2015年 · 第50卷第09期

The "Guidelines for Clinical Management of Twin Pregnancy (Part II)" mainly focuses on the diagnosis and management of complications of twin pregnancy, including complications of bichorionic twin, such as inconsistent twin growth, structural abnormalities of the first fetus, and intrauterine death of the first fetus; Special complications of monochorionic twins, such as twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), twin reversed arterial perfusion sequence (TRAPS), twin anemia polycythemia sequence (TAPS), etc. Due to the overall low incidence of twin pregnancy complications, especially monochorionic twin complications, there is a lack of large sample randomized controlled studies. Many related clinical research conclusions come from expert consensus and empirical conclusions, and the management of some complications is still controversial. The recommended content of this guideline is derived from the highest level of literature evidence published to date and needs to be continuously updated and refined as clinical practice develops.

Female reproductive organ malformations are more complicated, and their classification is not perfect. At present, the naming of some female reproductive organ malformations is not uniform, and there is a phenomenon of multiple names for one disease. Inaccurate naming and polysemy can cause misuse and confusion, and ambiguity can arise in citation. Therefore, it is very important and necessary to uniform the nomenclature of female reproductive organ malformations. The Obstetrics and Gynecology Branch of Chinese Medical Association put forward a unified opinion on some important and ambiguous names through retrospective analysis of relevant Chinese literature in the past 10 years, and gave necessary explanations.

Endometriosis (endometriosis) is a common disease in women of reproductive age, mainly causing pain and infertility^[1]。 Gonadotropin-releasing hormone agonist (GnRH-a) is widely used in the treatment of endometriosis as a major drug^[2,3]However, the low estrogen level caused by it can lead to obvious perimenopausal symptoms, such as hot flashes, sweating, sleep disorders, mood changes, etc. Long-term application also has the problem of reduced bone density, which seriously affects patients' compliance and quality of life. At present, the traditional strategy to reduce the side effects of GnRH-a is reverse addition therapy, that is, reverse addition of estrogen. However, reverse addition of estrogen therapy also has problems, such as the need to monitor estrogen during treatment, the compliance is not high, and the long-term protective effect of short-term hormone reverse addition therapy on bone mineral density is not obvious^[4]。 Therefore, the development of new drugs that can reduce side effects during GnRH-a treatment with few side effects itself is the key to ensuring good patient compliance. Black cohosh extract (other name: Lifumin tablets) is a preparation made of the standard extract in the medicinal plant black cohosh, which can effectively relieve menopausal syndrome, especially relieving hot flashes, sweating and other symptoms, and has been clinically recognized^[5,6,7]。 At present, there are few domestic studies on the side effects of Lifumin tablets in relieving GnRH-a treatment, and there are no relevant reports on the evaluation of health-related quality of life in drug therapy of Lifumin tablets in patients with endometriosis^[8]。 In this study, the endometriosis health profile-5 (EHP-5) and the menopause rating scale (MRS) were used to compare the effects of GnRH-a treatment in patients with endometriosis on the quality of life and the symptoms of low estrogen, and to explore the value of GnRH-a tablets in reducing the side effects of GnRH-a treatment.

Endometriosis (endometriosis) is a common endocrine disease that causes infertility in women of childbearing age. Its mechanism of infertility is complex, involving changes in pelvic microenvironment, abnormal immune function and pelvic adhesion. It has recently been discovered that peristaltic dysfunction of the fallopian tubes can occur in endometriosis^[1]Chronic salpingitis, hydrops and other pathological changes^[2,3]All of them suggest that fallopian tube factor is one of the important causes of endometriosis infertility. In recent years, telocyte (TC) has been discovered as a new type of interstitial cell, which is widely found in the heart, lung, kidney, uterus and fallopian tube of normal human body^[4,5,6,7,8], characterized by extremely elongated cellular processes called terminal branches or telopode^[9]。 At present, it is believed that TC is involved in signal transduction, immune regulation, stem cell-mediated tissue repair, mechanical support, internal environment stability, neurotransmission and other functions, but its changes and roles in diseases are still unknown. Therefore, this study established a model of fallopian tube endometriosis in SD rats, observed the ultrastructural changes of TC in fallopian tube by transmission electron microscopy, and quantitatively detected the expression of inflammatory factors-cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase (iNOS) by western blot. The aim of this study was to explore the effects of TC injury on the structure and reproductive function of fallopian tube, and its potential role in tubal infertility.

Robert's uterus is a rare asymmetric obstructive complete septal uterine malformation, which was developed by Robert in 1970^[1]First report, so named after Robert's womb. Subtype of completely septal uterus (U2b subtype) in the classification of female reproductive system dysplasia jointly developed by the European Society for Human Reproduction and Embryology (ESHRE) and the European Society for Gynecological Endoscopy (ESGE)^[2]。 The partition in the uterine cavity of Robert's uterus is biased to one side of the uterine cavity, completely closing the uterine cavity on this side, making it a blind cavity that does not communicate with the vagina or the contralateral uterine cavity; The closed uterine cavity can accumulate secretions or blood, and there are different degrees of primary dysmenorrhea. Severe dysmenorrhea in adolescence affects fertility in adulthood. From February 2005 to May 2014, Fuxing Hospital affiliated to Capital Medical University, Anzhen Hospital affiliated to it, and Dongguan Shilong People's Hospital diagnosed and treated 10 cases of Robert's uterus (6, 3, and 1 respectively), of which 1 case delivered successfully, which is now reported later.

Cervical cancer is one of the common malignant tumors of female reproductive system, which seriously endangers women's health, and there is still a lack of effective gene therapy for it^[1]。 ubiquitin-specific protease 22 (USP22) is a kind of deubiquitinating enzyme, which is widely present in muscle, liver, lung and other tissues. Recent studies have shown that USP22 gene is abnormally highly expressed in many kinds of malignant tumor tissues, and silencing USP22 gene expression has obvious inhibitory effect on the occurrence and development of malignant tumors^[2]。 However, there is still a lack of related research on the relationship between USP22 gene and the occurrence and development of cervical cancer. In this study, we used small molecule interfering RNA (siRNA) with the function of silencing USP22 gene expression to perform gene therapy on cervical cancer CaSki cells. We observed the effect of USP22-siRNA on the expression of USP22 gene in CaSki cells, as well as the effect on the proliferation and invasion and metastasis of CaSki cells, and explored the molecular biological mechanism of USP22-siRNA.

congenital heart disease (CHD) is a cardiovascular malformation caused by abnormal cardiovascular development in the fetus, developmental disorders or the failure to degenerate tissues that should degenerate after birth. It is caused by mutations in genes that control heart development and abnormal expression of these genes in time (developmental stage) and space (tissue specificity). CHD is the most common birth defect in humans and the leading cause of death among infants and young children^[1]。 According to the data reported in foreign literature, the incidence of CHD is (5.4~16.1) /1 000^[2], while the incidence of CHD was 25.1/10 000 in birth defect surveillance results reported in the domestic literature^[3]。 CHD can cause decreased physical exercise endurance, delayed brain development, pulmonary hypertension, enlarged heart, heart failure, Eisenmanger syndrome, thromboembolism, subacute bacterial endocarditis, arrhythmias, and death due to abnormal cardiac structure and hemodynamics^[4,5,6]。 In recent years, with the progress of research on the molecular mechanism of cardiac development, a series of key genes involved in the transcriptional regulation, signaling and morphogenesis of cardiac development have been discovered. Subsequent genetic analysis confirms that multiple genes are involved in the pathogenesis of CHD^[7]。 With the success of sequencing the whole human genome and the development of molecular genetics technology, the role of genetic factors in CHD has been paid more and more attention. Therefore, the identification of genetic defects has important clinical significance for the prevention and treatment of CHD. In this paper, the research progress of chromosome abnormalities, single gene mutations, copy number variation (CNV) and important transcriptional regulators in the molecular genetic mechanisms of CHD in recent years are reviewed as follows.

adenomyosis (AM) refers to the invasion of endometrial glands and interstitials with growth function into the myometrium, which can grow diffusely in the myometrium or show localized hyperplasia; It is a common benign gynecological disease, with an incidence rate of 8% ~62%^[1]The main manifestations are dysmenorrhea, menorrhagia and infertility, which seriously affect women's physical and mental health. The pathogenesis of AM is still unclear. This article summarizes the research on the pathogenesis and related factors of AM in recent years as follows.

gestational trophoblastic disease (GTD) is a group of diseases caused by abnormal proliferation of placental trophoblastic cells, including benign and malignant lesions. Benign lesions namely hydatidiform mole, including complete hydatidiform mole and partial hydatidiform mole; Malignant lesions, also known as gestational trophoblastic neoplasm (GTN), include erosive mole, choriocarcinoma (choriocarcinoma), placental site trophoblastic tumor (PSTT) and epithelial trophoblastic tumor (ETT)^[1]。 GTN occurs in women of childbearing age. Because it is highly sensitive to chemotherapy and can monitor the progression of the disease and the response to treatment by detecting serum hCG levels, almost 100% of low-risk patients and 80% ~90% of high-risk patients have been cured by chemotherapy^[2]However, some patients are still resistant to first-line chemotherapy or relapse after remission. Studies have shown that the incidence of resistance to first-line chemotherapy in patients with low-risk without metastasis, low-risk with metastasis, and high-risk GTN is 10% ~20%, 30% ~50%, and 20% ~30%, respectively, so they need to receive rescue chemotherapy^[3]。 At present, a variety of salvage chemotherapy regimens have been reported worldwide, but the effectiveness and side effects of various chemotherapy regimens still need further research. This article reviews the research progress of drug-resistant GTN treatment.

Endometrial cancer is one of the most common gynecological malignancies. In recent years, the incidence of endometrial cancer has increased significantly, and it tends to be younger, which seriously threatens women's health. Endometrial carcinoma is classified into type I and type II. Type Ⅰ endometrial cancer is estrogen-dependent, accounting for 75% to 85% of endometrial cancer, and often occurs in patients with long-term anovulation^[1]Its pathological type is endometrioid carcinoma, ER and PR are positive to varying degrees, and it is responsive to progesterone treatment. Most young patients with endometrial adenocarcinoma belong to this type. Because the lesions are mostly confined to the endometrium, the prognosis of patients is good^[2]。 For a long time, the standard surgical treatment plan for early endometriod adenoncarcinoma (EEC) is total hysterectomy + bilateral adnexectomy + pelvic (or para-abdominal aortic) lymphadenectomy. Although this surgical treatment plan has a high cure rate for EEC, it makes young and childless patients lose their fertility function. In 2014, the National Comprehensive Cancer Network (NCCN) guidelines for the first time added treatment recommendations for "young endometrioid cancer patients with fertility requirements". The recommendation states that continuous progesterone therapy may be considered for EEC (stage Ia) patients who wish to preserve fertility after strict screening (highly selective). This method is also suitable for patients with endometrial atypical hyperplasia (EAH) who need to preserve fertility after strict screening. This article mainly reviews the current status, progress and prospect of drug treatment of estrogen-dependent EEC and its precancerous lesions (EAH).

Cesarean section is a common surgical method to terminate pregnancy, and the rate of cesarean section in China is 54%^[1]。 Uterine scar after cesarean section can cause some long-term complications, including cesarean scar pregnancy (CSP), placental implantation, uterine rupture during another pregnancy. In addition, it may also lead to irregular vaginal bleeding, chronic abdominal pain, infertility, etc. With the increase of the number of cesarean sections (2nd, 3rd, 4th, 5th, 6th and above), the complications of elective cesarean section increased significantly, and the incidence of placental implantation increased by 0.3%, 0.6%, 2.1%, 2.3% and 6.7%, respectively, and the proportion of hysterectomy to stop bleeding was 0.4%, 0.9%, 2.4%, 3.5% and 9.0%, respectively. The incidence of placenta previa also increased significantly^[2]。 With the opening of the "two-child alone" policy, more scar uteruses after cesarean section are facing the problem of re-pregnancy. Therefore, the risk assessment of re-pregnancy of scar uterus after cesarean section is an important clinical issue in China and even the world. The more concerned issues in re-pregnancy are whether uterine scar can tolerate pregnancy and whether there is a risk of uterine rupture. However, the current research has found that cesarean scar defect (CSD) after cesarean section is an important factor leading to uterine rupture.