2016年 · 第51卷第12期

premature ovarian failure (POF) is a technical term that has been widely used in clinical practice. It refers to amenorrhea in women before the age of 40, accompanied by endocrine abnormalities such as increased FSH level (FSH>40 U/L) and decreased estrogen level and menopausal symptoms; It means premature, complete failure of ovarian function. With the deepening of etiology research and the accumulation of clinical cases, people gradually realize that ovarian failure is a group of diseases with diverse clinical manifestations, complex etiology and progressive development (including "three stages" of occult stage, biochemical abnormal stage and clinical abnormal stage). The POF concept has limitations and cannot reflect the progressiveness and diversity of the disease, and only represents the terminal stage of ovarian failure. Therefore, in 2008, the American Society of Reproductive Medicine (ASRM) proposed the concept of "primary ovarian insufficiency."^[1]。 In 2016, the European Society for Human Reproduction and Embryology (ESHRE) published the latest "Guidelines for the Treatment of POI"^[2]Change the full name of POI to "premature ovarian insufficiency (POI)". In 2016, the International Menopausal Association (IMS) newly published "Recommendations for Health Management and Menopausal Hormone Therapy for Middle-aged Women" mentioned the diagnosis and treatment of POI^[3]。 In the latter two guidelines, "primary" was changed to "premature", and the ESHRE guidelines reduced the diagnostic threshold of FSH (40 U/L) to 25 U/L, aiming at early detection of women with ovarian insufficiency, so as to achieve the purpose of early diagnosis and early treatment.

Since the beginning of human beings, there has been an exploration of oneself and nature. Before reason was fully developed, human beings tried to explain themselves and the phenomena of nature by the way of thinking of myth and primitive religion. The fear of life and death, transformed into the fear of ghosts and gods; The doubt about illness turned into the pursuit of witchcraft. From its origins, religion is the matrix of medicine. In a way, "medicine was born with the initial expression of human suffering and the initial desire to alleviate it". But in order to explain the human and natural occurrence of various phenomena to carry on the diligent exploration and become philosophy. Philosophy, which is the unity of a theorized, systematic worldview and methodology, is a reflection on the relationship between mind and existence, spirit and matter. In some ways, philosophy originated in medicine.

endometriosis (endometriosis) is a common disease in women of childbearing age. Its lesions are extensive, diverse in shape, extremely aggressive and easy to relapse, which can cause physical and psychological damage to patients and seriously affect their quality of life^[1]。 At present, the pathogenesis of endometriosis is unknown, including endometrial implantation theory, body cavity metaplasia theory, genetic immune endocrine mechanism and "eutopic endometrial determinism" proposed by academician Lang Jinghe^[2,3]。 Angiogenesis plays an important role in the pathophysiology of endometriosis; Similar to tumor metastasis, the implantation of ectopic endometrium requires the formation of blood vessels, which in turn invade the extracellular matrix and form endometriosis lesions^[4]。 Vascular endothelial growth factor (VEGF) and angiogenesis inhibitor platelet reactive protein 1 (TSP-1) play an important role in the development of endometriosis by regulating vascular formation^[5]。

Epithelial ovarian carcinoma (ovarian cancer) is a common gynecological malignant tumor and a common cause of malignant tumor-related death in women. In recent years, its incidence is on the rise^[1,2,3]。 Early ovarian cancer lacks typical clinical features and specific diagnostic indexes; As a generally accepted tumor marker of ovarian cancer in clinical practice, CA₁₂₅The expression rate in patients with stage I ovarian cancer is only 50%^[4], guiding unsatisfactory clinical effects^[1,5]Most patients were already in the advanced stage (stages III ~ IV) when diagnosed^[6]。 Therefore, despite years of clinical efforts, the 5-year survival rate of ovarian cancer is still lower than 45%^[7]The final 10-year survival rate of patients with advanced ovarian cancer is only about 10%^[1]。 It has become an important task for gynecologists and basic medical researchers to find more effective diagnostic and therapeutic methods and further explore the molecular mechanism of ovarian cancer.

The 26-year-old pregnant woman, with 1 pregnancy and 0 delivery, went to Zhejiang Provincial People's Hospital on July 4, 2013 due to 33 weeks of menopause, nausea and hyperemesis for more than 1 month. Pregnant women have nausea and vomiting for more than 40 days after menopause, more than 10 times a day, because the stomach contents are accompanied by bile, and they can eat, which improves slightly at 14 weeks of pregnancy. More than one month before admission, nausea and vomiting were aggravated without obvious trigger, vomiting immediately after eating, and the vomit was stomach contents with gastric juice, poor appetite, difficulty eating, and body weight decreased by about 5 kg. I was given nutritional support treatment for 5 days, but the symptoms did not improve. Physical examination at admission: listlessness, body temperature 37.0 ℃, pulse 98 beats/min, breathing 20 beats/min, blood pressure 99/76 mmHg (1 mmHg =0.133 kPa), height 160 cm, body weight 45 kg. Uterine height 24 cm, abdominal circumference 79 cm, left occipital anterior position, fetal heart rate 135 beats/min. On June 20, 2013, urine examination routine in our hospital: urine ketone body (+ + + +); B-ultrasound showed: intrauterine single live fetus, cephalic position, biparietal diameter 8.0 cm, femur length 5.6 cm. Admission diagnosis: (1) Pregnancy 1 delivery 0, gestation 33 weeks, single live fetus; (2) Pregnancy vomiting. After admission, the thyroid function and viral hepatitis indexes were examined without abnormality, and nutritional support treatment was given. On 5 Jul 2013, a pregnant woman had spontaneous uterine contractions after vomiting, and the fetal conservation treatment failed. She delivered a baby boy with a body weight of 1 660 g and a length of 42 cm, with an Apgar score of 10 at 1 minute and 10 at 5 minutes. Pregnant women who feel nausea and vomiting after delivery do not improve, and continue to be given nutritional support treatment. Chest tightness, shortness of breath, throat discomfort, and retrosternal pain occurred 3 days after delivery. Endoscopic examination was recommended for consultation with a gastroenterologist. The esophageal barium meal angiography on the 6th day after delivery showed that the lower esophagus was bill-like stenosis with smooth edges and no signs of mucosal destruction; A small amount of barium enters the stomach; The esophagus is dilated throughout the process, the wall of the tube is irregular and messy and contracted, and the edge is wavy. He was diagnosed with cardiac achalasia, and was transferred to the gastroenterology department for endoscopic balloon dilatation. On the second day after operation, he was able to eat semi-liquid diet and soft food, and was discharged. Telephone follow-up showed no recurrence of nausea and vomiting.

pre-eclampsia (PE) is a complication of pregnancy with hypertension as the basic manifestation. So far, the preventive measures of PE include diet, calcium supplementation, cod liver oil, antioxidants, low-dose aspirin and heparin, but most of the measures have no clear effect^[1,2]。 Recent studies have shown that pravastatin among statins has the potential effect of preventing and treating PE, which can play a role in lowering blood lipids, improving vascular endothelial cell function, and reducing oxidative stress levels in the body^[3]。 In this paper, the research progress of pravastatin in PE in recent years is summarized as follows.

cyclosporin A (CsA) is a macrolide immunosuppressant, which is widely used in the prevention and treatment of rejection and autoimmune diseases after organ transplantation. Recent studies have shown that CsA can effectively promote the proliferation and invasion of cytotrophoblasts in early pregnancy in the range of 0.000 1~1 μ mol/L^[1]； Animal studies have also found that low-dose CsA (1~10 mg/kg) can significantly reduce the embryo absorption rate in spontaneous abortion model mice^[2]； In recent years, domestic scholars have also tried to use CsA to improve the pregnancy outcome of patients with unexplained abortion^[3]。 All these suggested that CsA had a protective effect on pregnancy. In view of this, the present research progress of the molecular mechanism of CsA regulating pregnancy is reviewed.

Perimenopause is a period before and after menopause in women, including from the beginning of signs of decline in ovarian function to one year after the last menstrual period, which is the transition period from childbearing age to old age. The sharp decline and drastic fluctuation of hormone levels in women during perimenopause will not only lead to the appearance of perimenopausal symptoms such as hot flashes, night sweats, and abnormal mood, but also the duration and frequency of migraine attacks will increase accordingly^[1]。 Although most women and doctors believe that migraine does not belong to the category of perimenopausal symptoms, the occurrence of migraine is indeed closely related to perimenopause. Some women have new migraine during perimenopause, and women who have suffered from migraine have a significant increase in the frequency and duration of migraine attacks during perimenopause^[1]。 Menopause can improve the symptoms of migraine, but it is related to the pattern of menopause. 2/3 of migraine women with natural menopause have better postmenopausal symptoms, while 2/3 of migraine women with surgical menopause have worsened postmenopausal symptoms^[2]。 Symptoms of migraine also change as perimenopause progresses^[3]。 At present, hormone replacement therapy (HRT) is still controversial in the treatment of perimenopausal migraine. Migraine increases the risk of ischemic stroke, especially in migraine women with aura. The risk of stroke increases significantly after using HRT^[4,5]。 This article will review the epidemiology, pathophysiological mechanism, perimenopausal staging and migraine, and the treatment of perimenopausal migraine.

Platinum-based chemotherapy is an important treatment for gynecological malignant tumors, but once drug resistance occurs in patients with gynecological malignant tumors, their survival and prognosis will be seriously affected. Although second-line chemotherapy drugs such as liposomal doxorubicin and platinum oxalate are recommended in the National Comprehensive Cancer Network (NCCN) guidelines, the effective rate of each drug is only about 20%. Therefore, how to choose chemotherapy drugs with high efficacy, low toxicity and no cross-resistance for patients with advanced and recurrent drug resistance has become the focus of gynecological malignant tumor clinicians.