Journal of International Obstetrics and Gynecology

Research Progress of Elabela in Pre-Eclampsia

WANG Li-jing, WANG Fu-rong, SUN Xian-li, LI Yuan-mei, DONG Rui-feng

2022, 49 (2): 121-124. doi: 10.12280/gjfckx.20210746

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Pre-eclampsia is one of the main causes of maternal and neonatal death. At present, the pathogenesis is still unclear. Elabela is a newly discovered endogenous peptide ligand of Apelin receptor (APJ). Elabela and Apelin have a small number of similar sequences, showing similar biological effects, which are involved in many kinds of human diseases, such as acute kidney injury, heart failure, diabetes, hypertension, fetal dysplasia, tumor and so on. Compared with Apelin, the first ligand of APJ, Elabela can be detected in maternal serum, placenta, urine and fetal umbilical cord blood. Elabela participates in the formation of embryonic cardiovascular system and the early development of placenta, and plays a key role in the pathogenesis of pre-eclampsia. In this review, we summarize the structure and biological function of Elabela and its relationship with the pathogenesis of pre-eclampsia, and discusses the possible mechanism of Elabela′s involvement in the pathogenesis of pre-eclampsia, including the invasion of placental trophoblast, angiogenesis and damage to maternal vascular endothelial cells.

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Impact of Pre-Eclampsia on the Cardiovascular System of the Offspring

CHEN Hui-yun, HAN Bing, CHEN You-guo

2022, 49 (2): 125-128. doi: 10.12280/gjfckx.20210819

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Pre-eclampsia is an idiopathic disease during pregnancy that causes multisystem damage and is one of the leading causes of maternal and perinatal mortality, posing a serious threat to maternal and neonatal health. The adverse intrauterine environment in pre-eclampsia predisposes to adverse neonatal outcomes such as intrauterine growth retardation, preterm birth, and low birth weight. The pathogenesis is not fully understood but exaggerated oxidative stress and inflammatory responses are involved in it. And pre-eclampsia may induce altered epigenetic modifications in the offspring, resulting in cardiovascular system remodeling during growth and development and impairing cardiovascular structure and function, which would increase the risk of cardiovascular disease in adult offspring. This article reviews the possible mechanisms of cardiovascular disease in the offspring due to adverse intrauterine environment in pre-eclampsia and the alterations in cardiovascular structure and function in the offspring, with the aim of understanding the development of fetal-derived cardiovascular disease, contributing to early intervention and interruption of the disease, and improving the health of the offspring delivered by pregnancy complicated with pre-eclampsia.

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Research Progress of Trophoblast Ferroptosis in Placenta Related Diseases

DONG Hui, CHEN Xu

2022, 49 (2): 129-132. doi: 10.12280/gjfckx.20210739

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Ferroptosis is a new type of programmed cell death which is iron-dependent and different from apoptosis, pyroptosis, necrosis and autophagy. It is a process of oxidative death caused by imbalance of intracellular lipid reactive oxygen species metabolism, reduction of cell antioxidant capacity and accumulation of membrane lipid peroxides. The process of ischemia-reperfusion and anoxia reoxygenation of trophoblast during the formation of maternal fetal interface can produce a lot of reactive oxygen species, and trophoblast is rich in polyunsaturated fatty acids and has a high load of iron ions, so it is a susceptible cell of iron death. Ferroptosis of trophoblast may affect its invasion and proliferation ability, resulting in insufficient placenta infiltration and poor remodeling of uterine spiral arteries, causing placental dysfunction, and is involved in the development of placental related diseases such as pre-eclampsia, preterm delivery, gestational diabetes mellitus and so on. The regulatory mechanism of trophoblast iron death is complex, which needs further study, and is expected to provide new strategies for the study and treatment of placental related diseases.

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Effect of Free Position on Delivery and Applications on Vaginal Birth after Cesarean

LIU Guang-pu, ZHAO Ling, ZHANG Xiao-li, ZHANG Hui-xin

2022, 49 (2): 133-136. doi: 10.12280/gjfckx.20210844

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Different posture of pregnancy women during delivery has an impact on maternal-fetal outcomes. Free posture delivery is a free choice of postpartum delivery according to the mother′s own will, which benefits for both mothers and newborns. At present, with the opening of the two-child and three-child policy in our country, there are more and more pregnant women after cesarean section. Since the maternal and fetal outcome of vaginal delivery is significantly better than that of elective repeat cesarean section, more and more pregnant women choose vaginal birth after cesarean (VBAC). The application of free posture delivery in VBAC parturients has also accumulated certain experience. Free posture delivery not only helps relieve maternal tension, but also prevents and reduces dystocia by changing postural positions during labor. For women with VBAC who progress too quickly in labor should avoid vertical delivery to reduce the occurrence of emergency labor. During the second stage of labor, squat or sitting position should be avoided to prevent the occurrence of severe perineal laceration.

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The Application of Odon Device in Operative Vaginal Birth

XIAO Guang-hong, LI Yan, WANG Yan-hong

2022, 49 (2): 137-140. doi: 10.12280/gjfckx.20210658

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Operative vaginal birth refers to the use of vaginal midwifery instruments to traction the fetal head in the second stage of labor in order to accelerate or realize fetal vaginal delivery. The commonly used vaginal midwifery instruments are forceps and vacuum. But in clinical work, the application is limited by the possible damage caused by the instrument and the operator′s skills. In 2009, the World Health Organization (WHO) approved the testing of a new midwifery device (Odon Device) on humans. The purpose of Odon Device is to place a cuff over the widest diameter of the fetal head, and then use traction to assist the delivery of the fetus. Compared with common midwifery instruments, Odon Device has the features of low cost, high clinical safety and effectiveness, and operators can acquire operational skills with less training. With the encouragement of the WHO, six studies to test the device have been completed: four preclinical studies and two clinical studies in uncomplicated vaginal delivery. This article will comprehensively discuss the development history, working principle and obstetrical mechanism of Odon Device, as well as the results of preclinical and clinical studies, in order to provide reference for the operative vaginal birth.

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Risk Factors Analysis of 126 Venous Thromboembolism Obstetric Cases

ZHANG Ling, DUAN Tao

2022, 49 (2): 141-146. doi: 10.12280/gjfckx.202100805

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Objective: To analysis the characteristics and risk factors of pregnancy related venous thromboembolism (VTE). Methods: The clinical data of 126 maternal diagnosed with VTE in Shanghai First Maternity and Infant Hospital from January 2019 to March 2021 were collected, the characteristics and risk factors of the cases were analyzed retrospectively. Results: Of the 126 VTE patients, 6.35%(8/126) occurred during gestation and 93.65%(118/126) occurred during puerperium, mainly within 7 days after delivery (94.92 %, 112/118). The location of VTE during pregnancy and puerperium was mainly in pulmonary vessels (73.02%, 92/126), followed by lower limb veins (16.67%, 21/126). The most common clinical manifestation of VTE was asymptomatic (88.89%, 112/126), followed by lower limb swelling (6.35%, 8/126). Among the risk factors of VTE, the highest proportion was cesarean section (74.60%, 94/126), followed by maternal advanced age (24.60%, 31/126), preterm birth (15.08%, 19/126), assisted reproductive technology conception (14.29%, 18/126), postpartum hemorrhage or blood transfusion (10.32%, 13/126), other risk factors accounted for less than 10%. The proportion of VTE patients with Royal College of Obstetricians and Gynaecologists (RCOG) risk factor score ≤3 was 84.13%(106/126). Conclusions: Obstetric VTE in our hospital mainly occurred during puerperium, and the highest risk period was one week after delivery. Asymptomatic pulmonary embolism was the most common characteristic. Risk factors assessment should be carried out for all pregnant women continuously, active prevention and early diagnosis and treatment should be carried out.

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Successful Delivery of Twin Pregnancy in A Patient with Hypopituitarism

YAN Xin, WANG Yong-qing

2022, 49 (2): 147-149. doi: 10.12280/gjfckx.20210898

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Hypopituitarism is caused by a complete or partial deficiency of the pituitary hormone. Women with hypopituitarism are usually impaired fertility and almost unable to conceive naturally. This paper retrospectively analyzed the clinical data of a patient with hypopituitarism who was treated by assisted reproductive technology and successfully delivered twin pregnancy, in order to strengthen the understanding of pregnancy and peripartum management in hypopituitarism patients, and to provide reference for clinical work. With proper hormone supplementation and careful multidisciplinary management before and during pregnany and perinatal period, women with hypopituitarism can deliver healthy babies.

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The Role of Circular RNAs in the Development and Progression of Endometriosis

PENG Shu-zhen, ZHANG Ling, LIU Yi, ZHANG Wei, LIU Heng-wei

2022, 49 (2): 150-155. doi: 10.12280/gjfckx.20210907

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Endometriosis (EMs) is a common benign disease in women of childbearing age, which is characterized by the colonization and growth of active endometrial tissue outside the uterine cavity, the pathogenesis is not clear. Circular RNA (circRNA) is a type of closed circular non-coding RNA which exists widely in eukaryotic cells. Previous researches have confirmed that circRNA has the function of coding protein. On the one hand, circRNA can be used as competing endogenous RNA (ceRNA) combined with microRNA (miRNA) to regulate gene expression. On the other hand, combined with RNA-related proteins to perform biological functions, which makes it a research hotspot. Recent studies indicated that circRNA involved in regulating the proliferation and invasion processes of ectopic endometrial cells, and has a potential to become a diagnosis biomarker and therapeutic target for EMs. However, the research on the mechanism of circRNA in EMs is still in its infancy. Based on the latest research progress at home and abroad, this review summarized the relevant research of circRNA in the biogenesis, forming mechanism, biological functions, the current molecular regulation mechanism in the occurrence and development of EMs, and its biological significance in clinical diagnosis and treatment.

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New Advances in Autophagy in the Pathogenesis of Endometriosis

TAN Jia-huan, ZHANG Zong-feng

2022, 49 (2): 156-160. doi: 10.12280/gjfckx.20210782

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Endometriosis (EMs) is a common benign disease in women of childbearing age which seriously affects patients′ quality of life, and its incidence is increasing year by year. Autophagy is a kind of programmed cell death different from apoptosis, which supports cell survival and metabolism by degrading abnormal proteins or organelles within the cell to produce energy, which is an important mechanism for the degradation and recycling of intracellular components. In recent years, plenty of studies have found that autophagy participates in the occurrence and development of EMs. Previous studies reported that the level of autophagy in ectopic lesions of patients with EMs is lower than that in endometrial tissue of normal patients, and that the cyclical changes of autophagy in ectopic endometrial tissue of patients with EMs disappear. However, there are still a small number of studies demonstrate the higher levels of autophagy in ectopic lesions in patients with EMs. The complex environment of EMs ectopic lesion includes many factors that affect the level of autophagy, such as estrogen and progestin, hypoxia and oxidative stress, pathogen infection and iron overload, etc. In addition, autophagy plays a dual role in the occurrence development of EMs, it can not only hinder the progression of EMs by inhibiting the inflammatory response, promoting the immune system′s ability to clear lesions and inhibiting the fibrosis of the lesions, but also promote the progression of EMs by promoting the survival, migration and invasion of ectopic endometrial stromal cells.

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Application of Anti-Adhesion Materials in Intrauterine Adhesions

YE Jing-xuan, LI Yong

2022, 49 (2): 161-165. doi: 10.12280/gjfckx.20210798

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Intrauterine adhesions, also known as Asherman syndrome, is mostly secondary to transuterine surgery or infection. The main clinical manifestations are abnormal menstruation and fertility complications. With the advancement of society and medical technology, the popularity of hysteroscopy and the increasing number of intrauterine operations, the incidence of intrauterine adhesions has gradually increased. Accordingly, the female infertility rate has increased. Since the incidence of re-adhesion after transcervical resection of adhesion is relatively high, and the pregnancy rate and live birth rate are low, postoperative application of various anti-adhesion materials has become the focus of attention of gynecologists. At present, the common anti-adhesion materials include intrauterine devices, biological dressings, saccule, amnion, hyaluronic acid gel, tissue scaffolds, stem cells, and so on. Using these materials to isolate the wounds in the uterine cavity from each other to reduce the incidence of re-adhesion and the degree of endometrial fibrosis. Summarizing the application of anti-adhesion materials in animal experiments and clinical research, which can provide a basis for choosing appropriate treatments for patients with intrauterine adhesions after surgery.

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The Role of Food Supplements in Insulin-Resistant Obesity Women with Polycystic Ovary Syndrome

SHI Bai-chao, WANG Yu, WU Xiao-ke

2022, 49 (2): 166-171. doi: 10.12280/gjfckx.20210729

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Polycystic ovary syndrome (PCOS) is a reproductive endocrine disease with highly incidence. Insulin resistance and obesity not only are the main clinical characteristics of PCOS, but also participate in the pathogenesis of PCOS. Food supplements such as inositol, docosahexaenoic acid, red yeast rice, berberine, curcumin, probiotic preparations and emerging functional foods may regulate glucose metabolism in PCOS through a variety of regulatory mechanisms and signal pathways, such as enhancing insulin sensitivity, regulating intestinal microflora, increasing anti-inflammatory and antioxidant activity, inhibiting liver gluconeogenesis and increasing glucose transport. The use of specific food supplements in obese patients with PCOS may improve symptoms and signs including insulin resistance and metabolism, promote ovulation and increase the pregnancy rate. In view of this, the narrative review is to discuss the mechanism of food supplements from the point of view of the relationship between obese women with PCOS and insulin resistance, so as to provide potential treatment for clinical treatment of PCOS.

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Spondylodiscitis following Laparoscopic Sacrocolpopexy: A Case Report and Literature Review

WU Zhen-zhen, WEI Ying, ZHENG Jing, WANG Hui-ling, LIU Qing

2022, 49 (2): 172-175. doi: 10.12280/gjfckx.20211015

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Sacrocolpopexy has been applied in clinic for many years, but recently the complications associated with mesh were reported frequently. Spondylodiscitis is a rare complication of sacrocolpopexy. The clinical management is difficult and causes great pain to patients. A case of spondylodiscitis was reported 4 months after vaginal hysterectomy combined with laparoscopic sacrocolpopexy. The patient developed persistent pain of the lumbosacral portion,and the pain was worse and restricted the mobility. Gynecological examination indicated vaginal stump mucosal defects,and no obvious abnormalities were observed. Pelvic and spine MRI examination revealed presacral infection of L5-S2. Exploratory laparotomy was performed and partial infection of the mesh was found. The infected mesh was removed. Followed by the surgery,the patient was cured via antibiotics, peritoneal lavage and drainage and local application of estrogen cream. After 5 years of follow-up,no related complications and recurrence of vaginal prolapse were found. The mechanism,clinical evaluation,management and prevention of the complications were reviewed in order to improve clinicians′ understanding of the complication.

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Application of Organoid in Cancer Research

HUANG Hua, YAO Shu-zhong

2022, 49 (2): 176-180. doi: 10.12280/gjfckx.20211126

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Nowadays, precise treatment and much more advanced tumor mechanism research have higher demand for tumor models. Tumor organoids, stem cell originated three-dimensional in vitro tumor models. Due to its simulation of in vivo tumor structure and characteristic, tumor organoids attract extensive attention. Compared with previous tumor models such as tumor cell lines and primary cells, a number of studies have shown that the tumor organoids are directly derived from patients, which can retain the somatic mutations and biological characteristics. Thanks to its short time expansion in vitro, tumor organoids in high-throughput drug screening can be used as a reference for patients′ precise treatment. Besides, tumor organoids can mimic the internal tumor microenvironment, retain the interaction between cells and extracellular matrix. At the same time, tumor organoids are available for gene editing. These characteristics of organoids make them suitable for promoting application as an in vitro tumor model in tumor precision therapy and basic research.

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Application of Organoids Technology in Drug Sensitivity Test of Ovarian Cancer

WANG Ya-ni, JIANG Qi, ZHANG Yu-chen, ZHU Hai-yan

2022, 49 (2): 181-185. doi: 10.12280/gjfckx.20210949

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Ovarian cancer has the highest fatality rate among gynecologic malignant tumors. Because the majority of ovarian cancer patients lack of specific symptoms and reliable biomarkers in the early stage, about 70% of patients are diagnosed at an advanced stage. The already existing preclinical models of ovarian cancer include cancer cell lines, animal models, patient-derived xenograft, patient-derived organoid, etc. The traditional preclinical models have their limitations. Therefore, in recent years, organoids are very popular as they can maintain the heterogeneities of the original tumors and simulate tumor microenvironment. At present, organoids are mainly used in cancer mechanism research, prognosis prediction, drug screening and so on. But so far, the technology of organoid has not been fully mature. In order to overcome the origin of organoid, 3D organoid culture system and microfluidics have come into being. The article will introduce the origin of organoid, the advantages and limitations of organoid in ovarian cancer research, and the application of organoid in the ovarian cancer drug sensitivity test.

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Application of Organoids in Gynecological Malignant Tumors

WU Jia-xing, WANG Xi-peng

2022, 49 (2): 186-190. doi: 10.12280/gjfckx.20210751

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Organoids, as micro-organs with three-dimensional structures, can highly mimic the morphological structure and physiological functions of the source tissues, and cultivate tissue structures with stable phenotypes. Organoids are good models for basic and clinical researches. Organoids have great potential applications and can be used as in vitro models for various types of biomedical research. Organoids are of great significance in the research of growth and development, organ transplantation, signal transduction pathways, drug development, high-throughput drug screening, and individualized treatment of tumors. Studies have shown that organoids are novel and reliable clinical models for gynecological malignant tumor researches, which can play important roles in the precise and individualized treatment of patients. This article briefly reviews the molecular mechanism and drug screening of organoids in ovarian cancer, endometrial cancer, cervical cancer and other gynecological malignancies.

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Progress in Immunotherapy of Gynecological Malignant Tumors

LIANG Jin-xiao, HUANG Chun-xian, LIN Zhong-qiu

2022, 49 (2): 191-195. doi: 10.12280/gjfckx.20210555

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Recurrent or metastatic gynecologic tumors are usually resistant to conventional cancer therapies. Immunotherapy such as PD-1/PD-L1 blocking antibodies has revolutionized the treatment strategy, and even achieved unprecedentedly long durations of response in advanced malignancies including gynecologic tumors. Nevertheless, immunotherapy has met a bottleneck that the majority of patients do not have a good response to PD-1/PD-L1 blocking antibodies due to primary or acquired drug resistance, and the mechanisms are currently poorly understood. Currently, several hot issues are emphasized in clinical practice. First, the benefits of PD-1/PD-L1 blocking antibodies in the overall population are still very low. Therefore, it is a new trend that combination therapies with other agents are administrated to improve the antitumor efficacy. Second, the most widely investigated predictive biomarkers for immunotherapy are sufficiently validated for clinical use. There is an urgent need to identify biomarkers that upfront predict whether a patient is likely to respond to immunotherapy. Third, both hyperprogression and pseudo-hyperprogression pose challenges for immunotherapy, therefore it is important to assess how and when to evaluate the treatment efficacy. At the same time, how to evaluate and manage immune-related adverse events is an urgent focus of future research as well.

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Research Progress of Common Gynecological Malignant Tumors to Preserve Fertility

LI Cheng-yao, LI Pu

2022, 49 (2): 196-201. doi: 10.12280/gjfckx.20210573

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Common malignant tumors in gynecology include cervical cancer, endometrial cancer and ovarian cancer. Although many advances have been made in treatment, conventional treatments mostly involve hysterectomy. For women who still need pregnancy, it is necessary to meet the patient′s fertility needs to the greatest extent under the premise of ensuring safety. There have been many researches on preserving fertility, and more new methods have emerged, and disease assessment has become more and more perfect. Cervical conization, simple trachelectomy and radical trachelectomy can be selected for early cervical cancer. Fertility-sparing treatment for endometrial cancer isn′t the standard treatment, and hormone therapy or combined with hysteroscopic lesion resection can be given under strict selection. Early low-risk patients with ovarian cancer can choose to preserve the fertility of the affected side appendage resection or tumor rejection. This article intends to summarize and analyze the indications, treatment methods, treatment effects, and existing problems of common gynecological malignant tumors with fertility preservation treatment, hoping to provide ideas and help for clinical treatment.

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Research Progress in Brachytherapy for Cervical Cancer

JIN Ge, LI Kui-xiu, GUO Yun-feng, GAO Yang-yang

2022, 49 (2): 202-206. doi: 10.12280/gjfckx.20210574

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Cervical cancer is the most common malignant tumor of female reproductive tract in China, which seriously threatens women′s health. Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. In recent years, three-dimensional brachytherapy, interstitial implantation brachytherapy and radioactive seed implantation brachytherapy have developed rapidly. These technologies have improved the treatment effect of cervical cancer and reduced complications. The three factors are interrelated. For eccentric tumor, intracavitary brachytherapy has incomplete target coverage and poor dose distribution conformation, while interstitial implantation brachytherapy can make up for the deficiency of intracavitary brachytherapy. Radioactive seed implantation brachytherapy has the characteristics of low trauma and high safety, providing more possibilities for patients with recurrent cervical cancer. Therefore, individualized treatment plan should be formulated according to the characteristics of the patient′s condition in clinical practice.

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Research Progress of Immunological Pathogenesis of Cervical Cancer

WANG Jia-sen, ZHANG Yan, FU Xiao-xue, CHEN Fang

2022, 49 (2): 207-211. doi: 10.12280/gjfckx.20210785

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The incidence of cervical cancer ranks first in gynecological malignancies. Human papilloma virus (HPV) infection is a prerequisite for the occurrence of cervical cancer. Among them, persistent infection of high-risk HPV greatly increases the risk of cervical cancer. After HPV infection, its DNA is integrated into the host cell DNA, and the integration process will lead to the deletion of many early and late genes encoded by the virus, which further leads to the uncontrolled host cell cycle, resulting in cervical lesions. At the same time, HPV changes the immune microenvironment of the cervix through a variety of ways, which leads to the decline of the body′s local immune function, which in turn leads to immune escape and promotes disease progression. During this period, not only experienced the innate immune process involving macrophages, natural killer cells and dendritic cells, but also experienced the adaptive immune response dominated by T cells. The above-mentioned various immune cells and their secreted cytokines interact and cooperate with each other, and together play an important role in cervical cancer immune escape and tumor immune response. Clarifying the relationship between HPV infection, immune cells, immune factors and immune escape will provide directions for cervical cancer treatment.

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Research Progress of Polyethylene Glycol Liposome Doxorubicin in the Treatment of Recurrent Ovarian Cancer

ZHANG Ya-li, KONG Xian-chao

2022, 49 (2): 212-216. doi: 10.12280/gjfckx.20210774

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Ovarian cancer is insidious and has a high recurrence rate and mortality rate, which seriously threatens women′s life and health. In recent years, the development of pharmaceutical nanotechnology has provided new opportunities for tumor therapy. Polyethylene glycol liposome doxorubicin (PLD) is a small molecular nano particle made by embedding doxorubicin in polyethylene glycol liposomes. It is widely used as a new doxorubicin nano preparation because of its strong targeting, low toxicity to bone marrow and heart and stability of drugs in vivo. It has been proved that PLD alone or in combination can effectively improve the survival time of patients with recurrent ovarian cancer. This paper reviews the research progress of PLD in the treatment of recurrent ovarian cancer with single drug, or combined with trabecotidine, or combined with platinum drugs and maintenance therapy, in order to find a more safe, effective and individualized clinical treatment.

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Research Progress of Hydatidiform Mole′s Immunology

ZHU Guo-hua, DU Mei-rong, LU Xin

2022, 49 (2): 217-221. doi: 10.12280/gjfckx.20210617

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The trophoblasts of the hydatidiform mole and those of normal pregnancy were both originated from the ectoderm and were regulated by paternally imprinted genes. Trophoblasts of normal pregnancy during early pregnancy could induce immune tolerance at the maternal-fetal interface by expressing non-classical human leukocyte antigen and inducing immune cell suppression to ensure fetuses′ normal growth and development. However, the current understanding of the immunological changes of the hydatidiform mole was still limited. Recently, studies have revealed that the interaction between trophoblasts of the hydatidiform mole and immune cells of the maternal-fetal interface was a crucial factor that influenced the prognosis after uterine evacuation. The immune response of peripheral blood mononuclear cell (PBMC) in patients with mole was associated with the advance of mole, which reflected the adaptive changes of the patient′s immune system to the continuous pregnancy of mole. In order to explore the above-mentioned immunological characteristics of hydatidiform mole, this paper reviewed the recent research progress on the composition of immune cells at the maternal-fetal interface of hydatidiform mole and the immune status of PBMC.

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Current Status and Trend Analysis of Ovarian Cancer Disease Burden in China

TANG Zi-ying, DENG Ming-gang, YU Chuan-hua, LIU Qing

2022, 49 (2): 222-227. doi: 10.12280/gjfckx.20211193

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Objective: To analyze current status and trend of ovarian cancer burden in China from 1990 to 2019, in order to provide scientific basis for prevention and control of ovarian cancer. Methods: Global burden of disease (GBD) 2019 data were used to collect the standardized rate of prevalence (SPR), incidence (SIR), mortality (SMR), and disability adjusted life year (DALY) of ovarian cancer in China. The US, Russia, Japan, India, and Global from 1990 to 2019, so as to comparative analysis the ovarian cancer situation in Chinese women. Results: From 1990 to 2019, all four indicators of ovarian cancer in China showed a significant rising trend, with the SPR increasing from 10.11/100 000 in 1990 to 20.44/100 000 in 2019, the SIR increasing from 2.56/100 000 to 4.54/100 000 and the SMR increasing from 1.76/100 000 to 2.77/100 000 and the standardized DALY rate increased from 55.57/100 000 to 80.52/100 000. Compared with the overall global situation and the four countries included in the analysis, all four indicators in China were all at the low level in 2019, but China had the largest growth in three indicators (SPR, SIR, SMR) over the past 30 years, 202.18%, 177.34%, 157.39% respectively. Conclusions: From 1990 to 2019, the disease burden of ovarian cancer in China has shown a substantial increase, it turns out that relevant measures should be taken to pay attention to prevention and control.

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Clinical Analysis of 7 Cases of Leiomyomatosis Peritonealis Disseminate

XU Qian, LIU Xin, WANG Jin-juan

2022, 49 (2): 228-232. doi: 10.12280/gjfckx.20210758

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Objective: Improve the diagnosis and treatment of leiomyomatosis peritonealis disseminate (LPD). Methods: 7 cases of LPD admitted between June 2018 and July 2021 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively, including their clinical characteristics, diagnosis and treatment methods, pathological diagnosis and recurrence. Results: The average age of onset of the 7 patients was 41.6 years (33-48 years). All 7 cases had a history of laparoscopic uterine myomectomy with an average of (60.1±44.6) months (range 6 to 132 months). 57.1% of patients were asymptomatic, and they presented with the main complaint of masses in the pelvic and abdominal cavity found on physical examination. Imaging mainly showed multiple solid nodules in the pelvic and abdominal cavity. The diagnostic rates of MRI and CT were 28.6% and 25.0%, respectively. All 7 patients underwent surgical treatment. Nodules extensively involved the colon mesentery (4 cases), the surface of the peritoneum (3 cases), the omentum (2 cases), Douglas pouch (2 cases), ranging from 0.4 to 10 cm in diameters. One case underwent laparoscopic total hysterectomy, double adnexectomy and resected all LPD nodules, and the remaining 6 cases done laparoscopic or laparotomy LPD nodule resection. All cases were definitive diagnosed as LPD by histopathology and immunohistochemical examination, of which 1 case was cellular uterine leiomyomas. Conclusions: LPD is a rare benign tumor, lacking specific clinical symptoms and imaging. The diagnosis mainly depends on surgery, histopathology and immunohistochemistry. The preferred treatment is surgical resection if possible, and close follow-up is required after surgery.

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A Case Report of Epithelioid Trophoblastic Tumor Secondary to Hydatidiform Mole and Literature Review

QIU Shi-kang, JIANG Hui-hui, LI Chang-zhong, ZOU Yong-hui

2022, 49 (2): 233-237. doi: 10.12280/gjfckx.20210790

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Epithelioid trophoblastic tumor (ETT) is a malignant tumor derived from chorioamniotic intermediate trophoblast. ETT is often related to the previous pregnancy history, most of which are secondary to the previous normal pregnancy, while ETT patients who are secondary to gestational trophoblastic neoplasia (GTN) are very rare. A patient with ETT secondary to the previous hydatidiform mole underwent uterine curettage because of hydatidiform mole, and hysteroscopic surgery was performed 2 years later because of abnormal uterine bleeding. The disease was found and was considered as ETT with suspected lung metastasis. The prognosis of the patients was good after hysterectomy and adjuvant chemotherapy. Combined with related case reports, the clinical features, such as onset time, location, ultrasound, pathology and immunohistochemistry, treatment and prognosis of this kind of ETT were summarized in order to improve clinicians′ understanding of the disease and make efforts to improve the treatment and prognosis of the disease.

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Choriocarcinoma of Extremely High Risk with Hypercalcemia: A Case Report and Literature Review

CHENG Zhe, LIU Yu-zhen, ZHANG Hai-feng

2022, 49 (2): 238-240. doi: 10.12280/gjfckx.20210655

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Choriocarcinoma is a kind of gynecological tumor with extremely high mortality. With the rational application of chemotherapeutic drugs, choriocarcinoma can also get a satisfactory curative effect. Hypercalcemia is often associated with malignant tumors, but the incidence of hypercalcemia in choriocarcinoma is very low. We report a case of diagnosis and treatment of extremely high-risk choriocarcinoma (Ⅱ, 13) characterized by β-hCG up to 1 400 588.00 IU/L and hypercalcemia in blood. During the process of diagnosis and treatment, the patients were treated successfully by a combination of treatment about calcium reduction, chemotherapy and surgery. After β-hCG decreased to the normal range, the patient refused to receive consolidation chemotherapy. After 6 months of close follow-up, we don′t observe the disease bounces back. This case provides a new thinking for the clinical manifestation, diagnosis, treatment and follow-up of choriocarcinoma.

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