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15 October 2018, Volume 45 Issue 5
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Study Progress on Circular RNA in Female Reproductive System Malignancies DU Meng-yang，WANG Hai-jiao，CHEN Xiao-yue 2018, 45 (5):  485-488.  Abstract ( 1091 )   PDF (731KB) ( 6315 )   Circular RNA (circRNA) is a kind of widely existing special non-coding RNA molecular with covalently closed continuous loop structure without canonical 5′cap and 3′poly A. CircRNAs are stable, conserve across species and often exhibit tissue/development-stage-specific expression. They can act as a miRNA "molecular sponge", regulate alternative splicing and modify parental gene expression. CircRNA involves in RNA regulation network, protein translation and is closely related to the occurrence and progression of diseases. As a promising tumor marker and molecular therapeutic target, it becomes a hotspot in ncRNA research. Recently, studies on the biogenesis, biological characteristics and functions of circRNA have made a great progression. It has been found that circRNAs promote proliferation of cancer cells via multiple mechanisms. It is a promising molecular for the early diagnosis, prognosis and chemosensitivity prediction of the patients. There are so far only few reports on the biological functions and regulatory mechanisms of circRNAs in female reproductive malignancy. We review the researches on the molecular biological characteristics of circRNAs in malignant tumors of female reproductive system. Related Articles | Metrics

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Diagnosis and Treatment Advances in Uterine Serous Carcinoma LIU Jun-xiu，HE Mian，YAO Shu-zhong，FENG Feng-zhi 2018, 45 (5):  489-494.  Abstract ( 1831 )   PDF (1197KB) ( 6350 )   Uterine serous carcinoma(also known as Uterine papillary serous carcinoma ,UPSC ), is a main kind of estrogen-independent type Ⅱ uterine endometrial cancer. It is highly aggressive with high invasive ability, high recurrence rate after surgery. And the recurrent UPSC is often multifocal and the carcinoma is located outside the pelvic in most cases, leading to difficult situation which can′t be fixed with traditional treatment such as surgery or radiotherapy. Due to the low incidence rate of UPSC, previous study with limited cases can′t accomplish the classification and detailed statistical analysis. The present review lists recent articles with retrospective analysis of big data cases and introduces the clinical characteristics of UPSC with reference to treatment recommendation of the American Society of Gynecologic Oncology (SGO) and American National Comprehensive Cancer Network (NCCN), offering data support for various therapy choices for different FIGO stage patients. The present review also aims to improve the cognition of UPSC and help gynecologists to master the treatment principle of this disease. Related Articles | Metrics

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Systemic Treatment of Uterine Leiomyosarcoma LUO Pan，SHEN Yan，HUA Teng，WANG Hong-bo 2018, 45 (5):  495-499.  Abstract ( 1109 )   PDF (753KB) ( 6657 )   Uterine leiomyosarcoma (uLMS) is a rare uterine interstitial tumor with a low incidence and a high malignant tumor. Even with early treatment, uLMS still has a highly by recurrence rate and metastasis risk. The preoperative diagnosis of the disease is difficult, not like cervical cancer, endometrial cancer has good diagnostic tools, intraoperative existence of inappropriate treatment or inadequate treatment way, so the disease prognosis is poor. Surgical treatment is still the main treatment of the disease, postoperative adjuvant treatment has a lot of scheme, for example adjuant radiation therapy, chemotherapy, targeted therapy, combination treatment or follow-up observation. Due to low morbidity, low number of studies and rapid disease progression, there is still no unified standard solution, and the efficacy of adjuvant therapy is not ideal, with few clinical benefits. This paper discusses the knowledge of systematic treatment of uLMS, especially in the treatment of adjuvant therapy, metastatic lesion and accidental discovery of this disease, providing reference for clinical treatment. Related Articles | Metrics

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The Assessment and Treatment Status of Lymph Node Metastasis in Endometrial Cancer LI Zhuang, LI Li 2018, 45 (5):  500-503.  Abstract ( 1379 )   PDF (699KB) ( 6470 )   Endometrial carcinoma (EC) is one of the most common women malignant tumors. The prognosis of advanced EC is poor, and lymph node metastasis is an important factor affecting its prognosis. Lymphadenectomy in early EC is still controversial, adopting imaging examination, tumor markers,  sentinel lymph node biopsy to assess whether lymph node metastasis or not, decide lymph node dissection scope. Lymph node metastasis means the advanced EC, the treatment is comprehensive treatment model such as surgery, radiotherapy, chemotherapy and hormone therapy. Lymph node dissection has important implications for the prognosis, staging and postoperative treatment of EC. Surgical treatment of EC patients should follow the principle of individualization, develop a reasonable surgical plan, and determine whether lymph node dissection and its scope should be performed. Our purpose is mainly to focus on the assessment, treatment and prognosis related factors of EC lymph node metastasis for further discussion. Related Articles | Metrics

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Advances in the Omentextomy of Epithelial Ovarian Cancer DONG Xu-hui, YUAN Lei, YAO Liang-qing 2018, 45 (5):  504-509.  Abstract ( 1199 )   PDF (761KB) ( 6339 )   Epithelial ovarian cancer (EOC) is a common gynecologic carcinoma in women. It holds high recurrence rate and mortality due to dormant symptom. The standard treatment of EOC includes primary debulking surgery followed by chemotherapy. EOC have a clear predilection for metastasis to the omentum and hence omentextomy is an important part in EOC surgery. However, the scope of surgery remains disputed. All involved omentum should be removed if there is gross disease in the omentum. To those patients without gross disease in the omentum, the scope of surgery depends on the surgeon. The commonest one is an infracolic omentectomy while expanded resection may bring more benefits and complications to patients. A review of omentectomy in the staging and treatment of EOC was conducted to provide more accurate treatment for different EOC patients. Related Articles | Metrics

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Research Progress of Circulating Tumor Cells in Epithelial Ovarian Cancer AN Jian，SUN Peng-ming 2018, 45 (5):  510-514.  Abstract ( 1007 )   PDF (743KB) ( 6114 )   Ovarian cancer is a common gynecological malignancy with the highest mortality. Concealed clinical manifestations, recurrence and metastasis, and insensitivity to radiotherapy and chemotherapy are the main causes of poor prognosis of ovarian cancer. Early diagnosis plays an important role in improving the prognosis of ovarian cancer. At present, there are no optimal serum markers for the early diagnosis of ovarian cancer. Clinical biomarkers for evaluation of the rapeutic efficacy and prognosis are lacking in specificity. Circulating tumor cells (CTCs) test has the advantages of minimal invasion, real-time and high specificity, etc. More and more gynecologic oncologists have begun to pay attention to and further investigate this technique, which called ′liquid biopsy′, in ovarian cancer. This article reviews the research progress and application of CTCs in epithelial ovarian cancer. Related Articles | Metrics

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Different Scoring Methods in Predicting Respectability and Prognosis in Advanced Ovarian Cancer ZHANG Yue-ru，FENG Wei-wei 2018, 45 (5):  515-522.  Abstract ( 1631 )   PDF (906KB) ( 6837 )   Routine therapies for advanced ovarian cancer are as the followings: primary cytoreductive surgery+ platinum based chemotherapy, pathologic  diagnoses by laparoscopy or puncture biopsy,then doing neoadjuvant chemotherapy and interval debulking surgery. Whether to perform a primary cytoreductive surgery is determined by the patient’s tumor load and the risk of postoperative complications which several scoring systems have been developed to predict.We have several predictive scoring systems: Fagotti score, Fagotti-modified score, CT score, Aletti score, PCI score and other scoring systems. Both Fagotti score and Fagotti-modified score under laparoscopy are used to see the probability of optimal cytoreductive surgery. CT score is combined with clinical characteristics to decide whether to perform a primary debulking surgery. Aletti score describes the complexity of a surgery. We also have a score system to predict  postoperative complications. PCI score uses to evaluate tumor load of pelvic cavity and peritoneum. Besides, Anne-Lucie Dessapt presented a R0 prediction model and Eisenkop proposed a five-region prediction model. Related Articles | Metrics

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Approach on Treatment of Vaginal Intraepithelial Neoplasia after Total Hysterectomy CHEN Yan-qin，HE Chun-ni，HONG Xin-ru 2018, 45 (5):  523-526.  Abstract ( 1751 )   PDF (738KB) ( 6335 )   Vaginal intraepithelial neoplasia (VAIN) is a line of precancerous lesions limited to the female vaginal epithelium. Current research suggests that HPV infection is the most important factor for VAIN. Continuous HPV infection is an independent risk factor for the progression of a VAIN disease. The patient is often subject to cervical intraepithelial neoplasia (CIN) concomitantly. Because of the pervasion of thin-cytologic test (TCT), screening rate has been increased and an early diagnosis has been achieved to improve the diagnosis rate. Persistent lesion or relapse of CIN2+ after antiviral therapy and loop electrosurgical excision procedure (LEEP), total hysterectomy becomes a treatment option caused by cervical or non-cervical factors. In the patients after total hysterectomy VAIN due to a variety of factors, such as the lack of specific clinical symptoms, limitation of lesions particularity and structure of the vagina, postoperative anatomical changes may result in delayed diagnosis and treatment, and there has been no clinical guidelines for the treatment of VAIN after total hysterectomy so far. This article reviews the progress of treatment of VAIN after total hysterectomy. Related Articles | Metrics

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Research Progress on the HPV Preventive Vaccine of Cervical Cancer JIANG Bo-ling，LU Yuan 2018, 45 (5):  527-530.  Abstract ( 1148 )   PDF (711KB) ( 6648 )   Human papillomavirus (HPV) is one of the common sexually transmitted diseases. High-risk human papillomavirus (hrHPV) persistent infection is a major risk factor for cervical precancerous lesions and cervical cancer. HPV types 16 and 18 cause about 70% of cervical cancer worldwide. Cervical cancer screening can reduce the risk of cervical cancer, but it can not prevent HPV infection. Many reports indicate that an effective HPV vaccine can reduce HPV-associated cervical cancer, genital tract spasm morbidity and mortality. Therefore, in order to prevent such diseases effectively, the research on HPV preventive vaccines has been carried out worldwide. At present, the HPV vaccines for clinical application include HPV 2-valent vaccine, 4-valent vaccine and 9-valent vaccine, which can effectively prevent the infection of the corresponding HPV type, and greatly reduce the incidence and mortality of cervical lesions and cervical cancer. This article reviews HPV, cervical cancer, the immunogenicity and number of inoculation doses and clinical application of these three types of HPV vaccines.. Related Articles | Metrics

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Clinical Characteristics of 7 Cases with Small Cell Carcinoma of the Ovary-hypercalcemic Type WANG Yao，YANG Jia-xin，YU Mei，CAO Dong-yan，ZHANG Ying, SHEN Keng，GUO Li-na 2018, 45 (5):  531-536.  Abstract ( 1324 )   PDF (3884KB) ( 6644 )   Objective：To analyze the clinical characteristics, diagnosis, treatment and outcomes of patients with SCCOHT. Methods：A retrospective analysis was performed on clinical and pathological data of 7 patients with pathologically confirmed SCCOHT between 1994 and 2018. Results：The average age of 7 cases was  (23.4 ±9.9) years old, with 5 cases younger than 30 years old. There were 4 cases in stage I, 2 in stage III, and 1 in stage IV. Abdominal pain, bloating and pelvic mass were the most common clinical presentation. The affected ovary of 6 patients was on the right side, 1 patient was on the left. Five patients (71.4%) had elevated serum calcium and 6 (85.7%) had elevated serum CA125 level at the time of diagnosis. All 7 patients were treated with surgery and platinum-based combination chemotherapy. Only 1 patient received radiotherapy after surgery. During the follow-up period of 2-120 months, only 2 patients survived more than 3 years, and the remaining 5 patients all died within 2 years of onset. Conclusions：SCCOHT is an uncommon and highly malignant tumor that usually occurs in young females with a dismal prognosis. The clinical manifestations are nonspecific and immunohistochemistry is an efficient method for diagnosis. The traditional treatments for SCCOHT are surgery and adjuvant platinum-based chemotherapy. The optimal regimen needs further study. Related Articles | Metrics

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Research Progress of COX-2, E-cadherin and PPAR-γ in Pre-eclampsia ZHANG Na-na, WANG Chen-hong 2018, 45 (5):  541-543.  Abstract ( 975 )   PDF (729KB) ( 6229 )   Pre-eclampsia (PE) is a specific disease of pregnancy, which seriously affects the health and safety of pregnant women and perinatal infants. The pathogenesis of PE is not yet clear. Cyclooxygenase-2(COX-2) is an important inducible isoenzyme in the inflammatory response. Its prostaglandin is an important inflammatory mediator. E-cadherin has the function of promoting mutual among cells，and it is a potential marker for identifying cell trophoblast cells. Peroxisome proliferator-activated receptor-γ(PPAR-γ) is involved in various physiological and pathological processes after ligand activation. In addition, COX-2 is associated with E-cadherin and PPAR-γ in the development of certain diseases, respectively. COX-2, E-cadherin and PPAR-γ are closely related to the onset of PE. The in-depth study of three factors can provide more clues for the pathogenesis of PE, thus providing new directions and ideas for the prediction, prevention and treatment of the disease. References | Related Articles | Metrics

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Research Progress of Biological Pathway Synergistic Effect and Premature Rupture of Membranes LIU Wen-cui，BAI Yu-fang，MU Wan-ru，LU Li，QI Cun-xiu，SU Zhan-hai，WANG Rong-hua 2018, 45 (5):  544-548.  Abstract ( 1092 )   PDF (746KB) ( 6102 )   Premature rupture of membranes（PROM） is a risk factor for increased fetal morbidity and mortality during perinatal period. Existing data and medical techniques are still difficult to accurately predict the occurrence of premature rupture of membranes, it is essential to understand the mechanism of PROM and accurately diagnose PROM to reduce maternal and child infections. Existing studies have found that cytokines, thrombin and matrix metalloproteinase activation, oxidative stress and apoptosis are the main biological pathways of PROM. These biological processes are caused by a variety of causes including infection, inflammation, placental hemorrhage and excessive uterine uterus. To explore the biological mechanism of PROM by combining the synergistic actions of various biological pathways with the weakening of the membrane and to find a breakthrough in the prediction and prevention of PROM is of great significance to modern medicine. References | Related Articles | Metrics

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Application of Abdominal Aortic Balloon Occlusion in the Cesarean Section for Patients with Pernicious Placenta Previa DING Nan，WU Hai-ying 2018, 45 (5):  549-552.  Abstract ( 1021 )   PDF (694KB) ( 6295 )   With the increase of cesarean section rate, the incidence of pernicious placenta previa is also increasing year by year, which leads to an uncontrolled bleeding during the childbirth, a high rate of uterus resection, and a difficulty in clinical treatment, thereby severely threatening the life of the pregnant woman. The cause of the pernicious placenta previa mainly involves with the imbalance between the uterine decidual development and the trophoblast invasion during scar formation after cesarean section. Accordingly, the ways of an effective control on the intro-partum and postpartum hemorrhage as well as of retaining the uterus of the patient is credited as the key to the success of the rescue for the pernicious placenta previa. Recent domestic and foreign physicians have explored the application of coupling the technique of abdominal aortic balloon occlusion in the cesarean section to control the risk of intraoperative bleeding and reduce the rate of hysterectomy. Although the technique of the abdominal aortic balloon occlusion is simple and easy to operate, with obvious hemostatic effect and clear surgical field, it also has many influencing factors and surgical complications. The knowledge to its value and risk is still in the stage of gradual understanding. For this end, the development process, advantages and limitations of the abdominal aortic balloon occlusion will be reviewed overall in this paper. Related Articles | Metrics

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Risk Factors of Pelvic Organ Prolapse for Unipara after Vaginal Delivery in Early Postpartum LU Bang-chun，ZHANG Lin-na，ZHANG Chen，FAN Jian-xia, XU Hong 2018, 45 (5):  553-556.  Abstract ( 1046 )   PDF (815KB) ( 6252 )   Objective：To investigate risk factors of pelvic organ prolapse(POP) in early postpartum period among unipara women after vaginal delivery. Methods: From January to April 2017，a total of 1 216 primiparous women after vaginal delivery were recruited． Pelvic organ prolapse was assessed at 6-8 weeks postpartum，using the Pelvic Organ Prolapse Quantification(POP-Q) system. Logistic regression analysis was used to estimate the relative odds of each factor. Results: Of 1 216 participants, 52.96%(644/1 216) had prolapse to or beyond the hymen as POP group. There were significant difference at age, delivery pregnancy week, infant birth weight and forceps delivery between the two groups(P＜0.05). There were no significant difference at BMI before pregnancy, BMI when delivery, ponderal growth during pregnancy ,the second period of delivery, perineal tear and episiotomy between the two groups(P＞0.05). The results of nonconditional multivariate Logistic regression analysis showed that compared with the maternal age under 28, the incidence of early postpartum POP with older maternal age(≥36 years) was significantly higher(OR=2.352，P=0.010，95%CI：1.222-4.526); Compared with the infant birthweight under 3 000 g, women with infant birthweight 3 500-3 999 g and over 4 000 g had higher risk of early POP postpartum(OR=2.039，P＜0.001，95%CI：1.385-3.003；OR=2.676，P=0.007，95%CI：1.303-5.495, respectively). Women who had forceps deliveries were more likely to have POP than women who had natural deliveries(OR=1.760，P=0.019，95%CI：1.097-2.034). Conclusions: Postpartum POP is relevant to a variety of factors including theage, infant birthweight and forceps delivery. The incidence of postpartum POP among primiparous women after vaginal delivery was high. Early prevention for POP and training should be strengthened，specially for those who were at risk of POP. Related Articles | Metrics

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Clinical Value of Fetal Echocardiography on High Risk Pregnancies between 11 and 16 Weeks′ Gestation LI Hui-dong, TIAN Zhi-yun, ZHANG Zhi-kun 2018, 45 (5):  556-559.  Abstract ( 1190 )   PDF (829KB) ( 6268 )   Objective：To evaluate the clinical value of fetal echocardiography on high risk pregnancies of congenital heart disease between 11 and 16 weeks′ gestation. Methods: 668 women with high risk pregnancies underwent fetal echocardiography between 11 and 16 weeks′ gestation in Tianjin central hospital of Gynecology and Obstetrics and Division of Cardiology, the Children′s Hospital of Philadelphia. Among them , 404 cases were screened with four-chamber view scanning methods and 264 cases with sequential segmental scanning methods. Results: Among all the high-risk pregnancies, the detection rate of complicated congenital heart diseases was 5.7%（23/404） by fetal echocardiography four-chamber view scanning methods and 9.5%（25/264） by sequential segmental scanning methods, there was no statistical difference （P＞0.05）. The detection rate of complicated congenital heart diseases in increased NT and cystic lymphangioma pregnancies was 2.5% （9/362） by fetal echocardiography four-chamber view scanning methods and 10.0%（7/70） by sequential segmental scanning methods, with was statistical difference（P＜0.05）. The detection rate of complicated congenital heart diseases between 12 weeks′ and 14 weeks′ by the two scanning methods were 5.9%（21/358） and 10.4%（8/77）, respectively, with no statistical difference （P＞0.05）。Conclusions: As more and more high risk factors, such as increased NT, cystic lymphangioma and fetal non-cardiac malformation, were found in early pregnancy, it was necessary to screen the fetal heart malformation at the same time. Four-chamber view was the most important and easily available section in fetal echocardiography, especially in the early stages. Four-chamber view scanning methods had a high practical and clinical application value for the detection of severe congenital heart disease. Early detection of severe congenital heart disease can reduce the damage to pregnant women themselves. Related Articles | Metrics

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Analysis of Influencing Factors of Delivery Time and Delivery Mode Selection in Pregnant Women with Scarred Uterus HUANG Cui-lian, WU Xuan-hua, LAI Dong-mei 2018, 45 (5):  560-563.  Abstract ( 1032 )   PDF (794KB) ( 6256 )   Objective：To explore the influencing factors of delivery time and delivery mode of scarred uterus. Methods：228 cases of pregnant women with uterine cicatricial pregnancy were selected as the subjects in the department of Obstetrics and Gynecology in the People′s Hospital of Longhua District from January 2015 to December 2017, and were divided into the second cesarean section group and the vaginal delivery group according to the difference of the final delivery mode. The clinical data of two groups of pregnant women were collected and compared. Results：107 cases of pregnant women successfully completed vaginal delivery, the success rate was 46.93%, and all pregnant women had no uterine rupture. Single factor analysis showed that there were significant differences between the two groups of pregnant women in age, educational level, prenatal BMI, the time of the last cesarean section, the history of vaginal delivery, the regular antenatal examination, the use of oxytocin, the thickness of scar, the present pregnancy week and the weight of the newborn (P＜0.05). Multiple factors analysis showed that age, prenatal BMI, the distance from the last cesarean section, the history of vaginal delivery, the periodic antenatal examination, the thickness of the scar and the weight of the newborn were the influencing factors of the choice of delivery mode. Conclusions：Vaginal delivery of scar uterus is safe. Pregnant women under 35 years of age, BMI＜30 kg/m2, more than 2 years from the last cesarean section, the cicatricial thickness≥3 mm, the estimated newborn weight ＜ 2 500 g and the regular antenatal examination of the uterine cicatricial uterus should be given vaginal delivery. Related Articles | Metrics

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Placenta Implantation Resected by Laparotomy Complicated by Fistulas: A Case Report and Literature Review LIN Kai-xuan, YANG Lin-dong, HAO Qun，SHUI Ying-chun, WU Yuan-zhe 2018, 45 (5):  563-567.  Abstract ( 1163 )   PDF (1782KB) ( 6283 )   Cesarean section is the most important risk factor while the incidence of placenta implantation appears to be increasing of late years. By comparison, uterine fistula is rare complication of uterus operation. A case transferred from the other hospital will be introduced in this article. The patient had her placental residue after her first vaginal delivery, which was followed by manual removal of placenta. Placenta implantation was proved by ultrasound and the placenta was bluntly resected by a laparotomy with the help of bilateral uterine arterial embolization. Postoperative lochia persisted and accompanied with abnormal taste, then uteroabdominal fistula occurred about 2 months later. We resected the fistula and remodeled the uterus after finishing the essory examination. The patient accepted sequential therapy of large dose of estrogen and progestogen to repair her endometrium. Three months later, the patient had her menstrual recurrence. Besides, this article reviews the high-risk factors, hazards, diagnosis and treatment of placental implantation, the application and complications of arteriovenous embolization, and the formation, diagnosis and treatment of uterine fistula. Our experience in treatment will be summarized at last. Related Articles | Metrics

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Research Progress of Endometrial Cell Exosome YANG Hong，LI Jia，HU Tian-qi，QI Cong 2018, 45 (5):  574-578.  Abstract ( 1193 )   PDF (741KB) ( 6562 )   Exosomes are nanometer-sized vesicles with a diameter of 30-100 nm that are released to the outside of the cell during environmental stimulation or cell activation. They can transfer the bioactive substances carried to adjacent or distant cells, resulting in biological effects. They are involved in many physiological processes such as substance transport, information transmission and immunosurveillance, inflammatory reactions, and the occurrence and development of tumors. There is an important role in the pathological process. Exosomes can be secreted by a variety of cells, and exosomes have been extracted in various body fluids such as saliva, urine, ascites, and pleural effusions. The research on exosomes mainly focuses on the relationship between exosomes and tumors, immune regulation and blood diseases. The research in gynecology is still in its infancy, and mainly on gynecological tumors. In recent years, exosomes have also been successfully extracted from the endometrium. Studies have shown that endometrium-derived exosomes have a certain degree in the process of embryo implantation, endometrial cancer, and endometriosis. The role has gradually become a research hotspot in the field of gynecology. Related Articles | Metrics

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Research Progress on the Effects of Th1/Th2 Balance Regulation on Gynecological and Obstetrical Diseases YANG Hua，ZHAO Lu，CHEN Xu 2018, 45 (5):  579-581.  Abstract ( 1209 )   PDF (716KB) ( 6308 )   Recent studies have found that the balance regulation of helper T cell type 1 (Th1) / Th2 is closely related to the occurrence, development, treatment and prognosis of pregnancy and gynecological diseases. Th1 cells regulate cellular immunity, mainly promoting inflammation and cytotoxic activities; Th2 cells regulate humoral immunity, mainly stimulating cell differentiation and proliferation, Th1 cells inhibit Th2 cells by synthesizing IFN-gamma, Th2 cells inhibit Th1 cells by synthesizing IL-4, and they interact and regulate each other. Th1/Th2 cell response is physiologically unbalanced in normal pregnancy, and maternal Th2 cytokines inhibit the production of Th1 cytokines. This physiological imbalance can lead to recurrent abortion, premature delivery, preeclampsia, infertility and other pregnancy-related diseases, and cervical cancer, ovarian cancer, endometriosis and other gynecological diseases related to Th1/Th2 balance regulation, but the exact immunological mechanism is still unclear. With a view to a variety of further studies, the immunological treatment of obstetrics and gynecology has opened up new prospects. Related Articles | Metrics

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Influence of Education Level and Fertility on Women′s Perimenopausal Symptoms WU Hong-yan，ZHANG Zhi-fen，WEI Shuang-shuang，HE Yi-ran，JIA Cen-lin，HUANG Jian 2018, 45 (5):  582-586.  Abstract ( 951 )   PDF (910KB) ( 6299 )   Objective：To investigate the association of female education level and fertility with their perimenopausal symptoms. Methods: A total of 2 917 perimenopausal patients in the outpatient clinic of gynecology were enrolled in this study. A questionnaire was used to survey basic information. The perimenopausal symptoms were evaluated by revised Kupperman Menopause Index (KMI). Results: The menopausal age is (49.42±3.57) years old in this study. There were statistically significant differences in menopausal age, number of births, number of abortions, number of pregnancies, waist-to-hip ratio, paresthesia, mood swings, depression, suspiciousness, and sexual problems among women of different education levels(all P＜0.05). The total scores of revised Kupperman Menopause Index were also significantly different among different education levels, the number of births and the number of pregnancies (all P＜0.05). Conclusions: The lower the education levels, the more times of the birth and pregnancy, and the higher of the revised Kupperman scores, than the more severe the perimenopausal symptoms. The clinical treatment of perimenopausal women with different education level and fertility status should be individualized. Related Articles | Metrics

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ACOG Committee Opinion Number 750 Perioperative Pathways: Enhanced Recovery After Surgery 2018, 45 (5):  586-586.  Abstract ( 897 )   PDF (585KB) ( 5984 )   Related Articles | Metrics

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The Inflammatory Pressure of Adenomyosis/Ovarian Heterotopic Cyst and Its Correlation with Clinical Characteristics CHEN Dan-dan，LIU Hai-lun，JIANG Cai-xia，LU Yu-xia，QU Xiao-yan，CHENG Zhong-ping 2018, 45 (5):  587-593.  Abstract ( 978 )   PDF (1032KB) ( 6239 )   Objective：To investigate the expression of peripheral blood inflammatory index in adenomyosis/ovarian heterotopic cysts systematicly and their correlation with clinical features, providing evidences for anti-inflammatory treatment of adenomyosis/ovarian heterotopic cysts. Methods：58 patients with uterine adenomyosis, 37 patients with ovarian heterotopic cysts, 47 age-matched women without diagnosed endometriosis (control group) were enrolled in our study. Blood inflammatory cytokines and tumor-associated antigens were analyzed by real-time polymerase chain reaction and immunofluore scence technique respectively. Results：The serum expression of Neu, Neu%, NLR, IL-6, IL-8, CA199 and CA125 in adenomyosis group was significantly higher than that in the control group (P＜0.05). The serum expression of HGB in adenomyosis group was significantly lower than that in the control group (Z=688.50, P=0.00). The serum expression of Neu, Neu%, NLR, IL-6, IL-8, TNF-α, CA199 and CA125 in ovary heterotopic cyst group was significantly higher than that in the control group (P＜0.05). WBC and CA125 were obviously higher in adenomyosis moderate dysmenorrhea group than in the mild dysmenorrhea group (P＜0.05). WBC, Neu, Neu%, NLR, IL-6 and IL-8 were significantly expressed in the severe dysmenorrhea group of adenomyosis compared with moderate dysmenorrhea group (P＜0.05). WBC, Neu, Neu%, NLR, IL-6, IL-8 and CA125 were significantly expressed in the severe dysmenorrhea group of adenomyosis compared with mild dysmenorrhea group (P＜0.05). The serum expression of HGB in  the severe and mild dysmenorrhea group of adenomyosis was significantly lower than that in the mild dysmenorrhea group (P＜0.05). WBC, Neu, Neu%, NLR, IL-6, IL-8, CA125 were clearly increased in adenomyosis hypermenorrhea group compared with normal menstruation group (P＜0.05). IL-6 and IL-8 were significantly expressed in the severe dysmenorrhea group of ovary heterotopic cyst compared with mild and moderate ovary heterotopic cyst group (P＜0.05). There was no significant correlation between tumor-associated antigenswere and peripheral blood inflammatory cytokines in adenomyosis/ovarian heterotopic cysts patients. Conclusions：Adenomyosis/ovarian heterotopic cysts was a state of systemic inflammatory stress and these indicators were associated with clinical features closely. The results are beneficial to provid a basis for anti-inflammatory treatment of adenomyosis/ovarian heterotopic cysts. Related Articles | Metrics

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Comparison of Uterine Cavity Shaped Ballon and Intrauterine Device in Preventing Intrauterine Adhesion after Hysteroscopic Uterine Septum Resection ZHANG Bo, YE Hong 2018, 45 (5):  593-595.  Abstract ( 1615 )   PDF (710KB) ( 6278 )   Objective：To explore the clinical effect of uterine cavity shaped ballon and intrauterine device (IUD) in preventing intrauterine adhesion (IUA) after hysteroscopic transcervical resection of uterine septum (TCRS). Methods: The clinical data of 65 patients with septate uterus were retrospectively analyzed. After surgery, 30 patients (group A) received uterine cavity shaped ballon and hormone replacement therapy, 35 patients (group B) received IUD and hormone replacement therapy. The hysteroscopic examination was performed after 3 months of surgery, the IUD was removed. The patients′ data were collected including menstruation, vaginal bleeding and lumbar or abdominal discomfort. Results: No IUA occurred in the two groups. During 3 months after surgery, in group A no lumbar or abdominal discomfort and abnormal uterine bleeding occurred，in group B 2 cases incarceration of IUD occurred with the incidence of 5.71%, 6 cases of lumbar or abdominal discomfort occurred with the incidence of 17.14% (P=0.027), 10 abnormal uterine bleeding occurred with the incidence of 28.57% (P=0.001), these symptoms relieved after removing IUD. Conclusions: No difference between the groups in preventing IUA after TCRS. Because of the side effects of IUD, uterine cavity shaped ballon is a more appropriate method. Related Articles | Metrics

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Two Cases of Pulmonary Embolism in Patients with Gynecological Diseases and Review of the Literature XIE Bao-li 2018, 45 (5):  596-600.  Abstract ( 1032 )   PDF (743KB) ( 6227 )   Pulmonary embolism is one of the rare and dangerous diseases in clinic. The rate of missed diagnosis and misdiagnosis is very high. The clinical manifestations of pulmonary embolism are lack of typical specificity, mild patients can be completely asymptomatic, while severe patients can die of sudden death once they become ill. The clinical manifestation and severity of pulmonary embolism are determined by the size and quantity of embolus, the location of embolism and the presence of heart, lung and other basic diseases. Common risk factors for pulmonary embolism include sedentary intolerance (such as prolonged bed rest and long driving), lower limb fractures, major surgery, a history of venous thromboembolism, malignancies, and oral contraceptives. The clinicians should learn to recognize the high risk factors of pulmonary embolism. Patients with gynecological diseases with high risk factors should be alert to the possibility of pulmonary embolism once they have unexplained symptoms or clinical manifestations of pulmonary embolism. Early diagnosis and thrombolytic therapy are the key to successful rescue. Related Articles | Metrics