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    Gynecological Disease & Related Research:Review
    Research Progress of Ferroptosis in Endometriosis
    PENG Pei-xuan, WANG Li
    2022, 49 (5):  481-485.  doi: 10.12280/gjfckx.20220451
    Abstract ( 2018 )   HTML ( 214 )   PDF (713KB) ( 3365 )  

    Endometriosis as a common gynecological benign disease, however, has malignant behaviors such as invasion, infiltration, and distant metastasis. Ferroptosis is a newly discovered form of programmed cell death mainly characterized by the excessive intracellular free Fe2+ that mediates the Fenton reaction to produce hydroxyl radicals, inhibition of the intracellular antioxidant enzyme glutathione peroxidase 4, and peroxidation of cell membrane lipids leading to cell death. Endometriosis lesions exhibit ferroptosis resistance, a feature that impairs ectopic endometrial clearance and promotes their proliferation and migration. And part of the cells in turn promotes angiogenesis through ferroptosis. Sperm and oocyte damage as well as embryotoxicity from ferroptosis contribute further to endometriosis related infertility.

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    The Role of S100 Protein in Endometriosis
    DUAN Yu-han, LI Nan, CHEN Lei, ZHANG Kun
    2022, 49 (5):  486-491.  doi: 10.12280/gjfckx.20220524
    Abstract ( 1875 )   HTML ( 125 )   PDF (755KB) ( 3525 )  

    The S100 protein family is a family of 25 members of calcium-binding proteins that bind to Ca2+ and perform biological functions inside and outside the cell, regulating various cellular processes such as proliferation, differentiation, inflammation, migration and invasion, apoptosis, Ca2+ homeostasis and energy metabolism. They are closely associated with the development of many cancers, inflammatory diseases and immune disorders. Endometriosis (EMs) has a complex pathogenesis and is a chronic inflammatory disease that can cause pelvic pain and infertility. There are no accurate and easily accessible early non-invasive diagnostic methods and clear therapeutic targets. Studies have shown that S100B, S100A7 and S100A8 can participate in the inflammatory response by activating the nuclear factor-κB (NF-κB) signaling pathway; S10013 can participate in neovascularization and promotes disease progression by synergizing with other pro-angiogenic factors; S100A4, S100A6 and S100P may induce cell migration and invasion through Wnt/β-catenin signaling pathway and/or p38 MAPK signaling pathway. The research progress on the role of S100 protein family in the pathogenesis and diagnosis of EMs is reviewed to provide ideas for further applications of S100 proteins in EMs, and to provide references for the search of potential early diagnostic markers and therapeutic targets.

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    Application Progress of Tissue Clearing Three-Dimensional Imaging Technology in Ovarian Tissue
    CHEN Ying, HUANG Jin-zhi, WU Ke-feng, LI Qian
    2022, 49 (5):  492-496.  doi: 10.12280/gjfckx.20220292
    Abstract ( 1746 )   HTML ( 109 )   PDF (719KB) ( 3601 )  

    The ovaries are important organs of the mammalian reproductive system, and the understanding of the ovaries is mostly at the two-dimensional level. The rapid development of tissue clearing three-dimensional imaging technology provides an advanced platform for three-dimensional D visualization of the ovaries, which not only can be used to comprehensively image the normal and pathological ovarian tissues through tissue clearing and optical imaging microscopy techniques and explore ovarian tissue and its relationship with the vasculature and nervous system from the cellular or subcellular unit level, but also reveal the spatial relationship and structural characteristics of ovarian tissue. This technique can also analyze the three-dimensional structure and growth pattern of ovarian tumors, and study the density, integrity and morphological heterogeneity of the vasculature and nervous system, providing direction for the treatment and prognosis of ovarian tumors. In this article, we review the application progress of tissue clearing three-dimensional imaging technology in mammalian ovarian tissue, with a view to gaining a deeper understanding of ovarian tissue.

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    Research Progress of High-Concentration Androgen-Induecd KNDy Neuroendocrine Disorder in the Pathogenesis of PCOS
    WANG Ying-ying, ZHENG Zhou, ZHANG Xiu-ming
    2022, 49 (5):  497-501.  doi: 10.12280/gjfckx.20220496
    Abstract ( 1580 )   HTML ( 39 )   PDF (711KB) ( 3345 )  

    Polycystic ovary syndrome (PCOS) is one of the most common reproductive disorders in women worldwide, and its symptoms are mainly manifested as ovulation, endocrine and metabolic abnormalities. Although the pathogenesis of PCOS is not yet clear, more and more studies have demonstrated that high-concentration androgen-induced neuroendocrine disorders play a role in the pathogenesis of PCOS. The KNDy neurons in the hypothalamus play an important role in regulating female reproductive function. Recent studies have found that excessive concentrations of androgens may alter the regulation of GnRH by the KNDy neuronal network in the hypothalamus region, interfering with the hypothalamic-pituitary-ovarian/adrenal/adipocyte axis, which may increase the production of downstream target organs. The vicious cycle of excess androgens, aggravates the symptoms of PCOS. Therefore, it may be possible to treat PCOS patients by reducing androgen effects on neuroendocrine, restoring sensitivity to steroid feedback, and normalizing LH/FSH pulses by modulating GnRH secretion during critical developmental windows.

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    Animal Models of Pelvic Floor Dysfunctions and Biomechanical Measurements
    WANG Zhao, PING Yi
    2022, 49 (5):  502-506.  doi: 10.12280/gjfckx.20220278
    Abstract ( 1565 )   HTML ( 50 )   PDF (690KB) ( 3786 )  

    Pelvic floor dysfunctions (PFD) have become a public health problem that is increasingly harmful to women′s health, and its pathogenesis has not yet been fully understood. Because human trials are constrained by medical ethics, animal models are particularly important as a powerful tool for exploring PFD. The current animal models of PFD are roughly divided into rodents, small mammals, large mammals and nonhuman primates according to different species. By researching the status quo, it is found that among the four types of animals, rodent models are the most used, and nonhuman primate models are the most ideal. Simulating childbirth is the primary modeling method and genetic technology can be used to construct animal models with specific properties. Biomechanical measurements provide objective data for the pathology of pelvic floor injury and the evaluation of treatment effects, which can further optimize animal models and will provide more help for exploring the pathogenesis and treatment methods of PFD.

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    Gynecological Disease & Related Research: Original Article
    Clinical Application of Mussel Adhesive Proteins Dressing in Wound Repair and Vaginal Microecological Recovery after Loop Electrosurgical Excision Procedure
    WEI Ying-ting, YANG Bin-lie, HUANG Li-xia, GU Li-ying, HONG Zu-bei, WANG Yu-hua, QIU Li-hua
    2022, 49 (5):  507-510.  doi: 10.12280/gjfckx.20220506
    Abstract ( 2161 )   HTML ( 55 )   PDF (826KB) ( 3553 )  

    Objective: To evaluate the clinical application value of mussel adhesive proteins (MAP) dressing in wound repair and vaginal microecological recovery after loop electrosurgical excision procedure (LEEP). Methods: Patients who underwent LEEP for pathological diagnosis of cervical squamous intraepithelial diseases from November 2020 to April 2021 were randomly divided into 30 MAP group and 30 placebo control group without MAP. Wound healing was compared between the two groups at the 3rd week after surgery and vaginal microecological changes were compared between the two groups at the 5th week after surgery. Results: At the 3rd week after LEEP, the proportion of wound healing in the MAP group was significantly higher than that in the control group (53.33% vs. 13.33%, P=0.001). At the 5th week after LEEP, the vaginal microecology of the MAP group was significantly improved compared with that of the control group (66.67% vs. 3.33%, P=0.000). Conclusions: MAP dressing can effectively shorten the wound healing time after LEEP and improve vaginal microecology.

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    Gynecological Disease & Related Research: Case Report
    A Case of Abdominal Wall Endometriosis Involving Pubic Bone and Literature Review
    QIU Yu-qi, CHEN Yong
    2022, 49 (5):  511-515.  doi: 10.12280/gjfckx.20220363
    Abstract ( 1679 )   HTML ( 38 )   PDF (14239KB) ( 3385 )  

    A case of abdominal wall endometriosis involving pubic bone was successfully treated by surgical. The patient was diagnosed by abdominal wall ultrasound, pelvic magnetic resonance imaging and finally confirmed by fine needle biopsy. After admission, a multidisciplinary team including gynecologists, general surgeons, hernia surgeons, orthopedic surgeons and urologists was established to discuss and recommend surgical removal of abdominal wall endometriosis mass. The operation was completed by the multidisciplinary treatment team. Endometriosis was found in abdominal wall muscle, peritoneum and pubic symphysis. The endometriosis mass in the abdominal wall and pubic bone was completely removed. Because there were many abdominal muscles and fascia excised, the abdominal wall defect could not be sutured routinely. The abdominal wall defect was repaired with patches. The patient recovered well without complications and was followed up well. The successful treatment of this case showed that adequate preoperative examination and the cooperation of multidisciplinary treatment team were the key to the treatment of patients with complex abdominal wall endometriosis. For endometriosis involving pubic bone, tension-free hernia repair technique and postoperative compression bandage can be used as an alternative treatment for abdominal wall defect.

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    Endometriosis of Vaginal Stump 15 Years after Hysterectomy: A Case Report
    CHEN Xi, HU Yu-ping, HU Le, YANG Yong-xiu
    2022, 49 (5):  516-518.  doi: 10.12280/gjfckx.20220340
    Abstract ( 1939 )   HTML ( 45 )   PDF (2264KB) ( 3384 )  

    Endometriosis (EMs) is a common chronic inflammatory disease in women that refers to the presence of glands and stroma of the endometrium outside the uterine cavity, most commonly in the ovaries, pelvic peritoneal surfaces, or other pelvic tissues. We report a 48-year-old woman who developed vaginal stump endometriosis 15 years after hysterectomy for hysteromyoma. The patient was admitted to the hospital due to irregular vaginal bleeding accompanied by abdominal pain for 3 years and aggravation for 2 months. Enhanced CT of the whole abdomen found irregular soft tissue beside the left iliac vessels. After multidisciplinary consultation, the patient was diagnosed with vaginal stump disease and underwent laparoscopic exploration. Resection of the left vaginal stump mass was performed according to the intraoperative findings, and the excised tissue was confirmed to be EMs by paraffin section pathological examination. Combined with this case, we discussed and reviewed relevant literature to provide diagnosis and treatment ideas for clinical cases of vaginal bleeding after hysterectomy, so as to improve clinicians’ understanding of postoperative vaginal stump EMs.

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    Research on Gynecological Malignancies:Review
    Application of Immune Checkpoint Inhibitor in Gynecological Malignant Tumors
    WANG Fang, YANG Tao, WU Zhen-zhen, WANG Hui-ling
    2022, 49 (5):  519-523.  doi: 10.12280/gjfckx.20220005
    Abstract ( 1534 )   HTML ( 37 )   PDF (707KB) ( 3375 )  

    Endometrial cancer, cervical cancer and ovarian cancer are the three most common gynecological malignancies. The treatment methods are mainly surgery, radiotherapy and chemotherapy. However, the recurrence rate and metastasis rate are still high. By blocking the binding of inhibitory checkpoints and their ligands, immune checkpoint inhibitors activate the activity of immune cells and achieve antitumor effects. With the deepening of the research on immune checkpoint inhibitors in gynecological tumors, it is found that the objective response rate is mostly about 10%-20%, and the combination of radiotherapy and chemotherapy can greatly improve the curative effect, which may provide greater clinical benefits for gynecological tumor patients. However, its adverse reactions can not be ignored, such as skin itching, mucositis, diarrhea and colitis. Therefore, exploring predictive biomarkers, screening the applicable population for immune checkpoint inhibitor treatment, early identification and reasonable intervention of adverse events are very important for the application of immune checkpoint inhibitors in gynecological malignant tumors.

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    Research Progress of Radical Trachelectomy for Early Stage Cervical Cancer
    CHEN Yue, LI Na, HU Yuan-jing
    2022, 49 (5):  524-528.  doi: 10.12280/gjfckx.20220098
    Abstract ( 1800 )   HTML ( 33 )   PDF (692KB) ( 3401 )  

    Cervical cancer is one of the most common gynecological malignant tumors. With the trend of younger age of cervical cancer, more and more patients have the requirement of sparing fertility. Radical trachelectomy has become the standard surgical method for preserving reproductive function in patients with International Federation of Gynecology and Obstetrics (FIGO) stage ⅠA2 and ⅠB1 cervical cancer,and has also been applied in patients with cervical cancer with tumor diameter >2 cm after neoadjuvant chemo therapy and patients with pregnancy complicated with cervical cancer. Radical trachelectomy has a large operation scope, great difficulty, long operation time and high incidence of postoperative complications. Surgical approach, intraoperative technique and the way of lymph node evaluation may have different effects on tumor prognosis and pregnancy outcome. Therefore, seeking a balance between tumor prognosis and reproductive function after radical trachelectomy, reducing unnecessary tissue resection and injury while ensuring tumor resection scope, shortening operation time and reducing the probability of complications can benefit more cervical cancer patients undergoing radical trachelectomy.

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    Efficacy Evaluation of Neoadjuvant Chemotherapy for Cervical Cancer
    FENG Dan, SHEN Fu-jin
    2022, 49 (5):  529-534.  doi: 10.12280/gjfckx.20220114
    Abstract ( 1866 )   HTML ( 32 )   PDF (751KB) ( 3387 )  

    Cervical cancer is the most common malignant tumor in gynecology, which seriously threatens women′s life and health. It is a global public health problem that needs to be solved urgently. At present, the treatment of cervical cancer is mainly surgery and radiotherapy, supplemented by chemotherapy. Neoadjuvant chemotherapy (NACT) is a commonly used adjuvant therapy for patients with cervical cancer, which has the advantages of reducing the size of the primary tumor and tumor metastasis. However, due to individual variability and tumor heterogeneity, not all patients respond to chemotherapy. At the same time, NACT also has certain toxic reactions, such as hair loss, neutropenia and organ damage, and even lead to the death of patients. At present, serum squamous cell carcinoma antigen (SCC-Ag) and imaging examination are most commonly used to evaluate the efficacy of NACT, but they have some limitations. The evaluation methods of NACT for cervical cancer are reviewed from the aspects of imaging, pathology, molecular markers, toxicity and survival, to provide a basis for the clinical evaluation of NACT, and to help the selection and application of individualized treatment plans.

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    Diagnosis and Treatment of High-Grade Squamous Intraepithelial Lesion in High-Risk HPV-Infected Postmenopausal Women
    Amineguli ·Maimaitimin, Ayidana ·Jumabieke, HAN Li-li
    2022, 49 (5):  535-539.  doi: 10.12280/gjfckx.20220172
    Abstract ( 1874 )   HTML ( 28 )   PDF (707KB) ( 3426 )  

    High-grade squamous intraepithelial lesion (HSIL) is associated with the persistent infection of high-risk human papilloma virus, are considered cervical precancerous lesions with the potential for cancer. Difficulty of diagnosis and treatment of HSIL are increased due to age-dependent changes to the cervix in postmenopausal women. Though cervical biopsy is the gold standard for diagnosing cervical lesions, it is also missed, but endocervical curettage can improve the accuracy of HSIL in menopausal women, especially when colposcopy is not satisfactory but suspicious cervical lesions. Although positive margins are considered a key factor in residual/recurrence of lesions after cervical resection, a negative margin does not mean that the lesion has been completely removed. Moreover, because of cervical atrophy, cervical shortening, disappearance of the vaginal vault and other reasons, the difficulty of cervical resection surgery and the risk of damage to adjacent organs such as bladder and rectum are increased. At the same time, the hormone level of menopausal women is reduced, the predilection site of cervical cancer transformation zone of cervical moved to the cervical canal, and colposcopy cannot find the suspicious part in time, resulting in missed diagnosis of cervical cancer. Therefore, it is of great clinical significance to explore the optimal scheme for diagnosis and treatment of cervical lesions in postmenopausal women. By analyzing the current status and problems faced by cervical HSIL in postmenopausal, it provides individualized theoretical guidance for the diagnosis and treatment of cervical lesions in them.

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    Research Progress of High-Intensity Focused Ultrasound in the Treatment of Uterine Fibroids
    LIU Hai-hong, SHI Xiao-rong
    2022, 49 (5):  540-544.  doi: 10.12280/gjfckx.20220127
    Abstract ( 1546 )   HTML ( 41 )   PDF (741KB) ( 3403 )  

    Uterine fibroids can lead to abnormal uterine bleeding, frequent urination or constipation, infertility and other symptoms, affecting the physical and mental health of patients. High-intensity focused ultrasound (HIFU) is a technology that promotes the necrosis of target tissue by focusing low-energy ultrasound in vitro, which can significantly reduce the volume of uterine fibroids and improve the clinical symptoms of patients. It has become an important method for the treatment of uterine fibroids. As a kind of treatment of uterine fibroids, HIFU has the advantage of non-invasive and retaining the structural integrity of the uterus, which can be safely used in patients with uterine fibroids with fertility requirements and shorten the time of contraception after treatment. However, the long-term reintervention rate after HIFU treatment of uterine fibroids is high, and HIFU may increase the incidence of some pregnancy complications such as preterm birth and fetal growth restriction. There is no complete solution to the exclusion of malignant diseases such as uterine sarcoma before HIFU treatment. In this review, we summarize the research progress of HIFU treatment of uterine fibroids in recent years, so as to provide reference for clinical treatment of uterine fibroids.

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    Research on Gynecological Malignancies:Original Article
    Clinical Analysis of 13 Cases of Primary Cervical Malignant Melanoma
    LI Nan, WANG Li-ying
    2022, 49 (5):  545-548.  doi: 10.12280/gjfckx.20220018
    Abstract ( 1735 )   HTML ( 33 )   PDF (672KB) ( 3322 )  

    Objective: To investigate the clinical characteristics, treatment and prognosis of primary cervical malignant melanoma. Methods: The clinical data and follow-up data of 13 patients with primary cervical malignant melanoma diagnosed by pathology in Affiliated Cancer Hospital of Zhengzhou University were collected from January 2013 to December 2019. Analysis the clinical characteristics, treatment and prognosis. Results: The 13 patients were 30-64 years old, with an average age of (51.1±10.8) years old. According to FIGO 2018 staging system, there were 4 stage Ⅰ patients, 3 stage Ⅱ patients, 1 stage Ⅲ patient, and 5 stage Ⅳ patients. Six patients with stage ⅠA-ⅡA were treated with surgery, of which 2 patients received observation only, 3 patients received chemotherapy after surgery, and one patient received chemotherapy+immunotherapy. Two patients with stage ⅡB to Ⅲ and two patients with stage Ⅳ received radiotherapy + chemotherapy. The remaining 3 patients with stage Ⅳ received a combination of chemotherapy, local radiotherapy, immunotherapy or targeted therapy. The median follow-up time was 12 months (7-84 months), 9 patients died, distant metastasis occurred in 3 cases, and the median overall survival was 38 months. Conclusions: Primary cervical malignant melanoma is a relatively rare but highly malignant tumor with poor prognosis and susceptibility to distant metastasis. Surgical resection is the main treatment modality for early-stage patients, and a combination of immunotherapy and targeted therapy may be a new option for metastatic and unresectable patients.

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    Research on Gynecological Malignancies:Case Report
    Laparoscopy Trocar Port Site Leiomyoma after Laparoscopic Myomectomy: A Case Report
    XU Qian, LI Na, LIU Xin, WANG Jin-juan
    2022, 49 (5):  549-551.  doi: 10.12280/gjfckx.20211131
    Abstract ( 1824 )   HTML ( 22 )   PDF (2917KB) ( 3336 )  

    Laparoscopy Trocar port site leiomyoma after laparoscopic myomectomy is very rare. Its pathogenesis may be related to iatrogenic implantation after pelvic surgery. This article reports a case of abdominal wall leiomyoma treated in the gynecology minimally invasive center of Beijing Obstetrics and Gynecology Hospital of Capital Medical University. The patient underwent laparoscopic myomectomy in our hospital at 2010. Six years ago, the patient felt a mass at the previous surgical scar on the left lower abdomen at 2015 and the mass that had been progressively increasing over a 3-year period since 2018. Laparotomy was performed on admission at 2021. During the operation, a 4.0 cm×4.0 cm leiomyoma nodule was found in the fat layer of the abdominal wall of the previous left laparoscopy Trocar port site. The abdominal wall leiomyoma was confirmed by histopathology and immunohistochemistry. The formation of leiomyoma in the abdominal wall of laparoscopy Trocar port site was considered to be iatrogenic parasitism caused by previous laparoscopic myomectomy. The prevention of iatrogenic parasitic leiomyoma is very important, but it cannot completely avoid the formation of iatrogenic parasitic leiomyoma, which needs further research.

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    Adolescent Mixed Ovarian Germ Cell Tumor: A Case Report and Literature Review
    WU Si-yu, LIU Chuan-li, ZHANG Yan, SUN Yang, CHEN Jun, CHEN Xiao
    2022, 49 (5):  552-555.  doi: 10.12280/gjfckx.20211196
    Abstract ( 1513 )   HTML ( 28 )   PDF (685KB) ( 3402 )  

    Malignant ovarian germ cell tumor(MOGCT) are derived from primitive germ cells of embryos and occur mostly in children, adolescents and young women, so preserving the function of reproduction must be taken into consideration. We report a case of a 15-year-old girl presented with acute left lower abdominal pain after exercise. Transabdominal color ultrasound suggested a hypoechoic mass in the pelvic cavity and a ruptured left ovarian mass which caused massive intraperitoneal hemorrhage was found via laparoscope. Unilateral salpingo-oophorectomy was admitted, and serum alpha fetoprotein(AFP), carbohydrate antigen 19-9(CA19-9) and human chorionic gonadotropin(hCG) were increased postoperatively. Pathological results revealed a mixed ovarian germ cell tumor with dominant components of embryonal carcinoma and choriocarcinoma, and a few yolk sac tumor and teratoma. On the 11th day after surgery, positron emission tomography(PET)/CT showed no residuals. Four cycles of chemotherapy with the regimen of Ping-Yangmycin+etoposide+cisplatin (BEP) were performed. Her serum AFP and hCG came normal after two cycles of chemotherapy. Menstruation was resumed by February 2022 and there was no signs of recurrence until May 2022.

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    A Case of Uterine Mesothelial Cyst Misdiagnosed as Leiomyoma with Cystic Degeneration
    ZHU Shu, ZHANG Hui-yuan, XU Wei, WANG Cong, WANG Xiu-li
    2022, 49 (5):  556-559.  doi: 10.12280/gjfckx.20211101
    Abstract ( 1551 )   HTML ( 22 )   PDF (5410KB) ( 3427 )  

    Mesothelial cyst is a benign neoplastic lesion derived from mesothelial cells, mainly involves pelvic peritoneum and peritoneal peritoneum. It is more common in mesentery and omentum majus, and less in uterus. This paper reports the diagnosis and management of a patient with uterine mesothelial cyst misdiagnosed as leiomyoma with cystic degeneration in the First Affiliated Hospital of Nanjing Medical University. This patient with no typical clinical manifestations preoperatively was diagnosed as leiomyoma with cystic degeneration and underwent total hysterectomy and bilateral salpingo-oophorectomy, mainly based on imaging characteristics. But the postoperative pathology, indicated uterine mesothelial cyst. This paper analyzes the diagnosis and treatment of the patient and reviews relevant literature, discuss the differential diagnosis and treatment of uterine mesothelial cyst, in order to improve the academic vision of the disease in gynecologists and avoid misdiagnosis and underdiagnosis.

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    Primary Extrauterine Endometrial Stromal Sarcoma of the Small Intestine: A Case Report and Literature Review
    WU Zhen-zhen, WANG Yue-yuan, WANG Fang, ZHENG Jing, WANG Hui-ling, LIU Qing
    2022, 49 (5):  560-564.  doi: 10.12280/gjfckx.20220039
    Abstract ( 1289 )   HTML ( 21 )   PDF (4845KB) ( 3348 )  

    Endometrial stromal sarcoma (ESS) is a rare mesenchymal neoplasm of the uterus, which is predominantly composed of endometrial stromal cells. Primary extrauterine ESS is a special type originating from extrauterine organ without intrauterine lesions. Ovary is the most common primary site. Primary intestinal ESS is rarely described. Its clinicopathologic features have not been well characterized. We report a case of ESS arising in the small intestine in a 46-year-old woman. She was treated with cytoreductive resection surgery, followed by chemotherapy, megestrol acetate, and has been in remission for more than 77 months with disease-free. The patient′s main symptoms were epigastric pain during menstruation with radiating pain in the lower back, and she had a previous history of endometriosis. The diagnosis of ESS relies on immunohistochemical detection, and radical surgery is the first-line treatment.

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    Obstetric Physiology & Obstetric Disease :Review
    Research Progress of Intrauterine Flora Regulating Intrauterine Microenvironment and Affecting Embryo Implantation
    REN Shu-qing, GUO Jie, SONG Dian-rong
    2022, 49 (5):  565-569.  doi: 10.12280/gjfckx.20220317
    Abstract ( 1616 )   HTML ( 26 )   PDF (750KB) ( 3367 )  

    At present, many studies show that the microbiome of female genital tract plays a vital role in maintaining normal pregnancy and influencing reproductive outcomes. Normal intrauterine flora (intrauterine symbiotic flora) can maintain the homeostasis of intrauterine environment and provide good conditions for embryo implantation. However, the mechanism of its interaction with the host during embryo implantation is still poorly understood. When the intrauterine symbiotic flora is disordered, it may change the intrauterine microenvironment by destroying the antibacterial barrier, causing immune cell imbalance, promoting the release of inflammatory factors and producing abnormal metabolites, so as to reduce the endometrial receptivity and lead to embryo implantation failure. Therefore, it is of great significance to study the interaction between host and microbiome and the influence of abnormal intrauterine flora on the physiology and function of local endometrial microenvironment. In this article, we summarized the composition of normal intrauterine symbiotic flora, the characteristics of intrauterine flora in infertile patients and the interaction mechanism between intrauterine flora and host during embryo implantation periods, in order to provide new ideas for further studies about intrauterine flora in embryo implantation in the future.

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    Effects of Fetal Growth Restriction on Fetal Brain Neurodevelopment
    YANG Jun-juan, ZHANG Yan
    2022, 49 (5):  570-573.  doi: 10.12280/gjfckx.20211018
    Abstract ( 1630 )   HTML ( 21 )   PDF (709KB) ( 3341 )  

    Fetal growth restriction (FGR) can cause short-term and long-term developmental abnormalities in fetuses and neonates and severe neurological diseases in adulthood. Therefore, the impact of FGR on fetal and neonatal brain neurodevelopment has become a research hotspot in recent years. Human and experimental animal studies have shown that the onset time of FGR, the severity of FGR, and the gestational age at delivery are closely related to fetal brain neurodevelopment. Middle cerebral artery Doppler ultrasonography and cerebroplacental ratio can evaluate fetal cerebral hemodynamics in FGR, and phase contrast magnetic resonance imaging can monitor fetal cerebral blood flow and brain structure. Early-onset and late-onset FGR have different effects on the brain neurodevelopment of the offspring. FGR can also lead to abnormal fetal brain structure and function, and increase the incidence of intraventricular hemorrhage. In this article, we reviewed the research progress of the effects of FGR on fetal brain neurodevelopment, in order to strengthen the clinical management of FGR fetuses and improve its short-term and long-term outcomes.

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    Treatment of Postpartum Hemorrhage
    FENG Qiang, ZHANG Yue-xiang
    2022, 49 (5):  574-579.  doi: 10.12280/gjfckx.20220269
    Abstract ( 1391 )   HTML ( 33 )   PDF (806KB) ( 3411 )  

    Postpartum hemorrhage is the leading cause of maternal death in China. The main factors leading to postpartum hemorrhage are uterine atony, genital tract trauma, placental factors, anemia and coagulation dysfunction. In recent years, due to the adjustment of China′s birth policy, the average age of pregnant women has gradually increased, and the incidence and severity of postpartum hemorrhage are also on the rise. Medical institutions should identify postpartum hemorrhage according to the actual situation of the parturient, pay attention to the analysis of the causes of postpartum hemorrhage, take timely prevention and effective countermeasures, and then formulate individualized treatment strategies, maintain the stability of maternal hemodynamics, promote uterine contraction, perform appropriate surgical operations and blood infusion, and drugs such as tranexamic acid, recombinant human activating factor Ⅶ and fibrinogen should be used when necessary to improve hemostasis, so that the patients can receive timely and effective treatment, then reduce bleeding-related mortality, and improve the quality of life of patients in the future.

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    Progress in the Study of Pregnancy Complicated with Long QT Syndrome
    LIANG Mei-Yu, FAN Zhuo-Ran, HUA Shao-Fang
    2022, 49 (5):  580-584.  doi: 10.12280/gjfckx.20220290
    Abstract ( 1428 )   HTML ( 16 )   PDF (689KB) ( 3438 )  

    Long QT syndrome (LQTS) is a genetic heart disease caused by mutations in genes that lead to abnormalities in the structure or function of ion channels, and is characterized by prolonged QT interval and T-wave changes in the electrocardiogram (ECG), and it is prone to palpitation, synocope, arrhythmia, cardiac arrest and even sudden death. The most common genetic subtypes of LQTS patients are LQT1, LQT2, and LQT3. Different Genetic subtypes of LQTS have different mutation genes, triggers, and even ECG changes, so clarifying the genetic subtypes of patients can help clinical diagnosis, treatment and prevention of cardiac events. Effective prevention of cardiac events is one of the most important measures for patients with LQTS. During pregnancy and puerperium, women with LQTS will experience a series of physiological changes such as hormonal levels and hemodynamic changes, which may affect the risk of cardiac events associated with LQTS; their clinical management is also different from that of non-LQTS women, and it is necessary to review the research progress of its pathogenesis, diagnostic criteria, treatment options and perinatal management.

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    Correlation between Vitamin D Deficiency and Perinatal Depression
    WU Fang, LIU Xia
    2022, 49 (5):  585-589.  doi: 10.12280/gjfckx.20220463
    Abstract ( 1464 )   HTML ( 25 )   PDF (698KB) ( 3399 )  

    Vitamin D (VD) is one of the essential nutrients in pregnancy and perinatal period. It is not only related to bone metabolism, but also has multiple neural activities affecting neuroimmune regulation, neurotrophic factors and neurotransmission in the brain. Recent studies have found that VD has varying degrees of influence on the occurrence of depression. Prenatal and postnatal depression as a branch of depression, their relationship with VD is also being studied. VD deficiency can not only lead to recurrent spontaneous abortion, gestational diabetes and pre-eclampsia, but also be associated with depression symptoms during pregnancy and postpartum. It has been reported that VD deficiency may be one of the important risk factors for perinatal depression. Reasonable perinatal VD supplementation has a certain prevention and treatment effect on depression, but more studies are needed to confirm the timing and dose of VD supplementation. Combined with the domestic and foreign literatures published in recent years, we reviewed the correlation between VD deficiency and perinatal depression in this article, providing theoretical basis for early prevention, early diagnosis and timely treatment of the disease, and providing new ideas for later research.

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    Obstetric Physiology & Obstetric Disease:Case Report
    Reflection on Two Cases of Transvaginal Single Porosity Laparoscopic Tubal Pregnancy by Rear Approach
    GU Jian-juan, WU Jing-yi, SUN Gui-fang
    2022, 49 (5):  590-593.  doi: 10.12280/gjfckx.20211036
    Abstract ( 1509 )   HTML ( 15 )   PDF (6313KB) ( 3428 )  

    Vaginal natural orifice transluminal endoscopic surgery combines vaginal surgery with laparoscopic surgery, and usually takes the vaginal vault as the path to enter the abdominal cavity. We analyze two cases who diagnosed with ectopic pregnancy and treated by v-NOTES. One of the patients was unmarried and childless, no specific lesion site was found during v-NOTES, and MTX was selected for conservative medication. Postoperative serum β-hCG continued to rise, and the adnexal mass increased, thereupon transumbilical laparo-endoscopic single-site surgery (TU-LESS) was performed to remove fallopian tube. Another patient was found pelvic adhesions when the posterior fornix was opened, and it was difficult to enter. After resection of the fallopian tube, considering that pelvic adhesions may lead to residual pregnancy products, TU-LESS was required. Through two cases of operation, v-NOTES was found to be more limited operation field of vision than traditional laparoscopic surgery, which not only affects the determination of lesions, but also leads to a relatively prolonged operation time, and has certain limitations in the treatment of ectopic pregnancy.

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    A Case of Perineal Laceration Caused by Severe Obstetric Traumatic Pubic Symphysis Separation
    WU LAN Tu-ya, ZHAO Li-ping, GONG Xiao-ling
    2022, 49 (5):  594-596.  doi: 10.12280/gjfckx.20211068
    Abstract ( 1563 )   HTML ( 24 )   PDF (810KB) ( 3332 )  

    Pubic symphysis separation is a rare complication after delivery, and severe obstetric traumatic pubic symphysis separation is even more rare. A case of perineal laceration caused by separation of pubic symphysis after vaginal delivery was retrospectively analyzed. The patient had severe laceration and avulsion of perineum, which reached to the right fornix, up to the pubic symphysis and anterior pelvic wall, the lower part of pubic symphysis was empty, and the separation of pubic symphysis was 78.37 mm. The patient could not change her body position. Considering the perineal laceration caused by severe obstetric traumatic pubic symphysis separation, the patients should be treated with reduction and internal fixation of pubic symphysis + vaginal examination + perineal laceration repair + cystoscopy under general anesthesia. The patients can be helped out of bed at 6 weeks postpartum. For severe obstetric traumatic pubic symphysis separation, reduction and internal fixation can quickly restore the anatomical of pelvis structure and promote rehabilitation.

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    A Case of Prenatal HELLP Syndrome Complicated with Reversible Posterior Leukoencephalopathy Syndrome
    ZHANG Qiao-ni, LU Hui-xia
    2022, 49 (5):  597-600.  doi: 10.12280/gjfckx.20220035
    Abstract ( 1299 )   HTML ( 27 )   PDF (1401KB) ( 3347 )  

    The pathogenesis of HELLP syndrome and reversible posterior leukoencephalopathy syndrome (RPLS) is still unclear, lack of unified guidance in clinical treatment. A case of prenatal HELLP syndrome complicated with RPLS was reported. The main clinical manifestations of the patients were headache and blindness, the blood pressure was elevated. Laboratory examination showed that lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase increased, and platelets decreased. Patient has chills, convulsions irritability and other delirium symptoms after emergency lower segment cesarean section, was given rescue treatment such as analgesia, sedation, antihypertensive, diuresis, anti-infection, liver protection and multidisciplinary consultation. After 10 days, the patient′s condition was stable, with normal vision and stable blood pressure control. For patients with hypertensive disorders during pregnancy, those with symptoms of neurological and visual disturbances should consider the possibility of RPLS, and diagnose and treat as soon as possible to ensure maternal and infant safety.

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