2017年 · 第52卷第01期

In the past 2016, it was an exciting year for the medical profession and medical workers: the state held the National Health and Wellness Conference and the National Science and Technology Innovation Conference, launched the "Healthy China 2030" planning outline, showed a grand blueprint, and defined the direction and tasks.

We often say that reproductive endocrinology is the internal medical basis of obstetrics and gynecology, and gynecological oncology is the surgical and therapeutic basis of obstetrics and gynecology.

Early epithelial ovarian cancer (ovarian cancer) has no typical clinical manifestations and lacks effective diagnostic methods. Therefore, 70% of newly diagnosed ovarian cancer patients are in the middle and advanced stage, and 70% of them will still relapse after initial cure. At present, the clinical diagnosis of ovarian cancer is mainly through gynecological pelvic examination, serum CA₁₂₅, human epididymal protein 4 (HE4) and other markers, ultrasound, CT, MRI and other imaging examinations, and the combined application of these detection methods, but these detection methods have certain limitations in the early diagnosis and disease monitoring of ovarian cancer. Therefore, finding new ovarian cancer markers in the process of diagnosis and treatment of ovarian cancer has been a hot research topic.

Epithelial ovarian cancer (ovarian cancer) is one of the three common malignant tumors of female reproductive organs, and its incidence is ranked third after cervical cancer and endometrial cancer. About 240,000 newly diagnosed ovarian cancer patients and 150,000 deaths worldwide every year^[1]； 52,000 newly diagnosed ovarian cancer patients and 23,000 deaths in mainland China in 2015^[2]。 Over the years, although the diagnosis and treatment methods of malignant tumors have been continuously updated and developed, the early screening and treatment effect of ovarian cancer has not improved significantly. 70% of patients are advanced at the first visit, and the 5-year survival rate is only 25% ~30%. 5% ~10% of patients with ovarian cancer are hereditary, and about 90% of patients with hereditary ovarian cancer are mutations of breast cancer susceptibility gene (BRCA), which is autosomal dominant inheritance.

non-invasive prenatal test (NIPT) technology is to analyze the cell-free fetal DNA (cffDNA) in the peripheral blood of pregnant women, and analyze fetal chromosome aneuploidy to assess the risk of Down syndrome; The detection rate was>99% and the false positive rate was low (0.1% ~1.0%)^[1,2]And can reduce the number of pregnant women who undergo invasive prenatal diagnosis. At present, triple serological screening for Down syndrome in the second trimester of pregnancy is widely used in clinical practice in China. The detection rate is 50% ~70%, and the false positive rate is about 5%^[3,4]。 The NIPT technique can be performed as early as 9 weeks of pregnancy, while triple serological screening in the second trimester can only be performed as early as 14 weeks of pregnancy. Internationally, NIPT technology is gradually widely used due to its advantages, and professional societies have also issued guidelines^[5]。 There are few researches on screening strategies of NIPT technology in China, especially on economic evaluation^[6]。 Based on the decision tree model, the cost-effectiveness analysis of NIPT screening technology was carried out from the sociological perspective, which provided the basis for the clinical use of NIPT technology in China.

Ovarian mature teratoma is one of the common ovarian tumors in women of childbearing age. At present, laparoscopic surgery is considered as the standard method for treating mature teratoma^[1]。 However, with the increasing awareness of protecting ovarian reserve function, it is still unclear whether mature ovarian teratoma itself affects ovarian reserve function. Moreover, how to reduce surgical injury and protect ovarian reserve function is more important. Therefore, this study investigated the difference of ovarian function between patients with mature ovarian teratoma and healthy women by prospective control method, and used two hemostatic methods, suture and electrocoagulation, respectively, in laparoscopic mature ovarian teratoma excision. The serum anti-mullerian hormone (AMH), FSH, LH and estradiol levels were measured in all patients before and after operation, and the changes of ovarian reserve were observed.

Endometriosis (endometriosis) is a common benign gynecological disease. The disturbance of gene expression in the eutopic endometrium is considered to be the key factor leading to the development of endometriosis, known as "eutopic endometrial determinism"^[1]However, the specific genes of the eutopic endometrium have not been defined. The breast cancer anti-estrogen resistance 1 (BCAR1) gene is a major member of the CAS gene family. BCAR1 protein can induce estrogen-dependent breast cancer cells to develop resistance to estrogen antagonists in vitro, which is one of the important reasons for the failure of endocrine therapy in ER-positive breast cancer patients. The abnormal expression of ER in endometriosis eutopic intima has been reported^[2]Whether resistance to estrogen inhibitory factors will further enhance the local estrogen action in ectopic intima and lead to the occurrence of endometriosis, and whether BCAR1 gene plays an important role in the occurrence and development of endometriosis is worth exploring. In this study, the expression of BCAR1 mRNA and protein in ectopic and eutopic endometrial tissues of endometriosis was detected, and the role of BCAR1 gene in the occurrence and development of endometriosis was investigated.

intrahepatic cholestasis of pregnancy (ICP) is mainly characterized by pruritus, elevated serum total bile acid (TBA) levels, with or without abnormal liver function^[1]Is a disease unique to pregnancy. With the end of pregnancy, the symptoms of most ICP patients resolve spontaneously^[2]。 ICP mostly occurs in the third trimester of pregnancy, and clinically, ICP occurring in the first and second trimester of pregnancy is rare, but it can cause a series of adverse pregnancy outcomes, so obstetricians should pay attention to it and carry out timely and moderate intervention. This article summarizes the research progress of early-onset ICP in recent years as follows.

Epithelial ovarian cancer (ovarian cancer) accounts for 85% ~90% of ovarian malignant tumors, and its onset is often insidious. Most patients are in the middle and late stage and progress rapidly when diagnosed. Therefore, the mortality rate of ovarian cancer ranks first among gynecological malignant tumors. Combined chemotherapy with platinum drugs after standardized surgery is the main treatment for ovarian cancer at present. About 75% of newly treated ovarian cancer patients can get complete remission. However, after 16 to 21 months, most patients will have recurrence or metastasis. At this time, due to the emergence of multidrug resistance, the 5-year survival rate of ovarian cancer patients is only about 30%^[1]。 At present, the clinical diagnosis of ovarian cancer is mainly based on pelvic examination, imaging examination and serum CA₁₂₅Human epididymal protein 4 (HE4) detection, etc. However, these examination methods have certain limitations in the early diagnosis and efficacy monitoring of ovarian cancer. Therefore, it is an urgent problem to find new tumor markers in the diagnosis and treatment of ovarian cancer to assist in diagnosis and prognosis.