Journal of International Obstetrics and Gynecology

The Challenges and Impact of Artificial Intelligence on Obstetrics and Gynecology

GAO Yu, LANG Jing-he, LI Lei

2024, 51 (6): 601-606. doi: 10.12280/gjfckx.20240799

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With the rapid development of artificial intelligence (AI) in the medicine field, the application of AI in obstetrics and gynecology is increasing. This review summarizes the progress in the application of AI in obstetrics and gynecology in the past decade, covering gynecology, obstetrics, reproductive medicine, surgery, education and research innovation. AI technology has achieved remarkable achievements in the fields of screening and diagnosis of gynecological tumors, treatment response assessment, patient care, and medical big data management, with its applications gradually expanding in diagnosing obstetric and gynecological diseases. The primary functions encompass image recognition and analysis, data mining, genomics and metabolomics research, and laboratory evaluations. Integrating AI into the obstetrics and gynecology education system can help enhance teaching efficiency and learning experience. AI-assisted laparoscopic skills training and operating room management have opened up new avenues for advancing surgical skills and deepening of clinical practice in obstetrics and gynecology. However, the extensive adoption of AI has also brought challenges, such as the bias and variability of datasets, privacy protection of patient, the transparency of machine learning models, and the potential dilution of traditional medical knowledge. To address these challenges, it is necessary to improve AI regulatory policies, promote multidisciplinary collaboration, and build large-scale datasets. Through these strategies, AI technology can be expected to fulfil greater potential in obstetrics and gynecology and provide higher quality medical services to patients.

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Advances in the Etiological Research of Discordant Anomalies in Monozygotic Twins Pregnancy

QIU Wan-ning, WEI Yuan

2024, 51 (6): 607-610. doi: 10.12280/gjfckx.20240722

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Monozygotic twins originate from the early division of a single fertilized egg, theoretically possessing genetic homogeneity and consistency in the intrauterine environment, resulting in a high degree of phenotypic similarity. However, the observed inconsistencies in monozygotic twins pregnancy in clinical practice, such as one fetus developing normally while the other exhibits developmental abnormalities, suggest potentially complex mechanisms. By reviewing domestic and international literature, this paper summarizes the causes of these differences, including genetic factors such as mosaicism, de novo mutations, and chromosomal copy number variations, epigenetic factors covering differential DNA methylation and skewed X-chromosome inactivation, and intrauterine environmental factors involving gut microbiota and amniotic fluid environment, among others. For different disease phenotypes, clinical interventions such as elective fetal reduction, termination of pregnancy, or expectant management can be adopted. Reviewing the literature has enhanced the understanding of the developmental inconsistencies in monozygotic twins, which provides a scientific basis for the early prevention, diagnosis, and treatment of fetal diseases, and holds clinical guidance significance.

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Research Advancements on the Pathogenesis and Prediction Approaches of Twin Pregnancies Complicated with Preeclampsia

FAN Bo-yang, HU Li-yan

2024, 51 (6): 611-615. doi: 10.12280/gjfckx.20240630

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Preeclampsia(PE) constitutes a prevailing maternal complication that is intricately bound up with adverse maternal and infant outcomes. As one of the important risk factors for the development of PE, the pathogenetic mechanism of twin pregnancy in conjunction with PE is comparable to that of singleton pregnancies, which could potentially be correlated with large placenta size, augmented volume load, vascular endothelial dysfunction, oxidative stress, and immune mechanisms, etc., manifesting early disease onset yet mild disease attributes. However, the mechanism of PE in twin pregnancy remains nebulous, and its specific risk factors embrace assisted reproductive technology and chorionic sex. Clinically, twin pregnancies accompanied by PE hinge upon a solitary predictor, such as soluble fms-like tyrosine kinase-1(sFlt-1), placental growth factor (PlGF), pregnancy associated plasma protein-A (PAPP-A), or ultrasound indicators. Due to shortcomings such as insufficient sample size, the predictive performance of each indicator still needs to be tested. Further research with larger sample sizes is needed to explore the optimal predictive model for twin pregnancies with PE, in order to guide clinical decision-making.

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Effect of Preoperative Oral Carbohydrate on Enhanced Recovery after Cesarean Section

XI Xin-xin, GUO Hong, LI Shan, FENG Di, LIU Duo-duo

2024, 51 (6): 616-619. doi: 10.12280/gjfckx.20240649

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Preoperative oral carbohydrate is a key component of enhanced recovery after cesarean delivery (ERAC). It requires women to take an isotonic complex carbohydrate solution (containing maltodextrin, fructose, glucose and taurine) orally 2 to 3 hours before surgery. However, its beneficial and harmful effects have been controversial in this particular group of women. Studies have shown that preoperative oral carbohydrate intake, as a complex process involving multiple levels and angles, can alleviate maternal hunger, reduce insulin resistance, shorten the recovery time of intestinal function, prevent intraoperative hypothermia and reduce the incidence of postoperative nausea and vomiting, and help to reduce neonatal complications, promote breastfeeding, and thus improve maternal and infant outcomes. The specific effects of preoperative oral carbohydrate on ERAC and its mechanism in ERAC process were reviewed in order to provide theoretical support for in-depth study and clinical application of ERAC.

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Research Progress on High-Risk Factors for Postpartum Pelvic Floor Dysfunction

LIN Huan-yu, YU Min, LU Xu-hong

2024, 51 (6): 620-623. doi: 10.12280/gjfckx.20240762

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Pelvic floor dysfunction (PFD) is caused by degenerative changes and injuries to the supporting tissues of the pelvic floor, resulting in relaxation of the supporting tissues, which leads to the displacement of the pelvic organs and a series of diseases, mainly including sexual dysfunction, pelvic organ prolapse, fecal incontinence, urinary incontinence, etc., which brings a huge economic and psychological burden to the patients and their families. Due to the lack of awareness of PFD and limited understanding of treatment options, the disease seriously affects women′s quality of life and is often overlooked. Therefore, the search for risk factors contributing to the development of PFD can help prevent the disease, slow its progression, and improve the prognosis. It is widely accepted that PFD may be associated with mode of delivery, fetal size, body mass index (BMI), prolongation of the second stage of labor, maternal age, gestational diabetes mellitus, number of deliveries, and hormone levels, but the findings are inconsistent. The above risk factors for postpartum PFD are reviewed to gain a deeper understanding of their mechanisms and to provide clinical decision support for obstetricians and gynecologists.

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Pregnancy Complicated with Ebstein Anomaly: Two Cases Report

MA Guo-xia, WANG Jia-li, MIAO He-zhen, YAN Yu, LIU Jia-jia, YANG Yong-xiu

2024, 51 (6): 624-628. doi: 10.12280/gjfckx.20240580

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Ebstein anomaly, also known as tricuspid valve subluxation malformation, is a rare congenital heart disease associated with tricuspid valve displacement and insufficiency. Pregnant women with Ebstein anomaly have a high risk of heart failure and arrhythmia due to changes in the cardiovascular system during pregnancy, which leads to adverse pregnancy outcomes and management challenges. We report two cases of Ebstein anomaly in pregnancy, one with cardiac Ebstein anomaly was detected during prenatal examination in early pregnancy, who presented with shortness of breath and other symptoms in mid to late pregnancy. She delivered a live baby by cesarean section at 37⁺¹ weeks of gestation after active monitoring and symptomatic treatment. The other case underwent surgery for atrial septal defect before pregnancy, there were no obvious cardiac symptoms during this pregnancy, and no cardiac ultrasound examination was performed. At 38⁺¹ weeks of pregnancy, she requested admission for cesarean section to terminate the pregnancy and Ebstein anomaly was detected during the examination. She delivered a live baby by cesarean section at 38⁺⁶ weeks of gestation. The two cases had good prognosis for both the mothers and the fetuses. Combining these 2 cases of pregnancy complicated with Ebstein anomaly and full-term delivery of live babies and reviewing the relevant domestic and international literature, to discuss and deepen the understanding of the disease, in order to better manage pregnant women with Ebstein anomaly.

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A Case of Pregnancy Complicated with Neuropsychiatric Systemic Lupus Erythematosus

CHEN Hui-yun, HAN Bing, CHEN Jie, ZHANG Jie, ZHANG He, ZHANG Ying-hui

2024, 51 (6): 629-631. doi: 10.12280/gjfckx.20240400

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The patient was a female of childbearing age. She had a seizure in late pregnancy during sleep without any obvious trigger and with unconscious during the seizure, awakening on her own after a few minutes, but felt dizzy and had a headache and was admitted to the hospital as an emergency. This patient had a history of systemic lupus erythematosus, antiphospholipid syndrome, hypertension, deep vein thrombosis of the lower extremities, and disfavorable pregnancies(such as intrauterine fetal death, spontaneous abortion). Gestational diabetes mellitus was present in this pregnancy. Her mother has a history of epileptic seizures. The patient′s vital signs were stable and she has not had a seizure since admission. We performed the relevant ancillary examinations and multi-disciplinary treatment. We considered the patient′s diagnosis of neuropsychiatric systemic lupus erythematosus and treated her with high-dose methylprednisolone and therapeutic doses of low molecular heparin, and dexamethasone to promote fetal lung maturation. We performed a cesarean section under general anesthesia at 33⁺³ weeks of the patient′s gestation and the operation was successful. She delivered a female infant weighing 1 810 g and the infant′s 1 min, 5 min Apgar score were 10-10. The preterm baby was transferred to the neonatal unit for treatment, and the mother was discharged seven days after surgery and presented to the specialist four months later. The prognosis for both mother and daughter was favorable.

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Late Pregnancy with Ovarian Serous Cystadenoma Pedicle Torsion: A Case Report

LIU Si-min, LI Hong-li, GUO Xi, HU Ya-li, YANG Yong-xiu

2024, 51 (6): 632-635. doi: 10.12280/gjfckx.20240533

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Pedicle torsion is a common complications of ovarian tumors. There is an increased risk of torsion during pregnancy, usually in early or mid-pregnancy. Delayed treatment may lead to tumour necrosis, rupture, and secondary infection, or even loss of maternal ovarian function and fetal death. The diagnosis of torsion is difficult. As a cause of acute abdomen, its clinical manifestations are usually non-specific, the differential diagnosis range is wide-ranging, and it is prone to misdiagnose. Ultrasound is usually considered the first-line imaging method for evaluating acute abdomen in pregnant women, and surgery is the standard treatment for pedicular torsion. We report the case of torsion of the pedicle with serous cystadenoma of the ovary in the third trimester of pregnancy. The patient was treated for abdominal pain and underwent emergency surgery after diagnosis of torsion of the pedicle by ultrasonography. After 58 days of operation, a healthy baby girl was delivered spontaneously. Through this case we reviewed relevant literature and summarizing clinical experience, in order to deepen our understanding of this disease, improve diagnosis and treatment ability, and reduce misdiagnosis and missed diagnosis.

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Hyperlipidemia-Induced Acute Pancreatitis in Pregnancy: A Case Report

HUANG Chu-bing, GUO Chun, ZHENG Jia-yi, LIU Wei

2024, 51 (6): 636-640. doi: 10.12280/gjfckx.20240592

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Acute pancreatitis in pregnancy is a serious complication of pregnancy. Although the incidence is low, but because of its rapid onset, many complications, and atypical clinical manifestations, it is extremely harmful to the pregnant woman and the foetus. In recent years, the proportion of acute hyperlipidemia-induced pancreatitis in pregnancy has increased, and this kind of pregnant women have rapid progress and prone to become severe. This article reported a case of hyperlipidemia-induced acute pancreatitis in pregnancy. The patient′s initial symptoms were not typical but the routine blood specimens showed chyle-like changes when she was admitted to the hospital, which caused alertness of the medical staff. After a clear diagnosis, a cesarean section was performed in time to terminate the pregnancy, and a healthy baby girl was successfully delivered. After the operation, the patient was discharged from the hospital after symptomatic treatment such as fasting, lipid-lowering, anti-infection, gastrointestinal decompression, inhibition of pancreatic enzyme activity and secretion, acid suppression and stomach protection, and maintenance of electrolyte balance. This case can provide reference for clinical physicians to diagnose and treat the disease, strive for early diagnosis, improve cure rate, and ensure maternal and infant safety.

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Advances in Uterine Leiomyosarcoma：Mapping Based on Genomics

CHEN Xing-yu, WEI Ya-jing, LIANG Yan-chun

2024, 51 (6): 641-647. doi: 10.12280/gjfckx.20240791

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Uterine leiomyosarcoma (uLMS) is one of the most common uterine sarcomas with features such as chromosome instability, strong invasiveness and poor prognosis. The diagnosis of uLMS is mainly based on histopathology, with a lack of specificity in other auxiliary examination techniques. In recent years，with the maturation of high-throughput sequencing technology, genomics has witnessed rapid development in the research on the pathogenesis of uLMS, uncovering multiple gene-specific molecular alterations such as gene upregulation, downregulation, mutations, and gene fusions. This review will systematically introduce the latest progress of uLMS in genomics research. The goal is to construct a multi-angle and multi-faceted heterogenetic map of uLMS, and provide basis and direction for the accurate and early diagnosis of uLMS at the molecular level as well.

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Research Progress of the Relationship between Chemoradiotherapy-Induced Tumor Cell Death and Tumor Repopulation

CHEN Zhi-ru, DAI Lan

2024, 51 (6): 648-653. doi: 10.12280/gjfckx.20240767

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Tumor repopulation is the phenomenon of proliferation of residual tumor cells after cancer treatment, which is an important cause of treatment failure and tumor recurrence. The mechanism of tumor repopulation after radiotherapy or chemotherapy is extremely complex and is usually related to chemoradiotherapy-induced tumor cell death. After radiotherapy or chemotherapy, tumor cells may die in a variety of ways, including apoptosis, necrosis, autophagy, or pyroptosis. Studies have shown that tumor cell death may be associated with the tumor repopulation. On the one hand, they may directly affect the proliferation of residual tumor cells by regulating specific downstream signaling pathways. On the other hand, they may alter the functions of cancer-associated fibroblasts, immune cells, endothelial cells and other cells in the tumor microenvironment, then remodeling the tumor microenvironment in order to create conditions for the proliferation and metastasis of residual tumor cells. In this paper, we reviewed the relationship between tumor cell death and the repopulation of residual tumor cells after radiotherapy or chemotherapy, and analyzed the possible mechanisms of tumor repopulation from multiple perspectives, such as the mode of cell death and the tumor microenvironment, which is expected to provide a strategy for the prevention of cancer recurrence.

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Research Progress on Utilizing Single-Cell Sequencing Technology to Investigate Tumor Immune Microenvironment in Epithelial Ovarian Cancer

LI Dan-ning, WANG Xi-peng

2024, 51 (6): 654-658. doi: 10.12280/gjfckx.20240814

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Epithelial ovarian cancer (EOC) has the highest mortality rate among gynecological malignancies. The interactions between immune cells and tumor cells in the tumor immune microenvironment may form a vicious cycle, promoting tumor development. Therefore, in-depth exploration of the tumor immune microenvironment is crucial for developing immunotherapy strategies for EOC. Traditional high-throughput sequencing techniques can only detect average gene expression levels of cell populations, masking rare heterogeneous cells and limiting our comprehensive understanding of the complex tumor immune microenvironment. The advent of single-cell sequencing technology has overcome this limitation, revealing the heterogeneity of the EOC immune microenvironment at the individual cell level through high-resolution sequencing. This technology enables precise identification of different immune cell subsets, analysis of their developmental and differentiation pathways, and investigation of intercellular interactions. This review particularly focuses on the immune microenvironment characteristics of multiple sites in EOC, summarizes the application prospects of single-cell sequencing in guiding personalized immunotherapy and developing novel treatment strategies, and points out future research directions, providing important references for advancing immunotherapy.

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The Effect of BCL6 on Proliferation, Apoptosis, Invasion, and Migration of HTR-8/SVneo Trophoblast Cells

YANG Li, YANG Jing, YE Erdengqieqieke, HAN Rui, LA Xiao-lin

2024, 51 (6): 659-663. doi: 10.12280/gjfckx.20240555

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Objective: To explore the effects of overexpression of B cell lymphoma 6 (BCL6) gene on the proliferation, apoptosis, invasion, and migration of human trophoblast cells HTR-8/SVneo. Methods: Using lentivirus mediated overexpression of LV5-BCL6 (OE-BCL6) technology to construct HTR-8/SVneo cell lines with BCL6 overexpression, while a negative control group (OE-NC) was set up. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the mRNA and protein expression levels of BCL6. Subsequently, CCK8 assay, flow cytometry, Transwell assay, and Transwell chamber invasion assay were performed to compare the proliferation, apoptosis, invasion, and migration abilities of two groups of HTR-8/SVneo cells. Results: Fluorescence microscopy observation showed that the slow virus transfection of HTR-8/SVneo cells in the OE-BCL6 group and OE-NC group resulted in good cell growth and infection efficiency of over 70%, indicating successful slow virus transfection. mRNA level detection showed that BCL6 expression in the OE-BCL6 group was higher than that in the OE-NC group, and the difference was statistically significant (P<0.001). Protein level detection showed that the expression of BCL6 in the OE-BCL6 group was higher than that in the OE-NC group, and the difference was statistically significant (P<0.001). After transfection for 48 and 72 hours, the proliferation activity of OE-BCL6 group cells decreased compared to OE-NC group, while the apoptosis rate of OE-BCL6 group cells increased compared to OE-NC group, and the differences were statistically significant (all P<0.05). The amount of cells invaded and migratory cells in the OE-BCL6 group was significantly lower than that in the OE-NC group (both P<0.05). Conclusions: The BCL6 gene can inhibit the proliferation, invasion, and migration of HTR-8/SVneo cells, and promote cell apoptosis. BCL6 may be a potential target for diagnosis and treatment of clinical pathological pregnancy, but further research is needed to elucidate its molecular mechanism.

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Analysis on the Incidence and Mortality of Cervical Cancer in China Based on the Age-Period-Cohort Model from 1992 to 2021

WEI Jin-hua, QI Yu-chao, SHEN Xiao-ya

2024, 51 (6): 664-668. doi: 10.12280/gjfckx.20240828

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Objective: To analyze the incidence and mortality of cervical cancer in China from 1992 to 2021, and to explore the effects of age, period, and cohort factors on these trends. Methods: Using the Global Burden of Disease (GBD) 2021 database, we analysed cervical cancer incidence and mortality from 1992 to 2021, employing Joinpoint software to assess the time trends of age-standardized incidence and mortality rates. An age-period-cohort model was constructed to analyse the influence of age, period, and birth cohort on the trends of incidence and mortality trends. Results: In 2021, the incidence rate of cervical cancer in China was 19.12 /100 000, and the mortality rate was 7.18 /100 000, representing increases of 91.58% and 33.46% respectively since 1992. From 1992 to 2021, the age-standardized incidence showed a rising trend, averaging an increase of 0.70% per year, while the age-standardized mortality rate exhibited a declining trend, averaging a decrease of 1.20% per year, with statistical significance (both P<0.05). The age effect indicated that from 1992 to 2021, incidence rates increased among women aged 15 to 59 years old, while showing a fluctuating decreasing trend after age 60 years old; mortality rates increased with age. The period effect revealed a rising risk of incidence from 1992 to 2021, with the highest risk observed from 2017 to 2021 (RR=1.06); the risk of death showed a decreasing trend, peaking from 1992 to 1996 (RR=1.07). The cohort effect demonstrated that those born later had higher incidence risks but lower mortality risks. Conclusions: From 1992 to 2021, the age-standardized incidence of cervical cancer has risen, but due to advancements in medical treatment, the mortality rate has decreased. The incidence is higher among middle-aged women, while mortality increases in older populations. Individuals born later have higher incidence risks, highlighting the need for ongoing improvements in prevention and health education to address the public health challenge posed by cervical cancer in China.

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A Case Report of Pregnancy after Radical Cervicectomy with Neoadjuvant Chemotherapy in Stage ⅠB2 Cervical Cancer

LIU Yu, WU Rui-fang, LI Rui-zhen

2024, 51 (6): 669-671. doi: 10.12280/gjfckx.20240787

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With the popularity of cervical cancer screening and the proficient use of colposcopy, an increasing number of patients with early-stage cervical cancer are being diagnosed, and the trend of its incidence is skewing younger age. There is a significant clinical demand for preserve fertility while treating cervical cancer. For patients with large cervical tumors who wish to preserve their reproductive function, neoadjuvant chemotherapy can first ′reduce′ tumor stages, followed by radical cervical surgery to make pregnancy possible. It was reported that a 26-year-old patient with stage ⅠB2 cervical cancer underwent radical cervicectomy after neoadjuvant chemotherapy to reduce the tumor. During the operation, the bilateral ascending branches of the uterine arteries were preserved, and a patch was placed around the isthmus to prevent cervical insufficiency. The patch was exposed and removed after 11 months of exposure after the operation. The patient had a successful pregnancy nearly two years after surgery. Based on this case, the necessity of intraoperative patch placement and the choice of cesarean section were discussed.

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A Case of Soft Tissue Metastasis in the Back from Cervical Cancer

SONG Han, LIU Han-li, WANG Xi-bo

2024, 51 (6): 672-675. doi: 10.12280/gjfckx.20240591

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Cervical cancer is the fourth most common cancer among women in the world, with common sites of distant metastasis including the lungs, bones, liver, and brain. Metastasis to soft tissues is very rare. The clinical manifestations of soft tissue metastasis typically present as hard, ill-defined, and poorly mobile masses accompanied by pain, numbness, and muscle weakness. We report a case of a married woman who presented with vaginal bleeding after sexual intercourse for more than a month and was diagnosed with cervical squamous cell carcinoma via cervical biopsy. In August 2023, after excluding surgical contraindications, she underwent radical hysterectomy, pelvic lymph node dissection, and paraaortic lymph node dissection under general anesthesia, followed by postoperative chemotherapy combined with radiotherapy. Five months postoperatively, a subcutaneous mass was found on the left side of the back, and biopsy revealed squamous cell carcinoma, suggesting a cervical origin. Given the progression of the disease, radical resection of the skeletal muscle soft tissue tumor was performed, and the treatment regimen was changed to radiotherapy, immunotherapy, combined with chemotherapy using paclitaxel and platinum-based drugs. As of the last follow-up, the patient′s condition was stable. Soft tissue metastasis of cervical cancer is rare, and the clinical symptoms are often not obvious. Early diagnosis is crucial for the prognosis of patients.

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Ovarian Endometrioid Carcinoma Associated with Trousseau Syndrome: A Case Report

ZHOU Ting, LIANG Bao-quan

2024, 51 (6): 676-679. doi: 10.12280/gjfckx.20240359

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Ovarian endometrioid carcinoma (OEC) has no special clinical manifestations in the early stage and is not easy to be detect. Trousseau syndrome is a thrombotic disease associated with malignancy. It is reported that one patient with OEC combined with Trousseau syndrome diagnosed and treated in our hospital has lower extremity venous thrombosis as the first symptom, and perioperative preparations are carried out at the same time as anticoagulation therapy, during which the patient still has pulmonary embolism, cerebral infarction, myocardial infarction and other multi-organ embolism. After a multidisciplinary evaluation, we performed surgical treatment and six courses of postoperative adjuvant chemotherapy, and there were no signs of recurrence and metastasis, and there was no new infarction, resulting in a good prognosis. Through this case, the understanding of the disease by clinical gynecologists is strengthened, and the disease is diagnosed and treated in a timely manner. Early use of antithrombotic drugs, active resection of the primary lesion, resumption of anticoagulation on the first day after surgery, close monitoring of coagulation function and timely adjustment of anticoagulant dosage can reduce the rate of disability and mortality due to embolism, improve the prognosis of patients, and protect women′s health.

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Malignant Transformation of Ovarian and Tube Endometriosis into Clear Cell Carcinoma: A Case Report

GUO Xi, LIU Si-min, WEI Jia, YANG Yong-xiu

2024, 51 (6): 680-683. doi: 10.12280/gjfckx.20240598

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Endometriosis is a common gynecological disease, but the probability of malignant transformation is low, and the probability of malignant transformation of ovarian and fallopian tube endometriosis to clear cell carcinoma is lower, and there are few reports on this. Our hospital has found a case of ovarian and fallopian tube compound endometriosis malignant transformation into clear cell carcinoma. The patient was hospitalized due to abdominal distension. Imaging examination revealed huge pelvic masses and ascites, and multiple nodules in the omentum, which were considered to be metastatic. So, ovarian malignant tumor cytoreductive surgery was performed. The postoperative pathological biopsy was consistent with clear cell carcinoma, and the cancer foci were distributed in both fallopian tubes and the right ovary. Intravenous chemotherapy was performed postoperatively, in the first cycle, paclitaxel liposome and carboplatin were used, in the second cycle, bevacizumab was added to the original chemotherapy regimen for targeted therapy. Now the 6th cycle of chemotherapy, post chemotherapy evaluation has been done, there was no obvious adverse reaction, and no tumor recurrence or metastasis was found.

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Mechanism Study of MAPK Pathway in PCOS and Monomeric Treatment of Traditional Chinese Medicine

HU Die, REN Jia-jie, LIU Jia-ning, FENG Xiao-ling

2024, 51 (6): 684-691. doi: 10.12280/gjfckx.20240713

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Polycystic ovary syndrome (PCOS) is a common and complex gynecological endocrine disorder that mainly affects women of childbearing age. Its main characteristics include ovulation disorders, insulin resistance and hyperandrogenemia. The mitogen-activated protein kinase (MAPK) signaling pathway plays an important role in the occurrence of PCOS. It has been confirmed that the three classic MAPK pathways - extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 MAPK are closely related to the occurrence of PCOS. Once these pathways are abnormally activated, it will prompt the body to have a variety of adverse reactions and ultimately lead to PCOS. Specifically, it includes ovulation dysfunction, insulin resistance, elevated androgen levels, oxidative stress and inflammatory reactions. Studies have shown that a variety of traditional Chinese medicine monomers can regulate the activity and expression of MAPK signaling pathway-related proteins. These traditional Chinese medicine monomers include flavonoids, glycosides, terpenoids, alkaloids and polysaccharides. Through this modulation, they can effectively improve the pathophysiological process of PCOS patients, thus providing new ideas and methods for the treatment of PCOS.

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Regulatory Mechanism of Ovarian Granulosa Cell Apoptosis in Polycystic Ovary Syndrome with Progress in Traditional Chinese Medicine

LI Dong-nan, XIANG Rong, WANG Hai-yang, SUN Miao

2024, 51 (6): 692-697. doi: 10.12280/gjfckx.20240741

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Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disease that affects female reproductive health throughout her life from the onset of puberty to pre- and post- menopause. The study of PCOS is complicated due to the heterogeneity of clinical manifestations, biochemical characteristics and pathogenesis. The current study shows that the abnormal follicular development is closely related to the increased apoptosis of ovarian granulosa cells in PCOS patients, which changes the pathological state of abnormal apoptosis of granulosa cells and can affect the process of PCOS by intervening insulin resistance (IR), regulating ovarian hormone microenvironment, antagonizing the state of oxidative stress, regulating inflammatory factors and lipid metabolism. Traditional Chinese medicine has the advantages of synergistic multiple targets, multi-pathway intervention in ovarian granulosa cell apoptosis. This article tries to retrieve and summarize relevant literature from domestic and abroad, review the intervention of IR, hyperandrogenism, oxidative stress, chronic low-grade inflammation and lipid metabolism mechanism regulation of PCOS, in order to provide a theoretical basis for clinical prevention and treatment of PCOS.

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Advances in Research on Neuroendocrine Disorders Induced by Hyperandrogenism in Polycystic Ovary Syndrome

LI Chen-xi, FAN Meng-xiao, WU Lin-ling, DOU Zhen, JIA Jia, SUN Ya-xuan

2024, 51 (6): 698-702. doi: 10.12280/gjfckx.20240683

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Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age, with a high global prevalence. Its impact spans from puberty to menopause, characterized by hyperandrogenemia, ovulatory disorders, and polycystic ovary. Although the pathogenesis of PCOS is not yet fully understood, the central neuroendocrine system plays a significant role in the pathophysiology of PCOS indicated by many studies. One of the important mechanisms developing PCOS is below. High levels of androgens interfere with the activity of gonadotropin-releasing hormone (GnRH) neurons, and affect the feedback regulation of gonadal steroid hormones, leads to dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis that regulates reproductive function in the central nervous system. This article reviewed how hyperandrogenemia induces neuroendocrine disorders in PCOS and explored the potential directions of future researches. It is hoped to provide a scientific basis for further revealing the pathogenesis of PCOS and developing new therapeutic approaches.

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Exploring the Basis of Depression and Pain in Premenstrual Dysphoria Disorder from the Perspective of Estrogen Fluctuations

GAO Ming-zhou, GAO Dong-mei, MA Feng-jun, ZHANG Ke-xin, ZHANG Hao

2024, 51 (6): 703-706. doi: 10.12280/gjfckx.20240660

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Premenstrual dysphoria disorder (PMDD) is a common disease that endangers the health of women of childbearing age. with a high prevalence of suicidal tendencies in severe cases, and the sensitivity of ovarian steroid hormone fluctuations may be its core pathogenesis. In clinical practice, PMDD patients are plagued by both mental and physical symptoms, but previous studies have often focused on emotional changes such as depressive disorders, neglecting physical accompanying symptoms such as breast tenderness and migraine. Migraine itself is affected by fluctuations in female estrogen levels and exhibits different individual sensitivities, and the use of antidepressants in pain treatment can also be seen clinically. Previous studies have shown that depression pain may have a common pathological basis, and estrogen fluctuations regulate the pathological changes of both. This paper reviews the basis of depression-pain occurrence in PMDD from the perspective of estrogen fluctuations, in order to provide reference for exploring the core pathogenesis and promote the development of antidepressant pain comorbidity drugs.

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Progress in Evaluating Embryotoxicity of Compounds Based on Human Embryonic Stem Cell Model in Vitro

SUN Lu, CHEN Ran-ran, SONG Dian-rong

2024, 51 (6): 707-711. doi: 10.12280/gjfckx.20240854

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Embryonic stem cell test (EST) was widely used in evaluation of embryotoxicity or developmental toxicity of compounds in the fields of drugs, chemicals, and environmental safety. In recent years. Compared to the traditional reproductive toxicity tests, EST has the advantages of short cycletime, high throughput and low loss, in order to further improve the applicability and safety assessment of EST to various drugs and to avoid species differences, researchers used human embryonic stem cell (hESC) instead of the original mouse embryonic stem cell (mESC), and the researches which utilized hESC to evaluate embryotoxicity or developmental toxicity have been became more diversified and in-depth, such as the development of different evaluation models of differentiation types (myocardial cell, nerve cell and osteoblast etc.) or the construction of three-dimensional (3D) models which were closer to real living condition of embryo (embryoid bodys and organoid), these studies provided a new direction for establishing a more accurate and efficient model for the evaluation of embryotoxicity.

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Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery Versus Laparoscopic for Large Uterus: A Retrospective Cohort Study

HE Shan, HE Wen, HOU Tao

2024, 51 (6): 712-716. doi: 10.12280/gjfckx.20240432

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Objective: To investigate the safety and feasibility of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) of by hysterectomy. Methods: A retrospective cohort study was conducted on clinical datas from patients who underwent total hysterectomy for benign uterine diseases at Meizhou People′s Hospital from June 2018 to December 2022. Patients with a uterine volume ≥300 cm³ and without uterine prolapse were divided into vNOTES group and traditional laparoscopic hysterectomy (TLH) group based on the surgical approach. Comparative analysis was performed on the general index, perioperative index, and postoperative recovery index of the two groups. Results: The study included 47 cases in the vNOTES group and 215 cases in the TLH group. The uterine volume in the two groups were 426.03 (358.01, 531.43) cm³ and 436.14 (358.75, 579.05) cm³, and there was no statistically significant difference (P>0.05). There were no significant differences in surgical success rate, intraoperative blood loss, proportion of appendix resection surgeries, intraoperative and postoperative surgical complications, unplanned readmission within 30 days after surgery and postoperative anal exhaust time between the two groups (all P>0.05). The operation time, duration of catheter indwelling and postoperative hospital stay duration were shorter in the vNOTES group and there was a lower visual analogue scale pain score at 24 hours after surgery, these differences was statistically significant (all P<0.05). Conclusions: Hysterectomy by vNOTES is safe and feasible for benign diseases with non-prolapsed large uteri in terms of potential benefits such as reduced postoperative pain and enhanced recovery.

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A Case of Pelvic Abscess Following Oocyte Retrieval in A Patient with Adenomyosis and Ovarian Endometriosis Cyst

ZHANG Yan, ZHANG Yi-ming

2024, 51 (6): 717-720. doi: 10.12280/gjfckx.20240847

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Pelvic abscess is a rare but serious complication following oocyte retrieval in assisted reproductive technology. Its nonspecific clinical presentation often leads to misdiagnosis or delayed diagnosis, which can result in treatment delays and increased complexity. The risk of developing a pelvic abscess is significantly higher in patients combined endometriosis. This report presents a case of a female patient with adenomyosis and ovarian endometriotic cysts who developed a pelvic abscess after oocyte retrieval. While her symptoms initially improved with antibiotic therapy and abscess drainage, the condition later recurred, necessitating laparoscopic surgery combined with antibiotic resistance against infection for a definitive cure. This case underscores the importance of early diagnosis and intervention in managing pelvic abscesses post-oocyte retrieval. For recurrent cases, more aggressive interventions should be taken to optimise the patient′s prognosis and reduce the risk of complications.

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