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15 April 2018, Volume 45 Issue 2
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The Mechanism of Labor Pain and The Usual Methods of Labor Analgesia LI Mei-juan，XU Qiong，LI Mei-yan 2018, 45 (2):  125-129.  Abstract ( 1079 )   PDF (818KB) ( 6945 )   Labor pain, a complicated physiological and psychological activity during childbirth, contributes negative impact to labor, as its severe pain and long duration. This problem can be solved by several methods of labor analgesia, including pharmacological analgesia and non-pharmacological analgesia, which is going to reduce the pain during childbirth or even make it disappeared. Mostly, pharmacological analgesia is depended on using anaesthetic, analgesic and sedative, while non-pharmacological analgesia, the research hotspots of labor analgesia, relieves pains by psychological support, physical therapy and so forth. The ideal labor analgesia should effectively relieve the pains of the maternal and ensure the safety of maternal and infant. This paper summarizes the mechanism of labor pain and its impact on labor, the usual methods of labor analgesia and their features, so that we can grasp the characteristics of labor analgesia and then explore the method that not only effective but also easily accepted. Related Articles | Metrics

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Analysis of Related Factors Affecting the Clinical Application of Partogram GENG Hao，CHANG Ying，CHEN Xu 2018, 45 (2):  130-132.  Abstract ( 891 )   PDF (697KB) ( 6531 )   As a standardized graph depicting the process of production, the birth chart has evolved since its introduction, whose purpose is to better help medical staff to identify problems in the labor process, and to take interventions according to the clinical management program to reduce the occurrence of poor mother and child outcomes. But the partogram is complex and changeable, there is a gap between the theoretical best practice interventions and clinical practice. This article reviews and summarizes the research progress in the clinical application of partogram, and explore the effects of partogram factors, medical personnel professional skills, pregnant women, social environment, organizational background, economic and political background on the effective application of partogram in clinic. Medical staff should accurately identify these influencing factors, correctly assess the status of partogram in obstetrics, and rely on emerging technology to improve and optimize partogram, so that the partogram can be applied better and served the clinical work. Related Articles | Metrics

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Research Progress of MicroRNAs and Gestational Diabetes Mellitus LIU Jiao，HAN Ying，ZHANG Yun-shan 2018, 45 (2):  133-135.  Abstract ( 896 )   PDF (690KB) ( 6470 )   Gestational diabetes mellitus (GDM), defined as a type of diabetes during pregnancy, is one common complication of gestation period and it will cause adverse consequences for mothers and their offspring with the development of the disease. MicroRNA is a class of small non-coding RNAs and regulate gene expression through post-transcriptional level. During pregnancy, a large number of miRNAs associated with gestational diabetes can be detected in maternal blood, which is secreted by the placenta and is stable in the mother′s blood. With the growth of the placenta during pregnancy, miRNAs secreted in the placenta can regulate cell differentiation, adhesion, metabolism, migration, proliferation, apoptosis, angiogenesis and physiological and pathophysiological processes of glucose metabolism. Through different miRNA detection methods, understanding the abnormally expressed miRNA in the gestational diabetes population can be used as a biomarker for screening specific markers of gestational diabetes. Review the expression of different miRNAs in GDM and the mechanism of effect on newborns. Related Articles | Metrics

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Research Progress of Postpartum Hemorrhage CHENG Lan，CHEN Xu 2018, 45 (2):  136-140.  Abstract ( 943 )   PDF (728KB) ( 6576 )   Postpartum hemorrhage (PPH) is one of the top reasons of maternal morbidity and death. Estimated blood loss more than 500 mL after vaginal birth and more than 1 000 mL after cesarean birth are currently used to define postpartum hemorrhage. The diagnosis not only depend on the blood loss volume, but also the change of ■ hemodynamics. Oxytocin, the gold standard for PPH prevention and treatment is accepted by majority of obstetrician, and carbetocin, carboprost tromethamine, misoprostol are also can be used. When the patient has high risk of PPH, in addition to the prevention of oxytocin during cesarean section, intrarenous tranexamic acid may also be considered to reduce bleeding. Because there is no evidence to support the best way among current operation methods, we should choose the pattern by practical conditions. Once PPH occurs, coagulopathy is the forecasting indicators for massive transfusion and hysterectomy, and an early fibrinogen concentrate infusion in uncontrolled active PPH is effective and safe. Discernment earlier, disposal comprehensively, estabilish the emergency management team, debriefs and staff training ars indispensable procedure in PPH management. Related Articles | Metrics

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Research Progress of Aspirin and Low Molecular Weight Heparin in Preeclampsia ZHAO Xia，WANG Wei，HAO Min 2018, 45 (2):  141-144.  Abstract ( 1024 )   PDF (703KB) ( 6508 )   Pre-eclampsia (PE) is a common idiopathic disease occurring in pregnant women after 20 weeks of gestation. It changes rapidly, and the probability of serious complications of HELLP syndrome, placental abruption, preeclampsia, preterm birth, and fetal distress is high. PE is one of the leading causes of poor pregnancy outcomes in developing countries, and currently there is a lack of effective prevention and control measures. The basic pathological change of preeclampsia is systemic arteriospasm resulting in the poor erosion of gestational trophoblast, and shallow placental implantation, syncytio cells are ischemic and anoxic, inflammatory factor and procoagulant release, the blood pressure is raised, and the blood coagulation and fibrinolysis system are unbalanced, the blood is hypercoagulable in the early stage of the disease. Low molecular weight heparin (LMWH) and aspirin are two kinds of anticoagulant drugs commonly used in obstetrics. The coagulation state of preeclampsia is different from that of normal pregnant women, so the application of LMWH and aspirin in PE has attracted the attention of scholars all over the world. In this paper, the research progress on the effectiveness and safety of the two drugs in the prevention and treatment of PE will be reviewed. Related Articles | Metrics

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The Effect of Multimodal Analgesia in Total Stage of Labor on Maternal and Infant Safety LI Li，LYU Yan，ZHAI Xiang-jun，CUI Hong-yan 2018, 45 (2):  145-149.  Abstract ( 955 )   PDF (833KB) ( 6586 )   Objective：To investigate the effect of multimodal analgesia in total stage of labor on maternal and infant safety. Methods：300 full-term pregnant woman with single fetuses, aged 23-36 yr, weighing 61-95 kg, whose height were between 155-172 cm and have been pregnant for 38-41 weeks, were randomly divided into three groups: epidural anesthesia labor analgesia in active period (Group A, n =100), epidural anesthesia labor analgesia in total stage of labor (Group B, n =100) and TENS combined with epidural anesthesia labor analgesia in total stage of labor (Group C, n=100). VAS scores at different time, labor time, volume of postpartum hemorrhage, the rate of using pitocin, Apgar score and blood gas analysis to fetal umbilical blood were recorded. Blood samples were taken from three groups at the time of labor (T0) and complete cervical dilation (T1) to test the concentrations of β-endorphin, norepinephrine, epinephrine and blood sugar. Results：The VAS scores of group B, C at each point in incubation period of labor, were significantly lower than those of group A(P＜0.05). The first stage of labor and the rate of using pitocin in group A, C were shorter than those in group B (P＜0.05). There was no significant difference in the volume of postpartum hemorrhage, Apgar score and blood gas analysis of fetal umbilical blood in three groups (P＞0.05). Compared with T0, the concentrations of blood β-endorphin, norepinephrine, epinephrine and blood sugar in three groups significantly increased at T1 (P＜0.05). The concentration of β-endorphin at T1 was significantly higher in group C than that in group A and group B (P＜0.05). Norepinephrine, epinephrine and blood sugar concentrations in group B and group C were lower than those in group A (P＜0.05). Conclusions：Multimodal labor analgesia in total stage of labor can reduce the rate of using pitocin, avoid influences on stage of labor and the outcome of perinatal, protecting the safety of maternal and infant while improving the effect of labor pain in the first place. Related Articles | Metrics

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Analysis of 51 Cases of Cesarean Scar Pregnancy Treated with Suction Curettage under Ultrasound Guidance after Methotrexate Treatment Combined Uterine Artery Embolization WANG Yan-jie，ZHAI Yan，ZHANG Zhen-yu 2018, 45 (2):  150-154.  Abstract ( 930 )   PDF (880KB) ( 6577 )   Objective：To evaluate the effect and the best administration of suction curettage under ultrasound guidance after methotrexate (MTX) treatment combined uterine artery embolization(UAE) for cesarean scar pregnancy (CSP). Methods：This was a retrospective case study of 51 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization as an initial treatment of CSP in Chaoyang Hospital, Capital Medical University from January 2011 to December 2014. 51 patients were divided into three groups. Group A (23 cases): MTX systemic administration followed by UAE, and then fixed-point suction surgery. Group B (11 cases): Uterine arterial chemoembolization (UACE) followed by fixed-point suction surgery. Group C (17 cases): MTX systemic administration combined with UACE, and then fixed-point suction surgery. The basic information, the situation before treatment, intraoperative situation and assessment of therapeutic effect indicators of each group of patients were compared. Results：The three groups of patients were all one-time successful operation, with no secondary processing such as laparoscopic surgery. There was no case of bladder injury, uterus perforation and hysterectomy. The three groups in operation time, intraoperative blood loss, β-hCG to normal time, lesion absorption time, the success rate and the incidence of complications had no statistical significance (both P＞0.05). The hospitalization time and expenses in group B compared with the other two groups were decreased significantly (both P＜0.05). The maximum diameter of gestational sac or mass in Logistic regression model was statistically significant (OR=1.094, 95%CI: 1.012-1.183, P=0.024). Conclusions：Suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization is safe and effect. It can be widely used in the treatment of endogenous and exogenous CSP. UACE is recommended as the preferred method for preoperative pretreatment. It is more security for patients whose lesions biggest diameter is less than 4.3 cm. Related Articles | Metrics

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Investigation the Induced Abortion Effects of Application of Dinoprostone or Cervical Dilatation Double-Balloon in Borderline Oligohydramnios Full-Term Pregnancy WU Wen-juan，WU Hai-ying，WANG Yu，LIANG Fei，LIU Li 2018, 45 (2):  155-157.  Abstract ( 972 )   PDF (746KB) ( 6644 )   Objective：To investigate the induced abortion effects of application of dinoprostone or cervical dilatation double-balloon in borderline oligohydramnios full-term pregnancy. Methods：Ninety full-term pregnant women (50 mm＜AFI≤80 mm, cervical Bishop score≤4) who delivered in Henan Provincial People′s Hospital were selected as the observation objects. 45 patients of observation group were treated with dinoprostone vaginally, the other 45 patients were treated with cervical dilatation double-balloon vaginally. Then the cervical ripening effects and the materal and fetal outcomes of the two groups were compared. Results：The difference of time of induced labor to vaginal delivery was statistically significant in dinoprostone group and double-balloon group (t=3.204, P=0.003), the vaginal delivery rate within 24 h and the way of delivery in both groups had no obvious difference (P＞0.05). The rate of oxytocin infusion in dinoprostone group was statistically significant less than that of double-balloon group (46.7% vs. 68.9%, χ2=4.555, P=0.033). But dinoprostone group had more complications (fever, severe vomiting or diarrhea, excessive uterine activity, abnormal fetal heart, meconium-staining amniotic fluid), but the differences were not statistically significant. Conclusions：There is no statistically significant difference in the induced abortion effect between dinoprostone and cervical dilatation double-balloon. Related Articles | Metrics

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Initial Experiences of Intraoperative Cell Salvage during Hemorrhage in Cesarean Section LUO Li，SUN Qiu-lei，WU Xiao-hua，YING De-mei，CHEN Zheng-qiong 2018, 45 (2):  158-161.  Abstract ( 997 )   PDF (755KB) ( 6293 )   Objective：The aim of this article is to determine the feasibility and safety of intraoperative cell salvage (IOCS) technology in obstetric hemorrhage during cesarean section. Methods：Data of intraoperative blood salvage in the Army Medical University affiliated Xinqiao Hospital from January 2013 to December 2017 were analyzed. A total of 571 patients were included in this study, who were diagnosed for placenta previa and underwent cesarean section. 264 women who signed informed consent for accepting IOCS and received re-infusion were included in the observation group, 307 women signed informed consent allogeneic transfusion when necessary were included in the control group. Baseline demographic data, laboratory and perioperative findings, transfusion adverse effects were analyzed. Results：In the observation group, blood loss was more than that in the control group (Z=-6.993, P=0.000). The proportion of cases with total blood transfusion ≥2 000 mL, transfusion of plasma, cryoprecipitate, and platelet were more than those in the control group, but the amount of erythrocyte transfusion was less than those in the control group(P＜0.05). However, there were no significant differences regarding of the days of postoperative ICU the preoperative and postoperative Hb, HCT, PLT levels(P＞0.05). Postoperative complications within 24 hours were no significant differences between the two groups (P＞0.05). Conclusions：The strategy of intraoperative cell salvage was feasible and safe for women with placenta previa undergoing cesarean section. Related Articles | Metrics

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Clinical Efficacy of Calcium Gluconate Combination with Carboprost Tromethamine on Postpartum Hemorrhage in Preeclampsia Cesarean Section NI Yan 2018, 45 (2):  162-164.  Abstract ( 918 )   PDF (764KB) ( 6535 )   Objective：To investigate the clinical effect of calcium gluconate combined with carboprost tromethamine on postpartum hemorrhage in preeclampsia cesarean section. Methods：160 pregnant women with preeclampsia who were terminated by cesarean section from September 2016 to September 2017 in our hospital were enrolled in this study, who were divided into study group and control group according to the random number table, each 80 cases. All pregnant women were terminated by cesarean section. After the fetus was delivered, the control group was given oxytocin and carboprost tromethamine, and the study group was given calcium gluconate on the basis of the control group. The amount of bleeding during the operation, 2 h and 24 h after surgery and the postpartum hemorrhage rate were compared between the two groups. The serum concentrations of Ca2+ and hemoglobin before and after cesarean section were compared between the two groups. The incidence of adverse reactions was compared between the two groups. Results：There was no significant difference in bleeding volume between study group and control group during operation (P＞0.05). The amount of bleeding in the study group was less than that in the control group at 2 h and 24 h after the operation (P＜0.05). The postpartum hemorrhage rate in the study group was 15.00% (12/80), and the postpartum hemorrhage rate in the control group was 36.25% (29/80), which was statistically different (χ2=9.477, P=0.002). After cesarean section, serum concentrations of Ca2+ increased in both groups, the study group was more significant than the control group (P＜0.05), hemoglobin content decreased in both groups, the control group decreased more than the study group (P＜0.05). There was no significant difference in the incidence of adverse reactions between the study group (16.25%) and the control group (13.75%) (χ2=0.196, P=0.658). Conclusions：Calcium gluconate combined with carboprost tromethamine for preventing postpartum hemorrhage in pregnant women with preeclampsia has a better hemostatic effect, which is safe and effective and worthy of clinical promotion. Related Articles | Metrics

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Discussion on Preserving Uterus Operation Mode of 178 Patients with Pernicious Placenta Previa and Placenta Accreta WU Hai-ying，WANG Qiu-ming，WANG Ran，LIU Kan，WANG Huan-ping，YAN Jun 2018, 45 (2):  165-167.  Abstract ( 913 )   PDF (757KB) ( 6375 )   Objective：To investigate the preserving uterus operation mode and improve prognosis with pernicious placenta previa and placenta accreta. Methods：The clinical data of 178 patients with placenta previa and placenta accreta admitted to Henan provincial people′s Hospital, from April 2015 to November 2017 were analyzed retrospectively. According to the situation in the operation, patients underwent caesarean section, cerclage with tourniquet, ligation of ascending branch of uterine artery, cervical lifting suture, partial resection of anterior portion of lower uterine, double incision of lower uterine, stuffing with intrauterine balloon，and temporary aortic balloon of the abdominal aorta. Results：The mean blood loss of all 178 patients was 1 500 (1 421.5, 1 757.7) mL. The mean blood loss of 156 patients had not temporary aortic balloon of the abdominal aorta was 1 600(1 461.3, 1 707.2)mL, the blood loss of 22 patients had temporary aortic balloon of the abdominal aorta was mean 1 800 (1 761.9, 1 912.7) mL, there was no statistical significance (Z=2.13, P=0.98). The incidence of postoperative infection of intrauterine balloon and those without intrauterine balloon was 23.9% (22/92) vs. 18.6% (16/86), there was no statistical significance (χ2=0.75, P=0.39). 1 patient was treated with hysterectomy due to extensive placenta accrete. All patients were restored to health and discharged. Conclusions：A variety of surgical procedures were applied to the treatment of placenta previa and placenta accreta, which reduced the amount of bleeding during operation. Most of the uterus was retained, and achieved good results. Related Articles | Metrics

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Research Progress on Malignant Transformation of Adenomyosis GAO Yang，SONG Zhi 2018, 45 (2):  171-174.  Abstract ( 998 )   PDF (733KB) ( 6470 )   Adenomyosis is a kind of common benign gynecologic endometriosis disease, which shows the characteristics of malignant in certain aspects, such as the angiogenesis and invasion behavior, and has the potential of malignant transformation. The main histologic type is endometrioid adenocarcinoma. The pathogenesis may be related to abnormal smooth muscle cells, high estrogen status, female progesterone receptors, metabolic enzyme abnormalities, gene mutation and epigenetics and so on, but remains unclear. The clinic manifestations are not typical. Abnormal vaginal bleeding and vaginal bleeding after menopause are the most common clinical symptoms of malignant transformation of adenomyosis. It is difficult to make a preoperative diagnosis especially an early one, which leads to the high rate of misdiagnoses and the erroneous diagnosis. Postoperative histopathological examination could determine the diagnosis. Surgery combined with chemotherapy and radiotherapy is recommended for the treatment. The prognosis is unknown, which need to be further studied. This article will review the progress on malignant transformation of adenomyosis, intending to provide new way for the early diagnosis and treatment. Related Articles | Metrics

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Research Status of Endometriosis-Related Malignancies JING Lan-kai，NI Hua，LI Hua 2018, 45 (2):  175-179.  Abstract ( 905 )   PDF (757KB) ( 6441 )   Endometriosis is a common gynecological disease that troubles thousands of women, the incidence of which is 6%-10%. Though, it is a benign disease, the malignant incidence is about 1%. Recently, many researches have revealed endometriosis will increase the risk of ovarian cancer. What′s more, the age diagnosed with endometriosis, the large diameter of endometriosis cysts, infertility and obesity are high risk factors of the malignant transformation. On the contrary, more births, complete excision of endometriosis, unilateral oophorectomy and long-term use of contraceptive drugs will decrease the risk of ovarian carcinoma. There are a lot of theories about the pathogenesis of endometriosis related malignancies, such as oxidative stress and antioxidant defense, inflammatory reaction, hormonal effect, environmental factors and gene mutation, and so on. This article is about the onset risk, high risk factors, protective factors and the pathogenesis of endometriosis associated with malignancies so as to understand this disease more. Related Articles | Metrics

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Research Progress of the Relationship between Endometriosis and IL-16 DU Jing-ran，WANG Yan，YANG Yong-xiu 2018, 45 (2):  180-183.  Abstract ( 947 )   PDF (703KB) ( 6473 )   Endometriosis is a common female gynecological diseases, and it is histologically characterized by the displacement of endometrial tissue to extrauterine locations including the pelvic peritoneum, ovaries, and bowel. Dysmenorrhea, chronic pelvic pain, abnormal menstruation and infertility are the main symptoms, and the individual and global socioeconomic burden of endometriosis is significant. Laparoscopy remains the gold standard for the diagnosis of the condition. However, the invasive nature of surgery, coupled with the lack of a laboratory biomarker for the disease, results in a mean latency of 7-11 years from onset of symptoms to definitive diagnosis. Unfortunately, the delay in diagnosis may have significant consequences in terms of disease progression. The discovery of a high sensibility and specificity biomarker for the nonsurgical detection of endometriosis promises earlier diagnosis and prevention of deleterious sequelae and represents a clear research priority. The current pathogenesis is unknown. Immune factors and inflammatory responses have been reported to play an important role in the pathogenesis. Among them, the role of IL-16 in the pathogenesis of endometriosis has received increasing attention. IL-16 is a modulator of chemokine and T cell activation mediated by CD4 signaling. This article reviews the relationship between the expression of IL-16 and the pathogenesis of endometriosis. Related Articles | Metrics

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Effects of Obesity on Metabolic Dysfunction in Polycystic Ovary Syndrome ZHANG Duo-jia，CHANG Hui，SHEN Wen-juan，WU Xiao-ke，CONG Jing 2018, 45 (2):  184-187.  Abstract ( 967 )   PDF (708KB) ( 6454 )   Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive age women. It is associated with high risk of metabolic disorders, such as dyslipidemia, metabolic syndrome, sleep apnea syndrome and type 2 diabetes. Obesity and insulin resistance are the two most common symptoms of PCOS. In addition to increased prevalence of obesity, the accumulation of abdominal fat is also found in non obese PCOS patients. Studies have shown that the dysfunction of adipose tissue is a risk factor for metabolic disorders. The function of adipose tissue is abnormal in PCOS patients, including impairments in lipolysis and insulin action and abnormal secretion of adipokines. These abnormalities in lipocytes contribute to the development of insulin resistance. We provide an overview of lipocytes′ dysfunction and their impact on development of metabolic disorders. Related Articles | Metrics

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New Research Progress on the Relationship between Brown Fat Tissue and Polycystic Ovary Syndrome LI Zi-han，LI Xiu-yang，ZHANG Ning，WU Zhi-juan，ZHOU Guan-lun，LI Xiao-xia 2018, 45 (2):  188-191.  Abstract ( 1040 )   PDF (729KB) ( 6339 )   Polycystic ovarian syndrome (PCOS) is a common disorder of reproductive metabolism with high heterogeneity. Its main manifestations are obesity, insulin resistance (IR), hirsutism, infertility, late onset of cardiovascular and cerebrovascular diseases, ovarian cancer and other long-term complications. Brown adipose tissue (BAT) is the main body heat producing tissue and plays an important role in metabolism. It has been found that BAT is closely related to the formation of PCOS. On the one hand, obesity caused by metabolic disorders of BAT further accelerates the occurrence of abnormal ovulation and related complications; on the other hand, the cytokines secreted by BAT are the key to alleviate IR and reduce the inflammatory state of PCOS. Based on the study of the relationship between BAT and PCOS, we have derived the treatment methods including exogenous BAT transplantation, iris factor supplement, drug-induced adipose tissue browning and so on, so as to diversify the treatment methods of PCOS. In this paper, the research progress of BAT and its relationship with PCOS is reviewed. References | Related Articles | Metrics

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Study on Susceptibility Genetic Epidemiology and Detection in Pelvic Organ Prolapse ZHANG Li-fang，DUAN Ai-hong，LU Dan 2018, 45 (2):  192-195.  Abstract ( 843 )   PDF (718KB) ( 6399 )   Pelvic organ prolapsed (POP) not only seriously affects the quality of life, but also causes serious complications. With the aging society, POP patients are gradually increasing, and no consensus exists among researchers regarding its etiology and pathogenesis. Current research suggests that POP is a multifactorial disease with genetic predisposition, including environmental and genetic factors, etc. Environmental factors include high risk factors such as delivery injury, menopause, obesity and smoking, while genetic factors and genetic predisposition are not yet clear. The anabolism, catabolism, gene mutation, and/or polymorphism of pelvic floor support structures and extracellular matrix components were analyzed, and the leading-edge technologies of related genetic genes and related signal pathways were summarized. Related Articles | Metrics

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A Study on the Treatment of Cabergoline in Female Patients with Hyperprolactinemia Infertility SU Ya-qin，ZHANG Ning-ning，LIANG Xiao-qing，ZHANG Shao-jing，WEI Yong-zhi 2018, 45 (2):  196-199.  Abstract ( 1138 )   PDF (834KB) ( 6535 )   Objective：To explore the treatment efficacy of cabergoline in women with hyperprolactinemia infertility. Methods：109 cases of hyperprolactinemia infertility in our department of obstetrics and gynecology from June 2013 to June 2017 were analyzed retrospectively. The observation group (n=48) was treated with cabergoline, and the control group (n=61) was treated with bromocriptine. The serum PRL of 1, 3 and 6 months after the treatment in two groups, the treatment effect of infertility, the incidence of adverse reactions and drug resistance were recorded. Results：The serum PRL decline values of the observation group were more than those of the control group at 1 month, 3 months and 6 months after the treatment (P＜0.05). The cases of successful pregnancy in the observation group were more than those in the control group, and the difference was statistically significant ( χ2=5.068, P=0.024). The incidence of nausea & vomiting and hypotension in the observation group were lower than those in the control group, the difference was statistically significant (P＜0.05). The drug resistance rate of the observation group was lower than that of the control group (P＞0.05). Conclusions：In the treatment of hyperprolactinemia infertility, the treatment effect of cabergoline is better than that of the bromocriptine in reducing prolactin and the improvement of pregnancy rate, while the incidence of severe adverse reactions is lower. Related Articles | Metrics

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Effect of Probiotic Supplementation on Blood Sugar and Lipids in Patients with Polycystic Ovary Syndrome CHEN Ye，ZHU Ming-hui，WANG Chan-ni 2018, 45 (2):  199-202.  Abstract ( 1523 )   PDF (774KB) ( 6553 )   Objective：To investigate probiotic supplementation on blood sugar and lipids in patients with polycystic ovary syndrome. Methods：A total of 60 PCOS patients visited our hospital from March 2015 to January 2016 were divided into observed group (probiotic supplementation) and control group (metformin), each group of 30 cases. Serum levels of Fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting serum insulin (FSI), luteotropic hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E2), testosterone (T) was detected in this study; HOMA-IR were calculated in all patients. Results：Serum FBS, FSI, HOMA-IR, TG and VLDL leves in observed group were significantly decreased compared with control group after treatment (P＜0.05). After treatment, serum LH and T levels in observed group were lower than those before treatment (P＜0.05). In addition, probiotic supplementation in PCOS patients resulted in a significant reduction in weight and BMI compared with those patients without treatment. Conclusions：PCOS patients with probiotic supplementation have favourable effects on blood sugar, blood lipids and weight loss, which could alleviate PCOS and its associated complications development. Related Articles | Metrics

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Analysis of Hysteroscopy and Histopathological Diagnosis of Endometrial Tuberculosis LIU Lin-lin，HUANG Xiao-wu，XIA En-lan 2018, 45 (2):  203-206.  Abstract ( 1592 )   PDF (4653KB) ( 6713 )   Objective：To evaluate the coincidence and correlation between hysteroscopy and histopathological diagnosis of endometrial tuberculosis. Methods：A retrospective analysis of hysteroscopy data and histopathological result of 99 infertile women with a history of tuberculosis from July 2012 to August 2016 in the Hysteroscopy Center of Fuxing Hospital was performed. Results：In 99 women hysteroscopy was performed and histopathological examination was taken at the same time, the coincidence rate between them was 46.7%. 7 cases of endometrial tuberculosis were identified by both hysteroscopy and histopathology, one case of proliferative endometrium was considered as endometrial tuberculosis by hysteroscopy but disproved by histopathology, and 8 other cases of endometrial tuberculosis were confirmed by histopathology but not identified by hysteroscopy. However, 68 women with different degree of intrauterine adhesions were detected. Conclusions：The endometrial tuberculosis identified by hysteroscopy must be confirmed by histopathological diagnosis. Hysteroscopy helps to find intrauterine adhesions. Related Articles | Metrics

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Advances in Prediction Methods of Para-Aortic Lymph Nodes Metastasis in Endometrial Carcinoma FENG Xiao-dan，ZHANG Yu-quan 2018, 45 (2):  207-211.  Abstract ( 1043 )   PDF (804KB) ( 6395 )   Endometrial cancer is one of the most common malignancy of the female reproductive tract, and its incidence is steadily increasing. The lymphatic metastasis is the main route metastasis of endometrial cancer, in which pelvic lymph node metastasis is more common while para-aortic lymph node metastasis is rare. However, patients with para-aortic lymph node metastasis have a relatively poor prognosis. Preoperative and intraoperative techniques could be critical tools for tailoring the para-aortic lymph node metastasis in the endometrial cancer. The prediction methods of the para-aortic lymph nodes metastasis in endometrial carcinoma have been developing rapidly in recent years. But at present, there is still no uniform standard for forecasting techniques. Now we do a review on the comprehensive analysis about patients′ pathological examination, serological examination and imaging modalities to predict the para-aortic lymph node metastasis in the management of endometrial cancer, guide clinical decisions, avoid unnecessary aortic lymphadenectomies, reduce morbidity, lower the cost of surgery and select appropriate postoperative adjuvant therapy, which are all of great significance. Related Articles | Metrics

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Advances in the Aapplication of Arterial Embolization in Management of Gestational Trophoblastic Neoplasia YANG Ting-ting，YUE Xiao-ni，LU Xin 2018, 45 (2):  212-216.  Abstract ( 909 )   PDF (747KB) ( 6504 )   Gestational trophoblastic neoplasia (GTN) can invade and destroy blood vessels，early appearance of distant blood metastasis，prone to hemorrhage，endangering the life of patients. With the continuous development of radioactive interventional techniques in recent years, arterial embolization therapy is more and more applied in the treatment of GTN. As an alternative to surgical treatment, in the treatment of uterine lesions and metastatic lesions, safe and efficient, the treatment of arterial embolization can preserve the fertility function of women with fertility requirements. There is a risk of chronic or severe bleeding in uterine arteriovenous fistula, color doppler ultrasonography is the preferred screening method for arteriovenous fistula, enhanced computed tomography (CT) and magnetic resonance imaging (MRI) has high specificity, but now selective pelvic arteriography is still the gold standard for diagnosis. Theoretically good intubation technique, accurate positioning, and the reasonable choice of embolization agent, control the embolization agent dose and injection rate can prevent embolization agent into the ovary, will not affect ovarian and reproductive functions. The treatment of arterial embolization will not affect the efficacy of subsequent systemic chemotherapy. Positive and accurate assessment of arterial embolization before treatment, the postoperative attention to the possible complications and active intervention can improve the safety and efficacy of treatment. This artical is to summarize the arterial embolization therapy on the effect of acute bleeding, arteriovenous fistula, the choice of embolic agent, subsequent chemotherapy, fertility and postoperative complications of GTN. References | Related Articles | Metrics

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Therapeutic Strategies of Ultra High-Risk Gestational Trophoblastic Neoplasms WAN Qi-hong，QIAN Jian-hua 2018, 45 (2):  216-220.  Abstract ( 974 )   PDF (751KB) ( 6402 )   Gestational trophoblastic neoplasms (GTN) is a series of malignant tumor that is extremely sensitive to chemotherapy. The main therapeutic strategies include systemic chemotherapy and the treatment of metastatic tumors. The overall survival (OS) rate almost approaches 100% in low-risk patients, whereas high-risk patients can achieve a overall survival rate of 80%～90%. Patients with the FIGO prognosis score ≥12 points or those with liver, brain metastases, or extensive metastases were defined as ultra high-risk patients. Prognosis of ultra high-risk patients has been poor, and mortality rate has been high. The main reasons include widespread chemotherapy-resistant disease, respiratory failure due to progressive disease in the lungs or hemorrhage from brain and liver metastases. The therapeutic strategies for ultra high-risk GTN patients are treated primarily with combined chemotherapy, supplemented by surgery, radiotherapy or interventional therapy. It is recommended to diagnose as soon as possible and stable patient′s condition when faced with extremely serious ultra high-risk GTN patients, also referral to the gestational trophoblastic disease centres which have a comprehensive diagnosis and treatment capability. The research progress of treatment strategies for ultra high-risk GTN was discussed in this review. References | Related Articles | Metrics

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Effect of FAL1 on Biological Behavior of Epithelial Ovarian Cancer and Its Mechanism WANG Xiao-tong，TAN Wen-hua，LIU Wei 2018, 45 (2):  221-225.  Abstract ( 932 )   PDF (2683KB) ( 6421 )   Objective：To explore the difference in the expression of long chain non-coding RNA (lncRNA) FAL1 between epithelial ovarian cancer cells and normal human ovarian cells and the effect of lncRNA FAL1 expression in ovarian cancer cell line SKVO3 on invasion, migration and apoptosis of ovarian cancer cells. Methods：Using real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) technique to detect the FAL1 expression level of lncRNA in tissues; the design and synthesis of FAL1-siRNA primer sequence was transfected into SKVO3, detection of ovarian cancer cell migration by cell scratch test, Transwell to detect the invasive ability of ovarian cancer cells, detect the apoptosis of ovarian cancer cells by flow cytometry (Western blotting), Western blotting detection of phosphorylated extracellular signal regulated protein kinase 1/2 (p-ERK1/2) and phosphorylation of mitogen extracellular kinase 1/2 (p-MEK1/2) protein expression level. Results：The expression of lncRNA FAL1 in epithelial ovarian cancer tissues was higher than that of normal ovarian tissue [(15.04±2.24) vs. (2.93±0.39), P＜0.05]. After silencing the expression of lncRNA FAL1, the apoptotic ability of ovarian cancer cells was significantly enhanced [(18.38±0.73)% vs. (2.86±0.09)%, P＜0.05], while the migration and invasion ability of ovarian cancer cells were decreased [(6.68±1.49) μm vs. (12.85±2.56) μm, (25.80±2.59) vs. (145.6±5.23), P＜0.05], and the phosphorylation level of MEK1/2 and ERK1/2 protein in MEK/ERK pathway was significantly decreased (P＜0.05). Conclusions：lncRNA FAL1 can influence the invasion, migration and apoptosis of epithelial ovarian cancer cells by activating MEK/ERK pathway, and its abnormal expression may be an important molecular mechanism of occurrence and development of ovarian cancer. Related Articles | Metrics

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Characteristics of Lymphatic Metastasis and Clinical Analysis of 100 Patients with Locally Advanced Cervical Cancer CAO Ying，YUAN Lin，FU Shi-long，CHENG Wen-jun，HAN Su-ping 2018, 45 (2):  226-231.  Abstract ( 1219 )   PDF (886KB) ( 6586 )   Objective：To investigate the characteristics of lymphatic metastasis of locally advanced cervical cancer (LACC) and to evaluate prognostic significance of neoadjuvant chemotherapy (NACT) in patients with LACC (FIGO IB2/IIA2). Methods: Retrospectively analyze the  clinical records and follow-up information of 424 patients with cervical cancer or adenocarcinoma (FIGO IA2-IIA2) after radical hysterectomy in Department of Gynecology, Jiangsu Provincial People′s Hospital From January 2008 to December 2016. Results: In total, 424 patients with cervical cancer were enrolled in the study. Of the 100 patients with LACC, 68 patients underwent direct radical surgery, and 32 patients underwent radical cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. pelvic lymph node metastasis in 20 cases, and paraaortic lymph node metastasis was not found. Univariate analysis revealed that  deep muscular layer invasion and lymph vascular space invasion (LVSI) was associated with lymph node metastasis (P＜0.05). Histological type, degree of differentiation and whether neoadjuvant chemotherapy were not associated with lymph node metastasis (P＞0.05). Statistically significant single factor Logistic regression analysis showed that LVSI was an independent risk factor for lymph node metastasis (P＜0.05). There was no significant difference of  lymphatic metastasis rate between NACT group and RS group (22.2% vs. 17.2%, P＞0.05). The disease-free survival and overall survival of the LACC group were significantly lower than those of the early cervical cancer group. The NACT group has lower postoperative infection rate, shorter operating duration and less time to keep the abdominal drainage, but there was no statistic significance between the two groups (P＞0.05), and intraoperative ureteral stenting rate, blood transfusion rate and incidence of other adjacent organ injuries were similar in the 2 groups. Conclusions: Locally advanced cervical cancer has poorer prognosis with significantly higher lymphatic metastasis rate than early cervical cancer. Pelvic lymph nodes metastasis was mainly correlated with LVSI and deep muscular layer involvement. Weather neoadjuvant chemotherapy infects the prognosis of advanced cervical cancer is unclear , and there is no evidence that neoadjuvant chemotherapy affects the detection rate of pelvic lymph node metastases. A larger sample or multicenter study is needed in the incidence of surgical-related complications. References | Related Articles | Metrics

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Diagnosis and Treatment Analysis of 425 Cases of Pregnancy with Ovarian Tumor YU Gui-yuan，LI Qiu-xia，ZHANG Lei，CAO Guan-zhu，JIN Ping 2018, 45 (2):  231-235.  Abstract ( 816 )   PDF (812KB) ( 6368 )   Objective：To investigate the pathology, diagnosis and treatment characteristics of benign and malignant ovarian tumors in pregnancy, and the effect of different surgical methods on pregnancy outcome. Methods：A total of 425 patients with pregnancy ovarian tumors as research objects who were treated in Shenzhen Maternal and Child Health Hospital Affiliated Southern Medical University from September 2010 to September 2016, retrospectively analysing its clinical data, including discovery time, pathological type, surgical method, pregnancy outcome, etc. Results: Cystic mature teratoma was the most common pathological type in patients with gestational ovarian tumors, followed by endometriosis cyst and mucinous cystadenoma. There were 30 cases of complications during pregnancy, accounting for 7.10%, among which torsion was the most common complication, followed by malignant and rupture hemorrhage. There are mainly two kinds of operation methods during pregnancy period: laparoscope and laparotomy surgery, the amount of blood loss in the laparoscopic group [(39.62±28.25) mL vs. (68.50±33.60) mL, t=2.563, P=0.015], length of hospital stay of laparoscopy group were less than the laparotomy surgery group [(6.46±2.03) d vs. (9.90±1.92) d, t=4.925, P＜0.001]. In addition, the average surgical gestational weeks of the laparoscope group were smaller than that of the laparotomy surgery group [(12.71±3.71) weeks vs. (16.71±4.89) weeks, t=2.490, P=0.018]. However, there was no significant difference between the two groups in the rate of cesarean section, low birth rate, preterm birth rate and abortion rate (all P＞0.05). The prognosis of malignant tumor in pregnancy is better after treatment in a timely and individualized manner. Conclusions: To eliminate malignant tumor by early detection early treatment will have a good prognosis. It is safety to choose surgical intervention during pregnancy. Surgical indications are recommended for surgical intervention. Both laparoscopy and laparotomy has no effect on pregnancy outcome. The choice of operation can be individualized. Related Articles | Metrics

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Tubal Teratoma: A Report of 4 Cases and Review of the Literature XU Hai-hua，CHEN Li，DONG Bin-hua，MAO Xiao-dan，SUN Peng-ming 2018, 45 (2):  236-238.  Abstract ( 940 )   PDF (679KB) ( 6561 )   Objective：To summarize and analyze the clinical features and diagnosis of tubal teratoma. Methods：4 cases of tubal teratoma in our hospital from 2010 to 2017 years and 25 cases reported in domestic literature were analyzed retrospectively. Results：The average age of 29 cases of tubal teratoma was 35.17 (24～60) years age, and the pregnancy history was 86.96%. The tumors occurred in the left side, 55.17%, the right side, 44.83%, and 72.41% in the fimbria and ampulla. The size of the tumor was between 0.3～15 cm, and 6～10 cm accounting for 55.17%. Abdominal pain and pelvic mass account for 72.41%. No cases were diagnosed before operation, 5 cases were reversed, and 3 cases were infertile. Mature teratoma accounted for 89.66%. Of 4 cases in our hospital, 2 underwent tubal mass stripping. The follow-up after stripping (1 cases followed up for 6 years, 1 cases followed up for 29 months) showed no tumor recurrence, and one of them was subsequent pregnant after 3 months, and 1 case was not pregnant so far. Conclusions：The clinical features of tubal teratoma are nonspecific and easily misdiagnosed. There are torsion, malignant change, infertility and other risks, treatment should be timely. Related Articles | Metrics