrics

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Influence of Different Surgical Procedure on Postoperative Fatigue Syndrome and Immunity Function in Cervical Cancer Patients YU Xin-mei 2017, 44 (5):  512-515.  Abstract ( 1109 )   PDF (797KB) ( 6403 )   Objective：To observe the influence of laparoscopic surgery and laparotomy on postoperative fatigue syndrome (POFS) and immunity function in early cervical cancer patients with hysterectomy. Methods：78 patients with early cervical cancer who were admitted from January 2014 to December 2015 in our hospital were divided into laparoscopic surgery group, 43 cases, and laparotomy group 35 cases. The general information of operation, fatigue score by Christensen evaluation method and immunity function before operation and postoperative 1 d, 3 d and 7 d were compared between the two groups. Results：The laparoscopic surgery time is longer than laparotomy, but intraoperative blood loss and postoperative hospital stay was significantly less than laparotomy group (P＜0.05). After operation, all the patients′ POFS score was higher than preoperative, and declined gradually over time, while the laparoscopic group improved more significantly than the laparotomy group (P＜0.05). The immune globulin level and T cell subgroup count declined significantly after operation, and the laparoscopic group declined less than the laparotomy group (P＜0.05), the recovery effect in laparoscopic group was better than laparotomy group (P＜0.05). Conclusions：The laparoscopic hysterectomy for early cervical cancer caused less trauma on patients and less immunity function inhibition, could reduced the POFS degree and improve the operation effect and promote clinical rehabilitation. It′s worthy of clinical popularization. Related Articles | Metrics

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Effects of Intermittent Urethral Catheterization for Bladder Function Recovery and Urinary Tract Infection Prevention in the Patients after Radical Resection for Cervical Cancer DOU Na，GE Meng-qin，YOU Ting，ZHANG Zi，ZHANG Cui，ZHAO En-feng 2017, 44 (5):  516-519.  Abstract ( 1177 )   PDF (836KB) ( 6622 )   Objective：To analyze the effect of intermittent catheterization on the recovery of bladder function and urinary tract infection prevention in patients with cervical carcinoma. Methods：Patients (n=182) with early cervical cancer (FIGOⅠA, ⅠB and ⅡA ) were selected from the General Hospital of PLA in January 2014-December 2016. Postoperative patients with residual urine volume (≥100 mL) were randomly divided into observation group (n=89) and control group (n=93). The general materials of the two groups were recorded, and the recovery time of residual urine volume (＜100 mL) and the incidence of urinary tract infection were compared between the two groups. Results：There was no significant difference between the two groups in the mean age, the clinical stage of FIGO and the residual urine volume (P＞0.05). In the residual urine volume (100-200 mL, 201-350 mL) patients, the time up to standard of observation group  was less than that of the control group  (P＜0.001). The incidence of urinary tract infection in observation group was less than that in control group (P＜0.05). Conclusions：Intermittent catheterization can promote the recovery of bladder function and reduce the incidence of urinary tract infection in patients with cervical cancer. Related Articles | Metrics

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Experimental Study of Astragalus Polysaccharides on Subcutaneous Tumor Xenograft in Nude Mice with Human Endometrial Carcinoma QIU Yan-li，DING Yan，LI Li 2017, 44 (5):  520-523.  Abstract ( 1217 )   PDF (853KB) ( 6390 )   Objective：To extract the active ingredients of Astragalus astragalus polysaccharide, observe the immune reconstruction load in endometrial carcinoma SCID mice serum neutrophil gelatinase associated lipocalin (neutrophil gelatinase-associated lipocalin, NGAL) and its receptor NGALR expression influence. Methods：36 female CB-17 SCID mice were divided into blank control group, tumor group and treatment group, tumor group and treatment group were intraperitoneal injection of 5×107/mL Lymphocytes Separation Medium (PBMC), lymphocyte suspension hind leg subcutaneously with 3×106/mL endometrial adenocarcinoma cell line (HEC-1B) establishment of human immune reconstitution in endometrial cancer bearing model. After treatment, the treatment group was injected with astragalus polysaccharide at 20 mg/kg dose for 10 days (d), and the normal control group and the tumor bearing group were injected with normal saline. Enzyme linked immunosorbent assay (ELISA) expression of serum NGAL and NGALR protein were determined by reverse transcriptase polymerase chain reaction (RT-PCR) expression of NGAL gene and NGALR gene detection of tumor tissue, measuring tumor group and treatment group tumor volume, tumor weight and tumor inhibition rate was calculated. Results：After treatment, the treatment group of NGAL and NGALR protein expression decreased, NGAL mRNA and NGALR mRNA were low expression, tumor volume and tumor weight were significantly decreased, the inhibition rate increased, compared with the tumor bearing group and the same group before treatment, the differences were statistically significant (P＜0.05). Conclusions：Astragalus polysaccharides may exert antitumor effects by inhibiting the expression of NGAL and NGALR proteins and their genes. Related Articles | Metrics

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A Systematic Review of Surgical Evaluation Model for Advanced Epithelial Ovarian Cancer LIU Chuan-zhong，LI Li，ZHAO Bing-bing 2017, 44 (5):  524-528.  Abstract ( 1004 )   PDF (1341KB) ( 6322 )   Objective：To evaluate the accuracy of the evaluation models for advanced epithelial ovarian cancer (AEOC). Methods：Databases such as Pubmed, Cochrane Library, Medline, Embase and CNKI, VIP and CBM date were searched. Related literatures were published from the date of their establishment to March, 31, 2017. Reference articles of related articles were also researched. The searching language included Chinese and English. Meta-analysis was performed on studies meeting the inclusion criteria. Results：A total of 11 related studies were included. Meta-analysis showed that the total sensitivity and specificity of laparoscopy, CT and CA125 were 0.938, 0.816, 0.616 and 0.651, 0.830, 0.824 respectively. The total AUC of the corresponding model was calculated by calculating the area under the SROC curve. The AUC of the laparoscopy, CT and CA125 evaluation models were 0.949, 0.928 and 0.828, respectively. Conclusions：In all evaluation models, the CA125 evaluation model shows poor accuracy, while the CT evaluation model and the laparoscopic exploration evaluation model have higher accuracy, and the accuracy of laparoscopic exploration evaluation model is the highest. We expect more larger sample prospective clinical trials to validate the results of our study. Related Articles | Metrics

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Selection of Surgical Approaches for Sparing-fertility in Borderline Ovarian Tumors ZHAO Jian-guo，LIU Cai-yan，LIU Jing，HE Ping，QU Peng-peng，XU Xin-ran 2017, 44 (5):  529-532.  Abstract ( 1173 )   PDF (763KB) ( 6351 )   Objective：To research short-outcome and effect on pregnancy after sparing-fertility surgery of the borderline ovarian tumors (BOTs) with laparoscopy or laparotomy approach. Methods：Clinic-pathologic variants of 74 sparing-fertility cases with BOTs from January 2009 to July 2015 in the Tianjin Central Hospital of Obstetrics & Gynecology were analyzed retrospectively. 44 cases and 30 cases were carried out laparoscopic surgery and laparotomy surgery respectively. Recurrence and pregnancy of two groups were compared. Results：Age of laparotomy group was younger than that of laparoscopic group significantly (P=0.018). Maximal longitude of tumor in laparotomy group was significantly longer than that of the laparoscopic group (P=0.000). Number of unstaging cases in laparoscopic group were significantly more than that of laparotomy group (P=0.000). Total recurrent rate was 6.7% (5/74). There were no significant differences of recurrent rate between the two groups (P=0.980). The total pregnant rate was 33.8% (25/74) in sparing-fertility patients, 30% (9/30) in laparotomic group, 36.4% (16/44) in the laparoscopic group with insignificant difference between two groups (P=0.570). The pregnancy rate of unstaging cases in laparoscopic group was significantly higher than that of laparotomy group (P=0.041). No recurrence occurred in pregnant cases. Conclusions：Short-outcome and pregnancy of BOTs patients with unstaging laparoscopic sparing-fertility surgery were satisfactory. It was safe and feasible to undergo laparoscopic sparing-fertility surgery in selectable patients with BOTs. Related Articles | Metrics

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The Relationship between Two Phase Apoptosis of Trophoblast and Two Phase Pathogenesis of Preeclampsia XU Xin-ran，CHEN Xu，CUI Hong-yan，JIA Yan-ju 2017, 44 (5):  535-538.  Abstract ( 990 )   PDF (700KB) ( 6367 )   Preeclampsia is a serve obstetric complication, which not only affects maternal health, but also influences the long-term prognosis of  their offspring. The etiology and pathogenesis have not been fully understood. Preeclampsia is a placenta source disease, its development can be divided into two stages. The first stage for the forming process of pathophysiological changes which is characterized with abnormal extravillous trophoblast invasion, impaired spiral artery remodeling and reduced placental perfusion. The second stage for organ damage which cause a variety of clinical manifestations. Apoptosis of villous trophoblast plays an important role on the pathogenesis of preeclampsia, apoptosis imbalance can lead to the abnormal invasion ability. At different stage of the disease, apoptosis mechanism of the villous trophoblast is also different. Summarizes the literature found that first stage maily for the decidual killer cells induce excessive extravillous trophoblast apoptosis which causes impaired spiral artery remodeling, the second stage of the abnormal structure of spiral arteries which causes ischemia and hypoxia of placenta resulted in excessive syncytiotrophoblast apoptosis. But the related mechanism needs further research. Related Articles | Metrics

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Analysis of Labor Augmentation and the Pregnancy Outcome When the Onset of Active Phrase of Labor Change CHEN Feng-lan，YAN Jian-ying 2017, 44 (5):  539-542.  Abstract ( 1028 )   PDF (688KB) ( 6604 )   People worldwide have reach a common consensus about labor duration for six decades. The labor curve which raised by Friedman has become a golden standard for labor administration in their daily work. But as the characteristics of modern delivery population change, the past labor duration has been questioned by many researchers and become incommensurate with the modern population. This article would summarize the progression of labor duration and the time of some labor intervention like admission time of low risk nulliparous, when to start injection of oxytocin in the labor dystocia and when to stop it in labor induction amniotomy and labor analgesia in hope to have a new understanding of when and what to do during our daily work under the circumstance of new labor standard. Related Articles | Metrics

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The Treatment of Previous Cesarean Scar Defect LI Jian，BAI Wen-Pei 2017, 44 (5):  543-546.  Abstract ( 1687 )   PDF (704KB) ( 6612 )   Previous cesarean scar defect (PCSD) is one of the long-term complications after cesarean section, which can cause clinical manifestations of menstruation, infertility, cesarean scar pregnancy etc. The incidence rate of PCSD is increasing. The commonly used auxiliary examinations are transvaginal ultrasound and saline infusion sonohysterography. Minimally invasive surgerys are the main treatments, including hysteroscopy, laparoscopy and transvaginal surgery. Hysteroscopy is the most invasive surgery, it can remove the fibrotic scar tissue to facilitate menstrual blood drainage and perform fulguration of endometrial-like glands inside the scar to reduce irregular bleeding, it can also improve the endometrial environment conducive to pregnancy, but because of electrical injury and uterine perforation risk, it is suitable for patients whose residual muscle layer  thickness is more than 2 mm, the postoperative pregnant women need to be treated as the high risk population of uterine rupture. As for the patients whose residual muscle layer thickness is less than 2 mm, laparoscopic surgery or vaginal surgery should be adopted to remove the scar diverticulum and suture it again, which can improve the symptoms effectively. References | Related Articles | Metrics

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The Relationship between Recurrent Spontaneous Abortion and the STATs WU Rong-rong，ZHANG Yu-quan，YANG Xiao-qing 2017, 44 (5):  547-551.  Abstract ( 1019 )   PDF (713KB) ( 6335 )   Recurrent spontaneous abortion (RSA) is clinically defined that they had been at least three or more consecutive pregnancy losses, which is one of the common complications of pregnancy. Multiple factors can lead to RSA, such as chromosomal or endocrine abnormalities, blood type, immune, physiological anatomical abnormalities and genital tract infections. The occurrence and development of RSA is closely related to immune factors, especially in immune cells and the cytokines secreted by them. The balance between helper T cells (Th) and the cytokines secreted by them is of great significance, so control the steady state becomes a new breakthrough for the treatment of RSA by immunology. Janus kinase/signal transducers and activators of transcription (JAK/STAT) signal transduction pathway is the most widely studied and recognized pathways in the signaling pathways that regulate immune molecules. While RSA occurs, the expression of the key molecules of JAK/STAT signal transduction pathway changes significantly, and JAK/STAT signal transduction pathway can mediate the signal transduction of a variety of cytokines. Related Articles | Metrics

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Effects of Free Position in the Labor on Maternal and Neonatal Birth Outcomes: A Meta-analysis XIAO Qing-qing，GAO Jing，LI Xing，YU Jing-ya，GUO Xiao-xiao，LIU Jie 2017, 44 (5):  552-559.  Abstract ( 944 )   PDF (2576KB) ( 6718 )   Objective: To evaluate the effect of free position during labor on maternal and neonatal outcomes on primipara. Methods: We searched the PubMed, Embase, CENTRAL, Web of Science, CINAHL, CBM, CNKI, VIP, WanFang Data from inception to April, 2017, to collect the randomized controlled trials (RCTs) in which the use of the free position during the labor on primipara. Two reviewers independently selected and included literatures according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was conducted by RevMan 5.3 software. Results: A total of 18 RCTs involving 3 603 patients were included. Meta-analysis showed that duration of labor (MD=-2.98, 95%CI: -3.29～-2.68, P＜0.000 01), caesarean section rate (RR=0.43, 95%CI: 0.37～0.51, P＜0.000 01), postpartum hemorrhage rate (RR=0.25, 95%CI: 0.15～0.40, P＜0.000 01), the rate of third degree laceration of perineum (RR=0.33, 95%CI: 0.17～0.67, P=0.002), cervical laceration rate (RR=0.34, 95%CI: 0.21～0.55, P＜0.000 01), neonatal asphyxia rate (RR=0.31, 95%CI: 0.21～0.47, P＜0.000 01), neonatal intracranial hemorrhage rate (RR=0.22, 95%CI: 0.08～0.57, P=0.002) in the free position group were significantly lower than those in the conventional supine position group. There were no significant differences on the incidence of neonatal aspiration syndrome (RR=0.73, 95%CI: 0.30～1.80, P=0.50) in two groups of the study. Conclusions：Current evidence shows that, comparing to conventional supine position, free position on primipara can shorten duration of labor, and promote spontaneous labor, reduce the caesarean section, postpartum hemorrhage, laceration of birth canal, neonatal asphyxia, and neonatal intracranial hemorrhage, moreover, not increase postpartum hemorrhage. However, because limitation of quality of included studies, more high-quality studies are needed to confirm the above conclusion. Related Articles | Metrics

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Research on the Methods of Estimation of Fetal Weight Based on Ultrasound ZHANG Man，MA Lin，SUN Yu-wei 2017, 44 (5):  560-564.  Abstract ( 1025 )   PDF (842KB) ( 6401 )   Objective：To compare the accuracy of traditional prediction method and back propagation artificial neural network (BP-ANN) for estimation of fetal weight (EFW), to explore the best model for EFW. Methods：A total of 224 term pregnant women with singleton between November 2015 and July 2016 in North China University of Science and Technology Affiliated Hospital were included in the present study. They were divided into non-macrosomia group (FW＜4 000 g, n=183) and macrosomia group (FW≥4 000 g, n=41). An ultrasound examination was performed 0~5 days before delivery. Clinical data and ultrasound data were collected. Results：Reduced errors were seen when measurements were obtained by ultrasonic parameter and combined parameter BP-ANN than traditional prediction method (P＜0.05). In macrosomia group, the error of combined parameter BP-ANN decreased with the increase of the number of training samples (P＜0.05). For BP-ANN, less error were seen when measurements were obtained by combined parameter than ultrasonic parameter and clinical parameters in non-macrosomia group and overall (P＜0.05). Error of combined parameter BP-ANN and ultrasonic parametric network were less than those of clinical parameter BP-ANN (P＜0.05), but there was no significant difference between them (P＞0.05). Conclusions：BP-ANN is better than traditional prediction method for EFW. The best model for EFW is combined parameter BP-ANN. Related Articles | Metrics

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Relationship of Plasma D-dimer and Leucine Aminopeptidase in Hypertensive Disorders Complicating Pregnancy YE Gui-yun，CHI Xi-di，ZHU Jia-rui，HUANG Yuan-mao，CHEN Li-qing，LI Wen-yan 2017, 44 (5):  565-568.  Abstract ( 936 )   PDF (884KB) ( 6464 )   Objective：To investigate the relationship and the application value of plasma D-dimer and leucine aminopeptidase (LAP) in the hypertensive disorders complicating pregnancy (HDCP). Methods：A number of 404 healthy  pregnant women and 101 healthy non-pregnant women were enrolled from the obstetrical examination department of Fujian Medical University Affiliated Nanping First Hospital from August 2015 to December 2016, and a total of 116 HDCP were enrolled from the Obstetrics and Gynecology Department of Nanping First Hospital from August 2015 to December 2016. LAP, alkaline phosphatase (ALP), plasma D-dimer, urine total protein and urine creatinine of all the subjects were detected, and value of urinary total protein/creatinine ratio (UTPCR) was calculated. Single factor analysis of variance, Pearson correlation analysis and Trend chart were performed to test the relationship between plasma D-dimer and LAP, UTPCR. Results：Compared with the healthy non-pregnant women and various stages of healthy pregnant women, systolic blood pressure, D-dimer, UTPCR of HDCP were significantly higher (P<0.05), and LAP of HDCP significantly lower than that of late healthy pregnancy period (P<0.05). Correlation analysis showed that D-dimer of late healthy pregnancy women was only related to urinary protein (r=0.19, P=0.011), D-dimer of HDCP was strongly correlated to gestational period (r=-0.505, P=0.000), LAP (r=-0.443, P=0.001), UTPCR (r=0.372, P=0.004). Trend graph showed that D-dimer level of HDCP was significantly higher than that of the corresponding period of healthy pregnant women, and LAP level of HDCP was obviously lower. Conclusions：Plasma D-dimer is preferably related to LAP in HDCP, and plasma D-dimer, LAP and UTPCR are the important basises for early detection, treatment and prevention for HDCP. Related Articles | Metrics

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Investigation of the Two Different Surgical Methods for Cervical Incompetence at Pregnant Condition JIANG Qian-ying，SHENG Chun-yan，YU Wei-hua，CHEN Xi，ZHAO Shao-jie 2017, 44 (5):  569-572.  Abstract ( 1006 )   PDF (830KB) ( 6267 )   Objective：To investigate the suitable surgical method for cervical incompetence during pregnancy. Methods：A total of 67 patients with cervical incompetence during pregnancy from July 2013 to July 2017 in our hospital were enrolled in the retrospective analysis, had naturally conceived single birth with complete follow-up data after laparoscopic uterine isthmus cerclage or transvaginal cervical cerclage were divided into two groups according to two different surgical methods to compare the clinical effect. 30 patients in the research group were treated with laparoscopic uterine isthmus cerclage, and the other 37 patients in the control group treated with transvaginal cervical cerclage. Results：Operation time of the research group was higher than the control group [(48.13±1.85) min vs. (16.24±2.29) min, P=0.00]. The research group had got a longer average pregnancy period than control group [(37.07±3.15) weeks vs. (29.11±6.43) weeks, P=0.00]. Postoperative abortion rate (6.67%) and preterm birth rate (13.33%) of research group were obviously lower than that of the control group (P＜0.05). The term infant rate of research group (80.00%) was higher than that of the control group (P＜0.05). The hospital stay of the research group were less than that of the control group [(3.17±0.42) d vs. (5.32±1.63) d, P=0.00]. The complication rate of observation group was 0%, and the control group was 13.51%. The difference was significant (P＜0.05). There is no statistical significant difference in terms of the hemorrhage amount during operation between the two groups. Conclusions：Laparoscopic uterine isthmus cerclage in treatment of cervical incompetence at first trimester has better clinical effect and fewer post-operative complications than transvaginal cervical cerclage at second trimester. It has higher feasibility and security. It is worth promoting clinically. Related Articles | Metrics

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Research Progress in the Prevention Method of Intrauterine Adhesion CHEN Kun-ju，SHI Xiao-rong，DAI Xiao-qin 2017, 44 (5):  576-580.  Abstract ( 1020 )   PDF (820KB) ( 6369 )   Intrauterine adhesion (IUA) is one of the common causes of infertility gynecological diseases, which dose serious harm to the reproductive function and mental health of women who are childbearing age, and the main reason is pregnancy uterine cavity operation. The incidences rate increases with the increase in intrauterine operation. Hysteroscopy is the diagnostic criteria, and transcervical resection of uterine adhesions (TCRA) is the standard surgical procedure. The mild intrauterine adhesions treatment effect is good, but the recurrence rate of moderate intrauterine adhesions and severe intrauterine adhesions are high. There are many methods to prevent IUA, prophylactic use of antibiotics, oral estrogen, intrauterine injection of sodium hyaluronate, placement of intrauterine device or balloon stent, etc. but there is no uniform standard. It is always using TCRA+anti-adhesion material+artificial cycle of comprehensive treatment program to treat intrauterine, and the effect is better than hysteroscopic uterine cavity adhesion. Related Articles | Metrics

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The Influence of Endometrial Polyps on Infertile Patients LI Mu-bai，LYU Ying，WU Xiao-ke，ZHANG Duo-jia 2017, 44 (5):  581-584.  Abstract ( 1088 )   PDF (691KB) ( 6326 )   Endometrial polyps (EP) is a benign local lesion of the endometrium. It is common in women of childbearing age. Observational studies have shown that EP has an adverse effect on fertility, but its pathogenesis is not clear. Diagnosis methods of EP usually include two-dimensional transvaginal ultrasound and three-dimensional transvaginal ultrasound, saline infusion sonohysterography (SIS) and hysterosalpingography (HSG) and hysteroscopy. Hysteroscopy and biopsy is the gold standard for the diagnosis of EP. In most cases, small and asymptomatic polyps can adopt expectant therapy, however, in order to improve the natural conception or pregnancy rate of assisted reproduction, surgical resection of endometrial polyps is still the first choice for the treatment of infertility patients, and the curative effect is remarkable. Relevant evidence suggests that endometrial polypectomy in the course of ovarian stimulation improves the success rate of in vitro fertilization. Related Articles | Metrics

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Research Progress in the Treatment of Deep Infiltrating Endometriosis YU Gui-yuan，JIN Ping 2017, 44 (5):  585-588.  Abstract ( 1135 )   PDF (673KB) ( 6439 )   Deep infiltrating endometriosis (DIE) is a special type of endometriosis (EMs), which specifically refers to the infiltration depth of ≥ 5 mm of endometriosis lesions, involving in different parts of the pelvic cavity, mainly located in the posterior pelvic cavity, such as the uterosacral ligament, rectouterine pouch, vaginal septum, rectal colorectal etc. Pain is the main clinical symptoms with various forms, including dysmenorrhea, chronic pelvic pain, deep sexual pain and urinary system related pain. At present, the main treatment for DIE is the surgery, but the difficulty, safty, hard to avoid postoperative complications in the surgery are very difficult problems. According to the researchers, the methods of nerve sparing resection and robot assisted laparoscopic surgery are being explored. Therefore, the new research progress of the treatment of DIE is reviewed in this article. Related Articles | Metrics

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Advance on the Pathogenesis of Female Pelvic Floor Dysfunction CHEN Rui-e，ZHOU Xing-zhi，DING Miao，CHEN Jin，XIE Xin，LIN Zhong-qiu，CHEN Mei-wan 2017, 44 (5):  589-593.  Abstract ( 994 )   PDF (718KB) ( 6305 )   Female pelvic floor dysfunction (FPFD) is one of the most common chronic diseases affecting women′s health in our country, with primary clinical manifestations of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Currently, basic and clinical studies suggest that pelvic floor muscle damage and abnormal metabolism of protein in pelvic floor supportive tissue are the major pathogenesis of FPFD. On the one hand, pelvic floor muscle damage is mainly caused by pregnancy and menopause. On the other hand, the abnormal metabolism of collagen is associated with transforming growth factor β (TGF-β), decorin (DN), matrix metalloproteinases (MMPs) and their antagonists (TIMPs). Besides, lysyl oxidase (LOX) and Fubilin protein are relative to the abnormal metabolism of elastin. In this paper, related risk factors of pelvic floor muscle damage and factor regulation of pelvic floor supportive tissue are discussed, hoping to deepen the pathogenesis of female pelvic floor dysfunction and provide information for its clinical therapy. Related Articles | Metrics

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Reproductive Outcome Analysis of Two Kinds of Hysteroscopic Adhesiolysis AI Xi-xiong，LI Man-chao，ZENG Hai-tao，ZENG Zhi，LIANG Xiao-yan 2017, 44 (5):  594-598.  Abstract ( 1076 )   PDF (757KB) ( 6473 )   Objective：To analyze the efficacy and the reproductive outcome of hysteroscopic adhesiolysis. Methods：A total of 40 patients diagnosed with intrauterine adhesion received hysteroscopic adhesiolysis in The Sixth Affiliated Hospital of Sun Yat-Sen University from January 2014 to December 2016. The thickness of the endometrium and the reproductive outcome were observed. Results：Among the 40 patients (25 with moderate IUA, and 15 with severe IUA) who underwent hysteroscopic adhesiolysis, 19 cases use the bipolar electrode knife cutting adhesion, while 21 cases using micro-scissors. The reproductive outcome of 40 women underwent 64 assisted reproductive technology cycles were observed. The mean endometrial thickness and thin endometrium rate of the bipolar electrode knife group were 7.0 (6.0~9.3) mm and 46.9%, while 8.0 (7.0~9.8) mm and 31.3% in the micro-scissors group, no statistical significance was found between the two groups (P＞0.05). The implantation rate, conception rate, live birth rate, miscarriage rate and ongoing rate after hysteroscopic adhesiolysis in the bipolar electrode knife group were 46.9%, 37.5%, 18.8%, 6.3% and 12.5%, respectively, while in the micro-scissors group were 34.4%, 28.1%, 12.5%, 3.1% and 12.5%, respectively (P＞0.05). The average conception time of bipolar electrode knife group was 7.5 (4.0~12.0) months longer than the micro-scissors group 3.0 (3.0~8.5) months, the difference reached statistical significance (P＜0.05). Conclusions：Hysteroscopic adhesiolysis is an effective and safe option for IUA patients that can improve the reproductive outcome, different methods of operation does not affect the reproductive outcome. Related Articles | Metrics