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    Research on Gynecological Malignancies: Review
    Advances in Immune Checkpoint Inhibitors for Gynecological Malignant Solid Tumors
    LIU De-gao, ZHANG Shu-rong, GAO Yue-wen, ZOU Yong-hui, LI Chang-zhong
    2022, 49 (6):  601-605.  doi: 10.12280/gjfckx.20220578
    Abstract ( 1572 )   HTML ( 89 )   PDF (703KB) ( 2752 )  

    Gynecological solid cancers severely threaten women′s health. Adjuvant treatment such as radiotherapy and chemotherapy for advanced, recurrent and metastatic gynecological tumors is ineffective and the prognosis is poor. In recent years, immunotherapy based on immune checkpoint inhibitors has shown good efficacy in the treatment of malignant solid tumors, and also provides new treatment options for patients with gynecological malignant solid tumors. However, the effect of immune checkpoint inhibitors monotherapy in the failure of traditional platinum-based chemotherapy is poor, which may be related to the difficulty of effective immune response in patients with impaired immune system after multi-cycle chemotherapy. Many clinical studies have shown that immune checkpoint inhibitors combined with platinum-based chemotherapy and pre-application of immune checkpoint inhibitors can benefit patients with advanced, recurrent and metastatic gynecological malignant solid tumors. This article reviews the application progress of immune checkpoint inhibitors in gynecological malignant solid tumors.

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    Analysis of Conservative Treatment Plans for Atypical Endometrial Hyperplasia and Early Endometrial Carcinoma
    HAN Feng-jiao, QU Xing, LI Yu-lan, YUE Ling, XU Fei-xue
    2022, 49 (6):  606-610.  doi: 10.12280/gjfckx.20220194
    Abstract ( 1475 )   HTML ( 50 )   PDF (689KB) ( 2758 )  

    With the onset of cancer at a younger age, more and more women of childbearing age are suffering from endometrial cancer. In order to preserve fertility, most patients tend to conservative treatment. Therefore, many researchers have proposed conservative treatment plans for atypical endometrial hyperplasia and early endometrial cancer, and have been clinically studied in small samples. Traditional therapy is mainly oral high-dose progesterone. However, most patients with oral progesterone treatment have high recurrence rate and many complications. Levonorgestrel-releasing intrauterine system can reduce the side effects to the body caused by a large amout of progesterone through local effects on the endometrium. Hysteroscopy can precisely remove the lesion, protect the normal endometrium, and relatively reduce the risk of infertility and miscarriage in the later pregnancy. The anti-tumor effect of metformin can increase the effective rate of progesterone. Now,we summarizing relieving rate, recurrence rate, and pregnancy outcomes of the atypical endometrial hyperplasia and early endometrial cancer after various conservative treatments, in order to evaluate the own factors and disease characteristics of each patient before clinical treatment to choose the most beneficial treatment plan and management model for patients.

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    Low-Grade Endometrial Stromal Sarcoma
    JI An-xuan, ZHANG Qun, WANG Qing, ZHAO Shu-hua
    2022, 49 (6):  611-615.  doi: 10.12280/gjfckx.20220277
    Abstract ( 2553 )   HTML ( 36 )   PDF (705KB) ( 2827 )  

    Low-grade endometrial stromal sarcoma (LG-ESS) is a rare type of malignant tumor of mesenchymal origin, which is also known as the most common subtype of endometrial stromal sarcoma. As a genetically heterogeneous disease, LG-ESS has many characteristic chromosomal translocations. Abnormal fusion proteins expressed by fusion genes are an important driving factor for the development of LG-ESS and also provide potential therapeutic targets for LG-ESS. LG-ESS is a low-grade malignant tumor characterized by slow growth and late recurrence, with pelvic radiation and long-term use of tamoxifen or estrogen as important risk factors. Due to the atypial of clinical manifestations, there is still a lack of effective preoperative diagnosis. Morphology and combined application of immunohistochemical antibodies can improve the detection rate, but their value is limited. Therefore, its diagnosis and treatment remains a great challenge for clinicians. This article reviews the molecular mechanisms, clinical manifestations, pathological diagnosis, treatment and prognosis of LG-ESS.

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    Research Progress in Diagnosis and Treatment of Uterine Intravenous Leiomyomatosis
    XU Qian, WANG Xin
    2022, 49 (6):  616-620.  doi: 10.12280/gjfckx.20211159
    Abstract ( 1624 )   HTML ( 35 )   PDF (676KB) ( 2719 )  

    Uterine intravenous leiomyomatosis (IVL) is a rare disease. The tumor typically grows along vascular vessels and can extend to the inferior vena cava, even to the heart. The pathogenesis remains still controversial at present. Most scholars are inclined to consider that the leiomyoma directly invades into myometrial veins and spreads along the vascular lumen. Uterine IVL usually occurs in 40 to 50 years old women with a reproductive history. The clinical manifestations in the early stages are not typical. If the lesion involves the inferior vena cava or right heart, it can cause ascites, hepatosplenomegaly, dyspnea, heart failure, and even sudden death in severe cases. Surgery is currently the preferred treatment method, but there is no consensus on the specific surgical plan. The recurrence rate of the disease is high, and long-term and close follow-up is required after the operation. The pathogenesis, high risk fators, clinical and imaging manifestations, diagnosis and differential diagnosis, treatment and prognosis of uterine IVL are reviewed, in order to provide references for the diagnosis and treatment of the disease in the future.

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    Research Progress of Targeting Tumor-Associated Macrophages Therapy for Ovarian Cancer
    ZHENG Jia-hui, LIN Yan, CHEN Qiao-fen, WANG Xue-feng
    2022, 49 (6):  621-625.  doi: 10.12280/gjfckx.20220189
    Abstract ( 1476 )   HTML ( 27 )   PDF (699KB) ( 2768 )  

    Ovarian cancer (OC) remains the leading cause of death in gynecologic malignancies. Immune factors play an important role in its occurrence and development. Tumor-associated macrophages (TAMs) are important immune cells in the tumor microenvironment of OC, which can secrete a variety of cytokines to promote proliferation of cancers, angiogenesis and immunosuppression, playing an important role in the progress of OC. Therefore, targeted TAMs in the treatment of OC has become a research focus. The specific treatment strategies include blocking recruitment of TAMs, enhancing phagocytosis of TAMs, depleting TAMs, converting M2 TAMs to M1 TAMs or inhibiting M2 polarization of macrophages, blocking interactions between TAMs and OC. Numerous basic studies have confirmed that chemotherapeutic drugs, immune checkpoint blockers, nano-drugs and traditional Chinese medicines modulate TAMs to treat or synergistically treat OC to a certain extent. The principle and therapeutic progress of targeting TAMs in the treatment of OC will be reviewed, in order to provide reference for further researches and clinical applications.

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    Prognostic Indicators of Ovarian Cancer in Immunotherapy
    QU Xing, HAN Feng-jiao, MA Li, WANG Xiao-hui
    2022, 49 (6):  626-629.  doi: 10.12280/gjfckx.20220206
    Abstract ( 1492 )   HTML ( 22 )   PDF (735KB) ( 2780 )  

    Ovarian cancer has its own immunogenicity and can be recognized and attacked by the host immune system, which plays a very important role in the pathogenesis and disease progress of ovarian cancer. In recent years, drugs such as poly- adenosine diphosphate polymerase inhibitors, anti-angiogenesis drugs and targeted homologous recombination defects have been widely used in the maintenance treatment of ovarian cancer. These drugs have greatly improved the prognosis of patients, significantly improved the survival time of ovarian cancer patients, and delayed the recurrence. With the continuous application of immunotherapy in clinic, it is extremely important to explore the relevant predictive indicators that can be used to evaluate the prognosis of ovarian cancer immunotherapy. Effective and convenient prognostic indicators can provide reference for clinicians′ diagnosis, treatment and decision-making. At present, it is still one of the difficulties to evaluate the prognostic indicators of ovarian cancer. This paper reviews the predictive value of immune score, programmed cell death receptor 1, neutrophil-to-lymphocyte ratio, bone marrow-derived suppressor cells and other indicators in the prognosis of ovarian cancer immunotherapy.

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    Advances in Diagnosis and Treatment of Ovarian Granulosa Cell Tumor
    ZHOU Li, QU Peng-peng
    2022, 49 (6):  630-634.  doi: 10.12280/gjfckx.20220471
    Abstract ( 1390 )   HTML ( 22 )   PDF (682KB) ( 2733 )  

    Ovarian granulosa cell tumor (OGCT) is a rare neoplasia of sex-cord stromal origin and accounts for 2%-5% of ovarian tumors. It can be divided into adult granulosa cell tumor (AGCT) and juvenile granulosa cell tumor (JGCT) according to the histopathological characteristics. Due to its secretion function, it often presents estrogen stimulation symptom. Mutation of FOXL2 gene c.402C→G is the most important pathogenic factor in AGCT and a molecular diagnostic marker. Surgery is the first choice for OGCT. The most important factor affecting the prognosis of patients is clinical stage. Inhibin β and AMH can be used as serological markers in diagnosis and detection of OGCT. OGCT generally has a favorable prognosis. Due to the characteristics of long-term recurrence, long-term follow-up should be insisted.

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    Research Progress of Ovarian Sclerosing Stromal Tumor
    WANG Min, LI Jia-hui, CUI Jun-ze, MA Shuai
    2022, 49 (6):  635-639.  doi: 10.12280/gjfckx.20220187
    Abstract ( 1919 )   HTML ( 17 )   PDF (675KB) ( 2780 )  

    Sclerosing stromal tumor of the ovary is a rare clinical benign ovarian tumor with low incidence and unclear etiology. It is more common in young women, mostly with unilateral mass, often visit a doctor due to irregular menstrual bleeding or abdominal mass found in physical examination. Imaging examination showed changes such as "lake island sign", "fast in and slow out" and "centrality enhancement". Histopathology showed unilateral rounded cystic solid mass with "false lobule" as the characteristic lesion. Immunohistochemistry showed positive expression of inhibin, vimentin and actin. The diagnosis is mainly made by histopathology, and imaging examination has important reference value. Preoperative diagnosis is difficult and easily confused with ovarian fibroma, follicular membranous cell tumor, ovarian Kookenberg tumor, granulosa cell tumor, etc. Surgical treatment is the main means of treatment, mostly the affected side tumor resection or adnexectomy. Postoperative prognosis is good and ovarian function can be restored to normal. For the tumor with more nuclear mitosis and necrosis, it is necessary to be alert to the risk of recurrence, and long-term follow-up is recommended.

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    Research on Gynecological Malignancies: Case Report
    Endometrial Carcinoma with Adenomyosis Malignant Transformation: A Case Report and Literature Review
    LI Xia, LIU Shi-kai
    2022, 49 (6):  640-643.  doi: 10.12280/gjfckx.20220282
    Abstract ( 1525 )   HTML ( 45 )   PDF (4181KB) ( 2726 )  

    Endometrial cancer complicated with adenomyosis canceration is a rare disease with no specific clinical manifestations. The diagnosis is mostly determined by postoperative pathology, and its treatment is mostly based on the treatment principles of endometrial cancer. The prognosis is still unclear. We report a 57-year-old woman who presented for postmenopausal vaginal bleeding. Color Doppler ultrasound suggested adenomyosis with endometrium thickness of 9 mm, and curettage pathology suggested endometrioid adenocarcinoma. Further comprehensive staging of endometrial cancer was performed. Postoperative pathology revealed endometrial adenocarcinoma with adenomyosis canceration. The patient was diagnosed as stage Ⅰa endometrial cancer complicated with adenomyosis malignant transformation. Regular follow-up showed no recurrence at present.

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    Uterine Inversion Caused by Endometrial Adenosarcoma in Postmenopausal: A Case Report and Literature Review
    YE Sheng-long, ZHANG Lu-fang
    2022, 49 (6):  644-648.  doi: 10.12280/gjfckx.20220318
    Abstract ( 1389 )   HTML ( 32 )   PDF (7027KB) ( 2781 )  

    Postmenopausal chronic uterine inversion is a rare disease. A case of uterine inversion caused by endometrial adenosarcoma in an elderly woman, complicating with infection, urinary retention and venous thromboembolism was reported. The patient was hospitalized due to postmenopausal vaginal bleeding. During that period, it was found that the tumor gradually prolapse from the vagina. After gynecologic physical examination and imaging examination, it was considered that the chronic complete uterine inversion secondary to the tumor in the fundus of the uterus. During the course of the disease, the patient developed infection, urinary retention and left lower extremity venous thromboembolism. After multi-disciplinary consultation, transabdominal perineum combined with hysterectomy and bilateral adnexa resection were finally performed under spinal canal anesthesia in our hospital. The postoperative pathology showed endometrial adenosarcoma and the clinical diagnosis was stage ⅠA. The patient refused to undergo re-staged surgery and adjuvant treatment. There was no new tumor found in 2 years follow-up. For this kind of rare disease, combined with the typical signs of ultrasound and pelvic MRI, the diagnosis can be made as soon as possible. The treatment should be aimed at the primary tumor, complications secondary to the inverted uterus and the patient′s own complications, to develop an individualized perioperative management scheme.

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    Obstetric Physiology & Obstetric Disease: Review
    The Relationship between mTOR Signaling Pathway and Preeclampsia
    ZHAO Yu-lin, WANG Yong-hong
    2022, 49 (6):  655-658.  doi: 10.12280/gjfckx.2022455
    Abstract ( 1358 )   HTML ( 22 )   PDF (707KB) ( 2786 )  

    Pre-eclampsia (PE) is a common clinical idiopathic pregnancy disease. Its condition changes dynamically, and its clinical manifestations are diversified. The etiology and mechanism have not been fully clarified so far. The main research results show that it is closely related to genetic factors, immune factors, nutritional factors and environmental factors. Recent studies have shown that the mammalian target of rapamycin (mTOR) signal pathway is involved in the regulation of placental trophoblast and vascular endothelial cell activity by regulating cell proliferation, invasion, migration and apoptosis, and insulin signal initiates downstream molecules to regulate cell metabolism by activating mTOR signal pathway, which leads to maternal vascular endothelial injury, damaged uterine spiral arteriole remodeling and abnormal inflammatory immune response, and so on, and participates in the occurrence of PE. The purpose of this review is to explore the correlation between mTOR signaling pathway and the pathogenesis of PE, and to provide theoretical basis for pathophysiological research and disease treatment of PE.

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    Correlation between Anti-Müllerian Hormone and Polycystic Ovary Syndrome
    ZHAO Qian, ZHOU Shu
    2022, 49 (6):  659-663.  doi: 10.12280/gjfckx.20220217
    Abstract ( 1546 )   HTML ( 20 )   PDF (708KB) ( 2744 )  

    Anti-Müllerian hormone (AMH) is significantly elevated in patients with polycystic ovary syndrome (PCOS), which may be related to the primitive follicular development disorder of PCOS. The pathogenesis of PCOS is still unknown, and AMH may be an important pathogenic factor that plays a regulatory role through neuroendocrine mechanism and autophagy mechanism. In addition, the genetic changes of AMH and its receptor are also involved, which constitutes the epigenetic mechanism of PCOS. AMH can also be used as a biochemical index for the diagnosis of PCOS, the cutoff can be adjusted according to age and type. AMH is also correlated with the adverse pregnancy outcomes of PCOS, which can be used as a predictor of preterm birth. This paper reviews the research progress of AMH in the pathogenesis, diagnosis and impact on pregnancy outcomes of PCOS, so as to provide theoretical basis for the clinical work of obstetrics and gynecology.

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    Research Progress of Serum Anti-Müllerian Hormone in Patients with Polycystic Ovary Syndrome during Pregnancy
    GAO Jing, GAO Shang, CHENG Wei-wei
    2022, 49 (6):  664-667.  doi: 10.12280/gjfckx.20220534
    Abstract ( 1335 )   HTML ( 21 )   PDF (738KB) ( 2771 )  

    Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women, and serum anti-Müllerian hormone (AMH), as a new indicator for evaluating ovarian reserve, is widely used in the evaluation, diagnosis and treatment of PCOS. With the development of the research on AMH, the research of AMH of PCOS patients during pregnancy has made some progress. It is found that AMH decreases during pregnancy and fluctuates as pregnancy progresses. There is a certain correlation between AMH and androgens during pregnancy of PCOS patients. AMH can be used as a candidate factor for predicting preterm birth in PCOS patients, and provides new ideas and methods for the management of PCOS patients during pregnancy. In addition, it should be noted that the intrauterine environment with high AMH may be an adverse interfering factor in the early life of the offspring of pregnant women with PCOS. PCOS patients belong to a high -risk pregnancy group after pregnancy and face the challenges of various complications during pregnancy. Furthermore, AMH can better guard the maternal and fetal health of PCOS pregnant women, and has broad application prospects in the field of obstetrics. This article focuses on gestation period of PCOS patients and reviews the changes of AMH during pregnancy, the relationship between AMH and androgen, the correlation between AMH and preterm birth, and the condition of AMH in offspring.

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    Progress in Clinical Application of Antibiotics in Obstetrics
    PAN Yu-xia, XIANG Qing-yi, BAI Xiao-xia
    2022, 49 (6):  668-674.  doi: 10.12280/gjfckx.20220546
    Abstract ( 1341 )   HTML ( 22 )   PDF (795KB) ( 2788 )  

    Pregnant women have unique anatomical and physiological characteristics during pregnancy, delivery and puerperium, and are prone to genital tract bacterial infection. The progression of the disease can lead to adverse pregnancy outcomes such as premature birth, abortion, premature rupture of membranes, intra amniotic infection, fetal distress, stillbirth, puerperal infection, sepsis and so on. At present, antibiotics, as the most effective drugs to prevent and treat bacterial infections, are widely used in obstetric clinic. It is worth noting that rational use of drug for pregnant women should not only take into account the illness itself, but also take into account the safety of mother and child during pregnancy and lactation. Therefore, there are still many problems in the actual clinical application of antibiotics in obstetrics, which should be paid more attention to. This article reviews how to use antibiotics rationally, combined with different periods and common diseases, which is helpful to provide more theoretical basis for medication guidance during pregnancy and lactation.

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    Obstetric Physiology & Obstetric Disease: Original Article
    Case Analysis of Cytomegalovirus Infection and Prenatal Diagnosis in Early Pregnancy
    QIU Pei-mian, LIANG Xue-yan, WEN Ying-meng, LI Xue-mei, LIU Yan-hui
    2022, 49 (6):  675-678.  doi: 10.12280/gjfckx.20220404
    Abstract ( 1409 )   HTML ( 35 )   PDF (3776KB) ( 2831 )  

    Objective: To analyze the significance of the dynamic quantitative detection of cytomegalovirus (CMV) antibody levels in early pregnancy, and to provide a reference for clinicians to conduct the screening and diagnosis of CMV during pregnancy. Methods: A total of 810 pregnant women who were randomly selected from routine pregnancy examination in the Outpatient Department of Obstetrics and Gynecology of Huizhou Municipal Central Hospital from January to December 2021. All pregnant women were tested for IgG and IgM of CMV by electrochemiluminescence assay within 12 weeks of gestation, and were reviewed once every 1 to 2 weeks. Combine the two antibody quantification results to determine whether the pregnant woman was infected and the type of infection. Pathological analysis was performed on fetuses diagnosed with CMV infection in induced labor. Results: Among the 810 samples, 801 cases were infected with CMV, among which 783 cases (96.7%) were previously infected, 1 cases of CMV primary infection and 1 case of CMV recurrent infection. The primary infection rate and recurrent infection rate were both about 0.1%, 16 cases (2.0%) were IgM persistently positive, and 9 cases (1.1%) were not infected with CMV. One fetus of induced labor was diagnosed as disseminated congenital CMV infection. Conclusions: Dynamic and quantitative detection of CMV antibodies in early pregnancy can reflect the infection situation and infection type of pregnant women, effectively exclude the interference in clinical diagnosis and treatment, and avoid excessive medical intervention. Scientific and standardized CMV testing during pregnancy is the core of birth defect prevention and control.

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    Obstetric Physiology & Obstetric Disease: Case Report
    A Case of Heterotopic Cervical Pregnancy
    LI Lan, DU Fang, DING Xiao-yan, YE Hong
    2022, 49 (6):  679-682.  doi: 10.12280/gjfckx.20220053
    Abstract ( 1389 )   HTML ( 17 )   PDF (2879KB) ( 2771 )  

    The incidence of heterotopic pregnancy(HP) is low and the clinical manifestations is lack of specificity. It can be accompanied with abdominal pain, irregular vaginal bleeding and so on, as common ectopic pregnancy. Some patients do not even have any symptoms, and due to the existence of the sac of intrauterine pregnancy, it is easy to ignore the ectopic gestational sac, so the early diagnosis is difficult, often misdiagnosed as early abortion. Review the data of the transplant cycle in our center in the past 5 years, included 41 596 transfered cycles, only 1 heterotopic cervical pregnancy patient was admitted in 2020. The patient had multiple uterine cavity operations in the past and underwent multiple intrauterine adhesions separation. The fresh cycle was cancelled due to thin endometrium. Later, we performed frozen-thawed embryo transfer,thawed and transferred 2 cleavage-stage embryos. Due to repeated irregular vaginal bleeding after transplantation, the patient was admitted to the hospital as a "threatened abortion" in the early emergency department for fetal protection treatment. Later, B-ultrasound confirmed that it was a heterotopic cervical pregnancy. The patient had a strong desire to retain the intrauterine pregnancy, and underwent conservative treatment of fetal reduction (twice), and finally delivered a child. It is suggested that the complex pregnancy is easy to be missed and misdiagnosed, and the diagnosis should be made as early as possible. If the condition is stable and the gestational age is small, fetal reduction surgery can be regarded as an effective treatment.

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    A Case of Pregnancy Complicated with Abdominal Wall Desmoid Tumour and Literature Review
    SUN Jian-hao, WU Zhen-zhen, MAO Bao-hong, SONG Cheng, ZHANG Ying, LI Yang, LIU Qing
    2022, 49 (6):  683-686.  doi: 10.12280/gjfckx.20220338
    Abstract ( 1310 )   HTML ( 19 )   PDF (3977KB) ( 2762 )  

    Desmoid tumors are rare fibroblast-proliferating tumors characterized by infiltrative growth and a tendency to local recurrence and are classified into the extra-abdominal, abdominal wall and intra-abdominal types according to the location of growth. Pregnancy with abdominal wall desmoid tumors is even rarer. This study retrospectively analyzed a patient who was treated in Gansu Province Maternity and Child Health Care Hospital with a mass in the abdominal scar after cesarean section, and the mass gradually increased during the re-pregnancy monitoring. The preoperative puncture was considered to be pregnancy complicated with abdominal wall desmoid tumor, and the cesarean section and abdominal wall tumor resection were performed after the fetus was full-term. Combined with the relevant literature, to understand the diagnosis, treatment, and treatment principles of desmoid tumors, in order to provide experience for the diagnosis and treatment of the disease.

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    Recurrence and Metastasis after Treatment of Extraskeletal Ewing Sarcoma Combined with Pregnancy and Successfully Delivery: A Case Report
    MA Xue-ying, YE Ling, WANG Xiao-hui
    2022, 49 (6):  687-690.  doi: 10.12280/gjfckx.20220237
    Abstract ( 1659 )   HTML ( 11 )   PDF (3754KB) ( 2733 )  

    Extraskeletal Ewing sarcoma in pregnancy is very rare in clinic, with a high rate of recurrence and metastasis, and there is no unified and effective treatment plan at present. This paper reports a case of pregnancy complicated with extraperitoneal Ewing sarcoma. Due to lumbosacral pain, a healthy full-term live female infant was successfully cesarean section in the First Hospital of Lanzhou University, who had previously received retroperitoneal tumor resection combined with left nephrectomy, supplemented with postoperative chemotherapy, combined with relevant medical history and examination to consider the recurrence and metastasis of extraperitoneal Ewing sarcoma. Because extraosseous Ewing sarcoma in pregnancy is very rare, the treatment is more difficult and the prognosis is poor. It is suggested that the suspected pregnant women should be followed up on the basis of regular prenatal examination in clinical work to find the focus in time. Once diagnosed, treatment strategies should be developed under the multi-disciplinary joint management mode to help patients overcome the challenges posed by pregnancy associated cancer and minimize adverse outcomes.

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    Obstetric Physiology & Obstetric Disease: Standard and Guideline
    Guide Interpretation/Contrast the Guideline of Gestational Hyperglycemia from CMA and the Guideline of Gestational Diabetes Mellitus from ADA in 2022
    HUANG Jun-qiao, LI Ying-tao, LIU Meng-yue, WU Wei-zhen
    2022, 49 (6):  691-698.  doi: 10.12280/gjfckx.20220262
    Abstract ( 1494 )   HTML ( 20 )   PDF (960KB) ( 3090 )  

    The prevalence of gestational hyperglycemia/diabetes in pregnancy (DIP) or gestational diabetes mellitus (GDM) has been increasing in the world. It is not only associated with perinatal adverse events for mother and fetus, but also increases the risk of metabolic diseases in mother and offspring in the long term. However, there are still controversies about the diagnosis and treatment of DIP. Chinese Medical Association (CMA) in 2022 and American Diabetes Association (ADA) in 2021 had issued and updated their guidelines of DIP in order to provide the latest suggestion for the management of DIP. Two guidelines have been comparated in the nine aspects,such as disease classification, diagnosis, preconception counseling and care, lifestyle and behavior management, hypoglycemic drug therapy during pregnancy, glucose monitoring, maternal and child complications, postpartum care and follow-up, obstetric management. The possible causes of similarities and differences between the two guidelines were explored for providing a reference for clinicians′ practice.

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    Gynecological Diseases & Related Research: Review
    The Relationship between Pathological Changes and Complications of Caesarean Scar Defect
    WANG Ya-nan, WANG Lin, CHEN Ya-hui, DONG Yan, ZHOU Yan, SUN Lin
    2022, 49 (6):  699-703.  doi: 10.12280/gjfckx.20220210
    Abstract ( 1487 )   HTML ( 24 )   PDF (700KB) ( 3038 )  

    Caesarean scar defect (CSD) refers to the myometrial defect of the uterine scar after cesarean section, which causes the endometrial layer protrude to the myometrium and form a depression. Abnormal anatomical structures are formed due to poor healing of the scar, and a series of pathological changes have occurred over time, such as proliferation of fibrous tissue, formation of tortuous blood vessels, uneven distribution of hormone receptors, and inflammatory environment and other comorbidities. The pathological changes of CSD often cause complications such as abnormal vaginal bleeding, secondary infertility, dysmenorrhea and chronic pelvic pain, which affect the quality of life of women and cause great distress to patients with fertility requirements. Therefore, the diagnosis and treatment of CSD cannot be ignored in clinical work. The clinical related factors of CSD formation were analyzed, and the risk factors of CSD pathological changes were explored, so as to further study the relationship between CSD pathological changes and different complications, and better prevent, diagnose and treat CSD and its complications.

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    Advances in the Diagnosis and Treatment of Extra-Pelvic Endometriosis
    FENG Jing, XIE Jing-yan
    2022, 49 (6):  704-707.  doi: 10.12280/gjfckx.20220610
    Abstract ( 1385 )   HTML ( 30 )   PDF (777KB) ( 2748 )  

    Endometriosis (EMs) is one of the common benign diseases in women of childbearing age, and its incidence is increasing year by year. EMs refers to the presence of endometrial tissue outside the normal endometrium, mostly involving pelvic organs and parietal peritoneum, such as the ovary and sacral ligament. The pathogenesis of EMs has not been completely clarified. Currently, the widely accepted theories include the hypothesis of menstrual reflux, coelomic epithelium metaplasia, iatrogenic implantation, lymphatic metastasis and hematogenous dissemination. Diagnosis depends on clinical findings, imaging and pathological outcomes. Management of this disease includes drug treatment and surgery. Extra-pelvic endometriosis is a rare EMs that occurs in areas outside the pelvic cavity, such as the abdominal wall, thorax and perineum. Due to its rare occurrence and atypical clinical symptoms, the diagnosis is often difficult and misdiagnosis often occurs. In order to improve the diagnosis and treatment of extra-pelvic endometriosis, it is necessary to achieve early detection, timely diagnosis and standardized treatment to optimize the prognosis of patients.

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    Research Progress on the Role of Thioredoxin-Interacting Protein in Polycystic Ovary Syndrome
    YE Sha, HUANG Ye-pei, MA Lin, BAO Xiao-yan, YANG Ru, DENG Miao, HUANG Jian
    2022, 49 (6):  708-712.  doi: 10.12280/gjfckx.20220603
    Abstract ( 597 )   HTML ( 6 )  

    Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disease commonly in women of reproductive age, characterized by irregular menstruation, hyperandrogenemia and polycystic ovary changes, often manifested as obesity, infertility and insulin resistance. Thioredoxin-interacting protein (TXNIP) is a multifunctional regulator that is not only involved in the regulation of insulin secretion and glucose metabolism, but also closely related to oxidative stress, inflammatory factors and mood disorders. Studies have shown that TXNIP levels are significantly increased in PCOS patients, suggesting that TXNIP may be involved in the development of PCOS and its complications. In recent years, some in vivo and ex vivo studies have attempted to use herbal extracts and western drugs to inhibit TXNIP expression, and the discovery of TXNIP-specific inhibitors makes it a promising and effective target to inhibit the process of PCOS. This article reviews the role of TXNIP in PCOS, in order to provide new ideas and directions for the in-depth study of PCOS pathogenesis and its clinical diagnosis and treatment.

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    Gynecological Diseases & Related Research: Original Article
    Clinical Value of DNA Probe in Diagnosis of Vaginitis
    QI Wen-hui, WANG Chen, XUE Feng-xia
    2022, 49 (6):  713-716.  doi: 10.12280/gjfckx.20220627
    Abstract ( 1188 )   HTML ( 28 )   PDF (682KB) ( 2831 )  

    Objective: To evaluate the clinical value of DNA probe in diagnosis of vaginitis. Methods: A total of 714 women of childbearing age with vaginitis symptoms in the Department of Obstetrics and Gynecology of Tianjin Medical University General Hospital were enrolled and diagnosed by vaginal microecological detection and DNA probe technology. To explore the clinical value of DNA probe in the diagnosis of bacterial vaginosis, vulvovaginal candidiasis and vaginal trichomoniasis by comparing vaginal microecological detection. Results: The sensitivity, specificity, Youden index, positive predictive value and negative predictive value of DNA probe in the diagnosis of bacterial vaginosis were 98.32%, 87.39%, 0.86, 60.93% and 99.61%, respectively. The Kappa value of consistency test was 0.69 (P<0.001). The sensitivity, specificity, Youden index, positive predictive value and negative predictive value of DNA probe in the diagnosis of vulvovaginal candidiasis were 92.80%, 97.39%, 0.90, 89.58% and 98.24%, respectively. The Kappa value of consistency test was 0.89 (P<0.001). The sensitivity, specificity, Youden index, positive predictive value and negative predictive value of DNA probe in the diagnosis of vaginal trichomoniasis were 100%, 99.86%, 0.99, 87.5% and 100%, respectively. The kappa value of consistency test was 0.93 (P<0.001). Conclusions: DNA probe technique is easy to operate and can detect three kinds of pathogenic microorganisms of vaginitis at one time, and has good consistency with vaginal microecological detection method. At the same time, it overcomes the limitation of traditional vaginal microecological detection method and has high clinical application value.

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    Gynecological Diseases & Related Research: Case Report
    A Case of Oblique Vaginal Septum Syndrome and Literature Review
    CHEN Lu-lu, WU Zhen-zhen, LIU Qing
    2022, 49 (6):  717-720.  doi: 10.12280/gjfckx.20220300
    Abstract ( 1344 )   HTML ( 26 )   PDF (3223KB) ( 2794 )  

    Female genital tract malformation is a common disease in female population, with a incidence rate of 6%, of which oblique vaginal septum syndrome accounts for 3.7% of female genital tract malformations. Because of its complex, changeable, nonspecific symptoms and atypical imaging changes, the rate of misdiagnosis and missed diagnosis is high. The risk of endometriosis, pelvic adhesions and infertility will increase after missed diagnosis. Misdiagnosis may lead to excessive operation and delay of illness. A case of atypical oblique vaginal septum syndrome admitted to Gansu Provincial Maternity and Child-Care Hospital was analyzed retrospectively. The patient was asymptomatic for 15 years after menstruation and had menstrual vaginal bleeding in the middle of menstruation, intermittent fever and abdominal pain in 4 months after cesarean section. The patient was not correctly diagnosed and properly treated. The diagnosis was confirmed 4 years after cesarean section, and was cured successfully after vaginal oblique septectomy. The diagnosis and treatment of this patient has certain reference value for the clinical diagnosis and treatment of oblique vaginal septum syndrome, and the relevant literature is reviewed in order to provide experience for the diagnosis and treatment of oblique vaginal septum syndrome.

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