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    Research on Gynecological Malignancies: Review
    The Impact of the 2023 FIGO Staging Update of Endometrial Carcinoma on the Content of Pathological Diagnosis
    SI Jing-wen, YU Xiu-jie, SHEN Yan
    2024, 51 (3):  241-246.  doi: 10.12280/gjfckx.20240166
    Abstract ( 426 )   HTML ( 51 )   PDF (688KB) ( 136 )  

    Endometrial carcinoma is the most common malignancy of the female reproductive system. Recent years have witnessed pivotal developments in the diagnosis and treatment, including the quantitative assessment of lymphovascular space invasion, the ultrastaging of sentinel lymph nodes, and the molecular stratification of endometrial carcinoma, all progressively integrated into clinical practice. These new insights have been incorporated into the 2023 version of the staging system by the International Federation of Gynecology and Obstetrics (FIGO), heralding a new era of clinical adoption. The importance of precise pathological evaluation cannot be overstated, serving as a linchpin for prognosticating patient outcomes and steering the course of adjuvant therapies. Through the lens of the updated 2023 FIGO staging for endometrial carcinoma, this discourse aims to elevate the paradigm of pathological diagnosis, promoting a benchmark of standardization and precision for pathologists, thereby empowering clinicians with a deeper and more accurate application of the staging system.

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    The TCGA Molecular Classification and New Research Progress in the Treatment of Endometrial Carcinoma
    WU Xiao-li, LIU Kai-jiang
    2024, 51 (3):  247-252.  doi: 10.12280/gjfckx.20240142
    Abstract ( 271 )   HTML ( 37 )   PDF (604KB) ( 158 )  

    In 2013, the Cancer Genome Atlas (TCGA) research center completed the molecular classification endometrial carcinoma (EC), categorizing patients into POLE (DNA polymerase epsilon) mutation type, microsatellite instability-high (MSI-H) type, copy number low (CN-L) type, and copy number high (CN-H) type. Subsequently Western scholars refined this into the ProMisE and Trans-PORTEC classification to better suit clinical applications. Patients with POLE mutation EC have excellent prognosis and lower recurrence rate, allowing for a reduction in surgical scope and a deescalation of treatment. Patients with MSI-H or CN-H are still POLE mutant. MSI-H type patients have a high burden of tumor mutations and significant benefits from immunotherapy. CN-L type patients are the most common, with a prognosis second only to POLE mutant patients. These patients have a higher response rate to hormone therapy to preserve fertility. CN-H type patients have the worst prognosis, with invasive features and a high risk of recurrence. For these patients, postoperative supplementary treatment is necessary to avoid inadequate treatment. However, there are some studies have shown that targeted therapy is more effective for CN-H type patients. The TCGA molecular typing of EC has overcome the limitations of traditional pathological and histological classification for evaluating prognosis, providing new insights into the pathological characteristics, prognosis, clinical diagnosis and treatment decisions of EC.

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    Research Progress of Adoptive Cell Immunotherapy in Cervical Cancer
    ZHANG Lan-yue, SHEN Fu-jin
    2024, 51 (3):  253-257.  doi: 10.12280/gjfckx.20240124
    Abstract ( 264 )   HTML ( 25 )   PDF (543KB) ( 109 )  

    Cervical cancer is one of the most common malignant tumors among women. The 5-year survival rate of recurrent or metastatic cervical cancer is only 17% and the clinical treatment is very tricky. Programmed death-1(PD-1) monoclonal antibody has been used as a first-line treatment for recurrent or metastatic cervical cancer. However, the bottlenecks for PD-1 monoclonal antibody monotherapy are relatively lower objective response rate and higher drug resistance rate, which limits its clinical application. Recently, adoptive cell immunotherapy altered the landscape of cancer immunotherapy, which achieved antitumor effects by infusing antitumor cells back to the body. Currently, there are mainly three types of adoptive cell immunotherapy including tumor-infiltrating lymphocyte, T-cell receptor-engineered T cells and chimeric antigen receptor T-cell. Relative studies have demonstrated the significant value of adoptive cell immunotherapy on improvement of survival and prognosis for patients with advanced cervical cancer. The principles, biological characteristics, applications and limitations for adoptive cell immunotherapy are summarized in the review. Optimizing the productive technology and being combined with other oncological treatment may supply new ideas for cervical cancer immunotherapy.

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    Research on Gynecological Malignancies: Case Report
    A Case Report of Cervical Adenoid Cystic Carcinoma Combined with Basal Cell Carcinoma and Squamous Cell Carcinoma
    ZHANG Wen, WANG Xue-qian, SHI Yu-xiang, HUANG Zeng-fa, TIAN Xun
    2024, 51 (3):  258-262.  doi: 10.12280/gjfckx.20231022
    Abstract ( 242 )   HTML ( 28 )   PDF (10639KB) ( 104 )  

    Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor originating from salivary gland tissue. The occurrence of ACC in the cervix is even rarer, representing for only 1% of all cervical adenocarcinomas. It is highly invasive, has a poor prognosis, and lacks a standard treatment plan. This article reports the diagnosis and treatment of a patient with cervical ACC combined with basal cell carcinoma and squamous cell carcinoma. The patient, an elderly woman, was admitted to the hospital for a newly discovered mass at the vaginal opening accompanied by intermittent vaginal bleeding. The pathological biopsy results of the vaginal mass showed malignant tumors, consistent with ACC; she underwent laparoscopic pelvic lymph node dissection + total hysterectomy + high ovarian arteriovenous ligation (bilateral) + bilateral ovarian and fallopian tube resection + intestinal adhesion lysis + mesenteric neoplasm resection. Postoperative pathology showed cervix mixed cancer composed of ACC, adenoid basal cell carcinoma and squamous cell carcinoma, along with local non-specific spindle cell sarcomatoid stroma. She received two cycles of chemotherapy and one session of radiotherapy postoperatively; the patient recovered well after surgery, and no metastasis or recurrence was found in regular follow-up examinations until January 22, 2024.

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    Giant Angiomyofibroblastoma of the Vulva Misdiagnosed as Liposarcoma on Magnetic Resonance Imaging: A Case Report
    MA Hai-yan, ZHANG Yun-zhong, ZHENG Rong-fang, WANG Fu-rong, ZHANG Meng, GUO Yu-zhen
    2024, 51 (3):  263-266.  doi: 10.12280/gjfckx.20230979
    Abstract ( 246 )   HTML ( 13 )   PDF (4041KB) ( 119 )  

    Vulvar angiomyofibroblastoma (AMF) is a rare benign tumor that occurs in women of childbearing age, originating from the vulva or vagina. Liposarcoma typically occurs in the trunk and limbs of perimenopausal and postmenopausal women. We report a case where a large vulvar AMF was initially misdiagnosed as liposarcoma by magnetic resonance imaging (MRI). The patient who was admitted to the hospital because of the discovery of a vulvar mass for 3 years that had enlarged over one year, was diagnosed with liposarcoma via preoperative MRI. However, a preoperative biopsy revealed AMF. The patient underwent excision of vulvar mass and vulvovaginoplasty. Postoperative pathology confirmed the AMF diagnosis, with no recurrence observed during the postoperative follow up for 9 months. Clinicians should enhance the differential diagnosis of such condition and improve the diagnostic accuracy of AMF by combining preoperative histopathology and related imaging examinations, providing accurate clinical information for surgical guidance.

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    Vulvar Acantholytic Squamous Cell Carcinoma:A Case Report
    LIU Si-min, WEI Jia, WAN Yi, LI Yu-zi, YANG Yong-xiu
    2024, 51 (3):  267-270.  doi: 10.12280/gjfckx.20231082
    Abstract ( 236 )   HTML ( 25 )   PDF (2861KB) ( 104 )  

    Acantholytic squamous cell carcinoma (ASCC) is a rare histological variant of squamous cell carcinoma, with vulvar ASCC being an uncommon and atypical tissue variant characterized by acantholysis and unique morphological features. Its specific pathogenesis and etiology remain unclear. Given its low incidence, gynecologists generally lack understanding of it, raising the risk of misdiagnosis or missed diagnosis. We report the data of a 79-year-old patient with primary vulvar ASCC, who was admitted to our hospital due to self-reported vulvar pruritus for 5 years. Examination revealed an 8 cm×4 cm red and swollen ulcer on the left vulva with partial white change, and the pathological biopsy showed ASCC. Following 25 times of radical radiotherapy, close follow-up is recommended. And now three months post-radiotherapy, there is no evidence of tumor recurrence or metastasis. There are few research reports on vulvar ASCC both domestically and internationally. This article presents a case of vulvar ASCC in an elderly woman, analyzing its clinical characteristics, pathogenesis, pathogenic factors, differential diagnosis, treatment, and prognosis, in order to provide reference for the clinical diagnosis and treatment of ASCC.

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    A Case Report of Colon Aggressive Fibromatosis Misdiagnosed as Ovarian Tumor
    YANG Yi, LIU Hua
    2024, 51 (3):  271-273.  doi: 10.12280/gjfckx.20231101
    Abstract ( 234 )   HTML ( 23 )   PDF (1315KB) ( 107 )  

    Aggressive abdominal fibromatosis is a rare disease that is often misdiagnosed as carcinoma from ovarian or gastrointestinal due to untypical clinical signs and accessory examination symptoms. A retrospective study was conducted to analyze the diagnosis and treatment procedure of a women childbearing age who was misdiagnosed as ovarian tumor after color Doppler ultrasound examination due to huge abdominal and pelvic masses. Stromal tumor was considered according to the result of MRI. Exploration surgery was performed and the carcinoma deriving from transversum colon was identified. Doctors of anorectal department helped to remove the tumor completely. The postoperative histopathology and immunohistochemistry results suggested a aggressive fibromatosis disease of the colon. After more than 2 years′ follow-up, the patient recovered well and there is no signs of recurrence.

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    Gynecological Diseases & Related Research: Review
    Application and Progress of Adipose Derived Mesenchymal Stem Cell Exosomes in Gynecological Diseases
    SHI Li-juan, YU Xiao-chuan, WANG Hua-li
    2024, 51 (3):  274-278.  doi: 10.12280/gjfckx.20230908
    Abstract ( 215 )   HTML ( 17 )   PDF (544KB) ( 171 )  

    With the development of stem cell research, adipose derived mesenchymal stem cell (ADSC) and adipose derived mesenchymal stem cell exosome (ADSC-Exo) have become a hot research topic in the field of gynecology. ADSC, a type of adipose-derived mesenchymal stem cells, has high proliferative capacity and multidirectional differentiation potential like other mesenchymal stem cells. ADSC-Exo can deliver a variety of biologically active molecules, such as microRNAs, proteins, and cytokines through released extracellular vesicles to play a certain regulatory role in the target cells. The application of ADSC-Exo in gynecology has also received increasing attention. Some studies have shown that ADSC-Exo can promote endometrial regeneration and repair, bringing hope to patients with intrauterine adhesion and infertility. In addition, some studies mentioned that ADSC-Exo also has potential in the treatment of chronic endometritis, ovarian insufficiency, polycystic ovary syndrome and gynecological malignancies. This paper reviews the application and advancements of ADSC-Exo in gynecology.

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    Clinical Application of Stem Cell-Derived Exosomes in Gynecological Diseases
    GUO Shi-wei, SUN Jing-li, CHEN Zhen-yu, LIU Sen
    2024, 51 (3):  279-283.  doi: 10.12280/gjfckx.20230955
    Abstract ( 233 )   HTML ( 9 )   PDF (584KB) ( 124 )  

    Stem cell-derived exosomes (SC-Exo) are petite vesicles, released from stem cells. Exosomes originating from different cells or tissues play diverse roles in the pathogenesis and progression of diseases, and have made significant achievements and progress in various clinical fields. The application value of SC-Exo in gynecological diseases such as recurrent spontaneous abortion, polycystic ovary syndrome, premature ovarian insufficiency, intrauterine adhesions, wound repair in vaginal surgery, gynecological tumors and pelvic floor dysfunction is increasingly being recognized. SC-Exo can mediate the signaling and functional transfer of genetic information between targeted cells by releasing a variety of bioactive molecules such as nucleic acids, proteins, lipids and cytokines. It has potential benefits for the treatment of gynecological diseases and is a novel and promising therapeutic strategy.

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    Effect of Dienogest on the Volume of Endometriosis Lesions
    SUN Jia-fan, XU Wei, ZHU Shu, WANG Xiu-li
    2024, 51 (3):  284-289.  doi: 10.12280/gjfckx.20230960
    Abstract ( 245 )   HTML ( 16 )   PDF (710KB) ( 148 )  

    Endometriosis (EMs) is one of the leading causes of dysmenorrhea, chronic pelvic pain and infertility in women, and the long-term management of EMs should maximize the role of drug therapy. Progestogens are the first-line drugs for the treatment of EMs, among which dienogest has now been taken as the first choice of drug for long-term management of EMs. Dienogest not only effectively relieves EMs-associated pain and prevents postoperative recurrence, but also has been observed to reduced EMs lesion volume to some extent. For young patients with ovarian endometriotic cysts who have not yet given birth, patients with recurrent ovarian endometriotic cysts, and patients with deep-infiltrating endometriosis (DIE) who experience significant pain, dienogest can reduce the volume of lesions, delay or even avoid surgery. In this review, we provide an overview of dienogest′s impact on the volume of ovarian EMs and DIE, aiming to provide a basis for individualized nonsurgical treatment of EMs.

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    Application of 3D Printed Hydrogel Stents in Prevention and Treatment of Intrauterine Adhesion
    SHI Ming, SUN Ming-hui, YANG Wei-wei, HUANG Hui-hua, ZHANG Chang-lin, David YB Deng
    2024, 51 (3):  290-296.  doi: 10.12280/gjfckx.20231104
    Abstract ( 216 )   HTML ( 16 )   PDF (4256KB) ( 165 )  

    Intrauterine adhesion (IUA) often leads to amenorrhea, infertility, and recurrent miscarriage, seriously affecting the physical and mental health of women. Clinically, surgical separation is the main treatment for IUA, but this approach frequently results in postoperative recurrence and has poor treatment efficacy. 3D bioprinted scaffolds have emerged as a cutting-edge approach in the treatment of IUA, capable of separating damaged areas to prevent adhesion formation and undergoing controllable in vivo degradation without the need for surgical removal. These scaffolds can be used for drug loading, stem cell transplantation, and exosome delivery, enabling the release of drugs or growth factors to the injured area to promote tissue repair and regeneration. Transplanting 3D bioprinted hydrogels loaded with stem cells or stem cell-derived exosomes to the damaged area can effectively promote the repair of IUA and improve pregnancy rates. 3D bioprinting can provide personalized treatment plans for patients, and the combined treatment strategy with stem cells or stem cell-derived exosomes holds promise as a powerful tool for treating IUA.

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    Gynecological Disease & Related Research: Original Article
    Learning Curve of Laparoscope Radical Adenomyosis Resection by Temporary Uterine Artery Blocking
    REN Yi-wen, LI Yong, LI Fei-yan, ZHU Cong-xin
    2024, 51 (3):  297-301.  doi: 10.12280/gjfckx.20240105
    Abstract ( 214 )   HTML ( 17 )   PDF (1057KB) ( 101 )  

    Objective: To investigate the learning curve of radical adenomyosis resection by temporary uterine artery blocking via laparoscopy. Methods: Retrospectively analysis on the clinical data of 151 patients who underwent laparoscopic radical adenomyosis resection by temporarily uterine artery blocking from December 2015 to August 2023 in Changzhou Maternal and Child Health Hospital was conducted. The learning curve was drawn by cumulative sum analysis (CUSUM), and the whole process was divided into improvement stage (47 cases) and proficiency stage (104 cases) based on the cut-off point of the curve. Clinical data and surgical results were analyzed. Results: The fitting curve equation for the surgical time series was ?=-27.17ln(x)+330.74(x=cases number) based on the patients′ operation time and surgery cases number. The optimal fitting curve equation for CUSUM curve was ?=-0.005x3-1.387x2+98.643x-253.571 (x=cases number, the optimal fitting coefficient R2=0.931, P<0.05), when the cumulative number of cases reached to 48, requirement for proficiency stage will be achieved. The operation time [(263.72±38.07) min vs. (201.65±48.03) min, P<0.001], persistent postoperative fever rate (40.43% vs. 22.12%, P=0.020) and body temperature [38.0 (37.8, 38.1) ℃ vs. 37.7 (37.5, 38.0) ℃, P=0.002] were higher for patients in improvement stage than those in proficiency stage. There was no significant difference of postoperative hemoglobin level and the difference of hemoglobin before and after operation between the two stages (P>0.05). Conclusions: Intraoperative blood loss was controlled effectively by temporary uterine artery blocking. The surgeon needs to complete approximately 48 laparoscopic surgery cases for radical adenomyosis resection via temporary uterine artery blocking before technical proficiency was achieved and sustained surgical skill was required for reduction of infection risk.

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    Clinical Analysis of 84 Cases of Cervical Endometriosis
    XU Qian, DUAN Hua, WANG Sha, AN Yuan-yuan
    2024, 51 (3):  302-305.  doi: 10.12280/gjfckx.20240146
    Abstract ( 252 )   HTML ( 27 )   PDF (529KB) ( 98 )  

    Objective: To investigate the clinical features, treatment and prognosis of cervical endometriosis. Methods: The clinical data of 84 cases diagnosed with cervical endometriosis by histopathology from January 2009 to January 2021 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively, analyzing their clinical characteristics, imaging, intraoperative performance, pathological features and prognosis. Results: ①Among 84 patients, 73 (86.9%) were clinically asymptomatic, 1(1.2%) had dysmenorrhoea, 1(1.2%) had contact bleeding and 1(1.2%) had intermittent hyperthermia, and 8 (9.5%) had irregular uterine bleeding, of which 6 patients had intermittent or continuous few episodes of vaginal bleeding, 1 patient had postmenopausal vaginal bleeding, and one patient had massive vaginal bleeding. ②Preoperative pelvic ultrasound examination revealed cervical abnormal echoes in 19 cases (22.6%), and cervical haemorrhagic cystic lesions was found in only 3 of the 11 patients who underwent MRI. ③Localized purple-blue lesions in the cervix were seen in 14 cases, cervical cysts were seen in 12 cases and no obvious endometriosis lesions were seen in 58 cases, all patients were diagnosed with endometriotic lesions of the cervix on postoperative pathology. 17 patients were complicated with gynecological malignant tumors, and 17 patients were complicated with cervical intraepithelial neoplasia. 84 patients, with a follow-up period of 36-180 months, had no recurrence. Conclusions: The incidence of cervical endometriosis is insidious, most of which have no clinical symptoms. It can cause infection, a lot of vaginal bleeding and other symptoms. Because it can become malignant or coexist with gynecological malignant diseases, it needs clinical attention.

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    Obstetrics Physiology & Obstetrics Disease: Review
    Current Situation and Prospect of Pregnancy Management of Nausea and Vomiting in Pregnancy
    MA Li-na, QI Hai-ning, XING Jian-hong, LIU Mei, SONG Qin-wen, LIU Yang, QIN Ying, WU Xiao-ke
    2024, 51 (3):  306-311.  doi: 10.12280/gjfckx.20231063
    Abstract ( 266 )   HTML ( 17 )   PDF (754KB) ( 123 )  

    Nausea and vomiting of pregnancy (NVP) is one of the most common symptoms of pregnancy, severe and persistent NVP can progress to hyperemesis gravidarum (HG), affecting both the mother and fetus to varying degrees. Severe cases lead to the termination of pregnancy. At present, the pathogenesis of NVP is not clear, but it is generally believed that it is closely related to genetic, endocrine and infection factors. Therefore, the current clinical management of NVP during pregnancy mainly focuses on symptomatic treatment, prevention and treatment of serious complications, while minimizing adverse effects on the mother and fetus, including non-drug treatment, antiemetic drug treatment and routine rehydration treatment. Non-pharmacological treatments include adjustments to lifestyle and diet, as well as advising women not to take iron supplements or iron-containing vitamins during the first three months of pregnancy. Common antiemesis drugs include vitamin B6 or combined doxylamine, metoclopramide, ondansetron, promethazine, glucocorticoids, etc.

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    The Prevention and Prediction of Pre-Eclampsia: Recent Advances and the Way Forward
    WU Zhi-wei, LIN Xue-yan, ZHANG Xue-qin, YANG Mei-lin
    2024, 51 (3):  312-316.  doi: 10.12280/gjfckx.20240134
    Abstract ( 270 )   HTML ( 14 )   PDF (561KB) ( 111 )  

    Pre-eclampsia is a leading cause of maternal and newborn mortality worldwide, impacting long-term health outcomes for both mother and child. We describe and analyze the limitations and controversies related to using aspirin for pre-eclampsia prevention, and explore the involvement of other medications in preventative strategies. Furthermore, this article examines the pre-eclampsia prediction scheme for both singleton and twin pregnancies, emphasizing the importance of tertiary referral systems in the prevention and treatment of pre-eclampsia, aiming to further promoting high-quality pre-eclampsia prevention and treatment and improve maternal and child health in China.

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    Impact of Cervical Conization on Fertility and Pregnancy Outcomes and Improve Measures
    SU Rui-rui, WU Xiao-hong
    2024, 51 (3):  317-321.  doi: 10.12280/gjfckx.20240150
    Abstract ( 263 )   HTML ( 19 )   PDF (573KB) ( 153 )  

    Cervical cancer is the most common gynecological malignancy in women. With the widespread adoption of tertiary prevention and screening, the incidence of cervical cancer has been gradually decreasing, while the detection rate of cervical intraepithelial neoplasia (CIN) in women of reproductive age has been gradually increasing. Cervical conization is an important method for the diagnosis and treatment of CIN, of which cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP) are commonly used. In recent years, several studies have shown that cervical conization does not significantly affect fertility, but is associated with the occurrence of some adverse pregnancy outcomes, such as preterm delivery, premature rupture of membranes, and cesarean section. The risk of adverse pregnancy outcomes is associated with the conization procedure, the extent of resection, and the postoperative pregnancy interval. The incidence of postoperative adverse pregnancy outcomes increased with the increase in the extent of conization. The efficacy of LEEP and CKC in the treatment of CIN was comparable, but the postoperative pregnancy outcomes of LEEP were better than those of CKC. To reduce the incidence of adverse pregnancy outcomes and decrease the recurrence rate of the lesions, postoperative contraception can be extended, pregnancy monitoring can be strengthened, and if necessary, cervical cerclage and human papilloma virus (HPV) vaccine can be performed.

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    Obstetric Physiology & Obstetric Disease: Original Article
    RNA Sequencing of Villus Tissue Reveals Differentially Expressed Genes in Unexplained Recurrent Spontaneous Abortion
    YANG Li, YANG Jing, Yeerdengqieqieke , HAN Rui, LA Xiao-lin
    2024, 51 (3):  322-328.  doi: 10.12280/gjfckx.20230584
    Abstract ( 241 )   HTML ( 14 )   PDF (9478KB) ( 278 )  

    Objective: To discover the differentially expressed genes (DEGs) in villus tissue of patients with unexplained recurrent spontaneous abortion (URSA) and to analyze their functions, aiming to elucidate the mechanisms behind the onset and progression of URSA. Methods: Villus tissue samples were collected from four URSA patients and four elective termination of pregnancy(ETP) at Department of Gynecology Outpatient of the First Affiliated Hospital of Xinjiang Medical University in March 2022. RNA-seq was employed to screen for DEGs between the two groups, followed by Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses to identify the biological functions and pathways of the identified DEGs. A protein-protein interaction (PPI) network was constructed using the STRING database, and screen out the key genes of URSA. Results: RNA-seq analysis identified a total of 3 350 DEGs, of which 2 259 were upregulated genes and 1 091 were downregulated genes in the URSA group. Through PPI network analysis, the top 10 key genes related to URSA were identified, including TYROBP, CD74, GH1, GH2, STAT5A, HLA-DRA, STAT5B, HLA-DRB1, CISH, and HLA-A. Through GO and KEGG biological functional analysis, it was found that differentially expressed mRNA is involved in various immune response pathways related to white blood cell differentiation and allogeneic immune responses. Conclusions: This study utilized transcriptome sequencing technology to obtain the mRNA differential expression profile of URSA, and screened for key genes and biological pathways that may be related to URSA. Our data provide a theoretical basis for elucidating the pathogenesis and diagnostic and therapeutic targests of URSA.

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    A Qualitative Interview was Conducted to Assess the Ability of Different Medical Institutions to Treat Severe Postpartum Hemorrhage
    JIA Yan-ju, WANG Meng, CUI Hong-yan, CHEN Xu
    2024, 51 (3):  329-335.  doi: 10.12280/gjfckx.20230994
    Abstract ( 236 )   HTML ( 12 )   PDF (1941KB) ( 102 )  

    Objective: To explore the evaluation indexes of the ability of medical institutions to treat severe postpartum hemorrhage, it provides the basis and suggestions for the establishment of the evaluation system of the rescue ability of different medical institutions, the standardization of the rescue process and the improvement of the graded diagnosis and treatment referral. Methods: From February 2022 to November 2022, 65 health care workers from 35 primary hospitals and 30 tertiary hospitals were selected by purposive sampling to participate in semi-structured interviews regarding their ability to manage severe postpartum hemorrhage. Based on the grounded theory, the concept categories and core themes were analyzed by qualitative analysis software Nvivo11, and the existing problems in the treatment of severe postpartum hemorrhage in different medical institutions were summarized. Results: 44 initial concepts, 21 sub-concepts and 4 core themes related to the ability to treat severe postpartum hemorrhage were analyzed, the evaluation index pool of the ability to treat severe postpartum hemorrhage in different levels of medical institutions was constructed around 4 core themes. There are some problems in medical institutions in treating severe postpartum hemorrhage, such as lack of facilities, equipment and drugs, unqualified personnel, unskilled treatment technique and irregular treatment procedure. Conclusions: The ability of medical institutions to treat severe postpartum hemorrhage is uneven and there is no uniform evaluation standard, in order to improve the ability to treat severe postpartum hemorrhage, this study initially formed the evaluation index pool of rescue ability, and suggested that hospitals at all levels should further standardize the rescue process and perfect the grading diagnosis and treatment and referral system.

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    Comparison of Clinical and Pathological Features in Pregnant and Non-Pregnant Patients with Adnexal Torsion
    SHAO Hui, GUO Xiao-yue, ZHANG Hua, ZHAO Yang-yu
    2024, 51 (3):  336-341.  doi: 10.12280/gjfckx.20230956
    Abstract ( 258 )   HTML ( 16 )   PDF (646KB) ( 99 )  

    Objective: To investigate the clinical and pathological differences between pregnant and non-pregnant women with adnexal torsion (AT). Methods: A retrospective analysis was conducted on the clinical data of 376 AT patients who were hospitalized in the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2017 to November 2023, including 72 pregnant women with AT and 304 non-pregnant women with AT. Based on gestational weeks, pregnant women with AT were divided into the first trimester group (≤14 weeks) with 47 cases and the second and third trimester group (>14 weeks) with 25 cases. A comparative analysis of the clinical data between these groups was performed. Results: ① The proportion of vomiting, abdominal pain time <24 hours, persistent abdominal pain, the count of white blood cell and the percentage of neutrophil in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P<0.05). ② The rates of laparotomy, conservative surgery and postoperative pathology of luteal cyst in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P<0.05). The diameter of adnexal mass, the proportion of mature teratoma, mucinous cystadenoma and endometriosis cyst by postoperative pathology in pregnant women with AT were significantly lower than those in non-pregnant women with AT (P<0.05). ③ Compared to the second and third trimester AT group, in the first trimester AT group, the proportion of assisted reproductive technology, laparoscopic surgery and conservative surgery, and the diameter of adnexal mass were higher, the proportion of pathological cysts and the degree of torsion were significantly lower(P<0.05). Conclusions: The presence of symptoms such as lower abdominal pain, nausea and vomiting during pregnancy necessitates consideration of AT, especially in early pregnancy or following assisted reproductive technology, the pathology is often corpus luteum cysts. The treatment of AT during pregnancy, whether laparoscopic or open surgery, is safe and reliable, without adversely impacting pregnancy outcomes.

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    The Study of MiRNA Expression Profile in Prenatal Diagnosis of Fetal Congenital Heart Disease
    YANG Wei-wei, REN Chen-chun, CHANG Ying, WANG Wen-jing, JU Ming-yan, YAO Li-ying, ZHAO Xiao-min, ZHAO Dan-yang
    2024, 51 (3):  342-345.  doi: 10.12280/gjfckx.20230802
    Abstract ( 243 )   HTML ( 11 )   PDF (1311KB) ( 131 )  

    Objectives: To explore the application of microRNA (miRNA) expression profile in prenatal diagnosis of fetal congenital heart disease (CHD). Methods: 30 pregnant women diagnosed with CHD by ultrasound (case group) and 10 pregnant women who required amniocentesis (control group) were collected from January 2021 to December 2022 at Tianjin Central Hospital of Gynecology Obstetrics. The amniotic fluid supernatant of the two groups of pregnant women was sequenced by Illumina sequencing platform. All miRNAs of the two groups of pregnant women were normalized and the differentially expressed miRNAs were analyzed. The miRNA with P<0.05 and |log2 FC|>3(Fold Change, FC) were selected from the differentially expressed miRNAs for further validation by real time fluorescence quantitative polymerase chain reaction (RT-qPCR) in amniotic fluid and peripheral blood. The difference between miRNA sequencing and RT-qPCR in amniotic fluid was compared, and the miRNAs with consistent expression regulation direction in peripheral blood and amniotic fluid were selected. Results: A total of 138 differentially expressed miRNAs were found, of which 85 were up-regulated and 53 were down-regulated. Further, 15 differentially expressed miRNAs were selected, and the results of miRNA sequencing in amniotic fluid were consistent with those of RT-qPCR. There were two miRNAs with the same expression and regulation direction in peripheral blood and amniotic fluid, which were miR-222-3p and miR-189-5p, respectively. The expression of these two miRNAs in maternal blood of the case group was significantly higher than that of the control group, and the difference was statistically significant (all P<0.05). Conclusions: As a new serological marker, miRNA in maternal blood can be preliminarily applied to the screening of fetal CHD.

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    Obstetric Physiology & Obstetric Disease: Case Report
    Two Cases of Triplet Pregnancy with Cervical Incompetence Treated by Cervical Cerclage
    HUANG Qian, ZHENG Jiang-li, YING Xiao-yan
    2024, 51 (3):  346-349.  doi: 10.12280/gjfckx.20231064
    Abstract ( 267 )   HTML ( 15 )   PDF (1890KB) ( 134 )  

    Perinatal complications and comorbidities are significantly more common in triplets pregnancies than in single and twin pregnancies, the most significant of which are preterm and preterm birth morbidity and mortality. The risk of miscarriage or preterm birth increases if triplet pregnancies are combined with cervical incompetence. The paper reports two cases of dichorionic triamniotic triplet pregnancies conceived by assisted reproductive technology complicated with cervical incompetence. One case underwent preconception laparoscopic cervical cerclage, and the other underwent transvaginal cervical cerclage at 15+5 weeks of gestation. Regular vaginal ultrasound monitoring of cervical length and timely treatment to prevent premature birth were peformed during pregnancy. Three live babies were delivered by cesarean section at 33+2 weeks and 33+3 weeks respectively. Cervical cerclage is a reliable treatment option, especially for those opting against fetal reduction. Regular follow-up is very important for preventing premature birth, guiding clinical medication, timely removal of cervical cerclage and improving the prognosis of mother and child.

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    A Case of Incarceration of the Gravid Uterus in Late Trimester of Pregnancy
    ZHANG Ya-nan, ZHAO Feng, JIANG Hong
    2024, 51 (3):  350-353.  doi: 10.12280/gjfckx.20231112
    Abstract ( 291 )   HTML ( 31 )   PDF (5356KB) ( 107 )  

    Incarceration of the gravid uterus (IGU) is a rare and serious pregnancy complication, without specific clinical manifestations. IGU can causes distortion of the pelvic structures, and can be easily misdiagnosed as placenta previa during late-pregnancy ultrasound examination. Inadequate diagnosis and treatment of this disease can lead to adverse pregnancy outcomes such as spontaneous abortion, preterm labor, and uterine rupture. This paper retrospectively analyzes a late-pregnancy case of IGU. The case had no specific clinical presentation and was detected during a routine prenatal ultrasound performed in late trimester of pregnancy. The patient underwent a cesarean section at 36 weeks of gestation, and intraoperative exploration and postoperative pathology clarified that IGU was caused by adhesions between an adenomyoma at the base of the uterus and surrounding tissues, restricting the expansion of the uterine fundus as pregnancy progressed. In this case, the mother and baby had favorable outcomes. This paper summarizes the risk factors, clinical presentation, imaging manifestations, and treatment experience of IGU, in order to improve clinicians′ understanding of the disease, reduce misdiagnosis and missed diagnosis of IGU, and improve pregnancy outcomes.

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    Multiple Malformations in A Fetus with 6q14.1q16.3 Deletion
    HUANG Fen-fang, HUANG Yan-hua, HU Xue-mei, LIANG Pei
    2024, 51 (3):  354-356.  doi: 10.12280/gjfckx.20230875
    Abstract ( 250 )   HTML ( 18 )   PDF (2298KB) ( 120 )  

    Deletion of the proximal long arm of chromosome 6 is a rare chromosomal disorder, which is typically characterized by intellectual disability, developmental delay and abnormal facial features. The genetic etiology of a case of multiple malformation fetus was reviewed. The patient underwent amniocentesis at the 21+1 week of gestation, following findings of multiple fetal malformations indicated by ultrasound and high risk of fetal chromosome 6 abnormality indicated by noninvasive prenatal testing (NIPT). Routine G-banding chromosome karyotype analysis and copy number variation sequencing (CNV-seq) were performed. At the same time, the chromosome karyotypes of the parents were detected. Routine G-banding chromosome karyotype analysis of amniotic fluid showed 46,XX,del(6)(q14q16); CNV-seq results of amniotic fluid showed 23.68 Mb deletion in 6q14.1q16.3(80960000-104640000) region. Combining the above results, it is considered that the deletion is the cause of multiple fetal malformations. CNV-seq proves valuable in identifying the break point of fetal chromosome abnormalities, providing a basis for predicting the risk of fetal malformation and subsequent genetic counseling and enriching the prenatal clinical manifestations of 6q deletion.

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    Intrauterine Treatment of Fetal Hydrothorax Combined with Hydrops Complicating Mirror Syndrome:A Case Report
    ZHANG Chun-shuang, DONG Xiao-zhen, ZHOU Chang-rong, WANG Yi-shan, LI He-zhou
    2024, 51 (3):  357-360.  doi: 10.12280/gjfckx.20230980
    Abstract ( 237 )   HTML ( 17 )   PDF (532KB) ( 103 )  

    Fetal hydrothorax combined with hydrops complicating mirror syndrome is a rare obstetric pathological condition. Its pathogenesis is not clear at present. The prognosis is often poor when the symptoms are poorly controlled, even endangering both of the mother and child. There are few reports on this condition domestically and internationally, and there is no clinical guidelines for this disease. We report a case of a pregnant woman with massive fetal hydrothorax combined with hydrops complicating mirror syndrome who underwent thoraco-amniotic shunting. This procedure successfully prolonged the gestational week, improving the perinatal prognosis. This case report and the review of related literature can improve clinicians′ understanding of fetal hydrops complicated by mirror syndrome. With the development of mirror syndrome, pregnant women may be complicated by preeclampsia, requiring vigilant clinical monitoring. Clinicians can improve the condition of fetal hydrops through intrauterine treatment, appropriately prolong the gestational week, and improve the prognosis of perinatal infants, and at the same time, choose hospitals with the capability of critical care for termination of pregnancy.

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