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15 June 2019, Volume 46 Issue 3
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The Relationship between Tumor Necrosis Factor Related Apoptosis-Inducing Ligand and Its Receptors and Cervical Cancer ZHANG Di, LI Xiao-lan 2019, 46 (3):  245-248.  Abstract ( 1243 )   PDF (773KB) ( 7354 )   Cervical cancer is one of the most common malignancies of the female reproductive system. At present，in addition that operation, radiotherapy and chemotherapy were used to treat the cancer, oncobiology therapeutic methods are getting more and more important. Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) is one of the newly discovered tumor necrosis factor super family members. It binds to specific receptors on the surface of the cytomembrane. Through activation of caspase or mitochondrial dependent pathway, tumor cells were selectively induced to apoptosis and normal cells could escape. This property makes it considered as a potential target therapeutic factor in oncotherapy. It has extremely important clinical value. Studies found that TRAIL and its receptors were abnormally expressed in cervical cancer tissue, which has become the research hotspot in recent years. Therefore, this article reviews the structure and biological function of TRAIL and TRAIL receptors, their expression in cervical cancer epithelial cells and the research progress. Related Articles | Metrics

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Progress in Research on Uterine Sarcoma TAO Sheng-nan，ZHOU Ying，SUN Jin，YE Gui-ping，HU Lai-hua，HU Wei-ping 2019, 46 (3):  249-252.  Abstract ( 1930 )   PDF (716KB) ( 9756 )   Uterine sarcoma is a malignant tumor that occurs in the female genital system. Its incidence is low and its prognosis is poor. Its manifestations mainly include abnormal vaginal bleeding, abdominal pain and abdominal mass. Serological indicators such as serum lactate dehydrogenase, serum neutrophil to lymphocyte ratio (NLR), and ultrasound and magnetic resonance examinations can assist in the preoperative diagnosis of uterine sarcoma, but the diagnosis still depends on postoperative pathology. Uterine sarcomas include three pathological types: uterine leiomyosarcoma, endometrial stromal sarcoma and uterine adenosarcoma. Whole uterus and double attachment resection are standard surgical methods, and adjuvant treatment can be selected according to different pathological types and surgical stages. This article summarizes the clinical manifestations, auxiliary examinations, pathological features, treatment and prognosis of uterine sarcoma by consulting domestic and foreign literature. Related Articles | Metrics

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Overview of Lynch Syndrome-Associated Tomors SI Jing-wen，SHEN Yan 2019, 46 (3):  253-258.  Abstract ( 1281 )   PDF (1069KB) ( 7523 )   Lynch syndrome is a recognized hereditary tumor syndrome, which is the most common cause of hereditary colorectal cancer and the only known cause of hereditary endometrial cancer. Lynch syndrome-associated tumors also include ovarian cancer, gastric cancer, urothelial cancer and small bowel cancer. While we have known the mechanism of Lynch syndrome is mismatch repair deficiency and microsatellite instability, there have been new advances recently in their diagnosis and molecular pathogenesis, which suggests that different mismatch repair deficiency corresponds to different Lynch syndrome-associated tumors and different incidence, and produces new impact on the surveillance of patients, with the treatment methods constantly enriched and improved. For example, positive results have been achieved in the treatment of Lynch syndrome-associated tumors using the immune effects of microsatellite instability. We will introduce the genetic characteristics, diagnosis of Lynch syndrome and clinicopathological characteristics, treatment of its associated tumors, and the recent progress will be highlighted. Related Articles | Metrics

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Bisphenol A Induced Endometrial Cancer Cell Proliferation by Activating PI3K/AKT Pathway LIU Da-jiang，YANG Yuan，LIU Chang，YANG Yong-xiu 2019, 46 (3):  259-262.  Abstract ( 1066 )   PDF (914KB) ( 7180 )   Objective：To explore the mechanism of bisphenol A on the proliferation in human endometrial cancer cells (Ishikawa and RL952) via PI3K/AKT signaling pathway. Methods：CCK8 assay was used to detect the proliferation in Ishikawa and RL952 cells, and Western blotting was applied to observe the expression of phosphorylation-AKT. Results：Ishikawa and RL952 cells proliferation increased significantly with treatment of 1 μmol/L BPA after 48 h, and cell proliferation was (0.758±0.023) and (0.692±0.042) respectively (P＜0.01). The proliferation effect decreased when BPA was more than 1 μmol/L. Ishikawa and RL952 cells did not increase after treated for 24 h. Cytotoxic effects were showed after BPA treated for 72 h. After 1 μmol/L BPA treated for 48 h, p-AKT expression was increased significantly compared with controls（P＜0.05）. When PI3K was blocked by LY294002, p-AKT expression was decreased, but it is not significant compared to controls (P＞0.05). Conclusions：Bisphenol A induced endometrial cancer cell proliferation by activating PI3K/AKT pathway. Related Articles | Metrics

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Villoglandular Adenocarcinoma of the Uterine Cervix：Clinical Analysis of 36 Cases ZHANG Qiong-ying，HOU Wen-jing，ZHANG Meng-zhen 2019, 46 (3):  262-265.  Abstract ( 1325 )   PDF (812KB) ( 7195 )   Objective：To discuss the clinical features，treatment and prognosis of villoglandular adenocarcinoma of the uterine cervix(VGA). Methods: We retrospectively reviewed data on age distribution, clinical features, human papillomavirus(HPV) and TCT results, treatment and prognosis of the 36 patients with VGA, who had been treated and followed up from January 2013 to April 2018 in the First Affiliated Hospital of Zhengzhou University. Results: In the same period of 323 cases of cervical adenocarcinoma, VGA accounted for 11.15% (36/323). The average age of the 36 patients with VGA is 44.61±7.93 years (range 25-67 years). The most common clinical symptoms were cervical contract (33.3%) and irregular vaginal bleeding (33.3%). International Federation of Gynecology and Obstetrics (FIGO) stage ⅠB1 disease was found in 26 patients, ⅠB2 in 5, ⅡA1 in 3, ⅡB in 2. HPV was performed in 26 patients before treatment. 21 patients were positive (80.77%), and 5 patients were negative for HPV (19.23%). 35 patients were treated with radical hysterectomy with pelvic lymphadenectomy，6 young ⅠB patients retained ovary during operation;1 patient received concurrent chemoradiation therapy. Followed up 4 to 59 months, 2 patients died of recurrence, and the remaining 34 survived without tumor recurrence (includes 6 patients with ovarian retention). Conclusions: The incidence of VGA is very low. Its occurrence is closely related to high-risk HPV infection. Most patients are found in the early clinical stage. The degree of tumor differentiation is relatively good, and the depth of invasion is shallow. Ovarian metastasis, lymphatic vessel infiltration and lymph node metastasis are rare, the prognosis is better. Young patients who stay in early stage may consider retaining the ovaries after excluding high risk factors of ovarian metastasis. Related Articles | Metrics

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A Case Report of Ovarian Mature Teratoma with Peritoneal Gliomatosis HU Chao, ZHU Cheng-cheng, ZHAN Yi-qing, LU Kai-jun, ZHANG Yi-qing 2019, 46 (3):  265-268.  Abstract ( 1046 )   PDF (713KB) ( 7163 )   Gliomatosis peritonei（GP） is a rare disease. Up to now, only more than 100 cases have been reported. The typical clinical manifestations are benign and mature glial tissue widely distributed in the peritoneum, often coexisting with ovarian immature teratoma. Clinically, it is necessary to undergo a thorough biopsy to identify the mature glial tissue before the diagnosis can be confirmed. Treatment is mostly associated with primary tumors，but because of the rarity of the disease, a standard treatment scheme has not yet been established. In addition, because of the possibility of malignant transformation in a few cases, long-term follow-up is needed. In recent years, new progress has been made in the pathogenesis, treatment and follow-up of GP. Therefore, the research progress of GP is discussed in this paper to provide reference for subsequent treatment. Related Articles | Metrics

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Stromal Luteoma of The Ovary: A Case Report and Literature Review LIU Yao, YAN Fei, TANG Ju, WANG Chao-qun, YANG Ling 2019, 46 (3):  269-271.  Abstract ( 1002 )   PDF (662KB) ( 7262 )   Steroid cell tumors account for less than 0.1% of all ovarian tumors. There are three steroid cell tumor subtypes: stromal luteoma, Leydig cell tumor and steroid cell tumor not otherwise specified (NOS). Stromal luteoma is a rare disease. The clinical manifestations of stromal luteoma are unspecific, so it is hard to diagnosis before operation. In this study, we report a case of 47-year-old female who suffers from stromal luteoma. And we review the literatures about the case reports systematically. And we found that the diagnosis of ovarian stromal luteoma is based on abnormal uterine bleeding and pathology, and surgery is the most important treatment method. Related Articles | Metrics

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Primary Malignant Lymphoma of Female Reproductive System: A Case Report and Literature Review WANG Min，MA Shuai，WANG Yu-jia，ZHAO Zhe，ZHAO Shu-hui，YANG Shu-li 2019, 46 (3):  272-274.  Abstract ( 881 )   PDF (680KB) ( 7094 )   Malignant lymphoma is a rare tumor. For malignant lymphomas originating from the female reproductive system, non-Hodgkin′s lymphomas are relatively more common. Among them, diffuse large B-cell lymphoma is the most common, while Burkitt′s lymphoma is very rare. Due to the atypical clinical manifestations and the lack of effective auxiliary examinations, preoperative diagnosis is difficult, and it is easily confused with other benign and malignant tumors of the female reproductive system. And the disease is highly malignant, invasive, easy to metastasize, and the prognosis is extremely poor, so clinicians must pay enough attention. In this paper, we retrospectively analyze the data of a patient with Burkitt′s lymphoma, and review the relevant literature to further explore its origin, clinical manifestations, diagnosis and treatment, in order to deepen the understanding of clinicians and improve the ability of diagnosis and treatment. Related Articles | Metrics

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Chilaiditi Syndrome after Cervical Cancer Surgery：A Case Report and Literature Review WANG Qi，WANG Ling，XU Meng-qiu，TIAN Di，HAN Li-ying 2019, 46 (3):  275-277.  Abstract ( 863 )   PDF (1052KB) ( 7190 )   Interposition colon syndrome (Chilaiditi syndrome) was first proposed by Cantini in 1865. If there are only the imaging changes but no clinical symptoms, it is known as Chilaiditi sign. If there are symptoms, it is known as Chilaiditi syndrome. The incidence of Chilaiditi sign is extremely low, only 0.025%-0.28%, which is more common in male and elderly patients. The diagnosis of Chilaiditi sign mainly depends on X-ray, CT and ultrasound. Chilaiditi syndrome is easy to be misdiagnosed as intestinal obstruction, pneumoperitoneum, etc., and should be differentiated in clinical practice to avoid misdiagnosis and mistreatment. A 66-year-old female patient admitted to our hospital on October 16, 2018 was hospitalized with cervical cancer. After admission, the patient underwent extensive transabdominal hysterectomy + bilateral adnexectomy + bilateral pelvic lymph node dissection. The patient was complicated with Chilaiditi syndrome on the 2nd day after surgery, which led to respiratory distress and continuous decrease in blood oxygen saturation. After the diagnosis of Chilaiditi syndrome, the patients were given conservative symptomatic treatment, such as transanal intestinal obstruction catheterization, active control of pulmonary infection, and correction of hypoxemia. This paper reported the case and reviewed relevant literature. Related Articles | Metrics

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Management and Long-Term Rehabilitation of Chronic Metabolic Diseases in Pregnant Women with Advanced Maternal Age LU Sha，HU Wen-sheng 2019, 46 (3):  278-282.  Abstract ( 745 )   PDF (764KB) ( 7051 )   At present, the proportion of pregnant women with advanced maternal age is increasing. The risk of diabetes, hypertension, hyperlipidemia, obesity and other metabolic diseases increases with age. And age is an independent risk factor for these diseases. Therefore, women with advanced maternal age will have greater risks than younger ones, and need better management. However, there are lacks of attention on postpartum management and long-term rehabilitation of those patients. Health care is still limited. In order to improve the health quality of pregnant women with advanced maternal age, we will review the management of postpartum chronic metabolic diseases in this article. Obstetricians should pay more attention to pregnant women with advanced maternal age. We recommend a comprehensive follow-up concept to strengthen the standardized management of these women after delivery. They need a regular detection of blood sugar level, blood lipid level, blood pressure, body mass and waistline to reduce the risk of future metabolic diseases. Related Articles | Metrics

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The Research Advances in the Mechanism of Placental Development HAN Si-yang，QIN Xin-ran，XUE Chun-ran，PENG Qi-hua，WANG Ying-jin，DING Zhi-de 2019, 46 (3):  283-288.  Abstract ( 856 )   PDF (819KB) ( 7415 )   The placenta is an important communicating organ between the mother and the fetus, and its normal development is crucial for the growth and development of the fetus. The formation and development of placenta is greatly relevant to some factors, such as gender, epigenetics and external environment. For example, the gender affect the expression of sex hormone genes in male or female fetal placenta respectively, and the sex hormone synthesis gene STS in X-linked genes tends to express in female fetal placenta. Moreover, the expression of LHB-CGB gene cluster also tends to express in female fetal placenta, and its expression products such as luteinizing hormone and hCG are closely related to the growth, invasion and angiogenesis of placenta. On the other hand, the reconstructive process of methylation in epigenetics affects the early development of placenta, such as the inhibition of DNA methylation during early embryonic development can disrupt the proliferation and migration of trophoblasts. In addition, the growth of placenta requires a hyperoxic environment, and the decline of oxygen level can directly impair placental volume, development and maturation by inducing increases in the activity of hypoxia-inducible factor (HIF). To review a series of changes during placental development and their effects on the varied physiological functions, such as epigenetics and changes of vascular structure, are essential for elucidating the mechanism of embryonic development and the maternal and infant safety as well. Related Articles | Metrics

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The Role of Placenta Exosomes in Pregnancy Complications Associated with Dysfunctional Remodeling of Uterine Spiral Arteries XU Xin-ran，WANG Yan-ping，CUI Hong-yan 2019, 46 (3):  288-292.  Abstract ( 804 )   PDF (792KB) ( 7077 )   Uterine spiral artery remodeling is accomplished by the interaction between the maternal vascular endothelial cells, smooth muscle cells, immune cells and placenta trophoblast cells. Cell-to-cell communication plays an important role in the process. Our understanding of how cells communicate has undergone a paradigm shift since the finding of the role of exosomes in intercellular signaling. Exosomes are automatically secreted homogenous membrane vesicles with a diameter of 40-100 nm which have been found to be released by various cell types and isolated from biological fluids. Exosomes carry a variety of mRNA, microRNA and proteins which play an important role in cell-to-cell communication. Studies have shown that exosomes can be released by placenta trophblast. Placenta exosomes can be identified and isolated in maternal blood which carry informations of trophblast acting on the target cells. The biological functions of placenta exosomes include regulating immune tolerance, remodeling of uterine spiral arteries, promoting angiogenesis and formating the placental barrier，ect. This article summarized the characteristics and functions of placenta exosomes and the changes in pregnancy complications associated with dysfunctional remodeling of uterine spiral arteries, to explore the clinical value of placenta exosomes as a serum marker in diagnosis of pregnancy complications. References | Related Articles | Metrics

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Research Progress of Placental Growth Factor in High-Risk Pregnancy KUANG De-feng，HUA Shao-fang 2019, 46 (3):  293-296.  Abstract ( 1078 )   PDF (722KB) ( 7248 )   Pregnancy is a complex physiological process. The placenta is the bridge between maternal and child and plays an important role in the growth and development of the fetus and change on maternal physiological function which regulates maternal and child circulation through nutrition, metabolism, exchange, endocrine and other functions. Normal development and physiological function of placenta are the preconditions to maintain pregnancy and fetal growth and development. Placental formation and dysfunction are closely related to the occurrence of hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR), abortion and Down′s syndrome (DS). Placental growth factor (PlGF) is an important growth factor which is richly expressed in placenta and has high homology with vascular endothelial growth factor (VEGF). PlGF is mainly secreted by trophoblast cells and villi interstitial endothelial cells and plays an important role in the proliferation, activation of trophoblast cells and the formation of fetal-placental vascular network. Therefore, in-depth study of PlGF is of great significance for etiological research and clinical monitoring on placenta formation abnormality related diseases. Related Articles | Metrics

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The Advantages and Disadvantages of Uterine Artery Embolization in the Treatment of Uterine Scar Pregnancy LI Ping-fen，WANG Qu-yuan 2019, 46 (3):  297-300.  Abstract ( 1059 )   PDF (717KB) ( 7289 )   Uterine scar pregnancy refers to a woman who has a previous history of cesarean section or uterine cavity operation. During the post-operative pregnancy, the embryo tissue is implanted in the scar of the uterus. The incidence of scar pregnancy increased year by year and the degree of harm to mother and baby was relatively high. With the wide application of uterine artery embolization (UAE) in the treatment of uterine scar pregnancy, it has shown significant advantages in reducing bleeding, retaining the uterus and reducing the death rate. But at the same time, some serious adverse complications, such as pain, amenorrhea, intrauterine adhesion and reduced reproductive function, have been gradually revealed. Currently, the therapeutic effect is still not ideal. By elucidation of the advantages and disadvantages of UAE in the treatment of uterine scar pregnancy, the better therapeutic effect can be achieved by improving the technique of UAE. Related Articles | Metrics

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Influence of Preconception Over-Weight and Obesity on Gestational Weight Gain and Pregnancy Related Prognosis JIANG Xiang, BIAN Zheng, YUAN Ling, WANG Wei-lin, YING Hao 2019, 46 (3):  301-304.  Abstract ( 803 )   PDF (810KB) ( 7068 )   Objective：To assess the influence of preconception over-weight and obesity on gestational weight gain and other pregnancy prognosis. Methods：We collected data of singleton pregnancies delivered in our hospital from Jan 2015 to Dec 2017. All cases were divided into three groups(over-weight, obese and normal-weight) according to preconception body mass. Comparison was conducted among the three groups on the weight gain during pregnancy and pregnancy related prognosis. By multivariate analysis, the effect of preconception over-weight and obese on weight gain during pregnancy and other pregnancy outcome were clarified. Results：1 080 cases with complete data were included: 496 overweight cases, 44 obese cases and 540 control cases. The preconception BMI of over-weight, obese and normal-weight group were 26.3(2.0) kg/m2, 31.3(2.9) kg/m2 and 20.7(2.5) kg/m2 respectively. The over-weight and obese groups developed more above-gainers than the normal weight group(63.9%,72.7% vs. 41.3%). The risks of pre-eclampsia, GDM, cesarean section were higher than the normal weight group. The over-weight and obese group demonstrated higher average birth weight [(3 528.0±397.4) kg, (3 562.6±417.6) kg vs. (3 387.8±384.5 kg)] and high risk of macrosomia (12.3%, 15.9% vs. 5.0%). By multivariate analysis, preconceptional over-weight (OR=3.071, 95%CI: 2.345-4.022) and obese (OR=5.113, 95%CI: 2.507-10.431) exerted significant effect on the risk of exceeding the Institute of Medicine(IOM) recommended weight gain range and also the risk of pre-eclampsia, GDM, cesarean section and macrosomia. Conclusions：Preconception over-weight and obesity has significant influence on the result of gestational weight gain(especially the risk of over-gainer) and perinatal outcomes including pre-eclampsia, GDM, cesarean section and macrosomia. Therefore it is crucial to initiated body weight control before pregnancy especially for overweight and obese women. Related Articles | Metrics

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Clinical Analysis of 19 Cases of Unplanned Reoperation after Cesarean Section WANG Yin, ZHANG Xiao-bao 2019, 46 (3):  305-309.  Abstract ( 838 )   PDF (937KB) ( 7147 )   Objective：Analyze the causes and risk factors of unplanned reoperation in cesarean section patients, and illustrate the precautions for reoperation, to improve the identification of risk factors and explore ways to reduce and avoid reoperations. Methods：The clinical data of 19 patients with cesarean section who had undergone unplanned reoperation from January 2013 to July 2017 in Department of Obstetrics of Anhui Women and Children Health Hospital were retrospectively analyzed. Results：The incidence of unplanned reoperation after cesarean section was 0.06%（19/31 136）. The indications for cesarean section included: placental factors in 6 cases, multiple pregnancies in 4 cases, scarred uterus in 4 cases, cephalopelvic disproportion in 2 cases, social factors in 2 cases, and macrosomia in 1 case. The first operation included 15 elective patients and 4 emergency patients. The main indications for re-exploration were 7 cases of postpartum hemorrhage due to uterine inertia, 4 cases of placental factors, 2 cases of abdominal wall hematoma, 2 cases of bladder rupture, 2 cases of intra-abdominal hemorrhage, 1 case of uterine incision, and 1 case of uterine incision infection. Reoperation: 7 cases undergoing hysterectomy, 3 cases of abdominal hematoma removal, 2 cases of B-lynch suture, 2 cases of abdominal hematoma removal, 2 cases of bladder repair, 1 case placed Bakri ballon for postpartum hemorrhage, 1 case underwent laparoscopic uterine incision repair, and 1 case underwent laparoscopy. Nineteen patients were cured without death. Conclusions：The main reason for unplanned reoperation in cesarean section patients is postpartum hemorrhage caused by uterine inertia. The first indications for placental factors, multiple pregnancy, and scared uterus are higher risk of unplanned reoperation. Although the incidence is not high, the adverse consequences caused are serious and corresponding measures must be taken to reduce and avoid the occurrence of unplanned reoperation. Related Articles | Metrics

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Effects of Zinc Deficiency during Pregnancy on Methylation and Histone Acetylation of Fetal Cardiac GATA4 and Nkx2.5 Gene Promoters in Rats LIU Chao-bin, HONG Xin-ru, ZHANG Qun-fang, XIE Xi, WANG Qing, LIN Shun-he, WANG Zhen-hong, SUN Qing-hua 2019, 46 (3):  310-315.  Abstract ( 737 )   PDF (902KB) ( 7012 )   Objective：To investigate the changes of methylation and histone H3K9 acetylation in CpG sites of cardiac-specific transcriptor factors GATA binding protein 4 (GATA4) and NK2 homeobox 5 (Nkx2.5) gene promotors induced by zinc deficiency during pregnancy in rats. Methods: SD rats were randomized into either of the zinc deficient group, zinc sufficient group or paired feeding group (n=9 for each group). The rats in the three groups were fed by feedstuff which contains 2.8, 29.8 or 29.8 μg zinc element per gram, respectively. The quantity of feedstuff uptaken by the rats from the paired feeding group was comparable to that from the zinc deficient group. Copulation was performed 14 days after the zinc-deprived treatment began, and the same feedstuff feeding procedure was stretched till gestation day 19. The fetal hearts were then harvested. Zinc concentrations in the fetal blood and cardiac tissues were quantified. Levels of methylation and histone H3K9 acetylation in CpG sites of GATA4 and Nkx2.5 gene promotors were assayed. Results: ①The zinc levels in the blood were significantly different among the three groups. It was significantly lower in the zinc deficient group than in the zinc sufficient group (P＜0.001) and paired feeding group (P=0.014), and there was no significantly difference between the paired feeding group and zinc sufficient group (P=0.109). ②Levels of methylation in the promotor CpG sites for GATA4 and Nkx2.5 genes were significantly different among the three groups(P＜0.05). Level of methylation in the zinc deficient group was significantly higher than that in the zinc sufficient group (P=0.005; P=0.024) or paired feeding group (P＜0.001; P=0.029), whereas no significant difference was found between the paired feeding group and zinc sufficient group (P=0.497; P=0.929). ③Levels of histone H3K9 acetylation in the promotor CpG sites for GATA4 and Nkx2.5 genes were significantly different among the three groups, which were significantly lower in the zinc deficient group than those in the zinc sufficient group (P=0.018; P=0.033) or paired feeding group (P=0.007; P=0.007). No significant difference was found in these parameters between the paired feeding group and zinc sufficient group (P=0.701; P=0.512). Conclusions: The results indicate that zinc deficiency during pregnancy could induce alterations of methylation and histone H3K9 acetylation in CpG sites of GATA4 and Nkx2.5 gene promotors, which suggests a possible role of epigenetic mechanisms of cardiac transcription factors in the fetal heart maldevelopment induced by zinc deficiency during pregnancy. Related Articles | Metrics

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Analysis of Serum Metabolic Profiling of Pregnant Women with Pre-Eclampsia TAN Bing, MA Ya-nan, ZHANG Lei, LI Ni, LIU Shu-ye 2019, 46 (3):  316-320.  Abstract ( 838 )   PDF (971KB) ( 7051 )   Objectives To study the changes of serum metabolic profile before and after pregnancy in preeclampsia,to establish a disease differentiation model and to screen out characteristic metabolites with potential clinical diagnostic value. Methods The subjects were 20 cases of eclampsia of pregnancy (group PE)(44.4%)and 25 normal pregnant women (group Control)(55.6%)from September 2017 to March 2018.All the serum samples were analyzed by using the super high performance liquid chromatography and mass spectrometry (UPLC-MS). Based on the multivariate statistical analysis method of pattern recognition, we analyzed the experimental data and analyzed the trend of the differential characteristic metabolites.Results The serum metabolic profile principal component analysis model (PCA) and the orthogonal partial least square (OPLS-DA) discriminant model of the pregnancy eclampsia group were constructed. At the same time, 5 kinds of Characteristic Metabolites in the serum of the patients with eclampsia in the normal pregnancy group were screened and identified,They are LysoPC(18:0)、LysoPC(22:6)、(S)-14-Methylhexadecanoic acid、Behenic acid、1,25-Dihydroxyvitamin D3-26,23-lactone , and LysoPC(18:0)、LysoPC(22:6)、(S)-14-Methylhexadecanoic acid existed between the pre operation group and the postoperative group. The difference was statistically significant (P<0.05). Conclusions The construction of metabolic profile discriminant model has a strong ability of patients with preeclampsia and normal pregnant women. Screening out characteristic metabolites can reflect the state of lipid metabolism in early preeclampsia, and provide reference and help for the prediction and diagnosis and treatment of eclampsia, The characteristic metabolites can reflect the changing trend of the patient's metabolic level and provide reference and help for the prediction, diagnosis and treatment of PE. Related Articles | Metrics

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The Clinical Analysis of 160 Cases of Undiagnosed Postpartum Hemorrhage DUAN Yao, LIU Xin, HU Chen-yu 2019, 46 (3):  321-326.  Abstract ( 781 )   PDF (923KB) ( 7171 )   Objective：To discuss the causes，clinical characteristics, influence factors and preventions of undiagnosed postpartum hemorrhage（UDPPH）． Methods: 1 528 cases of vaginal delivery from January 2013 to December 2017 were retrospectively analyzed，and were divided into three groups: UDPPH group, postpartum hemorrhage (PPH) group and control group(those cases with neither UDPPH nor PPH). The clinical characteristics and influence factors of UDPPH group were analyzed and compared with those of PPH group． Results: The incidence of UDPPH and PPH was 10.5% and 6.1% of vaginal deliveries, respectively. The antepartum hemoglobin of UDPPH group and PPH group were both lower than that of the control group. The gravidity, the total duration of labor, duration of the third stage of labor, the incidence of retained placenta and perineal trauma were all higher than those of the control group (P＜0.05), with statistical differences between them. The rates of primiparity and episiotomy in UDPPH group were higher than those of the control group (P＜0.05), and there were statistical differences between them. But there were no significant differences in the rates of primiparity and episiotomy between PPH group and control group. The rates of primiparity and episiotomy were the influence factors those UDPPH were different from PPH. Conclusions: UDPPH is frequent among women giving birth vaginally. To reduce the incidence，we need to strengthen the observation after delivery，estimate blood loss accurately and prevent it according to the influence factors. Related Articles | Metrics

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Analysis of Pregnancy Outcome of Moderate and Severe Intrauterine Adhesions after Transcervical Resection of Intrauterine Adhesions CHEN Fang，ZHANG Ying，CHENG Jiu-mei 2019, 46 (3):  326-330.  Abstract ( 859 )   PDF (884KB) ( 7214 )   Objective：To investigate the pregnancy outcomes and its related influencing factors of moderate and severe intrauterine adhesions after transcervical resection of intrauterine adhesions(TCRA). Methods: One hundred and forty-five patients with moderate-to-severe IUA (IUA score ≥5) with fertility dysfunction who were diagnosed at the Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2014 to December 2016 were selected. The pregnancy outcome after TCRA was followed-up and the factors that may affect pregnancy were analyzed. Results: ①Among 145 patients with moderate to severe IUA, the pregnancy rate after TCRA was 46.9% (68/145), the natural conception rate was 54.4% (37/68), and artificial assisted conception rate was 45.6%(31/68); The pregnancy rate of secondary infertility was 45.8%(33/72), that of the adverse pregnancy history and the primary infertility was 48.3%(28/58), 46.7%(7/15) respectively. The postoperative pregnancy rate in patients with moderate IUA and severe IUA were 64.9% (48/74) and 28.2% (20/71), respectively. The pregnancy rate of patients with pregnancy-related curettage ≥ 3 times was 36.6%(34/93), while the others was 65.4% (34/52). The pregnancy rates of patients with normal menstruation, menstruation reduction and amenorrhea preoperatively were 73.1%（19/26）, 48.8% (40/82) and 24.3%(9/37), respectively. The pregnancy rate of of patients with normal menstruation, menstruation reduction postoperatively was 54.6% (59/108) and 28.6% (8/28) respectively. Among 28 patients with re-adhesion, only two patients with mild adhesions were pregnant (7.1%, 2/28). 41.2% (28/68) of pregnancies had abortion or spontaneous abortion before 12 weeks of gestation and 58.8% (40/68) were reached to live births, with the mean gestational age of 38±1 weeks (32 to 41 weeks), and mean body weight of 3 467± 461 g (1 800 to 4 400 g). For obstetric complications, there were 2 cases of placenta previa, 6 cases of postpartum hemorrhage, and 2 cases of blood transfusion. No uterine rupture occurred. ②Multivariate logistic regression was performed by stepwise regression.Only pregnancy-related curettage, preoperative adhesion, and postoperative re-adhesion were found to be independent predictors of postoperative pregnancy outcomes (P＜0.05). Conclusions: Even after TCRA surgery to restore uterine cavity morphology, the pregnancy rate of moderate to severe IUA is still low, especially the patients with recurrence of IUA. So pay attention to the protection of residual endometrium during surgery, and take effective measures to promote endometrium regeneration and prevention of re-adhesion after surgery are the key to treatment. Related Articles | Metrics

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One Case of Successful Term Labor after Comprehensive Treatment of Rectal Cancer and Literature Review ZHANG Hong，BAI Yu-fang，MU Wan-ru，NAN Lian-ling，LI Jie 2019, 46 (3):  331-333.  Abstract ( 803 )   PDF (716KB) ( 6977 )   Rectal Cancer is a common malignant tumor in the digestive tract. At present, the cause of it isn′t clear. Miles surgery, named abdominal perineectomy (APR), is the most commonly used radical surgery for low rectal cancer. Postoperative perineal tissue is weak, and significant changes have taken place in the patient′s physiology and psychology. FOLFOX6 is a commonly adjuvant chemotherapy for postoperative colorectal cancer. At present, patients with successful term labor after comprehensive treatment of rectal cancer are rare. This paper introduces a case of successful term labor after comprehensive treatment of rectal cancer in the Affiliated Hospital of Qinghai University, and discusses the epidemiological characteristics of rectal cancer, the interaction between radical resection of rectal cancer (Miles surgery), adjuvant chemotherapy and pregnancy. Related Articles | Metrics

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A Case of Perimortem Cesarean Section Successfully Used to Rescue a Pregnant Woman with Compound Injuries and the Fetus QIN Sheng, SHENG Fu-ting 2019, 46 (3):  334-336.  Abstract ( 828 )   PDF (700KB) ( 7054 )   Sudden compound trauma can be life-threatening for a pregnant woman in her third trimester. In view of such rare emergencies, this paper tries to discuss how to rescue pregnant women and fetuses and when to periform a perimortem cesarean section based on the condition of the pregnant woman and the fetus, in order to provide more effective reference for similar cases in the future. This article suggests that if spontaneous circulation can not return after active and effective cardiopulmonary resuscitation, perimortem cesarean section should be considered. Further rescue after cesarean section is beneficial for both the mother and the fetus. Related Articles | Metrics

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Guide Interpretation / Contrast the Guidelines for Gestational Diabetes Mellitus about ACOG in 2018 and ADA in 2019 CHEN Jia，LI Ying-tao，WANG Zhen-yu，ZHONG Cai-juan，LIANG Li-xuan 2019, 46 (3):  336-341.  Abstract ( 844 )   PDF (866KB) ( 7170 )   The prevalence of Gestational Diabetes Mellitus has been increasing in the world，It is not only associated with perinatal adverse events for mother and fetus, but also increases the risk of metabolic diseases in mother and off spring in the long term. However, there are still many controversies about the diagnosis and treatment in Gestational Diabetes Mellitus. ACOG in 2018 and ADA in 2019 had issued updated guidelines for GDM in order to provide the latest suggest for management of GDM. It is the guiding documents for the diagnosis and treatment of GDM in the United States. Two guidelines have been comparative analysed. Related Articles | Metrics

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Research Advances in the Function of Resveratrol on Hyperandrogen-Induced Abnormal Acetylation of Ovarian Cells LIU Bin, XU Qian, WANG Dao-juan, WANG Yong 2019, 46 (3):  342-345.  Abstract ( 806 )   PDF (745KB) ( 7204 )   Characterized by hyperandrogen, polycystic ovary syndrome (PCOS) is a common endocrine dysfunction in women, with relatively high incidence as well as incurability. However, due to its high heterogeneity, there is no clear mechanism for its pathogenesis and thus the treatment keeps hovering at the stage of symptom-oriented medication. Positively, some results over the past few years have indicated that there were abnormal acetylation changes in ovarian cells of PCOS patients, which were originated from the imbalance of histone acetyltransferase and histone deacetylase. Silent information regulator 1 (SIRT1) is a histone deacetylase that can be activated by resveratrol to reduce the level of acetylation of the corresponding histones. Meanwhile, resveratrol can also rely on inhibition of oxidative stress, regulation of androgen and estrogen levels and other pathways to alleviate PCOS-related symptoms. This review focuses on the regulation mechanisms of resveratrol, an agonist of the deacetylase SIRT1, on the abnormal acetylation of ovarian in hyperandrogen-induced PCOS, and restoring mechanisms of ovarian dysfunctions by resveratrol, expecting for potential application of resveratrol in clinical treatment of PCOS. Related Articles | Metrics

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Research Progress of Surgical Approaches for Total Hysterectomy DU Ling-yue，ZHANG Lin，NIE Xiao-cui 2019, 46 (3):  346-350.  Abstract ( 816 )   PDF (742KB) ( 7356 )   Hysterectomy is the most common gynecologic surgery method. Along with the advance of medical philosophy and medical apparatus and instruments, all kinds of surgical methods emerge in endlessly. At present the approaches of operation includes abdominal hysterectomy （TAH）, transvaginal hysterectomy （TVH） and laparoscopic hysterectomy（TLH）, laparoscopic single-site surgery（LESS）, transvaginal natural orifice transluminal endoscopic surgery（v-NOTES）, and robotic assisted laparoscopic surgery. For surgeons, it is the purpose of every doctor′s work to choose reasonable surgical methods and formulate standardized, humanized and individualized treatment plans according to specific conditions and on the premise of ensuring safety, so as to realize the maximum interests of patients. The author reviews the safety, feasibility, advantages and limitations of each surgical approach by reviewing domestic and foreign literatures in recent years and combining clinical experience, so as to provide references for better selection of appropriate surgical approaches for clinicians. Related Articles | Metrics

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Progress in Ultrasound Evaluation of Levator Ani Muscle and its Hiatus in Female Pelvic Organ Prolapse WANG Jing-jing，ZHANG Shu-shu，HUANG Xiao-ling 2019, 46 (3):  351-354.  Abstract ( 1579 )   PDF (724KB) ( 7239 )   The levator ani muscle and levator hiatus are important parts of the female pelvic organ support structure, supporting the female pelvic organs. Female pelvic organ prolapse (POP) is a common clinical pelvic organ dysfunction, which seriously affects women′s psychological and physical health. The etiology of POP is complicated, especially related to the levator ani muscle injury and the increase of the levator ani muscle area. Because ultrasound has the advantages of low cost, high reproducibility, no radiation, and good tolerance, it is currently used more and more widely in the application of female pelvic organ examination. And the application of transperineal ultrasound technique to evaluate the level of pelvic structures such as levator ani muscles and levator hiatus has gradually improved. This article mainly reviews the relationship between the anatomical structure of the levator ani muscle and levator hiatus, the occurrence of POP, and the application of transperineal ultrasound technique in the examination of female levator ani muscle and levator hiatus. Related Articles | Metrics

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Prevalence and Related Factors of Hot Flashes about Women during Menopausal Transition or Postmenopause in Gansu Province ZHOU Qi-min, ZHANG Xue-hong 2019, 46 (3):  355-360.  Abstract ( 797 )   PDF (893KB) ( 7086 )   Objective：The aim of this study was to investigate the incidence and severity of hot flashes in women during menopausal transitional period or postmenopause and examine the possible risk factors in Gansu Province. Methods：The study was a cross-sectional survey in Gansu Province. It was conducted by a quantitative survey method according to the approach of multi-stage cluster random samples. It was carried out in 13 cities/states-54 districts/counties-162 townships/towns in Gansu. A self-administered questionnaire was used to ascertain some information of the women aged 40-55. Results：A total of 2 807 valid questionnaires were obtained, including 1 393 women in menopausal transition and 1 414 women in postmenopause. There were 1 758 (62.6%) cases of hot flashes, of which 880 (50.1%) were mild degree, 624 (35.5%) were moderate degree, and 254 (14.4%) were severe ones. Ordinal logistic regression analysis showed that the increasing age (OR=1.070, P=0.000), hypertension (OR=1.547, P=0.000), and dysmenorrhea (OR=1.422, P=0.000) are the risk factors for hot flashes. Compared with women of normal weight, women who were overweight (OR=1.293, P=0.001) and obese (OR=2.056, P=0.000) were more prone to hot flashes. In addition, Hui women are more sensitive to hot flashes than Han women (OR=1.802, P=0.000); manual labors are more likely to develop into hot flashes than intelligent labors (OR=1.392, P=0.013). Conclusions：In this study, 62.6% of women in menopausal transitional periods or postmenopause were plagued by hot flashes, in Gansu province. Meanwhile, the elevating age, higher BMI, hypertension and dysmenorrhea are the risk factors to hot flashes. In addition, the prevalence of hot flashes is related to ethnic differences. What′s more, the incidence of hot flashes among manual workers is higher than mental workers. Related Articles | Metrics