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15 December 2020, Volume 47 Issue 6
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Advances in the Treatment of Gynecological Malignancies during Pregnancy TIAN Lei, XIN Yu-qi, HUANG Meng-wei, WANG Xiao-hui 2020, 47 (6):  605-610.  Abstract ( 1329 )   PDF (764KB) ( 8143 )    Cervical cancer, endometrial cancer and ovarian cancer are three common malignant tumors in gynecology. At present, the age of onset tends to be younger. Although gynecological malignancies are not common in pregnancy, epidemiological studies have been confirmed that the incidence rate of these diseases has been increasing in recent years. Cervical and ovarian cancers are the most common gynecological cancers in pregnancy, and endometrial cancer is rare in pregnancy. Due to the complexity of clinical management of gynecological malignancies during pregnancy, its treatment methods have been paid more attention. It is necessary to comprehensively consider the tumor stage, differentiation degree, histological type, gestational week, wishes of patients and possible fetal outcomes, comprehensively evaluate the condition of the disease and formulate individualized treatment plan. Conservative treatment, surgical treatment or chemotherapy can reduce the influence of malignant tumor on fetus and maintain pregnancy and maternal reproductive function on the basis of maternal health. In this paper, different treatment methods of gynecological malignant tumor in pregnancy were summarized in order to achieve better maternal and infant outcomes and provide reference for clinical experience. Related Articles | Metrics

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Research Progress on Tumor Suppressor Genes Methylation in Cervical Adenocarcinoma LI Ming, WANG Ling, WANG Yi-nan, DUAN Xue-feng, ZHOU Shun-qing, HAN Li-ying 2020, 47 (6):  611-615.  Abstract ( 1169 )   PDF (922KB) ( 7582 )   Cervical carcinoma is one of the most common cancers of women, which has a higher incidence in developing countries. With the popularization of the screening in cervical carcinoma, the incidence of cervical carcinoma, especially squamous cell carcinoma has declined. However, because human papilloma virus (HPV) infection does not always accompany cervical adenocarcinoma and the lesion is deep into the cervical canal, the existing screening methods are less effective in the diagnosis of cervical adenocarcinoma. Compared with cervical squamous cell carcinoma, the prognosis of cervical adenocarcinoma is poor. Gene methylation is an important part of epigenetic modification, which can change gene structure and inhibit gene expression without changing DNA sequence. The methylation of tumor suppressor gene can make it inactivated and lose its inhibitory effect on tumor, which is closely related to the occurrence and development of tumor. In this paper, the research progress of gene methylation in cervical adenocarcinoma was reviewed in order to provide new ideas for early diagnosis and treatment of cervical adenocarcinoma. Related Articles | Metrics

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Advances in Biomarkers of Pelvic Lymph Node Metastasis in Cervical Cancer JU Yu-ye, WANG Xue, CHEN Si-lu, WANG Xiao-hui 2020, 47 (6):  616-620.  Abstract ( 1174 )   PDF (742KB) ( 7448 )   Regional lymph node diffusion is the main route of cervical cancer metastasis. Lymph node status has been included in the latest cervical cancer staging system of the international federation of obstetrics and gynecology（FIGO）. Several studies have shown that pelvic lymph node metastasis is an independent prognostic factor for the survival of cervical cancer and determines the treatment strategy of cervical cancer. At present, except for the histopathological examination after surgery, the lymph node metastasis of cervical cancer can not be accurately detected before an operation. The discovery of cervical cancer lymph node metastasis biomarkers can improve the accuracy of preoperative lymph node metastasis diagnosis, help to identify patients with a high risk of death, and then provide effective clinical treatment for cervical cancer. In this review, we summarize the research progress on the molecular mechanism of pelvic lymph node metastasis of cervical cancer centered on epithelial mesenchymal transition (EMT), vascular endothelial growth factor-C (VEGF-C) and microRNA (miRNA) and find the possible biomarkers to provide a reference for preoperative diagnosis of cervical cancer lymph node metastasis. Related Articles | Metrics

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Advances in the Improving Direction of Laparoscopic Surgery for Cervical Cancer ZHAO Ming-he, LIU Qian 2020, 47 (6):  621-625.  Abstract ( 1114 )   PDF (698KB) ( 7556 )   Cervical cancer (CA) is one of common malignant tumors in women. With the development of minimally invasive concept and technology, laparoscopy has become a conventional method of cervical cancer surgery, which has the advantages of reducing intraoperative blood loss, decreasing wound infection rate, shortening hospital stay, and not increasing postoperative complications. However, the latest clinical experimental studies point out that laparoscopic radical hysterectomy (LRH) has low survival rate and high recurrence rate compared with traditional open surgery. The reasons leading to the poor prognosis of laparoscopic surgery may be related to the use of intraoperative uterine manipulator, CO2 pneumoperitoneum and the treatment of vaginal cuff. In view of the bottleneck problems encountered in the current minimally invasive surgery, this article explains the mechanism of the low survival rate and high recurrence rate of cervical cancer after laparoscopic surgery caused by the above reasons, and summarizes the surgical procedures and improved methods of equipment. It is helpful to strengthen the understanding of laparoscopic surgery of clinicians and provide directions for laparoscopic improvement. Related Articles | Metrics

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The Application Progress of Sentinel Lymph Node Mapping in Early-Stage Endometrial Cancer ZHAI Li-rong, XIE Hong-ying, ZHANG Xi-wen, LIU Zi-wei, ZHANG Li-ying, CUI Man-hua 2020, 47 (6):  626-631.  Abstract ( 1408 )   PDF (774KB) ( 7634 )   Endometrial cancer is one of the three main gynecologic malignancies and its incidence is increasing year by year. Surgery-based comprehensive treatment is its main treatment principle, and surgical staging is an important basis for determining the extent of disease, evaluating prognosis, and selecting adjuvant therapy in patients with endometrial cancer. Commonly used lymph node staging strategies include systemic lymphadenectomy (LAD) and selective lymphadenectomy (SLAD) according to the "Mayo criteria". However, LAD has higher surgical risks accompanying many postoperative complications and the survival benefit remains controversial. In recent years, sentinel lymph node mapping (SLNM) has gradually become an alternative to the staging of endometrial cancer. By removing a few highly relevant lymph nodes, it can provide sufficient information to guide surgical pathological staging and adjuvant treatment, while minimizing surgery injury without affecting the patients′ prognosis. This review aims to systematically analyze the progress and related controversies of SLNM in early-stage endometrial cancer, providing evidence for another treatment strategy in surgical staging and lymph node evaluation in endometrial cancer patients. Related Articles | Metrics

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The Intracrinology and Targeted Therapy of Endometrial Cancer ZHOU Lin-zhi, CHEN Xiu-hui, KONG Xian-chao 2020, 47 (6):  632-636.  Abstract ( 1946 )   PDF (722KB) ( 7954 )   Based on the scientific phenomenon that cells in peripheral tissues can synthesize and respond to hormones (peptides, proteins or steroids), a new concept of endocrinology - "intracrinology" was first proposed in the late 19th century. Peripheral tissues such as endometrium can express various enzymes including STS, SULT1E1, CYP19A1, 17β-HSD, which utilize steroid precursors presenting in the blood to participate in the local synthesis and metabolism of steroid hormones (intracrinology). In the absence of progesterone antagonism, sustained stimulation of endometrium by locally synthesized estrogen is a high risk factor for the occurrence and development of endometrial cancer. Drugs targeting the local estrogen metabolism in the peripheral tissues, such as aromatase inhibitors, STS inhibitors and inhibitors of HSD17B1 can effectively reduce serum estrogen level and thus can be used as therapeutic agents against endometrial cancer. These drugs also have a certain effect on other estrogen-dependent diseases such as uterine leiomyoma, endometrial hyperplasia and endometriosis. Related Articles | Metrics

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A Clinical Analysis of 48 Cases with Polypoid Adenomyoma of the Uterus Treated by Hysteroscopy REN Jian, ZHOU Qi, ZHANG Li-juan, LI Ting 2020, 47 (6):  637-641.  Abstract ( 1418 )   PDF (782KB) ( 7497 )   Objective：To analyze the characteristics, diagnosis and treatment of the polypoid adenomyoma (PA) of the uterus and to improve the understanding of the disease. Methods: A total of 48 patients with PA treated with hysteroscopy in gynecology department from February 2016 to February 2019 at Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University were collected, and their clinical characteristics, diagnosis and treatment were retrospectively analyzed. There were 26 cases of typical polypoid adenomyoma (TPA) and 22 cases of atypical polypoid adenomyoma (APA). Results: 48 patients were 26 to 72 years old, with a mean of (50.0±10.4) years old. There were 41 patients aged ≥ 40 years old, accounting for 85.42%; 22 menopausal patients, accounting for 45.83%. The BMI in the APA group was (26.3±3.9) kg/m2 and that in the TPA group was (24.0±4.0) kg/m2, the difference was statistically significant(P=0.046); 22 of the 48 patients (45.83%) had abnormal uterine bleeding symptoms, and 19 patients (39.58%) were found by physical examination. The fasting blood glucose level in the APA group was (5.8±0.7) mmol/L, and that of the TPA group was (5.4±0.6) mmol/L, the difference was statistically significant (P=0.043). Ultrasound showed that 24 patients (50%) could see intrauterine masses, and 21 patients (43.75%) showed uneven endometrial echo or thickening.  All 48 patients underwent hysteroscopic resection of lesions, and single lesions accounted for 83.33%. 21 patients with APA were given high-efficiency progestin for 3-6 months after operation.  One patient with APA had relapse, and was issued with total hysterectomy after followed up for one year. Conclusions: Most patients of the PA were middle-aged and elderly women over 40 years old. Abnormal uterine bleeding was the main clinical symptom. Most ultrasound examination of patients showed the intrauterine occupying lesions and the number of polyp was mainly single. Hysteroscopic surgery was proved to be safe and effective. High BMI and the fasting blood glucose level might be related to the incidence of APA and patients with APA should be closely followed. Related Articles | Metrics

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Uterine Natural Killer/T-Cell Lymphoma Combined with Hemophagocytic Syndrome: A Case Report and Literature Review TIAN Di, PENG Hao, HAN Li-ying, XU Hui 2020, 47 (6):  642-644.  Abstract ( 1098 )   PDF (7527KB) ( 7365 )   The case of uterine natural killer/T-cell lymphoma combined with hemophagocytic syndrome is very rare in clinic. It is a serious and aggressive disease with rapid progress and high mortality. In addition, it is difficult to differentiate the disease from other malignant tumors of the reproductive system due to the non-specificity of the related auxiliary examination results and clinical manifestations, leading to a high misdiagnosis rate. To reduce misdiagnosis and missed diagnosis of the disease and improve the prognosis, the case data of a patient treated by the Central Hospital of Enshi Tujia and Miao Autonomous Prefecuture in March 2020 is introduced, and the methods of diagnosis and treatment are discussed. Related Articles | Metrics

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Primary Vaginal Adenocarcinoma with Lymphoepithelioma-Like Carcinoma: A Case Report and Literature Review CHEN Yu-ying, CUI Man-hua, LIU Zi-wei, JIA Yan 2020, 47 (6):  645-647.  Abstract ( 1260 )   PDF (7478KB) ( 7306 )   Lymphoepithelioma-like carcinoma is defined as a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltrate, which is commonly reported in the nasopharynx and remains a rare condition in gynecology. Lymphoepithelioma-like carcinoma of the vagina is a subtype of squamous cell carcinoma. Primary vaginal adenocarcinoma combined with lymphoepithelioma-like carcinoma has not been reported at home or abroad. We present a case of a young patient with primary vagina cancer and the tumor was a mixed poorly undifferentiated vaginal carcinoma consisting of adenocarcinoma and lymphoepithelioma-like carcinoma. Atypical glands and large infiltration of lymphocytes and plasma cells were seen under the microscope and immunohistochemistry showed CK(AE1/AE3)(+). This rare tumor of the vagina is difficult to diagnose both preoperatively and perioperatively. However, the poorly undifferentiated vaginal carcinoma with massive involvement of lymphoplasmacytic infiltrate indicates that the prognosis is relatively good. In order to improve the understanding of this disease, this study retrospectively analyzed the clinical data of the patient, reviewed relevant literature, and summarized the clinical features, pathological morphology and immunophenotype of this disease. Related Articles | Metrics

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New Progress in the Research of Long Non-Coding RNA in Pre-Eclampsia XU Xiao-hong, GUAN Hong-qiong 2020, 47 (6):  648-652.  Abstract ( 960 )   PDF (737KB) ( 7449 )   Pre-eclampsia is one of the categories of hypertensive disorder complicating pregnancy, but its etiology and pathogenesis have not been clearly studied. Pre-eclampsia is a multi-factor, multi-mechanism and multi-pathway disease. At present, the main pathogenesis theories include insufficient recasting of uterine spiral arterioles, immune imbalance, oxidative stress, genetic factors and so on. Abnormal biological function of trophoblasts (proliferation, migration, invasion and apoptosis) may play a major role in the occurrence and development of pre-eclampsia, which will seriously affect maternal and infant health. Studies have shown that lncRNA was previously regarded as "transcriptional noise" with no biological function. However, with the rapid development of high-throughput sequencing technology and genome sequencing technology in recent years, it has been found that lncRNA can regulate the expression of various functions in the body. For example, lncRNA is abnormally expressed in the placenta of pre-eclampsia, which regulates the proliferation, migration, invasion and apoptosis of trophoblast cells through different target genes and signal pathways, thus leading to pre-eclampsia. Therefore, exploring the lncRNA associated with pre-eclampsia may provide a new way to understand the pathogenesis of pre-eclampsia and to identify new therapeutic targets. This review focuses on the regulation of trophoblast biology by abnormal expression of lncRNA in pre-eclampsia. Related Articles | Metrics

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Research Progress of LncRNA in Gestational Diabetes Mellitus LIU Yu-tong, CHEN Xuan 2020, 47 (6):  653-656.  Abstract ( 923 )   PDF (689KB) ( 7359 )   Gestational diabetes mellitus (GDM) is a disease unique to pregnancy. Because abnormal blood glucose and poor blood glucose control are not found as early as possible, it often has adverse effects on pregnancy outcomes and neonates. In recent years, with the continuous research of long non-coding RNA (lncRNA), it has been found that lncRNA not only affects tumors, obesity, metabolic diseases, cardiovascular and cerebrovascular diseases, but also plays an important role in the occurrence and development of GDM. LncRNA is differentially expressed in cord blood of patients. It can affect the disease through the lncRNA-miRNA axis, or by affecting downstream genes, or interacting with other genes, resulting in undesirable pregnancy. In-depth understanding of the mechanism of action of lncRNA related to GDM and further exploration of the molecular basis of the development of GDM may help us to timely predict and treat related diseases. This article reviews the research progress of lncRNA related to GDM in order to prevent and treat the disease better. Related Articles | Metrics

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Risk Assessment of Medication in Patients with Rheumatic Immune Disease during Pregnancy and Lactation JIANG Meng, DI Wen 2020, 47 (6):  657-661.  Abstract ( 1201 )   PDF (733KB) ( 7530 )   Rheumatic immune diseases usually involve multiple organs. Pregnancy and childbirth may aggravate the condition and endanger the life of patients. With the development of modern medicine and multi-disciplinary cooperation, rheumatic immune disease is no longer a contraindication for pregnancy. Meanwhile, breastfeeding is beneficial to both maternal and child health and family economy. The medication safety of patients with rheumatic immune disease should consider not only the disease itself, but also the safety of mothers and infants before and during pregnancy, as well as the development and health of breast-feeding children. The commonly used anti-rheumatic immune drugs include glucocorticoids, hydroxychloroquine, non-steroidal anti-inflammatory drugs, immune-suppressants and biological agents. Different drugs have different applications in pregnancy and lactation. Therefore, more attention should be paid to the safety of anti-rheumatic immune drugs in women of childbearing age. To have a good grasp of the influence of the medication on offspring and the safe dosage range is helpful to provide more theoretical basis for the guidance of drug use during pregnancy and lactation. Related Articles | Metrics

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Research Progress of Levothyroxine Treatment on TPO-Ab Negative Subclinical Hypothyroidism during Pregnancy YANG Yu-xi, LIU Rui-xia, YIN Cheng-hong 2020, 47 (6):  662-665.  Abstract ( 1020 )   PDF (692KB) ( 7339 )   Subclinical hypothyroidism (SCH) in pregnancy is insidious or asymptomatic and easy to be ignored. It may lead to miscarriage, premature delivery, placental abruption, low birth weight, gestational diabetes and other adverse pregnancy outcomes. Although serum free thyroxine (FT4) levels were normal in women with SCH pregnancy, the utilization of FT4 in fetal or fetal tissues was decreased, suggesting that FT4 in the normal range is not sufficient to fully play its role. L-thyroxine (L-T4) is the first choice in the treatment of SCH. Because its structure is the same as human thyroid hormone, L-T4 can affect the growth, development and division of embryonic and neonatal cells by enhancing enzyme activity and promoting the synthesis of protease. At the same time, L-T4 also has a significant regulatory effect on body temperature regulation, energy metabolism, carbohydrate, protein and fat metabolism of pregnant women. Whether L-T4 treatment can reduce the abortion rate and other complications in pregnant women with negative thyroid peroxidase antibody (TPO-Ab) is still controversial. This article reviews the research progress of L-T4 in the treatment of TPO-Ab negative hypothyroidism in pregnancy. Related Articles | Metrics

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Application of Multidisciplinary Diagnosis and Treatment Mode in Placenta Percreta LIU Xiao-hui, DONG Yan, LIU Xiao-ling, PU Wei-lin, LIU Xiao-li, GE Jun, ZHANG Yu-fang, GAO Li-na, HAO Man, HE Xiao-chun 2020, 47 (6):  666-669.  Abstract ( 939 )   PDF (740KB) ( 7371 )   Objective：To evaluate the clinical value of multidisciplinary diagnosis and treatment mode in the perioperative period of  placenta percreta. Methods: From January 2015 to June 2018, 67 cases were diagnosed placenta percreta by prenatal ultrasonic score system and confirmed by intraoperative findings at the Gansu Provincial Maternity and Child Care Hospital. According to the diagnosis and treatment mode, it is divided into two groups: specialized diagnosis and treatment group (32 cases) and multidisciplinary diagnosis and treatment group (35 cases). The general conditions, intraoperative and postoperative conditions were collected and compared between the two groups. Results: There were no significant differences between in the severity of placenta implantation, age, gravidity, number of abortions, number of cesarean section and gestational week of termination between the two groups (all P＞0.05). The intraoperative bleeding volume, intraoperative blood transfusion volume, the operation time, hysterectomy rate, bladder rupture rate and coagulation function abnormality rate in the multidisciplinary cooperative diagnosis and treatment group were lower than those in the specialized diagnosis and treatment group, and the differences were statistically significant (all P＜0.05). The postoperative hospitalization time, incidence of postoperative fever and hospitalization expenses in the multidisciplinary cooperative diagnosis and treatment group were lower than those in the specialized diagnosis and treatment group, and the differences were statistically significant (all P＜0.05). There was no significant difference in 24-hour blood loss after operation and Apgar score 5 minutes after operation between the two groups (P＞0.05). Conclusions: Multidisciplinary diagnosis and treatment mode plays a significant role in the perioperative period of placenta percreta, which can significantly reduce the amount of intraoperative bleeding, intraoperative blood transfusion, the occurrence of intraoperative bladder rupture, hysterectomy, reduce the occurrence of postoperative coagulation dysfunction, and effectively save medical resources. Related Articles | Metrics

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Intrauterine Pregnancy with Rupture of Fallopian Tube at 16 weeks: A Case Report  JIA Hong-jing, QIAN Yong-hong, LIANG Bao-quan, GE Hai-yun 2020, 47 (6):  670-671.  Abstract ( 999 )   PDF (7906KB) ( 7323 )   Compound pregnancy is a relatively rare type of pregnancy. With the development of assisted reproductive technology, the incidence of compound pregnancy is increasing year by year, and most of them were diagnosed by the ultrasound examination during the first trimester. Most patients have abdominal pain, vaginal bleeding and even hemorrhagic shock during the first trimester and are found, while compound pregnancy in the second trimester is extremely rare. It is reported that our hospital received a patient who could not tolerate acute abdominal pain during intercourse and her ultrasound examination in the emergency department of a local hospital showed a live intrauterine fetus and the cause of the abdominal pain could not be found. After being transferred to our hospital, the diagnosis turned to compound pregnancy and fallopian tube rupture and she underwent emergency surgery. We report this rare case with literature review in order to help with giving these patients timely diagnosis and effective treatment. Related Articles | Metrics

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The Interpretation of "2020 SOGC Clinical Practice Guideline: Progesterone for Prevention of Spontaneous Preterm Birth"#br# TANG Yu -ping, YING Hao 2020, 47 (6):  672-675.  Abstract ( 1203 )   PDF (843KB) ( 7618 )   Preterm birth，occurring in 5% to 18% birth of births worldwide, is the main cause of neonatal death and other adverse outcomes. Many surviving preterm birth need to face lifelong disability, including learning disabilities, vision and hearing problems. Among them, 70% to 80% are spontaneous preterm births (SPB), and the remaining 20% to 30% are therapeutic preterm delivery. Progesterone is an important substance to maintain pregnancy. More and more evidences show that vaginal use of progesterone can prevent the occurrence of SPB. In 2020, the society of Obstetricians and Gynaecologists of Canada, SOGC) summarized the latest clinical research evidence of progesterone in the prevention of SPB, and provided clinical guidance and recommendations for the mechanism of action, the appropriate population, unsuitable population, dosage, timing and side effects of progesterone in the prevention of SPB. At the same time, the guideline compared progesterone therapy with cervical cerclage, vaginal pessary and bed rest to prevent SPB. This paper interpreted the main points of its recommendation in order to provide reference for medical workers in China. Related Articles | Metrics

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Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment LIANG Yan-chun, WEI Ya-jing, YANG Ru-yu, YAO Shu-zhong 2020, 47 (6):  676-683.  Abstract ( 1286 )   PDF (8547KB) ( 7292 )   Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed. Related Articles | Metrics

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Research Status of Long Non-Coding RNA Expression Patterns in Endometriosis CAI Xue, HE Zheng-qin, ZHANG Guang-mei 2020, 47 (6):  684-688.  Abstract ( 1017 )   PDF (726KB) ( 7345 )   Endometriosis (EMs) is a common gynecological disease. Due to the lack of sensitive and specific biological indicators in clinic, the disease can only be diagnosed by laparoscopy. It is difficult to avoid recurrence of EMs either by drug therapy or by surgery. Therefore, exploring the pathogenesis of endometriosis is of great significance to guide clinical diagnosis and treatment, alleviate clinical symptoms, improve prognosis and reduce social burden. With the development of high-throughput sequencing and gene chip technology, long non-coding RNAs (lncRNAs) molecules, as an important regulator of cell function, have attracted more and more attention in the occurrence and development of a variety of chronic diseases. The article summarizes the expression pattern and mechanism of some popular lncRNAs in EMs in recent years, and discusses the feasibility of using many kinds of lncRNAs molecules as diagnostic and therapeutic targets for EMs. In addition, the article also points out that lncRNAs may mediate the association between autoimmune diseases and EMs, which provides a new idea for exploring the physiological and pathological process and treatment direction of EMs. Related Articles | Metrics

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The Research Progress on Immune Dysfunction in Endometrial Receptivity of Endometriosis LIANG Shuang, YANG Xiao-kui, ZHANG Ying 2020, 47 (6):  689-693.  Abstract ( 1117 )   PDF (713KB) ( 7397 )   In recent years, the incidence of endometriosis-induced infertility is increasing, the molecular mechanisms involved in the pathogenesis of endometriosis are not completely understood. These patients are often accompanied with local or whole body humoral immunity and cellular immune dysfunction, mainly showing significant reduction in CD56+CD16- uterine natural killer cell (uNK cell) subsets, abnormal activation of macrophage, imbalance of helper T cell 1 (Th1)/Th2 cell, greater numbers of regulatory T cells (Treg) and dysfunction, reduced expression of leukemia inhibitory factor (LIF), and abnormally increased cytokines, such as interleukin-1 (IL-1), IL-6, interferon-γ (IFN-γ) and tumor necrosis factor α (TNF-α). These are mainly manifested as immunosuppression and immune imbalance, which inhibit apoptotic pathways and promote adhesion and proliferation of endometriotic cells, as well as angiogenesis in endometriotic lesions. Therefore, these lead to the reduction of endometrial receptivity and cause infertility. This review summarizes the progress about immune dysfunction in endometrial receptivity of endometriosis, aiming to provide new ideas for the diagnosis and treatment of endometriosis with infertility. Related Articles | Metrics

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Medical Treatment of Endometriosis PENG Li-na, AN Chun-xiao, ZHANG Guang-mei 2020, 47 (6):  694-698.  Abstract ( 1177 )   PDF (741KB) ( 7383 )   Endometriosis is an estrogen dependent disease, which occurs frequently in women of childbearing age. The incidence rate is high, and the treatment time is long. It seriously affects the physical and mental health and quality of life of women. At present, its pathogenesis has not been clarified, and the available treatment methods have their limitations, so improving the existing treatment scheme and finding new treatment drugs have become a research hotspot. In this paper, the traditional medicine and emerging medicine of endometriosis are described. This article will focus on the introduction of emerging drugs such as gonadotropin-releasing hormone antagonist, aromatase inhibitors, selective progesterone receptor modulators, selective estrogen receptor modulators, anti-angiogenic agents and antioxidants, in order to provide new ideas for the research and treatment of endometriosis. Related Articles | Metrics

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Advance on the Applications of Platelet Rich Plasma in Fertility Preservation LI Xiao-feng, WANG Fang, YANG Feng-na, TAO Li-mei, YANG Xin 2020, 47 (6):  699-704.  Abstract ( 1060 )   PDF (782KB) ( 7430 )   Platelet rich plasma (PRP) is a platelet concentrate prepared by centrifugation of autologous or allogeneic whole blood. It contains a large number of growth factors and proteins. It has biological functions such as promoting tissue regeneration and repair, angiogenesis and so on. It has been widely used in orthopedics, ophthalmology, stomatology, dermatology and so on, with significant effect and no serious adverse reactions. At present, more and more studies have applied PRP to fertility protection. Lots of articles reported that PRP can improve endometrial receptivity, ovarian reserve function, recovery of reproductive organ structure and function after chemotherapy and ischemic injury, reproductive endocrine and sexual behavior of both men and women. But the preparation standards are not uniform. Centrifugal speed, centrifugal time, anticoagulant, activator, storage time, freezing temperature, preservative, volunteer characteristics and other factors may all affect its quality. This study discusses the research progress of PRP in fertility protection，the influencing factors of PRP quality and the safety issues in the hope of providing a reference basis for its clinical application. Related Articles | Metrics

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Advances of the Relationship between Chronic Endometritis and Reproductive Outcomes YE Hai-hua, LU Li-mei, WANG Xing, LIANG Yan-chun 2020, 47 (6):  705-711.  Abstract ( 1189 )   PDF (784KB) ( 7412 )   Chronic endometritis (CE) is a disease of continuous inflammation of endometrium. CE is generally asymptomatic or has vague symptoms, which makes it easy to be ignored clinically. Pathological identification of plasma cell within the endometrial stroma is the most important diagnostic criteria of CE. As a specific marker of plasma cell, immunohistochemical staining of CD138 improves the diagnosis of CE. The main treatment strategy of CE is antibiotic treatment. The prevalence of CE is higher in patients with recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF). Furthermore, antibiotic treatment of CE can improve the reproductive outcomes of these patients. These evidences suggest that CE is closely associated with RPL and RIF, but the etiology and pathogenesis of CE is still unknown. This article reviews the epidemiology, diagnosis and treatment of CE, as well as the relationship between CE and RPL/RIF, providing valuable information for the diagnosis and treatment of CE. Related Articles | Metrics

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Research Progress on the Relationship between Estrogen, Inflammatory Factors and Postmenopausal Osteoporosis CHEN Yi-jie, JIN Xue-jing, WANG Xue, DU Yi-ni, SHENG Zhu-mei, ZHANG Zhi-fen 2020, 47 (6):  712-715.  Abstract ( 1019 )   PDF (675KB) ( 7379 )   Due to the sudden drop in estrogen levels, postmenopausal women are in bone reconstruction imbalance. Osteoclast function enhanced, and osteoblast function decreased. At the same time, due to the increase of age, the physiological and immune functions of postmenopausal women decrease, and the body is in chronic inflammation state for a long time. Various inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease are associated with significant local or systemic bone loss. Inflammatory factors interact with the immune system and bone remodeling, and are closely related to the progress of osteoporosis. Estrogen regulate the process of bone reconstruction, the occurrence and development of inflammation in various ways. In the past, the relationship between estrogen and osteoporosis, or inflammation and osteoporosis was usually studied separately. In recent years, there is evidence that estrogen and inflammation are interrelated in postmenopausal osteoporosis. The decline of estrogen may cause postmenopausal osteoporosis by influencing the level of inflammation and exploring how estrogen regulates inflammatory factors may provide a new theoretical basis for the treatment of osteoporosis. This article reviews estrogen and inflammatory factors in postmenopausal osteoporosis as following. Related Articles | Metrics

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Diagnosis and Treatment of Adnexal Torsion during Pregnancy YU Jing-jing, LIU Xiao-hui, LI Xiao-xiao, XIE Ya-wen, TIAN Geng 2020, 47 (6):  716-720.  Abstract ( 1718 )   PDF (704KB) ( 7452 )   Adnexal torsion refers to axial rotation of the ovary or fallopian tube and its ligaments on its blood vessels, which is a rare gynecologic emergency. Delayed treatment can lead to abortion, premature delivery, hemorrhage and infection, which threats the safety of mother and fetal life and female fertility. Thus, we need early diagnosis and treatment for it. Ovarian hyperstimulation caused by assisted reproductive technology and ovarian masses are the most common causes of adnexal torsion. The clinical manifestations and laboratory tests of adnexal torsion were not specific. The most common symptoms are acute or subacute lower abdominal pain, followed by nausea and vomiting. Ultrasound can be used to diagnose torsion in the first trimester. "Whirlpool sign" of twisted vascular pedicle is the specific finding. In the second and third trimester of pregnancy, it is difficult to diagnose because of uterine occlusion while MRI is of high diagnostic value. And the diffusion-weighted imaging can be used to assess the severity of adnexal torsion. At present, the treatment methods for the adnexal torsion during pregnancy include manual reduction and surgical treatment. Operation is the main diagnosis and treatment method of adnexal torsion during pregnancy. Laparoscopic conservative treatment is of great significance for achieving a good outcome of mother and child and saving female fertility. Related Articles | Metrics