Journal of International Obstetrics and Gynecology

Research Advances on Protein Post-Translational Modification in the Pathogenesis of Preeclampsia

CHEN Jia-ying, FENG Ya-ling

2024, 51 (1): 1-4. doi: 10.12280/gjfckx.20230795

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Protein post-translational modification refers to a series of covalent modifications that occur after protein translation. These modifications can regulate the structure and function of protein, thereby, affecting the development and progression of various diseases. Preeclampsia is a pregnancy-specific syndrome, but the cause of it is still not fully understood. Recent investigations suggest that post-translational modifications of proteins may play a crucial role in the pathogenesis of preeclampsia. In this article, we review the progress of common protein post-translational modifications, such as phosphorylation, acetylation, glycosylation, ubiquitination, and lactypation, in the pathogenesis of preeclampsia, which will provide new directions for exploring the pathogenesis of preeclampsia and for improving diagnostic and therapeutic measures.

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The Relationship between Serum Vitamin Level during Pregnancy and Preeclampsia

LI Jie-peng, CHENG Yao, LIU Ze-jun, YE Ming-zhu, SUN Guo-qiang

2024, 51 (1): 5-9. doi: 10.12280/gjfckx.20230681

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Preeclampsia (PE) is one of the main causes of increased perinatal mortality, and its pathogenesis remains unclear. The present study has found that the levels of multivitamins during pregnancy were correlated with incidence of PE. It has been proved that vitamin D is involved in placental formation, inflammatory reaction, oxidative stress and immune activation in the pathogenesis of PE. Vitamin D deficiency can lead to PE through the above mechanisms. In addition, the levels of vitamin E in patients with PE are lower than those in normal pregnant women, suggesting that the lack of vitamin E may increase the risk of PE, but the specific mechanism is still under investigation, it may be related to its antioxidant activity. The relationship between vitamin A levels and PE is controversial. PE is also associated with homocysteine, folic acid (vitamin B₉), vitamin B₁₂ and vitamin B₆, also known as carbon metabolism. The deficiency of related vitamins leads to homocysteine metabolism disorder, thus causing PE. Vitamin B₃ primarily protects against PE by preserving the endothelium and regulating redox reactions. Vitamin C deficiency is associated with PE, and the use of vitamin C during fluid replacement therapy can partially reduce the incidence of pulmonary edema.

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The Role of Exosomes from Different Sources in Pathogenesis and Treatment of Preeclampsia

MENG Fei, LIU Hui-qiang

2024, 51 (1): 10-14. doi: 10.12280/gjfckx.20230727

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Preeclampsia (PE) is one of the most serious complications of pregnancy, which threatens the lives of pregnant women and fetuses. However, the pathogenesis and effective treatments of PE are still unclear. Exosomes are membrane vesicles secreted by cells and contain a variety of components. They have different biological functions, such as cell-to-cell communication and serving as biomarkers, which may provide new models for early screening and treatment of PE. And exosomes of different origins (especially placenta- and mesenchymal stem cell-derived exosomes) can play different roles in PE. For example, placenta-derived exosomes are involved in immune regulation processes in PE, while mesenchymal stem cell-derived exosomes promote endothelial cell proliferation and migration. In addition, the relationship between PE and exosomes from other sources still needs to be clarified. This article reviews the research of exosomes from different sources in the pathogenesis and treatment of PE.

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The Role of Placenta-Derived Exosomes in Immune Regulation during Pregnancy

ZHANG Yong-qing, CHEN Dan-qing

2024, 51 (1): 15-20. doi: 10.12280/gjfckx.20230709

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The placenta plays a critical role in maintaining immune tolerance at the maternal-fetal interface. Recent research has shown that syncytiotrophoblast cells of the placenta continuously release placenta-derived exosomes (Pd-Exos) into the maternal bloodstream. These Pd-Exos and their contents not only participate in pregnancy processes such as embryogenesis and implantation, but also contribute to immune regulation during pregnancy. They inhibit natural killer cell cytotoxicity, suppress T-cell activation, and promote the differentiation and polarization of macrophages during pregnancy. Precise regulation of the mechanisms is crucial for successful pregnancy and achieving favorable maternal and fetal health outcomes. Disruption of immune tolerance can lead to adverse pregnancy outcomes such as preeclampsia, gestational diabetes mellitus, and preterm birth. In this review, we summarized the immunomodulatory functions of Pd-Exos during normal physiological pregnancy and their involvement in pregnancy-related complications due to maternal-fetal immune dysregulation.

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Construction and Validation of A Predictive Model for Adverse Pregnancy Outcomes in Preeclampsia

ZHANG Ting, CHEN Zhen-yu, LIU Sen, ZHANG Xiao-hong, LI Ya-meng, LI Cai-xi

2024, 51 (1): 21-27. doi: 10.12280/gjfckx.20230728

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Objective: To analyze the risk factors associated with the occurrence of adverse perinatal pregnancy outcomes in preeclampsia, construct a risk prediction model and validate it. Methods: A retrospective analysis was conducted on clinical data of patients who delivered and diagnosed with preeclampsia at General Hospital of Northern Theater Command (our hospital) from January 1st, 2018 to December 31st, 2022. Multivariable logistic regression analysis was used to screen for independent risk factors for adverse perinatal pregnancy outcomes in preeclampsia. The R language was utilized to construct the risk prediction columnar graphical model. The predictive performance and goodness of fit of the model were evaluated based on the area under the receiver operator characteristic curve (AUC) and the Hosmer-Lemeshow test, the calibration curves were assessed for accuracy, decision analysis curve was used to assess the clinical use of the model. Patients with preeclampsia who delivered at our hospital from January 1st, 2023 to June 30th, 2023 were selected for external validation. Results: A total of 1 057 patients with preeclampsia were included for modelling, divided into a training set (739 patients) and a validation set (318 patients) in a 7∶3 ratio. 125 patients with preeclampsia were included for external validation. Multifactorial logistic regression analysis showed that the following factors were independent risk factors for adverse pregnancy outcomes in patients with preeclampsia: gestational week of onset ≤34 weeks, mean arterial pressure ≥120 mmHg (1 mmHg=0.133 kPa), fetal growth restriction, fibrinogen ≤4 g/L, urine protein qualification of ++ or higher, serum albumin ≤30 g/L, and lactate dehydrogenase ≥263 U/L (all P<0.05). Logistic risk prediction model was established accordingly. The AUC of the model was 0.941 (95%CI: 0.925-0.958), with Jordon index 0.382, specificity 87.8%, sensitivity 85.1%, and calibration curves show good agreement between the probability of predicting the occurrence of adverse pregnancy outcomes in preeclampsia and the probability of actual occurrence, internal validation calibration curves showed good model agreement. The external validation calibration curve showed that the model was well calibrated, and the Hosmer-Lemeshow test showed that the difference between the predicted probability of the model and the actual observed probability was not statistically significant ( χ²=12.164, P=0.144), clinical decision analysis curves indicated the clinical utility of nomograms to some extent. Conclusions: The prediction model of adverse pregnancy outcome in preeclampsia constructed has good accuracy, the selected indicators are simple and easy to obtain, and the nomograms are easy to apply, which can provide a certain reference basis for clinicians to assess the maternal and infant outcomes of patients with preeclampsia.

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Risk Factors and Perinatal Outcomes of Early Onset Preeclampsia Patients with Absent or Reversed End-Diastolic Velocity in the Umbilical Artery

LIAN Ya-nan, HE Tong-qiang, LYU Yan-xiang, QIAO Yuan

2024, 51 (1): 28-31. doi: 10.12280/gjfckx.20230396

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Objective: To analyze the risk factors and perinatal outcomes of early onset preeclampsia patients with absent or reversed end-diastolic velocity(AREDV) in the umbilical artery. Methods: We retrospectively analyzed the clinical data of 416 pregnant women with early onset preeclampsia admitted from January 2017 to September 2021. These patients were divided into AREDV group (58 cases) and non-AREDV group (358 cases) based on the presence or absence of AREDV before delivery. We compared the clinical data and perinatal outcomes between the two groups. We used binary logistic regression analysis to investigate the risk factors of AREDV in pregnant women with early onset preeclampsia. Results: There were statistically significant differences in gestational age of diagnosis of preeclampsia, hemoglobin levels, alanine aminotransferase and platelet distribution width between the two groups (all P<0.05). Multivariate logistic regression analysis showed that gestational age of diagnosis of preeclampsia and hemoglobin levels were associated with the occurrence of AREDV in preeclampsia patients. The risk of AREDV in patients whose gestational age <28 weeks and between 28 and 29⁺⁶ weeks is 8.244 times(95%CI: 2.631-25.832, P<0.001) and 6.532 times (95%CI: 2.033-20.985, P=0.002) higher, respectively, compared to those diagnosed at 32 to 33⁺⁶ weeks. Early onset preeclampsia patients with hemoglobin ≥135 g/L had a 2.438 times (95%CI: 1.173-5.065, P=0.017) higher risk of developing AREDV compared to those with normal hemoglobin levels. The incidence of intrauterine fetal death and induced abortion in the AREDV group were significantly higher than those in the non-AREDV group. The 1 minute Apgar score、birth weight of newborns and termination of pregnancy weeks in the AREDV group were significantly lower than those in the non-AREDV group(all P<0.05). Conclusions: For early onset preeclampsia pregnant women with early gestational age of diagnosis of preeclampsia and high hemoglobin levels, it is necessary to strengthen intrauterine monitoring of the fetus and be alert to the occurrence of AREDV.

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Prenatal Diagnosis and Pregnancy Selection in Pregnant Women at High Risk of Fetal Sex Chromosome Aneuploidy Disease with NIPT

YAO Jing-yi, FENG Shu-ren, XIE Xiao-yuan, LIU Xia

2024, 51 (1): 32-36. doi: 10.12280/gjfckx.20230703

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Objective: To investigate the status of prenatal diagnosis of pregnant women at high risk of fetal sex chromosomal aneuploidy (SCA) by noninvasive prenatal testing (NIPT), and the acceptance of SCA fetuses and pregnancy decision among them. Methods: Assemble basic information of 23 804 pregnant women who voluntarily came to Tianjin Women's and Children's Health Center for NIPT testing from December 2019 to February 2023, and conducted retrospective analysis for the interventional prenatal diagnosis and delivery of pregnant women with high risk of fetal SCA suggested by NIPT. Results: The positive rate of NIPT was 0.30% (72/23 730). Among the 72 pregnant women with high risk of fetal SCA detected by NIPT, only 44 cases (61.11%) underwent interventional prenatal diagnosis (all of whom underwent amniocentesis), then 25 cases were confirmed of SCA, with the total positive predictive value (PPV) of 56.82% (25/44). The overall PPV of NIPT for sex chromosomal trisomy syndrome was 95.45% (21/22), and the PPV for sex chromosomal monosomy syndrome was 13.64% (3/22), and the difference between the two groups was statistically significant ( χ²=29.700, P<0.001). Among the patients diagnosed with SCA, 13 cases chose to continue their pregnancies, and all of them had live births at term. The pregnancy termination rates varied for SCA of different subtypes following prenatal diagnosis (47, XXX 20%, 47, XXY 100%, 47, XYY 40%, 45, X 100%). 28 pregnant women who refused to undergo interventional prenatal diagnosis were followed up. 2 cases were lost to follow-up in the third trimester; 1 case of spontaneous abortion did not undergo relevant genetic testing; 1 case was induced due to fetal pleural effusion and omphalocele detected by ultrasound, and the fetus was induced without relevant testing. 24 full-term live births (one of them was followed up half a year after delivery: chromosomal karyotype analysis was performed due to genital problems, and 47, XXY was confirmed). Conclusions: Genetic counseling for high risk of fetal SCA should be comprehensive and cautious. For pregnant women diagnosed with fetal SCA who choose to continue their pregnancy and pregnant women who refuse prenatal diagnosis, comprehensive prenatal monitoring during pregnancy, as well as health management of fetal growth and development monitoring and intervention after delivery, should be provided.

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The Role of Pregnant Women's Educational School in Promoting Natural Delivery by Diversified Teaching Modes

XIE Wan-ying, QIU Xiao-yuan, YAO Jun-xue, CUI Hong-yan

2024, 51 (1): 37-41. doi: 10.12280/gjfckx.20230766

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Objective: To explore the effectiveness of diversified teaching modes in Pregnant Women's Educational School in promoting natural delivery. Methods: A retrospective study was conducted on primiparous pregnant women who were registered for prenatal examination and hospitalized for delivery at Tianjin Central Hospital of Gynecology Obstetrics from June to August 2023. Based on whether they had participated in the courses of Pregnant Women's Educational School, the participants were divided into experimental group (309 women) and control group (300 women). A questionnaire survey was conducted upon admission to compare the awareness of natural delivery knowledge and the willingness to undergo natural delivery between two groups. Analyze and compare the cesarean section rate, social factors cesarean section rate, incidence of pregnancy complications, application rate of labor analgesia, incidence rate of macrosomia and proportion of postpartum hemorrhage between two groups. Conduct a satisfaction survey on different teaching modes in the experimental group. Compare the number of learners attending each teaching modes in Pregnant Women's Educational School. Results: The awareness of natural delivery knowledge and the willingness to undergo natural delivery in the experimental group were higher than those in the control group, the differences were statistically significant (P<0.05). There was no significant difference in cesarean section rates between the two groups (P=0.051). However, compared to the control group, the experimental group had a lower rates of social factors cesarean section, lower incidence of pregnancy complications, macrosomia and postpartum hemorrhage, as well as a higher application rate of labor analgesia. The differences between two groups were statistically significant (all P<0.05). There was a statistically significant difference in the average number of learners among the five different teaching modes in the experimental group ( χ²=83.455, P<0.000 1). There were 596 students in each Recorded Course on average, higher than other teaching modes, followed by WeChat Video Account Live Course, 280 students in each course on average. There was a statistically significant difference in patient satisfaction of different teaching modes among the pregnant women who had participated in the courses of Pregnant Women's Educational School ( χ²=104.708, P<0.000 1), with 100% satisfaction of the WeChat Video Account Live Courses. Conclusions: The diversified teaching modes at Pregnant Women's Educational School can attract the attention of pregnant women, enhance their awareness of prenatal health care, reduce pregnancy complications and promote natural delivery. The WeChat Video Account Live Course has the characteristics of high satisfaction and wide audience, which is worth promoting.

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Advances in the Application of Engineered Exosomes in the Treatment of Drug Resistance in Gynecological Tumors

GUO Xin, ZHANG Jian-nan, GUO Nan, NING Wen-ting, SHANG Hai-xia

2024, 51 (1): 42-46. doi: 10.12280/gjfckx.20230767

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Gynecological malignant tumor is a serious threat to women's health, with high morbidity and mortality among various female diseases. The key reason lies in the inadequate curative effect of traditional chemotherapy on relapsed and drug-resistant patients. In recent years, to explore the mechanism of chemotherapy resistance of tumor cells and to develop new chemotherapy reversal agents has become a focus of gynecological cancer researchers. Exosomes are a kind of multivesicular bodies originated from the formation of intracellular lysosomal particle invaginations, with biological properties such as low immunogenicity, innate targeting and acquired targeting, and high delivery efficiency. Therefore, exosomes can be used as an ideal, natural nanocarriers for drug delivery, which can not only reduce tumor resistance to chemotherapy drugs, improving the therapeutic effect of drugs, but also reduce the toxic and side effects of chemotherapy drugs on the whole body. This review summarizes the research progress of exosomes as drug carriers in drug-resistant treatment of gynecological tumors in order to to providing assistance in the clinical treatment of gynecological tumors.

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Progress of Fluorescence Image-Guided Surgery in Gynecological Malignant Tumors

JIA Yan-feng, DANG Yun

2024, 51 (1): 47-51. doi: 10.12280/gjfckx.20230638

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Fluorescence image-guided surgery(FIGS) is a new technology in modern surgical practice, which uses near-infrared fluorescence(NIR) imaging agent to mediate the development of target tissue during surgery as a real-time, non-invasive and high-resolution diagnostic method to provide screen images for surgeons to achieve real-time intraoperative navigation. In gynecological malignant tumors, FIGS can be used to detect sentinel lymph nodes, perform lymphography, indicate tumor boundaries, detect tissue contamination and develop important blood vessels during surgery to evaluate blood supply. Due to the lack of targeting of NIR dye itself, targeted molecular probes combined with fluorescent dyes are being widely developed and used in clinical trials of gynecological malignant tumors. However, the high false positive rate is still the main problem hindering its clinical application. With the continuous development of new fluorescent dyes and imaging systems, FIGS may change the diagnosis and treatment strategy of gynecological malignant tumors and provide new treatment options for surgeons.

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Mechanisms of Resistance to PARP Inhibitor and Strategies to Improve Its Sensitivity in Epithelial Ovarian Cancer

ZHANG Wen-yang, WANG Xi-peng

2024, 51 (1): 52-59. doi: 10.12280/gjfckx.20230839

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The fatality rate of epithelial ovarian cancer (EOC) ranks first among malignant tumors of the female reproductive system. The traditional treatment approach for EOC involves cytoreductive surgery combined with platinum-based chemotherapy. However, within 2 years, approximately 70% of patients experience relapse or develop resistance. Poly (ADP-ribose) polymerase (PARP) inhibitors, as a novel molecular targeted drug, exert the "synthetic-lethal" effect on tumor cells with breast cancer-related gene (BRCA) mutations, offering a brand-new therapeutic model for EOC. PARP inhibitors have brought significant breakthroughs in targeted maintenance therapy for EOC. However, some patients still gradually fail to respond to PARP inhibitors, and the main resistance mechanisms include homologous recombination repair (HRR) recovery, drug target changes, and reduction of fatal DNA damage. Current strategies to improve its sensitivity include combining with DNA damage repair inhibitors, drugs that inhibit the HRR pathway, traditional anticancer regimens, P-glucoprotein (P-gp) inhibitors, and replacing alternative types of PARP inhibitors.

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Research Progress on the Diagnosis and Treatment of Abdominal Wall Endometriosis-Associated Clear Cell Carcinoma

ZHANG Wei-yue, YANG Jing, JI Jia-nan, LUO Cheng-yan

2024, 51 (1): 60-65. doi: 10.12280/gjfckx.20230712

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Abdominal wall endometriosis-associated clear cell carcinoma (AWECC) is characterized by low incidence, high invasiveness and poor prognosis. To date, there have been relatively few reports on AWECC. AWECC primarily originates from the malignant transformation of abdominal wall endometriosis (AWE). In recent years, there has been a rising incidence of AWECC, possibly attributed to the increased number of pelvic and abdominal surgeries, including cesarean section. Nevertheless, the mechanisms underlying its malignant transformation remain unclear. AWECC lacks specific clinical features, making it challenging to distinguish from benign AWE. The definitive diagnosis depends on histological examination. The treatment of AWECC primarily lies on the clinicians' personal experience, which varies greatly, and lacks corresponding guidelines. In clinical practice, surgical treatment with extended resection of the abdominal wall tumor, is typically employed. The efficacy of chemotherapy and radiotherapy in AWECC patients requires further investigation. Until now, most of the studies on AWECC have been case reports. Therefore, we reviewed the pathogenesis, diagnosis, treatment and prognosis of AWECC based on domestic and foreign literature, so as to arouse the attention of clinicians to the diagnosis of the disease and provide evidence for clinical diagnosis, treatment and follow-up.

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Selection of Surgical Methods and Quality of Life after Operation in 40-55 Years Old Patients with Uterine Fibroids

PENG Li-na, QIAN Lin-hua

2024, 51 (1): 66-69. doi: 10.12280/gjfckx.20230801

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Objective: To analyze the postoperative quality of life after myomectomy or hysterectomy (including total hysterectomy and subtotal hysterectomy) in patients with uterine fibroids aged 40 to 55 years, and to explore which surgical method can provide the best prognosis and the greatest benefit, in order to develop the best surgical program for this population. Methods: Collect clinical and follow-up data of 744 patients who underwent myomectomy or hysterectomy in the Women's Hospital, School of Medicine Zhejiang University, from January 2017 to December 2017, and compare the improvement in quality of life after operation under different surgical methods. Results: The 744 patients were divided into myomectomy group (439 cases) and hysterectomy group (305 cases). There were statistically significant differences between the two groups in age, menopause, clinical symptoms, duration of fibroid symptoms, number of fibroids, uterine size, and history of fibroid surgery (all P<0.05). In the myomectomy group, the rate of residual or recurrences was 69.25%. The myomectomy group showed greater improvement in daytime urination frequency, fatigue, mobility, self-care, usual activities, and EQ-5D-5L total quality of life score, compared to the hysterectomy group (all P<0.05). The sexual life satisfaction of the myomectomy group was higher than that of the hysterectomy group (91.47% vs. 68.20%, Z=-7.910, P<0.001), and the recommendation rate was also higher than that of the hysterectomy group (82.00% vs. 53.11%, χ²=75.826, P<0.001). Conclusions: The quality of life in the myomectomy group was higher than that in the hysterectomy group. For patients aged 40 to 55 who wish to preserve their uterus, if they are younger, have shorter conditions, have fewer symptoms, and have smaller uterus, myomectomy can be considered after informing them of the high risk of recurrence after surgery.

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Large Cell Neuroendocrine Carcinoma of Cervix Complicated with Syndrome of Inappropriate Secretion of Antidiuretic Hormone: A Case Report

ZHAO Ya-qin, WU Zhen-zhen, ZHENG Chang-cai, SUN Jian-hao, LIU Qing

2024, 51 (1): 70-73. doi: 10.12280/gjfckx.20230526

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Large cell neuroendocrine carcinoma (LCNEC) of cervix is a kind of cervical malignant tumor with endocrine function, which is one of the causes of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A case of pregnancy complicated with LCNEC of cervix was reported. Mild hyponatremia was found upon hospitalization. After termination of pregnancy by cesarean section, the patient underwent neoadjuvant chemotherapy. During the chemotherapy course, the patient developed severe hyponatremia accompanied by convulsions and unconsciousness, which was diagnosed as SIADH. After implementing rescue measures such as sedation, analgesia, sodium supplementation, potassium supplementation, cranial pressure reduction, and correction of acid-base imbalance, the patient's plasma sodium concentration returned to within normal range. Subsequently, the patient underwent 3 cycles of cisplatin combined with etoposide chemotherapy and concurrent chemoradiotherapy. Eventually, the tumor recurred, and the patient unable to tolerate anti-tumor therapy due to fourth-degree bone marrow suppression and poor physical condition, which led to eventual demise. Early recognition and diagnosis of SIADH are difficult, and improper diagnosis and treatment can lead to cognitive impairment, epilepsy, coma, osmotic demyelinating syndrome, etc., affecting the prognosis of patients.

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Endometrial Metastasis of Lung Adenocarcinoma with Abnormal Vaginal Bleeding as the First Symptom: A Case Report and Literature Review

CHEN Yan-xi, LIU Hui, JIANG Peng-cheng

2024, 51 (1): 74-77. doi: 10.12280/gjfckx.20230725

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Primary bronchial lung cancer, commonly known as lung cancer, is one of the malignant tumors with high morbidity and mortality in the world. In recent years, the incidence of lung cancer in women has increased, and most of them are lung adenocarcinoma. Because the early symptoms of lung cancer are occult, it is often detected when metastasis has already occurred. We report a case of endometrial metastasis of lung adenocarcinoma. The patient presented with abnormal vaginal bleeding, and the pathology after curettage indicated adenocarcinoma. After immunohistochemical examination and imaging examination were combined to exclude the possibility of tumor origin in other sites, the diagnosis was confirmed as lung adenocarcinoma metastasis to the endometrium. Metastasis of lung cancer to the endometrium is extremely rare and is likely to be missed or misdiagnosed. In this paper, the data of a case of endometrial metastasis of lung adenocarcinoma were retrospectively analyzed and the relevant literatures were reviewed in order to enhance the clinical vigilance of endometrial metastasis of lung adenocarcinoma.

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Advanced Epithelial Ovarian Cancer Misdiagnosed as Pelvic Tuberculosis: A Case Report

GAI Min-xue, WANG Hong-qing, WANG Yu-jia, LI Ling-ling, LI Chang-zhong

2024, 51 (1): 78-81. doi: 10.12280/gjfckx.20230505

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Pelvic tuberculosis is a form of female pelvic inflammation caused by Mycobacterium tuberculosis, which is a common cause of chronic pelvic inflammation and infertility. The characteristics of abdominal and pelvic blunt pain and abdominal distension caused by pelvic tuberculosis are similar to those of advanced epithelial ovarian cancer. And there are no specific clinical or imaging manifestations of extrapulmonary tuberculosis. The above reasons lead to pelvic peritoneal tuberculosis easily confused with peritoneal carcinoma and advanced epithelial ovarian cancer. In this paper, we analyzed a case of advanced epithelial ovarian cancer. Because no tumor cells were found in ovarian space lesion tissue puncture pathology and ascites exfoliative cytology, examination of tuberculosis was performed. The patient was misdiagnosed as pelvic tuberculosis based on positive tuberculin test and Mycobacterium tuberculosis interferon-γ, but later pathology confirmed the presence of epithelial ovarian cancer. We summarized the diagnosis and treatment process of this case in order to accumulate experiences for the clinical diagnosis and treatment of advanced epithelial ovarian cancer and pelvic tuberculosis.

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The Potential Application of Spatial Transcriptome Technology in the Research of Immune Microenvironment of Endometriosi

XU Ze-mei-hong, YANG Ru-yu, WU Qiong, LYU Yi, LIANG Yan-chun

2024, 51 (1): 82-86. doi: 10.12280/gjfckx.20230734

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Endometriosis is a common disease in women of childbearing age, and its pathogenesis has not yet been clarified. The disease has unique tumor-like characteristic, and the immune microenvironment, which consists of both cellular components (e.g., macrophages, natural killer cells, and T-lymphocytes) and non-cellular components, plays an important role in the development of ectopic lesions. Spatial transcriptome technology, as a new technology to study multiple cellular interactions and cellular spatial connectivity in recent years, can not only provides an overall view of the immune microenvironment, but also be used to explore the dynamic development and spatial specificity of immune cells in the microenvironment. Therefore, spatial transcriptome technology provides a new technique and new insights for in-depth investigation of the immune microenvironment in endometriosis.

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High Risk Factors and Pathogenesis of Cervical Incompetence

ZHAO Xue-qing, WANG Yong-qing

2024, 51 (1): 87-92. doi: 10.12280/gjfckx.20230483

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Cervical incompetence (CIC) is a disease caused by reduced cervical support, which can lead to recurrent miscarriage or premature birth, increasing the incidence of adverse outcomes in newborns. However, the etiology of CIC is currently unclear and there is no reliable method for identification and prediction. Risk factors for CIC include congenital or acquired cervical hypoplasia, body mass index (BMI), androgens level, anti-Müllerian hormone (AMH), relaxin and other endocrine hormones, as well as in vitro fertilization-embryo transfer (IVF-ET). The cause of CIC may involve gene mutations related to immune inflammation or collagen synthesis, as well as the role of endocrine hormones in cervical remodeling. At present, there is no good method for predicting CIC. There are some studies using ultrasound to measure cervical elasticity to achieve CIC prediction, and there are also studies establishing CIC prediction models, but their predictive value is limited. By reviewing research on the etiology of CIC, we aim to provide direction for future research.

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Effects of Vitamin E on the Health of Perimenopausal and Postmenopausal Women

LIU Xiang, AO Kai, GAO Yi-wei, WU Qiong, MU Yu-lan

2024, 51 (1): 93-98. doi: 10.12280/gjfckx.20230715

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With the increase of age, ovarian function gradually declines from the flourishing period, until the failure, women will gradually enter the old age from the reproductive period. This will not only affect the menstrual cycle and fertility, but also be accompanied by a series of physical and psychological changes, which can significantly impact daily life and work. Studies have found that the development of ovarian follicles and the occurrence and development of urogenital dysfunction, osteoporosis, neurocognitive dysfunction, cardiovascular diseases and other diseases before and after menopause may be closely related to oxidative stress. Vitamin E has antioxidant properties and the ability to stabilize cells, and has been proven to play an important role in the prevention and treatment of metabolic syndrome, osteoporosis, cardiovascular and cerebrovascular diseases, neurological disorder and other diseases. Moreover, it has been found that vitamin E also has estrogen-like effects to a certain extent. Therefore, vitamin E supplementation has potential benefits for the health of perimenopausal and postmenopausal women. This article comprehensively expounds the effects of vitamin E on ovarian follicle development and estrogen during perimenopause, and the preventive and therapeutic roles in menopause syndrome, so as to provide reference for considering vitamin E as an adjuvant or alternative therapy to improve the physical and mental health of perimenopause and postmenopausal women.

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SIRT2-Mediated Protein Deacetylation and Oocyte Senescence

JIN Qing-mei, HAN Qiao-song, LIANG Jing-nan, ZHOU Yue, SUN Zhen-gao, SONG Jing-yan

2024, 51 (1): 99-104. doi: 10.12280/gjfckx.20230739

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Female ovarian aging is much earlier than other organs of the body. With the age of human fertility delaying, the proportion of women experiencing infertility due to ovarian aging is increasing. Ovarian aging is a natural and physiological process characterized by a decline in the quantity and quality of oocytes. Recently, it was discovered that the silence information regulator 2 (SIRT2) mediated non-histone and histone deacetylation, which is involved in the process of oocyte cellular senescence. Age-related reduction of SIRT2 levels in mammalian follicles leads to meiosis defects, resulting in low-quality oocytes and affecting pregnancy outcomes. Ovarian aging is an inevitable natural and physiological process for senile infertile women. While human assisted reproductive technology has brought hope for infertile women at present, low-quality oocytes will also affect the outcome of assisted reproductive technology. In this paper, we will review the localization of SIRT2, its relationship with oocyte meiosis, and its primary role in it. In addition, SIRT2 mediates connexin 43 (Cx43), histone H4K16, α-tubulin, BUBR1, forkhead box O3a (FOXO3a), and other proteins deacetylation involved in the signaling pathway of meiosis, which provides a new idea for preventing oocyte aging.

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Evolution and Advances in Endometrial Sampling

LI Ying-tao, HUANG Xiao-wu

2024, 51 (1): 105-109. doi: 10.12280/gjfckx.20230697

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Endometrial lesions are common and prevalent gynecological diseases. Endometrial histopathology is the 'gold standard' for diagnosis, the traditional method of endometrial sampling is dilatation and curettage, which is a blind procedure that can causes missed diagnosis and severe pain. Other methods of endometrial sampling include endometrial tissue sampler, endometrial cytology sampler, microscale endometrial sampler and hysteroscopic-guided biopsy, etc. These various methods of endometrial sampling are commonly used to diagnose abnormal uterine bleeding or chronic endometritis, and some can be used for screening endometrial cancer. Endometrial tissue sampler and microscale endometrial sampler are suitable for screening lesions, but not for patients with focal lesions and atrophy endometrium. Endometrial cytology sampler is also used for screening lesions, especially for patients with atrophy endometrium, but cytology has no diagnostic value. Hysteroscopic-guided biopsy can diagnose focal lesions and is the 'gold standard' in endometrial sampling, but is not used for screening. The appropriate methods of endometrial sampling should be used for different kinds of condition.

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The Efficacy and Reproductive Outcome of Auto-Cross-Linked Hyaluronic Acid Gel for the Prevention of Recurrence of Mild to Moderate Intrauterine Adhesions

GUO Yan, XIA En-lan, XIAO Yu, HUANG Xiao-wu, LIU Yu-huan, YANG Ling-ling, LI Tian-zhao

2024, 51 (1): 110-113. doi: 10.12280/gjfckx.20230717

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Objective: To investigate the efficacy of auto-cross-linked hyaluronic acid (ACP) gel in preventing adhesion recurrence after transcervical resection adhesion (TCRA) in patients with mild to moderate intrauterine adhesion (IUA) and its effect on reproductive outcomes. Methods: 188 patients with mild to moderate IUA who underwent TCRA in Fuxing Hospital of Capital Medical University from May 2020 to March 2021 were collected, and the recurrence rate of postoperative IUA, American Fertility Association (AFS) score, menstrual improvement and reproductive outcomes were observed in a single-center prospective randomized controlled manner, and the efficacy of ACP gel in preventing recurrence of IUA and its effect on reproductive outcomes were analyzed. The study group (84 cases) was received intrauterine injection of ACP gel + balloon stent at the end of surgery, and the control group (87 cases) only received balloon stent at the end of surgery. Results: 171 cases underwent the second and third hysteroscopies at 4 and 8 weeks after surgery, respectively. The recurrence rate of IUA in the study group was slightly lower than that in the control group, but the difference was not statistically significant (20.2% vs. 23.0%, 9.5% vs. 11.5%, both P>0.05). There was no significant difference in AFS scores between the two groups (P>0.05). There was no significant difference in menstrual improvement between the two groups at 12 weeks after surgery (P=0.630). More than one year after TCRA operation, there was no significant difference in pregnancy rate and live birth rate between the two groups (both P>0.05). Conclusions: In patients with mild to moderate IUA, compared with balloon stent alone after TCRA, balloon stent combined with intrauterine injection of ACP gel did not reduce the recurrence rate and adhesion severity of IUA, nor could it promote the improvement of menstrual pattern and postoperative reproductive outcome.

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A Rare Case of Giant Cervical Polyp Protruding from the Vaginal Orifice and Literature Review

GENG Wei-hua, QI Bing, TONG Qing, LOU Jiao-ying

2024, 51 (1): 114-120. doi: 10.12280/gjfckx.20230622

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Giant cervical polyps are very rare in clinic, and only a few cases have been reported in the literature. The morphology of polyps varies, may present as malignant, and some cases occur in unmarried women without a history of sexual activity, which limits the accuracy of clinical diagnosis. While most cervical polyps are benign, there is a certain probability of malignant transformation, which should be differentiated from rare malignant lesions that manifest as cervical polyps. Hysteroscopic surgery is an important method for the treatment of this disease, and small hysteroscopy is particularly recommended for patients without sexual history. This paper reports a case of unmarried woman with huge excrescence of vaginal orifice, which was confirmed as cervical polyp by hysteroscopy and pathological examination, in order to enrich the understanding of giant cervical polyps and provide guidance for clinical diagnosis and therapy.

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