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15 February 2018, Volume 45 Issue 1
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Research Progress of Human Microbiome and Maternal-Fetal Health YAO Xue，WANG Wei 2018, 45 (1):  5-10.  Abstract ( 1046 )   PDF (828KB) ( 6995 )   Pregnancy is a typical and complex physiological process. In order to ensure the healthy development of mother and fetus, the changes of hormone level, immune regulation and metabolism level of pregnant women will be related. The human microbiome is closely related to these physiological processes. The research methods and strategies of microbial group are constantly updated. The characteristics and influencing factors of pregnant women′s body (intestinal, vaginal, oral cavity, etc.), fetus and its appendages and neonatal microbiome are revealed continuously. The microbial dysbiosis and specific microbial populations with unhealthy pregnancy complications has been studied. Some studies expect the control and treatment of some diseases by studying changes in the human microbial population. The research at this stage has changed people′s understanding of the role of initial microbiomes in life and provided clues for exploring the relationship between microbial flora and health throughout the developmental period. Related Articles | Metrics

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Advances in the Etiology of Fetal Growth Restriction JIAO Li-yuan，WANG Hua，WU Shuo 2018, 45 (1):  10-13.  Abstract ( 1280 )   PDF (693KB) ( 7249 )   Fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR), refers to the fetus under the influence of the mother, itself and the environmental factors and did not reach their growth potential, is one of the common complications of pregnancy in obstetrics and also is the most common causes of perinatal death in China. FGR can cause many perinatal adverse pregnancy outcomes including fetal distress, low birth weight, premature birth, etc and is associated with a variety of long-term complications in later life, such as metabolic syndrome and cardiovascular disease. It is of big significance to prevent FGR to improve the quality of the population. However, there are many factors that contribute to FGR, including maternal factors, fetal factors and placental umbilical cord factors and more factors exist in various forms. A comprehensive understanding of the factors responsible for FGR may help prevent the disease. The etiology of FGR is reviewed in order to provide a theoretical basis for the prevention of the disease. Related Articles | Metrics

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The Formation of Chromosome Mosaicism and Its Influence for Prenatal Screening and Diagnosis GUO Ying, CHANG Ying, CHEN Xu 2018, 45 (1):  14-18.  Abstract ( 2993 )   PDF (774KB) ( 9869 )   With the advent of cell-molecular biology, prenatal screening and diagnostic methods have also changed, and more data need to be interpreted correctly，which is a challenge for prenatal diagnosis doctors. Among them, chromosome mosaicism is one of the most important factors that affect the accuracy of prenatal screening and diagnosis. Chromosome mosaicism is prevalence in human and affected by many factors, such as mother, father, placental and other factors. The main reason for the formation of mosaicism is  chromosomal error separation in mitotic. The clinical manifestations of mosaicism are affected by a variety of factors, and their clinical outcomes are unique to each individual. The effect of mosaicism on prenatal screening and diagnosis are mainly in two aspects: ①Screening of cell-free fetal DNA (cfDNA) in maternal blood. Although a large number of related literature reported its higher detection rate for 21,18,13 trisomy, while cfDNA from the placenta, and confined placental mosaicism is an important factor affecting the accuracy of the results. ②If the chronic karatype is mosaicism，amniocentesis is required for futher confirmation. In conclusion, understanding the origin, mechanism and clinical outcome of chromosome mosaicism correctly, can provide patients with more valuable genetic information, and it′s importance for providing genetic counseling in prenatal screening and diagnosis. Related Articles | Metrics

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Advances in Inflammatory Causes of Preterm Birth GENG Qian，CHANG Ying，CHEN Xu 2018, 45 (1):  19-22.  Abstract ( 1202 )   PDF (708KB) ( 7077 )   Preterm birth (PTB) is a common obstetric complications and it is greatly harmful to mothers and fetals. At present, the mechanism of PTB is not clear. The present research shows that the inflammatory response, especially the inflammatory mediators，plays an important role in the initiation of PTB. The inflammatory mediators on one hand promote the synthesis of prostaglandin and induce uterine contractions, on the other hand promote cervical ripening and trigger matrix metalloproteinases to degrade extracellular matrix, reduce toughness of fetal membranes. The combined effect of all above finally cause uterine contraction, cervical ripening, rupture of fetal membranes, leading to PTB. Microbial infection and the oxidative stress, inhibited autophagy can cause inflammation. PM2.5 may induce mild intrauterine inflammation, resulting in PTB. Mechanism of PTB is unknown and this article will review the mechanism from three aspects. They are the related molecules in inflammation-mediated PTB, the biological and non-biological pathways inducing inflammation. References | Related Articles | Metrics

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The Research Advances in the Relationship between Leptin and Endometrial Receptivity YANG Mao, WANG Xue-tong, PAN Chu-qiao, TANG Xin-yue, GAO Xiu-xiu, DING Zhi-de 2018, 45 (1):  23-27.  Abstract ( 1099 )   PDF (746KB) ( 7111 )   In recent years, an increasing number of high-quality embryos are obtained accompanied by the development of assisted reproductive technology. However, the embryo implantation rate still remains unsatisfactory in the clinic. Therefore, endometrial receptivity becomes a key step for the successful embryo implantation. Leptin, a common adipokine, activates downstream signaling pathways and synthesizes transcription factors by binding to leptin receptors on target cell membranes, then interacts with DNA elements in the promoter region of specific genes to initiate transcription, plays an important biological role. It has been widely proven that leptin is significantly influencial in human reproductive function. In particular, leptin affects the expression of reproductive regulatory factors associated with embryo implantation, maternal endocrine and metabolic status, and endometrial microenvironment. Furthermore, more recent researches documented that both leptin and leptin receptor were high expressions on the endometrium in both human and rodents. Thus, it is considerable that leptin has taken an effect on the endometrial receptivity directly or indirectly. This review summarizes the research advances in relationship between leptin and endometrial receptivity in order to provide a new biomarker for the evaluation of endometrial receptivity clinically. Related Articles | Metrics

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Research Progress of Risk Factors for Development of Type 2 Diabetes Mellitus in Women with a History of Gestational Diabetes Mellitus YE Hua-ying，LI Hua-ping 2018, 45 (1):  28-32.  Abstract ( 1126 )   PDF (816KB) ( 7199 )   Gestational diabetes mellitus(GDM) is a common obstetric complication and increases the risk of pregnancy. Due to changes in lifestyle and diet, the incidence of GDM is gradually increasing. Blood glucose testing of most women with GDM is normal after delivery, but long-term risk for type 2 diabetes mellitus (T2DM) is still there. Women with a history of GDM have become potential susceptible population of diabetes, metabolic syndrome in the future. Older age, obesity, family history of diabetes, levels of plasma glucose, the need of insulin during pregnancy, and earlier diagnosis of GDM is increasingly valued. By recognizing the related risk factors and prediction markers, which include clinical features in pregnancy and postpartum, biochemical indicators, molecular genetic markers et al, predict the risk  of GDM progressing to T2DM in the future and improve the public′s awareness of risk for GDM women postpartum follow-up. Early lifestyle intervention and drug treatment can prevent or delay the onset of T2DM after GDM, improve health outcomes of women with a history of GDM. Related Articles | Metrics

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Research Progress of the Application Value of Fetal Middle Cerebral Artery Blood Flow in High-Risk Pregnancies ZHENG Lu-lu，QIAO Mei，ZHANG Tian-tian，XIN Hong 2018, 45 (1):  33-37.  Abstract ( 942 )   PDF (754KB) ( 6990 )   Fetal middle cerebral artery (MCA) blood supply to the brain hemisphere is the most abundant blood vessel, which has more important clinical value in reflecting the dynamic changes in fetal cerebral circulation and blood oxygen status. In normal pregnancy, fetal brain development gradually improved with the increase of the gestational age, and the reference curve of blood flow parameters is characterized by a typical parabolic pattern for the color Doppler ultrasonography of fetal MCA. There is a certain correlation in high-risk pregnancies between the perinatal adverse pregnancy outcomes and placental deficiency or vascular resistance increase. Fetal MCA hemodynamics will show an abnormal change when internal and external environment changes such as hypoxia. The various blood flow signal indicators of the color Doppler ultrasonography of fetal MAC also will show an abnormal trend. Color Doppler ultrasound used to detect fetal MCA blood flow index is safe, non-invasive, convenient and reproducible to mother and fetal, can be used to reflect a series of pathophysiological changes in the fetal, and become a significant clinical tool in the evaluation of fetal growth status and intrauterine safety in recent years. Related Articles | Metrics

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Clinical Study on Transcutaneous Electrical Nerve Stimulation in Labor Analgesia LI Li, LYU Yan, ZHAI Xiang-jun, WANG Bing, CUI Hong-yan 2018, 45 (1):  37-40.  Abstract ( 934 )   PDF (842KB) ( 6784 )   Objective: To observe the effects of electroacupuncture at Hegu, Sanyinjiao and Zusanli points in labor analgesia and to investigate the analgesic mechanism. Methods: 80 cases maternal were randomly divided into two groups, Group A: transcutaneous electrical nerve stimulation (TENS) group (Use TENS to Hegu, Sanyinjiao, Zusanli point in labor until the fetus was delivered); Group B: control group. Record VAS at different times, delivery outcome and perinatal outcome. Collect venous blood in both groups at the time of postpartum (T0), uterus opens to the full extent (T1) to test the concentration of β-EP, Cor and ACTH. Results: The VAS scores of group A were significantly lower than those of group B at each time points in incubation period of labor (P＜0.05), but there was no significant difference in both groups after active phase of labor (P＞0.05). The stage of labor in group A was shorter than that in group B (P＜0.05). There was no significant difference in postpartum hemorrhage and Apgar score between two groups (P＞0.05). Compared with T0, the concentrations of β-EP, Cor and ACTH in peripheral blood of both groups were significantly increased at T1 (P＜0.05). The concentration of β-EP at T1 was significantly higher in group A than that in group B (P＜0.05). Cor and ACTH concentrations were lower than those in group B (P＜0.05). Conclusions: Electroacupuncture at Hegu, Sanyinjiao, Zusanli points can effectively relieve the pain in incubation period of labor, shorten the stage of labor and increase the safety of maternal-neonatal. Its analgesic effect was associated with the increase of neurotransmitter β-EP content and the effective reduction of maternal stress response. Further researches should be aimed to improve the analgesia effect in the active phase of labor. Related Articles | Metrics

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Effect of Gestational Diabetes Mellitus on Umbilical Cord Blood Gas in Neonates MAO Xiao-yuan，BAO Yi-rong，YING Hao 2018, 45 (1):  41-45.  Abstract ( 837 )   PDF (810KB) ( 7066 )   Objective：We analyzed the umbilical blood gas and investigated its possible influencing factors in neonates of women with gestational diabetes mellitus (GDM). Methods：This study included 152 singleton pregnant women with GDM and 152 women with normal glucose tolerance (normal glucose tolerance, NGT) who delivered in Shanghai First Maternity and Infant Hospital from June to August 2015. Of 152 women with GDM, 69 were delivered vaginally, and 83 underwent cesarean delivery; and 11 required insulin therapy. Umbilical blood gases were measured. Results：The umbilical venous BE in the GDM group was lower than that in the NGT group (t=2.702，P=0.007). There were statistic differences in umbilical artery pH, umbilical venous pH, umbilical artery BE, umbilical venous BE and umbilical venous p(CO2), while neonatal outcomes showed no differences (P＞0.05), when compared with different delivery mode in women with GDM (P＜0.05). Insulin therapy showed no difference in umbilical blood gas analysis and outcomes (P＞0.05). Conclusions：The umbilical blood gas in neonates of women with GDM, who controls her blood glucose well, is similar to that of women with NGT. The mode of delivery and insulin therapy did not significantly affect neonatal-outcome. Related Articles | Metrics

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Study on the Expectant Management Time of HELLP Syndrome KANG Su-ya，ZHOU Li-ping，WANG Yun，YAO Yi-qian 2018, 45 (1):  46-50.  Abstract ( 863 )   PDF (908KB) ( 6942 )   Objective：To investigate the timing of termination of pregnancy in ＜34 weeks′ gestation with HELLP syndrome. Methods：Retrospective study was applied to analyze 51 cases of pregnancy in ＜34 weeks′ gestation with HELLP syndrome. According to the time from diagnosis to termination of pregnancy, the cases were divided into two groups. One group consisted of 29 cases with termination of pregnancy within 48 hours after diagnosis (expectant management ＜48 h group), while the other group consisted of 22 cases with expectant management ≥48 h. The cases was further divided into four subgroups according to the Tennessee diagnostic criteria: complete expectant management (CEM)＜48 h group (21 cases), complete expectant management(CEM) ≥48 h group (9 cases), partial expectant management (PEM) ＜48 h group (8 cases), and partial expectant management (PEM) ≥48 h group (13 cases). The indexes including general condition, mother and fetus condition, use of hormones and blood products, and main laboratory indexes in peak period and recovery period of HELLP cases in CEM＜48 h group, CEM ≥48 h group, PEM＜48 h group and PEM≥48 h group was compared. Results：There was no difference in general condition, use of hormones and blood products, and main laboratory indexes in recovery period. There were also no significant differences in postpartum hospital days, the minimum platelet recovery time, the amount and rate of postpartum hemorrhage, as well as the cumulative number of maternal damage. The incidence of fetal adverse outcomes in CEM≥48 h group was significantly lower than that in CEM＜48 h group (P＜0.05), which in PEM≥48 h group was also lower than that in PEM＜48 h group (P＜0.05); however, that in CEM≥48 h group showed no differences with CEM＜48 h group (P＞0.05). No significant difference was found between the lowest hemoglobin and the highest AST/ALT between the groups and subgroups in peak period of disease. The lowest platelet in EM and CEM＜48 h groups was lower than that in EM and CEM≥48 h groups (P＜0.05), but not found between PEM＜48 h group and PEM≥48 h group (P＞0.05). The highest LDH in EM＜48 h group were higher than that in CEM≥48 h  group (P＜0.01), which in CEM＜48 h group were lower than that in CEM≥48 h group (P＜0.01); however, no differences were found between PEM＜48 h group and PEM≥48 h group (P＞0.05). Conclusions：For patients with HELLP syndrome at the gestational age of ＜34 weeks, especially partial HELLP syndrome, if the condition is stable, closely observing the condition of the mother and fetus, and expectant treatment over 48 h does not significantly increase the risk of maternal injury  and can improve the prognosis of the fetus. Related Articles | Metrics

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Maternal Serum Homocysteine and Lipids in First Trimester for Prediction of Severe Preeclampsia YU Jin，SUN Feng，GUO Yu-na，ZHANG Chen 2018, 45 (1):  51-54.  Abstract ( 832 )   PDF (1064KB) ( 7090 )   Objective：To obtain the predictive value of serum homocysteine and lipid concentrations in first trimester for severe preeclampsia. Methods：This was a case-control study, selecting pregnant women underwent regular birth and delivery in our hospital from January 2016 to October 2016 as the research objects，74 severe preeclampsia and 75 uncomplicated singleton pregnancies were enrolled. The maternal serum Hcy, folic acid, VB12, TC, TG, LDL, HDL, Apo-A1, Apo-B and Lip a were tested in first trimester (11th to 12th week). Maternal characteristics and pregnancy outcome were collected for each individual woman. Logistic regression model was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI). Receiver operating curve (ROC) analysis and the area under ROC curve (AUC) was used to indicate the best model for prediction. Results：There was significant differences in maternal age, BMI, gestational weeks and birth weight between two groups (P＜0.05). Women who subsequently developed severe preeclampsia had higher concentrations of Hcy, TG, and Apo-B than control subjects (P＜0.05). The folic acid concentrations were lower in women with severe preeclampsia than that in control subjects (P＜0.05). Logistic regression revealed age and Hcy were risk factors for severe preeclampsia. The OR was 1.11 and 2.04 respectively (P＜0.05). AUC of individual marker is among 0.600~0.693. Hcy was the highest（AUC=0.693, P＜0.001, 95%CI: 0.607~0.779）. AUC of multiple markers (TG+Apo-B+folic acid+Hcy+age+BMI) was 0.777 (P＜0.001, 95%CI: 0.704~0.851). Conclusions：Advanced age and first-trimester high homocysteine are the risk factors for severe preeclampsia. First-trimester Hcy and TG combined with maternal characteristics are promising markers in the risk assessment of severe preeclampsia. Related Articles | Metrics

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Progress of Myeloid Derived Suppressor Cells and Proinflammatory Cytokines in Ovarian Cancer LIU Bei，HAN Ling-fei 2018, 45 (1):  55-59.  Abstract ( 852 )   PDF (755KB) ( 6976 )   Myeloid derived suppressor cells(MDSCs) is a kind of significant heterogeneous cells of the immunosuppressive activity, including at different developmental stages of immature granulocytes, dendritic cells and macrophages, and so on. Myeloid derived suppressor cells can inhibit the innate immunity, adaptive immunity mediated by CD4+ and CD8+ T cells, and stimulate tumor growth and metastasis through mediated tumor immune escape. Proinflammatory cytokines are a group of endogenous polypeptides that are mainly produced by immune system cells and have powerful biological effects. They mediate a variety of immune responses. Although molecular mechanisms of MDSCs and proinflammatory cytokines in ovarian cancer are not quite clear, but the current study suggests that some proinflammatory cytokines can induce MDSCs amplification, thus promoting tumor growth and development. Targeted therapies are new treatments besides routine surgery and chemotherapy. MDSCs have potential as clinical targets for immunotherapy. This article reviews research on the occurrence, development and treatment of MDSCs in ovarian carcinoma in order to reveal the mechanism of action of MDSCs and the provide theoretical basis for new treatment methods. Related Articles | Metrics

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Review of HPV-Negative Adenocarcinoma of the Uterine Cervix WANG Yao，YANG Jia-xin 2018, 45 (1):  60-65.  Abstract ( 1353 )   PDF (773KB) ( 7287 )   High-risk human papillomavirus (hrHPV) infection is the main cause of cervical intraepithelial neoplasia and invasive cervical cancer and closely related with the occurrence of cervical squamous cell carcinoma and most cervical adenocarcinoma. However, researchers have found that cervical cancer with negative hrHPV test results still exists, and about 10% of the carcinogenesis of cervical adenocarcinoma has no relationship with HPV infection. These adenocarcinoma mainly include: minimal deviation adenocarcinoma which belongs to gastric-type mucinous adenocarcinoma, clear cell carcinoma, mesonephric adenocarcinoma and papillary serous carcinoma. These unusual types of cervical adenocarcinoma were often misdiagnosed due to lack of specific clinical manifestations and difficulty in screening and diagnosis, so that most patients missed the best time of treatment and the prognosis was poor. This review summarizes the advances in the etiology, clinical manifestations, diagnosis, treatment and prognosis of cervical cancer associated with non-HPV infection by reviewing the literature. Related Articles | Metrics

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New Progress in Clinical Treatment of Locally Advanced Cervical Cancer CAO Ying，SUN Wei，FU Shi-long 2018, 45 (1):  66-70.  Abstract ( 895 )   PDF (739KB) ( 7004 )   Cervical cancer is one of malignant tumors which causes serious threat to women. Treatment for locally advanced cervical cancer （LACC） has being controversial because of its large lesions, operation difficulty and poor prognosis. Radical concurrent chemoradiotherapy, radical surgery and chemoradiotherapy plus hysterectomy are mainly recommended. In clinical treatments, due to the regional differences in radiotherapy levels and individual differences, the treatments of LACC still exhibit diversity. The therapeutic ratio of prophylactic semiextended field intensity-modulated radiation therapy is similar to conventional prophylactic extended-field radiotherapy, while the former reduces the incidence of toxicity. Chemoradiotherapy plus hyperthermia is well tolerated and causes no additional acute or long-term toxicity compared with chemoradiotherapy alone. There is no significant evidence indicates that para-aortic lymphadenectomy has a positive impact on overall survival in LACC, but it′s useful to predict the prognosis and related to better overall survival in patients with common iliac lymph node metastasis. Pelvic external beam radiotherapy with chemotherapy followed by type Ⅰ extra-fascial hysterectomy can be a good alternative for patients who cannot have no access to successful intracavitary brachytherapy. Related Articles | Metrics

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Prediction of the Progress of Cervical Intraepithelial Neoplasia JIANG Yan-ming，LI Li 2018, 45 (1):  71-75.  Abstract ( 773 )   PDF (766KB) ( 6851 )   Cervical intraepithelial neoplasia (CIN) is a precursor lesion for cervical cancer. The occurrence and progression of CIN is a multi-factor, multi-level process. Numerous studies have confirmed that high-risk HPV persistent infection is an important tumorigenesis cause of CIN and cervical cancer and is closely associated with the development of cervical cancer. With advances in molecular biology and the development of sequencing technology, the association of low genital tract microbiota with human papillomavirus (HPV) in the development of cervical intraepithelial neoplasia and cervical cancer is gradually being recognized. It has become a popular study to find and explore the prognostic biomarkers of CIN to predict the progression of CIN. This paper reviews the etiology, the influencing factors, and the markers associated with the progression of CIN, in order to properly predict the development of CIN, regulate the diversion and cervical intraepithelial management. Related Articles | Metrics

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Treatment Progresses on Fertility Preservation and Ovarian Preservation in Young Female with Endometrial Carcinoma LI Qiu-xia，YU Gui-yuan，JIN Ping 2018, 45 (1):  75-79.  Abstract ( 854 )   PDF (803KB) ( 6765 )   Endometrial carcinoma (EC) is one of the three common malignant tumor in female reproductive system. Young child-bearing female with endometrial carcinoma are respectively rare. However, with the increasing incidence of endometrial carcinoma and the changes of living habits, endometrial carcinoma shows the significantly young trend. The standard treatment programs of EC leads women to have permanent loss of fertility and premenopausal women advance into menopause, severely affecting the quality of life of young patients. So young EC women retain fertility preservation or ovarian preservation gradually taken attention. The current programs of fertility preservation include: progesterone, aromatase inhibitors, metformin and other medical treatment and hysteroscopic endometrial cancer resection. Several studies have confirmed that obesity was associated with the occurrence and development of endometrial carcinoma. Ovarian preservation and the weight management in period of treatment of young female with endometrial carcinoma are now discussed in this review. Related Articles | Metrics

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Research Progress of PPAR γ in Endometrial Cancer HUANG Mei-mei，MAO Xiao-dan，SUN Peng-ming 2018, 45 (1):  80-84.  Abstract ( 837 )   PDF (1215KB) ( 6964 )   Peroxisome proliferator-activated receptors (PPARs) are members of nuclear-hormone-receptor family which including PPARα, β/δ and γ. As a hotspot of researches in recent years, PPAR γ is closely related to a variety of metabolic diseases and tumors, which plays an important role in metabolism of lipid and carbohydrate. It functions as ligand-dependent transcription factors, connected with the proliferation，invasion and migration of endometrial cancer cells. The role of PPAR γ in tumorigenesis of endometrial cancer remains unclear. In this article, we reviewed studies progress of PPAR γ in endometrial cancer, discussing the role of PPAR γ in tumorigenesis of endometrial cancer and potential mechanism underlying endometrial cancer development and furthering propose theoretical basis for anti-tumor therapy. Related Articles | Metrics

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Clinicopathological Characteristics of Ovarian Stromal Tumor with Minor Sex Cord Elements ZHENG Mo，WU Huan-wen 2018, 45 (1):  85-89.  Abstract ( 905 )   PDF (7365KB) ( 6812 )   Objective：To explore the clinicopathological characteristics, immunophenotype, diagnosis, differential diagnosis, treatment and prognosis of ovarian stromal tumor with minor sex cord elements. Methods：Four cases of ovarian stromal tumor with minor sex cord elements were studied with histopathological and immunohistochemical staining, and their clinical and pathological findings were analyzed. The clinical and pathological data of 9 cases reported in the related literature were reviewed and summarized. Results：Ovarian stromal tumors with minor sex cord elements are frequently seen in middle-aged and elderly women. Patients often experience abdominal discomfort and vaginal bleeding. The tumors occur mostly in one of the ovaries. The maximum diameter of the tumor was larger than 4 cm. Histologically, the tumor was comprised mainly of fibro-thecoma component with few sex cord elements (less than 10%). Sex cord components varied in appearance between fully differentiated granulosa cells and tubular structures resembling immature Sertoli cells. All of the four cases showed positive staining for α-inhibin，CD99, and Calretinin. Four patients were followed up to the present and all of them showed no tumor survival. Nine cases in the literature were followed up to the publishment of  related references, and all exhibited no tumor survival. Conclusions：The diagnosis of ovarian stromal tumor with minor sex cord elements is based on distinctive histopathology and immunohistochemical staining. Its clinical manifestation is similar to other sex cord-stroma tumors. Surgical resection is the main method of treatment, and the prognosis of the tumor is good. Related Articles | Metrics

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Whether Retaining Myoma Pseudocapsule Has Effect on the Healing of Uterine Wound of Hysteroscopic Myomectomy? HUANG Xiao-wu，XIA En-lan，HUANG Rui，XU Ruo-nan，HAN Xiao，YANG Hai-yan 2018, 45 (1):  89-93.  Abstract ( 1097 )   PDF (5143KB) ( 7133 )   Objective：The aim of this study was to evaluate whether retaining myoma pseudocapsule has effect on the healing of uterine wound of hysteroscopic myomectomy for symptomatic type 2 uterine myoma (according to classification for myoma of FIGO, 2011). Methods：From January 2014 to September 2017 in Fuxing hospital, cases of type 2 uterine myoma (single, larger than 2.5 cm) were collected for heaving uterine bleeding and were performed one-step hysteroscopic myomectomy. A total of 70 cases were divided into 2 groups, the myoma pseudocapsule were retained after myomectomy for Group A (35 cases), the myoma pseudocapsule protruding into the uterine cavity were removed for Group B (35 cases). The following medical data were recorded: the age of patients, the size of the myoma, pre-operative treatment by GnRH analogue, operation time, blood loss during the operation, surgical complications. At 1 and 3 months after the operation, second-look hysteroscopy was performed to observe and compare the uterine cavity wounds healing condition of the two groups. Results：There is no significant difference of patients′ age, size of the myoma and the use of pre-operative GnRHa between the two groups; the mean operation time of group A was (33.3±12.3) min (range 17～65 min), the operation time of group B was (32.7±12.1) min (range 18～70 min), there was no significant difference (t=0.195，P=0.846). The mean volume of intra-operative blood loss of group A was (26.4±16.3) mL (10～50 mL), the mean volume of intra-operative blood loss of group B was (26.7±15.8) mL (10～50 mL), there was no statistical difference (t=－0.074，P=0.941); the incidence of intrauterine adhesions after 1 months was 5.71% (2/35) in group A and 20.00% (7/35) in group B, there was no significant difference ( χ2=3.188，P=0.074); the incidence of intrauterine adhesions after 3 months was 0 (0/35) in group A and 11.43% (4/35) in group B, there was significant difference (P=0.039). Conclusions：Myoma pseudocapsule should be protected and retained for hysteroscopic myomectomy surgery. Second-look hysteroscopy is important for prevention intrauterine adhesion after hysteroscopic myomectomy. Related Articles | Metrics

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Adjuvant Gonadotropin-Releasing Hormone Analog for the Prevention of Chemotherapy to Preserve Ovarian Function in Premenopausal Women：A Meta-Analysis WANG Qian，LANG Lin，JIA Ying 2018, 45 (1):  94-100.  Abstract ( 822 )   PDF (3231KB) ( 7011 )   Objective：To estimate whether gonadotropin-releasing hormone (GnRH) analog administration during chemotherapy can protect premenopausal women against the ovarian toxicity. Methods：We searched the electronic bibliographic databases, including the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP database and Wanfang database to assemble relevant clinical trials. The search covered January 2000 to July 2017 and clinical studies related to GnRH analog co-treatment with chemotherapy to ovarian function in premenopausal women. Data were extracted and evaluated using the methods recommended by Cochrane handbook. The RevMan 5.3 software was used for Meta-analysis. Results：Thirteen RCTs involving 1 539 patients were included. GnRH analog co-treatment significantly increase ovarian function resumption (OR=2.42, 95%CI: 1.48~3.95, P=0.000 4). Seven trials mentioned pregnancy rates. The occurrence of spontaneous pregnancy showed statistically significant difference between GnRH analog co-treatment and the control groups (OR=1.69, 95%CI: 1.06～2.69, P=0.03). Conclusions：Evidence from RCTs suggests a potential benefit of GnRH analog co-treatment with chemotherapy in premenopausal women, with higher rates of resumption of ovarian function and improvement in pregnancy. Related Articles | Metrics

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Research Progresses of the Association between Gut Microbiome and Polycystic Ovary Syndrome ZHANG Ning，LI Fei，LI Ling，GAO Hai-xia 2018, 45 (1):  101-105.  Abstract ( 1098 )   PDF (759KB) ( 7067 )   Polycystic ovary syndrome (PCOS) is a common endocrine disorders in women of childbearing age characterized by sporadic ovulation or no ovulation, hyperandrogenism, insulin resistance or hyperinsulinemia. It is one of the leading causes of infertility in women of childbearing age and its pathogenesis is still not fully clear. As "the second brain of the adult", gut microbiome can interact with the brain through the brain gut axis pathway, and integrate the nerve, hormones, immune signals and other elements. Therefore, the imbalance of gut microbiome has an important relationship with metabolic diseases such as obesity, hyperlipidemia and insulin resistance. The change of gut microbiome is closely related to the pathological process of PCOS. This paper reviews the research progresses of possible mechanisms of gut microbiome in the occurrence of PCOS. Related Articles | Metrics

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Research Progress of Stem Cells in the Pathogenesis of Endometriosis LI Jia-wen，WU Rui-jin 2018, 45 (1):  106-110.  Abstract ( 930 )   PDF (739KB) ( 7053 )   The incidence of endometriosis is nearly 15% among women of childbearing age with the pathogenesis been a research focus. The classic theory may encounter plentiful challenges, because it can′t account for the occurrence of ectopic lesions located in special areas distant from pelvic, while stem cell theory tries to demonstrate the pathogenesis of various kinds of ectopic lesions with "monism" point of view. Adult stem cells involved in endometriosis lesions may originate from the endometrium, bone marrow, ovary and other sources. Various kinds of molecules, such as estrogen, chemokines, epidermal growth factor, platelet-derived growth factor and other factors involved in differentiation of adult stem cell. The change of microRNA levels and epigenetic may be related to regulate the differentiation of mesenchyme stem cells into endometrial-like cells. Abnormal colonization of stem cells may change the uterine receptivity, leading to infertility, miscarriage and other adverse reproductive outcomes. Among different types of endometriosis formed, the gene expression of stem cells of peritoneal and deep infiltrating was similar, which is different from that of eutopic endometrial stem cells. With the deepening of research, stem cells are commonly used in the field of obstetrics and gynecology and have promising prospects in the treatment of premature ovarian failure, Asherman syndrome, endometriosis related infertility and targeted drug development Related Articles | Metrics

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The Research Progress of VEGF-A in Endometriosis GUO Lu-lu，WANG Wei，HAO Min 2018, 45 (1):  111-114.  Abstract ( 864 )   PDF (712KB) ( 6935 )    Endometriosis (EMs) is a frequent occurrence of women with reproductive age, which mainly causes pain and infertility. As tumor growth and recurrence of ectopic EMs around the lesion vascularization degree of endothelial cell proliferation, metastasis and recurrence of EMs lesions of important factors, so the inhibition of vascular endothelial growth factor has become the new target of EMs treatment. Recent studies on the role of VEGF-A in EMs, such as VEGF, as a diagnostic marker of EMs, VEGF-A gene polymorphism, VEGF-A receptor inhibitor for the treatment of EMs and microRNA (miRNA) expression of VEGF in regulating, have made certain progress, help to further reveal the onset of EMs, recurrent focal shift and focal mechanisms, as well as more accurately assess the EMs of progression and recurrence. Recent advances in the research of VEGF-A in EMs are reviewed. Related Articles | Metrics

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Clinical Value of Frusemide on Hysteroscopic Electrosurgery NIE Ming-yue, SUN Jing, YE Hong 2018, 45 (1):  115-118.  Abstract ( 1051 )   PDF (830KB) ( 6836 )   Objective：To observe the change of blood sodium level and other biochemical indexes during class-4 hysteroscopic surgery after intravenous injection of 20 mg Frusemide when the uterine distention fluid is more than 5 000 mL, so that to find out when Frusemide should be used. Methods：Totally 61 patients with class-4 hysteroscopic surgery whose uterine distention fluid exceeded 5 000 mL were randomly divided into the experimental group（30 patients） and the control group（31 patients）. 20 mg Frusemide were injected intravenously for patients in the experimental group, while the control group had no special treatment. Their blood potassium, sodium and serum glucose after 1 h, 4 h, 8 h and the incidence rates of hyponatremia after surgery were compared, retrospectively. Results：The comparison of electrolyte level, glucose level and plasma osmotic pressure in two groups were of no statistical significance（P＞0.05）. The level of potassium, sodium and plasma osmotic pressure after 1 h and 4 h of the operation were significantly lower than that  before operation. There was a significant higher blood glucose level after operation than that before operation（P＞0.05）. Compared with the control group, sodium level in the experimental group was significant higher after 1 h of the operation （P＜0.05）, there was no difference in the blood potassium, glucose level and plasma osmotic pressure（P＞0.05）. The incidence of dilutional hyponatremia in the experimental group and the control group were 13.3％ and 19.4% respectively, which was with no significantly difference（P＞0.05）. Conclusions：Frusemide can be used when the uterine distention fluid is more than 5 000 mL during hysteroscopic electrosurgery, which is benefit for keeping the balance of blood electrolytes, avoiding the complication of overload and improving the safty of class-4 hysteroscopic surgery. Related Articles | Metrics