Journal of International Obstetrics and Gynecology

Application of Transvaginal Natural Orifice Transluminal Endoscopic Surgery in Gynecological Malignant Tumors

CAI Lin-juan, LI Da-ke

2021, 48 (6): 601-604. doi: 10.12280/gjfckx.20210182

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Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has flourished in the past decade. Compared with traditional laparoscopic surgery or laparoendoscopic single-site surgery, vNOTES has the advantages of scar-free, mild pain and fast recovery. Nowadays it is mostly used for gynecological benign diseases, and its application in gynecological malignant tumors is still controversial. Therefore, domestic and foreign scholars have made many beneficial attempts for the treatment of gynecological malignant tumors, initially confirming the feasibility of this operation. In this paper, the current situation, advantages, difficulties and technical skills of vNOTES surgery in gynecological malignant tumors are discussed.

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Progress in the Clinical Application of PD-1/PD-L1 Inhibitor in the Treatment of Ovarian Neoplasms

MAO Ruo-nan, JIANG Wei

2021, 48 (6): 605-609. doi: 10.12280/gjfckx.20210173

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Ovarian neoplasm has the highest mortality among female reproductive system tumors. The methods of treating ovarian cancer involve surgery combined with radiotherapy, chemotherapy and targeted therapy, yet there is no significant improvement in the survival rate of patients. Immunotherapy is a new strategy for malignant ovarian tumors and aims to boost the capacity of the immune system to recognize and attack tumor cells. Some of them have been proven to show effects, among which programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) checkpoint inhibitors had been applied to improve the prognosis of advanced, recurrent platinum-sensitive or platinum-resistant ovarian cancer patients. PD-1/PD-L1 inhibitors include Nivolumab, Pembrolizumab, Atezolizumab, Avelumab, Durvalumab, etc. In this paper, we reviewed the progress of PD-1/PD-L1 inhibitors for ovarian cancer especially the combination therapy.

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Research Progress of the Quality of Life of Patients with Ovarian Cancer

LIN Yu-xuan, KONG Wei-min

2021, 48 (6): 610-614. doi: 10.12280/gjfckx.20210102

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Clinical symptoms of ovarian cancer are relatively hidden, and most patients are diagnosed at the advanced stage. However, with the improvement of treatments, many patients can now achieve long-term survival. Therefore, for ovarian cancer patients, especially those with advanced recurrent ovarian cancer, improving their quality of life and prolonging their survival should be equally important. A large number of researches have confirmed that ovarian cancer patients suffer serious damage in physical, psychological, social and sexual status. To improve the patients′ quality of life, besides the psychological adjustment carried out throughout the whole period, physicians should also emphasize on the improvement of quality of life according to different periods of ovarian cancer patients. For patients receiving initial treatments, therapies should be supervised, side effects or complications should be tackled with appropriately, and patients should be urged to strengthen physical exercise; for patients with tumor-free survival, should be paid attention to helping patients restore their work and social ability and enhancing their confidence in survival; for patients with tumor survival, symptom management and family support should be carried out.

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Research Progress of Double Primary Breast and Ovarian Cancer

ZHAI Jia-wei, XU Fang-yu, LI Li

2021, 48 (6): 615-619. doi: 10.12280/gjfckx.20210185

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Double primary breast and ovarian cancer (DPBOC) is a common type of multiple primary malignant neoplasms of the female reproductive system. Both breast and ovary are sex hormone regulating organs, and they have similar endocrine regulating mechanism. Because breast cancer is diagnosed early and has a good prognosis, the risk of primary ovarian cancer is higher than in the general women population. Studies on sporadic breast cancer or ovarian cancer have been relatively mature. However, the pathogenesis of DPBOC is still unclear. Due to the lack of sensitive and specific screening methods, it is difficult to differentiate from metastatic tumors, which has attracted little attention from clinicians. This review will focus on the pathogenesis, differential diagnosis of ovarian metastasis from breast cancer, treatment and prevention of DPBOC. The study may make clinicians pay attention to the early monitoring of the second primary carcinoma organ, take necessary preventive measures for high-risk groups, seize the best treatment opportunity, and prolong the survival time of patients with DPBOC as long as possible.

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Research Progress of Long Non-Coding RNA HOTAIR in Cervical Cancer

GU Xuan-yan, WANG Xin-yu

2021, 48 (6): 620-623. doi: 10.12280/gjfckx.20210097

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Cervical cancer is one of the most common female reproductive system tumors in China, which seriously threatens women′s life and health. HOTAIR is a typical antisense long non-coding RNA, and its expression in cervical cancer cells is significantly increased, which is closely related to the occurrence and development of cervical cancer. In recent years, researches on the mechanism of HOTAIR in the occurrence and development of cervical cancer found that HOTAIR inhibits the expression of a large number of tumor suppressor genes, and is widely involved in the proliferation, apoptosis, invasion and migration of cervical cancer cells. HOTAIR assists the treatment of advanced cervical cancer by regulating the resistance to radiotherapy, anti-retroviral transcription and immune targeting. It plays an important role in the genetic susceptibility of cervical cancer, and has a significant correlation with tumor progression and poor prognosis. In the future, therapeutic targets will be designed according to the molecular mechanism of HOTAIR, and their effectiveness and practicability would be confirmed through large-sample, multi-center, prospective clinical trials, which will provide new ideas for the early diagnosis and personalized treatment of cervical cancer patients.

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Research Progress on the Correlation between DKK3 and Cervical Cancer

ZHANG Shao-fen, WANG Zhi-lian

2021, 48 (6): 624-627. doi: 10.12280/gjfckx.20210129

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Cervical cancer is a common gynecological malignant tumor with high morbidity and mortality. DKK3 (dickkopf-3) is an antagonist of the classic Wnt signaling pathway and a tumor suppressor gene discovered in recent years. DKK3 exerts its anti-tumor function by regulating β-catenin signal transduction pathway, reversing epithelial-mesenchymal transition, inhibiting tumor angiogenesis and other pathways. It is a potential target in tumor therapy. Epigenetic modification of genes, especially promoter methylation, plays a very important role in the occurrence and development of a variety of malignant tumors. Hypermethylation in the promoter region of DKK3 gene is an important reason for the inactivation of DKK3 protein, which makes the Wnt signaling pathway abnormally activated, leading to the occurrence of tumors. The expression of DKK3 is often down-regulated in cervical cancer tissues, and the silencing of DKK3 expression caused by the methylation of the gene promoter is a frequent event in cervical cancer. The methylation level and expression level of DKK3 are significantly correlated to the prognosis of patients with cervical cancer, and it has a good predictive effect. Therefore, in-depth study on the relationship between DKK3 and cervical cancer may provide new ideas for the mechanism research, targeted therapy and prognosis judgment of cervical cancer.

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Related Immunotherapy and Progress of Cervical Cancer

YIN Bo, DING Jian-yi, YANG Mei-qin, HAN Ling-fei

2021, 48 (6): 628-633. doi: 10.12280/gjfckx.20210116

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Cervical cancer is the most common gynecological malignant tumor, which is a serious threat to women′s health. High-risk human papillomavirus (HPV) persistent infection is the main risk factor of the cervical cancer. In recent years, HPV vaccine has achieved favorable results in the prevention of cervical cancer. Immunotherapy has also become a new pattern of treatment of cervical cancer, especially for patients with poor effect of surgery, radiotherapy and chemotherapy, postoperative metastasis and late recurrence. The strategies of immunotherapy mainly include immune checkpoint inhibitors, vaccine therapy, dendritic cell immunotherapy and adoptive cellular immunotherapy. At present, the related immunotherapy has achieved good results in the treatment of cervical cancer and its precancerous lesions. This article will describe the progress of immunotherapy in cervical cancer, and look forward to the future research direction, so as to provide a basis for clinical treatment and fundamental research of cervical cancer.

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Advances and Applications of MRI in Staging Assessment of Cervical Cancer

HONG Shi-bin, CHENG Jie-jun, DI Wen

2021, 48 (6): 634-638. doi: 10.12280/gjfckx.20210165

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Cervical cancer is the tumor with the highest incidence in gynecological malignancies. The requirements for accurate clinical diagnosis and staging evaluation are increasing with the development of precise treatment. New changes have taken place in the update of cervical cancer guidelines at home and abroad. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) updated the surgical staging of cervical cancer, which proposed imaging and pathology-assisted staging for the first time to more accurately assess tumor progression compared to the previous clinical staging alone. In terms of imaging evaluation, since MRI has no ionizing radiation, better soft tissue resolution and more functional imaging sequences, the 2021 NCCN Clinical Practice Guidelines in Cervical Cancer recommends pelvic MRI as imaging for the evaluation of local disease extent. With the clinical application of MRI technology and the exploration of artificial intelligence technology, MRI has great application potential in the accurate assessment of cervical cancer diagnosis and follow-up after treatment. This article will discuss the recent progress and applications of MRI in cervical cancer staging assessment based on the updates of the FIGO staging of cervical cancer.

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A Case Report on Spindle Cell Rhabdomyosarcomas of The Cervix

CHENG Xin, CHEN Juan, SUN Yang, DONG Qu-long

2021, 48 (6): 639-641. doi: 10.12280/gjfckx.20210088

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As one of soft tissue tumors, spindle cell rhabdomyosarcoma originates from the differentiation of skeletal muscle, which is more common in male children, especially often occurs in paratesticular tissue and rarely occur in female reproductive system. Now, a clinical case on a woman diagnosed with spindle cell rhabdomyosarcoma of the cervix who were hospitalized in the Department of Obstetrics and Gynecology, the Characteristic Medicine Center of the Chinese People′s Armed Police Forces in 2019 is reported. This patient was the first manifestation of postmenopausal bleeding and has developed to urinary retention. The disease developed rapidly and was extremely rare with obvious clinical symptoms, but there was no specific effective treatment. We hope to share the case report in order to improve the academic vision and enhance the understanding of the disease in obstetricians and gynecologists.

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Research Progress on the Mechanism of Obesity Influencing Endometrial Decidualization

WANG Meng-yao, GONG Zheng, XIA Tian, DOU Zhen, ZHAO Zhi-mei

2021, 48 (6): 642-645. doi: 10.12280/gjfckx.20210003

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Endometrial decidualization is necessary for embryo implantation, placental formation, and maintenance of pregnancy. Impaired decidualization is associated with multiple adverse pregnancy outcomes. At present, the obesity population has increased significantly, which has different degrees of damage to health. The mRNA expression of prolactin and insulin-like growth factor binding protein 1 in the decidual stromal cells of obese women decreased significantly. Obesity affected progesterone-related protein, insulin receptor substrate 2, signal transduction and activator 3, Wnt protein and decidual immune cells involved in decidualization, which was closely related to the impaired decidualization. To study the correlation between obesity and endometrial decidualization damage is helpful to further understand the pathogenesis of endometrial decidualization damage and to prevent decidualization damage and improve the adverse pregnancy outcome. Further research on this aspect may provide a new idea for the diagnosis and treatment of obese patients with recurrent pregnancy loss.

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Study on the Relationship between Adenomyosis and Infertility

CHEN Mo, JIANG Xiu-xiu

2021, 48 (6): 646-650. doi: 10.12280/gjfckx.20210233

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Adenomyosis tends to occur in childbearing age women. The abnormal menstruation, dysmenorrhea and infertility caused by adenomyosis seriously affect the health of the patient. Especially, infertility seriously affect the family life of the patient. The treatment of patients with fertility preservation requirements is a major problem faced by gynecologists and reproductive doctors. Until now, the mechanism of infertility caused by adenomyosis is unclear. The cause may be related to the changes in uterine cavity morphology, abnormal uterine junctional zone, altered endometrial, inflammatory mediators and oxidative stress, immune dysfunction and other factors. This article reviews the research on the relationship between adenomyosis and infertility.

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Research Progress of Endogenous Peptides in Gestational Diabetes Mellitus

YIN Ya-dong, LIU Lan

2021, 48 (6): 651-655. doi: 10.12280/gjfckx.20210406

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Gestational diabetes mellitus (GDM) is a common complication of pregnancy, and its incidence rate is increasing worldwide. At present, there are still some limitations in the diagnosis and treatment of GDM. It is difficult to find and adjust the unhealthy lifestyle before or in the early pregnancy period to avoid the occurrence and development of GDM. Endogenous polypeptides is a class of life regulating substances that exist in organisms. They have the advantages of low molecular weight, high activity and easy to synthesize and modificate. As a good molecular basis for drugs, they are becoming a research hotspot in recent years. More and more studies have shown that endogenous peptides plays an important role in the prediction, diagnosis and treatment of diseases, and their research in GDM has attracted more and more attention. This paper aims to review the research progress of GDM related peptides.

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The Relationship between Lipid Alterations during Pregnancy and Gestational Diabetes Mellitus

LI Tian-tian, YUAN Jing

2021, 48 (6): 656-659. doi: 10.12280/gjfckx.20210266

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Due to the changes of estrogen and progesterone level during pregnancy, the endocrine metabolism will undergo corresponding physiological changes during pregnancy. But when the changes exceed the physiological upper limit, it will cause a series of pregnancy complications, such as gestational diabetes mellitus (GDM), hypertensive disorder complicating pregnancy, premature rupture of membranes, preterm delivery and giant babies. GDM is one of the more common complications, and as an endocrine disease, GDM is often associated with abnormalities in glucose and lipid metabolism. However, abnormalities in lipid metabolism can also increase the risk of developing GDM. The detection and control of dyslipidemia in early pregnancy is of great significance for the prevention, confirmation and treatment of GDM, and therefore the study of lipid metabolism in GDM is of great interest. There are no clear findings on whether alterations in lipid metabolism increase the risk of developing GDM or whether the onset of GDM leads to disturbances in lipid metabolism. This paper will review the progress of research on normal lipid metabolism in pregnancy and the relationship between lipid metabolism and GDM in pregnancy.

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Research Progress on the Effect of Cervical Conization on Fertility and Pregnancy Outcomes

GAO Yue, WANG Hua-li

2021, 48 (6): 660-665. doi: 10.12280/gjfckx.20210280

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Cervical squamous intraepithelial lesion (SIL) is closely related to the occurrence of cervical cancer. In recent years, the incidence of cervical SIL is gradually increasing and showing a younger trend. Cervical conization is widely used as the first choice for the treatment of cervical high-grade squamous intraepithelial(HSIL) patients. For patients with fertility requirements after conization, most existing studies believe that cervical conization does not affect their fertility, but may increase the incidence of adverse pregnancy outcomes such as preterm delivery, abortion, premature rupture of membranes and perinatal death, and will not significantly affect the progress of labor or increase the rate of cesarean section. The pregnancy outcome after LEEP is better than that of CKC, and contraception should be given at least 6 months after conization. The increase of depth and volume of conization can increase the incidence of adverse pregnancy outcome, and prophylactic cervical ligation is not necessary after conization. For patients with fertility requirements, we should pay attention to postoperative follow-up, individually guide pregnancy according to intraoperative and postoperative recovery, closely monitor cervical length and vaginal infection during pregnancy, and actively encourage patients without vaginal delivery contraindications to carry out vaginal trial delivery.

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Preliminary Study on the Role of Autophagy in Mouse Endometrium during Peri-Implantation

SHEN Meng-meng, LIU Yan-feng, MA Xiao-na, JIA Jing, WANG Zheng, ZHU Qing-wen

2021, 48 (6): 666-669. doi: 10.12280/gjfckx.20210160

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Objective:To observe autophagy in mouse endometrium during peri-implantation period.Methods: ICR pregnant mice (n=36) were randomly divided into blank group and embryo implantation disorder model group (each n=18). The model group was prepared with mifepristone. Mice in each group were given normal saline and 6 mice were killed by neck dislocation respectively on the 4th, 5th, 6th day of gestation. The appearance of uterus was observed. The average number of implantation sites was calculated. The protein expression of microtubule associated protein light chain 3 (LC3-Ⅱ) was detected, and autophagosomes in endometrial cells were observed by transmission electron microscope.Results: In control group, there were no obvious bead-like changes in the uterus on the 4th day of gestation(pd4), but that were obvious and evenly distributed on the 5th day of gestation (pd5) and the 6th day of gestation(pd6). There was no obvious bead-like changes in the uterus on pd4 and pd5 in model group, but few and sparsed bead-like changes on pd6. The average number of embryo implantation sites on pd5 and pd6 in control group was higher than that on pd4, and that on pd6 was significantly different compared with that on pd4 (P<0.05). The average number of embryo implantation sites on pd5 and pd6 in model group respectively decreased compared with control group (P<0.05, P<0.01). Both control group and model group showed that the protein expression of LC3-Ⅱ was not significantly different (P>0.05). Under the transmission electron microscope, endometrial cells of control group were intact. The number of autophagosomes in control group on pd5 was decreased, and increased on pd6. Some endometrial cells in model group were necrosis. There were more autophagosomes in model group on pd4 than that in control group, model group on pd5 and pd6.Conclusions: Autophagy participates in and regulates the process of embryo implantation. Abnormal autophagy may destroy the activity and function of endometrial cells, which is harmful to embryo implantation.

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Application of Double Uterine Incision Combined with Cervical Lifting Suture in the Operation of Placenta Percreta

MENG Zhao-yan, LIU Xiao-hui, LIU Xiao-ling, ZHANG Yu-fang, HE Xiao-chun, DONG Yan

2021, 48 (6): 670-674. doi: 10.12280/gjfckx.20210151

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Objective:To evaluate the effect of double uterine incision combined with cervical lifting suture in the operation of placenta percreta.Methods: From January 2016 to December 2019, data from the patients diagnosed with placenta previa and percreta by prenatal ultrasonic and confirmed by intraoperative findings at the Gansu Provincial Maternity and Child Care Hospital were collected. 39 cases of patients with placenta percreta and placenta invasion in the cervix were treated with double uterine incision combined with cervical lifting suture. The general situation, intraoperative and postoperative conditions and perinatal outcomes of pregnant women were collected and analyzed retrospectively.Results: The median gestational weeks of 39 pregnant women were 35 weeks. The prognosis of all newborns was good. The intraoperative blood loss and blood transfusion volume was （2 083.33±927.60） mL and （1 190.38±718.68） mL, respectively. The operation time was （160.13±56.96） min. The median hospitalization days were 6 days. Bladder injury occurred in 4 patients when adhesion was separated. Transient coagulation dysfunction occurred in 4 patients. Fever occurred in 6 patients after operation. All patients were cured after symptomatic treatment. No hysterectomy or serious postoperative complications occurred. All patients recovered well and discharged smoothly.Conclusions: Double uterine incision combined with cervical lifting suture has significant hemostatic effect in the operation of pregnant women with placenta percreta and placenta invasion in the cervix orifice, which reduces the hysterectomy rate and is worthy of clinical application.

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Clinical Analysis of 7 Cases of Pregnancy Complicated with Traumatic Spinal Cord Injury

ZHANG Xin-hong, YU Rong, WANG Feng-ying

2021, 48 (6): 675-678. doi: 10.12280/gjfckx.20210343

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Objective:To investigate the clinical characteristics and pregnancy outcome of women with traumatic spinal cord injury.Methods: 7 women with spinal cord injury were examined and delivered in Xuanwu Hospital of Capital Medical University from February 2012 to June 2020. We reported the clinical characteristics and analyzed the pregnancy outcome and the management of perinatal period retrospectively.Results: All of 7 women aged 27 to 42 years. The course of disease was 3 ~ 18 years in 6 cases. One case was acute spinal cord injury caused by traffic accident during pregnancy. All 7 cases were spinal cord injury caused by trauma, and the injury level was below T6-T10. There were 5 primipara and 2 multipara patients. EPDS scores ranged from 0 to 17 in first trimester pregnancy, 3 to 27 in the second trimester, 2 to 13 in the third trimester, and 1 to 9 in puerperium. Urinary tract infection was the most common complication during pregnancy, followed by anemia, premature rupture of membrane, fetal growth restriction and gestational diabetes mellitus. The gestational age was 35⁺³-39⁺⁵ weeks. 2 cases were delivered vaginally, and one of two was delivered by forceps. 5 cases had cesarean section. Apgar score of all babies were 10 points at 1, 5, 10 min, the body weight was 2 350-3 250 g. Puerperal complications including 2 puerperal infection, 1 urinary tract infection and 1 lower limb venous thrombosis, 1 postpartum hemorrhage and 1 pneumonia. Four cases were breast-fed.Conclusions: Patients with spinal cord injury should be evaluated before pregnancy, strengthened monitering during pregnancy and supervised by multidisciplinary team. Prenatal patients should be in hospitalized earlier in order to alert to the occurrence of premature labor, and during delivery, it is of great importance to eliminate the risk of abnormal autonomic reflex. Additonally, the prevention of thrombogenesis and bedsore after delivery is crucial. Whether breastfeeding is suitable depends on the individual condition of the patients.

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Pregnancy with Glycogen Storage Disease Type Ⅰa: A Case Report and Literature Review

YIN Hong-yu, LI Li-ling, CHEN Yue

2021, 48 (6): 679-683. doi: 10.12280/gjfckx.20210135

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Glycogen storage disease typeⅠ(GSDⅠ), also known as von Gierk disease, is an autosomal recessive disorder resulting from the deficiency of glucose-6-phosphatase (G6Pase) activity. GSDⅠa is the most common subtype of GSDⅠ, which can cause many kinds of clinical symptoms. The clinical data of one case of pregnancy complicated with GSDⅠa admitted to the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively. The clinical characteristics, diagnosis and management of pregnancy complicated with GSDⅠa were analyzed based on previous literature and some cases. GSD should be diagnosed and treated early, because it is easy to be misdiagnosed due to its complicated characteristics. Patients with GSDⅠa can successfully conceive under the condition of strict diet management, ensuring good metabolic control with pre-pregnancy counselling. Series strategies should be taken by multidisciplinary involvement when necessary.

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The Interpretation of 2021 ACOG Practice Bulletin: Prediction and Prevention of Spontaneous Preterm Birth

JIANG Xiang, YING Hao

2021, 48 (6): 684-690. doi: 10.12280/gjfckx.20211040

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Preterm birth is the main cause of neonatal death and short-term and long-term complications, of which 70%~80% are spontaneous preterm birth (SPB), and the other 20%~30% are iatrogenic preterm birth. The rate of preterm birth has been increasing in recent years and efforts were made to improve the prognosis of preterm birth. In August 2021, the American College of Obstetricians and Gynecologists (ACOG) issued the practice bulletin No. 234 "Prediction and Prevention of Spontaneous Preterm Birth", covering the increased preterm birth rate and its associated risk factors, measures to reduce the risk of preterm birth by intervening modifiable risk factors, strategies to assess the risk of preterm birth individually and prevent preterm birth. This paper interpreted the main points of its recommendation in order to provide evidence-based basis for clinical practice related to preterm delivery.

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Research Progress of NLRP3 Inflammasome/IL-1β Signaling Pathway in Endometriosis

WANG Shi-yao, SUN Yun

2021, 48 (6): 691-695. doi: 10.12280/gjfckx.20210484

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Endometriosis(EMs) often occurs in women of reproductive age, histologically characterized by the presence of glands and stroma of endometrial tissue outside the uterus. The main clinical manifestations are pain (dysmenorrhea, dyspareunia, chronic pelvic pain, dysuria, etc.) and infertility. Currently, the pathogenesis of EMs is still undefined, in which inflammation is believed to be the main pathophysiological process. NOD-like receptor family, pyrin domain containing protein 3(NLRP3) takes part in the assembly of the inflammasome which is an important role of the innate immune system. Recently, studies have shown that the activation of NLRP3 inflammasome is involved in the occurrence and development of EMs, thus elevating the level of interleukin 1β (IL-1β) and enhancing the adhesion, proliferation, differentiation and invasion of ectopic endometrial cells. In this paper, the research progress of NLRP3 inflammasome/IL-1β signaling pathway in EMs was reviewed in order to provide new strategies for the diagnosis and treatment of EMs.

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The Research Progress of Retinoic Acid in Endometriosis

LI Qian-qian, TANG Xiao-han, LU Mei-song

2021, 48 (6): 696-699. doi: 10.12280/gjfckx.20210358

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Endometriosis (EMs) is a common gynecological benign disease that seriously affects the quality of life and fertility of women. Its complex pathophysiological mechanism has not been clear. Despite the continuous improvement in diagnostic criteria and treatment protocols of EMs, the high incidence rate and low cure rate did not improve significantly. Retinoic acid (RA), as an active metabolite of vitamin A, is involved in various cell growth, differentiation and organogenesis processes. RA is abnormally low in EMs due to metabolic defects, and a large number of studies have shown that RA signal defects may participate in the occurrence of EMs by increasing local endometrial estrogen levels, inhibiting apoptosis and autophagy, pro-inflammatory and abnormal immune regulation, etc. Therefore, RA and its derivatives are expected to become new drugs for the treatment of EMs. The abnormal metabolism of RA in EMs, the possible mechanisms by which RA signal defects promote the occurrence and development of EMs, and the therapeutic potential of RA in EMs are reviewed in order to provide new ideas for the pathogenesis and treatment of EMs.

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Research on the Complications of Pessary in the Treatment of Female Pelvic Organ Prolapse

WANG Li, WANG Jia, WEI Xiao-xuan, NIU Hai-ying

2021, 48 (6): 700-703. doi: 10.12280/gjfckx.20210297

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Pelvic organ prolapse(POP) is a problem faced by many elderly women, and the incidence is increasing year by year. The pessary treatment is not only a conservative treatment method but also a first-line treatment method for this disease. However, if it is used improperly, multiple complications may occur during the treatment process, severe cases have to receive surgical intervention, and some may even be life-threatening. At present, there is a lack of unified guidelines for the treatment of pessaries in the world. Non-standard treatment operations and poor patient compliance are closely related to the occurrence of complications. This article focuses on summarizing and categorizing the currently reported pessary-related complications, introduces a grading method for pessary-related complications, and proposes a few ways to the prevention of complications as following.

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Study on the Relationship between Vaginal Microecology and HPV Infection in Outpatients

CHENG Qian-qian, SONG Dian-rong, WANG Ya-nan, GUO Jie, ZHAO Lin, CHEN Xiu-jie, ZHANG Qian-yu, WANG Qiang

2021, 48 (6): 704-709. doi: 10.12280/gjfckx.20210221

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Objective:To analyze the distribution characteristics of vaginal microecology and cervical human papilloma virus (HPV) in patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion, and to explore the relationship between vaginal microecology disorders and HPV infection.Methods: From February 1, 2019 to December 31, 2019, 483 patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion in the gynecological clinic of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were selected as the study subjects. Simultaneously, vaginal microecology and cervical HPV were detected and the results were analyzed.Results: Among the 483 patients, only 4 cases had normal vaginal microecology (0.8%) and 479 cases had microecology disorders (99.2%). of which 350 cases (73.1%) had microecological disorders (i.e. vaginal infections) with clear pathogens and 129 cases (26.9%) without clear pathogens. Among 350 cases of vaginal infection, 287 cases (82.0%) were single infection and 63 cases (18.0%) were mixed infection. The single infection of VVC (38.7%, 111/287) and mixed infection (79.4%, 50/63) with VVC had the highest incidence. The proportion of patients with decreased Lactobacillus and decreased H₂O₂ in vaginal infection was higher than that in vaginal microecological disorder without clear pathogens, and the difference was statistically significant (P<0.05). Of the 483 patients, 162 were infected with HPV, at a rate of 33.5%. The HPV infection rate in vaginal infection (37.1%, 130/350) was significantly higher than that in vaginal microecological disorders without clear pathogens (24.0 %, 31/129). Among them, the HPV infection rate of patients with trichomonal vaginitis (TV), bacterial vaginosis (BV), aerobic vaginitis (AV), VVC, and BV intermediate were 73.3% (11/15), 52.9% (72/136), 34.5% (10/29), 29.2% (47/161) and 27.4% (20/73), respectively. Multivariate regression analysis showed that TV and BV were positively correlated with HPV infection (OR were 5.325 and 3.298, respectively, P<0.05 ).Conclusions: Vaginal microecological disorders are common in patients with vulvovaginal pruritus, dryness, pain, and/or abnormal secretion, and they are susceptible to HPV infection. When vaginal infection occurs (especially TVand BV), the risk of HPV infection is greatly increased.

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Study on the HPV Infection and Its Correlation with Cervical Columnar Ectopy

CHEN Xiu-jie, WANG Qiang, WANG Ya-nan, GUO Jie, ZHAO Lin, ZHANG Wei, SONG Dian-rong

2021, 48 (6): 710-713. doi: 10.12280/gjfckx.20210113

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Objective:To study the human papilloma virus (HPV) infection conditions in patients from gynecology outpatient department and its correlation with cervical columnar ectopy, to provide clinical evidence for prevention and treatment of HPV infection.Methods: Selected 1 130 patients who accepted cervical HPV screening in the gynecology outpatient department of the Second Affiliated Hospital of Tianjin University of TCM from May 2018 to December 2019 as the research subjects, age ranged from 21 to 65 years old, and the main reasons for visiting included reproductive endocrine diseases, abnormal vaginal secretions, previous HPV infection, gynecological tumors, endometriosis and gynecological physical examination, recorded the appearance of cervix simultaneously, detected HPV using fluorescent polymerase chain reaction technology, and analyzed the conditions of HPV infection and its correlation with ages, reasons for medical visits and cervical appearance.Results: The overall HPV infection rate was 40.00% (452/1 130). The top five of the most common types of HPV infection were 16, 58, 52, 51 and 18 in order. The HPV infection rate was the highest in the 60-65 years old group, accounting for 74.07%. The HPV infection rate was the highest in patients with abnormal vaginal discharge (54.57%), followed by patients with previous HPV infection (50.77%). There was no statistical difference (P>0.05) between cervical columnar ectopy group and smoothy cervix group including total HPV infection rate (39.94% vs. 40.08%), high-risk HPV(HR-HPV) infection rate (33.75% vs. 34.09%), low-risk HPV infection rate (4.33% vs. 3.93%), possible HR-HPV infection rate (1.86% vs. 2.07%), single subtype HPV infection rate (28.95% vs. 28.10%) and multiple HPV infection rate (10.99% vs. 11.98%).Conclusions: There is no relationship between HPV infection and cervical columnar ectopy. We should strengthen the HPV screening for patients with advanced age, abnormal vaginal secretions, and previous HPV infection in clinical work, detect persistent HPV infection in time, and make targeted interventions to effectively prevent cervical cancer and precancerous lesion.

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Refractory Drug Fever with Leukopenia caused by Vancomycin: A Case of Misdiagnosis

WANG Fan, WANG Jin-yong

2021, 48 (6): 714-717. doi: 10.12280/gjfckx.20210122

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Vancomycin is a glycopeptide antibiotic that inhibits bacterial growth and reproduction by inhibiting bacterial cell wall protein synthesis, changing the permeability of bacterial cell membranes and hindering bacterial RNA synthesis, thereby killing bacteria. Adverse reactions such as nephrotoxicity, red man syndrome, gastrointestinal reactions, cytopenia (leukopenia, platelets, eosinophilia, etc.), hyperpyrexia, allergic reactions may occur during the application. Differentiated adverse reactions from uncontrolled infections could avoid blind surgery and over treatment. A case of refractory drug fever, leukopenia with suspected red man syndrome after 9 days of fever withdrawal with vancomycin was misdiagnosed as an uncontrolled infection and treated surgically was reported. The aim was to raise awareness of the adverse effects of vancomycin, thereby better improve the level of diagnosis and treatment of pelvic inflammatory diseases.

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A Case Report of Treatment of Pregnancy in Robert Uterus with Hysteroscopy Combined with Laparoscopy Guided by Ultrasound

BI Fu-xi, YAN Ying, HE Yan-nan, GE Jing

2021, 48 (6): 718-720. doi: 10.12280/gjfckx.20210356

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The oblique septum of uterus, known as Robert′s uterus, is an developmental malformation of obstructive Mullerian tube. The lower end of the septum is fused with one side of the uterine, and this part of uterine cavity is closed. It is rare in uterine malformations. Robert′s uterus is usually divided into two cavities by mediastinum. Mediastinum is inclined to one side of the uterine cavity. It is often found after menarche in puberty, because of the progressive dysmenorrhea occurs due to the increasing blood accumulation in the uterine cavity. Dysmenorrhea is not particularly obvious in some cases. Clinically, the pregnancy implanted in the oblique septum is more rare, and some of them are misdiagnosed. After 41 days of menopause, the hCG of the patient′s blood was 3 077.83 mIU/mL. Gynecological sonography showed that there was an uneven echo mass on the right muscle wall - tubal interstitial pregnancy is not excluded. The size was about 1.6 cm×0.9 cm×1.2 cm, and there was a dark area with a size of 0.5 cm×0.4 cm×0.4 cm, which was not connected to the uterine cavity. Hysteroscopy and dilatation and curettage were performed. Three days later, the retested hCG is 10 220.12 mIU/mL, ultrasound-guided hysteroscopy combined with laparoscopic surgery was performed, the final diagnosis of oblique septal pregnancy. The diagnosis and treatment experience of this case has a certain reference value for the treatment and diagnosis process of clinical abnormal pregnancy and provides clinical experience for reducing missed diagnosis and misdiagnosis of rare abnormal pregnancy.

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