Journal of International Obstetrics and Gynecology

Composition and Research Progress of the Endometrial Microbiota

ZHONG Xiao-ying, LIU Hai-yuan

2024, 51 (5): 481-485. doi: 10.12280/gjfckx.20240451

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In recent years, the research of endometrial microbiota has gradually gained attention. The composition of microbial communities in different proportions is closely related to the occurrence of reproductive system disease and pathological pregnancies. The composition of endometrial microbiota has not yet been fully elucidated. Many studies hold the view that lactobacilli dominate the endometrial microbiome, but this theory remains controversial due to differences in sample collection and analysis methods across studies. The 16S rRNA sequencing technology is currently the most commonly used method for studying the endometrial microbiota, although studies using different omics technologies have also been reported. Endometrial receptivity is crucial for successful embryo implantation, and the dominance of lactobacilli in the endometrium may be associated with improved reproductive outcomes. Chronic endometritis (CE) has been confirmed to be associated with infertility, recurrent miscarriage, and repeated implantation failure. Although the correlation between endometrial microbial imbalance and CE has not yet been established, some studies have found that a decrease in the proportion of lactobacilli in CE patients, suggesting a potential association between the endometrial microbiome and CE. This paper reviews the different research findings and methods on the composition of endometrial microbiome and summarizes the recent impacts and roles of endometrial microbiota on endometrial receptivity and CE.

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Progress in the Application of High Intensity Focused Ultrasound Technology in Obstetric and Gynecological Diseases

LI Hui-min, HU Ya-li, ZHANG Sen-huai, MA Xiao-mei, XU Fei-xue

2024, 51 (5): 486-491. doi: 10.12280/gjfckx.20240505

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High intensity focused ultrasound (HIFU) technology is a non-invasive thermal tissue ablation method that can achieve image-guided therapy and treatment control through magnetic resonance guided high intensity focused ultrasound (MRgHIFU) or ultrasound guided high intensity focused ultrasound (USgHIFU). HIFU offers the advantages of being non-invasive, non-ionizing, and associated with fewer post-treatment complications. As a non-surgical treatment modality, HIFU technology has been increasingly applied in the treatment of obstetric and gynecological diseases over the past decade. HIFU achieves tissue ablation through precise focusing of ultrasound energy and has demonstrated efficacy in treating conditions such as uterine fibroids, cervical lesions, adenomyosis, non-neoplastic epithelial disorders of the vulva, caesarean scar pregnancy, abdominal wall endometriosis, uterine arteriovenous fistula, twin reversed arterial perfusion sequence, among others. Its benefits include reduced complications, suitability for patients with surgical contraindications, and shorter recovery times, which is particularly significant for women who have not yet had children. Although HIFU shows a promising outlook in the treatment of obstetric and gynecological diseases, further research is needed to assess its long-term effectiveness and safety. In the future, HIFU is expected to become a new treatment option for gynecological diseases, benefiting more patients.

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Research Progress on Exosomes in the Diagnosis and Treatment of Premature Ovarian Failure

GUO Pei-yi, ZHU Xue-hong, LIU Hui-xing, LU Li-miao, LIN Zhong

2024, 51 (5): 492-496. doi: 10.12280/gjfckx.20240378

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Premature ovarian failure (POF) is an endocrine disorder with an increasing incidence in recent years, often leading to decreased female fertility and various postmenopausal symptoms. The etiology of POF remains unclear, and current treatment options are limited, necessitating new approaches to improve ovarian function and enhance fertility in affected women. Exosomes are nano-vesicles that carry a variety of active substances and participate in intercellular signal transmission, exhibiting strong targeting and specificity. Studies have revealed significant differences in certain exosomes between normal and PDF tissues, suggesting their potential as biomarkers for diagnosing POF. Additionally, exosomes may play a crucial role in POF treatment by affecting granulosa cells, promoting hormone secretion, angiogenesis, and combating oxidative stress. This review summarizes the research progress on the relationship between exosomes and POF, aiming to provide a reference for future studies on the role of exosomes in POF.

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The Relationship Between Ferroptosis and Premature Ovarian Insufficiency

GAO Yi-wei, LUO Wei, WU Qiong, MU Yu-lan

2024, 51 (5): 497-502. doi: 10.12280/gjfckx.20240412

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Premature ovarian insufficiency (POI) is a complex condition that not only leads to perimenopausal symptoms, but also affects female fertility and overall physical and mental health. Once ovarian function is impaired, it is irreversible. Therefore, exploring the pathogenic mechanisms of POI and delaying its progression are paramountly important. Recent studies have revealed a close relationship between ferroptosis and POI. Ferroptosis is an iron-dependent form of cell death that regulates a variety of cellular biological processes in the body. Oxidative stress, autophagy, abnormal iron metabolism, and lipid metabolism disorders can induce ferroptosis, damaging ovarian function. Additionally, abnormal activation of the Hippo/Yes-associated protein (YAP) and tumor protein p53 (TP53) / nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway can also impair ovarian function though ferroptosis. Moreover, research has found that activation of glutathione peroxidase 4 (GPX4), ferrostatin-1 (Fer-1), and Coenzyme Q10 (CoQ10) can effectively reduce ferroptosis, suggesting these as potential therapeutic targets for future treatment of POI.

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Regulation Role of Talin1 on the Adhesion Function of Human Fallopian Tube Epithelial Cells

CHEN Li-zhu, QIU Pin

2024, 51 (5): 503-508. doi: 10.12280/gjfckx.20240410

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Objective: To investigate the effect of Talin1 on the adhesion function of human fallopian tube epithelial cells and explore the potential molecular mechanism involved. Methods: Human normal fallopian tube epithelial cells were transfected with Talin1. The adhesion strength of cell line overexpressed Talin1. The adhesion strength of these cells was assessed through a cell adhesion assay, with normal fallopian tube epithelial cells serving as controls. Immunofluorescence was used to observe changes in the cytoskeleton and the expression of ciliary dynamics proteins in Talin1-overexpressing cells. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were employed to detect the mRNA and protein expression of adhesion factors and cytoskeletal proteins in these cells. Results: After transfection with the Talin1 overexpression plasmid, both mRNA and protein levels of Talin1 were significantly increased (P<0.05), successfully establishing a stable cell line overexpressing Talin1. Talin1 significantly enhanced the adhesion strength of fallopian tube epithelial cells (P<0.01). The average fluorescence intensity of cytoskeletal F-actin, dynein axonemal heavy chain 5 (DNAH5), forkhead box J1 (FOXJ1), and radial spoke head component 9 (RSPH9) was markedly increased (all P<0.01). Talin1 downregulated the mRNA and protein expression of the adhesion factor E-cadherin (both P<0.001), while upregulating the mRNA and protein expression of adhesion factors β-catenin, P120 catenin (P120ctn), and intercellular adhesion molecule-1 (ICAM-1) (all P<0.05), as well as the protein expression of Paxillin, β-tubulin and Keratin (Krt) (all P<0.000 1). Conclusions: The occurrence of tubal pregnancy may be associated with Talin1′s role in promoting the expression and rearrangement of cytoskeletal proteins and regulating the expression of related adhesion molecules, thereby influencing the adhesion properties of fallopian tube epithelial cells.

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Prospective Randomized Controlled Clinical Study on the Efficacy of A Novel Temperature-Controlled Radiofrequency Treatment for Postpartum Vaginal Laxity

SHAO Hui, WANG Lu, CHEN Lu-jia, DONG Rui-jia, TANG Jie-ying, LIAO Xue-yin, YANG Jian-min, LI Wei-wei

2024, 51 (5): 509-514. doi: 10.12280/gjfckx.20240509

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Objective: To investigate the clinical efficacy and safety of a novel temperature-controlled radiofrequency (TCRF) treatment for postpartum vaginal laxity. Methods: A total of 43 female patients with postpartum vaginal laxity, treated at Beijing Tsinghua Changgung Hospital, affiliated with Tsinghua University from June 2022 to June 2023, were selected for this study. The patients were randomly divided into two groups: the experimental group (21 patients) received the novel TCRF treatment, while the control group (22 patients) received a sham treatment (no temperature or energy applied). Clinical efficacy and safety were comprehensively evaluated by comparing subjective scores from the female sexual function index (FSFI), female sexual distress scale-revised (FSDS-R), vaginal laxity questionnaire (VLQ), and sexual satisfaction questionnaire (SSQ) before and after treatment, alongside objective assessments of labia minora basal length, vulvar pigmentation, and elasticity. Results: At the 18th week after the first treatment, the mean change in total FSFI score (△T) in the experimental group was 8.72±3.94 points, while in the control group (△C), it was -0.03±1.28 points. The mean difference in FSFI score change between the two groups (△T-△C) was 8.75 points, with a 95%CI of 6.889-10.613 points, indicating that the lower limit of the 95%CI for the difference between the two groups was greater than 0. The experimental group showed a significant improvement in FSFI scores compared to the control group (t=4.810, P<0.001). Two-factor repeated measures ANOVA demonstrated that the main effects of time (F_time=24.156, P_time>0.001), group (F_group=12.754, P_group=0.001), and the interaction between time and group (F_time×group= 25.689, P_time×group>0.001) was statistically significant. Intervention effects, with group as the independent variable, indicated that FSFI scores in the experimental group were significantly higher than those in the control group at 6, 10, and 18 weeks post-treatment (all P<0.05). Time effect analysis, with time as the independent variable, showed that FSFI scores at all post-treatment time points were significantly higher than baseline, with scores at 6, 10, and 18 weeks significantly higher than those at 3 weeks (all P<0.05); however, no significant differences were found between FSFI scores at 6, 10, and 18 weeks post-treatment (all P>0.05). At 10 and 18 weeks post-treatment, FSDS-R scores and labia minora base length in the experimental group were significantly lower, and SSQ scores were significantly higher, than those in the control group (all P<0.05). At 3, 6, 10, and 18 weeks post-treatment, the experimental group showed significantly better VLQ scores, digital assessment of vaginal laxity improvement, and vulvar condition compared to the control group (all P<0.05). No adverse events related to the experimental device were reported in any enrolled patients. Conclusions: The novel TCRF technology effectively improves vaginal laxity and enhances sexual satisfaction, with a high safety profile, making it a promising option for clinical application.

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Research Progress on Low-Dose Aspirin in the Prevention of Preeclampsia

DENG Ling-ling, WU Shao-wen, ZHANG Wei-yuan

2024, 51 (5): 515-518. doi: 10.12280/gjfckx.20240369

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Aspirin prossesses anti-inflammatory, antipyretic, analgesic and antiplatelet aggregation properties. Studies have shown that taking low-dose aspirin during pregnancy can effectively reduce the incidence of preeclampsia (PE) in high-risk pregnant women, and it is now widely used in clinical practice. However, there is still no consensus on the standard for aspirin use in both domestic and international guidelines, leading to possible overextension of indications or blind use in clinical practice, which may prevent achieving the desired outcomes. Based on domestic and international guidelines and recommendations from experts and scholars, this review focuses on the applicable population, timing of administration, recommended dosage and precautions during the use of low-dose aspirin for the prevention of PE, aiming to better guide clinical practice.

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Effects of Intraspinal Labor Analgesia on Maternal and Neonatal Outcomes

TANG Shi-cheng, ZHANG Guo-ying

2024, 51 (5): 519-524. doi: 10.12280/gjfckx.20240594

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Intraspinal labor analgesia is a primary method for alleviating labor pain in women. Administering intraspinal labor analgesia during the latent phase of the first stage of labor can significantly reduce labor pain, making women more willing to attempt vaginal delivery and thereby reducing the rate of cesarean sections, especially those without clear medical indications due to pain factors. It can also decrease the incidence of severe maternal morbidity (SMM) and postpartum hemorrhage, thus improving the quality of delivery. However, intraspinal labor analgesia may have some adverse effects on maternal and neonatal outcomes. While it can accelerate cervical dilation during the latent phase of the first stage of labor, it may prolong the active phase of the first stage and the second stage of labor. Intraspinal analgesia increases the risk of instrumental vaginal delivery and postpartum urinary retention, with the latter potentially leading to urinary tract infections and postpartum hemorrhage. Additionally, intrapartum fever may be associated with intraspinal labor analgesia. Risk factors for intrapartum fever include premature rupture of membranes, excessive vaginal examinations, prolonged labor duration, prolonged time from rupture of membranes to delivery, high maternal body mass index, and prolonged duration of intraspinal labor analgesia. Intrapartum fever may increase the risk of low Apgar scores and neonatal infections, leading to adverse neonatal outcomes. This review examines the impact of intraspinal labor analgesia on labor progress, delivery mode, and maternal and neonatal outcomes, providing a reference for improving delivery quality and reducing adverse maternal and neonatal outcomes.

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Research Progress on SLRPs in Placental Development and Pregnancy-Related Diseases

ZHANG Qi, WANG Xin, REN Yi, LIU Chao, GAO Hui-jie

2024, 51 (5): 525-530. doi: 10.12280/gjfckx.20240589

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The small leucine-rich proteoglycans (SLRPs) are a family of small proteoglycans rich in leucine repeat sequences and are key components of the extracellular matrix, involved in regulating various physiological functions. SLRPs are classified into five categories, with the main members of class Ⅰ SLRPs, such as decorin and biglycan, and the main members of class Ⅱ SLRPs, such as lumican and fibromodulin, being particularly prominent in the placenta and uterus, playing significant role during pregnancy. These proteoglycans participate in maintaining the homeostatic balance of the extracellular matrix during pregnancy, mediate intercellular signal transduction, regulate the proliferation, migration and invasion capabilities of extravillous trophoblast cells, and influence the formation and function of placental blood vessels. They play a crucial role in maintaining the structural and functional integrity of the placenta and fetal membranes. Their abnormal expression or functional alterations may be closely related to the pathogenesis of various pregnancy-related diseases, such as preeclampsia and fetal growth restriction. This review discusses the mechanisms by which SLRPs influence placental development and pregnancy-related diseases, aiming to provide theoretical support for clinical prevention and treatment.

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Progress in the Diagnosis and Treatment of Pregnancy Complicated by Krukenberg Tumor

HUANG Mo-ya, ZHAO Ya-qian, HE Yin-fang

2024, 51 (5): 531-535. doi: 10.12280/gjfckx.20240516

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Krukenburg tumor refers to an ovarian malignancy that metastasizes from a primary site, and its incidence is relatively low. Pregnancy complicated by Krukenberg tumor is even rarer in clinical practice, often associated with a poor prognosis. Most patients exhibit nonspecific early clinical symptoms, which are easily masked by physiological and hormonal changes during pregnancy, making early diagnosis challenging, leading to delayed diagnosis and missed optimal treatment timing. To date, there is no consensus on the diagnosis and treatment of pregnancy complicated by Krukenburg tumor. According to domestic and international studies, diagnosis should be confirmed based on clinical manifestations and imaging examinations, treatment should be individualized according to the patient′s condition, gestational age, maternal-fetal status. Therefore, more research is needed on this rare disease to provide recommendations for early detection, diagnosis and treatment methods. This review summarizes the progress in the diagnosis and treatment of Krukenberg tumor during pregnancy, providing a valuable reference for clinical practice.

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The Value of Early Pregnancy Fasting Serum ANGPTL-2 and ANGPTL-8 Levels in Predicting Gestational Diabetes Mellitus Based on Propensity Score Matching

ZHANG Yong-qing, CHEN Dan-qing, CHEN Lu-ping, MA Xin-rui, CAI Wang-ying, WANG Mei-lin

2024, 51 (5): 536-540. doi: 10.12280/gjfckx.20240680

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Objective: To investigate the predictive value of serum angiopoietin-like protein-2 (ANGPTL-2) and ANGPTL-8 levels in early pregnancy for gestational diabetes mellitus (GDM) in pregnant women. Methods: A prospective study was conducted to collect data from 135 pregnant women in early pregnancy (10-13 weeks) who attended prenatal check-ups at Linhai Maternal and Child Health Hospital from July to December 2023. Venous blood was drawn, and based on inclusion and exclusion criteria, a total of 114 pregnant women were enrolled. According to the OGTT results at 24-28 weeks of gestation, participants were divided into the GDM group (15 cases) and the control group (99 cases). Propensity score matching (1∶1) was performed according to maternal age and parity, resulting in 14 successful matched pairs (14 cases in the GDM group and 14 cases in the control group). Serum levels of ANGPTL-2 and ANGPTL-8 were compared between the two groups, and Pearson correlation analysis was conducted to determine the correlation of these protein levels with clinical indicators in pregnant women. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of the two proteins for GDM. Results: Serum levels of ANGPTL-2 and ANGPTL-8 were significantly higher in the GDM group than in the control group (both P<0.05). Pearson correlation analysis indicated that both ANGPTL-2 and ANGPTL-8 were positively correlated with fasting blood glucose levels during the OGTT (r=0.537, P=0.003; r=0.394, P=0.038, respectively). ROC curve analysis revealed that the areas under the curve (AUC) for predicting GDM occurrence were 0.75 (95%CI: 0.57-0.93) for ANGPTL-2 and 0.79 (95%CI: 0.61-0.97) for ANGPTL-8, while the combined predictive AUC was 0.81 (95%CI: 0.65-0.91). Conclusions: Serum levels of ANGPTL-2 and ANGPTL-8 in early pregnancy can serve as early predictors for GDM, facilitating the early identification and management of GDM.

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Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D₃ in Gestational Diabetes Mellitus

LIU Zhao, ZHAO Lin-lin, LI Xia, WANG Xi-xian

2024, 51 (5): 541-545. doi: 10.12280/gjfckx.20240421

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Objective: To investigate the interaction and predictive value of body mass index (BMI) and 25-hydroxyvitamin D₃ [25-(OH)D₃] in gestational diabetes mellitus (GDM). Methods: A retrospective analysis was conducted on the clinical data of 102 pregnant women with GDM (GDM group) admitted to Beijing Aerospace General Hospital from January 2020 to January 2023. Another 102 healthy pregnant women during the same period were selected as the control group. The BMI and 25-(OH)D₃ levels in early pregnancy (8-12 weeks gestation), as well as fasting blood glucose (FBG), 1-hour postprandial blood glucose (1 h PBG), 2-hour postprandial blood glucose (2 h PBG) levels during the oral glucose tolerance test (OGTT), were compared between the two groups. The predictive value of BMI and 25-(OH)D₃ in GDM was evaluated, the interaction between BMI and 25-(OH)D₃ in GDM was analyzed. Results: The GDM group had higher FBG, 1 h PBG, 2 h PBG, and early pregnancy BMI levels than the control group, while the early pregnancy 25-(OH)D₃ levels in the GDM group were lower than those in the control group (all P<0.05). Early pregnancy BMI was positively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT, whereas 25-(OH)D₃ was negatively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT (all P<0.001). High BMI in early pregnancy was an independent risk factor for GDM (OR=1.285, 95%CI: 1.161-1.422, P<0.001), while high 25-(OH)D₃ was an independent protective factor against GDM (OR=0.924, 95%CI: 0.899-0.948, P<0.001). After adjusting for confounding factors, a positive interaction between early pregnancy BMI and 25-(OH)D₃ was observed in the risk of GDM, with a synergistic effect that was 2.096 times the sum of their individual effects (SI=2.096). Receiver operating characteristic (ROC) curve analysis showed that the combined prediction of GDM using early pregnancy BMI and 25-(OH)D₃ have an area under the curve (AUC) of 0.832, with a sensitivity of 76.47% and a specificity of 75.49%. Conclusions: The simultaneous presence of high BMI and low 25-(OH)D₃ levels in early pregnancy increases the risk of GDM, which can serve as a predictive indicators to provide guidance for the preventing GDM.

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A Case of Choriocarcinoma Discovered after Preterm Cesarean Section

ZHU Dan-mo, LIU Qin

2024, 51 (5): 546-548. doi: 10.12280/gjfckx.20240403

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Choriocarcinoma is a highly malignant type of trophoblastic tumor, and cases of choriocarcinoma detected after preterm cesarean section are rare. This report details a case of choriocarcinoma discovered following a preterm cesarean section. The patient underwent a lower segment cesarean section due to poor fetal heart monitoring, an abnormal S/D ratio in the umbilical artery on fetal ultrasound, and elevated alpha-fetoprotein levels. After birth, the newborn was diagnosed with anemia. The patient experienced persistent abnormal vaginal bleeding for more than a month post-cesarean section. A follow-up test revealed elevated levels of β-human chorionic gonadotropin (β-hCG), and ultrasound showed an abnormal intrauterine echo mass. After excluding retained products of conception and new pregnancy, and considering the patient′s history, clinical presentation, specialized examinations, and auxiliary tests, the diagnosis of choriocarcinoma was made. The patient was treated with three courses of fluorouracil and methotrexate chemotherapy from day 1 to day 8, and the follow-up β-hCG level decreased to 4.13 IU/L. Both mother and child had a favourable outcome as of the follow-up in May 2024. Therefore, regardless of whether the patient has a full-term pregnancy, abnormal postpartum vaginal bleeding and abnormal β-hCG levels in postpartum women should raise suspicion for gestational trophoblastic tumors. Early diagnosis and treatment, along with regular follow-up after chemotherapy, are crucial.

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A Case of Euglycemic Diabetic Ketoacidosis Complicating Gestational Diabetes Mellitus

CHEN Chun-lan, LIU Hai-wei

2024, 51 (5): 549-551. doi: 10.12280/gjfckx.20240441

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Euglycemic diabetic ketoacidosis (eDKA) during pregnancy is a rare and potentially fatal emergency that can endanger the life of the fetus. This paper reports a case of a pregnant woman with gestational diabetes mellitus who developed eDKA at 32⁺³ weeks of gestation. After active intravenous fluid replacement and insulin therapy, the ketoacidosis was corrected. Blood glucose was subsequently controlled using a combination of insulin lispro and insulin detemir, avoiding the need for an emergency cesarean section. At 35⁺⁴ weeks of gestation, due to obstetric ultrasound indicating macrosomia, a cesarean section was performed, and a live female infant was delivered, weighing 4 400 g.

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Successful Delivery after Pharmacological Expectant Management without the Opportunity for Emergency Cervical Cerclage: A Case Report

LIU Ya-xin, ZHANG Shu-ning, CHEN Xiao-jun, YU Yi-si, FU Shuai

2024, 51 (5): 552-555. doi: 10.12280/gjfckx.20240452

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Cervical incompetence is a significant factor leading to recurrent mid-trimester miscarriages and preterm births, resulting in serious complications for preterm infants and neonatal mortality, which can severely impact the physical and mental health of women of childbearing age and their families. This paper reports a case of a pregnant woman who had previously undergone hysteroscopic septum resection and cold knife conization of the cervix. During her pregnancy, cervical length was not monitored, and at 24⁺³ weeks of gestation, painless cervical dilation was discovered, with the amniotic sac prolapsing into the vagina. Due to the inability to palpate the cervical edge during speculum and vaginal examinations, an emergency cervical cerclage could not be performed. The patient was managed with antibiotics, tocolytics, and other medications for expectant management until preterm premature rupture of membranes (PPROM) occurred at 29⁺⁵ weeks, leading to oligohydramnios. An emergency cesarean section was performed, resulting in the successful delivery of a live infant who was eventually discharged home. This case review summarizes the clinical management and highlights recent advancements in the diagnosis and treatment of cervical incompetence, providing a new treatment option for similar cases in clinical practice.

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A Case of Early Pregnancy Pulmonary Embolism

ZHANG Ming, WANG Han-ting, CAO Yuan-yuan, CHEN Lu-jie, WANG Juan

2024, 51 (5): 556-559. doi: 10.12280/gjfckx.20240507

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Pulmonary embolism is a serious complication during pregnancy. It presents suddenly with diverse clinical manifestations and is prone to misdiagnosis. Computed tomography angiography (CTA) is the definitive diagnostic tool. We report a case of pulmonary embolism diagnosed in a patient 40⁺ days into an assisted reproductive pregnancy, who presented with palpitations, chest tightness, and shortness of breath. Cardiac color Doppler ultrasound estimated the pulmonary artery pressure at 63 mmHg (1 mmHg=0.133 kPa). The diagnosis was confirmed after chest CT and CTA. The patient improved after thrombolytic, anticoagulant, and symptomatic treatment, followed by an induced abortion to terminate the pregnancy. The prognosis is currently favorable. This case aims to heighten clinical awareness of early pregnancy pulmonary embolism. Besides taking a detailed medical history, clinicians must promptly perform relevant tests and examinations to achieve a rapid diagnosis and timely intervention.

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Application of Microfluidic Technology in Ovarian Cancer Disease Modeling, Drug Evaluation, and Precision Medicine

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

2024, 51 (5): 560-565. doi: 10.12280/gjfckx.20240523

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Ovarian cancer is the third most common malignant tumor of the female reproductive system worldwide, with a five-year survival rate of only 40%. The lack of early diagnostic methods and chemotherapy resistance are significant challenges in the diagnosis and treatment of ovarian cancer. Microfluidic technology, an integrated analytical technique that uses microchips to control fluid flow, offers notable advantages such as high sensitivity, high throughput and low cost. Additionally, this technology can simulate the tumor microenvironment at the micro/nanoscale, facilitating the study of interactions between tumor cells and the immune system. In recent years, microfluidic technology has been widely used in medical research, drug development, and precision medicine, among other areas of life science. In the context of ovarian cancer research, microfluidic technology can be utilized for tumor modeling, early detection of tumor biomarkers, and screening of anti-cancer drugs, providing innovative perspective and future directions for early diagnosis and precision treatment of ovarian cancer.

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Research Progress on Lymphocyte Activation Gene-3 in Gynecological Tumors

BAI Yao-jun, HU Xiao-hong, LI Hong-li, LIU Chang

2024, 51 (5): 566-571. doi: 10.12280/gjfckx.20240456

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Gynecological tumors are one of the important causes of death among women. Although standard treatments can improve the condition of some patients, many still experience disease progression and poor prognosis. Early diagnosis and treatment are crucial for improving the prognosis of gynecological tumors and reducing the burden of disease. Therefore, identifying more effective therapeutic targets is essential. Lymphocyte activation gene-3 (LAG-3) is an emerging immune checkpoint molecule that is highly expressed on the surface of tumor infiltrating lymphocytes in various types of tumors. It participates in immune suppression and tumor immune evasion by inhibiting the function of immune cells. Recent studies have shown that LAG-3 is highly expressed in gynecological tumors and is closely associated with tumor development, making it a promising new target for immunotherapy in gynecological tumors. This review outlines the structure and function of LAG-3 and discusses the research progress on its association with the three major gynecological tumors, providing new insights for future therapeutic research in gynecological tumors.

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Application and Prospects of Artificial Intelligence in the Diagnosis and Treatment of Endometrial Cancer

HE Qing, HU Hong-bo

2024, 51 (5): 572-577. doi: 10.12280/gjfckx.20240489

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The increasing incidence of endometrial cancer has driven innovations in diagnostic and therapeutic approaches. Among these, artificial intelligence (AI) technologies, particularly advances in deep learning and machine learning, have opened up new possibilities for improving diagnostic accuracy and developing personalized treatment plans. AI significantly enhances early detection and diagnostic precision for endometrial cancer through improved medical image analysis, automated pathological image interpretation, and in-depth genomic data analysis. Additionally, AI aids in personalized treatment decisions and prognosis evaluation by integrating multi-source data to accurately predict treatment outcomes. Recent research has focused on data fusion and real-time patient monitoring applications, further exploring AI′s potential in the comprehensive management of endometrial cancer patients. However, the widespread application of AI still faces challenges related to data quality, generalization, interpretability, and associated legal and ethical issues. Therefore, realizing the full potential of AI in the entire management process of endometrial cancer requires continuous technological innovation and interdisciplinary collaboration to ensure the reasonable, transparent, and safe application of these technologies. This presents a positive outlook for the future of healthcare, aiming to optimize treatment outcomes and improve patients′ quality of life through technological advancements.

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Five Cases of Diagnosis and Treatment of Ovarian Brenner Tumors

JIN Xiao-lei, XU Fei-xue

2024, 51 (5): 578-583. doi: 10.12280/gjfckx.20240491

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Objective: To summarize the clinical features, pathological characteristics, and treatment of ovarian Brenner tumors. Methods: A retrospective analysis was performed on the clinical data of five patients who underwent surgery and were subsequently diagnosed with ovarian Brenner tumors through postoperative paraffin pathology at the First Hospital of Lanzhou University from January 2000 to December 2023. We aimed to summarize their clinical features, pathological characteristics, and treatment experiences. Results: The ages of the five patients ranged from 46 to 72 years, with a median age of 70 years. The body mass index (BMI) ranged from 19.11 to 28.77 kg/m², with a median BMI of 25.64 kg/m². Among them, two cases were classified as borderline Brenner tumors (BdBT) and three as malignant Brenner tumors (MBT). Two patients with MBT exhibited significantly elevated carbohydrate antigen 125 (CA125) levels. All five patients had a maximum tumor diameter greater than 2 cm, and all tumors were unilateral. Imaging results indicated cystic solid lesions. Microscopic examination revealed that the ovarian BdBT consisted of transitional cell epithelium nests and fibrous stroma, with increased cellular layers and atypical nuclei but no stromal invasion. The cells in ovarian MBT showed pronounced atypia, and the cytoplasm was eosinophilic or clear, with infiltrative growth of tumor tissues. All five patients tested positive for cytokeratin 7 (CK7), GATA3, and P63, while CK20 and Wilms tumor gene 1 (WT1) were negative. The Ki-67 proliferation index was less than 5% in one BdBT patient, while the remaining four patients had a Ki-67 index of approximately 20% to 40%. All five patients underwent surgical treatment, and two patients received adjunctive chemotherapy. Except for one patient with ovarian MBT who was lost to follow-up, the other four patients remained alive without recurrence during the follow-up period. Conclusions: Preoperative imaging and CA125 tests have no definitive diagnostic value for ovarian Brenner tumors, which should be diagnosed based on histopathological and immunohistochemical examinations. The differentiation between MBT and BdBT lies in the degree of cellular atypia and the presence or absence of stromal invasion. Surgery is the primary treatment modality for ovarian Brenner tumors.

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A Case of Ovarian Malignant Tumor with SMARCA4 Gene Deletion

CHEN Zhi-wei, LIU Lin

2024, 51 (5): 584-587. doi: 10.12280/gjfckx.20240286

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Ovarian tumors with SMARCA4 gene deletion are rare, highly malignant, and have a poor prognosis. Patients often present with a typical early symptoms, leading to a late-stage diagnosis. This report discusses a case of an ovarian malignant tumor with SMARCA4 gene deletion. The patient was admitted with symptoms of lower limb swelling and increased bowel movements. CT imaging revealed a mass in the left adnexal area, with peritoneal and omental metastasis, retroperitoneal lymph node enlargement, and ascites in the abdominal and pelvic cavities. After being admitted in May 2023, imaging and tumor marker tests suggested ovarian malignancy. After ruling out surgical contraindications, the patient underwent laparoscopic exploration and pelvic biopsy under general anesthesia, revealing metastases throughout the abdominal cavity, pelvis, and surfaces of abdominal and pelvic organs. Postoperative pathology confirmed an ovarian malignant tumor with SMARCA4 gene deletion. The patient subsequently received chemotherapy, radiotherapy and microwave ablation of metastases. A six-month follow-up showed an improvement in the patient′s quality of life.

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A Case of Parasitic Leiomyoma with Massive Ascites and Elevated CA125

LIU Yan-jun, ZHANG Ying

2024, 51 (5): 588-592. doi: 10.12280/gjfckx.20240156

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Parasitic leiomyoma is a benign solid tumor formed by ectopic implantation of uterine fibroids, and it is rarely associated with ascites and elevated carbohydrate antigen 125 (CA125). This case reported presents a rare instance of parasitic leiomyoma, which was complicated by massive ascites and significantly elevated CA125 levels. Imaging examination suggested a large adnexal mass and multiple nodules in the pelvic-abdominal cavity, leading to a preoperative misdiagnosis of ovarian malignancy with peritoneal metastasis. The patient′s symptoms were alleviated, and CA125 levels returned to normal following surgical treatment. This case highlights the importance of thoroughly considering the patient′s surgical and medication history, along with a comprehensive evaluation that includes tumor markers, pelvic-abdominal MRI, ascitic fluid biochemical and cytological analysis, and intraoperative frozen section pathology, in order to avoid misdiagnosis.

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A Case of Recurrent Cellular Uterine Leiomyoma with Peritoneal Dissemination after Surgery

MING Yang, HU Yuan-yuan, FENG Tong-fu

2024, 51 (5): 593-596. doi: 10.12280/gjfckx.20240285

Abstract ( 207 )

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Cellular uterine leiomyoma is relatively rare in clinical practice and often resembles the clinical presentation of common uterine fibroids, leading to frequent preoperative misdiagnosis. This report presents a case of a patient with cellular uterine leiomyoma treated at Maternal and Child Health Hospital of Hubei Province, who underwent a single-port gasless myomectomy. In June 2022, the patient was readmitted due to a recurrence of the leiomyoma two years post-surgery and underwent a laparoscopic total hysterectomy and bilateral salpingectomy. During surgery, tumors were found in the pelvic peritoneum, omentum, mesocolon and abdominal wall. Pathological and immunohistochemical examinations indicated that all the tumors were cellular uterine leiomyomas. Preoperative diagnosis requires comprehensive consideration of blood flow signals, and imaging results to improve diagnostic accuracy. During surgery, strict adherence to the principle of tumor-free techniques and close postoperative follow-up are essential to reduce the risk of recurrence and iatrogenic dissemination.

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Cervical Carcinosarcoma：A Case Report and Literature Review

WANG Jing, WANG Xiao-hui

2024, 51 (5): 597-600. doi: 10.12280/gjfckx.20240193

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Cervical carcinosarcoma is a malignant tumor composed of malignant epithelial tissue and stromal components. Patients typically present with irregular vaginal bleeding and discharge. The etiology and pathogenesis of this condition remain unclear, and it is clinically very rare, making misdiagnosis and missed diagnosis common. This report presents a case of 42-year-old woman with cervical carcinosarcoma. The patient was admitted to the hospital due to contact bleeding accompanied by lower abdominal pain. Pelvic magnetic resonance imaging revealed a significant enlargement of the cervical region, with an initial diagnosis of cervical tumor. The patient subsequently underwent radical hysterectomy, pelvic lymphadenectomy, and omentectomy. Postoperative pathology confirmed the diagnosis of cervical carcinosarcoma, stage Ⅱb. As of March 2, 2024, the patient had undergone three rounds of chemotherapy, with no evidence of recurrence or metastasis detected so far. Cervical carcinosarcoma is highly malignant with nonspecific clinical manifestations, and definitive diagnosis relies mainly on pathological and immunohistochemical examinations. Therefore, early recognition and treatment are crucial for improving patient prognosis.

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