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15 August 2019, Volume 46 Issue 4
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Research Progress of Stem Cell Repair Following Endometrial Injury HAN Xiao，HUANG Xiao-wu 2019, 46 (4):  365-369.  Abstract ( 2152 )   PDF (879KB) ( 9692 )   Endometrial repair is a common pathophysiological process in obstetrics and gynecology. It is divided into physiological endometrial repair and endometrial repair following injury. Physiological repair is the process of self-exfoliation and regeneration of the intima. It does not form scars, unlike the intimal repair, which is often incomplete. When there is an injury to the basal layer of the endometrium or destruction of the endometrial growth microenvironment，it will result in endometrial proliferation dysfunction, endometrial regeneration disorders, and even scar formation and intrauterine adhesion. These changes will affect the potential for implantation of embryos, leading to female infertility or repeated miscarriage. At present, how to promote the repair of endometrial injury still poses a great challenge. In recent years, stem cell research on endometrial repair has attracted much attention. This paper aims to review the pathophysiology of endometrial regeneration and the research progress of stem cell repair following endometrial injury. Related Articles | Metrics

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Advances in Research on Signaling Pathway Related to Endometriosis ZHU Xiao-lin，HAN Ya-guang，HAN Yan-hua，XU Feng-hua，CONG Jing，WANG Xue-lian 2019, 46 (4):  370-373.  Abstract ( 1928 )   PDF (771KB) ( 9464 )   Endometriosis (EMs), as a difficult disease recognized by gynecologists, has seriously affected the physical and mental health of women. Because of its polymorphism, invasion and extensiveness, there is no uniform conclusion on the pathogenesis of EMs. Abnormal activation of related signaling pathways and the interaction of multiple cytokines can lead to the formation of ectopic endometrium adhesion, invasion and inflammation. At present，mitogen-activated protein kinases (MAPKs) pathway, Wnt/β-catenin pathway, transforming growth factor β (TGF-β)/Smad pathway, nuclear factor κB (NF-κB) pathway, Ras homolog gene/ Rho-associated coiled coil-forming protein kinase (Rho/ROCK) pathway, Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway are closely related to the pathogenesis of EMs. This review aims to illustrate the pathogenesis of EMs by explaining these mentioned pathways，to provide a new strategy for finding effective drugs to treat EMs. Related Articles | Metrics

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Research Progress in Robotic-Assisted Sacrocolpopexy LIU Chang，YANG Pan-pan，ZHANG Jia-jun，LIU Cui-ping，QING Li-mei，WANG Xiao-hui 2019, 46 (4):  374-377.  Abstract ( 1805 )   PDF (2030KB) ( 9477 )   Pelvic organ prolapse (POP) has become a common condition in adult women as risk factors such as age, obesity and childbirth increase. The treatment and management of POP are obviously individualized and diversed, and the optimal strategy should be selected from a variety of strategies according to the individual situation of patients. The surgical strategy also developed from the initial open surgery to minimally invasive laparoscopic technology, and now the minimally invasive robotic technology. Robotic-assisted sacrocolpopexy (RASC) is an emerging surgical technique. Recent studies have shown that RASC not only has the advantages of less blood loss, faster internal recovery, and less risk of mesh exposure, but its short-term and medium-term postoperative repair effect is similar to that of abdominal sacrocolpopexy（ASC）. Although RASC has a long learning curve, unclear long-term efficacy and high cost, these problems will be gradually overcome by the development of this technology. Related Articles | Metrics

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Tissue Engineering in Rehabilitate Female Pelvic Floor Dysfunction WU Xiao-tong，WANG Jian-liu，SUN Xiu-li 2019, 46 (4):  378-381.  Abstract ( 1430 )   PDF (719KB) ( 7564 )   Pelvic floor dysfunction is a common and frequently-occurring disease in middle-aged and elderly women. Patch implantation is an ideal surgical treatment. Polypropylene-based filler material has been suggested as a common method to rehabilitate the pelvic support structure, but there are complications such as exposure and erosion. Biogenic patches have good tissue compatibility but insufficient mechanical properties. Tissue engineering is a new discipline which the applied the principles and techniques of life sciences and engineering, based on a correct understanding of the relationship between tissue structure and function in normal and pathological conditions of mammals, researching and developing biological substitutes of function and morphology to repair, maintain and promote various tissues or organs damage of the human body. Tissue engineering technology is applied to the treatment of pelvic organ prolapse, which can meet the mechanical requirements of pelvic floor support, and its biocompatibility is superior to traditional polypropylene patch, and can promote tissue repair to a certain extent. It′s the urgent need for patch implantation therapy. This article outlines the research progress of tissue engineering, to understand and guide the application of tissue engineering in the treatment of pelvic organ prolapse. Related Articles | Metrics

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Effect of Mechano Growth Factor on Levator Ani Muscle Repair in Patients with Stress Urinary Incontinence DONG Run-nan，SONG Zhi-ying，WANG Wen-yuan 2019, 46 (4):  382-386.  Abstract ( 1084 )   PDF (2021KB) ( 7355 )   Objective: To explore the therapeutic effect of mechano growth factor (MGF) on patients with stress urinary incontinence (SUI) through detecting the survival rate of levator ani myoblasts and the expression of Laminin and Dystrophin in female patients with SUI and patients undergoing radical resection of rectal cancer. Methods：Levator ani myoblasts were isolated from female patients with SUI and patients undergoing radical resection of rectal cancer, and identified by actin immunofluorescence assay. The survival rate of levator ani myoblasts was determined by MTT assay using different concentrations of MGF (0 ng/mL, 50 ng/mL, 100 ng/mL, 150 ng/mL) at different time (24 h, 48 h, 72 h). After 72 hours incubation of myoblasts, the contents of these two proteins were determined by reverse transcription polymerase chain reaction (RT-PCR). Results：The effects of different concentrations of MGF on the proliferation of levator ani myoblasts were different (F浓度=65.055, P浓度=0.000). The effects of different action time of MGF on the proliferation of levator ani myoblasts were different (F时间=24.586, P时间=0.000). There was interaction between MGF concentration and MGF action time(F时间×浓度=3.222, P时间×浓度=0.008). When MGF concentration was 150 ng/mL and MGF action time was 72 h, the survival rate of levator ani myoblasts was the highest. Compared with the control group (levator ani myoblasts of patient undergoing radical resection of rectal cancer), the expression of Laminin and Dystrophin in levator ani myoblasts in SUI group (0 ng/mL) was lower (P＜0.05). Compared with the SUI group (0 ng/mL), the expression of Laminin and Dystrophin in levator ani myoblasts in MGF group (150 ng/mL) was higher (P＜0.05). Conclusions：The concentration of MGF and the action time of MGF can interact with each other to promote the proliferation of levator ani myoblasts in SUI patients cultured in vitro. The expression of Laminin and Dystrophin in levator ani myoblasts decreased in patients with SUI. MGF can promote the expression of Laminin and Dystrophin in levator ani myoblasts of SUI patients. Related Articles | Metrics

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The Efficacy of Four Different Therapies in Postmenopausal Atrophic Vaginitis Dilinuer·wubuli，LIU Xin-lian，HUANG Xiu-ju，DING Yan 2019, 46 (4):  387-391.  Abstract ( 1882 )   PDF (822KB) ( 7884 )   Objective: To compare the therapeutic efficacy and safety of four different options for postmenopausal atrophic vaginitis，to guide clinical diagnosis and treatment. Methods：120 cases of atrophic vaginitis in our department of gynecology from November 2016 to August 2018 were voluntarily enrolled according to the inclusion and exclusion criteria and randomly divided into four groups, which were group A(vaginal moisturiser without hormone：Weirun collagen vaginal gel), group B (Honglilai estrogens cream), group C (Honglilai estrogens cream + herbalanti-inflammatory agent: Baofukang froth) and group D (Weirun collagen vaginal gel + Baofukang froth). After the treatment, we made comparision of efficacy and safety among the four groups. Results：After the treatment，signs and symptoms scores off our groups are group A (7.59±1.28), group B (6.76±1.33), group C (4.48±1.02), group D (5.34±1.01), efficacy：group C＞group D＞group B＞group A，and the difference was statistically significant (P＜0.05). Vaginal pH results of four groups are group A (5.10±0.15), group B (4.38±0.17), group C (4.04±0.18), group D (4.24±0.13), efficacy：group C＞group D＞group B＞group A，and the difference was statistically significant (P＜0.05). MV results are group A (31.94±3.16), group B (65.68±2.44), group C (72.19±2.86), group D (54.40±2.56). MV of group A shows no statistical difference after the treatment (P＞0.05), but the other three groups were significantly higher，efficacy：group C＞group B＞group D，and the difference was statistically significant(P＜0.05). In terms of safety, plasma level of E2, FSH, LH and endometrial stripe show no significant difference (P＞0.05). Conclusions：For patients who don′t want to or can′t take estrogen therapy, non-hormonal vaginal moisturisers and lubricants with local anti-inflammatory drugs can be an alternative choice. Related Articles | Metrics

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Laparoscopic Self-Tailoring Artisyn-Y Mesh for Simultaneous Correction of Middle and Posterior Pelvic Defects ZHAO Cheng-zhi，SUN Yu-han，LU Shen-tao，LEI Li，LIU Ming-bo，LIU Lu-bin 2019, 46 (4):  392-393.  Abstract ( 1138 )   PDF (698KB) ( 7641 )   With the development of laparoscopy technology, it plays an increasingly important role in the diagnosis and treatment of gynecological pelvic floor dysfunction diseases. It has a definite effect in solving the problems of middle pelvic cavity and anterior pelvic cavity. Laparoscopic diagnosis and treatment of posterior pelvic cavity defects are rarely reported. There are few literatures describing the diagnosis and treatment of posterior pelvic cavity defects through laparoscopic surgery. A POP-Q score is given for a case：Aa-3, Ba-3, C+2, Ap+3, Bp+3, D+1. Considering the patients with uterine prolapse Ⅲ degree and rectocele Ⅲ degree, the gynecological pelvic floor and oncology department of Chongqing Maternal and Child Health Hospital designed a new operation for the patients with pelvic defect in the middle and posterior pelvic cavity. It can correct the posterior pelvic defect while correcting the middle pelvic defect, and can achieve the advantages of flat mesh and adjustable. Self-tailored Artisyn-Y mesh was used to fix cervix and suspend uterus to correct middle pelvic defect, and to reinforce vaginal rectal fascia to correct posterior pelvic defect. Related Articles | Metrics

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Right Atrial Leiomyomatosis: A Case Report YANG Qiong，XIE Rong-kai，HUANG Qiang，SONG Han-xiang 2019, 46 (4):  394-396.  Abstract ( 1003 )   PDF (669KB) ( 7551 )   Uterine fibroids are the most common benign tumors in female reproductive organs. They are called intravascular leiomyomatosis when they grow into the veins or lymphatic vessels. The menstrual volume can be increased and the menstrual period is prolonged. The excessive tumor compression can cause swelling of the lower limbs. Abdominal discomfort, abdominal pain, difficult breathing, palpitations, chest pain, chest tightness, syncope and other symptoms can occur when the major arteries or veins are involved, there may even be sudden major bleeding and shock. This article described a case of a 49-year-old female patient with uterine leiomyomas growing to the right heart chamber leading to edema of the lower extremities for 3 years, chest tightness and chest pain for 2 months. The total hysterectomy + bilateral oophorosalpingectomy + pelvic mass resection was performed. The mass in the right atrium, right ventricle, pulmonary artery was removal and atrial septal defect was repaired. The pathological findings were uterine leiomyoma and intravascular leiomyoma. After 8 months of follow-up, the tumor did not recur. Uterine leiomyomatosis invading blood vessels into the right atrial and reaching the pulmonary artery is rare. The condition is serious, early detection, early diagnosis and early treatment is particularly important. Related Articles | Metrics

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The Value of Glycated Hemoglobin Testing in Screening and Prediction Pregnancies Complicated Diabetes Mellitus CHENG Lan，Zumureti·Abudusanlimu，WANG Xiao，CHEN Xu 2019, 46 (4):  397-401.  Abstract ( 898 )   PDF (784KB) ( 7357 )   Pregnancies complicated with diabetes mellitus including pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), are at risk of developing a number of serious obstetric complications as well as having long-term implications for the wellbeing of mother and infant. Glycated hemoglobin (HbA1c) may reflect glucose levels over the previous 2-3 months, and acts as one of the diagnostic criteria outside of pregnancy recently. Many studies had been carried through about the role of HbA1c in pregnancy, included how can HbA1c in different gestational weeks predict GDM subsequently and adverse pregnancy outcomes even postpartum diabetes risk, the difference of HbA1c levels in different races and the influence factors of HbA1c levels. Further, whether HbA1c level is various in different ethnical and the influence factors of HbA1c level had been investigated. Most authors believed that HbA1c, as a diagnostic indicator of GDM, is not highly sensitive and may increase the rate of missed diagnosis. HbA1c alone or in combination with more indicators is a powerful supplement in screening and diagnosis of GDM and can reduce the number of oral glucose tolerance test (OGTT). HbA1c levels at different time points during pregnancy may be correlated with pregnancy outcomes, and prenatal HbA1c levels are also of certain value in identifying high-risk GDM pregnant women who may progress to T2DM. On account of the cut-off value of HbA1c, the strategies of GDM screen and diagnosis with HbA1c are inconsistent, more researches are needed further. Related Articles | Metrics

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MiRNAs and Pathogenesis of Gestational Diabetes Mellitus XIE Qi-jun，LIU Lan 2019, 46 (4):  402-406.  Abstract ( 830 )   PDF (769KB) ( 7190 )   Gestational diabetes mellitus (GDM) is one common gestational complication of gestation period, which leads to serious consequences and even long-term effects on pregnant mother and their offspring. With the change of lifestyle, the incidence of the disease in China is increasing year by year. MicroRNAs (miRNAs) are a class of single-stranded small-molecule non-coding RNAs with a length of 19-24 nucleotides. They inhibit the transcription or translation of target genes by specifically binding to regulate biological processes such as cell development, differentiation and proliferation, early embryo development, fat metabolism, neuronal cell differentiation and autoimmune regulation. At present, the pathogenesis of GDM has not been fully illuminated. In recent years, the role of miRNAs in GDM′s pathogenesis has attracted much attention, mainly through insulin resistance, insulin secretion abnormalities and adipokines involved in the occurrence of GDM. Related Articles | Metrics

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Relationship between Aspirin Resistance and Gene Polymorphism in Pregnant Women with High Risk of Pre-Eclampsia ZHANG Yan-hong，LI Jie，SU Jing，LI Zeng-yan 2019, 46 (4):  407-411.  Abstract ( 858 )   PDF (837KB) ( 7258 )   Pre-eclampsia is a hypertensive disorder specific to pregnancy that remains a significant cause of maternal and neonatal morbidity and mortality, especially early onset pre-eclampsia in recent years. Low-dose aspirin has been clearly proved effective for pre-eclampsia prevention in foreign countries and it can decrease the development of pre-eclampsia and reduce the incidence of preterm birth and fetal growth restriction. However, some patients cannot achieve the expected effect and this phenomenon is called aspirin resistance (AR). AR also exists in studies related to the prevention of thrombosis by aspirin. The study of correlation between AR and genetic polymorphism has become a hot topic, including ABC transporter family genes, COX genes (COX-1 and COX-2), TXA2R, ADP receptor, GP receptor and interaction between genes. However，it is studied rarely in pregnant woman. We will expound the possible mechanisms of AR in cardiovascular disease from the perspective of gene polymorphism, to guide the use of aspirin in pregnant women and improve the pregnancy outcome. Related Articles | Metrics

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Advances in Serological Predictors of Early Pre-Eclampsia WANG Qiong，WANG Yong-hong 2019, 46 (4):  412-416.  Abstract ( 924 )   PDF (809KB) ( 7249 )   Pre-eclampsia (PE) is a pregnancy-specific disease characterized by multiple organ and system damage, which seriously threatens the life of pregnant women and perinatal infants. Because of the unclear pathogenesis and rapid progress in clinical manifestations, there is no pertinence in prevention, treatment and management. The results of active termination of pregnancy and conservative treatment are not satisfactory. PE is still the main cause of maternal and neonatal mortality in developing countries. Current studies have confirmed that early intervention and treatment of PE can effectively reduce maternal and infant mortality and improve prognosis. In recent years, early prediction of the occurrence of PE through serological examination has become a research hotspot, including various cytokines and cyclic RNA, microRNAs, long non-coding RNAs and exosomes, etc. Some of them have achieved good predictive results. This article reviews recent advances in predictive markers of peripheral blood. Related Articles | Metrics

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The Research Progress on Inherited Thrombophilia and Adverse Pregnancy Outcomes ZHU Qian-jing，HE Qian，YUAN Ning-lu，ZHANG Dong-xue，ZHAO Yan-hui 2019, 46 (4):  417-421.  Abstract ( 1083 )   PDF (797KB) ( 7376 )   In recent years, it has been found that the incidence of thrombophilia during pregnancy tends to increase. Thrombophilia is divided into inherited thrombophilia and acquired thrombophilia. Inherited thrombophilia is mainly related to abnormal protein expression caused by coagulation gene mutation, including factor V Leiden (FVL) mutation, prothrombin gene G20210A mutation, methylenetetrahydrofolate reductase (MTHFR) gene mutation, protein S (PS) deficiency, protein C (PC) deficiency and antithrombin (AT) deficiency. Coagulation, anticoagulation, and dysfunction of the fibrinolysis system can cause poor placental perfusion, and adverse pregnancy outcomes such as pre-eclampsia (PE), placental abruption, fetal growth restriction (FGR), and habitual abortion may be associated with this. However, whether inherited thrombophilia is a direct cause of adverse pregnancy outcomes and whether prophylactic anticoagulation can improve pregnancy outcomes remains to be further explored. This review aims to illustrate the relationship between inherited thrombophilia and adverse pregnancy outcomes, so as to assess the need for preventive anticoagulation, and to provide ideas for clinical diagnosis and treatment. Related Articles | Metrics

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Study on Expression Relationship of MiR-210 and HIF-1α in Placenta of Patients with Pre-Eclampsia CHEN Min，WANG Ming-zhu，LIU Zeng-you 2019, 46 (4):  422-425.  Abstract ( 827 )   PDF (915KB) ( 7188 )   Objective: To detect the expression of micro RNA-210 (miR-210) and hypoxia-inducible factor 1α (HIF-1α) in placenta of pre-eclampsia (PE) patients, and analyze the relationship between them as well as the correlation between the expression and clinicopathological characteristics of PE patients. Methods: 46 pregnant women with PE admitted to our hospital from January 2016 to February 2018 were selected as the study subjects. According to the severity of PE, 21 cases were divided into mild group and 25 cases into severe group. Another 34 pregnant women with normal pregnancy examination and cesarean delivery were selected as the control group. The clinical symptoms of PE patients were analyzed by routine biochemical indicators test. Fluorescent quantitative PCR was used to detect the expression of miR-210 and HIF-1α mRNA in placenta. Immunohistochemical staining was used to detect the expression of HIF-1α in placenta. And the correlation between the expressions of miR-210 and HIF-1α in placenta of PE patients and their relationships with the basic pathological data of patients were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of miR-210 and HIF-1α mRNA expression levels in PE. Results: Systolic blood pressure (SBP), diastolic blood pressure (DBP) and urinary protein (PRO) levels in PE patients were significantly higher than those in the control group (P＜0.05), and severe PE group were significantly higher than mild PE group (P＜0.05). The levels of miR-210 and HIF-1α in placenta of PE patients were significantly higher than those of control group (P＜0.05), and severe PE group were significantly higher than mild PE group (P＜0.05). The levels of miR-210 and HIF-1α in placenta were correlated with the levels of SBP, DBP, PRO and the severity of PE (P＜0.05). The expressions of miR-210 and HIF-1α in placenta of PE patients were positively correlated (P＜0.05). ROC analysis showed that the cut-off values of miR-210 and HIF-1α mRNA were 1.06 and 1.27, and the sensitivity of PE diagnosis was 80.43% and 78.26%, the specificity was 70.59% and 82.35%. Conclusions: MiR-210 and HIF-1α are highly expressed in the placenta of PE patients, and they are positively correlated with each other, and participate in the occurrence and development of PE disease. Related Articles | Metrics

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Effect of MiR-18a on the Expression of MMP-2 and MMP-9 in Human Normal Trophoblast Cells YANG Yang，CHEN Rui，WANG Wen-ying，LIU Cheng-juan 2019, 46 (4):  426-429.  Abstract ( 844 )   PDF (939KB) ( 7148 )   Objective：To investigate the effect of pre-eclapmsia related miR-18a on the expression of matrix metallopeptidase 2 (MMP-2) and MMP-9 in human normal trophoblast cells (HTR-8). Methods：According to the expression of miR-18a in HTR-8 cells, it was divided into 3 groups (5 times in each group): miR-18a overexpression group, miR-18a inhibition group, negative control group. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression of miR-18a mRNA in HTR-8 cells after transfection. The mRNA and protein levels of MMP-2 and MMP-9 in HTR-8 cells were detected by RT-qPCR and Western blotting after transfection. Results：The expression of miR-18a mRNA in miR-18a overexpression group was higher than that in negative control group (P＜0.001). The expression of miR-18a mRNA in miR-18a inhibition group was lower than that in negative control group (P＜0.001). The expression of MMP-2 and MMP-9 mRNA and protein in the miR-18a inhibition group was lower than that in the negative control group, and the difference was statistically significant (both P＜0.001). Conclusions：MiR-18a could affect the expression of MMP-2 and MMP-9 in human normal trophoblast cells at mRNA and protein levels, and may be involved in the regulation of trophoblast infiltration through this pathway. Related Articles | Metrics

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The Effect of Modified Laparoscopic Combined Hysteroscopic Surgery on Cesarean Section Incision CHEN Fang，WANG Xin，ZHANG Tong，YE Hong 2019, 46 (4):  430-433.  Abstract ( 971 )   PDF (773KB) ( 7109 )   Objective: To investigate the effect of modified laparoscopic combined hysteroscopic surgery on cesarean section incision diverticulum repair. Methods: From October 2017 to October 2018, 21 patients with re-fertility requirements who were confirm the diagnosis of uterine incision diverticulum in the cesarean section, and the muscle layer thickness ≤2 mm at the bottom of the diverticulum using ultrasound combined with hysteroscopy received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center，Beijing Obstetrics and Gynecology Hospital，Capital Medical University. Follow-up of menstrual recovery and improvement of diverticulum muscle thickness was recorded. Results: All patients underwent surgery without complications. There was no conversion to open surgery or blood transfusion. 21 patients were followed up for 6 to 14 months after menstrual rehydration. The menstrual period was shortened significantly after operation [(6.0±1.2) d vs. (11.2±3.5) d，t=10.79，P=0.00] . The thickness of the lower uterine segment measured by transvaginal ultrasound was increased significantly after operation [(3.25±0.95) mm vs. (1.59±0.30) mm, t=8.00, P=0.00]. Conclusions: The modified laparoscopic combined hysteroscopic operation can accurately locate the diverticulum and fully remove the scar through the light-transmitting positioning, the suture incision is good and the anatomy of the lower uterus is restored. It is safe and effective, and worthy of clinical application. References | Related Articles | Metrics

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Early Intrauterine Pregnancy Complicated with Left Tubal Umbrella Pregnancy: A Case Report and Literature Review CHEN Yan-si，DONG Qu-long，ZHANG Yan，LI Na 2019, 46 (4):  434-436.  Abstract ( 901 )   PDF (680KB) ( 7218 )   Heterotopic pregnancy is rare in clinic and in recent years, with the rise of assisted reproductive technology, the incidence has risen. Its clinical manifestations are different, mainly depending on the development of ectopic pregnancy lesions implanted outside the uterine cavity. The mild cases have no obvious symptoms or signs, and the severe cases may cause abdominal hemorrhage, hemorrhagic shock or even death. As heterotopic pregnancy is very dangerous, clinical diagnosis should be made as soon as possible and individualized treatment should be taken to ensure the safety of mothers and children. In order to take the attention of gynecologists and obstetricians, now we report a case of early intrauterine pregnancy complicated with left tubal umbrella pregnancy and consult the relevant literature, summarize the knowledge of heterotopic pregnancy. Related Articles | Metrics

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Concurrent Intrauterine and Uterine Caesarean Scar Pregnancy after IVF-ET：A Case Report LI Hui-ling，FAN Li-mei 2019, 46 (4):  437-439.  Abstract ( 1100 )   PDF (921KB) ( 7314 )   bryos were successfully matched. 3 embryos were transplanted and 2 of them were successfully implanted, but one was implanted at the normal position in the uterus, and the other was implanted at the scar position of the previous cesarean section. The patient was treated with the reduction of the gestation sac at the scar position. Then the patient came to the hospital for treatment because of irregular vaginal bleeding. The gynecological ultrasonography showed that there were 2 fetal sacs in the uterine cavity. The fetal bud and fetal heart of one fetal sac could be seen; the other fetal sac was located at the scar position of the previous cesarean section, and only the fetal sac of irregular shape could be seen while the yolk sac or fetal bud could not be seen. Finally, the fetus was removed by intra-abdominal placenta removal + CSP lesionectomy+ cesarean section scar diverticulum neoplasty, and the pregnancy was terminated. This particular case was reported to compare the advantages and disadvantages of ultrasonography and magnetic resonance imaging (MRI) for diagnosing CSP. Some thoughts on the treatment and prevention of CSP were provided. Related Articles | Metrics

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The Interpretation of "2019 SOGC Clinical Practice Guideline: Magnesium Sulphate for Fetal Neuroprotection" TANG Yu-ping，HAN Huan，YING Hao 2019, 46 (4):  440-443.  Abstract ( 1470 )   PDF (786KB) ( 7232 )   Cerebral palsy (CP), a common and serious complication for premature infants, seriously threatens the health of premature infants. More and more evidence have shown that antenatal application of magnesium sulfate for fetal neuroprotection can decrease the incidence of CP in preterm infants. Based on the latest clinical research evidence of magnesium sulfate for fetal neuroprotective effect, The Society of Obstetricians and Gynaecologists of Canada(SOGC) developed the clinical practice guideline in 2019. This guideline provide opinions and recommendations on the gestational age, time and dosage regimen of using magnesium sulfate, whether you need a repeat course of antenatal magnesium sulfate and neonatal resuscitation. This article interpreted the main points of the guideline so as to provide reference for Chinese medical staffs. Related Articles | Metrics

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The Progress on Pregnancy-Preserving Management of Cervical Cancer during Pregnancy WU Ai-jia，AI Zhi-hong 2019, 46 (4):  444-448.  Abstract ( 867 )   PDF (755KB) ( 7159 )   As the age of pregnancy grows, the rate of cervical cancer during pregnancy is increasing and the management of cervical cancer during pregnancy is also becoming more difficult in clinic. During treatment, safety of both pregnant women and offspring should be taken into account. Management of patients wishing to preserve of her pregnancy aim at fewer adverse effects on fetuses, less tumor progress and similar outcomes with non-pregnancy women with cervical cancer. Current options to treat pregnant patients with cervical cancer desired to preserve pregnancy contains expectant treatment, surgery and chemotherapy. Radical trachelectomy, simple trachelectomy and conization are common surgical methods and most common chemotherapy is based on platinum，with or without other agents. Commonly, patients with stage ⅠA1 cervical cancer are eligible for expectant treatment. Surgical treatment is option for patients with stage ⅠA2-ⅠB1 cervical cancer and neoadjuvant chemotherapy is used in patients with stage ⅠB1 or greater cervical cancer. Patients with lymph nodes metastasis should terminate pregnancy. We will make conclusions on the latest progression of pregnancy-preserving managements. Related Articles | Metrics

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Progress on Uterine Perivascular Epithelioid Cell Tumor WANG Min，MA Shuai，YANG Shu-li 2019, 46 (4):  449-452.  Abstract ( 1293 )   PDF (727KB) ( 7465 )   Uterine perivascular epithelioid cell tumor is a clinically rare mesenchymal tumor, and its biological behavior is still uncertain, and malignantcy is rare. The incidence of such diseases is low, the cause is not clear, the clinical and imaging findings are not typical, and it is more common in middle-aged and older women. It is often found because of abdominal mass in physical examination. Usually, the immunophenotype can have characteristic dual expression: simultaneous expression of melanin specific antibody HMB45 and myogenic marker SMA. Recent studies have found that translocation factor E3 (TFE3) is associated with the occurrence of disease. Folpe divides it into benign, malignant potential and malignant according to its degree of risk. The disease is difficult to diagnose before surgery, and it is easy to be confused with uterine epithelioid leiomyoma, low-grade endometrial stromal sarcoma, malignant melanoma and clear cell sarcoma. At present, there is no standardized treatment plan at home and abroad. In actual clinical work, surgical treatment is the main treatment, and complete resection of the tumor is an effective treatment. The effect of radiotherapy and chemotherapy is uncertain, and long-term follow-up should be followed after surgery. Related Articles | Metrics

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Advances in Research of Homologous Recombination Repair Genes in Ovarian Cancer HU Dan，YANG Yong-Xiu，WANG Xin，LI Yong-Xia 2019, 46 (4):  453-457.  Abstract ( 945 )   PDF (769KB) ( 7348 )   Ovarian cancer is one of the three major malignant tumors common in female genitalia. Because the ovary is located in the deep pelvic cavity, the onset is concealed. About 70%-75% of patients have reached the advanced stage when symptoms appear, which seriously threatens women′s health. Most of the ovarian cancer susceptibility genes currently known play a role in repairing DNA double-strand breaks by homologous recombination: BRCA1 and BRCA2 are the two most common genes in ovarian cancer, which are the key factors in the process of homologous recombination repair of double-stranded DNA breaks. The multiple pathogenic mutations in the BRCA tumor suppressor network with its core composition can damage the integrity and stability of genomics and increase the susceptibility of ovarian cancer. A number of studies have shown that the expression of homologous recombination-related genes or proteins is related to the sensitivity of tumors to radiotherapy and genotoxic drugs, and can be used as a biomarker for individualized treatment of tumors. In this paper, the relationship between several important gene mutations closely related to ovarian cancer in the homologous recombination repair pathway and ovarian cancer is discussed, which lays a clinical foundation for the screening and early prevention of ovarian cancer. Related Articles | Metrics

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Mechanisms of Ferroptosis and Its Involvement in Ovarian Cancer LI Ping-fen，WANG Qu-yuan 2019, 46 (4):  458-461.  Abstract ( 986 )   PDF (721KB) ( 7324 )   Ovarian cancer, as a kind of female reproductive system tumor with extremely high malignant degree, is the leading cause of death in gynecologic malignancies. Ovarian cancer is insidious and lacks specific detection methods at the early stage. It often develops into recurrent and multi-drug resistant diseases in the middle and late stages, with poor prognosis. In recent years, relevant basic and clinical studies have found that ferroptosis plays an important role in the development of ovarian cancer. Many scholars believe that iron death, as an iron-dependent cell death mode, is closely related to a variety of biochemical processes and can inhibit the proliferation of tumor tissues by depriving iron in cancer cells or changing the metabolism of iron ions in tumor tissues. Moreover, iron death was also identified as a potential therapeutic target for ovarian cancer. This paper summarizes the biochemical process of iron death and its research progress in ovarian cancer, and provides new ideas for the treatment of ovarian cancer. Related Articles | Metrics

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Analysis of Influencing Factors Associated with Pelvic Lymph Node Metastasis in Stage ⅠB to ⅡB Cervical Cancer GUAN De-feng，CHEN Si-lu，CHEN Ge-shuyi，LYU Xiao，YANG Yong-xiu 2019, 46 (4):  462-465.  Abstract ( 1370 )   PDF (792KB) ( 7276 )   Objective: To investigate the influencing factors associated with pelvic lymph node metastasis (PLNM) in stage ⅠB to ⅡB cervical cancer. Methods: Clinical data of 630 patients with stage ⅠB to ⅡB cervical cancer treated with surgery were retrospectively studied. The PLNM condition of each patient was abstracted and the influencing factors of PLNM were analyzed by χ2, Mann-Whitney U test and multivariate logistic regression analysis. Results: 27.9% (176/630) patients had PLNM. Among 754 metastatic lymph nodes, 74.8% (564/754) of them were located in parametrial/obturator region. Result of univariate analysis suggested clinical stage, cell differentiation, uterine involvement, lymphovascular space invasion (LVSI), depth of stromal invasion, the level of SCC-Ag and CA125 were associated with PLNM (both P＜0.05). The multivariate analysis suggested low cell differentiation (OR=3.874, 95%CI: 1.100-13.646, P=0.035), deep 1/3 stromal invasion (OR=2.735, 95%CI: 1.675-4.466, P＜0.001) and LVSI (OR=73.822, 95%CI: 22.304-244.336, P＜0.001) were the independent risk factors of PLNM. Conclusions: Parametrial/obturator region are the most vulnerable areas of PLNM in cervical cancer. Patients with low cell differentiation, deep stromal invasion and LVSI are associated with a high risk of PLNM. In clinical treatment, surgeon should ensure the parametrial-excision range, and the implementation of systemic lymphadenectomy. Related Articles | Metrics

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Pigment Epithelium-Derived Factor Reduces HeLa Cell Viability and Invasion-Related Protein Expression by Inhibiting PI3K/Akt Pathway ZHOU Yang, JIN Zhi-jun, WANG Dan, WU Yu-xian, WANG Cheng-cai 2019, 46 (4):  466-471.  Abstract ( 965 )   PDF (1270KB) ( 7137 )   Objective: To investigate the roles and mechanisms of pigment epithelial-derived factor (PEDF) in down-regulating the viability and invasion-related c-Met protein expression of HeLa cells via inhibiting phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway. Methods: 40 cases of cervical cancer diagnosed in our hospital and 40 corresponding normal uterus samples were selected. The expression of PEDF, PI3K and p-Akt were detected by immunohistochemistry. At the cellular level, it was divided into normal cervical epithelial HCerEpiC group, HeLa group, HeLa+PEDF group, HeLa+PEDF+PI3K/Akt activator group and HeLa+PI3K/Akt inhibitor group. The expression levels of PEDF, PI3K, p-Akt, Akt and c-Met protein in each group were detected by Western blotting. The cell viability of each group was detected by CCK-8 assay. Results: The PI3K/Akt pathway was significantly activated in cervical cancer samples and HeLa cells, and the expression of PEDF was significantly decreased (P＜0.01). PEDF significantly inhibited PI3K/Akt activation, cell viability and invasion-related protein level of HeLa cells (P＜0.01). Akt activator can reverse the effects of PEDF on HeLa cell viability and invasion protein expression, while activation of PI3K can not affect the effects of PEDF. The simple drug inhibition of the PI3K/Akt pathway is insufficient to mimic the effects of PEDF on HeLa cells. Conclusions: PEDF reduces HeLa cell viability and invasion-related protein expression through the dual inhibitory effect of PI3K/Akt, which provides a novel theoretical basis for the clinical treatment of cervical cancer with PEDF. Related Articles | Metrics

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Ovarian Sclerosing Stromal Tumor：A Case Report and Literature Review MA Shuai，WANG Min，BAO Yi-gang，DAI Xiao-wei，ZHENG Lian-wen 2019, 46 (4):  472-474.  Abstract ( 873 )   PDF (704KB) ( 7219 )   Ovarian sclerosing stromal tumor (OSST) accounts for about 2%-6% of ovarian sex cord stromal tumors, which is rare in clinic. Although its histology is benign tumor, the clinical manifestations can be menstrual disorder, anemia and peritoneal effusion, which is easily misdiagnosed. In order to improve the understanding of OSST, we retrospectively analyzed the clinical data of one case of OSST and analyzed its clinical and pathological characteristics in combination with literature, in order to deepen clinicians′ understanding of OSST and improve the level of diagnosis and treatment, so as to avoid misdiagnosis and missed diagnosis. Related Articles | Metrics

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Cervical Primitive Neuroectodermal Tumor: A Case Report and Literature Review ZHAI Li-rong，GAO Ya-juan，CUI Man-hua 2019, 46 (4):  474-478.  Abstract ( 896 )   PDF (789KB) ( 7411 )   To investigate the genesis, clinical characteristics, diagnosis and treatment progress of cervical primitive neuroectodermal tumor (PNET), also called Ewing sarcoma, improve the understandings of this special type of cervical malignancies. A case of cervical PNET, at the Second Hospital of Jilin University in January 2016, was analyzed retrospectively. The tumor was found accidently in a routine examination with no clinical manifestations. The patient was finally confirmed by surgical pathologic examination and immunohistochemical staining. Immunohistochemistry was positive for CD99 and vimentin. Cervix PNET is a extremely rare and aggressively invasive tumor with high malignancy and mortality. The diagnosis depends on pathology, immunohistology and cytogenetics and there is no consensus on treatment so far. Related Articles | Metrics

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Cervical Cancer Patients Combined with Multiple Primary Malignant Tumors: A Case Report and Literature Review WANG Xin，YANG Yong-xiu 2019, 46 (4):  478-480.  Abstract ( 941 )   PDF (682KB) ( 7149 )   Multiple primary malignant tumors (MPMT) describes a phenomenon that two or more primary malignancies occur simultaneously or successively in different organs or tissues of the same patient. This case reported a cervical cancer patient, who suffered from multiple benign and malignant tumors from 2000 to 2019, accepted surgery and adjuvant therapy in The First Hospital of Lanzhou University. The patients now is generally in good condition with no special discomfort and no signs of recurrence or metastasis after five months follow-up. This article elaborated accurate diagnosis and individualized treatment of patients and explored the pathogenesis, treatment regimen and survival rate of MPMT, so as to provide information and reference for medical researchers and clinical workers. Related Articles | Metrics