Journal of International Obstetrics and Gynecology

Research Progress on Influencing Factors of Intrapartum Cesarean Section in New Labor Standard

LIU Yuan-ying, WANG Yong-qing

2021, 48 (5): 481-485. doi: 10.12280/gjfckx.20210171

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With the implementation of the new labor standard in China, the vaginal delivery rate increases, the primary cesarean section rate decreases, but cesarean sections during labor indicated by fetal distress and intrapartum fever increase, intrapartum cesarean section will increases the risk of complications for mothers and neonatus. Vaginal delivery is a complex physiological process. During this process, influencing factors such as age, height, body mass index, gestational age, induced labor method, premature rupture of membranes and labor analgesia are valuable predictors of intrapartum cesarean section. One abnormal factor may not leads to intrapartum cesarean section, but the superposition of multiple influencing factors may significantly increase the probability, even the puerpera has no cesarean section indications. Therefore, it is very important to identify the risk factors of cesarean section during labor and control the indications and timing of cesarean section. It is planned to summarize the influencing factors of intrapartum cesarean section under the new labor standard, in order to provide directions for the construction of risk prediction model of intrapartum cesarean section.

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Oxytocin Exposure during Labor and Risk of Postpartum Hemorrhage

ZHAO Ying, CHANG Ying, YOU Xin, CHEN Xu

2021, 48 (5): 486-489. doi: 10.12280/gjfckx.20201041

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Postpartum hemorrhage is still one of the main causes of maternal death. Some studies have confirmed that oxytocin administration during labor is associated with a higher risk of postpartum hemorrhage, especially when the dose used during labor is high, the duration of time is long, or the woman does not receive active management in the third stage of labor. The desensitization sequence in oxytocin receptors is one of the pathophysiologic hypotheses, and clinically this can manifest as a reduction in oxytocin-induced contractility, resulting in uterine atony and postpartum hemorrhage. This paper reviews the research progress of the association between oxytocin during labor and risk of postpartum hemorrhage, so as to contribute to the establishment of a reasonable oxytocin administration and decrease the incidence of postpartum hemorrhage secondary to uterine atony.

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The Advance of Impaired Decidualization in the Pathogenesis of Preeclampsia

YANG Jie-qiong, ZHANG Cong, DI Wen

2021, 48 (5): 490-493. doi: 10.12280/gjfckx.20210283

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Preeclampsia is a pregnancy-related disorder which seriously affects maternal and fetal health. Its etiology and pathogenesis have not been clarified yet. How to predict, diagnose and treat preeclampsia has always been the focus of attention in the field of obstetrics and gynecology. Decidualization of the endometrium provides a critical nutrient and immune matrix for embryo implantation and development. However, impaired decidualization caused by biological dysfunction of decidual cells (proliferation, differentiation, apoptosis, angiogenesis and energy metabolism) can affect the invasion of trophoblast cells, resistance to inflammation, oxidative stress, and immune protection, and impair embryo implantation and pregnancy maintenance, and thus regulate the occurrence and development of preeclampsia. To fully understand the role of decidualization defeat caused by abnormal biological function of decidual cells in the pathogenesis of preeclampsia will provide more theoretical basis for the prediction, diagnosis and treatment of preeclampsia.

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Process of Adipokines in First Trimester for Predicting Gestational Diabetes Mellitus

LOU Hai-feng, CHEN Dan-qing

2021, 48 (5): 494-498. doi: 10.12280/gjfckx.20201168

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As a common gestational complication, prevalence of gestational diabetes mellitus (GDM) is increasing steadily, leading to short- and long-term adverse outcomes for both mother and infant. The pathogenesis of GDM is unclear, however, screening biomarkers in maternal serum for predicting GDM in the first trimester is of great significance for early intervention to lessen the harm. Recent evidence suggests that some adipokines in the first trimester showed correlations with GDM development, including decreased levels of adiponectin, omentin-1, irisin, chemerin, and increased levels of leptin, resistin, visfatin, fatty acid-binding protein 4, retinol-binding protein 4 and betatrophin. These adipokines would help complete a predictive or early diagnostic model for GDM.

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Research Progress of Asymptomatic Hypercholanaemia of Pregnancy

LUO Ting, GUO Xue-dong, BAI Xiao-xia

2021, 48 (5): 499-502. doi: 10.12280/gjfckx.20210365

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Asymptomatic hypercholanaemia of pregnancy (AHP) refers to the increase of serum total bile acids during pregnancy, which exceeds the normal value by more than two times, without hepatobiliary diseases or intrahepatic cholestasis of pregnancy (ICP)-related symptoms. The incidence of AHP is higher than ICP, which may be related to hormone factors and genetic susceptibility. The composition of bile acid mass spectrometry is different from ICP, but the perinatal outcome is better than ICP. AHP with high total bile acid level is often difficult to differentiate from severe ICP in clinic, which leads to premature termination of pregnancy and even iatrogenic premature birth. Therefore, early detection and correct diagnosis of AHP, selection of appropriate treatment methods and appropriate timing of termination of pregnancy are the key to reduce iatrogenic intervention and premature delivery. In this paper, the etiology, pathogenesis, diagnosis and treatment of AHP are summarized.

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Research Status of Prenatal and Perinatal Influence Factors of Female Levator Ani Muscle Injury

LIU Yin-xia, ZHANG Bin, WANG Yu-xian

2021, 48 (5): 503-507. doi: 10.12280/gjfckx.20201111

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Levator ani muscle injury (LAMI), which is the most common muscle injury after vaginal delivery, has been considered as a risk factor and independent predictor of pelvic organ prolapse, and plays an important role in the occurrence and development of a variety of pelvic floor functional disorders. In recent years, although the understanding of the factors related to the prenatal and perinatal aspects of female LAMI is not completely clear, there is still some progress. Among them, vaginal delivery represented by forceps delivery and prolonged second stage of labor are widely considered to be the risk factors for LAMI. Cesarean section and epidural anesthesia had certain protective effects on LAMI. Gestational age and multiple deliveries were irrelevant of LAMI, but the understanding of the relationship between other factors and LAMI remains to be unified. It is of great significance to pay attention to the research status of influencing factors of LAMI in women before and during childbirth for reasonably estimating the risk of pelvic floor diseases and timely and effective obstetric intervention.

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The Progress of Ultrasound Diagnosis of Fetal Growth Restriction

WANG Can, HUANG Meng

2021, 48 (5): 508-511. doi: 10.12280/gjfckx.20201231

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Fetal growth restriction (FGR) is the main cause of death and frailty of modern perinatal infants. It not only affects the development of the fetus in the mother′s body, but also directly affects the prognosis of the fetus without timely intervention. The advantages of simplicity, safety, and non-radiation promote the application of ultrasound to the detection of fetuses during pregnancy. With the development of ultrasound technology, the development of the fetus can be evaluated in many aspects from structure to function. This article reviews the progress of ultrasound diagnosis of FGR from the aspects of measuring fetal diameter, hemodynamic parameters, placental volume, thymus volume, cerebellar transverse diameter, brain-placental ratio and adrenal volume under ultrasound, and provides a reliable basis for clinical diagnosis and treatment.

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Research Status of Correlation between Telomere Length and the Etiology of Spontaneous Abortion

BAI Le-le, ZHAO Xiao-xi

2021, 48 (5): 512-516. doi: 10.12280/gjfckx.20210034

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The study on the etiology of spontaneous abortion has always been a hot topic in the field of obstetrics and gynecology. The influence of various factors on pregnancy has been confirmed in numerous clinical studies, such as embryo, mother, father and environment, but there are still many cases of spontaneous abortion causes can not be explained. Telomeres are "cap" structures at the ends of linear DNA molecules in eukaryotic chromosomes, which are involved in maintaining chromosome stability and DNA replication integrity. Telomere plays an important role in the process of human reproduction, telomere length is closely related to the gamete and embryo development, positively correlated with the potential of embryonic stem cell proliferation. Most studies confirmed that spontaneous abortion is characterized by telomere shortening, especially in aneuploid embryos, and telomere length is in correlation with the mother, father and environmental factors. In this paper, the research on the correlation between telomere length and the etiology of spontaneous abortion is reviewed, to provide theoretical basis and direction guidance for the prevention and treatment of spontaneous abortion as well as further research.

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Perinatal Outcomes of Single Intrauterine Fetal Death in Dichorionic Twins

WANG Lian-lian, YANG Ling, ZHOU Yan, Gu Ning, DAI Yi-min

2021, 48 (5): 517-520. doi: 10.12280/gjfckx.20201244

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Objective: Compare the perinatal outcomes of selective feticide and spontaneous single intrauterine fetal death (SIUFD) in dichorionic twins, analyze the perinatal outcomes of feticide at different gestational ages, and explore the clinical application of selective feticide. Methods: Fifty-five dichorionic twins pregnancies that underwent selective feticide or spontaneous SIUFD to reduce the twins to single birth in the Obstetrics Department of Nanjing Drum Tower Hospital from January 2011 to December 2019 were retrospectively reviewed. The patients were grouped into selective feticide group (N=39) and spontaneous SIUFD group (N=16) according to reasons of fetal reduction, analysis and compare the perinatal outcome retrospectively. Results: The total pregnancy loss rate in 55 cases was 9.1% (5 miscarriages), and the live birth rate was 90.9%. The gestational age of fetal reduction-death in the selective feticide group was significantly lower than that in the spontaneous SIUFD group, the overall termination of pregnancy gestational age and live birth rate in the selective feticide group were significantly higher than that of the spontaneous SIUFD group, and the cesarean section rate, miscarriage rate were lower than the spontaneous SIUFD group (P<0.05). There was no significant difference in preterm birth rate, full-term birth rate, birth weight, birth weight percentile, healthy discharge rate of newborns, and NICU rate of newborns between the two groups (both P>0.05). According to the gestational age at which selective feticide, there were 24 cases of gestational reduction of ≤20 weeks, and 15 cases of gestational reduction of >20 weeks. There was no statistically significant difference in the birth weight percentile between the two groups (P>0.05), but the preterm birth rate was lower, the full-term birth rate of gestational weeks was higher, and the birth weight of newborns was larger of ≤20 weeks (both P<0.05). Conclusions: Twin pregnancy will cause adverse effects on the perinatal outcomes of surviving children after SIUFD. For those with indications of fetal reduction, selective feticide in early pregnancy may be beneficial for the perinatal outcome in multiple pregnancy, improve the live birth rate of surviving children.

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Twin-Twin Transfusion Syndrome with Mirror Syndrome Induced Labor: A Case Report

TANG Xiao-tong, GE Zhi-ping

2021, 48 (5): 521-524. doi: 10.12280/gjfckx.20210005

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Mirror syndrome, also known as Ballantyne syndrome, is characterized by fetal and placental edema, secondary maternal edema and hemodilution. The incidence rate of mirror syndrome is extremely low, the disease progresses rapidly, and the number of reported cases is relatively small at home and abroad. The etiology is mostly related to the factors inducing fetal edema. Twin-twin transfusion syndrome is one of the causes of fetal nonimmune edema. This article reviews the cases of twin-twin transfusion syndrome combined with mirror syndrome in the First Affililated Hospital of Nanjing Medical University in February 2019, analyzes the general situation of the patients, gives reasonable treatment intervention, and analyzes the prognosis. In the case, the patient′s condition worsened under the condition of conservative treatment, and finally chose to terminate the pregnancy. After the termination of pregnancy, the patient′s condition improved significantly, and was discharged from the outpatient clinic for follow-up. The diagnosis, differential diagnosis and treatment were discussed.

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A Case Report on Treatment of Cervical Ectopic Pregnancy Using High Intensity Focused Ultrasound Combined with Curettage

ZHANG Xiao-rong, MA Yan-wei, DONG Qu-long, HOU Hai-yan, YANG Zhen-hua

2021, 48 (5): 525-527. doi: 10.12280/gjfckx.20201175

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As one of ectopic pregnancies, cervical ectopic pregnancy, which is rare in clinic, may cause severe bleeding and other adverse outcomes because the embryo is implanted in the cervical mucosa. In some severe cases, hysterectomy is necessary and it would be even life-threatening while there is no specific method to treat the disease and individualized treatment is needed. At present, there are few reports on the treatment of cervical ectopic pregnancy by high intensity focused ultrasound. Now, a female diagnosed with cervical ectopic pregnancy who was hospitalized in the Department of Obstetrics and Gynecology, The Characteristic Medicine Center of The Chinese People′s Armed Police Forces in 2020 cured by high intensity focused ultrasound combined with curettage is reviewed. We hope to share the treatment experience in order to attract the attention of obstetricians and gynecologists, and strive for more effective, safer and more economic treatment for cervical ectopic pregnancy patients.

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A Case of Spontaneous Ovarian Hyperstimulation Syndrome with Ovarian Rupture and Literature Review

WANG Xin-xin, QIAN Yong-hong

2021, 48 (5): 528-531. doi: 10.12280/gjfckx.20201199

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Ovarian hyperstimulation syndrome (OHSS) is an iatric disease frequently occurred in patients with controlled ovarian hyperstimulation, but also can be observed in spontaneous ovulation cycles, especially those with multiple-pregnancy, hypothyroidism, polycystic ovary syndrome. The incidence of natural pregnancy complicated with OHSS is very low, which seriously affects the health of patients and even endangers their lives. This paper reported a case of spontaneous ovarian hyperstimulation syndrome (sOHSS) with ovarian rupture, and discussed the pathogenesis, clinical manifestations, complications, differential diagnosis and treatment of sOHSS, so as to provide a reference for clinical treatment.

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A Case of Spontaneous Rupture of Non-Scar Uterus during Delivery

ZHANG Hai-juan, SUN Lu-lu, XU Yan-lei

2021, 48 (5): 532-534. doi: 10.12280/gjfckx.20201190

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Uterine rupture refers to the rupture of the body, bottom or lower part of the uterus during delivery or late pregnancy, which directly threatens the life of parturient and fetus, and is a critical obstetric disease. The most common causes are the history of uterine operation and obstructive dystocia, followed by uterine dysplasia, myometrium dysplasia, improper selection of cesarean section incision and vaginal midwifery injury. The main clinical manifestations were abnormal fetal heart, abdominal pain and vaginal bleeding. For patients without high risk factors of uterine rupture and atypical clinical symptoms, uterine rupture is prone to missed diagnosis. A case of spontaneous rupture of non-scar uterus during delivery in the Fourth Hospital of Shijiazhuang was discussed and analyzed to provide help for early identification, early diagnosis and timely treatment of the disease.

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Research Progress of DNA Methylation in Predicting Cervical Lesions

CHEN Cong, ZHAO Min

2021, 48 (5): 535-538. doi: 10.12280/gjfckx.20201124

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Existing studies suggest that it takes decades for cervical precancerous lesions to progress to cervical cancer. Therefore, cervical cancer is a preventable gynecological malignant tumor, and the key to its prevention is to screen out cervical lesions as soon as possible. Based on China′s national conditions, the majority of cervical lesions screening still choose a single thin-prep cytology test(TCT) examination or HPV DNA detection to shunt TCT results abnormal way, resulting in missed diagnosis or over diagnosis of cervical lesions in clinical work. To choose the best screening method to improve the diagnosis rate of cervical lesions is an urgent problem in the prevention and control of cervical cancer. Epigenetic accumulation of genes regulated by DNA methylation may mediate or predict the progression of malignant tumors. The key mechanism of carcinogenesis lies in the suppression of gene expression through promoter silencing, leading to global hypomethylation and gene specific hypermethylation. It has been confirmed that there is an increase in the methylation level of specific genes in cervical lesions. Because of its high specificity, it is also developed as a new additional tool for cervical lesions screening. This article will make a brief review of the related gene methylation in predicting cervical lesions.

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Research Progress on the Relationship between DKK3, Wnt/β-Catenin Signaling Pathway and Cervical Cancer

WANG Ling, WANG Zhi-lian

2021, 48 (5): 539-542. doi: 10.12280/gjfckx.20201169

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Cervical cancer is one of the malignant tumors in women, and the pathogenesis and related pathway molecules have been studied more and more deeply. Among them, the research on Wnt/β-catenin signaling pathway has attracted great attention. The Wnt/β-catenin signaling pathway involves a wide range of physiological and pathological processes, including cell growth, differentiation, ontogeny, migration, genetic stability, apoptosis, stem cell self-renewal, and maintenance of adult tissue homeostasis. Stable β-catenin is accumulated in the cytoplasm and transferred to the nucleus, which activates the Wnt/β-catenin signaling pathway and is one of the inducing factors of multiple cancers. The accumulation of β-catenin occupies a core position in the Wnt/β-catenin signaling pathway. β-catenin drives target genes through Wnt/β-catenin signaling pathway and participates in the multi-step occurrence and development of cervical cancer. DKK3 may inhibit the Wnt/β-catenin signaling pathway by degrading β-catenin, blocking the nuclear transport of β-catenin, and thus become a potential key role in the inhibition of cervical cancer. Therefore, it is particularly important to study the relationship between DKK3, Wnt/β-catenin signaling pathway and cervical cancer.

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Research Progress on the Relationship between Uterine Fibroids and Vitamin D

WANG Zi-hao, ZHOU Jian-zheng, WANG Mei-yun, YANG Ling

2021, 48 (5): 543-547. doi: 10.12280/gjfckx.20210021

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Uterine fibroids are common benign tumors in gynecology, which seriously affect women′s quality of life. The current idea of clinical treatment of uterine fibroids is to formulate different conservative treatment plans or surgical treatment plans based on individual differences, but these treatment plans have drawbacks. For many years, the medical profession has been looking for better treatments for uterine fibroids, and the relationship between vitamin D and uterine fibroids has also been discovered. As a steroid compound, vitamin D plays an important role in various organs and tissues of the human body. The confirmed obstetrics and gynecology diseases related to vitamin D include infertility, polycystic ovary syndrome and premature delivery. Studies in the past decade have confirmed that reduced levels of vitamin D in the human body are one of the risk factors for the occurrence and development of uterine fibroids. Some current studies have also found that drug supplementation with vitamin D and its analogues can play a role in the treatment of uterine fibroids.

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Advances in Small Cell Carcinoma of the Ovary-Hypercalcemic Type

XU Yan-ning, LIU Yi-xin, CHEN Ling

2021, 48 (5): 548-552. doi: 10.12280/gjfckx.20210203

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Primary small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare but extremely lethal malignancy that mainly impacts young women. Although the origin of SCCOHT is still obscure, it is difficult to differentiate from other ovarian small cell tumors in histomorphology, and there are no definite treatment guidelines as the rarity, some breakthrough progress has been made in the molecular pathogenesis recent years. SCCOHT is characterized by a diploid genome with loss of SMARCA4 and lack of SMARCA2 expression. The lack of expression of BRG1 and BRM proteins encoded by these two genes in immunohistochemical staining has become an important means to identify the tumor in pathological diagnosis. In addition, there are also some studies on treatment, such as targeted drugs for pathogenic molecules. In this review, the clinicopathological characteristics, differential diagnosis, pathogenesis and treatment of SCCOHT were analyzed and summarized, in order to further deepen the understanding of this disease and lay the foundation for more accurate diagnosis and treatment.

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Comprehensive Analysis of Prognostic Biomarkers in Cervical Squamous Carcinoma Based on Aberrant MiRNA-mRNA Axes and Cox Regression Models

LI Yuan-xing, NIU Xiao-chen, CHANG Jing-jing, LUO Hai-xia, WANG Wei

2021, 48 (5): 553-559. doi: 10.12280/gjfckx.20201204

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Objective: To explore the expression of microRNA(miRNA)-messenger RNA(mRNA) and predict its prognostic significance in cervical squamous carcinoma (CESC), analyze its significance in predicting the prognosis of CESC. Methods: TCGA database was used to screen the differential expression profiles of miRNA and mRNA in CESC and normal cervical tissue. The interaction between miRNA and targeted mRNA was verified by miRTarBase, TargetScan and miRDB databases. The prognostic markers of CESC were determined by Kaplan-Meier survival analysis and visualized by Cytoscape software. Construction the miRNA-mRNA regulatory network related to the prognosis of CESC, the selected mRNAs were analyzed by gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Results: Four miRNAs and nine mRNAs differentially expressed in CESC and normal tissues were detected. Four miRNA-mRNA axes closely related to the prognosis of CESC were obtained. The target mRNA of hsa-miR-505-5p was CBX8, and hsa-miR-142-3p targeted ADAMTS3, PTPRB and SEC23A respectively. Biological function and pathway analysis showed that the differentially expressed mRNAs were mainly enriched in biological process and PI3K-Akt pathway, HPV infection pathway. Conclusions: Above miRNA-mRNA axes obtained in this study are related to the prognosis of CESC, which can be used as a new perspective for the study of the pathogenesis and an effective indicator for monitoring the prognosis of CESC.

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Mesonephric Adenocarcinoma of the Uterus Corpus: A Case Report and Literature Review

ZHANG Fang-yuan, LIU Zi-wei, CHEN Yu-ying, JIA Yan

2021, 48 (5): 560-562. doi: 10.12280/gjfckx.20201202

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Mesonephric adenocarcinoma is a rare malignant tumor with a low incidence. It originates from mesonephric remnants or its hyperplasia, which often lies in cervix and rarely remains in the uterus corpus. Mesonephric adenocarcinoma of the uterus corpus(UCMA) is lack of special clinical presentation, which often presents with vaginal bleeding, thus leading to the diagnosis of genital tract inflammation, uterine fibroids, cervical cancer, endometrial cancer and so on. Cytology, pathology, immunohistochemistry and molecular character are required to get accurate diagnosis. According to recent reports, GATA3 is regarded as its special marker. In addition, the prognosis of UCMA is poor, and its treatment options include surgery and adjuvant radiotherapy and chemotherapy. This paper reports a case of UCMA that was misdiagnosed as uterine fibroids before surgery, reviews the relevant literature and summarized the clinical features in order to reduce its misdiagnosis and get awareness raised.

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Pseudo-Meigs Syndrome: A Case Report and Literature Review

WANG Bo, LIU Yun-fei, LI Xi-mei, LIU Yi, LIU Shu-yan

2021, 48 (5): 563-565. doi: 10.12280/gjfckx.20201238

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Meigs syndrome refers to the clinical symptoms that these four ovarian tumors: ovarian fibroma, follicular mesenchymoma, Brenner tumor, granulosa cell tumor, accompany with ascites and/or pleural effusion, and the effusion diappear after tumorectomy. Pseudo-Meigs syndrome is defined as a clinical symptoms that except for the above four ovarian tumors, abdominal and pelvic tumors with ascites and/or pleural effusion, effusion disappear after tumorectomy. It rarely happened in clinical work. This report gives an account of the medical history of one case of pseudo-Meigs syndrome admitted to the Second Hospital of Jilin University. The case is uterine leiomyoma complicated with ascites and ascites disappear after myomatectomy. This article improve the understanding of majority of clinicians on pseudo-Meigs syndrome and avoid misdiagnosis by analysing retrospectively the case of diagnosis and treatment process, pathological examination and follow-up results and the related literatures were reviewed.

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Tubulovillous Adenoma of Vagina with Local Canceration: A Case Report

SU Rui, XU Fei-xue, WEI Meng, CAO Jing, WANG Xiao-hui

2021, 48 (5): 566-568. doi: 10.12280/gjfckx.20201236

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Tubulovillous adenoma is a kind of malignant benign tumor commonly occurring in gastrointestinal tract. Primary tubulovillous adenomas of the vagina are rare and have similar pathological features to gastrointestinal adenomas and are prone to recurrence. Its clinical symptoms are not typical, easy to misdiagnose. Diagnosis is mainly based on tissue biopsy. There is no standard diagnosis or treatment for these cases because of their low incidence and infrequent reporting. We report a case of primary tubulovillous adenoma of the vagina with local carcinogenesis. The clinical manifestations, imaging features and pathological features of the patient were reviewed, and a large number of literatures were reviewed to summarize the characteristics of the patient, so as to improve the clinician′s cognition of the disease.

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Collection and Interpretation of Medical Terms of Gestational Trophoblastic Disease/Neoplasia

SHI Yi-fu, LI Juan-qing

2021, 48 (5): 569-574. doi: 10.12280/gjfckx.20210530

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With the in-depth research into the diagnosis and treatment of gestational trophoblastic disease (GTD)/ gestational trophoblastic neoplasia(GTN), there are more and more papers on the etiology, genetics, molecular biology and clinical research of GTD/GTN. Therefore, the correct application of GTD/GTN-related proper nouns is crucial. According to our own national conditions, we explains nine categories in detail, including gestational trophoblastic cells, GTD classification, GTD tissue typing, hydatidiform mole, GTD/GTN of hydatidiform mole subordinates, choriocarcinoma, GTD treatment, post-treatment grading, hCG molecular family and clinical questions. Furthermore, this article collects and interprets the proper nouns related to GTD/GTN, which is convenient for obstetricians and gynecologists to understand and use these proper nouns.

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Advances in the Diagnosis and Treatment of Thoracic Endometriosis Syndrome

PAN Yu-wen, YAO Shu-zhong

2021, 48 (5): 575-578. doi: 10.12280/gjfckx.20210220

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Endometriosis is a common chronic disease in women of reproductive age, among which thoracic endometriosis syndrome is a relatively rare type. Endometrial-like tissue moves into the thoracic cavity and causes a variety of clinical manifestations related to the menstruation, including catamenial pneumothorax, hemothorax, hemoptysis, pulmonary nodules and chest pain. Among them, menstrual pneumothorax is the most common. The pathogenesis of this disease is not yet fully understood. At present, there are many hypotheses explaining how endometrial tissue moves into the thoracic cavity and the pathogenesis of menstrual pneumothorax, but there is no single hypothesis that can explain all the clinical manifestations of thoracic endometriosis syndrome. The examinations include radiological imaging (e.g., chest X-ray, CT and MRI), histological examination and so on. Management of this disease includes drug treatment and surgery. Drug therapy is the first-line treatment, among which gonadotropin-releasing hormone agonists are the first-line drugs. For patients who still relapse after drug treatment or cannot tolerate the adverse reactions caused by drug treatment, surgical treatment should be considered and drug treatment should be supplemented after surgery.

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Research Progress of Diagnostic Markers for Endometriosis

SUN Xiu-li, ZHANG Guang-mei

2021, 48 (5): 579-582. doi: 10.12280/gjfckx.20201115

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Endometriosis (EMs) is a benign disease with high malignant potential in women of childbearing age, with a incidence rate of 10%. Because the onset of the disease is hidden, and can only be diagnosed by laparoscopy and histopathology and other invasive operations, the lack of sensitive and specific biological indicators in clinical diagnosis leads to the delay of diagnosis and treatment of the disease, which seriously affects the quality of life of women. Therefore, it is of great significance to find non-invasive biomarkers for clinical diagnosis and treatment of EMs. Studies have found that there are some diagnostic markers in the serum, urine and menstrual blood of women with EMs. The use of these markers has the advantages of simple, rapid and noninvasive diagnosis, which has become an important direction in the diagnosis of the disease.

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Research Progress of MicroRNA in Endometriosis

CAO Min, ZHANG Guang-mei

2021, 48 (5): 583-587. doi: 10.12280/gjfckx.20201192

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Endometriosis (EMs) is a common gynecological disease in women of childbearing age. Its clinical manifestation is complicated, often characterized by pain, infertility, intercourse discomfort and other symptoms. In recent years, the incidence of EMs is on the rise, which brings physical and psychological burden to women, and also brings huge medical and economic burden to the society. But its pathogenesis has not been clearly explained. At present, a large number of studies have shown that some microRNAs (miRNAs) with important functions are closely related to the occurrence of EMs. MiRNAs are a class of endogenous non-coding RNA molecules with a length of about 22 bases, which can regulate target genes after transcription and affect protein expression, thus affecting cell activities. Therefore, a comprehensive explanation of the functions of miRNAs in regulating ectopic endometrial cells, such as cell proliferation, apoptosis, cell adhesion and metastasis, and angiogenesis, can provide effective help for the diagnosis, treatment and prognosis of EMs.

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Progress in Diagnosis and Treatment of Septate Uterus

GAO Li, XIA En-lan

2021, 48 (5): 588-591. doi: 10.12280/gjfckx.20201206

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Septate uterus is the most common type of congenital uterine malformation, which may lead to adverse pregnancy outcomes such as abortion, premature delivery and fetal growth restriction. At present, the etiology of septate uterus is not clear. The researchers try to explore the causes of septate uterus and the mechanism of adverse pregnancy outcome through the study of gene level, embryonic development process and anatomical structure of septate uterus, but they can not completely reveal the causes of its formation. Septate uterus can be diagnosed by ultrasound. With the development of diagnostic techniques, magnetic resonance imaging (MRI) and three-dimensional ultrasound technology make the diagnosis of septate uterus more accurate, but hysteroscopic diagnosis is still the gold standard for the diagnosis of septate uterus. Because the current classification system for uterine deformities is different and the definition of septate uterus is different, it often leads to different therapeutic outcomes. Although there are a large number of retrospective studies and prospective controlled studies supporting the treatment of septate uterus by transcervical resection of septum (TCRS), high-quality randomized controlled studies are needed to support clinical decisions.

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Progress in Clinical Treatment of Menstrual Blood Stem Cell-Derived Exosomes

LIU Bo-tong, LIU Dong-zhe, CHEN Xiu-hui

2021, 48 (5): 592-596. doi: 10.12280/gjfckx.20210181

Abstract ( 1428 )

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Menstrual blood stem cell-derived exosomes (MenSC-Ex) showed unique charm to researchers by advantages such as non-invasive obtaining procedure, no ethical problems and low immunogenicity. The therapeutic potential and underlying mechanisms were investigated in a series of diseases, showing positive resultes. Recent studies have found that MenSC-Ex can enhance tissue regeneration by limiting inflammatory response and inhibiting autoimmunity. It can also regulate the production of various cytokines such as angiopoietin and interleukin-6 through paracrine and other pathways to assist tissue repair. By targeting the reactive oxygen species and other pathways, MenSC-Ex can also affect the synthesis of vascular endothelial growth factor in cancer cells so as to regulate tumor angiogenesis and subsequently have an impact on tumor process. In the aspect of reproductive medicine, MenSC-Ex has shown promising effect of promoting embryonic development to improve the outcome of in vitro fertilization, and also promoting follicular development to restore ovarian function. In addition, its unique nano-lipid bilayer structure makes it possible for MenSC-Ex to be applied as an efficient nanoparticle delivery system, bearing drugs and biomolecules, which could transfer through the biological barriers and play therapeutic role at the targeted site. In this paper, we made a systemic review on the biological features and working mechanism of MenSC and MenSC-Ex, emphasizing on the clinical application of MenSC-Ex. Future research directions and innovative strategies were expounded as well.

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The Diagnostic Value of Platelet and Coagulation Indexes in Ovarian Endometriosis Cysts

WANG Ya-nan, SONG Dian-rong, ZHANG Wei

2021, 48 (5): 597-600. doi: 10.12280/gjfckx.20201128

Abstract ( 1048 )

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Objective：Discuss the value of platelet and coagulation parameters in diagnosis of ovarian endometriosis cysts. Methods: Patients with ovarian cyst treated by gynecologic surgery in the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from May 2013 to May 2017 were selected. Patients with ovarian endometriosis cysts confirmed by pathology after surgery were the observation group, patients with simple cysts were the control group. The parameters of two groups were compared: platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), large platelet count (P-LCR), prothrombin time (PT), thrombin time (TT), activated partial thrombin time (APTT), fibrinogen (FIB), prothrombin international ratio (INR), plasma D-dimer and serum CA125. To evaluate the diagnostic value of platelet and coagulation parameters in ovarian endometriosis cysts. Results: Compared with the control group, PLT, PCT, CA125 were higher and PDW, APTT were lower in the observation group, the difference was statistically significant (P<0.05). Compared with the observation groupⅠ, Ⅱ, PLT, PCT and MPV were higher and PDW、P-LCR、APTT were lower in the observation group Ⅲ, Ⅳ, the difference was statistically significant (P<0.05). There was a positively correlated between CA125 and MPV,negative correlation between CA125 and PDW, P-LCR in the observation group. Compared with preoperative, postoperative PLT, PCT and MPV were lower, PDW, P-LCR were higher in observation group, the difference was statistically significant (P<0.05). Conclusions: The correlation between platelet and coagulation parameters and the incidence of ovarian endometriosis cysts has certain diagnostic value in clinic, but further study is needed.

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