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    Research on Gynecological Malignancies: Review
    Research Progress on the Mechanism of Tumor Resistance in Polyploid Giant Cancer Cells
    DING Yi-ling, LU Di, SONG Dian-rong
    2024, 51 (4):  361-365.  doi: 10.12280/gjfckx.20240393
    Abstract ( 278 )   HTML ( 90 )   PDF (731KB) ( 74 )  

    Chemotherapy is a commonly used method for tumor treatment, which has a positive effect in the early stage of tumor treatment. However, as the chemotherapy course increases, the sensitivity of tumor cells to chemotherapy drugs gradually weakens, leading to chemotherapy resistance. Tumor drug resistance is a complex process mediated by multiple factors, which is currently believed to be related to tumor cell stemness, heterogeneity, tumor immune microenvironment, and increased chemotherapy drug transport and efflux. But the specific mechanism is not yet clear. Polyploid giant cancer cells(PGCCs) are a special subset of tumor cells with increased volume and abundant nuclei. Research has found that PGCC generally exist in colorectal cancer, breast cancer, ovarian cancer and other tumors, and were closely related to the occurrence, metastasis, drug resistance and recurrence of tumors. This paper describes the formation and significance of the research progress of PGCC in tumors, and expounds the possible mechanism of PGCC causing drug resistance from the perspective of its special mechanism, autophagy, aging and DNA repair, so as to provide a possible strategy for improving tumor drug resistance.

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    Advances in Methylation Detection for Ovarian Cancer Screening and Diagnosis
    SU Hai-qi, LI Lei
    2024, 51 (4):  366-369.  doi: 10.12280/gjfckx.20240167
    Abstract ( 271 )   HTML ( 37 )   PDF (686KB) ( 54 )  

    Ovarian cancer has the highest mortality rate and poorest prognosis in gynecologic cancers. Presently, there is a lack of effective tools for early diagnosis and early screening for ovarian cancer. Methylation plays a key role in the origin and progression of ovarian cancer. Based on liquid biopsy technique, several studies had been conducted to analyze the efficacy of cell-free DNA methylation detection in diagnosing ovarian cancer. The overall median accuracy of cell-free DNA methylation reached 85%, which is superior to traditional protein molecular markers such as CA125. The findings from methylation detection in ovarian cancer tissue were also closely related to patients' survival outcomes and drug sensitivity. The advances and improvement of methylation assays for ovarian cancer hold promise for providing novel direction and opportunities in exploring molecular strategies for diagnosing and treating.

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    Research Advances of Exosomes in Angiogenesis of Ovarian Cancer
    ZHANG Jing-yi, LIU Dong-zhe, CHEN Xiu-hui
    2024, 51 (4):  370-374.  doi: 10.12280/gjfckx.20240329
    Abstract ( 247 )   HTML ( 37 )   PDF (743KB) ( 61 )  

    In the treatment of ovarian cancer, tumor cells often become resistant to chemotherapy drugs, leading to weakened or ineffective treatment outcomes. Therefore, anti-angiogenesis therapy serves as an important adjunctive treatment, can effectively slow disease progression by synergizing with other treatment modalities through various mechanisms. Exosomes, extracellular vesicles secreted by living cells, carry a variety of genetic materials and play crucial roles in cell communication within the tumor microenvironment. Studies have shown that exosomes derived from tumor cells and other cell sources can influence angiogenesis and other tumor-related processes by releasing non-coding RNAs, proteins, and other genetic materials. Utilizing exosomes to target specific proteins or as exogenous carriers for encapsulate therapeutic agents has become an important strategy for anti-angiogenesis therapy in ovarian cancer. This review summarized the regulatory mechanism of exosomes on angiogenesis in ovarian cancer and it also explores the potential of exosomes as anti-angiogenic agents, providing a theoretical basis for new treatment methods.

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    The Role and Treatment of Mitochondria in Endometrial Carcinoma
    ZHANG Yi-tian, LI Xiao-li
    2024, 51 (4):  375-379.  doi: 10.12280/gjfckx.20240245
    Abstract ( 361 )   HTML ( 35 )   PDF (701KB) ( 49 )  

    Mitochondria are dynamic, semi-autonomous organelles widely found in mammalian cells and play an important role in maintaining normal endometrial cell homeostasis. Endometrial carcinoma is a common malignant tumor in women, and its age of onset is showing a trend towards younger age, so improving the ability to treat endometrial carcinoma is important to improve its prognosis. Recent studies have shown that abnormal mitochondrial biosynthesis process, dysregulation of mitochondrial dynamics, and mitochondrial dysfunction are closely related to the occurrence and development of endometrial carcinoma. Mitochondria also show great potential in endometrial carcinoma treatment, such as induction of apoptosis and targeting of mitochondria-associated endometrial carcinoma stem cells.Deeply understanding of the role of mitochondria in the pathogenesis of endometrial carcinoma will provide new perspectives for endometrial carcinoma treatment.

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    Research on Gynecological Malignancies: Case Report
    A Case Report of Primary Ovarian Carcinoid with Liver Metastases
    ZHANG Ting-ting, YU Ping-yuan, CHEN Xi, ZHENG Duo, YANG Yong-xiu
    2024, 51 (4):  380-383.  doi: 10.12280/gjfckx.20240154
    Abstract ( 257 )   HTML ( 52 )   PDF (667KB) ( 39 )  

    Primary ovarian carcinoid tumor is a rare neuroendocrine tumor with no specific manifestations in most patients, and the diagnosis mainly relies on histopathological examination. A case of primary ovarian atypical carcinoid tumor was reported. The patient was admitted to the clinic on the basis of an increase in abdominal circumference for 2 years and discovery of a huge pelvic mass on the third day of treatment, and the pelvic magnetic resonance imaging (MRI) showed a huge cystic solid abnormally enhancing mass in the abdomen and pelvis cavities, and abnormally reinforcing nodules in the liver and right retroperitoneum as well as a soft tissue mass, so she was treated with a comprehensive staging operation for malignant tumor of the ovary and a biopsy of the surface of liver, and was diagnosed as ovarian atypical carcinoid tumor at stage Ⅳ(G2T3cN1bM1b ) based on the results of the postoperative examination combined with liver metastasis and retroperitoneal metastasis, 6 cycles of postoperative chemotherapy, recurrence more than 1 year after surgery. With the discussion of this case and review of related literature, the clinical features, histopathological manifestations, diagnosis, treatment and prognosis of primary ovarian carcinoid tumor are summarized, aiming to improve the clinicians' understanding of primary ovarian carcinoid tumor, and to provide reference for the clinical diagnosis and treatment of this kind of disease.

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    Malignant Transformation of Mature Cystic Teratoma of Ovary: A Case Report
    JI An-xuan, ZHAO Shu-hua
    2024, 51 (4):  384-387.  doi: 10.12280/gjfckx.20240004
    Abstract ( 248 )   HTML ( 46 )   PDF (3109KB) ( 45 )  

    Mature cystic teratoma of ovary (MCTO) is the most common ovarian germ cell tumor, which is usually benign. However, in rare cases, it may undergo malignant transformation. Malignant transformation of MCTO (MT-MCTO) is common in postmenopausal women. Due to its rarity, there is still no standard diagnosis and therapeutic options. This paper reports the diagnosis and treatment of a 77-year-old patient with MT-MCTO to squamous cell carcinoma at stage ⅡB. After cytoreductive surgery, the patient received a course of chemotherapy with bleomycin+etoposide +cisplatin. However, because the patient's physical condition could not tolerate further treatment, the patient died after six months of postoperative follow-up.

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    Broad Ligament Endometrioid Carcinoma: A Case Report
    YAN Hai-yan, YIN Qing-qing, WANG Mei, ZHANG Ai, YE Wen-feng, LI Tian-tian
    2024, 51 (4):  388-391.  doi: 10.12280/gjfckx.20240159
    Abstract ( 266 )   HTML ( 56 )   PDF (13258KB) ( 55 )  

    Endometrioid carcinoma of the broad ligament is a rare malignant tumor in a specific site. Due to its low incidence rate, the mechanism, diagnosis and treatment have not been clarified. The clinical manifestations lack specificity and it is often misdiagnosed as uterine or ovarian tumors before surgery. Therefore, this paper reports the diagnosis and treatment of a 65-year-old patient with broad ligament endometrioid carcinoma. Preoperatively, the patient was misdiagnosed as an ovarian tumor, but the diagnosis was confirmed through surgical exploration and postoperative pathology. The patient underwent a second surgery which was a comprehensive staging. Currently followed up for seven months,the patient recovered well, and showed no abnormalities in imaging examination and normal tumor indicators. With retrospective analysis of this case, when gynecological examination revealed the fixation of the tumor in the adnexal area, combined with imaging findings indicating clear boundaries of the tumor, it is necessary to consider the possibility of a broad ligament tumor and surgery should be performed as soon as possible. Once diagnosed with endometrial carcinoma of the broad ligament, timely and comprehensive staged operation should be performed, and long-term follow-up should be conducted after surgery.

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    A Case Report of Complete Androgen Insensitivity Syndrome Complicated with Dysgerminoma
    YIN Yu-xin, WANG Chang-he
    2024, 51 (4):  392-394.  doi: 10.12280/gjfckx.20240083
    Abstract ( 245 )   HTML ( 36 )   PDF (649KB) ( 31 )  

    Androgen insensitivity syndrome (AIS) is rare and difficult to diagnose at an early stage. This paper reports the diagnosis and treatment of a patient with complete androgen insensitivity syndrome (CAIS) complicated with dysgerminoma. The patient was admitted to the hospital due to abdominal distension for 2 days and received color ultrasound in the outpatient department indicating pelvic tumor. After admission, pelvic tumor resection was performed. Since the cause of hyperandrogenemia was unknown before surgery, it was diagnosed as CAIS complicated with dysgerminoma by chromosome analysis and genetic testing, finally underwent radical resection of gonadal malignant tumor. At present, the patient is still under close follow-up and his condition is stable. Through retrospective analysis of the clinical characteristics and diagnosis and treatment of this case, in order to improve the clinical understanding of the disease.

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    Gynecological Disease & Related Research: Review
    Hormonal Pathways and Regulatory Factors That Lead to Endometrial Disease
    GUO Xi, WEI Jia, YANG Yong-xiu
    2024, 51 (4):  395-400.  doi: 10.12280/gjfckx.20240269
    Abstract ( 217 )   HTML ( 29 )   PDF (733KB) ( 43 )  

    The development and function of the endometrium are highly dependent on the cyclic secretion of steroid hormones and the expression of their homologous receptors, the most important of which are estrogen and progesterone and their receptors. Estrogen and progesterone enable the endometrium to have a proliferative and secretory phase, maintain a normal menstrual cycle, and prepare for pregnancy. Dysregulation of estrogen and progesterone can lead to a series of diseases such as endometrial cancer, endometrial hyperplasia, and endometriosis, causing serious health problems. Under pathological conditions, estrogen interacts with estrogen receptors to promote excessive proliferation of the endometrium, which is closely related to the increased risk of endometrial lesions. However, progesterone can effectively inhibit the proliferative effect of estrogen, but when the expression of progesterone receptors is abnormal or when progesterone resistance occurs, it can lead to progesterone dysfunction. Effective treatment of endometrial-related diseases depends on the understanding of hormone pathways. This article reviews the hormone pathways and regulatory factors that cause endometrial diseases, with a view to providing reference for the clinical development of new drugs that can effectively prevent and improve treatment outcomes of endometrial diseases.

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    Gynecological Disease & Related Research: Review
    Non-Surgical Treatment Methods for Pelvic Floor Dysfunction
    TAN Mi, TAN Qing-qing
    2024, 51 (4):  401-405.  doi: 10.12280/gjfckx.20240026
    Abstract ( 239 )   HTML ( 25 )   PDF (708KB) ( 46 )  

    Pelvic floor dysfunction (PFD) is a common disease in women, which can lead to pelvic organ prolapse (POP), urinary incontinence, anal incontinence, sexual dysfunction, and other serious symptoms that affect the quality of life of patients, due to pelvic floor damage caused by factors such as pregnancy and childbirth. With the progress of population aging, the burden of these diseases will continue to increase. The current treatment strategy is to prefer non-surgical treatment, especially for patients with mild to moderate symptoms. There are numerous non-surgical treatment such as pelvic floor muscle training (PFMT), electrical stimulation, biofeedback, magnetic stimulation, uterine support, urethral bulking agents, regenerative medicine. With the development of medicine, more and more new materials and technologies related to the treatment of such diseases have emerged. When selecting a treatment plan for patients, it is necessary to fully consider the characteristics of each treatment method and provide personalized treatment for the patients. This review elaborates on several non-surgical methods for PFD mentioned above, providing references for selecting treatment options and further research on this disease.

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    Gynecological Disease & Related Research: Review
    Progress in The Application of Ultrasound-Guided High Intensity Focused Ultrasound in Gynecological and Obstetric Diseases
    ZHANG Yan, HU Meng-ying, WANG Hua, DONG Qu-long
    2024, 51 (4):  406-411.  doi: 10.12280/gjfckx.20240211
    Abstract ( 251 )   HTML ( 15 )   PDF (724KB) ( 51 )  

    In the past two decades, as a probe-free, non-ionizing radiation minimally invasive thermal ablation technology, high intensity focused ultrasound(HIFU) has developed rapidly. It can focus ultrasound waves on a single point and produce instantaneous high temperature to achieve the therapeutic purpose of thermal degeneration, coagulative necrosis, and apoptosis of target tissue. HIFU can be divided into two categories: ultrasound-guided and magnetic resonance-guided. Among them, ultrasound-guided HIFU is more widely used. It has obtained a large amount of evidence-based data and clinical experience in the treatment of gynecological and obstetric diseases such as uterine fibroids, uterine adenomyosis, cesarean scar pregnancy, postpartum placenta accreta spectrum, and cervical pregnancy, confirming its safety and effectiveness. It can even replace some traditional treatment methods in the treatment of certain diseases. However, ultrasound-guided HIFU is more commonly used in patients with stable conditions, and surgical intervention is often required for the rescue of critical and severe cases. Correct understanding and master of its indications and contraindications are necessary for precise treatment to benefit patients.

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    The Research Progress on Related Risk Factors and Treatment of Sleep Disorders in Perimenopausal and Postmenopausal Women
    HE Fei, ZHOU Jian-hong, CHU Ke-tan
    2024, 51 (4):  412-416.  doi: 10.12280/gjfckx.20240174
    Abstract ( 228 )   HTML ( 25 )   PDF (868KB) ( 55 )  

    Sleep disorder refers to abnormal sleep quantity, quality or some clinical symptoms occur during sleep, which seriously affects human function and health. The incidence of sleep disorders is positively correlated with age, and perimenopause in women is usually the turning point of female sleep due to the high incidence of menopause syndrome and metabolic related diseases. Sleep disorders in perimenopausal and postmenopausal women are characterized by difficulties in falling asleep, sleep maintenance disorders, daytime dysfunction, and anxiety and depression in severe cases. According to the related risk factors, symptomatic treatment, alleviate menopause-related symptoms, improve sleep quality, increase effective sleep time, restore social function, and improve the quality of life are the goals of the treating of perimenopausal sleep disorders. Therapeutic measures for perimenopausal and postmenopausal sleep disorders include non-drug therapy (sleep hygiene education, cognitive-behavior therapy for insomnia) and pharmacological therapy (menopausel hormone therapy, psychotropic and sedative hypnotic drugs, melatonin, traditional Chinese medicine, etc.). This article reviews the research progress on the risk factors and diagnosis and treatment of sleep disorders in perimenopausal and postmenopausal women.

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    Gynecological Disease & Related Research: Original Article
    Perinatal Depression Symptom Detection Rate and Influencing Factors in Economically Underdeveloped Areas of Sichuan
    HUANG Yue, TAN Xin-lin, YUAN Yu-hong, ZHANG Qiang, REN Yu, BIN Dong-mei, QI Hong-bo, SHI Qi
    2024, 51 (4):  417-423.  doi: 10.12280/gjfckx.20240014
    Abstract ( 224 )   HTML ( 30 )   PDF (769KB) ( 54 )  

    Objective: To investigate the occurrence of depressive symptoms and influence factors among perinatal women at different stages in economically underdeveloped areas of Sichuan province, China. Methods: Pregnant women receiving prenatal care or hospitalized for delivery at four medical institutions in Zigong and Nanchong cities from October 2022 to September 2023 were selected. Sociodemographic and clinical data were collected, and the Edinburgh Postnatal Depression Scale (EPDS) was utilized for depression screening. Logistic regression analysis was conducted to identify factors influencing depression symptoms during five perinatal periods [early pregnancy (<14 weeks), mid-pregnancy (14-27+6 weeks), late pregnancy (≥28 weeks), 1 week postpartum, and 6 weeks postpartum]. Results: A total of 3 696 pregnant women were included, with depression symptom detection rates ranging from 26.39% to 35.38% during the five perinatal periods. Logistic regression analysis revealed different risk factors for depressive symptoms among different perinatal periods. Risk factors included unplanned pregnancy, family history of psychiatric illness, experiencing 2 weeks of depressed mood in the year before pregnancy, and experiencing low mood or anxiety during the last menstrual period in early period of pregnancy; family history of psychiatric illness, current rural residence, experiencing 2 weeks of low mood or anxiety in the year before pregnancy, and experiencing low mood or anxiety during the last menstrual period in mid-pregnancy; family history of hypertension, diabetes, or cancer, experiencing 2 weeks of low mood or anxiety in the year before pregnancy, and experiencing anxiety during the last menstrual period in late pregnancy; family history of psychiatric illness, hypertension, diabetes, or cancer, experiencing 2 weeks of low mood in the year before pregnancy, and experiencing anxiety during the last menstrual period in the first week postpartum; being a primipara, current rural residence, family history of psychiatric illness, and experiencing 2 weeks of anxiety in the year before pregnancy in the sixth week postpartum. Conclusions: The detection rate of depressive symptoms among perinatal women in Nanchong and Zigong areas is relatively high level. It is recommended that perinatal health care providers initiate depression screening from early stage of pregnancy, focus on pregnant women with risk factors at different stages, repeat screening when if necessary, provide timely psychological interviews and specialized treatment to individuals at risk of hidden perinatal depression, and reduce the occurrence of adverse maternal and infant events.

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    Human Umbilical Cord Mesenchymal Stem Cells Treat Mouse Premature Ovarian Insufficiency through GDF-15/FOXO3a
    SI Xiao-sa, WANG Jian-bo, WENG Ping, SHI Peng-fei, WANG Chang-liang, CHEN Chen, WANG Yong
    2024, 51 (4):  424-432.  doi: 10.12280/gjfckx.20240599
    Abstract ( 203 )   HTML ( 34 )   PDF (12625KB) ( 49 )  

    Objective: To investigate the ovarian damage and mechanism of human umbilical cord mesenchymal stem cells (hUC-MSCs) to improve the ovarian injury in mice with premature ovarian insufficiency (POI). Methods: A mouse model of POI was established by plantar injection of zona pellucida 3 peptide (pZP3), and the mice were divided into control group, adjuvant control group, pZP3 group and hUC-MSCs group, with 10 mice in each group. A vaginal smear was used to monitor the estrous cycle, enzyme-linked immunosorbent assay (ELISA) was used to detect serum follicle-stimulating hormone (FSH) and estradiol (E2) levels, HE staining was used to observe the histology of the ovary, Western blotting was used to detect the expression levels of FOXO3a, p-FOXO3a, p53, Caspase-3 and Bax, and qRT-PCR was used to detect the markers of POI such as bone morphogenetic protein 15 (BMP15), anti-Müllerian hormone (AMH), WNT, and follicle-stimulating hormone receptor (FSHR). qRT-PCR detected the expression levels of tumor necrosis factor-α (TNF-α), interleukin-6(IL-6), and IL-1β, and RNA-seq detected the expression level of growth differentiation factor-15(GDF-15). The in vitro model was established by cyclophosphamide(Cy). Results: ①After 6 weeks of administration, compared to the control group, the pZP3 group and hUC-MSCs group showed disturbances in the estrous cycle, and the serum FSH level was increased and the E2 level was decreased, indicating that the model construction was successful.②Compared with the control group, atretic follicles increased and primordial follicle number decreased in the pZP3 group, and the proportion of primordial follicles was significantly increased and the number of primordial follicles was increased after hUC-MSCs intervention(P<0.05). ③Compared with the control group, the expression levels of apoptotic proteins p53 and Bax were up-regulated in the ovaries of mice in the pZP3 group, and the expression of apoptotic proteins p53 and Bax were down-regulated after the intervention of hUC-MSCs (both P<0.05); the changes of Caspase-3 in the mice in the pZP3 group were not significantly different from that of the control group (P>0.05). pZP3 group inflammatory factors IL-1β and TNF-α expression were up-regulated, and their expression was significantly down-regulated after hUC-MSCs intervention (both P<0.05). ④The number of Treg cells in mice in the pZP3 group was significantly lower (P<0.01) and significantly higher after hUC-MSCs intervention (P<0.000 1). mRNA expression levels of BMP15, AMH, WNT and FSHR in ovarian tissues of mice in the pZP3 group were lower than those in the control group. Their expression levels were elevated compared with those in the pZP3 group after the intervention of hUC-MSCs (all P<0.05). ⑤The phosphorylation level of FOXO3a was increased in the pZP3 group compared with the control group (P<0.000 1) and decreased after hUC-MSCs intervention (P<0.000 1). The sequencing results suggested that GDF-15 expression was up-regulated in POI mice and down-regulated in the hUC-MSCs group. Conclusions: The expression of GDF-15 and p-FOXO3a was up-regulated in POI mice, hUC-MSCs improved the morphology of ovarian tissues in POI mice and achieved the therapeutic effect on POI mice by down-regulating the expression of GDF-15 and reducing the phosphorylation level of FOXO3a.

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    Gynecological Disease & Related Research: Case Report
    A Case of Recurrent Adolescent Ovarian Cyst after Two Torsion Operations
    SHI Jie-chun, FAN Zi-yu, GU Chen-jie, MA Xin-yu, XING Yan
    2024, 51 (4):  433-437.  doi: 10.12280/gjfckx.20240259
    Abstract ( 232 )   HTML ( 23 )   PDF (8640KB) ( 38 )  

    Ovarian cyst is a common gynecological disease, which can be seen at all ages during the reproductive age, and ovarian follicular cyst is an ovarian tumor-like lesion that lacks specific symptoms. In childhood and adolescence, ovarian follicular cyst may present as adnexal torsion. In recurrent ovarian follicular cyst, short-acting contraceptives can effectively promote the regression of follicular cysts and prevent the formation of follicular cysts. This paper reports a case of recurrent adolescent ovarian cyst treated with short-acting contraceptive pills after two torsion operations for ovarian cysts. In this case, the patient was admitted twice for torsion of the pedicle of ovarian cyst and underwent surgical treatment, and both recurred again within a short period of time after the two surgical treatments, both of which were multilocular and huge cysts, which was relatively uncommon. Considering the age of the patient and the history of two operations on ovarian cysts in a short period, due to the concept of fertility protection and long-term management, no further operation was chosen after the second postoperation recurrence. The patient was given short-acting oral contraceptives for 5 months, during which the cysts gradually decreased in size until they disappeared. No recurrent ovarian cyst was found in regular follow-up review.

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    Severe Anemia Associated with Immune Checkpoint Inhibitor: A Case Report
    YANG Zu-jiao, NING Xian-ling, LIU Zhou-mei, WANG Wen-yan, YIN Qiao-xian, YANG Xie-lan
    2024, 51 (4):  438-441.  doi: 10.12280/gjfckx.20240121
    Abstract ( 240 )   HTML ( 20 )   PDF (3304KB) ( 45 )  

    We report a case of severe anemia in a patient with recurrence of ovarian cancer who underwent comprehensive treatment with the immune checkpoint inhibitor (ICI) Tislelizumab combined with the paclitaxel + carboplatin (TC) regimen. The patient's medical history and additional diagnostic tests led to the consideration of autoimmune hemolytic anemia. Following a blood transfusion, administration of high-dose corticosteroids and immunoglobulin, and consistent oral cyclosporine soft capsule maintenance therapy for over 2 months, the individual's hemoglobin concentration gradually increased to 110 g/L. Subsequent monitoring over a 3-month period indicated sustained stability in the hemoglobin levels. In patients receiving ICI therapy combined with cytotoxic chemotherapy or radiotherapy, severe hematological adverse reactions attributed to ICI are very rare among immune-related events. Early diagnosis is challenging, as these reactions can easily be confused with bone marrow suppression caused by radiotherapy and chemotherapy. The earlier use of corticosteroids, the better the treatment outcome and prognosis of adverse reactions caused by ICI. Therefore, when combining clinical anti-tumor therapy with ICI in patients, it is important to pay attention to adverse reactions in the hematologic system and promptly identify them.

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    Obstetric Physiology & Obstetric Disease: Review
    Clinical Application and Modern Pharmacological Progress of Traditional Chinese Medicine in Preeclampsia
    REN Yi, HU Yu-lian, WANG Xin, ZHANG Qi, LIU Chao, GAO Hui-jie
    2024, 51 (4):  442-447.  doi: 10.12280/gjfckx.20240382
    Abstract ( 235 )   HTML ( 28 )   PDF (722KB) ( 47 )  

    Preeclampsia is a pregnancy-related disease clinically characterized by high blood pressure and proteinuria after 20 weeks of gestation. Preeclampsia is a serious danger to the life and health of mothers and infants, and is one of the main causes of maternal and perinatal mortality. For the past few years, multiple Chinese herbal formulas and Chinese medicine injections have been shown to prevent and treat preeclampsia, and good clinical efficacy has been achieved. Modern pharmacological studies have found that Puerarin, Gastrodin, Rhynchophylline, Ginsenoside, Atractylenolide, Danshensu, Tetramethylpyrazine, Astragaloside can promote trophoblast proliferation and invasion, improve the process of pregnancy in experimental animals and play a positive role in the treatment of preeclampsia. Through the relevant literature and analysed the rationality of the clinical use of traditional Chinese medicines by combining clinical efficacy and mechanism studies, this research aims to accelerate and promote the clinical application and development of traditional Chinese medicine in the prevention and treatment of preeclampsia.

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    Confused Problem of Magnesium Sulfate in the Treatment of Preeclampsia and Its Adverse Effects
    ZHAO Li-xia, WANG Xiao-qing
    2024, 51 (4):  448-452.  doi: 10.12280/gjfckx.20240157
    Abstract ( 260 )   HTML ( 26 )   PDF (757KB) ( 41 )  

    Preeclampsia is an idiopathic disease during pregnancy that leads to adverse pregnancy outcomes for both mothers and children. Spasmolysis is an important and effective means to treat preeclampsia, and magnesium sulfate is the first-line spasmodic drug. At present, there are still some controversies about magnesium sulfate in the treatment of preeclampsia, including:whether magnesium sulfate is used for non-severe preeclampsia, magnesium sulfate is not recommended to prevent seizures in previous studies. However, recent studies believe that magnesium sulfate should be used to prevent eclampsia in patients with preeclampsia. Regarding the question of the course of prenatal magnesium sulfate for preeclampsia, several studies in recent years have concluded that the course of magnesium sulfate should be less than 24 h. Postpartum magnesium sulfate can prevent seizures, and existing studies support that postpartum magnesium sulfate application can be less than 24 h or even not used. Adverse reactions associated with the use of magnesium sulfate, including increased maternal postpartum haemorrhage risk, maternal hypermagnesemia, hypocalcemia, neonatal hypocalcemia and bone calcium deposition, neonatal hyperkalemia, etc.

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    Application Progress of Bioengineering Principle in Cervical Remodeling and Spontaneous Preterm Labor
    CHEN Xin-xin, LI Mao, JIANG Feng
    2024, 51 (4):  453-457.  doi: 10.12280/gjfckx.20240256
    Abstract ( 250 )   HTML ( 8 )   PDF (798KB) ( 43 )  

    The mechanical function of the cervix is critical for the normal progression of pregnancy. During normal pregnancy, the cervix softens significantly and becomes more compliant, which are essential for maintaining pregnancy and facilitating a successful delivery. Abnormal cervical remodeling is believed to contribute to spontaneous preterm labor. Currently, there are limited methods available for predicting spontaneous preterm labor, with transvaginal ultrasound being the most commonly applied in clinical approach to measure cervical canal length. With the development of bioengineering, it is possible for related technologues to be applied in scientific research and further practice in clinical work. This article mainly summarized the application of bioengineering principles and technologies such as electrical impedance spectroscopy, ultrasound shear wave elastography, diffusion tensor imaging, cervical aspiration, and Raman spectroscopy in predicting spontaneous preterm labor and establishing models of cervical remodeling, as well as the exploration of new materials such as biocompatible hydrogels in preventing spontaneous preterm labor.

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    Research Progress on the Brain Injury in Survivors Following Single Intrauterine Fetal Death in Monochorionic Twins
    HE Yu-ru, XIA Ge-qing
    2024, 51 (4):  458-462.  doi: 10.12280/gjfckx.20240136
    Abstract ( 245 )   HTML ( 25 )   PDF (735KB) ( 46 )  

    With the development of ovulation promotion and assisted reproductive technology, the rate of multiple pregnancies is increasing year by year. Single intrauterine fetal death(sIUFD) in twins is a serious complication of monochorionic twins in middle and late stages. After single intrauterine death, neurological impairment of the surviving fetus is an important factor affecting the long-term prognosis of newborns and infants, which seriously affects the quality of the population. The study of the mechanisms of neurological damage and effective monitoring of possible brain damage in surviving fetus are essential for the prevention of severe brain injury complications and important basis for causing the management of pregnancy and the timing of delivery. By identifying the risk factors associated with neurological damage in surviving fetuses with sIUFD, adopting appropriate monitoring and intrauterine treatment, and developing appropriate delivery plans, we can reduce the incidence of poor neurological outcomes in surviving fetuses.

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    Research Progress of Oxytocin in Preventing Postpartum Hemorrhage
    YANG Ke-xin, ZHANG Yan
    2024, 51 (4):  463-467.  doi: 10.12280/gjfckx.20240247
    Abstract ( 228 )   HTML ( 28 )   PDF (743KB) ( 51 )  

    Postpartum hemorrhage is a common obstetric complication and the leading cause of maternal death worldwide, and weak uterine contraction is the main cause of postpartum hemorrhage. Uterine contractions such as oxytocin and carbe oxytocin are the first-line drugs for the prevention and treatment of weak uterine contraction. Oxytocin, as the first-line uterine contractions recommended by WHO for the prevention of postpartum hemorrhage, has not yet reached a consensus on the medication route, administration time, dosage and rate in different delivery methods. Among them, the use of oxytocin in high-risk groups of postpartum hemorrhage such as multiple pregnancies and obesity is different from that in low-risk groups. Current research focuses on how to achieve the best preventive effect with the lowest dose and reduce the adverse effects of the drugs in high-risk groups of postpartum hemorrhage. This paper reviews the prevention of postpartum hemorrhage with oxytocin and its administration plan. The application of oxytocin in different delivery modes was summarized and the future research direction was prospected.

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    Obstetric Physiology & Obstetric Disease: Original Article
    Relationship between Enolase Level and Pregnancy Outcome in Patients with Vulvovaginal Candidiasis during Pregnancy
    WANG Fang-fang, ZHAO Hui-hai, WU Yang, SUN Li
    2024, 51 (4):  468-472.  doi: 10.12280/gjfckx.20231013
    Abstract ( 247 )   HTML ( 29 )   PDF (784KB) ( 48 )  

    Objective: To investigate the relationship between enolase (Eno) content, vaginal microecology and pregnancy outcomes in patients with vulvovaginal candidiasis (VVC) during pregnancy. Methods: A retrospective study was conducted on 77 pregnant VVC patients who were hospitalized and delivered in the obstetrics department of the 980th Hospital of PLA Joint Logistics Support Forces from April 2021 to April 2022. The pregnancy outcomes of pregnant VVC patients were observed and statistically analyzed, and they were divided into 49 cases with adverse pregnancy outcomes and 28 cases with normal pregnancy outcomes. The general data, vaginal microecological indicators, (1,3)-β-D-glucan and Eno levels were compared between the two groups. Logistic regression was applied to analyze the influencing factors of adverse pregnancy outcomes in VVC patients during pregnancy. Receiver operating characteristic curve was applied to analyze the diagnostic value of (1,3)-β-D-glucan and Eno for adverse pregnancy outcomes in patients with VVC during pregnancy. Results: The proportion of patients treated with anti-infection treatment in the adverse pregnancy outcome group was lower than that in the normal pregnancy outcome group, and the difference was statistically significant ( χ2=4.270, P=0.039). The proportions of vaginal flora density of grade Ⅱ-Ⅲ, flora diversity of grade Ⅱ-Ⅲ, cleanliness of grade Ⅰ-Ⅱ, pH value 3.8-4.5, hydrogen peroxide positivity, and leukocyte esterase negativity in the adverse pregnancy outcome group were lower than those in the normal pregnancy outcome group, the differences were statistically significant (all P<0.05). The levels of (1,3)-β-D-glucan and Eno in the adverse pregnancy outcome group were higher than those in the normal pregnancy outcome group, the differences were statistically significant (all P<0.001). (1,3)-β-D-glucan and Eno were independent risk factors for adverse pregnancy outcomes in patients with VVC during pregnancy (P<0.05), the vaginal flora density of grade Ⅱ-Ⅲ was protective factor (P<0.05). The AUC of (1,3)-β-D-glucan and Eno in the combined to diagnosis adverse pregnancy outcomes in patients with VVC during pregnancy was higher than that of a single index, with a sensitivity of 95.92% and a specificity of 82.14%. The combination of the two methods was better than that of (1,3)-β-D-glucan (Z=2.092, P=0.036) and Eno (Z=2.703, P=0.007). Conclusions: Elevated levels of (1,3)-β-D-glucan and Eno, and abnormalities in vaginal microecology can increase the risk of adverse pregnancy outcomes in VVC patients during pregnancy, and (1,3)-β-D-glucan combined with Eno can be used to screen the risk of adverse pregnancy outcomes in patients with VVC during pregnancy.

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    Obstetric Physiology & Obstetric Disease: Case Report
    Analysis of Small Supernumerary Marker Chromosomes Repeated in Two Fragments of 15q in A Fetal Amniotic Fluid Case
    TONG Fei, HUANG Wei-tong, LIU Kai-min, ZHOU Shuo-an, LU Xiu-hua
    2024, 51 (4):  473-476.  doi: 10.12280/gjfckx.20240047
    Abstract ( 259 )   HTML ( 22 )   PDF (4537KB) ( 40 )  

    By using the conventional G-banding technique to analyze the chromosome karyotype of one fetal amniotic fluid cell and peripheral blood of the fetal's parents, and furtherly the clinical value of chromosome copy number variation (CNV) technique was used to identify the source of fetal small supernumerary marker chromosome (sSMC). The G-banding karyotype of fetal amniotic fluid was 47,XY,+mar; Fetal amniotic fluid CNV-seq showed dup(15)(q11.2q13.2) region repeats and dup(15)(q13.2q13.3) region repeats with fragment sizes of 7.64 Mb and 1.58 Mb respectively, pathogenicity. Chromosome aneuploidy was not detected from the fetal's father, the mother had a deletion of a 0.28 Mb region of chromosome 3 at q13.13, the clinical significance was unclear. The source of sSMC could be identified by CNV technique which could be used as a supplement to traditional karyotype analysis and provide a reliable basis for clinical prenatal diagnosis and genetic counseling.

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    Intrafetal Radiofrequency Ablation for Fetal Pulmonary Sequestration with Edema and Pleural Effusion: A Case Report
    WANG Qiu-ming, WANG Rui-li, WU Hai-ying, WANG Li
    2024, 51 (4):  477-480.  doi: 10.12280/gjfckx.20240225
    Abstract ( 277 )   HTML ( 20 )   PDF (5979KB) ( 46 )  

    A case of a pregnant woman at 24+6 weeks of pregnancy was reported. Four dimensional color ultrasound showed homogeneous hyperechogenicity of 55 mm×50 mm×45 mm in the left chest cavity of the fetus, with a tumor to head ratio of 2.63, abdominal fluid accumulation, systemic skin edema, and cardiac compression and rightward displacement. The homogeneous hyperechogenicity is fetal pulmonary sequestration. After sufficient communication and multidisciplinary consultation, ultrasound guided fetal pulmonary sequestration radiofrequency ablation was performed. Regular follow-up color ultrasound was performed after surgery, and the fetal condition gradually improved. After 46 days of surgery, color ultrasound showed a tumor to head ratio of 0.95 and no abdominal fluid or skin edema. 49 days after surgery (32 weeks of pregnancy), premature rupture of membranes occurred, and the patient was rushed to the local county hospital for emergency treatment. Regular uterine contractions occurred, and a cesarean section was performed due to emergency hip position. The newborn died 20 minutes after birth. The surgical effect of this case was ideal, but the newborn did not survive, which may be related to various factors such as small gestational week, concomitant with fetal pulmonary sequestration, and insufficient treatment with dexamethasone. Radiofrequency ablation is an effective treatment for large tumor to head ratios and with abdominal fluid, but further research is needed to confirm its safety, and postoperative management of such patients should also be strengthened.

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